Posterior Face Research Articles

Expanded Spectrum of Optical Coherence Tomography Findings in Patients with Ocular Toxoplasmosis

ABSTRACT Purpose To describe the optical coherence tomography (OCT) findings of toxoplasmic retinochoroiditis at different stages of activity. Methods Observational case series. Results A total of 32 eyes of 31 patients were included; 43 sets of OCT were reviewed. A total of 14 lesions were classified as active, 13 as partially active, and 16 as inactive. All active lesions demonstrated increased retinal thickness and reflectivity with blurring of details of retinal layers. Choroidal granuloma was detected in eight (61.5%) and serous retinal detachment in nine (64%). In partially active lesions, sustained thickening and/or attachment of posterior hyaloid face with fine epiretinal membrane was the hallmark. Scarified lesions showed decreased retinal and choroidal thickness starting from the periphery. Characteristic signs for decreased activity of a lesion seen in majority of both partially active and inactive lesions were RPE changes and retina-RPE approximation. We called this unique feature ‘hourglass configuration’. Conclusion Features in OCT are helpful to specify and monitor the activity of toxoplasmic retinochoroiditis.

Visual mechanisms for voice-identity recognition flexibly adjust to auditory noise level.

Recognising the identity of voices is a key ingredient of communication. Visual mechanisms support this ability: recognition is better for voices previously learned with their corresponding face (compared to a control condition). This so‐called ‘face‐benefit’ is supported by the fusiform face area (FFA), a region sensitive to facial form and identity. Behavioural findings indicate that the face‐benefit increases in noisy listening conditions. The neural mechanisms for this increase are unknown. Here, using functional magnetic resonance imaging, we examined responses in face‐sensitive regions while participants recognised the identity of auditory‐only speakers (previously learned by face) in high (SNR −4 dB) and low (SNR +4 dB) levels of auditory noise. We observed a face‐benefit in both noise levels, for most participants (16 of 21). In high‐noise, the recognition of face‐learned speakers engaged the right posterior superior temporal sulcus motion‐sensitive face area (pSTS‐mFA), a region implicated in the processing of dynamic facial cues. The face‐benefit in high‐noise also correlated positively with increased functional connectivity between this region and voice‐sensitive regions in the temporal lobe in the group of 16 participants with a behavioural face‐benefit. In low‐noise, the face‐benefit was robustly associated with increased responses in the FFA and to a lesser extent the right pSTS‐mFA. The findings highlight the remarkably adaptive nature of the visual network supporting voice‐identity recognition in auditory‐only listening conditions.

Outcomes of vitrectomy for retinal detachment in a patient with Ehlers\u2013Danlos syndrome type IV: a case report

BackgroundThe Ehlers–Danlos syndrome (EDS) is a group of connective tissue disorders characterized by fragile blood vessels and an increased tendency for bleeding and scarring. Here, we report the outcome of a pars plana vitrectomy for the treatment of rhegmatogenous retinal detachment in a patient with EDS type IV (vascular type).Case presentationA 40-year-old Slovenian man with high myopia, unilateral bullous retinal detachment, and vitreous hemorrhage was referred for surgery. The patient had a history of colon perforation, muscle and arterial rupture in both lower limbs, and recurrent shoulder joint luxations. Genetic testing revealed a pathogenic mutation in the COL3A1 gene. The patient underwent a 25-gauge three-port pars plana vitrectomy. The tendency for bleeding during surgery was prevented by endodiathermy applied to the edges of the retinal breaks. Endolaser photocoagulation was performed under air. The surgical procedure was completed with the injection of gas tamponade, followed by the patient remaining for a few days in a face-down position. Mild postoperative vitreous hemorrhage was resorbed in first week after the surgery. Postoperative extensive pigment dispersion on the posterior lens face persisted for several weeks. After the gas tamponade had resorbed, the retina was flat and remained attached during the follow-up period. Eight months after the surgery, visual acuity continued to improve from a preoperative 6/38 to 6/6.6 (Snellen chart) at the last checkup.ConclusionA small-gauge pars plana vitrectomy with gas tamponade and laser photocoagulation under air may successfully achieve reattachment of the retina in patients with high myopia with EDS type IV and restore visual acuity.

An image analysis approach to identification and measurement of marbling in the intact pork loin

An image analysis method for identifying marbling on exposed boneless pork loin surfaces was developed, solving the problem of influences from uneven lean colour. Comparing results from RAW and JPEG images of the mid-loin pork chop showed that, except at very high marbling levels, estimation of %IMF (intramuscular fat) was similar with both image types (R2 = 0.72 and 0.74 respectively). Marbling calculated from JPEGs was positively related to %IMF, but also diverged as %IMF increased. Estimations of %IMF at the mid-loin chop from JPEGs of external loin sites showed marbling on the posterior face to be the most strongly related (r = 0.72, P < 0.0001), followed by the ventral surface (r = 0.62–0.64, P < 0.0001), and the anterior face (r = 0.56, P < 0.0001). For on-line application, computing speed is important. This study suggested that an image capture system could be reduced to the capture of a cyan-filtered monochrome JPEG image for analysis.

Role of Small-Gauge Proportionate Reflux-Assisted Hydrodissection In Elevated Symptomatic Vitreofoveal Traction.

To describe a new technique to release the elevated symptomatic vitreofoveal traction. This was a retrospective, interventional case series where a new technique of hydrodissection by proportionate reflux property of small-gauge vitrectomy cutter was used in cases of elevated symptomatic vitreofoveal traction as evident on optical coherence tomography. After vitrectomy, an opening was made in the taut posterior hyaloid face around the foveal elevation. Then, the cutter tip was insinuated inside the hyaloid opening, and the port opening was directed toward the tip of the fovea at its hyaloid attachment. The proportionate reflux property of the cutter was then used to cause reflux of cassette fluid. The hydrostatic force thus generated separates the vitreofoveal attachment. End point was separation of vitreofoveal traction. Seven eyes of seven patients were operated by 27-gauge (n = 3) or 25-gauge (n = 4) vitrectomy system. Mean preoperative and postoperative BCVA were LogMAR 0.44 (20/55) ± 0.14 and LogMAR 0.27 (20/37) ± 0.11, respectively ( P = 0.23). Mean preoperative foveal elevation was 560.86 ± 196.57 μ m, which significantly decreased postoperatively to 251 ± 79.13 μ m ( P < 0.01). VMTs were successfully released in all cases. Mean follow-up was 184.00 ± 80.32 days. Small-gauge proportionate reflux-assisted hydrodissection is an innovative technique for management of elevated symptomatic cases of vitreofoveal traction.

Lynnia grapsolytica n. gen, n. sp. (Ciliophora: Apostomatida: Colliniidae), a Deadly Blood Parasite of Crabs with a Novel Pseudocytopharynx.

We describe a new genus and species of blood-dwelling apostome ciliate, Lynnia grapsolytica n. gen., n. sp. (Apostomatida: Colliniidae). A distinct kinety "hook" pattern on the tomite's posterior ventral face, coupled with its marine habitat and use of a decapod host, readily distinguishes this ciliate from all known colliniids. We detected the parasite in ~12% of Pachygrapsus crassipes (Brachyura: Grapsidae) crabs in a California estuary and confirmed its presence at a Baja California rocky intertidal site. As existing methods failed to adequately stain this ciliate, we developed a new miniaturized silver carbonate impregnation staining method that produced excellent somatic and nuclear stains in all five observed cell types. A possibly unique trait is the active invagination of the tropho-tomont's anterior to form a temporary "pseudocytopharynx," likely used for feeding. Histological examination revealed that the ciliate invaded and damaged skeletal muscle, the heart, connective tissues, and gonads. Survivorship analysis indicated that infected crabs experienced 2.6 times greater daily mortality than uninfected crabs. Laboratory and field experimental infection attempts failed, suggesting a complex life cycle with outside-host development. Phylogenetic analysis at the 18S and COI loci confirmed the ciliate's placement in the Colliniidae. We emend the diagnosis of Family Colliniidae.

Widefield Swept-Source OCT Angiography Metrics Associated with the Development of Diabetic Vitreous Hemorrhage: A Prospective Study

To investigate the association among widefield swept-source (SS) OCT angiography (OCTA) metrics and systemic parameters and vitreous hemorrhage (VH) occurrence in eyes with proliferative diabetic retinopathy (PDR). Prospective, observational study. Fifty-five eyes from 45 adults with PDR, with no history of VH, followed up for at least 3 months. All patients underwent widefield SS OCTA (Montage 15× 15 mm and high-definition (HD)-51 line scan) imaging. Images were evaluated independently by 2 graders for quantitative and qualitative widefield SS OCTA metrics defined a priori. Systemic and ocular parameters and widefield SS OCTA metrics were screened using least absolute shrinkage and selection operator and logistic or Cox regression for variable selection. Firth's bias-reduced logistic regression models (outcome, occurrence of VH) and Cox regression models (outcome, time to occurrence of VH) were used to identify parameters associated with VH occurrence. Occurrence of VH. Over a median follow-up of 363 days (range, 28-710 days), 13 of 55 PDR eyes (24%) demonstrated VH during the follow-up period. Presence of extensive neovascularizations (odds ratio, 8.05; 95% confidence interval [CI], 1.43-58.56; P= 0.02), defined as neovascularizations with total area of more than 4 disc diameters, and forward neovascularizations (odds ratio, 5.42; 95% CI, 1.26-35.16; P= 0.02) that traversed the posterior hyaloid face into the vitreous were associated with the occurrence of VH. The presence of flat neovascularizations (odds ratio, 0.25; 95% CI, 0.04-1.01; P= 0.05) confined to the posterior hyaloid face was associated with a lower risk of VH with borderline significance. Similarly, presence of extensive neovascularizations (hazard ratio, 18.24; 95% CI, 3.51-119.47; P < 0.001) and forward neovascularizations (hazard ratio, 9.60; 95% CI, 2.07-68.08; P=0.002) was associated significantly with time to development of VH. Widefield SS OCTA is useful for evaluating neovascularizations and their relationship with the vitreous. The presence of forward and extensive neovascularizations was associated with the occurrence of VH in patients with PDR. Larger samples and longer follow-up are needed to verify the risk factors and imaging biomarkers for diabetic VH.

Genetic and environmental components of vertical growth in mono- and dizygotic twins up to 15-18 years of age.

To determine the additive genetic and environmental contributions to the vertical growth of craniofacial structures. The sample consisted of 64 untreated monozygotic (44 male, 20 female) and 61 untreated dizygotic twins (32 male, 29 female). Lateral cephalograms taken at 15 and 18 years of age were traced to analyze the sella-nasion-nasal line angle (SN-NL), nasal line-mandibular line angle (ML-NL), sella-nasion-mandibular line angle (SN-ML), sella-nasion-sella-gnathion angle (Y-axis), posterior face height/anterior face height (PFH/AFH), and lower anterior face height/anterior face height (LAFH/AFH). The genetic and environmental components of variance were analyzed with structural equation modeling for multilevel mixed effects. At 15 years of age, strong dominant genetic control was seen for NL-ML (81%), LAFH/AFH (73%), and Y-axis (57%), whereas strong additive genetic components were found for PFH/AFH (78%), SN-NL (58%), and SN-ML (57%). Unique environmental factors accounted for 18-42% of observed variance, with SN-NL being affected the most (42%). At 18 years of age, only LAFH/AFH (86%) was under strong dominant genetic control, whereas the remainder were under additive genetic influence. The sole exception was SN-NL, which changed from additive to unique environmental influence. Either additive or dominant genetic components were found at 15 or 18 years of age for most vertical variables. Environmental factors accounted for about 10-40%, with SN-NL being mostly affected.

Craniofacial shape in patients with beta thalassaemia: a geometric morphometric analysis

The shape of the craniofacial complex of patients with beta thalassaemia was evaluated using geometric morphometrics on lateral cephalometric radiographs and was compared with matched controls. The beta thalassaemia group consisted of 40 patients (16 females, 24 males, mean age 33.4). Each patient was matched by age and gender to two controls (32 females, 48 males, mean age 33.1). The 120 lateral cephalometric radiographs were digitized and traced with 15 curves, 10 landmarks and 117 sliding semi-landmarks. These landmarks were subjected to Procrustes superimposition and principal component analysis in order to describe shape variability of the cranial base, maxilla and mandible, as well as of the entire craniofacial complex for each sex. The first 4 principal components accounted for 50% of the total sample’s variability. The beta thalassaemia group was significantly different in overall shape to the control group for both sexes. Similar findings were noted for the maxilla, the mandible and the cranial base. The main differences were related to smaller mandibular body for the thalassaemia group, midface protrusion and decrease in posterior face height. The shape of the craniofacial complex in these patients is prone to be more convex and hyperdivergent.

Unilateral non-rotated left kidney with vascular and ureter variations in a cadaver: a unique case report with embryological and educational aspects.

The kidneys and ureters are retroperitoneal structures in the upper part of the paravertebral gutters, tilted against the structures on the sides of the lowest two thoracic and upper three lumbar vertebrae, so that their anterior and posterior surfaces face antero-laterally and postero-medially, respectively. Congenital anomalies of the urinary tract are often the underlying cause of renal pathologies; 40% of these pathological conditions are due to variations in location, shape, and size of the kidney(s), calyces, ureter, or bladder. This case report describes the presence of a unilateral non-rotated left kidney with vascular and ureter variations found during routine cadaveric dissection for medical graduates. Alterations in rotation of the kidney and its relation to structures at the hilum have great clinical significance when conducting surgical procedures like partial nephrectomy, nephron sparing surgery, and renal transplantation.

Spleen preserving distal pancreatectomy in a situs inversus totalis patient

Purpose: Solid pseudopapillary tumor (SPT) of the pancreas is an uncommon neoplasm with a low malignant potential that generally occurs in young women. Surgical resection is the gold standard treatment for this entity. When possible, laparoscopic resection is advisable. We present the case of a 26 years old patient with situs inversus totalis diagnosed with a SPT located in the tail of the pancreas. Methods: A 25-year-old woman presented after being study for renal pain and incidentally finding a distal pancreatic mass. CT-Scan showed a rounded hypodense mass of 25 mm located in the tail of the pancreas and a situs inversus totalis. None laboratory alteration was founded. Histology by USE confirmed the presence of a solid pseudopapillary tumor. A laparoscopic distal spleen preserving pancreatectomy was proposed. Results: The usual trocar position was changed like a mirror and the surgeon was located between the patient's legs. The first visualization showed a complete inverted position of all abdominal organs. An extra 5 mm trocar was used to remove the gallbladder due to stones and recurrent upper right quadrant pain. The cystic duct and artery had to be dissected with the left hand to be able to dissect from medial to lateral. Completion of cholecystectomy did not present any extra complexity. After opening the lesser omentum, an intraoperative ultrasonography of the pancreas was performed that showed a hypoechogenic mass on the tail of the pancreas located on the right of the patient. The splenic artery and vein were dissected and were also in a mirror position. The dissection of the superior border of the pancreas, as well as the splenic artery, resulted easy as the right hand was straightforward while splenic vein dissection that was very encircled in the posterior face of the pancreas resulted in an increased difficulty. After the division of these vessels and the neck of the pancreas, spleen preserving distal pancreas were completed as usual. The patient was discharged on the 5 th postoperative day with drainage after a biochemical pancreatic leakage. Conclusion: Despite technical difficulties when operating situs inversus totalis patients, laparoscopic spleen preserving pancreatectomy is a safe and feasible technique.

Cephalometric evaluation of skeletal relationships after bimaxillary surgical correction of mandibular prognathism

Background/Aim. In recent years, bimaxillary surgery has widely been accepted as an effective surgical procedure for the correction of mandibular prognathism. The aim of this study was to determine how bimaxillary surgical correction can change the skeletal dimensions and relations typical of mandibular prognathism and whether the postoperative results can be compared with biometric values of these dimensions in subjects with normal occlusion. Methods. The study included 50 subjects divided into two groups. The analyzed group consisted of 20 patients with mandibular prognathism, mean age 19.8 ? 5.3 years. The control group consisted of 30 subjects with skeletal class I and normal occlusion, mean age 21.5 ? 3.5 years. Cephalometric studies were conducted on 70 lateral cephalograms made on subjects of the analyzed group before and after surgery and in controls. All radio-graphs were transformed into a digital form. Using the computer program "Dr. Ceph", 30 linear and angular skeletal vari-ables were analyzed and compared on each radiograph. The values of examined variables in the analyzed group were compared before and after surgery and with the values of the same variables in the control group. Results. Bimaxillary os-teotomies changed most of the variables that characterize the mandibular prognathism. Changes in the sagittal plane were reflected in a significant increase of angles SNA (by 4? on the average), ANB (6?), and a significant reduction in angles SNB (3?), ArGoMe (8?), NGoMe (6.2?), Bjork?s sum (7?) and the angle of skeletal convexity NAPg (2?). Changes in vertical relationships were reflected in a significant reduction in overall anterior face height N-Me (by 5 mm on average), the lower anterior face height ANS-Me (4 mm), in a significant increase in the total posterior face height S-Go (2.5?3 mm), lower posterior face height PNS-Go (4 mm), in a significant reduction of the basal angle PP/MP (5?) and angle that mandibular plane closes with the anterior cranial base NS/MP (4?). Comparison of investigated variables in the analyzed group after surgery with the same values in the control group showed that they were significantly closer to biometric standards. Conclusion. Bimaxillary surgery significantly alters the skeletal relationships and facial dimensions typical of mandibular prognathism and normalizes the skeletal profile and appearance in operated patients.

Gonial Angle Characteristics of Class III Malocclusion in Javanese Ethnic

Objective: To describe the gonial angle characteristics in class III skeletal malocclusion in Javanese ethnic . Material and Methods: Pretreatment lateral cephalometric radiographs of 43 Javanese ethnic patients were measured: upper (Go1) and lower gonial angle (Go2), anterior (AFH) and posterior face height ratio (PFH), maxilla-mandibular length difference, mandibular plane angle (FMA), Y axis, ramus position, ANB angle, posterior cranial base/ramus height and mandibular body length/anterior cranial base. The relation between Go1, Go2 and other variables were analysed using correlation and regression analysis. Results: The total gonial angle is within normal range, but Go1 is below normal and Go2 is above normal. There is no difference between male and female gonial angle measurements (p=0.939 and p=0.861, respectively). Ramus position is positively correlated to Go1 (p=0.003), while AFH (p=0.000), maxilla-mandibular length difference (p=0.000), FMA (p=0.000), Y axis (p=0.000), and posterior cranial base/ramus height (p=0.018) are positively correlated to Go2. PFH is negatively correlated to Go2 (p=0.018) . Conclusion: The upper gonial angle is influenced by the position of mandibular ramus, while the lower gonial angle is affected by the posterior and anterior lower facial height and mandibular size and rotation. Javanese with class III malocclusion tends to have hypodivergent facial type, with more posteriorly located mandibular ramus and excess mandibular length.

Extended Lymphadenectomy during Robotic Pancreatico-duodenectomy: Case Reporting a Right Hepatic Artery Coming from SMA and a Median Arcuate Ligament Syndrome

Purpose: The video shows the dissection time with an extended lymphadenectomy during a pancreatico-duodenectomy performed by robotic approach. Method: The patient is a 63-years-old woman diagnosed with a pancreatic head cancer. In the CT-Scan, a median arcuate ligament is observed causing a stenosis of the celiac trunk and a right hepatic artery coming from the superior mesenteric artery (SMA). After a multidisciplinary tumor committee, we decided to perform a pancreatico-duodenectomy (PD) with total meso-pancreas excision by robotic approach. Results: The surgery begins with an extreme Kocher maneuver that allows us to access the posterior face of the duodenopancreatic block. After this we proceed to dissect the origin of the SMA and the origin of the celiac trunk cutting the median arcuate ligament in order to release the celiac trunk. During the dissection of the SMA the right hepatic artery is dissected and preserved. We continue with lymphadenectomy of the hepatic artery and the bile duct section.The next step is the gastric section that allows us to access the anterior pancreatic face. The retropancreatic tunnelisation allows us to put a loop in order to achieve the pancreatic hanging maneuver and sectioning the pancreas safely. The meso-pancreas is totally resected. Conclusion: Robotic approach is safe, effective and reproductible. Through a standardised technique, it may overcome some of the technical difficulties of laparoscopic PD.

The difference between Begg and Straightwire appliances on molar position, occlusal plane angle, and anterior and posterior facial height changes

Background: Bimaxillary and bidental protrusion Class I Angle malocclusions have a characteristic convex facial profile and protrusion lips due to the labial inclination of the anterior teeth. Extraction of the first four premolars is the most common choice for orthodontic treatment of these cases when all the permanent teeth are complete and in good condition. Orthodontic treatment can be performed using the Begg or Straightwire techniques. Purpose: This study aims to investigate the difference in the effect of orthodontic treatment with Begg and Straightwire appliances on molar position, occlusal plane, and anterior and posterior facial height. Methods: Sixty pairs of lateral cephalograms before and after the treatment of patients with bimaxillary and bidental protrusive Angle malocclusion Class I, aged 18–35 years old, who underwent orthodontic treatment using the Begg and Straightwire techniques with the extraction of all first premolars that met the inclusion criteria. Data analysis was performed using two-way repeated analysis of variance (p&lt;0.05) and Pearson correlation (p&lt;0.05). Results: Molar position, occlusal plane angle, and anterior and posterior facial heights increased significantly after the Begg technique treatment and decreased significantly after the Straightwire technique treatment (p&lt;0.05), but there were no significant differences between the four variables in the two techniques (p&gt;0.05). Medium correlation was found between variables in both the Begg and Straightwire techniques. Conclusion: Molars were extruded and mesialized and the occlusal plane angle and height of the anterior and posterior faces increased after the Begg appliances treatment. The molars moved mesially and occlusally and there was a decrease in the occlusal plane angle, as well as the height of the anterior and posterior faces, after treatment with the Straightwire appliances. However, there was no difference between the two techniques.

Opposing JAK-STAT and Wnt signaling gradients define a stem cell domain by regulating differentiation at two borders.

Many adult stem cell communities are maintained by population asymmetry, where stochastic behaviors of multiple individual cells collectively result in a balance between stem cell division and differentiation. We investigated how this is achieved for Drosophila Follicle Stem Cells (FSCs) by spatially-restricted niche signals. FSCs produce transit-amplifying Follicle Cells (FCs) from their posterior face and quiescent Escort Cells (ECs) to their anterior. We show that JAK-STAT pathway activity, which declines from posterior to anterior, dictates the pattern of divisions over the FSC domain, promotes more posterior FSC locations and conversion to FCs, while opposing EC production. Wnt pathway activity declines from the anterior, promotes anterior FSC locations and EC production, and opposes FC production. The pathways combine to define a stem cell domain through concerted effects on FSC differentiation to ECs and FCs at either end of opposing signaling gradients, and impose a pattern of proliferation that matches derivative production.

Prolapsus mitral et mort subite : à propos d’un cas

The association between the mitral valve prolapse and the sudden Cardiac Death remains controversial, the high prevalence of this valvulopathy contrasting with the low incidence of sudden death in this population. We report the case of a 54-year-old woman admitted for a sudden cardiac death, revealing a bi-prolapse with low-grade leakage, leading to the implantation of a subcutaneous automatic defibrillator. Combined echocardiography and cardiac MRI can identify the mitral annular disjunction, the rolling motion of the posterior face of the mitral annulus towards the myocardium, and the myocardial fibrosis of the inferolateral wall induced by streching forces of the sub valvular apparatus, that may lead to ventricular arrhythmias. More than the conventional clinical parameters (young woman, ventricular premature beats with a right bundle branch block morphology, mitral bi-prolapse), mitral annular disjunction and myocardial fibrosis are to be considered as powerful markers of the rhythmic risk of mitral prolapse and must be systematically sought and integrated into the prognostic evaluation of these patients. In the absence of randomised trials, therapeutic management is difficult especially in primary prevention, and needs Heart Team advice.

Correction of bimaxillary dentoalveolar protrusion in a growing male with class I malocclusion by extraction of premolars and profile improvement using conventional fixed orthodontic treatment- A case report on orthodontic camouflage

This case report evaluates the management of a Bimaxillary Dentoalveolar protrusion with a Class I malocclusion in a male patient with extraction of 1 premolars for correction of the prognathic profile of the patient. Clinical and cephalometric evaluation revealed skeletal Class I malocclusion with crowding with a convex facial profile, a Horizontal growth pattern, potentially incompetent lips, a posterior divergent face, average overjet and overbite. Following fixed orthodontic treatment by removal of 1 premolars in the upper and lower arch with retraction of anterior segment , a marked improvement in patient's smile, facial profile and occlusion was achieved and there was a remarkable increase in the patient's confidence and quality of life The profile changes and treatment results were demonstrated with proper case selection and good patient cooperation with Fixed appliance therapy.

Balser Plate Stabilization for Traumatic Sternoclavicular Instabilities or Medial Clavicle Fractures: A Case Series and Literature Review.

ObjectiveThis study was performed to observe the effect of internal Balser plate fixation for treating unstable sternoclavicular joints (SCJ) and displaced medial clavicle fractures.MethodsFrom April 2009 to September 2016, 17 consecutive patients who underwent open reduction and internal Balser plate fixation for SCJ dislocations or medial clavicle fractures were retrospectively reviewed. There were 11 male and six female patients, with a mean age of 45.6 ± 15.5 years. Standardized treatment procedures consisted of reduction, creating a space posterior dorsal osteal face of the sternal manubrium, an inverted Balser plating, and postoperative immobilization. At follow‐up, plain radiographs were assessed for fracture union, implant loosening, degenerative changes, and joint congruity. Clinical evaluation included: completion of the Disability of the Arm, Shoulder, and Hand (DASH) questionnaire; determination of the Constant and Murley score and visual analog scale (VAS) score; and assessment of intraoperative and postoperative complications.ResultsAll patients were followed up, at a mean follow‐up of 20.1 ± 7.9 months, each fracture had a solid union, and each dislocation showed no sign of recurrent dislocation. The mean shoulder forward flexion was 162.9° ± 8.1°. The mean DASH score was 5.2 ± 5.2 points. The mean Constant and Murley joint function score was 93.7 ± 7.9 points, with 15 excellent cases and two good cases. The mean VAS score was 1.1 ± 1.4 points, showing significant improvement compared with the VAS score preoperatively. Postoperative complications included one wound hematoma which was healed after a debridement and one recurrent instability due to hook migration, which underwent revision reconstruction. All patients were satisfied with their treatment outcome at the final follow‐up.ConclusionSternoclavicular joints dislocation or medial clavicle fractures can be treated successfully with Balser plate fixation. This technique permits early functional exercise while preserving the SCJ.

Neural Oscillatory Abnormalities During Gaze Processing in Schizophrenia: Evidence of Reduced Theta Phase Consistency and Inter-areal Theta-Gamma Coupling

BackgroundAbnormal gaze discrimination in schizophrenia (SZ) is associated with impairment in social functioning, but the neural mechanisms remain unclear. Evidence suggests that local neural oscillations and inter-areal communication through neural synchronization are critical physiological mechanisms supporting basic and complex cognitive processes. The roles of these mechanisms in abnormal gaze processing in SZ have not been investigated. The present study examined local neural oscillations and connectivity between anterior and bilateral posterior brain areas during gaze processing. MethodsDuring electroencephalography recording, 28 participants with SZ and 34 healthy control participants completed a gaze discrimination task. Time-frequency decomposition of electroencephalography data was used to examine neural oscillatory power and intertrial phase consistency at bilateral posterior and midline anterior scalp sites. In addition, connectivity between these anterior and posterior sites, in terms of cross-frequency coupling between theta phase and gamma amplitude, was examined using the Kullback-Leibler Modulation Index. ResultsParticipants with SZ showed reduced total power of theta-band activity relative to healthy control participants at all sites examined. This group difference could be accounted for by reduced intertrial phase consistency of theta activity in SZ participants, which was related to reduced gaze discrimination accuracy in SZ. In addition, SZ participants exhibited reduced Kullback-Leibler indexing, both feedforward and feedback connectivity, between the posterior and anterior sites. ConclusionsThese findings suggest that abnormal theta phase consistency and dysconnection between posterior face processing and anterior areas may underlie gaze processing deficits in SZ.