Small Protrusion Research Articles

A comprehensive study on the microstructure evolution and mechanical property characterization of selective laser melted 18Ni300 stainless steel during heat treatment processes

The influence of different heat treatment processes on the microstructure and mechanical properties of 18Ni300 stainless steel manufactured by selective laser melting has been investigated in the present study. The microstructures, nanoprecipitates, and mechanical properties of the differently heat-treated samples were analyzed using various precision instruments. Compared with a non-treated 18Ni300 stainless steel sample, the results showed that the microstructure was mainly composed of fine lath-like martensite, with a large number of nano-precipitates dispersed both within the martensite and in the boundaries. In addition, there was a preserved amount of austenite between the lath-like martensite and the spherical nanoprecipitate in the SAT sample. The interactions between the martensite matrix and the nanoprecipitates and dislocations were assumed to be the main reason for the high strength of 18Ni300 stainless steel. These precipitates included rod-shaped or needle-shaped, Ni3Ti, Ni3Mo, and Ni3(Ti, Mo) nano-precipitates, as well as spherical Ti–Al nano-oxidized precipitates and massive Ni-rich precipitates. The shear and by-pass mechanisms between the strengthened nano-precipitate and the dislocations were found to depend on the size of the nanoprecipitate. The influence of the nanoprecipitation on the indentation hardness became more evident after heat treatment, but the effect on the indentation modulus was not that obvious. The AT- and SAT-treatments significantly improve the strength, hardness, and modulus of samples but were found to reduce the toughness and plasticity. After the AT- and SAT-treatments, the protrusions became smaller, and the small isometric protrusion of a shear lip became significantly smaller than for the as-built material.

Long-term cardiovascular outcomes after mini-crush or T and minimal protrusion techniques in complex bifurcation lesions: the EVOLUTE-CRUSH III study.

Mini-crush (MC) and T-stenting and small protrusion (TAP) techniques are frequently used, but the long-term comparison of both techniques in patients with complex bifurcation lesions (CBLs) is still a debatable issue. This study sought to retrospectively evaluate the long-term outcomes of MC and TAP techniques in patients with CBLs. A total of 271 patients [male: 202 (78.9%), mean age: 58.90 ± 10.11 years] patients in whom complex bifurcation intervention was performed between 2014 and 2023 were involved. The primary endpoint was major cardiovascular events (MACE) as the combination of cardiac death, target vessel myocardial infarction, or clinically driven-target lesion revascularization. The Cox proportional hazard models were adjusted by the inverse probability weighting approach to reduce treatment selection bias. The initial management strategy was MC in 146 patients and TAP in 125 cases. MACE occurred in 52 patients (19.2%) during a mean follow-up period of 32.43 ± 16 months. The incidence of MACE (13 vs. 26.4%, P = 0.005) and major cardiovascular and cerebral events (15.1 vs. 28.8%, P = 0.006) were significantly lower in the MC group than in the TAP group. Additionally, the incidence of definite or probable stent thrombosis was numerically lower in the MC group compared with the TAP group but did not differ significantly (2.7 vs. 8%, P = 0.059). The long-term MACE was notably higher in the TAP group than the MC group [adjusted hazard ratio (inverse probability weighted): 1.936 (95% confidence interval: 1.053-3.561), P = 0.033]. In this study involving patients with CBLs, percutaneous coronary intervention with the MC technique had better long-term outcomes than the TAP technique.

Histomorphological Development Study of Cecum in Local Awassi Sheep Fetuses (Ovis Aris): Prenatal Periods

This study was conducted at Al-Qasim Green University/College of Veterinary Medicine, Anatomy and Histology Branch. The experiment was designed to study the cecum of Awassi sheep fetuses: prenatal periods. Samples (30 male and female samples) were collected from healthy females uterine and divided according to age groups into four groups by crown rump length formula (CRL) for the prenatal stage. In the first age group (50-55), the cecum was in the process of development, as it was not distinguished visually. In the second age group (70-75 days), it was a small protrusion located between the ileum and the beginning of the ascending colon. With advancing age, the third group, which includes two ages in the third trimester of pregnancy, we found that the cecum was completely formed in (100-105) days and at (130-140) days of gestation. Also, upon histological study, we found that the wall of the cecum consists of four layers, as in the rest of the parts of the digestive system, and is lined with an epithelial layer surrounded by a layer of connective tissue. It is supportive of the epithelial tissue. We also found tunica submucosa constantly devolving with age, as it is mesenchymal cells in the first stage of intrauterine life and begin to transform into connective tissue with the presence of fibers and collagen (tunica submucosa) as a result of these cells transforming into spindle cells to form the inner muscle layer, as well as tunica muscularis externa. The latter is surrounded by loose connective tissue that contains a few collagen and elastic fibers surrounded by mesothelial cells (tunica serosa) that contain blood vessels to support development in the inner layers.

Enhanced anti-welding and arc erosion performance of Ag-8 wt%SnO2 contact material with different addition of graphene nanoplatelets

To improve the welding resistance of Ag-8 wt%SnO2 contact material at large current, the graphene nanoplatelets (GNPs) was selected as the additive, and Ag-8 wt%SnO2 contact materials with different GNPs addition were prepared by powder metallurgy route. The electrical contact tests were performed under 36 V/16 A and 36 V/25 A, the welding, material transfer behavior and their mechanism were investigated combined with the analysis of arc duration, arc power and eroded morphology. The results show that 0.2 wt% GNPs addition decreases the welding frequency and welding force significantly, this can be attributed to the arc extinction effect and the weaken effect of the welding area. However, the excessive GNPs addition in turn aggravates the welding, the reason is that excessive GNPs addition weakens the bond between eroded layers, resulting in the decrease of arc stability and the generation of the small protrusion which cause the concentration of the contact stress and the electric field, which further results in the serious welding. Furthermore, 0.2 wt% GNPs addition decreases the mass loss rate, increasing the combination performance of Ag-8 wt%SnO2 contact material.

Comparison of long-term outcomes of double kissing crush versus T and minimal protrusion techniques in complex bifurcation lesions: The EVOLUTE-CRUSH II registry.

Double kissing (DK)-crush and T-stenting and small protrusion (TAP) techniques are gaining popularity, but the comparison for both techniques is still lacking. This study sought to retrospectively evaluate the long-term outcomes of DK-crush and TAP techniques in patients with complex bifurcation lesions. A total of 255 (male: 205 [80.3%], mean age: 59.56 ± 10.13 years) patients who underwent coronary bifurcation intervention at a single-center between January 2014 and May 2021 were included. Angiographic features, procedure details, and in-hospital or long-term outcomes were assessed. The primary endpoint was target lesion failure (TLF), defined as the combination of cardiac death, target vessel myocardial infarction, or clinically driven-target lesion revascularization (TLR). The regression models were adjusted applying by the inverse probability weighted (IPW) approach to reduce treatment selection bias. The initial management strategy was DK-crush in 152 (59.6%) patients and TAP in 103 (40.4%) cases. The SYNTAX scores (24.58 ± 7.4 vs. 24.26 ± 6.39, p = 0.846) were similar in both groups. The number of balloon (6.32 ± 1.82 vs. 3.92 ± 1.19, p < 0.001) usage was significantly higher in the DK-crush group than in the TAP group. The rates of TLF (11.8 vs. 22.3%, p = 0.025) and clinically driven TLR (6.6 vs. 15.5%, p = 0.020) were significantly lower in the DK-crush group compared to the TAP group. The long-term TLF was significantly higher in the TAP group compared to the DK-crush group (unadjusted HR: 1.974, [95% CI: 1.044-3.732], p = 0.035 and adjusted HR [IPW]: 2.498 [95% CI: 1.232-5.061], p = 0.011). The present study showed that the DK-crush technique of bifurcation treatment was associated with lower long-term TLF and TLR rates compared to the TAP technique.

Demystifying the Quandary of Ostial Stenting.

Accurate stent placement is known to be hampered by the anatomical nature of percutaneous coronary intervention (PCI) of ostial lesions, such as aorta-ostial lesions and Medina 001 bifurcation lesions. The Ostial Pro device, the aorta floating wire technique, the stent pull-back technique, the Szabo (tail-wire) techniques, the marker wire technique, the T-stent and small protrusion technique, the cross-over 1-stent technique, and new dedicated ostial stents are some of the techniques used to achieve perfection in precise ostial stent placement. The current state of knowledge about ostial PCI and novel approaches for optimizing these procedures are compiled in this review.

DetectCilia: An R Package for Automated Detection and Length Measurement of Primary Cilia.

The primary cilium is a small protrusion found on most mammalian cells. It acts as a cellular antenna, being involved in various cell signaling pathways. The length of the primary cilium affects its function. To study the impact of physical or chemical stimuli on cilia, their lengths must be determined easily and reproducibly. We have developed and evaluated an open-source R package called detectCilia to detect and measure primary cilia automatically. As a case study to demonstrate the capability of our tool, we compared the influence of 4 different cell culture media compositions on the lengths of primary cilia in human chondrocytes. These media compositions include (1) insulin-transferrin-selenium (ITS); (2) ITS and dexamethasone (Dexa); (3) ITS, Dexa, insulin-like growth factor 1 (IGF-1), and transforming growth factor beta 1 (TGF-β1); and (4) fetal bovine serum (FBS). The assessment of detectCilia included a comparison with 2 similar tools: ACDC (Automated Cilia Detection in Cells) and CiliaQ. Several differences and advantages of our package make it a valuable addition to these tools. In the case study, we have observed variations in the ciliary lengths associated with using different media compositions. We conclude that detectCilia can automatically and reproducibly detect and measure primary cilia in confocal microscopy images with low false-positive rates without requiring extensive user interaction.

Time-delayed failure process of granite and its energy evolution and acoustic emission characteristics

Time-delayed rockbursts during underground engineering construction seriously endangered the engineering safety. In this paper, an experiment of rock time-delayed failure is designed and conducted, and the associated energy evolution laws and acoustic emission (AE) characteristics were analyzed. There is an obvious time effect of granite time-delayed failure under true triaxial conditions. There are two calm periods in granite time-delayed failure process. The failure modes can be divided into two categories, i.e., time-delayed failure I and time-delayed failure II. In the load maintenance stage, the total energy continues to increase, the elastic strain energy didn’t change significantly, and the dissipated strain energy increases rapidly. For time-delayed failure I, when the AE hits rises sharply, it reached its maximum subsequently, and the first small peak of absolute energy appeared. On the eve of the rockburst, the AE hits began to rise gradually, and the absolute energy was with a small protrusion. For time-delayed failure II, when the AE hits rises rapidly, it reached a high level. The small peak of absolute energy appeared. In the eve of the rockburst, the hits showed a steep increase trend and reached its maximum, the absolute energy also presented a rapid rise trend. The research results have certain reference value for the early warning and control of the time-delayed rockbursts in underground engineering.

Configuration of two-stent coronary bifurcation techniques in explanted beating hearts: the MOBBEM study.

In patients with complex coronary bifurcation lesions undergoing percutaneous coronary intervention (PCI), various 2-stent techniques might be utilised. The Visible Heart Laboratories (VHL) offer an experimental environment where PCI results can be assessed by multimodality imaging. We aimed to assess the post-PCI stent configuration achieved by 2-stent techniques in the VHL and to evaluate the procedural factors associated with suboptimal results. Bifurcation PCI with 2-stent techniques, performed by expert operators in the VHL on explanted beating swine hearts, was studied. The adopted bifurcation PCI strategy and the specific procedural steps applied in each procedure were classified according to Main, Across, Distal, Side (MADS)-2 and to their adherence to the European Bifurcation Club (EBC) recommendations. Microcomputed tomography (micro-CT) was used to assess the post-PCI stent configuration. The primary endpoint was "suboptimal stent implantation", defined as acomposite of stent underexpansion (<90%), side branch ostial area stenosis >50% and the gap between stents. Atotal of 82 PCI with bifurcation stenting were assessed, comprised of 29 crush, 25 culotte, 28 T/T and small protrusion (TAP) techniques. Suboptimal stent implantation was observed in as many as 53.7% of the cases, regardless of baseline anatomy or the stenting strategy. However, less frequent use of the proximal optimisation technique (POT; p=0.015) and kissing balloon inflations (KBI; p=0.027) and no adherence to EBC recommendations (p=0.004, p multivariate=0.006) were significantly associated with the primary endpoint. Commonly practised bifurcation 2-stent techniques may result in imperfect stent configurations. More frequent use of POT/KBI and adherence to expert recommendations might reduce the occurrence of post-PCI suboptimal stent configurations.

Umbilical Outpouchings in two Danish herds raising pigs with minimal use of antibiotics - Results from a field trial evaluating the efficacy of autogenous vaccines and iodine application.

In Denmark, a Pure Pork concept for raising pigs without antibiotics was initiated in 2015 by the Danish Crown slaughterhouse cooperative. Pure Pork herds are characterised by minimal use of antibiotics and pigs are mainly treated individually. An increased prevalence of pigs suffering from umbilical outpouchings (UO) is a considerable challenge for Pure Pork producers. Umbilical outpouchings in pigs are challenging due to reduced welfare and increased workload and cost for the farmer. Therefore, Pure Pork producers require means other than antibiotic treatment to prevent UO. The primary objective of this study was therefore to evaluate the effect of autogenous sow vaccines based on bacteria isolated from the inflamed umbilici of piglets and a 7% iodine treatment at birth on the risk of pigs developing UO during the first 12 weeks of life. In addition, umbilical clinical and necropsy findings were presented, including variation over time and an identification of risk factors. A total of 5852 live-born piglets were included at birth from two Pure Pork herds. In this study, UO was defined as the presence of a rounded outpouching and/or a small firm protrusion at the umbilical area. Among 5614 pigs examined at weeks 5 and 12 and/or at death a total of 534 (9.5%) pigs were recorded with UO. The incidence of outpouchings was 10.2% for Herd A and 8.8% for Herd B. In the present field trial, neither autogenous vaccination of sows nor a 7% iodine spray on the umbilical area of new-born piglets had a statistically significant effect on the incidence of UO, but there was a tendency for a lower risk of UO in pigs treated with iodine spray at birth in one herd (OR = 0.7, p=0.07), which might be worth investigating further. The risk factors for UO identified in this study included sow parity in one herd with more UO pigs from second parity sows and older compared to gilts (OR = 2.0, p=0.02), batch in the second herd, and sex in both herds with male pigs at lower risk of UO development compared to female pigs (OR = 0.8, p=0.006). Furthermore, antibiotic treatment as an indicator of the presence of other diseases resulted in a higher risk of UO compared to untreated pigs (OR = 1.9, p<0.0001). The presence of UO in one pig varied over time; For UO pigs examined alive at both week 5 and 12, 136 pigs (2.4%) had an UO record at week 5 but not at week 12 and 179 pigs (3.2%) did not have an UO at week 5 but a UO record at week 12. For 115 pigs (2.0%) an UO was recorded both at week 5 and week 12.

Aryalidonta itishreea, a new genus and species of Thoradontini (Orthoptera, Tetrigidae) from Nepal honors the Emperor of Laughter

Aryal’s Ten Avatar Groundhopper, Aryalidonta itishreeagen. et sp. nov., named in honor of the late Bhairav Aryal, an iconic Nepali satirist, is a new genus and species of Tetrigidae described as a part of the tribe Thoradontini. The species is native to Nepal, a country with a rich tetrigid fauna in need of taxonomic revisions. This monotypic genus can be easily separated from other Thoradontini genera by its enlarged proximal halves of middle femora, a peculiar lateral lobe morphology (small caudal protrusion in its caudal part and a sharp lateral tip), a triangular, anteriorly narrowing vertex, and by its unique head morphology. The species was observed in its natural habitat. It was found to harbor many color variations that are cryptic in nature. It feeds on detritus, algae, lichen, and moss. Specimens heavily infested by mites were found, as well as those in interaction with wasps (possibly Eulophidae), but the nature of the latter could not be determined.

Sirenomelia or “mermaid syndrome”: an extremely rare case in Indonesiasia

Sirenomelia, also known as mermaid syndrome, is a very rare lethal congenital disorder with multisystem malformations, characterized by fusion of the lower limbs. Here we report a preterm neonate with fusion of the lower limbs. The baby was born by cesarean section to a 27-year-old primigravida mother at 35 weeks and 3 days’ gestation. There was no maternal history of hypertension, heart disease, asthma, or diabetes mellitus. At birth, the infant did not cry, had weak tone, a heart rate (HR) of &lt;60 beats per minute (BPM), an Apgar score of 1/2, and a birth weight of 2,300 grams. The infant had an imperforate anus and no urogenital openings or external genitalia. There was a small penis-like protrusion without an aperture, such as in cases of ambiguous genitalia. The two lower limbs were fused, with five toes on each foot. Despite neonatal resuscitation, the infant died within 75 minutes of birth. The child was diagnosed with sirenomelia. This case report aims to emphasize the importance of early prenatal diagnosis and education of the patient’s family.

Structure and Function of Gli123 Involved in Mycoplasma mobile Gliding.

Mycoplasma mobile is a fish pathogen that glides on solid surfaces by means of its own gliding machinery composed of internal and surface structures. In the present study, we focused on the function and structure of Gli123, a surface protein that is essential for the localization of other surface proteins. The amino acid sequence of Gli123, which is 1,128 amino acids long, contains lipoprotein-specific repeats. We isolated the native Gli123 protein from M. mobile cells and a recombinant protein, rGli123, from Escherichia coli. The isolated rGli123 complemented a nonbinding and nongliding mutant of M. mobile that lacked Gli123. Circular dichroism and rotary-shadowing electron microscopy (EM) showed that rGli123 has a structure that is not significantly different from that of the native protein. Rotary-shadowing EM suggested that Gli123 adopts two distinct globular and rod-like structures, depending on the ionic strength of the solution. Negative-staining EM coupled with single-particle analysis revealed that Gli123 forms a globular structure featuring a small protrusion with dimensions of approximately 15.7, 14.7, and 14.1 nm for the "height," major axis and minor axis, respectively. Small-angle X-ray scattering analyses indicated a rod-like structure composed of several tandem globular domains with total dimensions of approximately 34 nm in length and 6 nm in width. Both molecular structures were suggested to be dimers, based on the predicted molecular size and structure. Gli123 may have evolved by multiplication of repeating lipoprotein units and acquired a role for Gli521 and Gli349 assembly. IMPORTANCE Mycoplasmas are pathogenic bacteria that are widespread in animals. They are characterized by small cell and genome sizes but are equipped with unique abilities for infection, such as surface variation and gliding. Here, we focused on a surface-localizing protein named Gli123 that is essential for Mycoplasma mobile gliding. This study suggested that Gli123 undergoes drastic conformational changes between its rod-like and globular structures. These changes may be caused by a repetitive structure common in the surface proteins that is responsible for the modulation of the cell surface structure and related to the assembly process for the surface gliding machinery. An evolutionary process for surface proteins essential for this mycoplasma gliding was also suggested in the present study.

Time-lapse imaging of primary cilium behavior with physiological expression of fluorescent ciliary proteins.

Almost all cell types of mammals have a small protrusion named a primary cilium on their surface. Primary cilia are enriched by cilia-specific ion channels and G-protein-coupled receptors. They are known to regulate various cellular functions that contribute to the development and homeostasis of living organisms by receiving extracellular signals and transfusing them to the cell body. All functions are performed when the structure of the primary cilia is maintained properly. Abnormalities in primary cilia or their signaling can lead to a collection of diseases in various organs called ciliopathies. The primary cilium is dynamic, static, or fixed. The length of primary cilia varies as the cell cycle progresses and is also altered by extracellular stimuli. Ligand binding to cilia-specific receptors is also known to alter the length. Thus, there is a need for a method to study the morphological changes of the primary cilium in a time-dependent manner, especially under stimuli or mechanical shocks. Time-lapse imaging of primary cilia is one of the most powerful methods to capture the time-dependent behavior of primary cilia. Overexpression of ciliary proteins fused to fluorescent proteins is commonly used for the time-lapse imaging of primary cilia. However, overexpression has drawbacks in terms of artifacts. In addition, the time-lapse imaging of the tiny primary cilia requires some technical tricks. Here, we present a detailed description of the methods for time-lapse imaging of primary cilium, from the generation of cell lines that stably express fluorescent protein-labeled cilia-localized proteins at the physiological level to image analysis, including quantification through image acquisition.

Multimodality imaging results of TAP versus novel modified TAP stenting in coronary bifurcation: From bench testing to first-in-man investigation.

We investigated the results of T and small protrusion (TAP) versus a novel modification of TAP (mTAP) stenting by multimodality imaging in bench testing and in patients with coronary bifurcation lesions (CBL). TAP stenting is a suboptimal technique for bailout side branch (SB) stenting. In a bench model, optical coherence tomography (OCT), microscopic examinations (ME), and computational fluid dynamics (CFD) were performed after TAP and mTAP stenting. In 20 patients with CBL, 80 intravascular ultrasound(IVUS) examinations were performed during mTAP stenting in which the SB stent was pulled-back to indent the inflated main vessel (MV) balloon and deployed while deflating it. For TAP stenting, the tip of the SB stent was positioned in the MV and deployed. In bench testing, OCT showed neocarina length (NL) was shorter and minimum stent area (MSA) was larger after mTAP versus TAP stenting (2.84 ± 0.70 vs. 4.80 ± 020 mm; 6.75 ± 1.50 vs. 4.5 ± 2.2 mm2 ; respectively; p < 0.05). By ME, NL was shorter and shear rate trended lower after mTAP versus TAP stenting. In patients, IVUS showed MSA was larger after versus before mTAP stenting (6.32 ± 0.58 vs. 5.21 ± 0.56 mm2 ; p < 0.01); NL was 1.43 ± 0.22 mm with SB ostium coverage. The Seattle Angina questionnaire (SAQ) score was higher at 6 months versus baseline (85 ± 4.0 vs. 48 ± 6.0, respectively; p < 0.001). This multimodality imaging study showed, for the first time, mTAP stenting resulted in larger stent area and shorter neocarina than TAP stenting in bench testing. In patients with CBL, mTAP stenting led to larger stent area, short neocarina with complete SB ostium coverage, and improved the SAQ score at follow-up.

Numerical Investigation of Negative Corona Discharge From Protrusion on Parallel Plane Electrodes in Air Insulation

Compared to a spherical metal particle motion within gas insulation, a wire-type particle could have a standing position on the ground electrode. In this work, a numerical investigation and validation from the experimental data of corona discharge from a small protrusion in air insulation within a uniform field under a dc voltage are performed. Three drift-diffusion models and Poisson equations are employed and solved using a finite element method to investigate negative corona discharge phenomena. The results show that the current characteristic with different applied voltages is within good agreement with the experimental results. A typical pulse train and the total number of charged species are also presented. Furthermore, the spatial distribution of charged species, the electric field distribution, and the ionization rate are explained. The effect of physical geometries of the particle on negative corona discharge characteristics is also investigated. It is found that the variation of the particle length, diameter, and tip radius is influencing the pulse characteristics.

S2361 Pancreatic Protrusion: A Rare Case of Grade IV Hiatal Hernia With Complete Pancreatic Herniation

Introduction: Hiatal hernias are commonly described as herniation of abdominal contents through the esophageal hiatus of the diaphragm. With this, classification systems exist to define hernias as either sliding or type one, or to consider types 2, 3 and 4 as paraesophageal which also present with other sequelae. While most commonly, hiatal hernias are type one and less severe in nature, 5 percent of cases become more involved and severe. The current prevalence of hernias ranges between 10 to 80 percent of North Americans. In this case, we shed light on the diagnosis and imaging of a rare sequelae of hiatal hernia which included not only small and large protrusion, but also herniation of the pancreas. Case Description/Methods: The patient is a 95 year old woman with a past medical history of abdominal aortic aneurysm as well as a large hiatal hernia presenting with a chief complaint of poor oral intake over the last several days prior to presentation. The patient was found to be significantly lethargic compared to baseline and reported decreased oral intake due to discomfort after eating. The patient’s initial vitals demonstrated a mild tachycardia with initial lab findings within normal ranges. A CT chest and abdomen was performed which demonstrated a large hiatal hernia, which now contained loops of small and large bowel as well as the pancreas. During the hospital course, interdisciplinary rounds were conducted in regards to the patient case with surgical and gastroenterology recommendations. The uniqueness of presentation of pancreatic protrusion was discussed as well as the current treatment and monitoring modalities of a Grade 4 hiatal hernia, now presenting with complications. Ultimately, the discussions were conducted with the patient who reported she was most amenable to comfort focused care with a pleasure based diet in an attempt to avoid any medical and surgical intervention. Discussion: In emergent cases, such as with respiratory distress and bowel strangulation, emergent surgical intervention is considered in cases of hiatal hernia. However, lesser defined and established are the findings and management as well as treatment modalities of more severe hernias involving protrusion of pancreatic contents. Here, we add to imaging the unique presentation of a common diagnosis with rare sequelae. We also hope to add to a growing body of literature on the imaging, and potential stepwise approach to management of type 4 hiatal hernias with severe and emergent treatment considerations.

Two new surprising species of leaf-litter toad of the Rhinella margaritifera species group (Anura: Bufonidae) from the Peruvian Amazon, LoretoPeru.

We describe two new species of Rhinella (Anura: Bufonidae) from the department of Loreto, Peru. We integrate morphological and phylogenetic analyses to provide evidence of new species. R. angeli sp. nov. is diagnosable from all congeners by its pronounced fleshy proboscis and R. unapensis sp. nov. by the small size (mean snout-vent length=37.7 4.1 mm) of adult males, snout pointed in dorsal view, nearly acute in lateral view, and small bony protrusion at the angle of jaws among other characters. The two species are allopatric, where the first species is known to be associated inhabits upland (=terra firme) forests, while the second white sand forests (=varillales) around Iquitos city. The two new species represent the 20th and 21st species of the Rhinella margaritifera species group.

Efficacy of Navigated Laser Photocoagulation for Chronic Central Serous Chorioretinopathy: A Retrospective Observational Study.

Background. No consensus has been reached regarding the management of central serous chorioretinopathy (CSCR). We aimed to investigate the efficacy of navigated laser treatment for chronic CSCR and changes in the morphology of the retinal pigment epithelium (RPE). In this retrospective observational study, 19 patients with subjective symptoms admitted to the Nanjing Medical University Affiliated Eye Hospital were included between January 2021 and August 2021. All patients underwent visual acuity and optical coherence tomography (OCT) examination during follow-up. Fluorescein angiography (FA) was performed at baseline and at the final follow-up to confirm the dye leakage sites. The mean logMAR BCVA at baseline and at the end of follow-up was 0.49 ± 0.24 and 0.24 ± 0.15, respectively. The mean logMAR BCVA 3 months after treatment was significantly better than that before treatment (p = 0.002). Significant improvements were observed in central macular thickness (CMT) and subfoveal choroidal thickness (SFCT) after navigated laser photocoagulation (p < 0.0001). Subretinal fluid was completely resolved in 13 (68%) of 19 eyes at 3 months. RPE lesions on OCT images showed RPE detachment in 17 eyes (61.5%), small protrusion of the RPE layer in 5 eyes (7.5%), and a rough RPE layer in 4 eyes (31%). After laser treatment, 9 points (35%) showed retinal detachment, and 10 (38.5%) regions showed an irregular RPE layer. An irregularly protruded RPE layer was also observed in different regions of the leakage spot in 5 (19%) eyes, and RPE defects were seen in 2 (7.5%) eyes. Navigated laser photocoagulation for chronic CSCR can achieve substantial anatomical and visual improvement. OCT outcomes may provide new information to facilitate understanding of the mechanism of chronic CSCR. Navigated laser photocoagulation should be chosen as an optimal treatment option in patients with chronic CSCR who cannot afford photodynamic therapy.

Palatal Electrotactile Display Outperforms Visual Display in Tongue Motor Learning.

Incomplete tongue motor control is a common yet challenging issue among individuals with neurotraumas and neurological disorders. In development of the training protocols, multiple sensory modalities including visual, auditory, and tactile feedback have been employed. However, the effectiveness of each sensory modality in tongue motor learning is still in question. The objective of this study was to test the effectiveness of visual and electrotactile assistance on tongue motor learning, respectively. Eight healthy subjects performed the tongue pointing task, in which they were visually instructed to touch the target on the palate by their tongue tip as accurately as possible. Each subject wore a custom-made dental retainer with 12 electrodes distributed over the palatal area. For visual training, 3×4 LED array on the computer screen, corresponding to the electrode layout, was turned on with different colors according to the tongue contact. For electrotactile training, electrical stimulation was applied to the tongue with frequencies depending on the distance between the tongue contact and the target, along with a small protrusion on the retainer as an indicator of the target. One baseline session, one training session, and three post-training sessions were conducted over four-day duration. Experimental result showed that the error was decreased after both visual and electrotactile trainings, from 3.56 ± 0.11 (Mean ± STE) to 1.27 ± 0.16, and from 3.97 ± 0.11 to 0.53 ± 0.19, respectively. The result also showed that electrotactile training leads to stronger retention than visual training, as the improvement was retained as 62.68 ± 1.81% after electrotactile training and 36.59 ± 2.24% after visual training, at 3-day post training.