Contusion Research Articles

Retrospective Analysis of 73 Hanging and Ligature Strangulation Cases.

Objective To retrospectively analyze 40 cases of hanging and 33 cases of ligature strangulation in Kunming, to explore the neck injury characteristics and similarities and differences of related asphyxia signs of corpses in hanging and ligature strangulation cases, in order to provide reference for forensic identification. Methods Statistics of hanging and ligature strangulation cases accepted by Kunming Municipal Public Security Bureau from 2000 to 2017 were collected. Data including the gender, age, injury tool, neck injury and related asphyxia signs of the deceased in hanging and ligature strangulation cases were statistically tested by SPSS 23.0. Results There were more males in hanging cases than females. However, there were more females than males in ligature strangulation cases. In hanging cases, suicide was common, while homicide was rare. In ligature strangulation cases, homicide was common, while suicide or accidental death was rare. The average age of the deceased in hanging cases were older than those in ligature strangulation cases. The ligature mark in hanging was usually above the thyroid cartilage. The ligature mark in ligature strangulation was usually at the same level of the thyroid cartilage. The most common vital reactions were exfoliation and subcutaneous hemorrhage at the ligature mark, common among the deceased in hanging cases. Hyoid fracture rate of the deceased in ligature strangulation cases was more common than those in hanging cases. Conclusion The gender, age distribution, position of ligature mark, detection rate of vital reactions at the ligature mark and hyoid fracture rate of the deceased can help distinguish hanging from ligature strangulation.

Brain Tissue Pulmonary Embolism Due to Severe Blunt Force Head Trauma in a Dog

A 9-week-old male puppy was submitted for necropsy examination after a reported history of developing acute melaena and vomiting blood before death. Grossly, the animal had multiple skull fractures, mostly affecting the occipital region and cranial floor, associated with extensive regions of subcutaneous, periosteal and subdural haemorrhages, as well as petechial haemorrhages within the right middle and caudal lung lobes. Histopathology of the brain revealed multifocal acute meningeal and parenchymal haemorrhage with laceration of the cerebellar folia. In the lung, multiple small- and medium-calibre branches of pulmonary arteries were occluded by aggregates of brain tissue, which exhibited weak immunoreactivity for glial fibrillary acidic protein and strong labelling for neuron specific enolase on immunohistochemistry. These findings were consistent with brain tissue pulmonary embolism, an infrequent phenomenon following severe head trauma. To the best of the authors' knowledge, this is the first reported case of canine brain tissue pulmonary embolism.

P144 Vitamin C deficiency in inflammatory bowel disease: the forgotten micronutrient

Abstract Background Micronutrient deficiencies are common in patients with inflammatory bowel disease (IBD). To date, the majority of the literature has focused on vitamin D, vitamin B12, and iron deficiencies. We report a case series of patients with IBD and vitamin C deficiency. Methods We performed a retrospective chart review of 20 patients with IBD who had vitamin C deficiency (defined as a level ≤0.2 mg/dl) treated in a single tertiary care centre from February 2018 to October 2019. Demographics as well as disease characteristics and laboratory data were collected. In addition, data from routine nutritional assessments, performed by a nutritionist, were also included. Results Of these 20 patients, 11 (55%) were female with a median age of 27.5 years. Fifteen (75%) had Crohn’s disease (CD) and 5 (25%) had Ulcerative colitis (UC). Ten (50%) had been diagnosed with IBD within the last 3 years, and 10 (50%) had a duration of disease >5 years. Disease location was L1 ileal in 6 (30%) patients, L2 colonic in 5 (25%) and L3 ileocolonic in 9 (45%); behaviour was B1 non-stricturing, non-penetrating in 10 (50%) patients, B2 stricturing in 7 (35%) and B3 penetrating in 3 (15%). Nine (45%) patients had previous history of surgery. At the time of the study, 13 (87%, N=15) CD patients had a Harvey–Bradshaw Index >5, and 3 (60%, N = 5) UC patients had a Partial Mayo Score 5–7, indicating active disease. Overall, 14 (70%) patients were on biologic therapy. Sixteen (80%) patients had symptoms consistent with clinical scurvy, including 9 (45%) arthralgia, 6 (30%) dry brittle hair with hair loss, 4 (20%) pigmented rash, 3 (15%) gingivitis, 2 (10%) easy bruising and 1 (5%) brittle nails. Six (32%) had 3 or more of these clinical manifestations. Of those who underwent a nutrition evaluation (N = 18), 10 (56%) reported avoidance of all fruits and vegetables and 3 (17%) reported a reduction of fruits and vegetables in their diet. While all patients experienced vitamin C deficiency, some also had concomitant vitamin D, vitamin B12, iron and ferritin deficiencies (Table 1). Conclusion Vitamin C deficiency can occur in IBD patients and is associated with clinical symptoms of scurvy. Prospective studies are needed to evaluate prevalence of vitamin C deficiency in IBD and its ultimate impact on clinical outcomes. Meanwhile this study emphasises the need for appropriate dietary counselling in patients with IBD.

Back hemorrhage in bath-related deaths: Insights into the mechanism of bath-related deaths

Forensic pathologists often encounter difficulties while diagnosing bath-related deaths owing to a lack of specific findings for determining the cause. This study reports the characteristic findings noted during autopsy associated with bath-related deaths. The subjects included individuals found deceased in water-filled bathtubs. Originally, a “bathtub death” was defined as a case of drowning in a bathtub without a known cause despite complete investigation including a complete autopsy and examination of the death scene. We also excluded cases with ethanol and/or high drug concentrations in the blood from “bathtub death” cases. Muscular hemorrhages around the scapula were the most common in cases of accidental drowning (72.7%). The frequency of muscular hemorrhages around the scapula was low in cases involving bathtub deaths (11.1%) and natural disease. Subcutaneous hemorrhages in the back were the most frequent in cases of bathtub death (88.9%), followed by accidental drowning (81.8%). The frequency of subcutaneous hemorrhages in the back was low in cases involving suicide and natural disease. The presence of subcutaneous hemorrhages in the back without muscular hemorrhages around the scapula were strongly associated with bathtub deaths (Fisher's exact test, P < 0.0001; sensitivity, 0.84; specificity, 0.91). Subcutaneous hemorrhages were the most frequent in the waist (68.8%), followed by the upper back (50%). Subcutaneous hemorrhages in the back without muscular hemorrhages around the scapula indicated that the deceased had hit their back on falling from a standing position after experiencing disturbances of consciousness. We found the occurrence of orthostatic hypotension while getting out of the bathtub to be the most likely cause for these autopsy findings. Subcutaneous hemorrhages in the back without muscular hemorrhages around the scapula is a characteristic finding of “bathtub deaths”. Although this was a preliminary study, the presence of this finding may aid in clarifying the mechanism of bath-related deaths.

Incidence of Displaced Posterolateral Tibial Plateau and Lateral Femoral Condyle Impaction Fractures in the Setting of Primary Anterior Cruciate Ligament Tear

Background: Bone bruising of the posterolateral tibial plateau and the lateral femoral condyle sulcus terminalis has a well-established association with anterior cruciate ligament (ACL) tears. Impaction fractures of the femur and tibia may occur in these locations; however, there is a paucity of literature describing these fractures. Purpose: The primary objective was to quantify the incidence, size, and location of impaction fractures of the posterolateral tibial plateau and lateral femoral condyle in patients with primary ACL tears. The secondary objective was to investigate the association between impaction fractures and concomitant meniscal and ligamentous injuries. Study Design: Case series; Level of evidence 4. Methods: Patients with available magnetic resonance imaging (MRI) scans who were treated for primary ACL tear by a single surgeon were identified. MRI scans were reviewed with denotation of posterolateral tibial and femoral condylar contusions and displaced impaction fractures. Measurements of the lateral tibial plateau were taken in all patients with displaced lateral tibial plateau fractures and in a subset of control patients without tibial plateau fracture present to characterize the size and location of the bony lesion. Associations of impaction fractures with concomitant meniscal or ligamentous injuries were evaluated through use of chi-square testing. Results: There were 825 knees identified with available MRI scans. Lateral tibial plateau bone bruising was present in 634 knees (76.8%), and lateral femoral condyle bone bruising was present in 407 knees (49.3%). Posterolateral tibial plateau impaction fractures were present in 407 knees (49.3%), and lateral femoral condylar impaction fractures were present in 214 knees (25.9%). Patients with posterolateral tibial plateau impaction fractures were older than patients without these fractures (42.6 vs 32.7 years; P < .001), whereas patients with lateral femoral condylar impaction fractures were younger (23.8 vs 32.7 years; P < .001). There were 71 knees (8.6%) with a posterolateral tibial plateau impaction fracture with greater than 10% loss of lateral tibial plateau depth, and this group had an increased incidence of lateral meniscus posterior root tears (22.1% vs 12.0%; P = .02). Conclusion: Posterolateral tibial plateau impaction fractures occurred with a high incidence (49.3%) in patients with primary ACL tears and demonstrated an increased association with lateral meniscus posterior horn root tears as their size increased. Lateral femoral condylar impaction fractures occurred in 25.9% of patients with primary ACL tears and entailed an increased incidence of lateral meniscal tears and medial meniscal ramp lesions.

Safety of Non-Vitamin K Oral Anticoagulants in Elderly Patients with Atrial Fibrillation

Aim. To study the safety of non-vitamin K oral anticoagulants (NOAC) in patients with atrial fibrillation (AF) over 75 years old. Material and methods. The observation study included patients ≥75 years of age with confirmed AF, receiving dabigatran in a reduced dosage, apixaban or rivaroxaban in full or reduced dosage. Previous experience of NOAC treatment from the very beginning of therapy, if a patient was ≥75 years old, or from the point a patient reached 75 years was considered; episodes of NOAK change, as well as hemorrhagic and ischemic events associated with taking an anticoagulant, were recorded. Patient groups were comparable in risk score by CHA2DS2-VASc and HAS-BLED scales. Results. Patients with AF (n=102; 39 men and 63 women; an average age 79.4Ѓ}4.1 years) were included: 32 patients were in dabigatran group, 34 patients – in apixaban group and 36 patients – in rivaroxaban group. 19 clinically significant bleedings were recorded, 10 occurred in patients taking dabigatran and 9 in those taking rivaroxaban. No hemorrhagic events in patients treated with apixaban were observed. Hematuria (31.6%), large subcutaneous hematomas (26.3%) and intensive nasal bleedings (26.3%) were the most frequent events. No ischemic cardioembolic stroke was recorded. Conclusions. In elderly patients, all NOAC (dabigatran, rivaroxaban and apixaban) demonstrated good safety profile without major bleeding within a 1.5-year follow-up period.

Identification of Candidate Biomarkers for Idiopathic Thrombocytopenic Purpura by Bioinformatics Analysis of Microarray Data.

Idiopathic Thrombocytopenic Purpura (ITP) is a multifactorial disease with decreased count of platelet that can lead to bruising and bleeding manifestations. This study was intended to identify critical genes associated with chronic ITP. The gene expression profile GSE46922 was downloaded from the Gene Expression Omnibus database to recognize Differentially Expressed Genes (DEGs) by R software. Gene ontology and pathway analyses were performed by DAVID. The biological network was constructed using the Cytoscape. Molecular Complex Detection (MCODE) was applied for detecting module analysis. Transcription factors were identified by the PANTHER classification system database and the gene regulatory network was constructed by Cytoscape. One hundred thirty-two DEGs were screened from comparison newly diagnosed ITP than chronic ITP. Biological process analysis revealed that the DEGs were enriched in terms of positive regulation of autophagy and prohibiting apoptosis in the chronic phase. KEGG pathway analysis showed that the DEGs were enriched in the ErbB signaling pathway, mRNA surveillance pathway, Estrogen signaling pathway, and Notch signaling pathway. Additionally, the biological network was established, and five modules were extracted from the network. ARRB1, VIM, SF1, BUB3, GRK5, and RHOG were detected as hub genes that also belonged to the modules. SF1 also was identified as a hub-TF gene. To sum up, microarray data analysis could perform a panel of genes that provides new clues for diagnosing chronic ITP.

Microangiopathic hemolytic anemia/Acquired Thrombotic Thrombocytopenic Purpura as a first presentation of pancreatic cancer

Thrombotic thrombocytopenic purpura (TTP) is a rare life-threatening hematologic disorder. It is mainly characterized by thrombocytopenia, microangiopathic hemolytic anemia (MAHA), fever, renal impairment and neurological abnormality. Plasmapheresis and steroids are the standard of care. MAHA/TTP can be the initial presentation of solid organ malignancies especially gastrointestinal tumors. We report a 56-year-old female patient who presented with progressive back pain, tiredness, easy bruising, fever and weight loss. Laboratory results showed anemia, thrombocytopenia, and schistocytes in the peripheral smear. An initial diagnosis of thrombotic thrombocytopenic purpura (TTP) was made on the basis of clinical presentation and lab findings. She was treated with corticosteroids and plasma exchange but with no major response. CT abdomen and PET CT were suggestive of pancreatic carcinoma with extensive lymph nodal, organs and bone metastases. Supraclavicular lymph node biopsy was compatible with metastatic adenocarcinoma. As a result, the diagnosis of pancreatic cancer was established and the decision was for palliative treatment. This case highlights the need to consider malignancy in patients with MAHA/TTP especially if it does not respond to plasmapheresis. Hence, the treatment of MAHA/TTP could be directed to the underlying malignancy if available.

Effect of Sodium Hyaluronate on Inflammatory Cytokine Levels in Synovial Fluid of Patients with Knee Osteoarthritis

This study evaluated the efficacy of intraarticular injection of sodium hyaluronate in the treatment of knee osteoarthritis and its influence on the levels of stromal cell-derived factor-1 and matrix metalloproteinases 3, 9 and 13 in the synovial fluid of patients with knee osteoarthritis. A total of 180 patients with knee osteoarthritis treated in the orthopaedic outpatient department of the Hubei Provincial Hospital from April 2015 to April 2017 were selected as the research objects and all of them were given intraarticular injection of sodium hyaluronate with synovial fluid extracted before the injection, 1 and 3 mo after the injection, and the level of stromal cell-derived factor-1 and matrix metalloproteinases 3, 9, 13 were determined using a sandwich enzyme-linked immunosorbent assay method. After 3 mo of treatment, the effect on the efficacy of patient’s gender, age, body mass index, swollen joint degree, involved joint space, Kellgren and Lawrence grading as well as tibiofemoral angle were observed and studied. Among the 180 cases there were 132 cases with 73.3% effective rate and 48 cases of with ineffective rate of 26.7%. Significant differences were found in the levels of stromal cell-derived factor-1, matrix metalloproteinases 3, 9 and 13 in the synovial fluid before the treatment, 1 and 3 mo after the treatment (p 1.7 in joint effusion and osteoarthritis involving tibiofemoral joint gap. In the treatment of knee osteoarthritis, the intraarticular injection of sodium hyaluronate could effectively reduce the levels of stromal cell-derived factor-1, matrix metalloproteinases 3, 9 and 13 in synovial fluid and decrease inflammatory reaction. But it should be used with great caution for treating patients with moderate and severe knee osteoarthritis involving tibial and femoral joints with the joint effusion graded above II or bone contusion.

The clinical application of color Doppler ultrasound in guiding the puncture of new internal fistula in deep arteriovenous

Objective To investigate the clinical value of color Doppler ultrasound guidance in the puncture of new internal fistula in deep arteriovenous of hemodialysis patients. Methods Selected thirty patients with arteriovenous fistula not less than 5 mm deep in the Department of Hemodialysis Room of Wuhan First Hospital, and they were divided into observation group and control group by the method of random number generator in IBM SPSS Statistics 22.0 software, with 15 patients in each group. The control group was treated with conventional blind puncture by experienced nurses (849 times), while the observation group was treated with color Doppler ultrasound guided puncture (855 times). By comparing two groups of deep arteriovenous fistula in new fistula patients within 6 months of the one-time success rate of puncture, the incidence of adverse events such as subcutaneous hematoma, bleeding, pain, interruption or postponement of treatment, and accidental injury to arteries caused by puncture errors of internal fistula, and the patient′s satisfaction with the puncture and dialysis results was evaluated to observe the advantage of color Doppler ultrasound guidance in clinical application of deep arteriovenous new fistula puncture. Results The success rate of one-time puncture for internal fistula puncture in observation group was 98.95% (846/855), which was significantly higher than that in control group 81.27% (690/849), and the difference was statistically significant (χ2 = 149.753, P 0.05). The total incidence of adverse events caused by internal fistula puncture errors in the two groups was 1.99% (17/855) and 22.97% (195/849), respectively, and the difference was statistically significant (χ2=172.126, P < 0.01). The average rank of satisfaction in observation group was 1 261.25, which was higher than control group 440.86, and the difference was statistically significant (Z=-38.107, P < 0.01). Conclusions Color Doppler ultrasound guidance in the puncture of new internal fistula in deep arteriovenous of hemodialysis patients has important clinical application value. It can significantly improve the success rate of one-time new internal fistula puncture, reduce the occurrence of adverse events due to puncture failure, and reduce patient′s pain, which is worthy of clinical promotion. Key words: Doppler ultrasound; Arteriovenous fistula; Applied

Medico-legal profile of hanging cases in rural region of Maharashtra: An Autopsy based cross-sectional study

Violent deaths resulting from asphyxia chiefly includes hanging. Hanging may be suicidal, homicidal or accidental in nature. Suicide by hanging is the most common, accidental hanging is less common and homicidal hanging is still less common. A retrospective study was conducted at mortuary of SRTR Government Medical College, Ambajogai, Dist. Beed, Maharashtra, India, between the period 1 January 2018 to 31 December 2018 on all cases of hanging brought for post mortem examination where the cause of death was attributed to hanging. Data was collected with help of police inquest, post-mortem notes and forensic science lab reports. Results were obtained after tabulating and analysing data. Maximum deaths were reported (20 cases i.e. 33.89%) in 21-30 age group followed by (11 cases i.e. 18.64%) 51-60 years age group. The ligature material most commonly used was rope (59.32%). Type of knots was, fixed in 27 (45.76%) cases. The position of knot was mostly cases on posterior aspect of neck in 21 (35.59%). Direction of ligature mark was oblique in 57 (96.61%) cases. Ligature mark was above the level of thyroid cartilage in 52 (88.13%) cases. Dribbling of saliva was present in 25 (42.37%) cases. Peri-ligature subcutaneous haemorrhages were present in 16 (27.11%) cases. Fractured hyoid bone was seen in 1 (01.69%) case only. Type of suspension was complete in 45 (76.27%) cases. Manner of hanging was suicide in 56 (94.91%) cases.

A Multicenter Randomized Controlled Pilot Trial Testing the Efficacy and Safety of Pterygopalatine Fossa Puncture Using One Acupuncture Needle for Moderate-to-Severe Persistent Allergic Rhinitis.

Objective To compare the efficacy and safety of pterygopalatine fossa puncture using one acupuncture needle inserted through the temporal fossa (intervention) and Chinese verum acupuncture (VA) in patients with moderate-to-severe persistent allergic rhinitis. Methods The patients were randomized to an intervention group receiving pterygopalatine fossa puncture with one acupuncture needle for 4 weeks (once or twice weekly, 4–8 sessions in total, with a second course performed if required) or to a control group receiving individualized VA for 4 weeks (twice weekly, eight sessions in total). Patients were followed up 4 weeks later. Results Ninety-six participants were assigned to intervention (n = 48) or VA (n = 48) or VA (P > 0.05 in all cases). Compared with the VA, the time to onset of effect in the intervention group was shorter and the duration of effectiveness was longer. The mean clinical waiting time was significantly shorter in the intervention group than in the control group (6.640 ± 3.035 min and 31.19 ± 10.216 min, respectively). The total number of sessions in the VA group was 384; 7 episodes of subcutaneous bleeding occurred but did not require treatment. The total number of sessions in the intervention group was 185. Two cases of subcutaneous bleeding (one of local hematoma during the intervention and the other one of bruising in the palpebra inferior on the day after intervention) resolved upon withdrawal from the study. Conclusions Pterygopalatine fossa puncture using one acupuncture needle resulted in a shorter time to onset of effect, a longer duration of effectiveness, and less clinical waiting time when compared with VA. Though the significant differences for TNSS and TNNSS were shown within intervention and VA groups, there were no differences between the two groups. Although the rate of subcutaneous bleeding was low, these adverse events may influence patient compliance. This trial is registered with ISRCTN21980724.

Classification, nosology and diagnostics of Ehlers-Danlos syndrome

Ehlers-Danlos syndrome (EDS) comprises a group of heritable connective tissue disorders which has as cardinal features varying degrees of skin hyperextensibility, joint hypermobility, easy bruising and skin fragility. The 2017 New York nosology distinguishes 13 types of EDS, which all, except hypermobile EDS, have a known molecular basis. Hypermobile EDS is recognized as a common and often disabling disorder, incorporating benign joint hypermobility syndrome. EDS needs to be differentiated from other connective tissue disorders, in particular Marfan syndrome, Loeys-Dietz syndrome and cutis laxa. The frequent types of EDS can be diagnosed after careful history taking and clinical examination, but for definite diagnosis molecular confirmation is needed in all types. Management for EDS patients preferably is provided by multidisciplinary teams in expertise centres. After diagnosing EDS genetic counselling is an essential part of the management of patients and their family.

Chicken Anaemia Virus in Egyptian Broiler; Clinical Signs and Molecular Characterization

A total of 18 flocks , 45 day old broiler from Ismailia, Egypt were tested for chicken anemia virus (CAV) using serological evidence and molecular characterization. Tested birds had history of diarrhea, blue wing, depression, and deaths. Necropsy findings were pale liver, severe atrophy of bursa Fabricius and thymus, pale discoloration of the bone marrow and subcutaneous hemorrhages. The viral DNA of the VP1 gene was detected and sequenced. Nucleic acid alignment showed 100% similarities with many CAV viruses. Antibodies against CAV were detected in 73.9% of the tested samples using commercial ELISA kit. Hemoglobin (Hb) revealed low percentage (4.3% to 8.02%), and packed cell volume (PCV) were measured and showed anemic level (22.5 to 34.2). The data strengthen the concept that CAV may have a negative economic impact on the chicken industry in Ismailia.

Analysis of pediatric neurosurgical diseases: A single-center study

Objective To summarize the clinical epidemiological characteristics of pediatric neurosurgical diseases at a single center. Methods A total of 5 790 children (≤15 years old) with neurosurgical diseases admitted to Department of Neurosurgery, Xijing Hospital, Air Force Medical University from January 2008 to June 2018 were retrospectively enrolled. Their clinical data were analyzed and included the distribution of various diseases and clinical characteristics such as age, gender and lesion location. Results All 5 790 children included 2 259 cases (39.0%) of congenital malformation, 1 561 cases of tumor (27.0%), 953 cases of trauma (16.5%), 360 cases of cerebrovascular disease (6.2%), 159 cases of inflammation (2.7%), 91 cases of functional disorder (1.6%) and 407 cases of other diseases (7.0%). The gender ratio (male ∶female) was 1.76 ∶1.00. In all kinds of diseases, the proportion of male children was higher than that of female children, and the difference was statistically significant (P<0.001). The overall peak age of onset was 0-3 years old. Congenital malformations and tumors were predominant in 0-3 years old (42.9%) and 13-15 years old (26.3%), respectively. Three most frequent congenital malformations were arachnoid cyst (29.6%), hydrocephalus (28.2%) and tethered cord syndrome (20.0%). Temporal lobe was the most common site of arachnoid cyst (45.4%). Three most common tumors were glioma (19.7%), craniopharyngioma (9.0%) and medulloblastoma (8.8%). The ratios of brain tumors to spinal canal tumors, supratentorial tumors to infratentorial tumors and low-grade tumors to high-grade tumors were 5.61 ∶1.00, 1.73 ∶1.00 and 1.67 ∶1.00, respectively. Primary brain injury(365 cases) accounted for 58.6% of traumatic diseases and 59.2% (the highest proportion) of primary brain injury was brain contusion and laceration. In cerebrovascular diseases, the proportion of spontaneous hemorrhage (27.2%) was the highest. The most common inflammatory disease was inflammatory granuloma(22.6%). In addition, with the increase of age, the incidence of congenital malformation decreased gradually, while the incidence of cerebrovascular diseases increased gradually(both P<0.001). Conclusions Pediatric neurosurgical diseases have unique clinical epidemic characteristics. Congenital malformations and tumors are more common, and the incidence of arachnoid cysts and gliomas seems to be the highest. In various diseases, the incidence of male is higher than that of female, and the peak ages are different. Key words: Child; Neurosurgery; Epidemiology; Single-center study

Efficacy of double-eyelid plasty: a clinical analysis of 162 cases

Objective To discuss one double-eyelid surgery which is conformed to the anatomy characteristics of the asian upper eyelid. Methods A total of 162 cases were performed blepharoplasty for double eyelids, who aged 19 to 33 years with average 24.22±3.05 years, including 28 men and 134 women. Double eyelid line was designed according to the overall characteristics of eyebrows and eyes of beauty seekers combined with aesthetic standards. The surgery was performed to restore the anatomical characteristics of natural double eyelids as far as possible. Results The double eyelid surgery was designed and performed in 162 cases based on this method. All the patients underwent suture removal 7 days after operation, none of them had postoperative infection, and 15 patients had the bruising during the first week. After symptomatic treatment, the bruising had gone in 1 month. All the cases were followed up for more than six months postoperatively, and eight cases presented shallow double eyelid and the satisfactory results were achieved after the second operation of small incision. Conclusions The double-eyelid line should be designed individually before operation and the surgery done according to the natural characteristics of Asian upper eyelid. It will get coherent double eyelid without obvious scar or depression at resection margin, with high satisfactory rate. Key words: Esthetics; Blepharoplasty; Double lid blepharoplasty; Upper eyelid; Epicanthal folds

Application of modified arterial venalization in replantation of distally severed finger at nail root without venous anastomosis

Objective To introduce an improved method of reconstructing venous reflux in replantation of distally severed finger at nail root, and explore its clinical efficacy. Methods From January 2016 to September 2018, 12 patients with 13 distally severed fingers at nail root were replanted. There were no veins to anastomose the two severed ends. The proximal bilateral proper digital artery was anastomosed with the distal digital artery or two branches. The proximal digital artery was cut off and anastomosed with the proximal dorsal digital vein to establish venous reflux. Results In 13 replanted fingers, 1 finger had partial necrosis due to serious tissue contusion, and the other 12 fingers survived completely. No venous crisis occurred after operation. The postoperative follow-up time ranged from 3 to 9 months with an average of 6.0 months. The skin texture of replanted finger was good, the nail grew well, and the sensation recovered to over S3. The patient was satisfied with the appearance and function. Conclusion The modified arterial venalization can effectively solve the venous reflux problem in venous deficiency and improve the survival rate of replantation of distally severed finger at nail root. It is an effective way to reconstruct venous reflux in the absence of severed veins. Key words: Replantation; Treatment outcome; Arterial venalization; Venous reflux

A Study to Assess the Efficacy and Safety of Efgartigimod in Adult Patients With Primary Immune Thrombocytopenia (an Autoimmune Disorder That Destructs Platelets, Blood Cells That Help With Clotting, and Can Lead to Easy or Excessive Bruising and Bleeding)

A Study to Assess the Efficacy and Safety of Efgartigimod in Adult Patients With Primary Immune Thrombocytopenia (an Autoimmune Disorder That Destructs Platelets, Blood Cells That Help With Clotting, and Can Lead to Easy or Excessive Bruising and Bleeding)

New Insights on Lipedema: The Enigmatic Disease of the Peripheral Fat.

Although a large number of adult women worldwide are affected by lipedema, the physiologic conditions triggering onset and progression of this chronic disease remain enigmatic. In the present study, a descriptive epidemiologic situation of postoperative lipedema patients is presented. The authors developed an online survey questionnaire for lipedema patients in Germany. The survey was conducted on 209 female patients who had been diagnosed with lipedema and had undergone tumescent liposuction. Most of the participants (average age, 38.5 years) had noticed a first manifestation of the disease at the age of 16. It took a mean of 15 years to accomplish diagnosis. Liposuction led to a significant reduction of pain, swelling, tenderness, and easy bruising as confirmed by the majority of patients. Hypothyroidism [n = 75 (35.9 percent) and depression [n = 48 (23.0 percent)] occurred at a frequency far beyond the average prevalence in the German population. The prevalence of diabetes type 1 [n = 3 (1.4 percent)], and diabetes type 2 [n = 2 (1 percent)] was particularly low among the respondents. Forty-seven of the lipedema patients (approximately 22.5 percent) suffered from a diagnosed migraine. Following liposuction, the frequency and/or intensity of migraine attacks became markedly reduced, as stated by 32 patients (68.1 percent). Quality of life increases significantly after surgery with a reduction of pain and swelling and decreased tendency to easy bruising. The high prevalence of hypothyroidism in lipedema patients could be related to the frequently observed lipedema-associated obesity. The low prevalence of diabetes, dyslipidemia, and hypertension appears to be a specific characteristic distinguishing lipedema from lifestyle-induced obesity.

Relationships between temperament, meat quality, and carcass traits in Nellore cattle1.

The aim of this study was to evaluate the relationship between temperament in Nellore bulls with carcass and meat quality traits. In total, 1,400 bulls were studied, and temperament was assessed using two measurements: movement score (MOV) and flight speed test (FS). Both MOV and FS were measured at two time points, with background (MOVb and FSb) temperament measured at yearling age, ~550 d after birth, and the preslaughter (MOVps and FSps) temperament measured at the end of the feedlot period. The change of temperament resulting in an increase or decrease in reactivity was also used to measure meat quality. The traits used to define carcass and meat quality included carcass bruises (BRU), hot carcass weight (HCW, kg), ribeye area (REA, cm2), backfat thickness (BFT, cm), marbling score (MS), meat pH after thawing (pH), presence or absence of dark cutters, color parameters of luminosity (L*), redness (a*) and yellowness (b*), cooking loss (CL, %), and Warner-Bratzler shear force (WBSF, kg). A principal component (PC) analysis was initially applied to the carcass and meat quality traits, followed by logistic regression models and linear mixed models to evaluate the effects of temperament on carcass and meat quality. The risks of carcass bruises and dark cutters did not differ as a function of any temperament trait (P > 0.05). In turn, animals classified as high MOVb (reactive) had lower PC3 values (P = 0.05), CL (P = 0.02), and tended to have lower MS (P = 0.08). In addition, animals classified as high FSb (faster and reactive cattle) produced carcasses with smaller REA (P < 0.01), higher meat pH (P < 0.01), lower color gradients (L*, P = 0.04; b*, P < 0.01), and lower PC1 and PC4 scores (P < 0.01) when compared with the low FSb class. For preslaughter temperament, high MOVps was related to lower color a* (P = 0.04), whereas high FSps was related to lower HCW, MS, and PC2 (P < 0.01) than the calmer ones (low FSps). The reduction in MOV was related to more tender meat, and the reduction in FS to heavier carcass and brighter meat. We conclude that excitable temperament in Nellore cattle may have negative effects in some of the carcass and meat quality attributes assessed, mainly those related to muscle deposition on carcass and color gradients. Measurement of temperament before the cattle entered the feedlot was a better predictor of carcass and meat quality traits, compared with temperament assessment at the end of the feeding period.