Types IIa Research Articles

Computed Tomography Bronchus Sign Subclassification during Radial Endobronchial Ultrasound-Guided Transbronchial Biopsy: A Retrospective Analysis

The presence of computed tomography bronchus sign (CT-BS) substantially increases the diagnostic yield of peripheral pulmonary lesions. However, the clinical significance of subdividing CT-BS remains controversial. We classified bronchus types on CT into six subtypes (CT-BS group I: types Ia-Ic with the bronchus connected within the lesion, group II: types IIa-IIc without connection) to clarify the differences in their characteristics and investigate the factors associated with diagnosis during radial endobronchial ultrasound (rEBUS)-guided bronchoscopy. In total, 1021 cases were analyzed. Our findings in diagnostic yields were that in CT-BS group I, penetrating type Ic was inferior to obstructed type Ia and narrowing type Ib (59.0% vs. 80.0% and 76.3%, p < 0.001, p = 0.004); in CT-BS group II, compressed type IIa showed no difference when compared with invisible type IIb and uninvolved type IIc (IIa: 52.8% vs. IIb: 46.3% and IIc: 35.7%, p = 0.253). Multivariable analysis revealed that bronchus type (types Ia and Ib vs. Ic) was a significant independent predictor of successful diagnosis in CT-BS group I (odds ratio, 1.78; 95% confidence interval, 1.04-3.05; p = 0.035), along with known factors such as rEBUS visualization. CT-BS subclassification may provide useful information regarding the bronchoscopic technique to facilitate accurate diagnosis.

Cementless augmented versus cemented Dual Mobility cups: medium-term outcome of case series with a control group

BackgroundPost-operative dislocation and reconstruction of acetabular defects are two challenging topics in revision Total Hip Arthroplasty (rTHA). Cemented Dual Mobility (DM) cups on top of Kerboull Cross and bone graft have been successfully employed to overcome these challenges. The cementless augmented DM cups were recently introduced. In this study medium term results of the augmented cementless DM Coptos cups are reported and compared to the established technique of cemented DM cups and Kerboull plate.Material and methodsThis is a retrospective analysis of data collected on patients who received rTHA using DM cups in the period between June 2015 and September 2020. Two groups of patients were identified. The first group received cementless augmented DM-cups (NOVAE® Coptos TH–SERF) (Coptos TH cup group). The second comparable group who had Kerboull ring (KE ring group) and cemented DM cups (NOVAE® STICK). Demographic data, surgical technique, functional and radiological outcome as well as complications during the follow-up visits are reported.ResultsForty-two patients with a mean age at the time of revision 48.8 ± 13.6 years. 29 patients received Coptos TH DM-cup, while 13 patients had Bone Graft (BG), KE ring and cemented DM cups for acetabular reconstruction. Acetabular defects were Paprosky types IIB and IIC in 31 patients and IIIA and B in 11 patients. The follow-up was 52.8 ± 21 months (mean ± STD); and the mean Harris Hip Score (HHS) at last visit was 91 ± 5. Good stability of all cups was reported. Full integration of the impaction graft was observed in 94% of the Coptos and 92% of the KE groups. One of the Coptos cups was readjusted and one case of single dislocation was recorded in the KE group. None of the DM cups in both groups was revised or awaiting revision.ConclusionCoptos TH cups achieve similar results to the cemented DM on KE ring at the medium term but long term outcome remains to be seen.

Vascularized lymph node flaps can survive on venous blood without an arterial inflow: an experimental model describing the dynamics of venous flow using indocyanine green angiography (With video).

Several surgeons have described studies of free-tissue transfers using veins instead of arteries. These innovative microsurgical techniques can offer several advantages, such as an easier dissection during flap harvesting, and represent an alternative during an accidental surgical mistake or development of new surgical procedures. The purpose of this study was to describe and explore different constructs of vascularized lymph node transfer (VLNT) only based on venous blood flow in a mouse model, evaluate their blood flow microcirculation through indocyanine green (ICG) angiography and investigate the lymphatic drainage function and the lymph nodes' structures. Five types of venous lymph node flaps (LNF) were created and investigated: Types IA, IB, IC, IIA and IIB were developed by ICG intraoperatively (with videos in the article). Seven weeks later, by applying methylene blue, the recanalization of the lymphatic vessels between the LNF and the recipient site was detected. Lymph nodes were collected at the same time and their structures were analyzed by hematoxylin and eosin staining analysis. All of the venous LNFs developed except Type IC. Seven weeks later, methylene blue flowed into Types IA, IB, IIA and IIB from recipient sites. When comparing with arteriovenous lymph node, the medullary sinus was diffusely distributed in venous lymph nodes. The proportion of cells was significantly reduced (p < 0.05). The artery diameters were significantly smaller (p < 0.05). The veins diameters and lymphatic vessels output in Types IA, IB, IIA and IIB were more dilated (p < 0.05). This research demonstrated that Type IA, IB, IIA and IIB venous LNFs can retrogradely receive venous blood supply; they can survive, produce a lymphatic recanalization and integrate with the surrounding tissue, despite lymph node structural changes. Our results will improve the understanding of the survival mechanism of venous LNFs and will help researchers to design new studies or lymphatic models and eventually find an alternative procedure for the surgical treatment of lymphedema.

COMPLICATIONS AFTER SURGICAL TREATMENT OF JUPITER'S MONTEGGIA TYPE II FRACTURES.

To evaluate the incidence of complications and risk factors that may influence the postoperative outcomes of Jupiter lesions. This retrospective study was conducted with surgically treated patients. The characteristics related to fractures and surgical approaches were evaluated and these variables were correlated with radiographic and functional postoperative complications. A total of 15 patients were evaluated, mostly men and with a higher prevalence of Types IIA and IID. The most frequent complications were heterotopic ossification and osteolysis around the radial head prosthesis. Postoperative instability occurred only in the lateral collateral ligament. According to MEPS functional score, 53% of the patients evolved with unfavorable outcomes. The studied cases evolved with high rates of postoperative complications, mainly in Jupiter's Type IID fractures and associated coronoid fractures. Level of Evidence III, Therapeutic Study.

Total Operating Room Time and Total Surgical Procedure Time in Treating Pelvic Ring Fractures with Calcium Phosphate: A Guide for Surgery Scheduling

Introduction: The purpose of this study is to look at total surgery time and to calculate surgical procedure time as well as surgery set up time. Methods: Over an eighteen-month period, 6/2018 -12/2019, we retrospectively reviewed the results of 45 cases of pelvic injuries consisting of fragility fractures. Data consisting of Total OR Time (TOT), Total Surgical Time (TST) and Total Set Up Time (TOT – TST = Total Set Up Time) was recorded at surgery. This information comprises the rationale of this report. Results: Classification of the fracture types were 28 Type Ia, 1 Type Ib, 1 Type IIa, 7 Type IIb, and 8 IVb. Total Operating Room time for Type Ia was one hour. Types IIb which include an ipsilateral sacral alae fracture was again found to take 60 minutes. The Total Set Up Time for Type Ia was 30 minutes. The Total Surgery Time for Type Ia was 30 minutes. The combined Total Operating Room Time for Type IIb fractures, which include the ipsilateral sacral fracture, was 1 hour. Total Surgery Time was less than 1 hour. The 8 bilateral sacral fragility fractures Type IVb was 47 minutes. The times as reported demonstrate procedures representative of the minimally invasive treatment of pubic rami fractures. Discussion: The purpose of this report was to look at the surgical time required to complete a new surgical technique to treat Fragility Fractures of the pelvis. Calcium Phosphate treatment for these fractures provides a delivery system that accommodates comminuted fracture patterns, minimally invasive, and supplies a supportive endothermic material adding stability to the fracture site. Conclusion: Calcium Phosphate treatment is minimally invasive and easily performed. All fracture Types are amendable for this treatment. The times as reported demonstrate procedures representative of the minimally invasive treatment of pubic rami fractures.

Management Strategy and Radiologic Outcomes of Symptomatic Spontaneous Isolated Superior Mesenteric Artery Dissection Based on Angiographic Classification: The Follow-Up Experience in a Single Center

Purpose: To investigate the demographics, clinical features, radiologic measurement, treatment, and outcomes of symptomatic spontaneous isolated superior mesenteric artery dissection (SISMAD) according to computed tomography (CT) classification. Methods: This retrospective study included 201 patients diagnosed with symptomatic SISMAD from November 2014 to December 2020. Symptomatic spontaneous isolated superior mesenteric artery dissection was categorized into four types based on CT images by Yun’s angiographic classification. Their clinical characteristics, images features, treatment methods, and radiological outcomes were comparatively analyzed by CT angiographic types. Results: SISMADs were categorized into type I (13.9%) patent false lumen (FL) with both entry and re-entry; type IIa (37.3%), blind pouch of FL; type IIb (43.3%), thrombosed FL; and type III (5.5%), and the occlusion of superior mesenteric artery (SMA). Type IIb, the most common SISMAD, showed the largest true lumen (TL) residual diameter and the lowest percentage of TL stenosis. Type III positioned most proximally to SMA origin and had the maximum dissection length. Symptomatic spontaneous isolated superior mesenteric artery dissections underwent conservative (75.1%), endovascular (22.4%), and surgical (2.5%) treatment. Conservative treatment was more frequent in type I (85.7%) and type IIb (83.9%) than in type IIa (65.3%) and type III (45.5%). Endovascular intervention was more commonly utilized in type IIa (32.0%) and type III (36.4%) than in type I (14.3%) and type IIb (14.9%). Conservative patients achieved FL vanishment/shrinkage (57.8%), stabilization (26.6%), and enlargement (15.6%). After conservative treatment, type I showed angiographic FL stabilization; type IIa achieved FL shrinkage (48.1%), stabilization (22.2%), and enlargement (29.6%); type IIb exhibited FL vanishment/shrinkage (92.0%) and enlargement (8.0%). Cumulative rate of stent patency was 92.3% during 6-year follow-up. Conclusions: Conservative management with close follow-up is initially provided especially for types I and IIb. Morphological stabilization is more frequent in type I of patent FL with entry and re-entry. False lumen vanishment or shrinkage was more likely to occur in type IIb due to the thrombus absorption. Endovascular intervention has excellent long-term in-stent patency and is predominantly utilized in types IIa and III. Blood flow sustained into a blind-ending FL causes the TL compression and stenosis in type IIa. Type III with the occlusion of SMA has the high risk of bowel ischemia. Clinical Impact According to Yun’s angiographic classification of spontaneous isolated superior mesenteric artery dissection (SISMAD), type I (13.9%) has patent true and false lumen and the morphological pattern is maintained stable; type IIa (37.3%) possesses a patent blind-ending false lumen which might shrink, remain unchanged, or enlarge; and endovascular intervention is suggested when conservative treatment failed; type IIb (43.3%) recovers spontaneously due to the absorption of false lumen thrombus and conservative treatment is preferentially considered; type III (5.5%) with the occlusion of main trunk carries a high risk of bowel necrosis, early endovascular intervention is proposed, and open surgery might be necessary.

Expression of cation chloride cotransporter (NKCC1/KCC2) in brain tissue of children with focal cortical dysplasia type Ⅱ

Objective: To investigate the expression of cation chloride cotransporter (NKCC1/KCC2) in the neurons from cerebral lesions of children with focal cortical dysplasia (FCD) type Ⅱ, to provide a morphological basis for revealing the possible mechanism of epilepsy. Methods: Eight cases of FCD type Ⅱ diagnosed at Beijing Haidian Hospital, Beijing, China and 12 cases diagnosed at Xuanwu Hospital, Capital Medical University, Beijing, China from February 2017 to December 2019 were included. The expression of NKCC1 and KCC2 in FCD type Ⅱa and FCD type Ⅱb was detected using immunohistochemistry and double immunohistochemical stains. The average optical density of NKCC1 in dysmorphic neurons and normal neurons was also determined using immunohistochemical staining in FCD type Ⅱa (10 cases). Results: The patients were all younger than 14 years of age. Ten cases were classified as FCD type IIa, and 10 cases as FCD type Ⅱb. NKCC1 was expressed in the cytoplasm of normal cerebral cortex neurons and KCC2 expressed on cell membranes. In dysmorphic neurons of FCD type Ⅱa, expression of NKCC1 increased, which was statistically higher than that of normal neurons (P<0.01). Aberrant expression of KCC2 in dysmorphic neurons was also noted in the cytoplasm. In the FCD Ⅱb type, the expression pattern of NKCC1/KCC2 in dysmorphic neurons was the same as that of FCD type Ⅱa. The aberrant expression of NKCC1 in balloon cells was negative or weakly positive on the cell membrane, while the aberrant expression of KCC2 was absent. Conclusions: The expression pattern of NKCC1/KCC2 in dysmorphic neurons and balloon cells is completely different from that of normal neurons. The NKCC1/KCC2 protein-expression changes may affect the transmembrane chloride flow of neurons, modify the effect of inhibitory neurotransmitters γ-aminobutyric acid and increase neuronal excitability. These effects may be related to the occurrence of clinical epileptic symptoms.

Research of Lipid Metabolism Disorders in Female Combatants

The objective: to find out the peculiarities of stress-induced changes in lipid metabolism indicators in women who have experienced concussion during combat operations. Study the state and morphostructure of adipose tissue. To analyze the relationship between lipid metabolism disorders and changes in reproductive health of female combatants. Materials and methods. The research was conducted at the Department of Obstetrics, Gynecology and Reproductology of the Ukrainian State Institute of Reproductology of the Shupyk National Healthcare University. 118 women participated in the study. Group I consisted of examination data of women who suffered concussion during combat operations with PTSD, group II – control, it consisted of healthy women. Average age of women who participated in hostilities and suffered contusion 27.08±4.23 years. Results. The influence of stress factors associated with military service in women servicemen on the development of lipid metabolism disorders is obvious. In the main group (118 women), blood cholesterol levels were significantly higher than in the control group. In parallel, a very low level of anti-atherogenic lipoprotein fractions was detected. Lipid metabolism in women who experienced concussion during combat with PTS was characterized by a high frequency of hyperlipidemia of types IIa and IIb, higher serum concentrations of atherogenic lipids fractions (CL, CL-LDL) and low anti-atherogenic fractions (CL-HDL), which were observed in all age subgroups and progressed with age. Conclusions. As a result of lipid metabolic disorders, the prerequisites for the development of hyperproliferative diseases of the female reproductive system, early and severe atherosclerosis are created.

Urethral duplication associated with complex chordee: a narrative review of literature and report of a case

BackgroundUrethral duplication (UD) is reportedly rare. It is rarer in females. Knowledge on this anomaly comes from isolated report of cases. The aim of this review is to summarize information available on this anomaly thereby revealing gaps in knowledge, and to appropriately situate a recently managed case.MethodsPublications on UD in English language from 2001 to 2021 were searched for in the literature. Of importance were age at presentation, class of UD, nature of associated penile deformity and other structural anomalies. Available information was used to synthesize opinions after descriptive analyses using SPSS® version 21 (IBM Co., Armonk, NY, USA). In addition, a recently managed case of UD was reported and appropriately situated in the discourse.ResultIn all, 115 articles met the inclusion criteria. Majority (75.7%) were individual case reports, while the rest were retrospective review of case series. These provided a total of 269 reported cases. Of this lot, 38 cases were excluded because they either had no Effmann’s class or were not described well enough for an Effmann’s class to be assigned. Ultimately, 231 cases formed the basis for this review. Male to female ratio was 12:1. Types III and IIB had more females. Types IIA 2 (26.0%), IIA 2 “Y” (26.4%) and IA (22.5%) were frequently reported. About 61.8% males and 68.4% females had no associated defects. Isolated dorsal chordee was prevalent (7.1%), especially among type IA (16.7%) UD. Reported in 10.4%, vesicoureteric reflux may not be attributable always to high pressure voiding.A boy who presented at the age of 18 years with Effmann type IA UD and an associated complex chordee of the penile shaft was reported. The complex nature of the chordee adds to the challenge of explaining associated penile defects in UD.ConclusionUD is rare, but reported from all parts of the globe. There are a number of associated defects involving the external genitalia and other organs reported in UD in the male. The mechanisms of these defects are yet to be fully understood.

Identifying the relationship between lumbar sacralization and adjacent ligamentous anatomy in patients with Bertolotti syndrome and healthy controls.

Bertolotti syndrome is a diagnosis given to patients experiencing low-back pain due to a lumbosacral transitional vertebra (LSTV). LSTVs cause altered biomechanics at the lumbosacral junction, predisposing these patients to degenerative disease. It has been proposed that these patients have additional non-osseous variation such as ligamentous differences in the lumbar spine. The iliolumbar ligament, which attaches from the iliac crest to the transverse process of L4 and L5, plays a significant role in reducing lumbar motion in all six degrees of freedom; therefore, altered ligament anatomy can have a significant impact on stability. The purpose of this study was to examine the iliolumbar ligament complex in patients with Bertolotti syndrome and anatomically normal controls to determine if underdevelopment of the iliolumbar ligament complex is seen in Bertolotti syndrome. This is a retrospective analysis of patients with Bertolotti syndrome and anatomically normal controls who received care at the authors' institution between 2010 and 2020. Axial thickness of the iliolumbar ligament at the L5 vertebral level was assessed via MRI. Results were compared between the defective and normal side within unilaterally affected (Castellvi types IIa and IIIa) Bertolotti syndrome patients, between defective sides in bilaterally affected Bertolotti syndrome patients (Castellvi types IIb, IIIb, and IV), and between the affected side in Bertolotti syndrome patients and the corresponding location in normal controls. A total of 173 patients were included in the study, 102 with Bertolotti syndrome and 71 controls. Among the Bertolotti patients, 49 had left LSTVs, 29 had right LSTVs, and 24 had bilateral LSTVs. For patients with unilateral defects, defective side ligaments were thinner than ligaments on the normal side (p < 0.05). For bilateral LSTVs, ligament thickness on each side was considered statistically equivalent (p < 0.05) and not significantly different from that in controls. Bertolotti syndrome correlates to significant underdevelopment of the iliolumbar ligament corresponding to the side of the LSTV as compared to the ligament on the contralateral side. In patients with bilateral LSTVs, no difference in the iliolumbar ligament compared to that in controls was seen. Developmental changes in the iliolumbar ligament may further exacerbate the altered lumbosacral biomechanics seen in patients with unilateral LSTV, whereas bilateral LSTVs may still allow normal development of the ligament complex. Further research should be done to examine the discrepancies seen in this study.

A comparative analysis of titanium anatomic plate and titanium reconstructive plate for treatment of extra-articular fractures of the scapula (Miller types IIb, IIc, and IV).

Because of the irregular shape of the scapula and the different types of fractures, a standard internal fixation device is lacking in clinical practice, even though there are many options available. This study aimed to compare the therapeutic efficacy of titanium anatomic and reconstructive plates for extra-articular fractures of the scapula (Miller types IIb, IIc, and IV). A retrospective study of 41 patients who underwent treatment for extra-articular fractures of the scapula between March 2017 and March 2020 was conducted. Patients were divided into 2 groups based on the fixation device: titanium anatomic plate group (20 patients) and titanium reconstructive plate group (21 patients). After follow-up for 12-18 months, the general characteristics, perioperative characteristics, postoperative follow-up findings, and imaging data of the 2 groups were compared. The surgical procedures were uneventful in both groups. The anatomic plate group significantly outperformed the reconstructive plate group with respect to surgical duration and intraoperative blood loss (P<.001). At 3-month postoperative follow-up, the Constant-Murley score (P=.026), shoulder flexion range of motion, and shoulder abduction range of motion in the anatomic plate group were all significantly better than those in the reconstructive plate group (P<.001). The postoperative Western Ontario Shoulder Instability scores of the 2 groups were similar. Imaging showed functional recovery and stable and reliable fixation in both groups. Time to bone union was similar in both groups (9.10±1.25 weeks in anatomic plate group and 9.24±1.41 weeks in reconstructive plate group, P=.742). No complications occurred in any patient, such as fixation failure, instability, or bone nonunion. Surgeons should favorably consider titanium anatomic plates for the treatment of extra-articular scapular fractures owing to their clear efficacy associated with a shorter surgical time, less intraoperative blood loss, better fixation, and rapid short-term functional recovery.

Clinical and Radiological Outcomes of Closed-Loop, Double Button, Coracoclavicular Fixation for Extralateral (Neer Type IIC) Fractures of the Distal Clavicle.

Background: The distal end of the clavicle accounts for 10-28% of all clavicle fractures of which 52.8% are considered displaced and require internal fixation due to their high percentage of non-union. Numerous surgical techniques have been described for the well-known Neer types IIA, IIB, and V. Still, the literature is scarce for the rare “extralateral” (type IIC) fracture where the fracture line is located lateral to the completely torn coracoclavicular (CC) ligaments; such small fractures are sometimes not amenable for standard locking plate fixation.Methods: We present a series of seven patients treated surgically with closed-looped double button CC stabilization via an open approach. There were four males and three females with a mean age of 31 years (range: 19-46 years). The mechanism of injury was a motor vehicle accident in four cases and a fall from height in three cases. The average time from injury to surgery was 2.7 ± 1.3 days and the average follow-up period was 25.7 months (range: 16-48 months). A custom-made, closed-looped, double button device was made using the ProCinch Adjustable Cortical Fixation for anterior cruciate ligament (ACL) (Stryker, Kalamazoo, Michigan) and another standard or slotted button. The fracture was reduced anatomically and the device was tightened and secured with five to six knots. In two cases, additional interfragmentary sutures were used for extra stability. Postoperatively, the arm was immobilized in a simple sling for four weeks; passive assisted elevation up to 90 degrees was allowed from the second postoperative week, followed by active elevation after the sixth postoperative week. Radiological outcomes (bony union, loss of reduction, implant mispositioning, or subsidence of buttons) were assessed using serial plain radiographs. The Constant score (CS) and the Acromioclavicular Joint Instability Score (AJIS) were used for the final clinical evaluation, at least one year postoperatively.Results: Bony union was achieved in all patients at a mean time of 2.7 months (range: 2.5-3.6 months). No cases of delayed union, loss of reduction, button migration, or subsidence were noted. The mean CS was 96.6 ± 3.4 and the mean AJIS score was 94.1 ± 4.7 in a mean follow-up period of 25.7 months (range: 16-48 months). One patient developed a hypertrophic scar and another had mild skin irritation by the suture knots; no other complications were noted except for one patient who developed an early superficial skin infection managed with antibiotics and debridement under local anesthesia. Four patients who participated in sports before injury were able to regain almost full activity seven to nine months after the operation. All were satisfied with the final result. Two patients showed ossification of the CC ligaments with no significant clinical implications.Conclusions: Although we retrospectively reviewed a small series of patients, we were able to demonstrate a complete rate of fracture union and excellent clinical outcomes with no major complications. Type IIC distal clavicle fractures are rare and require special attention in terms of reduction and optimal fixation. Open CC fixation with closed-looped double buttons is a relatively easy and reproducible technique. We advocate the readjustment of Neer’s classification, including “extralateral” fractures as a IIC subtype.

Treatment of Wehbe-Schneider typesⅠB and ⅡB bony mallet fingers with one-stage closed reduction and elastic compression fixation with double Kirschner wires

To investigate the effectiveness of one-stage closed reduction and elastic compression fixation with double Kirschner wires for Wehbe-Schneider types ⅠB and ⅡB bony mallet fingers. Between May 2017 and June 2020, 21 patients with Wehbe-Schneider type ⅠB and ⅡB bony mallet fingers were treated with one-stage closed reduction and elastic compression fixation using double Kirschner wires. There were 15 males and 6 females with an average age of 39.2 years (range, 19-62 years). The causes of injury were sports injury in 9 cases, puncture injury in 7 cases, and sprain in 5 cases. The time from injury to admission was 5-72 hours (mean, 21.0 hours). There were 2 cases of index finger injury, 8 cases of middle finger injury, 9 cases of ring finger injury, and 2 cases of little finger injury. The angle of active dorsiflexion loss of distal interphalangeal joint (DIPJ) was (40.04±4.02)°. According to the Wehbe-Schneider classification standard, there were 10 cases of typeⅠB and 11 cases of type ⅡB. The Kirschner wire was removed at 6 weeks after operation when X-ray film reexamination showed bony union of the avulsion fracture, and the functional exercise of the affected finger was started. The operation time was 35-55 minutes (mean, 43.9 minutes). The length of hospital stay was 2-5 days (mean, 3.4 days). No postoperative complications occurred. All patients were followed up 6-12 months (mean, 8.8 months). X-ray films reexamination showed that all avulsion fractures achieved bony union after 4-6 weeks (mean, 5.3 weeks). Kirschner wire was removed at 6 weeks after operation. After Kirschner removal, the visual analogue scale (VAS) score of pain during active flexion of the DIPJ was 1-3 (mean, 1.6); the VAS score of pain was 2-5 (mean, 3.1) when the DIPJ was passively flexed to the maximum range of motion. The angle of active dorsiflexion loss of affected finger was (2.14±2.54)°, showing significant difference when compared with preoperative angle (t=52.186, P<0.001). There was no significant difference in the active flexion angle between the affected finger (79.52±6.31)° and the corresponding healthy finger (81.90±5.36)° (t=1.319, P=0.195). At 6 months after operation, according to Crawford functional evaluation criteria, the effectiveness was rated as excellent in 11 cases, good in 9, and fair in 1, with an excellent and good rate of 95.24%. For Wehbe-Schneider typesⅠB and ⅡB bony mallet fingers, one-stage closed reduction and elastic compression fixation with double Kirschner wires can effectively correct the deformity and has the advantages of simple surgery, no incision, and no influence on the appearance of the affected finger.

Functional outcomes of plate fixation in comminuted fractures of olecranon: A case series

Objectives: To report and evaluate the functional outcome of plate fixation in comminuted olecranon fractures (Mayo types IIB and IIIB).Method: 16 patients with comminuted fractures of the olecranon presented to our unit, were operated on with a locking Olecranon plate. Main outcome measurements included radiographic healing, postoperative range of motion, complications, outcome score and patient satisfaction measured at 1 year follow up. Results: Our study included six females and ten males with a mean age of 48(18–67). Nine were Mayo type IIB and seven were Mayo type IIIB. Fourteen patients had no complications post-operatively with good outcomes with a mean oxford score of 44, full rotational ROM and mean flexion arc of 20-130 deg. Two patients had a range of motion between 40-90 deg with full rotational ROM and a mean oxford score of 28. No patients required hardware removal. No non-unions were noted in our series. Conclusion: Plate fixation of complex olecranon fracture is an effective, reliable treatment method with a low risk of non-union. Restoration of a functional flexion arc of movement can be expected with the use of correct technique and early post-op mobilization.

Driving an Oxidative Phenotype Protects Myh4 Null Mice From Myofiber Loss During Postnatal Growth.

Postnatal muscle growth is accompanied by increases in fast fiber type compositions and hypertrophy, raising the possibility that a slow to fast transition may be partially requisite for increases in muscle mass. To test this hypothesis, we ablated the Myh4 gene, and thus myosin heavy chain IIB protein and corresponding fibers in mice, and examined its consequences on postnatal muscle growth. Wild-type and Myh4–/– mice had the same number of muscle fibers at 2 weeks postnatal. However, the gastrocnemius muscle lost up to 50% of its fibers between 2 and 4 weeks of age, though stabilizing thereafter. To compensate for the lack of functional IIB fibers, type I, IIA, and IIX(D) fibers increased in prevalence and size. To address whether slowing the slow-to-fast fiber transition process would rescue fiber loss in Myh4–/– mice, we stimulated the oxidative program in muscle of Myh4–/– mice either by overexpression of PGC-1α, a well-established model for fast-to-slow fiber transition, or by feeding mice AICAR, a potent AMP kinase agonist. Forcing an oxidative metabolism in muscle only partially protected the gastrocnemius muscle from loss of fibers in Myh4–/– mice. To explore whether traditional means of stimulating muscle hypertrophy could overcome the muscling deficits in postnatal Myh4–/– mice, myostatin null mice were bred with Myh4–/– mice, or Myh4–/– mice were fed the growth promotant clenbuterol. Interestingly, both genetic and pharmacological stimulations had little impact on mice lacking a functional Myh4 gene suggesting that the existing muscle fibers have maximized its capacity to enlarge to compensate for the lack of its neighboring IIB fibers. Curiously, however, cell signaling events responsible for IIB fiber formation remained intact in the tissue. These findings further show disrupting the slow-to-fast transition of muscle fibers compromises muscle growth postnatally and suggest that type IIB myosin heavy chain expression and its corresponding fiber type may be necessary for fiber maintenance, transition and hypertrophy in mice. The fact that forcing muscle metabolism toward a more oxidative phenotype can partially compensates for the lack of an intact Myh4 gene provides new avenues for attenuating the loss of fast-twitch fibers in aged or diseased muscles.

Carnegie Supernova Project-II: Near-infrared Spectroscopy of Stripped-envelope Core-collapse Supernovae*

Abstract We present 75 near-infrared (NIR; 0.8−2.5 μm) spectra of 34 stripped-envelope core-collapse supernovae (SESNe) obtained by the Carnegie Supernova Project-II (CSP-II), encompassing optical spectroscopic Types IIb, Ib, Ic, and Ic-BL. The spectra range in phase from pre-maximum to 80 days past maximum. This unique data set constitutes the largest NIR spectroscopic sample of SESNe to date. NIR spectroscopy provides observables with additional information that is not available in the optical. Specifically, the NIR contains the strong lines of He i and allows a more detailed look at whether Type Ic supernovae are completely stripped of their outer He layer. The NIR spectra of SESNe have broad similarities, but closer examination through statistical means reveals a strong dichotomy between NIR “He-rich” and “He-poor” SNe. These NIR subgroups correspond almost perfectly to the optical IIb/Ib and Ic/Ic-BL types, respectively. The largest difference between the two groups is observed in the 2 μm region, near the He i λ2.0581 μm line. The division between the two groups is not an arbitrary one along a continuous sequence. Early spectra of He-rich SESNe show much stronger He i λ2.0581 μm absorption compared to the He-poor group, but with a wide range of profile shapes. The same line also provides evidence for trace amounts of He in half of our SNe in the He-poor group.

Применение расширенной эндоскопической фронтотомии у пациентки c рецидивирующим мукоцеле лобной пазухи

A clinical case in patient with a recurrent frontal sinus mucocele is described. An extended endoscopic frontotomy of the Draf IIb type was performed; a mucoperiosteal flap was used to prevent postoperative stenosis of the neo-ostium. However, within a year after the intervention, ostium stenosis developed with recurrence of the mucocele due to severe hyperostosis, which required repeated surgical treatment. The method of choice was an extended frontotomy of the Draf III type using a combination of pedicled flap and free mucosal graft to reduce the risk of restenosis of the frontal sinus ostium.

Revisiting the explodability of single massive star progenitors of stripped-envelope supernovae

Stripped-envelope supernovae (Types IIb, Ib, and Ic) that show little or no hydrogen comprise roughly one-third of the observed explosions of massive stars. Their origin and the evolution of their progenitors are not yet fully understood. Very massive single stars stripped by their own winds (≳25−30 M⊙ at solar metallicity) are considered viable progenitors of these events. However, recent 1D core-collapse simulations show that some massive stars may collapse directly into black holes after a failed explosion, with a weak or no visible transient. In this Letter, we estimate the effect of direct collapse into a black hole on the rates of stripped-envelope supernovae that arise from single stars. For this, we compute single-star MESA models at solar metallicity and map their final state to their core-collapse outcome following prescriptions commonly used in population synthesis. According to our models, no single stars that have lost their entire hydrogen-rich envelope are able to explode, and only a fraction of progenitors left with a thin hydrogen envelope do (IIb progenitor candidates), unless we use a prescription that takes the effect of turbulence into account or invoke increased wind mass-loss rates. This result increases the existing tension between the single-star paradigm to explain most stripped-envelope supernovae and their observed rates and properties. At face value, our results point toward an even higher contribution of binary progenitors to stripped-envelope supernovae. Alternatively, they may suggest inconsistencies in the common practice of mapping different stellar models to core-collapse outcomes and/or higher overall mass loss in massive stars.

ACTN3 genotype influences masseter muscle characteristics and self-reported bruxism.

Main aim of the study was to explore the association between genetic polymorphisms in ACTN3 and bruxism. Secondary objectives included masseter muscle phenotypes assessment between bruxers and non-bruxers and according to genetic polymorphisms in ACTN3. Fifty-four patients undergoing orthognathic surgery for correction of their malocclusion were enrolled. Self-reported bruxism and temporomandibular disorders status were preoperatively recorded. Saliva samples were used for ACTN3 genotyping. Masseter muscle samples were collected bilaterally at the time of orthognathic surgery to explore the muscle fiber characteristics. There were significant differences in genotypes for rs1815739 (R577X nonsense) (p=0.001), rs1671064 (Q523R missense) (p=0.005), and rs678397 (intronic variant) (p=0.001) between bruxers and non-bruxers. Patients with self-reported bruxism presented a larger mean fiber area for types IIA (p=0.035). The mean fiber areas in individuals with the wild-type CC genotype for rs1815739 (R577X) were significantly larger for type IIA fibers (1394.33μm2 [572.77μm2 ]) than in those with the TC and TT genotypes (832.61μm2 [602.43μm2 ] and 526.58μm2 [432.21μm2 ] [p=0.014]). Similar results for Q523R missense and intronic variants. ACTN3 genotypes influence self-reported bruxism in patients with dentofacial deformity through specific masseter muscle fiber characteristics.

The role of obesity in structural and functional characteristics of left cardiac chambers

Abstract Purpose of study To evaluate the role of obesity in structural and functional characteristics of left cardiac chambers according to the echocardiographic study. Materials and methods The retrospective analysis of 1760 echocardiographic studies in patients 30–65 years old with hyperlipoproteinemia IIa and IIb types was evaluated. The body mass index (BMI) of the patients varied from normal to morbid obesity. Results The achieved results showed positive correlation between structural and functional heart characteristics and BMI. Anteroposterior size and BMI reliable correlated (KK=0,70, p&amp;lt;0,05). In obese patients the thickness of left ventricular wall increased in 20% (1,25±0,15sm), compared to 1,0±0,19sm in patients with normal weight. The thickness of interventricular wall raised from 1,02±0,15sm to 1,23±0,14sm. End-diastolic volume in obese patients was higher than in normal weight patients (70±16 and 123±32,3sm3). End-systolic volume of left ventricle grows to 45% (from 30±8,5 to 54,3±20,5sm3). Impact volume in patients with obesity increased from 52±9,8 ml to 68,4±15,0ml. In patients with BMI 25–39.9kg/m2 the left ventricle mass myocardium index raised in 10%, and in patients with BMI over 40kg/m2 – more than 20%. Concentric remodeling of left ventricle was found in 28,18% women and 43,39% men with normal BMI, in 30,76% women and 34,12% men with obesity, and in 15,9% women and 15,26% men with morbid obesity. Concentric hypertrophy of left ventricle wall was diagnosed in 10% women and 10,74% men with normal BMI, in 33,38% women and 32,4% men with obesity and in 59,36% women and 54,82% men with morbid obesity. Eccentric hypertrophy of left ventricle wall was diagnosed in 4,61% women and 2,89% men with normal BMI, in 9,42% women and 16,74% men with obesity and in 14,87% women and 25,9% men with morbid obesity. The proportion of women with normal LV geometry decreased more than 6 times as obesity progressed, proportion of men decreased by 9 times. Conclusions Thus, the typical presentation of structural and functional changes in the left heart chambers of obesity is the combination of concentric hypertrophy and/or remodeling of LV myocardium, diastolic LV dysfunction and dilatation of the left atrium. All these changes are the basis for the formation of dilated cardiopathy in obesity. Funding Acknowledgement Type of funding sources: None.