Ventral Aspect Research Articles

The long-term outcome of extra cardiac lateral tunnel total cavopulmonary connection

Abstract Background Although early results of total cavopulmonary connection (TCPC) using an extracardiac conduit are favorable, the patients' growth leads to linearization of the Fontan route causing energy loss by collision of blood flow from the SVC and the IVC, and PV compression. Use of oversized conduit in young children also causes energy loss due to caliber change, and a risk of thrombosis by flow stagnation. We have performed TCPC with the Extra Cardiac Lateral Tunnel (ECLT) technique using e-PTFE patch to make an angled route design for laminar IVC and SVC blood flow confluence, and to avoid caliber change of the IVC-Fontan route. Purpose To clarify the long-term outcome of the Extra Cardiac Lateral Tunnel TCPC (ECLT-TCPC) using e-PTFE patch. Methods Medical records of the patients who underwent staged ECLT-TCPC from April 2003 to March 2020 were reviewed retrospectively. The surgical technique consists of creation of IVC and PA opening connected by atrial appendage and free wall as a floor and suturing a cut-open e-PTFE graft over the anterior external wall of the right atrium to make a Fontan route 14–16 mm in diameter entering the PA from the ventral aspect to merge the SVC flow with an angle. Sixty five patients were included in the study: 46 cases of functional single ventricle, 10 HLHS, 9 tricuspid atresia. Age at surgery were 33.0±22.2 month and the weight was 11.1±3.7 kg. Preoperative catheterization data were following; PA pressure: 10.3±4.0 mmHg, PVR: 1.9±0.65 woods. Results We had one in-hospital death (1.8%) and three long-term deaths (6.2%) during a follow-up period of 7.3±4.3 years. Long-term complications included 6 cases of arrhythmias requiring medical or surgical treatment. Other complication included 2 cases of thrombotic complications, and 1 case of hemorrhagic complication. Two patients underwent re-operation for TCPC: 1 cyanosis due to residual shunt and 1 cases for occlusion of the Fontan route. The anticoagulant therapy was usually terminated eight months after surgery. At the latest follow-up, 55 (84.6%) patients were anticoagulantion-free. At the one-year follow-up, the diameters of the Fontan route were 11.0±2.4mm at the PA anastomosis level, 10.8±2.5mm at the middle level, 10.0±2.5mm at the IVC anastomosis level. At the latest follow-up, the diameters of the Fontan route at the three levels were 14.9±3.4mm, 13.0±3.2mm, and 13.6±4.9mm, respectively. Using the normal IVC diameter as a reference, the Fontan route diameter at the three levels were 127±35%, 123±28%, and 143±44% of Normal, respectively, remaining above 100%Normal. The pressure gradient between IVC and PA was 1.5±1.0mmHg at the latest follow-up, and no significant changes in the route design were noted. Conclusion The long-term results of ECLT TCPC using e-PTFE patch seemed acceptable. This technique may provide advantages of a long-term maintenance of the Fontan route diameter and design, and an option of a long-term freedom form anticoagulation. Funding Acknowledgement Type of funding sources: None.

Integration of mouse ovary morphogenesis with developmental dynamics of the oviduct, ovarian ligaments, and rete ovarii.

Morphogenetic events during the development of the fetal ovary are crucial to the establishment of female fertility. However, the effects of structural rearrangements of the ovary and surrounding reproductive tissues on ovary morphogenesis remain largely uncharacterized. Using tissue clearing and lightsheet microscopy, we found that ovary folding correlated with regionalization into cortex and medulla. Relocation of the oviduct to the ventral aspect of the ovary led to ovary encapsulation, and mutual attachment of the ovary and oviduct to the cranial suspensory ligament likely triggered ovary folding. During this process, the rete ovarii (RO) elaborated into a convoluted tubular structure extending from the ovary into the ovarian capsule. Using genetic mouse models in which the oviduct and RO are perturbed, we found the oviduct is required for ovary encapsulation. This study reveals novel relationships among the ovary and surrounding tissues and paves the way for functional investigation of the relationship between architecture and differentiation of the mammalian ovary.

Ventral organization of Jianfengia multisegmentalis Hou, and its implications for the head segmentation of megacheirans

AbstractMegacheirans, or great‐appendage euarthropods, have featured prominently in discussions regarding the early evolution of the head region in total‐group Euarthropoda. However, several aspects of the ventral morphology of most representatives remain incompletely known given the loss of data associated with fossil compression, coupled with the rarity of some of these taxa. Here, we describe the ventral aspect of head organization of the jianfengiid megacheiran Jianfengia multisegmentalis using micro computed‐tomography, and explore its evolutionary significance. The head consists of a pair of stalked eyes, a pair of great appendages, and four pairs of biramous appendages, all covered by a dorsal head shield. The rostral portion of the head bears a median projection, which we interpret as an anterior sclerite akin to that observed in several other Cambrian euarthropods. The anterior sclerite in J. multisegmentalis articulates with robust stalks with rounded projections in a more adaxial position, and bears the compound eyes. Critically, the ventral side of the head of J. multisegmentalis features a prominent lobe‐shaped hypostome/labrum complex located immediately behind the great appendages, and between the first pair of biramous appendages. This situation is consistent with that observed in Leanchoilia illecebrosa and suggests a conserved, and possibly ancestral, pattern of a six‐segmented head (eyes, great appendages and four biramous limb appendages) with a hypostome/labrum complex for Megacheira. The existence of the hypostome/labrum complex in J. multisegmentalis falsifies the hypothesis that the anterior projections on the head of jianfengiids might be homologues of the euarthropod labrum.

P6. Normal anatomy of the lumbar sublaminar ridge in the lateral recess with potential implications to surgical technique in degenerative spinal stenosis: a cadaveric study

<h3>BACKGROUND CONTEXT</h3> The lateral extent of the lumbar sublaminar ridge – the bony, superior insertion site of the ligamenta flava – and its topological relationship to the nerve root are not yet described in the literature. In the setting of degenerative lumbar stenosis this structure can hypertrophy and impinge the nerve root within the lateral recess even after excision of the corresponding ligamentum flavum. Failure to address this may contribute to failed lateral recess decompression. <h3>PURPOSE</h3> To provide anatomic descriptions of the normal lumbar sublaminar ridge in the lateral recess and it's potential to impact on the exiting nerve root there, with implications to surgical technique in lumbar spinal stenosis. <h3>STUDY DESIGN/SETTING</h3> This was a dissection study of preserved cadaver donor specimes from the McMaster University Department of Anatomy. <h3>PATIENT SAMPLE</h3> Fifteen donor cadavers from the McMaster University Department of Anatomy. <h3>OUTCOME MEASURES</h3> Observed anatomy of the lumbar sublaminar ridge in the lateral recess and its relations to the exiting nerve root there. <h3>METHODS</h3> Fifteen lumbar vertebrae, not obviously degenerated, were resected en bloc from three fixed adult human cadavers and then transected through the ventral base of the pedicles immediately dorsal to the floor of the central spinal canal and the PLL, leaving the posterior column and neural elements intact and articulated. The shape of the sublaminar ridge in each of these 30 lateral recesses and its relationship to the exiting nerve root were carefully examined from the ventral aspect of these specimens (ie, from the deep surface of the [laminas and] lateral recesses). <h3>RESULTS</h3> The exiting nerve root consistently crosses the sublaminar ridge immediately inferior to the mid-pedicle, lateral to the subarticular gutter and on the medial aspect of the true intervertebral foramen. A hypertrophic ridge can compress the exiting root by elevating the nerve root superiorly against the bony underside of the pedicle or displacing it anteriorly against the disc or vertebral body. <h3>CONCLUSIONS</h3> The sublaminar ridge in the lateral recess commony crosses or underscores the exiting nerve root and so if hypertrophied might potentially contribute to degenerative lumbar stenosis. Comprehensive appreciation of this anatomy and the need at surgery in the lateral recess to confirm that the exit nerve root is not compressed or elevated by the sublaminar ridge may facilitate thorough lateral recess decompression. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Slow-growing thumb nodule in an African American female

A 61-year-old African American female presented with a 1-year history of an asymptomatic bump on her right thumb that had been gradually increasing in size. Examination revealed a firm, well-circumscribed, smooth, pale white nodule with peripheral erythema on the ventral aspect of the right thumb just proximal to the interphalangeal joint (Fig 1). Radiograph of the hand did not demonstrate osseous extension. Histopathologic examination showed diffuse reticular dermal involvement by densely packed haphazardly arranged CD34+ short spindle cells, with few interspersed banal-appearing vessels and slight thinning of overlying epidermis.

Visualising and quantifying microvascular structure and function in patients with heart failure using optical coherence tomography.

Heart failure (HF) is characterised by abnormal conduit and resistance artery function in humans. Microvascular function in HF is less well characterised, due in part to the lack of tools to image these vessels in vivo. The skin microvasculature is a surrogate for systemic microvascular function and health and plays a key role in thermoregulation, which is dysfunctional in HF. We deployed a novel optical coherence tomography (OCT) technique to visualise and quantify microvascular structure and function in 10 subjects with HF and 10 age‐ and sex‐matched controls. OCT images were obtained from the ventral aspect of the forearm, at baseline (33°C) and after 30 min of localised skin heating. At rest, OCT‐derived microvascular density (20.3 ± 8.7%, P = 0.004), diameter (35.1 ± 6.0 μm, P = 0.006) and blood flow (82.9 ± 41.1 pl/s, P = 0.021) were significantly lower in HF than CON (27.2 ± 8.0%, 40.4 ± 5.8 μm, 110.8 ± 41.9 pl/s), whilst blood speed was not significantly lower (74.3 ± 11.0 μm/s vs. 81.3 ± 9.9 μm/s, P = 0.069). After local heating, the OCT‐based density, diameter, blood speed and blood flow of HF patients were similar (all P > 0.05) to CON. Although abnormalities exist at rest which may reflect microvascular disease status, patients with HF retain the capacity to dilate cutaneous microvessels in response to localised heat stress. This is a novel in vivo human observation of microvascular dysfunction in HF, illustrating the feasibility of OCT to directly visualise and quantify microvascular responses to physiological stimuli in vivo. Key points Microvessels in the skin are critical to human thermoregulation, which is compromised in participants with heart failure (HF).We have developed a powerful new non‐invasive optical coherence tomography (OCT)‐based approach for the study of microvascular structure and function in vivo.Our approach enabled us to observe and quantify abnormal resting microvascular function in participants with HF.Patients with HF were able to dilate skin microvessels in response to local heat stress, arguing against an underlying structural abnormality. This suggests that microvascular functional regulation is the primary abnormality in HF.OCT can be used to directly visualise and quantify microvascular responses to physiological stimuli in vivo.

Estimation of Bluefin Tuna (Thunnus thynnus) mean length in sea cages by acoustical means

This paper proposes an indirect method to estimate Bluefin Tuna (Thunnus thynnus) biomass in cages using acoustic techniques. Two Simrad EK60 echosounders working at 120 and 200 kHz and a stereo camera were used to obtain target strength (TS) to fork length (FL) relationships for both operating frequencies. The equipment was placed at the bottom of a floating cage, facing towards the surface to record the ventral aspect of fish. The acoustic and optical recordings were automatically analysed and the combination of acoustic and optical results provided unequivocal TS-FL assignments. Good relationships between TS and FL were obtained for both frequencies even without discriminating data from different fish tilts and without using beam directivity compensation. Stronger correlations were obtained for compensated TS at 200 kHz when reduced tuna swimming tilt was considered. TS measurements were compared to MFS numerical predictions for a Bluefin swimbladder model, with the simulation results showing good agreement with experimental measurements. The results allow the mean tuna length to be predicted in growing or fattening cages from acoustic data raising the possibility of improving production management and of providing a useful tool for catch control estimations made by international organisations (like ICCAT) and government bodies.

Feasibility of Implanting a Foot-Ankle Endoprosthesis within Skin in a Rabbit Model of Transtibial Amputation.

Prosthetic limbs that are completely implanted within skin (i.e., endoprostheses) could permit direct, physical muscle–prosthesis attachment to restore more natural sensorimotor function to people with amputation. The objective of our study was to test, in a rabbit model, the feasibility of replacing the lost foot after hindlimb transtibial amputation by implanting a novel rigid foot–ankle endoprosthesis that is fully covered with skin. We first conducted a pilot, non-survival surgery in two rabbits to determine the maximum size of the skin flap that could be made from the biological foot–ankle. The skin flap size was used to determine the dimensions of the endoprosthesis foot segment. Rigid foot–ankle endoprosthesis prototypes were successfully implanted in three rabbits. The skin incisions healed over a period of approximately 1 month after surgery, with extensive fur regrowth by the pre-defined study endpoint of approximately 2 months post surgery. Upon gross inspection, the skin surrounding the endoprosthesis appeared normal, but a substantial subdermal fibrous capsule had formed around the endoprosthesis. Histology indicated that the structure and thickness of the skin layers (epidermis and dermis) were similar between the operated and non-operated limbs. A layer of subdermal connective tissue representing the fibrous capsule surrounded the endoprosthesis. In the operated limb of one rabbit, the subdermal connective tissue layer was approximately twice as thick as the skin on the medial (skin = 0.43 mm, subdermal = 0.84 mm), ventral (skin = 0.80 mm, subdermal = 1.47 mm), and lateral (skin = 0.76 mm, subdermal = 1.42 mm) aspects of the endoprosthesis. Our results successfully demonstrated the feasibility of implanting a fully skin-covered rigid foot–ankle endoprosthesis to replace the lost tibia–foot segment of the lower limb. Concerns include the fibrotic capsule which could limit the range of motion of jointed endoprostheses. Future studies include testing of endoprosthetics, as well as materials and pharmacologic agents that may suppress fibrous encapsulation.

LB974 Blastomycosis-like pyoderma: A diagnosis of correlation

A 63-year-old fisherman presented for a chronic and progressive eruption, beginning on his right hand and extending up his right arm over the past 8 years. He reported that he spent time in forests and handled raw fish without gloves frequently; he also recalled an inoculation injury while in a forest. The patient denied previous exposure to halogens. On examination, he had multiple edematous verrucous plaques with crust and elevated borders on the dorsal and ventral aspects of his right hand and right upper extremity.

Operative techniques and long-term outcomes of hypospadias repair in the absence of preputial skin after neonatal circumcision

PurposeTo present the results of hypospadias repair in the absence of preputial skin following neonatal circumcision, and the analyses of surgical techniques and predictors of procedural success. MethodsRecords of all children who underwent hypospadias repair between 10/1999 and 12/2018 were retrospectively reviewed. All of those who underwent neonatal circumcision prior to surgery were included. Patients with any prior penile reconstruction surgery and those with the megameatus intact prepuce variant were excluded. The primary endpoint was the need for reoperation. ResultsA total of 69 patients with a history of neonatal circumcision underwent surgical reconstruction of hypospadias during the study period. Their mean age at surgery was 14 months (interquartile range [IQR] 9,22). Forty-five cases (65%) involved distal hypospadias, and ventral curvature was present in 24 (35%). Dartos flaps were harvested from the dorsal aspect in 37/58 (64%) patients and from the ventral aspect in 21/58 (36%). Twenty-two patients (22/69, 32%) required reoperation after a median follow-up of 9 years (IQR 6,13). Indications for revision surgery included urethral fistula (n = 16, 22%), meatal stenosis (n = 5, 7%), and skin redundancy (n = 1). Ventral curvature (odds ratio [OR] 3.5, p = 0.02) and higher grades of hypospadias. (OR 3.3, p = 0.03) had a higher probability of reoperation (univariate logistic regression). ConclusionHypospadias repair following neonatal circumcision in the absence of preputial skin is a challenging reconstruction. The reoperation rate in our cohort was 30%, similar to reoperative hypospadias surgery. Parents of newborns diagnosed with hypospadias should be encouraged to refrain from pre surgical neonatal circumcision. Level of evidenceTreatment study, level IV

Laparoscopic Left Hemihepatectomy Using the Hilar Plate-First Approach (with Video).

Effective inflow and outflow control of the liver is essential for a safe hepatectomy. Detachment of the hilar plate is a fundamental technique in the Glissonean approach. The hilar plate is situated near the middle hepatic vein, which runs in the midplane of the liver, and serves as a landmark during hemihepatectomy. In this study, we describe the technical details and surgical outcomes of laparoscopic left hemihepatectomy using the hilar plate-first approach. The key procedures of the hilar plate-first approach included the following: (1) detachment of the hilar plate for the left Glissonean approach, (2) the middle hepatic vein approach from the hilar plate, (3) parenchymal transection along the ischemic line and middle hepatic vein, and (4) transection of the left Glissonean pedicle at the ventral aspect of the Arantius ligament. Between September 2020 and September 2021, 12 patients underwent laparoscopic left hemihepatectomy using the hilar plate-first approach. The median operation time was 227min (range 140-350min), and the median estimated blood loss was 82.5ml (range 50-150ml). The median length of postoperative hospital stay was 7days (range 5-10days). No major complications, including biliary complications, were observed. The hilar plate-first approach contributes to the standardization of surgical techniques for laparoscopic left hemihepatectomy. This technique is a safe and effective approach for the inflow and outflow systems of the left hemiliver.

Reappraisal of the braincase anatomy of the ornithopod dinosaurs Telmatosaurus and Zalmoxes from the Upper Cretaceous of the Haţeg Basin (Romania) and the taxonomic reassessment of some previously referred specimens

The hadrosauroid Telmatosaurus and the rhabdodontid Zalmoxes were the first and second dinosaur taxa that were described in detail from the famous Upper Cretaceous continental deposits of the Haţeg Basin by Franz Baron Nopcsa at the beginning of the twentieth century. Although they are among the most common and best-known dinosaurs discovered from these deposits, there are still many open questions as to their taxonomy and anatomy. Here, we re-describe two partial braincases from the uppermost Cretaceous of the Haţeg Basin that have been recently referred to the rhabdodontid Zalmoxes and re-assign them to hadrosauroids, possibly to Telmatosaurus. These specimens both exhibit basicranial features that are characteristic of derived hadrosauroids but are absent in more basal iguanodontians. These include an antero-posteriorly short basioccipital lacking a distinct neck, the presence of two well-developed sphenoccipital tubercles on the ventral aspect of the braincase and that are directly positioned anterior to the basioccipital, as well as a deep depression on the ventral aspect of the braincase between the sphenoccipital tubercles. The comparison provided herein demonstrates several important differences between the basicranium of hadrosauroids and that of rhabdodontids, which allows for the confident identification of even isolated and incomplete specimens. Moreover, the removal of the only basicranium that has been referred to Zalmoxes shqiperorum prompts a revised diagnosis of that species.

Estimation of differences and reapplication effect of peel bond strength between silicone-based and water-based adhesives

Statement of problemRetention is essential for maxillofacial prosthesis. Adhesives are commonly used for retention because of their simplicity, availability, and cost-effectiveness. Studies that have estimated the differences in bond strength between the types of adhesives and the impact of reapplication are sparse. PurposeThe purpose of this observational clinical study was to estimate the peel bond strength and reapplication effects of water-based and silicone-based adhesives at 0, 24, and 48 hours. Material and methodsA total of 46 participants were enrolled, with 23 participants in each adhesive test group—water-based and silicone-based adhesive. Silicone elastomeric strips were attached to the ventral aspect of the participants' forearm 5 cm away from the radial styloid prominence. The strength of each adhesive group was tested at 0 hours, and its reapplication effects were evaluated at 24 and 48 hours. The peel bond strength was estimated by using a universal testing machine, and the data were recorded in N/m and statistically analyzed by the independent Student t test and Spearman rho correlation coefficient tests (α=.05). ResultsThe mean ±standard deviation of peel bond strength at 0 hours for silicone-based adhesive (111.5 ±2.5 N/m) was higher than that for water-based adhesive (99.9 ±3.9 N/m) (P<.001). On reapplication, the silicone-based adhesive had a higher peel bond strength (113.5 ±2.8 N/m) than the water-based adhesive (105.2 ±3.0 N/m) (P<.001). The results were statistically significant between the 2 groups at different time intervals (P=.04). ConclusionsThe mean peel bond strength of the silicone-based adhesive was higher than that of the water-based adhesive. The reapplication of adhesives improved the bond strength in both the groups.

EFFECT OF AN ELECTRO-STIMULATOR DEVICE ON THE AVERAGE 24-HOUR BLOOD PRESSURE IN PATIENTS WITH MILD AND MODERATE HYPERTENSION

Objective: Hypertension is considered the third leading killer over the world. Non-pharmacological therapy to prevent and to manage hypertension gained more popularity worldwide. Low frequency transcutaneous electrical nervous stimulation (TENS) was found to be beneficial in decreasing systolic and diastolic blood pressures. The aim of the study was to assess the effectiveness of TENS-based device in reducing blood pressure in hypertensive patients. Design and method: This was a prospective interventional paired study which examined the effect of low frequency TENS device (Inferum-050) on the 24-hour ambulatory blood pressure in a cohort of 50 patients with mild and moderate hypertension (based on the European Society of Cardiology definition). The device looks like a digital watch and in the baseline visit, patients were taught to use. They were told to wear the device on the ventral aspect of the distal left forearm. turn it on and just sit and relax as the device acts automatically. Patients were instructed to use the device for 6 minutes/session, twice daily, for 14 consecutive days at home. Office and Ambulatory blood pressures were evaluated at baseline and after 14 days of device use. Results: The mean age of patients was 51.8 ± 15.0 years and almost half were females (n = 26, 52%). Baseline office measurements showed that 28 patients (56%) had moderate hypertension. There were statistically significant reductions of office systolic (147.9 ± 14.4 vs 159.2 ± 8.6mmHg, p &lt; 0.001), office diastolic (88.5 ± 8 vs 96.7 ± 6.6 mmHg, p &lt; 0.001), 24-hours ambulatory systolic (147.7 ± 14.5 vs 158.4 ± 8.2mmHg, p &lt; 0.001) and 24-hours ambulatory diastolic blood pressures (89.1 ± 8.1 vs 95.1 ± 7.1 mmHg, p &lt; 0.001) in follow up as compared to baseline values. Nineteen patients (38%) complained of symptoms, mostly headache and fatigue, at baseline, and most of them (n = 15, 79%) reported improvement of these symptoms at follow up. Conclusions: Inferum ABP-050 device could be used as a non-pharmacologic adjuvant therapy to help further reduction of blood pressure in patients with mild and moderate hypertension. Most of the symptomatic patients reported improvement of their symptoms after device use. However, further studies and larger number of patients are needed to validate these results.

Immunohistological study of the density and distribution of human penile neural tissue: gradient hypothesis.

Immunohistological patterns of density and distribution of neural tissue in the human penis, including the prepuce, are not fully characterized, and effects of circumcision (partial or total removal of the penile prepuce) on penile sexual sensation are controversial. This study analyzed extra- and intracavernosal innervation patterns on the main penile axes using formalin-fixed, paraffin-embedded human adult and fetal penile tissues, single- and double-staining immunohistochemistry and a variety of neural and non-neural markers, with a special emphasis on the prepuce and potential sexual effects of circumcision. Immunohistochemical profiles of neural structures were determined and the most detailed immunohistological characterizations to date of preputial nerve supply are provided. The penile prepuce has a highly organized, dense, afferent innervation pattern that is manifest early in fetal development. Autonomically, it receives noradrenergic sympathetic and nitrergic parasympathetic innervation. Cholinergic nerves are also present. We observed cutaneous and subcutaneous neural density distribution biases across our specimens towards the ventral prepuce, including a region corresponding in the adult anatomical position (penis erect) to the distal third of the ventral penile aspect. We also describe a concept of innervation gradients across the longitudinal and transverse penile axes. Results are discussed in relation to the specialized literature. An argument is made that neuroanatomic substrates underlying unusual permanent penile sensory disturbances post-circumcision arerelated to heightened neural levels in the distal third of the ventral penile aspect, which could potentially be compromised by deep incisions during circumcision.

Cutaneous Microvascular Responses to Local Heating on Ventral and Dorsal Aspects of the Forearm

The cutaneous microvasculature is considered a representative vascular bed and is regularly used to interrogate the mechanisms of microvascular function in healthy and diseased humans. For instance, cutaneous dilation in response to local heating can provide an index of nitric oxide (NO) bioavailability. While the skin of the forearm is typically used for local heating studies, some studies have used the ventral forearm while others have used the dorsal forearm skin for this assessment. Since the dorsal aspect of the forearm typically has more hair and receives greater sun exposure than the ventral side, there is speculation that cutaneous dilation may differ from one side of the forearm to the other, in magnitude and/or mechanism. As such, studies utilizing different sides of the forearm may not be comparable. Therefore, we aimed to test the hypothesis that cutaneous local heating responses differ between the ventral and dorsal aspects of the forearm in response to the two most common temperature stimuli, 39°C and 42°C.MethodsTen young, normotensive individuals (6 men/4 women, age: 26 ± 2 years) were studied on two separate occasions separated by 2‐7 days. At each visit, 4 intradermal microdialysis fibers were placed in either the ventral or dorsal forearm, in a random order. Two fibers were perfused with Ringer’s solution to serve as control sites and the other 2 fibers were perfused with 10 mM N(G)‐Nitro‐L‐arginine methyl ester (L‐NAME) to inhibit NO synthase. Red blood cell flux (RBCF) was assessed at all sites via laser Doppler flowmetry. Each pair of sites (control and L‐NAME) was heated to either 39°C or 42°C for ~40‐45 min until RBCF plateaued. All sites were then infused with 28 mM sodium nitroprusside and heated to 43°C to establish maximal RBCF. Cutaneous vascular conductance (CVC) was calculated as RBCF / mean arterial pressure measured during the plateau and maximal phases. Plateau results are reported as a percentage of maximal CVC at each respective site. The relative NO contribution is reported as: [(control plateau – L‐NAME plateau)/control plateau] x 100.ResultsNo differences were observed at the control site between ventral and dorsal aspects of the forearm when heated to 39°C (62 ± 13 vs. 62 ± 16 % CVCmax, P=0.99). Likewise, the heating response to 42°C was similar across the forearm (ventral: 90 ± 9 vs. dorsal: 86 ± 12% CVCmax, P=0.21). The relative contribution of NO to the plateau was comparable across the forearm at 39°C (ventral: 70 ± 20 vs. dorsal: 66 ± 21%, P=0.71) and 42°C (ventral: 63 ± 16 vs. dorsal: 69 ± 11%, P=0.11).DiscussionThese preliminary findings suggest that cutaneous vasodilation elicited by local heating is similar on both sides of the forearm at both 39°C and 42 °C. Additionally, it appears that the relative contribution of NO to local heating‐induced microvascular vasodilation is not different across the forearm.

Correcting gender dysphoria –the anatomical changes with male to female gender reassignment surgery

ABSTRACT Introduction &amp; Objectives Increased Global acceptance of transgender communities, gender-affirming genital reconstructive surgery is becoming more prominent. Formalised education and training however has not quite entered the curriculum of many surgical training programs yet it remains imperative we have an understanding of modified anatomy in out patients. We demonstrate anatomical reconstruction during the transition between male to female anatomy. Methods Patient consent was obtained to take a series of photographs during gender affirming surgery from male to female. Results Contemporary patients receive both spinal and general anaesthesia prior to positioning in standard lithotomy. A perineal incision of approximately 10cm in the midline raphae exposes the corpora and spongiosum. A simple bilateral orchidectomy was performed at the level of the external inguinal ring. A neovaginal cavity was created by firstly dividing the bulbospongiosus attachments to the perineal body and the space is both blunt and sharply dissected. Further dissection is carried out in the avascular perirectal fat plant anterior to the Denonvilliers fascia. During this dissection a 18-22Fr urethral sound is used to apply downward traction on the rectum. A sterile ultrasound sleeve is placed in the rectum to allow bimanual palpation to confirm intact rectal mucosa. A circumferential incision proximal to the glans is performed to aide degloving of the penis. Bucks fasica is left intact and distal penile skin will later be used to form the clitoral hood. The dorsal neurvascular bundle is raised off the corporal bodies but an attachment to the glans remains. A triangular section of dorsal glans is preserved and dissected off the tips of corpora. The penile tissue is then disassembled separating the corpus spongiosum from the corporal bodies. The corpora are amputated at the level of the pubis, remaining erectile tissue destroyed and oversewn for haemostasis. The Urethra is shortened to an appropriate length to allow the dorsal aspect to align between the neoclitoris and neomeatus. The ventral aspect is spatulated to expose the neomeatus. The penile skin flap is invaginated within the neovaginal space and the skin incised to expose the neoclitoris and neomeatus. The penile skin is then anastomosed to the neoclitoris and neomeatus The distal end of the penile skin flaps is oversewn to create a blind ending tube and thus creating the neovagina. Labia Majora are formed by excising excess scrotal skin to create an appropriate contour. This form of neovagina is compared to methods that involve intestinal and peritoneal lining transfer. Conclusions We have outline the stepwise transition of male to female anatomy with a conventional contemporary technique. Creation of a neovagina with penile inversion has become common practice in gender affirming surgery. However there are other means of creating genitalia with alternative tissues, which subspecialised practitioners should be aware. Disclosure Work supported by industry: no.

Elevations in sweat sodium concentration following ischemia‐reperfusion injury during heat stress

INTRODUCTIONAcute kidney injury is a major cause of excess hospitalizations during heat waves. The etiology of this acute kidney injury is likely contributed to by renal ischemia‐reperfusion (IR) injury. Renal IR injury results in damage to the renal tubules and a subsequent impairment in sodium reabsorption. Fractional excretion of sodium is often used as an indirect marker of damage to the renal tubules and increases of &gt;1% reflect ischemic acute kidney injury. Mechanistic studies, which are limited to rodent IR models, have reported that impairments in sodium reabsorption following ischemic acute kidney injury are mediated by a reduction in active transporters for sodium reabsorption in the renal tubules. However, similar in vivo studies are not possible in humans. The eccrine sweat glands have been proposed as a model of the nephrons given the anatomical and physiological similarities (e.g., sodium reabsorption).PURPOSETest the hypothesis that sweat sodium concentrations are elevated following IR injury during passive heat stress.METHODSFifteen healthy adults (10 women; age: 25±3 y; body mass index: 23.7±3.5 kg·m‐2) completed a cross‐body design experiment consisting of ~160 min of passive heat stress (core body temperature: +1.5±0.2°C) utilizing a suit perfused with 50°C water. At 60 min of whole‐body heating, one upper arm (randomized) was occluded (220 mmHg) for 20 min followed by reperfusion. Sweat was collected from the ventral aspect of each forearm via an absorbent patch (~77 cm2) pre‐ and post‐IR for 24±4 and 30±6 min, respectively. Sweat sodium concentration (mmol·L‐1) was measured in duplicate via electrolyte analyzer (EasyLyte® Plus). Local sweat rate was measured on the distal aspect of the dorsal forearm continuously via hygrometry (mL·min‐1·cm‐2). Comparisons were made between the experimental (IR) and control arms. Data are reported as mean±SD.RESULTSLocal sweat rate increased during whole‐body passive heating (p&lt;0.001) and was not different between the experimental and control arms at any timepoint except during ischemia (0.45±0.53 vs.1.31±0.43 mL·min‐1·cm‐2, respectively; p&lt;0.001). Sweat sodium concentration did not change from pre‐ to post‐IR in the control arm (pre: 54.9±32.2 mmol·L‐1 and post: 58.7±25.6 mmol·L‐1; p=0.99), but increased from pre‐ to post‐IR in the experimental arm (pre: 48.4±23.3 mmol·L‐1 and post: 63.8±30.9 mmol·L‐1; p=0.02). Furthermore, the change from pre‐IR in sweat sodium concentration was different between experimental and control arms post‐IR (+12.5±14.70 mmol·L‐1 versus ‐0.3±20.5 mmol·L‐1, respectively; p=0.05).CONCLUSIONIn support of our hypothesis, sweat sodium concentration was elevated following IR injury and does not appear to be mediated by alterations in sweat rate. These observations are in‐line with rodent renal IR models demonstrating impaired sodium reabsorption. While these findings appear to support the use of eccrine sweat glands as a model, further testing is required to verify its use to understand impaired sodium handling following IR injury in humans.

V06-09 DORSAL ONLAY LINGUAL MUCOSA GRAFT URETHROPLASTY FOR FEMALE URETHRAL STRICTURE

You have accessJournal of UrologyCME1 May 2022V06-09 DORSAL ONLAY LINGUAL MUCOSA GRAFT URETHROPLASTY FOR FEMALE URETHRAL STRICTURE Claire Richard, Benoit Peyronnet, Alice Drain, Juliette Hascoet, Nirit Rosenblum, Rachael Sussman, Lucas Freton, Lee C. Zhao, Victor W. Nitti, and Benjamin Brucker Claire RichardClaire Richard More articles by this author , Benoit PeyronnetBenoit Peyronnet More articles by this author , Alice DrainAlice Drain More articles by this author , Juliette HascoetJuliette Hascoet More articles by this author , Nirit RosenblumNirit Rosenblum More articles by this author , Rachael SussmanRachael Sussman More articles by this author , Lucas FretonLucas Freton More articles by this author , Lee C. ZhaoLee C. Zhao More articles by this author , Victor W. NittiVictor W. Nitti More articles by this author , and Benjamin BruckerBenjamin Brucker More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002586.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The most widely accepted definition of female urethral stricture (FUS) is a symptomatic, anatomical narrowing of the urethra based on a failure of catheterization, urethral calibration, visual inspection, endoscopy or radiography. Thus it is a rare condition, its diagnostic and treatment are challenging for the reconstructive urologist. METHODS: We present the case of a 47 year-old female, with a urethral stricture due to vulvar lichen sclerosus inducing incomplete bladder emptying and recurrent urinary tract infections. We decided to use lingual mucosa because the buccal mucosa was also affected by the lichen. The aim of this video was to describe the procedure of dorsal onlay lingual mucosa graft urethroplasty. RESULTS: The operating time was 70 minutes. The procedure began with the injection of adrenaline and xylocaine serum. An inverted U incision was performed anterior to the urethra. Dissection was carried out in the plane developed between the underlying urethra and overlying clitoral cavernous tissue. A dorsal urethrotomy was performed at a 12 o’ clock position until healthy proximal urethra was reached. The lingual mucosa graft was harvested after having identified the Wharton’s duct orifices. The graft edges were incised using a scalpel and the graft was removed using sharp scissors. The graft was maturated by removing the fat and muscular tissue of its non-mucosal side. The graft was sutured to the margins of the urethral plate. The distal part of the graft was quilted to the above periurethral flap in order to recreate the ventral aspect of the urethral meatus. A 18FR silicone catheter was placed carefully at the end of the procedure. No peri operative complication occurred. The patient was discharged two days after surgery and did not have recurrence of stricture after 6 months. CONCLUSIONS: Dorsal onlay lingual mucosa graft urethroplasty is a feasible option for female urethral stricture with satisfactory postoperative outcomes. Source of Funding: No © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e567 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Claire Richard More articles by this author Benoit Peyronnet More articles by this author Alice Drain More articles by this author Juliette Hascoet More articles by this author Nirit Rosenblum More articles by this author Rachael Sussman More articles by this author Lucas Freton More articles by this author Lee C. Zhao More articles by this author Victor W. Nitti More articles by this author Benjamin Brucker More articles by this author Expand All Advertisement PDF DownloadLoading ...

Gross Anatomical Features of Tongue of Khaki Campbell Duck (Anas platyrhynchos domesticus) At Different Postnatal Ages

The present study aims to investigate the gross morphological structure of the tongue of the khaki Campbell duck at different postnatal ages. The ducks were from four age groups (A total of 25 ducks): day one (1), one (1) month, two (2) months, three (3) months, and four (4) months, having five ducks in each group. The tongues were collected immediately after the ethical killing of the birds for gross anatomical observations. The tongue of the Khaki Campbell duck was located on the floor of the oropharynx. In all examined ages, the tongue did not extend to the total limits of the lower beak. The elongated shaped tongue was divided into three parts, i.e., apex, body, and root. The spatula-shaped apex of the tongue was smooth dorsally and devoid of lingual papillae. On the ventral surface of the apex, there was a flat, triangular, white plate of the lingual nail. The dorsal surface of the body of the tongue was divided into two symmetrical parts by a median groove, which became more prominent at the advancement of age. Large and small conical papillae were found symmetrically along both body edges. The root of the tongue was the smallest part which was located adjacent to the laryngeal prominence. Papillae were found on both sides of the root. A fold of membrane, the frenulum linguae present on the ventral aspect of the body. The length and width of the tongue increased with the advancement of age. The present study revealed the gross anatomical structure of the tongue of the Khaki Campbell duck at different postnatal ages and helped to compare the findings with other avian species.