An Anatomical Clue for Minimizing Iliac Vein Injury During the Anterolateral Approach at L5–S1 Level: A Cadaveric Study

Objective: The injury to the common iliac vein (CIV) seems to be the most important concern during the anterior approach to the spine at L5–S1 level. We investigated the anatomy of the L5–S1 vertebral structures related to the CIV through a cadaveric study to find an anatomical clue for safe dissection of CIV.Methods: Ten cadavers were prepared for this study. After removing the peritoneum and the presacral fascia, the section from the lower part of the L5 to the upper part of the S1 vertebral body was removed with the CIV attached. After decalcification, 2 sections in the vertical and horizontal directions were made for histological study.Results: An adipose tissue layer was present between the intervertebral disc and CIV. The adipose tissue layer in 6 cadavers was thin, and in 3 of these cadavers, the CIV was attached to the vertebral body and the disc. In the other 4 cadavers, the CIV was clearly separated from the vertebral body and the disc by the intervening adipose tissue layer (IATL). Under the microscope, a thin layer surrounding the anterior longitudinal ligament, periosteum, and disc was observed, and we named this structure the ‘perivertebral membrane’. The perivertebral membrane was attached to the CIV when there was no IATL, but a potential space was detected under the membrane.Conclusion: There was a thin membrane, perivertebral membrane, between the CIV and L5–S1 disc. In cases with CIV adhesion to the disc due to the absence of IATL, the CIV may be mobilized indirectly through the perivertebral membrane.

Traumatic Bone Cyst in the Mandibular Symphysis : Case Reports

Traumatic bone cyst (TBC) is an asymptomatic lesion seen most in adolescents. TBC is found incidentally on routine panoramic examinations and appears as a relatively well-demarcated unilocular radiolucency with scalloped margins. Histological examination reveals a vacant cavity of cancellous bone usually unlined or very occasionally lined with a thin connective tissue layer. The lack of lining epithelial membrane is common histological feature. The most affected site is between the mandibular canine and third molar. The involvement of the mandibular symphysis is rare. The etiopathogenesis of the TBC is unclear. TBC is treated with surgical exploration and curettage; new bone is formed in place of the lesion within 6 - 12 months of surgery. Diagnosis of TBC prior to surgical intervention has limitations in most of the cases. Both of our patients were diagnosed through radiological examination and biopsy. Neither patient had a history of trauma. After surgery, the panoramic radiograph and CBCT were used to confirm bone healing.

A Critical Review on Avipathi Choorna- A Unique Formulation for Peptic Ulcer Disease

Peptic-ulcer-disease is the ulceration of gasrtric or duodenal mucosa due to the digestive action of pepsin and stomach acid. Gastritis, gastric ulcer and duodenal ulcer are included under this. It can be correlated with the condition Parinamasoola mentioned in Ayurveda. Avipathichoornam is a famous Ayurvedic formulation, mentioned in the texts Ashtanga Hridaya and Sahasrayoga. Avipathi choorna exerts its effect in Peptic ulcer disease probably through Deepana, Pachana and Saraka actions by virtue of the pharmacological properties of the ingredients with which the vitiated Pitta can get normalized. It can be deducted that Avipathi choorna probably neutralize the excess acid secretion in the gastrointestinal tract and maintain a healthy pH. The formulation also probably acts by the anti inflammatory property of most of the ingredients which can help pacify the inflamed tissue layer of the gut. The aim of this paper is to demonstrate mode of action of Avipathi choorna in peptic ulcer disease by critically analyzing the pharmacological properties as well as chemical constituent of the ingredients.

Towards an intraoperative feedback system for laparoscopic access with the Veress needle

About 50 % of complications during laparoscopy occur when surgical access is created. The Veress needle and proposed technical alternatives do not provide reliable information to support the surgeons in guiding the needle, or the feedback is not clearly perceivable. Based on acoustic emissions, Surgical Audio Guidance (SURAG) proposes a non-invasive and efficient way to enhance the perception of guidance information through acoustic and visual feedback displayed in real-time. This article demonstrates that the developed feedback matches the information about tissue layer crossings provided by force measurements. This indicates that SURAG can provide an effective means to make laparoscopic access more precise and safe, especially in pediatric surgery, where space for placing the needle is minimal.

The characteristics of host lipid body biogenesis during coral-dinoflagellate endosymbiosis

Intracellular lipid body (LB) biogenesis depends on the symbiosis between coral hosts and their Symbiodinaceae. Therefore, understanding the mechanism(s) behind LB biosynthesis in corals can portentially elucide the drivers of cellular regulation during endosymbiosis. This study assessed LB formation in the gastrodermal tissue layer of the hermatypic coral Euphyllia glabrescens. Diel rhythmicity in LB size and distribution was observed; solar irradiation onset at sunrise initiated an increase in LB formation, which continued throughout the day and peaked after sunset at 18:00. The LBs migrated from the area near the mesoglea to the gastrodermal cell border near the coelenteron. Micro-LB biogenesis occurred in the endoplasmic reticulum (ER) of the host gastrodermal cells. A transcriptomic analysis of genes related to lipogenesis indicated that binding immunoglobulin protein (BiP) plays a key role in metabolic signaling pathways. The diel rhythmicity of LB biogenesis was correlated with ER-localized BiP expression. BiP expression peaked during the period with the largest increase in LB formation, thereby indicating that the chaperoning reaction of abnormal protein folding inside the host ER is likely involved in LB biosynthesis. These findings suggest that the host ER, central to LB formation, potentially facilitates the regulation of endosymbiosis between coral hosts and Symbiodiniaceae.

Multi-tissue layering and path planning of in situ bioprinting for complex skin and soft tissue defects

Purpose Reconstructing multi-layer tissue structure using cell printing to repairing complex tissue defect is a challenging task, especially using in situ bioprinting. This study aims to propose a method of in situ bioprinting multi-tissue layering and path planning for complex skin and soft tissue defects. Design/methodology/approach The scanned three-dimensional (3D) point cloud of the skin and soft tissue defect is taken as the input data, the depth value of the defect is then calculated using a two-step grid division method, and the tissue layer is judged according to the depth value. Then, the surface layering and path planning in the normal direction are performed for different tissue layers to achieve precise tissue layering filling of complex skin soft tissue defects. Findings The two-step grid method can accurately calculate the depth of skin and soft tissue defects and judge the tissue layer accordingly. In the in situ bioprinting experiment of the defect model, the defect can be completely closed. The defect can be reconstructed in situ, and the reconstructed structure is basically the same as the original skin tissue structure, proving the feasibility of the proposed method. Originality/value This study proposes an in situ bioprinting multi-tissue layering and path planning method for complex skin and soft tissue defects, which can directly convert the scanned 3D point cloud into a multi-tissue in situ bioprinting path. The printed result has a similar structure to that of the original skin tissue, which can make cells or growth factors act on the corresponding tissue layer targets.

A novel technique to prevent the breast implant from exposure after mastectomies

Introduction After mastectomies, we do our reconstruction, either immediately or delayed. In both ways of reconstruction for post mastectomies defect, the most commonly performed reconstruction is by using breast prosthesis [1]. For many years, surgeons have been trying to find out any solution to reduce the rate of implant exposure and develop some new techniques and modifications. However, once the infection develops or implant expose the only permanent solution is to remove the implant [2-3]. Although there is less evidence found in the literature regarding the salvage of implant once the infection occurs and when implant becomes expose in implant-based reconstruction [4]. Radiation also plays additional role in post-operative complication rates following implant-based breast reconstruction, as it is well documented that the incidence of complications is to be higher in radiated breasts compare to similar non-radiated breasts [5]. With the new advancement in radiation therapy the number of patients have been increasing who are receiving radiation therapy after immediate breast reconstruction [5]. Description of the Technique For more than 15 years we have been reconstructing the breasts deformities after different types of mastectomies, ranging from skin sparing, nipple areola sparing to different types of lumpectomies, by immediate insertion of breast implants. The main problem which we face during post-reconstruction, is the exposure of implant in addition to infection. With the advent of ADM (Artificial Dermal Matrix) [6], serratus anterior muscle [7], rectus fascial flap [7] and inferior dermal flaps [8] although they do an addition to thickness of skin envelop over the implant after mastectomy, but still the rate of implant exposure has not changed noticeably. It has been well understood that of ADM expose in air it dries immediately which later on results in implant exposure. Meanwhile we have developed a novel tech- nique to augment the soft tissue coverage under the incision line over the ADM and implant. By this way, if there is any dehiscence over suture line, there will be no implant exposure as there is additional soft tissue layer of dermal flap. These dermal flaps are actually a de-epithelialized dermal flap from the inferior half of the breast skin, which we used to excise and throw it to the garbage, particularly in skin sparing mastectomies. In this technique we suture the inferior based dermal flap over the artificial dermal matrix in a way that suture lines of skin flaps of mastectomy lie over the de-epithelialized dermal flap, which actually in- crease the survivability of ADM as well as increase the thickness of soft tissue over the implant (figure 1 and 2). By addition of this layer of de-epithelialized dermal flaps over the artificial dermal matrix and breast implants have promising reduction effect over implant exposure as well as it provides the additional vascularized soft tissue layer over the implant. Although we are using dermal flap with ADM frequently in most of our skin spring mastectomies but we did this new technique in 2 patients till now with the mean follow up of 8 weeks till now there is not a single case report of implant exposure in those patients (figure 3).