Spatially unique Shh-Fgf8 distribution in regenerating limb guarantees consistent limb morphogenesis in different limb sizes and contributes to axolotl specific digit patterning.

Limb regeneration in Ambystoma mexicanum occurs in various sizes of fields and can recreate consistent limb morphology. It was not known what mechanism supports such stable limb morphogenesis regardless of size. Limb regeneration in urodele amphibians has been basically considered to recapitulate the limb developmental processes. Many molecules in the limb developmental processes are conserved with other tetrapods. SHH and FGF8 play important roles in the morphogenesis of limbs among them. Focusing on these two factors, we investigated the detailed expression pattern of Shh and Fgf8 in the various sizes of blastema in axolotl limb regeneration. Fgf8 is expressed in the anterior side of a blastema and Shh is expressed in the posterior side. These are maintained in a mutually dependent manner. We also clarified that the size of Shh and Fgf8 expression domains were scaled as the size of the blastemas increased. However, it was found that the secretion and working range of SHH were kept constant. We also found that the consistent SHH secretion range contributed to promoting cell proliferation and the first digital cartilage differentiation near the Shh expression domain. This would be a reasonable system to guarantees constant limb morphogenesis regardless of the blastema size. We also showed that the Shh-Fgf8 expression domain was shifted posteriorly as the digital differentiation progressed. Consistently, slowing the timing of blocking Shh signaling resulted in morphological defects that could be observed in only posterior digits. The revealed posteriorly shifting Shh-Fgf8 domain might explain urodele specific digit formation, in which digits are added posteriorly.

Are coveralls required as personal protective equipment during the management of COVID-19 patients?

Objectives Few studies have investigated the contamination of personal protective equipment (PPE) during the management of patients with severe-to-critical coronavirus disease (COVID-19). This study aimed to determine the necessity of coveralls and foot covers for body protection during the management of COVID-19 patients. Methods PPE samples were collected from the coveralls of physicians exiting a room after the management of a patient with severe-to-critical COVID-19 within 14 days after the patient’s symptom onset. The surface of coveralls was categorized into coverall-only parts (frontal surface of the head, anterior neck, dorsal surface of the foot cover, and back and hip) and gown-covered parts (the anterior side of the forearm and the abdomen). Sampling of the high-contact surfaces in the patient’s environment was performed. We attempted to identify significant differences in contamination with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between the coverall-only and gown-covered parts. Results A total of 105 swabs from PPEs and 28 swabs from patient rooms were collected. Of the PPE swabs, only three (2.8%) swabs from the gown-covered parts were contaminated with SARS-CoV-2. However, 23 of the 28 sites (82.1%) from patient rooms were contaminated. There was a significant difference in the contamination of PPE between the coverall-only and gown-covered parts (0.0 vs 10.0%, p = 0.022). Conclusions Coverall contamination rarely occurred while managing severe-to-critical COVID-19 patients housed in negative pressure rooms in the early stages of the illness. Long-sleeved gowns may be used in the management of COVID-19 patients.

The Challenge of Skin Lesions in Systemic Diseases

A 47-year-old man, obese, without medical problems, presented with a 15-day history of painful erythematous nodular lesions on the anterior side of lower limbs. He had no improvement with antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs). He developed migratory and symmetric arthralgias (ankles, knees, elbows) and low-grade fever. The skin lesions progressed to the upper limbs. On physical examination, a mild swelling and tenderness in both ankles was noted, and lesions suggestive of erythema nodosum were seen.[...]

Determination of Appropriate Personal Protective Equipment for Management of Patients With COVID-19

Objectives Few studies have investigated the contamination of personal protective equipment (PPE) during the management of patients with severe to critical coronavirus disease (COVID-19). This study aimed to determine the necessity of coveralls and foot cover for body protection during the management of patients with COVID-19. Methods PPE samples were collected from physicians exiting a room after the management of a patient with severe to critical COVID-19 who was within 14 days after symptom onset. The PPE sites were categorized into coverall-only parts (the frontal surface of the head, anterior neck, dorsal surface of the foot cover, and back and hip) and gown-covered parts (the anterior side of the forearm and the abdomen). Environmental sampling was performed in patient rooms. We tried to identify significant differences in contamination with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between the coverall-only and gown-covered parts. Results A total of 105 swabs from PPE and 28 swabs from patient rooms were collected. Of the PPE swabs, only three (2.8 %) swabs from gown-covered parts were contaminated by SARS-CoV-2. However, 23 of the total 28 sites (82.1%) from patient rooms were contaminated. There was significant difference in the contamination of PPE between coverall-only and gown-covered parts (0.0 vs 6.7%, p = 0.022). Conclusions Coverall contamination rarely occurred while managing severe to critical COVID-19 patients residing in negative pressure rooms in the early stages of the illness. Long-sleeved gowns may be used safely in the management of COVID-19 patients.

MORPHOMETRIC ASSESSMENT OF FEMORAL CONDYLAR PARAMETERS IN GUJARAT REGION AND ITS CLINICAL RELEVANCE : AN OSTEOLOGICAL STUDY

The Femur is the longest and strongest bone of the lower limb in which there is a groove present on anterior side and a notch present on posterior side. The anterior groove is called as patella-femoral groove and posterior notch is called Intercondylar (IC) Notch. There are two most important ligaments are connected with notch called Anterior Cruciate Ligament (ACL) and Posterior Cruciate Ligament (PCL), associated by embryological and cognitive to the notch.The aim of this study is to find out the condylar parameters of femur. We obtained 50 completely ossified dry femur of both sides from Department of Anatomy, SBKSMIRC, Sumandeep Vidyapeeth. The Mean ± SDof femoral parameters were measured and correlation were also calculated between various parameters which is found to be positively correlated.It guides to the anatomists as well as Orthopaedicians and forensic practices also.

Easy Surgical Approach of the Posterolateral Corner of the Knee

Background: The anatomy of the posterolateral corner (PLC) of the knee is complex. The approach of the PLC can be a challenging and stressful surgical time. Indications: The indications are posterolateral meniscal repair, open lateral meniscus allograft transplantation, posterolateral tibial plateau fracture, and PLC reconstruction for grade III sprains. Technique Description: The skin incision is straight, realized with the knee positioned at 90° of flexion, passing slightly posterior to the lateral epicondyle, anterior to the fibular head (FH), and ending on Gerdy’s tubercle. The subcutaneous tissues are dissected posteriorly so as to expose the FH and the biceps femoris (BF) tendon. The aponeurosis of the peroneus muscles is incised vertically opposite to the anterior side of the FH. The common fibular nerve is exposed at the neck of the fibula. Metzenbaum scissors are then inserted subaponeurotically, posteriorly, and parallel to the BF tendon, superficially to the nerve. An incision is made opposite the scissor’s blades, freeing the common fibular nerve. The BF tendon is spread forward and the lateral gastrocnemius is pulled posteriorly. Metzenbaum scissors are inserted in a closed position between the lateral gastrocnemius and the posterolateral joint capsule, and then spread to create a triangular door with a proximal base. The base consists of the BF tendon, the posterior side of the lateral gastrocnemius, and the anterior side of the posterolateral joint capsule. A counter-angled Hohmann retractor can now be applied against the posterior tibial plateau to retract the lateral gastrocnemius posteriorly and medially, exposing the PLC of the knee. Results: Noble structures are easily exposed and protected. The common fibular nerve is dissected and reclined posteriorly, and the popliteus vessels are reclined posteriorly and medially, protected by the lateral gastrocnemius. Passing under the BF tendon allows a better vision of the PLC along with less constraint than passing above, as the working window is further away from the femoral insertion of the lateral gastrocnemius. Discussion/Conclusion: The present surgical approach allows a simple, safe, and reproducible exposure of the PLC of the knee.

Assessment of the Shank-to-Vertical Angle While Changing Heel Heights Using a Single Inertial Measurement Unit in Individuals with Incomplete Spinal Cord Injury Wearing an Ankle-Foot-Orthosis

Previous research showed that an Inertial Measurement Unit (IMU) on the anterior side of the shank can accurately measure the Shank-to-Vertical Angle (SVA), which is a clinically-used parameter to guide tuning of ankle-foot orthoses (AFOs). However, in this context it is specifically important that differences in the SVA are detected during the tuning process, i.e., when adjusting heel height. This study investigated the validity of the SVA as measured by an IMU and its responsiveness to changes in AFO-footwear combination (AFO-FC) heel height in persons with incomplete spinal cord injury (iSCI). Additionally, the effect of heel height on knee flexion-extension angle and internal moment was evaluated. Twelve persons with an iSCI walked with their own AFO-FC in three different conditions: (1) without a heel wedge (refHH), (2) with 5 mm heel wedge (lowHH) and (3) with 10 mm heel wedge (highHH). Walking was recorded by a single IMU on the anterior side of the shank and a 3D gait analysis (3DGA) simultaneously. To estimate validity, a paired t-test and intraclass correlation coefficient (ICC) between the SVAIMU and SVA3DGA were calculated for the refHH. A repeated measures ANOVA was performed to evaluate the differences between the heel heights. A good validity with a mean difference smaller than 1 and an ICC above 0.9 was found for the SVA during midstance phase and at midstance. Significant differences between the heel heights were found for changes in SVAIMU (p = 0.036) and knee moment (p = 0.020) during the midstance phase and in SVAIMU (p = 0.042) and SVA3DGA (p = 0.006) at midstance. Post-hoc analysis revealed a significant difference between the ref and high heel height condition for the SVAIMU (p = 0.005) and knee moment (p = 0.006) during the midstance phase and for the SVAIMU (p = 0.010) and SVA3DGA (p = 0.006) at the instant of midstance. The SVA measured with an IMU is valid and responsive to changing heel heights and equivalent to the gold standard 3DGA. The knee joint angle and knee joint moment showed concomitant changes compared to SVA as a result of changing heel height.

A short note on the article by prof. Dm. Ott: "The volume of operative treatment of vesicovaginal fistulas complicated by the destruction of the urethra"

In the Journal "Obstetrics and Women's Diseases" for June this year, an article by prof. Dm. Otta: "About the operative treatment of vesicovaginal fistulas, complicated by the destruction of the urethra." In this article, prof. Ott proposes, in cases of significant destruction of the urethra, where and after successful plasty of the vesicovaginal wall, all the same, the patient is not able to keep urine, an operative problem, consisting in lengthening the urethra up to the lip of the anterior side of the labrum.

Taxonomy of the Cryptopygus complex. III. The revision of South African species of Cryptopygus and Isotominella (Collembola, Isotomidae)

Species of the genera of the Cryptopygus complex in South Africa are morphologically revised. Five new species of the genus Cryptopygus Willem, 1902 s. s. and one new species of the genus Isotominella Delamare Deboutteville, 1948 are described. Cryptopygus abulbussp. nov. and C. bulbussp. nov. have only one chaeta on the anterior side of dens and no chaetae on the anterior side of manubrium, the latter species being characterized by the presence of a bulb at apex of antennae; C. inflatussp. nov. shows a rare combination of eight ocelli on each side of the head with a tridentate mucro; C. longisensillussp. nov. has five long s-chaetae on the fifth abdominal segment; C. postantennalissp. nov. is unique by having a very long and slender postantennal organ with strong inner denticles; Isotominella laterochaetasp. nov. is the second member of the genus and differs from the type species by many more anterior chaetae on the manubrium and the presence of chaetae on ventral side of metathorax. The genera are discussed and a key to all species of the Cryptopygus complex recorded in South Africa is given. The focus is on the Western Cape Province where the complex is the most diverse and sampling more complete than in other provinces of South Africa.

Vishwachi (Cervical Radiculopathy) and its management- A Conceptual study

Pain is the most complicated area of human experience. An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. In this disease severe and throbbing type of pain which radiates from neck, shoulder, arm, forearm, & digits is experienced. It is also associated with numbness and emaciation of upper limbs and its muscles. Pain from posterior part of finger and anterior side of prakoshtha and kandara affect motor function. Disease spreading from posterior part of fingers and anterior part of prakoshtha and kandara and which affects the nerve in hand and by affecting the motor function known as vishwachi. . Thus Nasya, Abyanga, Swedana , Nasya and Niruha , Matrabasti becomes the line of treatment.