Frontal Recess Cells in International Frontal Sinus Anatomy Classification (IFAC); Prevalence, Infection Incidence, and Relation to Frontal Sinus Infection in Chronic Sinusitis Patients

Frontal recess cells have many types with different sizes, arrangement, and extend. It plays an important role in successful functional endoscopic sinus surgery (FESS) as most causes of failure are related to it. Outline the prevalence of the frontal recess cells, pathological incidence of each cell regarding to frontal sinus pathology. Prospective study on 100 consecutive patients (200 sides) complaining from nasal and sinus symptoms which did not respond to medical management and indicated for FESS. Anterior group was infected in 30.8%; agger nasi cell (ANC) present in 97% (25.8% infected, 74.2% not infected), supra agger cell (SAC) present in 48% (39.6% infected, 60.4% not infected), supra agger frontal cell (SAFC) present in 11% (36.4% infected, 63.6% not infected). Posterior group was infected in 24.8%; supra bulla cell (SBC) present in 72% (30.6% infected, 69.4% not infected), supra bulla frontal cell (SBFC) present in 23% (17.4% infected, 82.6% not infected), supra orbital ethmoid cell (SOEC) present in 42% of cases (19% infected, 81% not infected). Medial group [frontal septal cell (FSC)] was present in 21% (33.3% infected, 66.7% not infected). FSC, SAC, SAFC, and SBC showed high infection rate in association with infected frontal sinus, while, the SOEC, ANC, and SBFC did not have such high infection rate. Frontal recess cells show no difference in their prevalence either if the frontal sinus infected or not, however their infection rate show significant difference.

Lateral distal tibial locking compression plate fixation through single lateral incision technique is biologically superior and mechanically equivalent alternative to medial plate fixation for lower third tibia-fibula fractures

<p><strong>Background:</strong> A number of surgical options for management of distal tibia fractures makes scenario confusing and available techniques are associated with complications. Recently lateral plating of tibia has shown good promise. To compare results between medial and lateral distal tibial locking compression plate for treatment of distal third tibia fractures</p><p><strong>Methods:</strong> Prospective clinical study was carried out among 24 patients presenting with distal third tibia fractures. Patients were randomized into two groups of 12 each. One group was allocated into medial distal tibial LCP and second group was allocated into lateral distal tibial LCP. In first group, approach taken was medial or anteromedial while in second group, approach taken was lateral. Follow up was done for six months after surgery.</p><p><strong>Results:</strong> There were 10 cases in medical group and eight cases in lateral group which had fracture due to road traffic accidents. All cases in medical group had concomitant fibula fracture while such cases were 10 in lateral group. One case in each group developed infection after surgery. There was one case of superficial skin dehiscence and one case of hardware problem in medial group compared to none in lateral group. Two cases from medial group required removal of implant compared to none from medial group.</p><p><strong>Conclusions:</strong> Lateral distal tibial LCP seems to provide biological advantage than medial distal tibial LCP without difference in biomechanical properties of implants. Single lateral incision technique is an ingenious, biologically sound, and cosmetically superior for fixation of both lower third tibia &amp; fibula fractures together.</p>

Evaluation of Contrast Flow Patterns with Cervical Interlaminar Epidural Injection: Comparison of Midline and Paramedian Approaches

Background and objectives: The purpose of this study was to compare and to analyze contrast spread patterns between the paramedian and midline approaches to cervical interlaminar epidural injection (CIEI). Materials and Methods: We retrospectively enrolled 84 CIEI cases that had been performed for unilateral cervical spinal pain from April 2019 to April 2020. After 3 mL of contrast had been injected into the epidural space, fluoroscopic images were obtained. The CIEI was divided into a midline (Group M, n = 42) and a paramedian (Group P, n = 42) approach by anteroposterior imaging. The P Group was classified into a more medial (Group Pm, n = 26) and a more lateral (Group Pl, n = 16) group. Using ImageJ on an anteroposterior image, we assessed the grayscale brightness ratio of the ipsilateral or contralateral side of the vertebral body as well as the intervertebral disc space one level just above the needle location. We identified the dispersion of contrast into the ventral epidural space. Results: The grayscale brightness ratio was significantly higher in Group P than in Group M (p < 0.001). The incidence of ventral epidural spread in Group M was 57.1% versus 88.1% in Group P, which was significantly different (p = 0.001). Conclusions: The fluoroscopic CIEI finding in the paramedian approach predominantly showed an excellent delivery of the injectate to the ipsilateral side in comparison to the contralateral side. This showed a greater advantage in delivery toward ventral epidural space as compared to the midline approach.

Morphological Analysis of Posterior-Medial Intertrochanteric Fracture Patterns Using Fracture-Mapping Technique

Background: The purpose of this study was to analyze the fracture patterns of different posterior-medial wall types of intertrochanteric fractures by 3-D fracture-mapping technique and to further assess their clinical utility.Methods: In a retrospective analysis of interochanteric fractures treated in a large trauma center, fractures were classified into predesigned groups based on 3D-CT imaging techniques, and a 3-D template of the intertrochanteric region was graphically superimposed on the fracture line. Fracture characteristics were then summarized based on fracture-mapping. Finally, radiographic parameters, function, and range of motion were recorded in different fracture classification states.Results: A total of 348 intertrochanteric fractures were included. There were 111 patients (31.9%) in the posterolateral + posteromedial + medial group, with the most severe fracture displacement (typically characterized by fragmentation of the posteromedial wall into three isolated fragments). There were 102 cases (29.3%) in the posterolateral + posteromedial + simple medial group, and the most common fracture feature was a complete fragment posteromedially. A total of 81 cases (23.3%) were classified into the posterolateral + medial group, with the medial fracture line extending the anterior fracture line but leaving the lesser trochanter intact. In the isolated medial group of 33 cases (9.5%), the fracture type was similar to type IV, but the integrity of the greater trochanter was ensured. In the posteromedial + medial group of 12 cases (3.4%), the fracture was characterized by an interruption when the fracture line of the anterolateral wall extended to the posteromedial wall, often resulting in a complete isolated fragment posteromedially and medially. There were 9 patients (2.6%) in the isolated posterolateral group. In addition, we found significantly different radiographic scores and range of motion scores between groups.Conclusions: This morphometric study helps us to further characterize posterior-medial fracture patterns of intertrochanteric fractures, which may be closely related to different clinical outcomes. Further studies are needed to verify the reliability of this classification scheme in clinical application.Study Design: Crossover Study Design; Level of evidence, 3.

Social Dimensions of Communication in Project Activities of the Authorities

The research is contingent on the interim results received by the Russian Chamber of accounts for strategic audit of national projects. Most experts have outlined the problem of achieving quantitative and qualitative indicators of national projects, and, as a result, the planned results of the country development. The author educes the reasons for the current problem in project management as follows: (1) the contradiction of the method and the tasks set; (2) the lack of mechanisms for implementing national projects in their relationship with Federal and regional projects. Besides, the author adds to this list (3) the issues of the social consequences of the project activities initiated by the public authorities in 2005-2009 and 2018-2020, such as the exclusion of the population from the implementation of projects. The author clarifies that the mobilization of public energy to achieve the planned socially significant results of the development of Russian society is only possible if the content of the projects corresponds to the values of the population towards the future. Based on empirical data, the author demonstrates the sensitivity of various social groups (supporters, opponents, medial group) to the actions / inaction of the authorities to solve the problems of society’s life. The article shows that purposeful problematization of certain areas of state policy leads to the formation of a new social group, which includes representatives of three groups at the same time. It proves that the organization of communication in the project activity of the public authorities, its forms and means are mediated by the characteristic of the medial group.

Implantation technique, safety and complications of robot-assisted stereoelectroencephalography exploration of the limbic thalamus in human focal epilepsy

IntroductionDespite numerous imaging studies highlighting the importance of thalamus in surgical prognosis, human electrophysiological studies involving the limbic thalamic nuclei are limited. The objective of this study was to evaluate the safety and accuracy of robot-assisted stereotactic electrode placement in the limbic thalamic nuclei in patients with suspected temporal lobe epilepsy (TLE).MethodsAfter obtaining informed consent, 24 adults with drug-resistant suspected TLE undergoing Stereo-EEG evaluation were enrolled in this prospective study. The trajectory of one electrode planned for clinical sampling the operculo-insular cortex was modified to extend to the thalamus, thereby preventing the need for additional electrode placement for research. The anterior thalamus (ANT) (N=13) and the medial group of thalamic nuclei (MED) (N=11), including mediodorsal (MD) and centromedian (CeM) were targeted. The post-implantation CT was co-registered to the pre-operative MRI, and Morel’s thalamic atlas was used to confirm the accuracy of implantation.ResultsTen out of 13 (77%) in the ANT group and 10 out of 11 patients (90%) in the medial group had electrodes accurately placed in the thalamic nuclei. None of the patients had a thalamic hemorrhage. However, trace asymptomatic hemorrhages at the cortical level entry site were noted in 20.8% of patients and they did not require additional surgical intervention. SEEG data from all the patients were interpretable and analyzable. The trajectories for the ANT implant differed slightly from the medial group at the entry point i.e., precentral gyrus in the former and postcentral gyrus in the latter.ConclusionsUsing judiciously planned robot-assisted SEEG, we demonstrate the safety of electrophysiological sampling from various thalamic nuclei for research recordings, presenting a technique that avoids implanting additional depth electrodes, or comprising clinical care. With these results, we propose that if patients are fully informed of the risks involved, there are potential benefits of gaining mechanistic insights to seizure genesis, which may help to develop neuromodulation therapies.

Medial versus lateral approach to harvesting of anterolateral thigh flap

Objective This study was performed to evaluate two classic procedures guided by anatomic markers for harvesting the anterolateral thigh (ALT) flap: one began with an incision on the lateral side to identify perforators emerging from the muscle to the superficial tissue and to track the perforators upward to the upper stem vessel, and the other began with an incision on the medial side to identify the vessel branch from the stem artery and to track it downward to the flap perforators. Methods Twenty-eight consecutive patients with tissue defects repaired with ALT flaps were investigated; 13 and 15 patients underwent the lateral and medial incision technique, respectively. The surgeon’s subjective view regarding procedural difficulty and the operative times were statistically analyzed. Results All flaps were harvested successfully. A two-paddle flap from one thigh in the medial group failed due to necrosis; all others survived completely. Subjectively, harvesting of flaps starting with a lateral incision was somewhat difficult, and the operative time was significantly longer using the lateral technique. Conclusions Classic procedures to harvest the anterolateral thigh flap are still practicable, and starting with a medial incision is more efficient than starting with a lateral incision. Type of study/level of evidence: Therapeutic IV.

Histomorphological and Histochemical Observations of the Common Myna (Acridotheres tristis) Tongue

Common myna tongue was studied histomorphologically and histochemically. Four tongues of adult birds were carried out macroscopically and microscopically. The tongue was triangular; the dorsum of the body had median groove. Two to three backward directed papillae were located on each side of the body-base junction. A single transverse row of pharyngeal papillae was located behind the laryngeal cleft. The parakeratinized mucosa covered the entire surface of the tongue except clearly keratinized band on the ventrolateral surface and the conical papillae. Compared with the lateral group (LG), the secretory cells of the medial group (MG) of the anterior lingual glands (ALG) and the posterior lingual glands (PLG) contained large amount of mucin. It was neutral mucin. However, the LG had weak acid mucin with carboxylated group. Meanwhile, the MG of the ALG and the PLG had strong acid mucin with both carboxylated and sulphated groups. In conclusion, the morphological observation of the common myna tongue showed some variation from the other birds. Histochemical results indicated the differences between the LG and MG of the anterior lingual glands. However, no difference was observed between the latter and the PLG.

Shaping and Navigating Methods of Microcatheters for Endovascular Treatment of Paraclinoid Aneurysms

OBJECTIVE To determine whether the use of a specific shape and a navigating method of microcatheters are suitable for placement at paraclinoid aneurysms. METHODS The clinical data from 122 patients with 132 paraclinoid aneurysms that underwent endovascular treatments during a 2.5-year period were retrospectively reviewed. Microcatheter shapes were classified as “straight,” “primary curves” (45, 90, and J), “preshaped-C,” “pigtail” (simple, right, and left), and “S” (simple, right, left, and preshaped). The navigating methods were classified as antegrade/retrograde microcatheter shift, wire-steering, looping, and coil/wire guiding. The shapes and navigating methods were compared among 3 aneurysm groups, which were categorized as superior, medial, and other, based on direction. RESULTS Shapes were significantly different between the 3 groups; the most commonly engaged shape in the superior group, medial group, and other group was S (55%), pigtail (60%), and primary (56%), respectively. The straight and S shapes were used in 5 (83%) and 18 (86%) cases, respectively, in the superior group, whereas the pigtail shape was used in 50 (86%) cases in the medial group. Aside from pigtail-simple shape, the side of pigtail, right vs left, coincided with the side of the internal carotid artery involved in every case of the medial group. The navigating methods were not significantly different among the 3 groups. CONCLUSION A specific shape by paraclinoid aneurysm direction tends to be suitable for the first trial of microcatheter shapes. Operators may reduce unnecessary struggling time of intra-aneurysmal placement of microcatheters by practicing the use of that shape.