Understanding the Use of Polycaprolactone in East Asian Structural Rhinoplasty: Questions and Answers

Surgery as an art in rhinoplasty involves grafting techniques wherein materials (usually autologous) are taken from the septum and supplemented by conchal cartilage. However, not all noses have adequate cartilage material. The quest for materials as possible replacement for human tissue have led to invention of synthetic (e.g. silicone, e-PTFE, porous polyethelene) and non-synthetic products (e.g. processed homograft and xenograft). In this era of advanced medical science, tissue engineering has started the use polycaprolactone (PCL) as a template and scaffold for tissue growth. Because of this characteristic feature, PCL as a mesh has a significant role in structural rhinoplasty. What is structural rhinoplasty? The surgical goal of rhinoplasty is to achieve functional improvement in breathing and aesthetic overall look, most notably the tip. The tip is determined by the final shape of the lower cartilage in its proper location - - but since the lower cartilage is a floating structure supported only by fibrous tissue and ligaments, there is a high incidence of tip drooping post op. So, the idea of structured rhinoplasty was conceptualized in 1997 by Dr. Byrd and popularized by Dr. Toriumi.1,2 A piece of central septum is harvested and fashioned as an extension of the caudal margin of the septum. This is called a septal extension graft (SEG) and the lower cartilage is sutured to the caudal margin of the SEG for better control of the tip. Since then, the technique has been the main workhorse support graft for the tip.3 (Figure 1) Why is structural rhinoplasty needed in East Asian noses? East Asian noses, particularly Southeast Asian noses are usually short and small, with low dorsum and upturned bulbous nose. Tremendous strength in the design of the structural support with its foundation base at the caudal septum should be achieved in order to elongate the nose, counter rotate and project the tip. (Figure 2) This is made possible by using the central harvested cartilage as a SEG attached to the residual strong dorsal and caudal strut.4 (Figure 3)

Morphometry of infraorbital foramen applied to local anesthesia in hoary fox (Lycalopex vetulus Lund, 1842)

Whilst considering the need anesthetic techniques supported by species-specific morphology, it has been sought to describe the morphometry of the Hoary Fox's infraorbital foramen with aims at correlating its topography with points of anatomic reference in the skull, thereby providing subsidy for a more effective local anesthetic block in that species. Four skulls of Lycalopex vetulus had been used, from which all of the measurements in each antimere were performed. The infraorbital foramen was located at the maxilla bone, dorsally-wise from the third upper pre-molar tooth, and, from the ventral end of its caudal margin, it would stand apart from the alveolar margin of that bone by 4.19 mm, in average; from the orbital margin at the level of the lacrimal foramen by 14.10 mm; from the dorsal end of the frontal process of the zygomatic bone by 37.10 mm; from the rostral end of the alveolar margin of the first upper incisor tooth by 38.54 mm; and, from the caudal end of the nuchal crest by 100.53mm - at the level of the median sagittal plane; as it also presented a sagittal axis of 5.21 mm in average. It is suggested that, for the Hoary Fox, the needle be introduced by 4.19 mm in contact with the maxilla bone, in a perpendicular fashion, and in a ventral-dorsal orientation from the alveolar margin of the same - whilst using, as an anatomic reference, the diastema that exists between the third and the fourth upper pre-molar teeth.

A New Genus and Species of Delphacidae (Hemiptera: Fulgoroidea: Delphacidae) from Costa Rica

Melaniphax suffusculus gen. et sp. nov. is described from Costa Rica, representing the 57th delphacid species recorded from the country to date. The new genus is superficially similar to Caenodelphax Fennah in general appearance in that the body is uniformly colored with the wings infuscated. Distinctive features of the new taxon include simple, forceps-like gonostyli, a broadly compressed aedeagus with large serrate lateral flanges, and the anal tube bearing a pair of short, stout, truncate, caudally-directed processes on the ventro-caudal margin and slender, elongate processes from the antero-ventral margin.

A description of Pseudechiniscus xiai sp. nov., with a key to genus Pseudechiniscus in China

The new species from the Liupan Mountains in China, Pseudechiniscus xiai sp. nov., differs from other Pseudechiniscus species by the following characters: absence of striae between dots which institute cuticular sculpture, projections absent on caudal margin of pseudosegmental plate, notches absent on caudal margin of terminal plate, dots on ventral side of body forms a reticular patched design. A diagnostic key to the Chinese Pseudechiniscus species is provided.

The Termination Level of the Dural Sac Relevant to Caudal Epidural Block in Lumbosacral Transitional Vertebrae: A Comparison between Sacralization and Lumbarization Groups

Background: Lumbosacral transitional vertebrae (LSTV) are a relatively common variant and have been considered as one of the reasons for back pain. It is not unusual for clinicians to encounter patients with LSTV who require caudal epidural block (CEB) for pain management. Objective: We investigated the termination level of the dural sac (DS) and anatomical features of the lumbosacral region relevant to CEB in patients with LSTV and compared these findings between sacralization and lumbarization groups. Study Design: A retrospective evaluation. Setting: A university hospital with inpatient and outpatient LSTV cases presenting low back pain. Methods: Four hundred ninety-four LSTV patients were included and categorized into sacralization (n = 201) or lumbarization groups (n = 293). Magnetic resonance imaging (MRI) of all of the LSTV patients were reviewed to determine the level of DS termination, the shortest distance between the apex of the sacral hiatus and DS, and the presence and the caudal level of sacral perineural cysts. Each lumbosacral vertebra column was divided into 3 equal portions (upper, middle, and lower thirds). The MRI findings in both of the groups were compared and analyzed. Results: The distribution frequency of the levels of DS termination demonstrated a significant difference between the 2 groups. The mean caudal DS level in the lumbarization group was significantly lower than the sacralization group (lower third of the S2 [131 {44.7%} of 293 patients] vs. lower third of the S1 [78 {38.8%} of 201 patients]). The DS terminated at the S3 in more than 19% of the lumbarization group, whereas in only one case of the sacralization group. Although the incidence of perineural cysts was not significantly different between the 2 groups, the mean level of caudal margin of perineural cysts in the lumbarization group was significantly lower than the sacralization group (middle third of the S3 [10 {35.7%} of 28 cases] vs. middle third of the S2 [11 {44%} of 25 cases]). Limitations: This study reveals several limitations including the practical challenge of accurate enumeration of the transitional segment and the constraints on generalizability posed by the single-country study. Conclusion: When planning CEB for patients with LSTV, pre-procedural MRI to check the anatomical structures, including the level of DS termination and caudal margin of perineural cysts, would be of great use for lowering the risk of unexpected dural puncture during the procedure, especially in the lumbarization cases. Key words: Termination of the dural sac, dural sac termination, lumbosacral transitional vertebrae, transitional vertebra, caudal epidural block

Management of the Cephalically Malpositioned Lower Lateral Crus in Aesthetic Rhinoplasty

Cephalic malposition of the lower lateral cartilages (LLC) gained increasing awareness as a distinct anatomical entity within the last years. It has become clear that this type of deformity is not amenable to traditional rhinoplasty techniques. Repositioning of the lateral crus of the LLC enables the surgeon to achieve significant and reliable changes in the shape and function of the nose. The authors present their technique for repositioning of the cephalically malpositioned LLC. Their method is based on a turn-in flap that is positioned along the caudal margin of the repositioned LLC. This flap straightens a convex LLC and gives reliable structural support to the caudal alar margin. In this article, they discuss the various indications of this technique, introduce a new, more precise concept for evaluation of the axis of the lateral crus of the LLC, and highlight additional details of this reliable technique.

Bryochoerus liupanensis sp. nov. and Pseudechiniscus chengi. sp. nov. (Tardigrada: Heterotardigrada: Echiniscidae) from China

Two new species from China, Bryochoerus liupanensis sp. nov. and Pseudechiniscus chengi sp. nov. (Tardigrada: Heterotardigrada: Echiniscidae), are reported. Bryochoerus liupanensis sp. nov. is characterized by median plates 1 and 2 divided into four parts while median plate 3 is divided into three parts, and by two lateral plates on each side of all median plates. The new species differs from Bryochoerus intermedius in having a different cuticular sculpture and different lateral plates. Pseudechiniscus chengi sp. nov. is characterized by: head plate faceted, cephalic papilla dome-shaped, pseudosegmental plate with a longitudinal median fold, all plates including the dorsal plates and plates on legs with ornamentation composed of dense round dots, differing in size, and lacking striae between the dots. Pseudechiniscus chengi sp. nov. is most similar to Pseudechiniscus santomensis but differs by: lacking striae between the round dots on dorsal plates, lacking the tiny projections on the caudal margin of pseudosegmental plate, and the divided pseudosegmental plate.

Role of the retrotrapezoid nucleus/parafacial respiratory group in coughing and swallowing in guinea pigs

The retrotrapezoid/parafacial respiratory group (RTN/pFRG) located ventral to the facial nucleus plays a key role in regulating breathing, especially enhanced expiratory activity during hypercapnic conditions. To clarify the roles of the RTN/pFRG region in evoking coughing, during which reflexive enhanced expiration is produced, and in swallowing, during which the expiratory activity is consistently halted, we recorded extracellular activity from RTN/pFRG neurons during these fictive behaviors in decerebrate, paralyzed, and artificially ventilated guinea pigs. The activity of the majority of recorded respiratory neurons was changed in synchrony with coughing and swallowing. To further evaluate the contribution of RTN/pFRG neurons to these nonrespiratory behaviors, the motor output patterns during breathing, coughing, and swallowing were compared before and after brain stem transection at the caudal margin of RTN/pFRG region. In addition, the effects of transection at its rostral margin were also investigated to evaluate pontine contribution to these behaviors. During respiration, transection at the rostral margin attenuated the postinspiratory activity of the recurrent laryngeal nerve. Meanwhile, the late expiratory activity of the abdominal nerve was abolished after caudal transection. The caudal transection also decreased the amplitude of the coughing-related abdominal nerve discharge but did not abolish the activity. Swallowing could be elicited even after the caudal end transection. These findings raise the prospect that the RTN/pFRG contributes to expiratory regulation during normal respiration, although this region is not an essential element of the neuronal networks involved in coughing and swallowing.

Poecilimon bosphoricus group (Orthoptera, Phaneropterinae): iteration of morpho-taxonomy by song characteristics

More than 20 species were reported under the circum Black Sea lineage Poecilimon bosphoricus group (Orthoptera, Tet-tigonioidea, Phaneropterinae). The taxonomy of the group has for a long time been controversial; once these species weretransferred to Eupoecilimon and many new species have been described since the revision by Ramme (1933) or synonymshave been suggested/re-established. This study aims to test the classification of the group presently based on morpholog-ical characters by bioacoustic data. The following results were obtained or conclusions arrived. First, several qualitativemorphological characters previously used in descriptions/diagnoses of the species are variable and overlap between spe-cies. Those are the elevation and widening of pronotum in metazona, the emargination of caudal margin of pronotal discand the structure of male subgenital plate at caudal margin. Thus, still the male cercus, especially the orientation of den-ticles, is the most productive structure may allow more objective delimitation of species. As in qualitative morphology thegeneral morphometry seems uninformative for the taxonomy of the group. Second, male calling song and partly the num-ber of stridulatory pegs are more useful characters both for delimitation of species and describing their relationships. Es-pecially, the pattern of the syllable, the number of impulses per syllable and the duration of early part of syllable in speciesgroup allow us a more objective delimitation of the species and definition of relationships. Third, from the distributionand relationships of species, we suggested three radiation centres for the lineage: (1) Northwest Anatolia + Eastern Bal-kans, (2) Northeast Anatolia + Caucasus and (3) Crimea. Fourth, after evaluating morphological and song phenotypes we considered 21 species in P. bosphoricus group constituting three subgroups: (1) P. sureyanus and P. kocaki (+ P. athos),(2) P. turcicus + P. turciae and (3) P. bidens, P. bischoffi, P. bosphoricus, P. cervus, P. demirsoyi, P. geoktschajcus, P. hei-nrichi, P. istanbul, P. miramae, P. pliginskii, P. proximus, P. roseoviridis sp. n., P. scythicus, P. similis and P. tauricus (+ P.djakonovi). The following nomenclatural actions were made: (1) P. roseoviridis Chobanov & Kaya sp. n. described, (2)P. similis proximus Ünal, 2010 raised to species level as P. proximus stat. n., (3) P. naskrecki Ünal, 2001 syn.n. syn-onymised with P. demirsoyi Sevgili, 2001 (4) P. diversus Ünal, 2010 syn.n. and P. anatolicus Ramme 1933 syn.n. put insynonymy with P. sureyanus Uvarov, 1930, (5) P. oligacanthus Miram, 1938 syn.n. and P. tereckensis Stshelkanovtzev,1910 stat.rev. resynonymised with P. similis Retowski, 1889, (6) P. beybienkoi Tarbinsky, 1932 syn.n. and P. kusnezoviMiram, 1929 syn.n. synonymised with P. tauricus Retwoski, 1888, and (7) P. boldyrevi Miram, 1938 syn.n. synonymised with P. pliginskii Miram, 1929.

Radiographic landmarks for measurement of cranial tibial subluxation in the canine cruciate ligament deficient stifle

SummaryObjectives: The primary objective was to develop a repeatable radiographic technique for assessment of cranial tibial subluxation (CTS) and test the intra-observer and inter-observer repeatability of the chosen landmarks. A secondary objective was to determine the effects of digital radiographic magnification on CTS measurement repeatability.Methods: Twenty-three normal canine pelvic limbs were used to determine the magnitude of CTS before and after transection of the cranial cruciate ligament. Mediolateral radiographs were taken with and without fiduciary markers in place. Three investigators measured the CTS using radiographically visible anatomic landmarks at two different magnifications. The total observed variabilities were assessed by inter-observer and intra-observer differences. Paired t-tests were used to determine the effect of magnification and marker presence on CTS measures.Results: Measurement of the CTS from the caudal margin of the intercondylar fossa on the femur to the intercondylar eminence was the most repeatable. Poor correlation between the anatomic landmarks and the fiduciary bone markers was observed. We found no effect of magnification or presence or absence of bone markers on measurement of CTS.Clinical significance: Cranial tibial subluxation can be detected with the most repeatability by measuring between the caudal margin of the intercondylar fossa and the intercondylar eminence. Magnification of the digitized radiographic image had minimal effect on repeatability. This technique can be used for in vivo analysis of the canine cruciate ligament deficient stifle joint.