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Background Although laparoscopic liver resection has become the standard for minor resections, evidence is lacking for more complex resections such as the right posterior sectionectomy (RPS). We aimed to compare surgical outcomes between laparoscopic (LRPS) and open right posterior sectionectomy (ORPS). Methods An international multicenter retrospective study comparing patients undergoing LRPS or ORPS (January 2007—December 2018) was performed. Patients were matched based on propensity scores in a 1:1 ratio. Primary endpoint was major complication rate defined as Accordion ≥ 3 grade. Secondary endpoints included blood loss, length of hospital stay (LOS) and resection status. A sensitivity analysis was done excluding the first 10 LRPS patients of each center to correct for the learning curve. Additionally, possible risk factors were explored for operative time, blood loss and LOS. Results Overall, 399 patients were included from 9 centers from 6 European countries of which 150 LRPS could be matched to 150 ORPS. LRPS was associated with a shorter operative time [235 (195–285) vs. 247 min (195–315) p = 0.004], less blood loss [260 (188–400) vs. 400 mL (280–550) p = 0.009] and a shorter LOS [5 (4–7) vs. 8 days (6–10), p = 0.002]. Major complication rate [n = 8 (5.3%) vs. n = 9 (6.0%) p = 1.00] and R0 resection rate [144 (96.0%) vs. 141 (94.0%), p = 0.607] did not differ between LRPS and ORPS, respectively. The sensitivity analysis showed similar findings in the previous mentioned outcomes. In multivariable regression analysis blood loss was significantly associated with the open approach, higher ASA classification and malignancy as diagnosis. For LOS this was the open approach and a malignancy. Conclusion This international multicenter propensity score-matched study showed an advantage in favor of LRPS in selected patients as compared to ORPS in terms of operative time, blood loss and LOS without differences in major complications and R0 resection rate.

Objective Advances in surface-based morphometric methods have allowed researchers to separate cortical volume into cortical thickness (CTh) and surface area (SA). Although CTh alterations in major depressive disorder (MDD) have been observed in numerous studies, few studies have described significant SA alterations. Our study aimed to measure patients’ SAs and to compare it with their CTh to examine whether SA exhibits alteration patterns that differ from those of CTh in drug-naïve patients with MDD.Methods A total of 71 drug-naïve MDD patients and 111 healthy controls underwent structural magnetic resonance imaging, and SA and CTh were analyzed between the groups.Results We found a smaller SA in the left superior occipital gyrus (L-SOG) in drug-naïve patients with MDD. In the CTh analysis, the bilateral fusiform gyrus, left middle occipital gyrus, left temporal superior gyrus, and right posterior cingulate showed thinner cortices in patients with MDD, while the CTh of the bilateral SOG, right straight gyrus, right posterior cingulate, and left lingual gyrus were increased.Conclusion Compared with the bilateral occipito-temporal changes in CTh, SA alterations in patients with MDD were confined to the L-SOG. These findings may improve our understanding of the neurobiological mechanisms of SA alteration in relation to MDD.

Background Attention deficit hyperactivity disorder (ADHD) is an early-onset neurodevelopmental disorder that can extend into adulthood with multiple reported neuroimaging abnormalities. The focus of this research was to assess white matter impairments in ADHD children’s fathers with and without potential adult ADHD to see if these differences are connected with the persistence of ADHD into adulthood. Results The occurrence rate of the potential adult ADHD diagnosis among fathers of children with ADHD was 60%. There were statistically significant differences between fathers with ADHD and the non-ADHD population, due to the fact that the mean FA of the left superior corona radiata and the right posterior corona radiata were lower in the ADHD group than in the non-ADHD group, while the FA of the ADHD group was significantly greater than that of the non-ADHD group in terms of the left and right anterior thalamic radiations, the right superior longitudinal fasciculus and the left anterior corona radiata. Conclusions We observed an increased prevalence of ADHD in fathers of children diagnosed with ADHD. Fathers with potential adult ADHD have a variety of white matter abnormalities that reflect the neurobiological basis of ADHD, even in sub-threshold cases. This may provide insight into the neuroanatomical locations associated with the maintenance of ADHD throughout adulthood.

Background This study aimed to evaluate the effect of mandibular complete dentures relining using soft relining material on the distribution of various occlusal forces using T-Scan system. Fifty completely edentulous patients having their conventional complete dentures earlier fabricated and utilized were selected for this study. Patients were controlled diabetics, characterized by having their residual alveolar ridges moderately developed and lined with firm mucoperiosteum. Mandibular complete dentures were relined with soft denture liner and T-Scan device was used for occlusal force distribution measurement prior to denture relining and three months thereafter the relinning procedure. Results Comparison between occlusal forces percentages before and after denture relining revealed that occlusal forces percentages was significantly lower after denture relining in anterior area, significantly higher after denture relining in right posterior area, where it was insignificantly higher after relining in left posterior area. Conclusions Our findings revealed that the use of soft denture liner for mandibular complete denture relining significantly improved the occlusal load distribution. Clinical trial registration Trial registration NCT, NCT04701970. Registered 23/11/2020—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04701970

Objective: The present study estimated the prevalence of gingival recession (its severity and distribution) and assessed the association of potential risk indicators with the occurrence of gingival recession in Qena governorate, Egypt. Subject and methods: A representative sample of 1959 patients aged from 18 -90 years old (984 males and 975 females) from different areas in Qena governorate, Egypt were examined. A descriptive questionnaire was prepared for the examinations and full personal data were recorded. Results : The prevalence of gingival recession was 32.8%; Class I recession was (24.2%) followed by Classes II, III and IV (7.2, 1.3 and 0.1%, respectively). The most affected quadrants were the lower left quadrant while the least affected quadrant was the upper right quadrant. The most affected teeth were lower anterior teeth while The least commonly affected teeth were lower right posterior teeth. Conclusion: Prevalence of gingival recession showed more frequently in males than in females. Gingival recession was found to be more common in mandibular arch than maxillary. Lower anterior teeth than posterior ones and Left side of the arch was more commonly affected. This is a preliminary basis toward establishing a complete epidemiological study regarding the prevalence, severity as well as manifestations of oral diseases in Egypt. Hopefully, this help toward planning effective, preventive as well as therapeutic measures in this regard.

Neurobiological models of speech perception posit that both left and right posterior temporal brain regions are involved in the early auditory analysis of speech sounds. However, frank deficits in speech perception are not readily observed in individuals with right hemisphere damage. Instead, damage to the right hemisphere is often associated with impairments in vocal identity processing. Herein lies an apparent paradox: The mapping between acoustics and speech sound categories can vary substantially across talkers, so why might right hemisphere damage selectively impair vocal identity processing without obvious effects on speech perception? In this review, I attempt to clarify the role of the right hemisphere in speech perception through a careful consideration of its role in processing vocal identity. I review evidence showing that right posterior superior temporal, right anterior superior temporal, and right inferior / middle frontal regions all play distinct roles in vocal identity processing. In considering the implications of these findings for neurobiological accounts of speech perception, I argue that the recruitment of right posterior superior temporal cortex during speech perception may specifically reflect the process of conditioning phonetic identity on talker information. I suggest that the relative lack of involvement of other right hemisphere regions in speech perception may be because speech perception does not necessarily place a high burden on talker processing systems, and I argue that the extant literature hints at potential subclinical impairments in the speech perception abilities of individuals with right hemisphere damage.

This is a case report of a spontaneous retinal pigment epithelial (RPE) rip in a 64-year-old woman who presented with progressive, painless, blurring of vision in her right eye for 2 weeks. Her vision was 6/60 in the right eye and 6/6 in the left eye. On fundoscopy, there was a large depigmented area over the right posterior pole. A large area of RPE rip involving the fovea was revealed via optical coherence tomography and angiogram. Spontaneous RPE rip is a rare manifestation. However, when the fovea is involved the visual prognosis is poor. This article aims to highlight the vital role of multimodal imaging in aiding the diagnosis of RPE rips or tears.

BACKGROUND: Uncinate process dissection is a key step in minimally invasive pancreaticoduodenectomy (MIPD), including laparoscopic and robotic procedures, which increase the intraoperative blood loss and operative time and decrease the R0 resection rate if improperly handled. However, few studies have reported the operative skills in detail. METHODS: We performed uncinate process dissection using a combination of the anterior superior mesenteric vein (SMV)-first approach and the right posterior superior mesenteric artery (SMA)-first approach in MIPD for 138 patients with periampullary tumors between March 2017 and October 2019. The demographic and perioperative data of all the patients were collected to evaluate the efficacy of this method. RESULTS: All patients underwent an uneventful operation. An assistant incision was performed to separate extensive adhesion between the tumor and the SMV in 3 patients. The combined approach had a notably shorter operation time and resection time, less intraoperative blood loss and a shorter postoperative hospital stay than the traditional approach (P0.05). There were no deaths during the perioperative period. CONCLUSIONS: The combination of the anterior SMV-first approach and the right posterior SMA-first approach is a safe and feasible technique for uncinate process dissection in MIPD.

We report a rare case of osteochondromatosis of the posterior ankle extra-articular space with a longitudinal tear of flexor hallucis longus (FHL). A 77-year-old woman was referred to our hospital with an approximately 4-year history of pain and swelling in the right posterior ankle joint without obvious trauma. The pain had worsened in the previous 2 years. On presentation, she had tenderness at the posteromedial and posterolateral ankle. Imaging revealed several ossified loose bodies in the posterior ankle extra-articular space. We removed the loose bodies, performed tenosynovectomy around the FHL, and released the FHL tendon using a posterior arthroscopic technique via standard posterolateral and posteromedial portals. A longitudinal tear and fibrillation were detected in the FHL. The patient was able to return to her daily activities approximately 3 weeks after surgery. At the 1-year follow-up visit, she continued to have minor discomfort and slight swelling on the posteromedial aspect of the right ankle but had no recurrence of the ossified loose bodies. To our knowledge, this is the first report of osteochondromatosis of the posterior ankle extra-articular space with a longitudinal tear of the FHL that was treated by removal of loose bodies, tenosynovectomy around the FHL, and release of the FHL tendon via posterior ankle arthroscopy.

The exact contribution of the insula to risky decision making remains unclear, as are the specific outcome parameters and inter-individual characteristics that modulate insular activity prior to a risky choice. This fMRI study examines the contributions of outcome valence, magnitude, probability, and expected value (EV) to insular activity during risky decision making, and explores the influence of sensitivity to reward and to punishment, and anxiety, to insular activity. Participants (N = 31) performed a gambling task requiring choice between two roulettes with different outcome magnitude, probability and EV, under gain and loss conditions separately, and filled questionnaires assessing sensitivity to punishment/reward, and state/trait anxiety. Parametric analyses were conducted to examine the modulation of brain activity during decision making in relation to each task parameter. Correlations were examined between insular activity and psychometric questionnaires. EV of the selected roulette was associated with right posterior insula activation during decision making. Higher sensitivity to punishment was associated with lower bilateral insular activation. These findings suggest that the right posterior insula is involved in tracking the EV of a risky option during decision making. The involvement of the insula when making risky decisions also appears to be influenced by inter-individual differences in sensitivity to punishment.

A typical bile duct branching patterns represent one of the major causes of bile duct injury (BDI) during laparoscopic cholecystectomy (LC). The most common classified variations of bile duct branching, involve the right posterior sectoral duct (RPSD) and its joining with the right anterior or left hepatic duct. Variant bile duct anatomy can rarely be extremely complex and unclassified. This report describes an extremely rare case of an isolated injury to an aberrant right hepatic duct formed by the joining of ducts from segments V, VII, and VIII draining into the cystic duct (cysticohepatic duct) during LC, associated with an inferior RPSD opening to left hepatic duct. Detailed evaluation of both endoscopic and magnetic cholangiograms established the diagnosis. Bile duct injury was subsequently managed surgically by a demanding Roux-en-Y hepaticojejunostomy. This extremely rare case aims to serve as a useful reminder of the consistent inconsistency of biliary anatomy, alerting surgeons to beware of variant bile duct branching patterns during open or LC that constitute a dreadful pitfall for severe and life-threatening bile duct injuries.

Calcifying epithelial odontogenic tumor is a rare benign odontogenic tumor which accounts for approximately 1% of the entire odontogenic tumor. It was firstly described by Pindborg, and thus, is also referred to as the “Pindborg tumor”. Histologically, Pindborg tumor consists of three distinct histological compo­nents: sheets of polyhedral epithelial cells, amyloid like deposits, and calcifications. This case report describes a case of Calcifying epithelial odontogenic tumor in 26 years old female patient presented with the swelling in right posterior region of mandible. Taking into account of the aggressive nature of the lesion segmental resection of the mandible followed by reconstruction was planned for treatment. This case report highlights the importance of appropriate clinical, radiographical and histological correlation for the correct diagnosis and treatment of Pindborg tumor.

Background Alzheimer's disease (AD) and dementia with Lewy bodies (DLB) are often misdiagnosed with each other because of similar symptoms including progressive memory loss. The metabolic network topology that describes inter-regional metabolic connections can be generated using fluorodeoxyglucose positron emission tomography (FDG-PET) data with the graph-theoretical method. We hypothesized that different metabolic connectivity underlies the symptoms of AD patients, DLB patients, and cognitively normal (CN) individuals. Objective This study aimed to generate metabolic connectivity using FDG-PET data and assess the network topology to differentiate AD patients, DLB patients, and CN individuals. Methods This study included 45 AD patients, 18 DLB patients, and 142 CN controls. We analyzed FDG-PET data using the graph-theoretical method and generated the network topology in AD patients, DLB patients, and CN individuals. We statistically assessed the topology with global and nodal parameters. Results The whole metabolic network was preserved in CN; however, diffusely decreased connection was found in AD and partially but more deeply decreased connection was observed in DLB. The metabolic topology revealed that the right posterior cingulate and the left transverse temporal gyrus were significantly different between AD and DLB. Conclusion The present findings indicate that metabolic connectivity decreased in both AD and DLB, compared with CN. DLB was characterized restricted but deeper stereotyped network disruption compared with AD. The right posterior cingulate and the left transverse temporal gyrus are significant regions in the metabolic connectivity for differentiating AD from DLB.

This study presents brain electrophysiological characteristics of perspective-taking for blind individuals ver. sighted ones, aiming to extend our knowledge on social concept formation with visual sensory modality loss. A blind and a sighted group instructed to consider the moral dilemmas therein from a neutral (observer), a morally positive or a negative stance, after the auditory presentation of Aesop’s fables. We recorded the basic emotions evoked by every stance in each fable, and the late positive potentials (LPP) component of Event-Related Potential detected with Continuous Wavelet Transform, believed to reflect the sustained attention and stimuli encoding processes. Blind participants demonstrated: i) significantly attenuated LPP amplitudes at distributed brain areas, particularly at leads T3, P4, O2, T6, Cz, Pz, CPz and CP4 (p values 0.026-0.003), ii) prolonged LPP latencies at parietal areas, at leads CP4 (p=0.009), Pz (p=0.019), and P4 (p=0.023), iii) shorter latencies at the frontal area (lead FPz, p=0.026) and iv) significantly shorter latencies at the right posterior centrotemporal area under the negative than the positive condition (lead C4, p=0.009). Both groups exhibited higher LPP amplitudes under the morally positive, and lower under the negative condition located at the parietal areas (P3, p=0.001 and CPz, p=0.013). The relationships between behavior and LPP activation conform to the proposed generation and modulation of LPP. Our findings suggest that the visually deprived cortex may become more responsive to processes associated with perspective-taking, possibly through compensatory plasticity enabling cross-modal reorganization. Thus, the study introduces a novel model for accessing the sustained attention and stimulus-encoding processes underlying perspective-taking.

The aim of our research is to perform a retrospective analysis of all cases involving biliary complications after liver transplantation in two transplant centers of Kazakhstan. In the period from December 2011 and December 2019, 106 adult patients underwent LT at Syzganov's National Scientific Center of Surgery and City Clinical Hospital №7, Almaty, Kazakhstan. Eighty-nine (84%) patients underwent living donor liver transplantation (LDLT) from an adult donor, while 17 (16%) patients underwent deceased donor liver transplantation. The graft types were as follows: whole liver (n=17; 16%), right lobe (n=82; 77.3%), left lobe (n=6; 5.6%), and right posterior section (n=1; 0.9%). Duct-to-duct anastomosis was performed in 102 cases, the types of which were as follows single duct-to-duct anastomosis (n=95; 93.1%), double duct-to-duct anastomosis (n=5; 4.9%), combined-type anastomosis (duct-to-duct anastomosis and roux-en-Y hepaticojejunostomy [n=2; 1.9%]). Roux-en-Y hepaticojejunostomy was performed in 3 cases. A biliary splint was used in 53 (52%) cases; biliary splints were not used in 49 (48%) cases. Preoperative and intraoperative methods of investigating (MRC, IOC) the biliary tracts can reveal the types of biliary tracts and are useful for planning the type of biliary reconstruction. Various types of biliary reconstruction are associated with a high risk of biliary complications after liver transplantation. Biliary splinting in duct-to-duct anastomosis reduces the incidence of biliary complications.

Objective To determine the correlation between portal vein diameter and spleen size (craniocaudal). Methodology The study was conducted at the University Ultrasound Clinic, The University of Lahore, Lahore Pakistan from 1st January to 1st July 2013. All the individuals who referred for abdominal sonographic examination, including male, female, older and younger were conveniently included in the study, voluntarily, irrespective of the disease state. Ultrasonographic measurements of the caudocranial length of the spleen and portal vein were carried out on all of the one thousand subjects. The subject position for spleen was supine or right posterior oblique during suspended inspiration and right anterior oblique position for portal vein diameter with quiet respiration. The correlation between the splenic length and portal vein diameter was evaluated. Result A total of 1000 subjects; 36.9% females and 63.1% males aged from 4 to 79 years. The mean splenic length was 10.29 ± 1.89 cm. The mean portal vein diameter was 10.27 ± 1.78 mm. A statistically significant correlation was found between the spleen size and portal vein diameter; the Pearson correlation was significant at the 0.01 level. Conclusion Portal vein diameter is directly correlated to splenic caudocranial length. A regression formula was developed to measure the splenic length from the calculation of portal vein diameter.

Background The aim of this study was to assess the prevalence of biliary anatomical variants using 3-T MR cholangiography (MRC) with its impact in reduction of the complication of hepatobiliary surgical techniques. Results MRC was applied to 120 subjects (24 potential liver donors and 96 volunteers) and the right posterior hepatic duct insertion was documented, and accordingly, the biliary variants were classified based on Huang classification (Huang et al, Transplant Proc 28: 1669–1670, 1996). Biliary anatomic variants were divided based on Huang classification: Huang A1, 65.83% (n = 79); Huang A2, 11.67% (n = 14); Huang A3, 13.3% (n = 16); Huang A4, 7.5% (n = 9); and Huang A5, 1.67% (n = 2). The total frequency for A2, A3, A4, and A5 was 34.17% (n = 41). The distance between RPHD insertion and the junction of right and left hepatic ducts (L) was measured, and Huang A1 cases were then subtyped into S1 subtype (L > 1 cm) and S2 subtype (L ≤ 1 cm). We had 52 subjects with subtype S1 (43.33%) and 27 subjects with subtype S2 (22.5%). Twenty-three subjects had bile duct exploration or intraoperative cholangiograms and showed Huang type A1 in 14 (60.87%), type A2 in 3 (13.05%), and type A3 in 6 (26.08%). Twenty-two (95.65%) had the same classification in MRC and intraoperative while only one case (4.35%) was considered as A2 at MRC but the intraoperative classification was Huang A3, which was attributed to the insertion of the RPHD insertion at the distal end of the left hepatic duct. Conclusion MRC is an accurate tool for biliary tract mapping before hepatobiliary surgery to provide excellent identification of biliary variants which can reduce the incidence of biliary complications.

Soft tissue myofibromas of the head and neck are relatively common lesions diagnosed within the first two decades of life; however, these myofibromas are rarely found to affect the jaw bones. Myofibromas that do develop within the bone are referred to as intraosseous myofibromas (IM). A thorough search and review of the literature has found only five cases of IM impacting the mandible of an adult patient. The current case report describes a myofibroma impacting the right posterior mandible in a 44-year-old male patient with no previous history of pathology or surgery within the affected area. Histologic examination of the incisional biopsy specimen revealed a proliferation of spindle cells, and the spindle cells showed positivity for SMA on immunohistochemical staining supporting the diagnosis of myofibroma. The final pathology results of the subsequent composite resection of the lesion yielded a 1.5cm myofibroma that was < 1mm from the nearest bone/soft tissue edge; the resection margin was uninvolved by tumor. The purpose of this case report is to present the sixth case of IM of the mandible of an adult patient and to review the pertinent radiographic and clinical features, and necessary methods for diagnosis and treatment of this rare entity.

Aberrant insertion of the right posterior sectoral duct is a particularly hazardous variation of biliary anatomy which makes it prone to injury during laparoscopic cholecystectomy. Such injuries are challenging to manage, as multiple therapeutic options are available with no clear consensus in the literature for an optimal approach. Options include conservative management, intraoperative ligation of the injured duct, Roux-en-Y reconstruction and segmental liver resection. Most cases in the literature advocate for nonoperative management or hepaticojejunostomy. We present an unusual case of aberrant right posterior sectoral duct injury in which neither of these approaches was viable, necessitating a bi-segmental liver resection.

No study has reported a unilateral localized cerebral lesion of the posterior insula bilaterally reducing noxious stimuli perception. A 57-year-old man with an infarct involving the right posterior insula presented with reduced somatosensory response in the upper and lower left extremities. Furthermore, there was a reduced response to noxious stimulation in the right upper and lower limbs. We noted reductions in pain, noxious heat and cold perceptions, and sensitivity to increasing temperature. Other somatic sensations, including non-noxious temperatures, remained intact in the right upper and lower extremities. These findings in our patient with a unilateral insular lesion indicated a bilaterally reduced perception of noxious stimulation.

Background Minimally invasive right posterior sectionectomy (RPS) is a technically challenging procedure. This study was designed to determine outcomes following robotic RPS (R-RPS) and laparoscopic RPS (L-RPS). Methods An international multicentre retrospective analysis of patients undergoing R-RPS versus those who had purely L-RPS at 21 centres from 2010 to 2019 was performed. Patient demographics, perioperative parameters, and postoperative outcomes were analysed retrospectively from a central database. Propensity score matching (PSM) was performed, with analysis of 1 : 2 and 1 : 1 matched cohorts. Results Three-hundred and forty patients, including 96 who underwent R-RPS and 244 who had L-RPS, met the study criteria and were included. The median operating time was 295 minutes and there were 25 (7.4 per cent) open conversions. Ninety-seven (28.5 per cent) patients had cirrhosis and 56 (16.5 per cent) patients required blood transfusion. Overall postoperative morbidity rate was 22.1 per cent and major morbidity rate was 6.8 per cent. The median postoperative stay was 6 days. After 1 : 1 matching of 88 R-RPS and L-RPS patients, median (i.q.r.) blood loss (200 (100–400) versus 450 (200–900) ml, respectively; P 500 ml; P = 0.001), need for intraoperative blood transfusion (10.2 versus 23.9 per cent, respectively; P = 0.014), and open conversion rate (2.3 versus 11.4 per cent, respectively; P = 0.016) were lower in the R-RPS group. Similar results were found in the 1 : 2 matched groups (66 R-RPS versus 132 L-RPS patients). Conclusion R-RPS and L-RPS can be performed in expert centres with good outcomes in well selected patients. R-RPS was associated with reduced blood loss and lower open conversion rates than L-RPS.

Background In living donor liver transplantation (LDLT) for patients with Budd‒Chiari syndrome (BCS), there are several concerns about reconstruction of the inferior vena cava (IVC) and hepatic veins. Herein, we report the case of a patient with BCS who underwent LDLT with right posterior segment graft (RPSG) and patch plasty for reconstruction of the hepatic venous outflow, using the patient’s own superficial femoral vein (SFV). Case presentation A 19-year-old man, who was diagnosed with primary BCS, underwent LDLT. His main hepatic veins were totally obstructed, and membranous stenosis was seen in the IVC. The LDLT donor was his mother; however, liver volumetric analysis showed that only her RPSG was appropriate. In the recipient surgery, 16 cm of the left SFV was harvested and was cut longitudinally and opened. The right hepatic vein (RHV) of the RPSG was anastomosed to the sidewall of the SFV graft. After explantation of native diseased liver was completed, the stenotic and thickened wall of the IVC was widely resected, and a large anastomotic orifice was created. Patch cavoplasty was performed with the RHV‒SFV graft patch. After portal reperfusion started, hepatic venous outflow was satisfactory, and there was no venous graft congestion. Both his postoperative course and his long-term course after discharge were uneventful. Conclusions In LDLT for BCS patients, ingenuity is required for the reconstruction of venous outflow. The SFV patch can be safely harvested from liver transplant recipients and is suitable for venous reconstruction. In addition, RPSG is an alternative type of liver graft for LDLT if a conventional right- or left-lobe graft cannot be used.

Background The right posterior segment (RPS) graft was introduced to overcome graft size discrepancy in living donor liver transplantation (LDLT). However, it was very rarely used in pediatric patients. Here we presented 4 pediatric LDLT cases receiving RPS graft between January 2015 and April 2020 in our center. A total of 1868 LDLT procedures were performed in this period. Methods Recipients included 1 boy and 3 girls with a median age of 45 months (range from 40 to 93 months). They were diagnosed with progressive familial intrahepatic cholestasis, propionic academia, ornithine transcarbamylase and biliary atresia, respectively. Four donors were all mothers with a median age of 32.5 years (31–38 years). Computer tomography angiography indicated posterior right branches branched off separately from main portal veins (type III variation). Three of these donor livers had 1 orifice of right hepatic veins (RHV). In the remaining 1 donor liver, the RHV showed 3 orifices and an outflow patch plastic was performed. Inferior right hepatic veins weren’t found in four donor grafts. The median graft weight was 397.5 g (352–461 g) and the median graft-to-recipient weight ratio was 2.38% (1.44–2.80%). Results Postoperative complications occurred in neither donors nor recipients. Within the median follow-up duration of 29 months (14–64 months), four children are all alive with normal liver function. Conclusion In summary, for older children weighed more than 15 kg with donors’ variation of type III portal veins, the use of RPS grafts could be a feasible and favorable option.

Laparoscopic cholecystectomy is a very frequent surgical procedure with a low complication rate. The reasons for such complications range from anatomical anomalies, obesity, poor exposure of anatomic structures, bleeding or lack of surgical experience. If complications arise, prompt recognition and correct management are essential. Early and correct treatment allows avoidance of serious complications, such as secondary biliary cirrhosis, hepatic failure, and ultimately death. In this paper is presented a case of a 40-years-old male patient, who sustained iatrogenic major bile duct, right hepatic artery and duodenum injury during routine laparoscopic cholecystectomy due to symptomatic gallstones.

Langerhans cell histiocytosis is a rare condition ranging in manifestation from a focal boney lesion to multisystem involvement. Several treatment modalities have been proposed including curettage, low-dose radiotherapy, chemotherapy and intralesional injection of corticosteroids. These treatment options can be used as a single or combined approach. Prognosis depends on the extent of systemic involvement, and solitary lesions respond favorable to treatment. Here, the authors report a case of a 10-year-old male patient with Langerhans cell histiocytosis affecting his right posterior mandible that was successfully treated with intralesional injection of triamcinolone in multiple sessions. Complete recovery was confirmed clinically and radiographically in 18 months from the time of diagnosis.

Odontomas are considered a type of odontogenic hamartoma, and are generally reported not to exceed 3 cm in diameter. Some authors have referred to odontomas with a diameter exceeding 3 cm as giant odontomas. As hamartomas, giant odontomas generally show no signs or symptoms, but if they perforate the mucosa to become exposed in the oral cavity, oral and maxillofacial infections can result. Surgical removal and a histopathological examination may also be required to differentiate them from osteomas, cemento-osseous dysplasia, or mixed odontogenic tumors. This report presents the case of a 28-year-old woman with a giant odontoma in the right mandibular third molar area. Based on a review of the literature published since 2010, only 11 cases of "giant" or "large" odontomas have been reported, most of which were of the complex odontoma type. It was confirmed that they tend to occur in the right posterior mandible.

In the present work, we applied anodal transcranial direct current stimulation (tDCS) over the posterior parietal cortex (PPC) and frontal eye field (FEF) of the right hemisphere in healthy subjects to modulate attentional orienting and disengagement in a gap-overlap task. Both stimulations led to bilateral improvements in saccadic reaction times (SRTs), with larger effects for gap trials. However, analyses showed that the gap effect was not affected by tDCS. Importantly, we observed significant effects of baseline performance that may mediate side- and task-specific effects of brain stimulation.

Background Anatomic variation may increase the difficulty and risk of anatomic segmentectomy. The preoperative three-dimensional computed tomography bronchography and angiography (3D-CTBA) can provide a detailed model of the segmental structure, and contribute to precise and safe segmentectomy. Case presentation This is a case of anomalous bronchi and pulmonary vessels in the right upper posterior segment (RS2). Under the guidance of 3D-CTBA, anatomic RS2 segmentectomy was performed accurately and safely. The postoperative condition was uneventful. Conclusions This rare case highlights the importance of 3D-CTBA to guild accurate segmentectomy with anatomic variation.

Aim: to assess biliary anatomical variants in potential living liver transplant donors using Yoshida classification.Patients and methods: the study was carried out on 54 potential living liver transplantation donors. The donors were randomly selected and evaluated with preoperative MRCP. All candidates’ pattern of biliary tree was classified according to Yoshida classification.Results: The most common biliary tree arborizing pattern was bifurcation of the right and left ducts (RL) with 40 candidates (74.04%). The second most common pattern was A-PL where right posterior intrahepatic duct joins the left hepatic duct, then they both join the right hepatic duct to form the common hepatic duct, this pattern was seen in 9 candidates (16.66%). Least common was the trifurcation pattern (APL), seen in 5 candidates (9.25%).Conclusion: Preoperative MRCP is an essential step in evaluating potential living liver transplant donors. As a non-invasive technique, MRCP can safely and accurately delineate the branching pattern of biliary tree, guiding the surgical team and reducing post-operative complications.

Hidradenitis suppurativa is a chronic, recurrent follicular-based inflammatory condition classically occurring in apocrine-rich areas; commonly affected areas include the anogenital, axillary, inframammary, and inguinal regions. Infrequently, hidradenitis suppurativa can occur in locations where apocrine glands are scant or absent; in this setting, it has been referred to as ectopic hidradenitis suppurativa. The case of a 59-year-old man with ectopic hidradenitis suppurativa on his right posterior thigh is described. The postulated pathogenesis, treatment modalities, and various reported locations of ectopic hidradenitis suppurativa are reviewed.

Intracranial aneurysms (ICAs) are focal dilatations that imply a weakening of the brain artery. Incidental rupture of an ICA is increasingly responsible for significant mortality and morbidity in the American’s aging population. Previous studies have quantified the pressure-volume characteristics, uniaxial mechanical properties, and morphological features of human aneurysms. In this pilot study, for the first time, we comprehensively quantified the mechanical, collagen fiber microstructural, and morphological properties of one resected human posterior inferior cerebellar artery aneurysm. The tissue from the dome of a right posterior inferior cerebral aneurysm was first mechanically characterized using biaxial tension and stress relaxation tests. Then, the load-dependent collagen fiber architecture of the aneurysm tissue was quantified using an in-house polarized spatial frequency domain imaging system. Finally, optical coherence tomography and histological procedures were used to quantify the tissue’s microstructural morphology. Mechanically, the tissue was shown to exhibit hysteresis, a nonlinear stress-strain response, and material anisotropy. Moreover, the unloaded collagen fiber architecture of the tissue was predominantly aligned with the testing Y-direction and rotated towards the X-direction under increasing equibiaxial loading. Furthermore, our histological analysis showed a considerable damage to the morphological integrity of the tissue, including lack of elastin, intimal thickening, and calcium deposition. This new unified characterization framework can be extended to better understand the mechanics-microstructure interrelationship of aneurysm tissues at different time points of the formation or growth. Such specimen-specific information is anticipated to provide valuable insight that may improve our current understanding of aneurysm growth and rupture potential.

Openness to experience (OTE) has relatively stable and heritable characteristics. Previous studies have used candidate gene approaches to explore the genetic mechanisms of OTE, but genome-wide polygenic scores have a greater genetic effect than other genetic analysis methods, and previous studies have never examined the potential effect of OTE on this cumulative effect at the level of the brain mechanism. In the present study, we aim to explore the associations between polygenic scores (PGSs) of OTE and brain structure and functions. First, the results of PGSs of OTE at seven different thresholds were calculated in a large Chinese sample (N = 586). Then, we determined the associations between PGSs of OTE and cortical thickness and functional connectivity. The results showed that PGSs of OTE was negatively correlated with the thickness of the fusiform gyrus, and PGSs of OTE were negatively associated with the functional connectivity between the left intraparietal sulcus (IPS) and the right posterior occipital lobe. These findings may suggest that the brain structure of fusiform gyrus and brain functions of IPS and posterior occipital lobe are partly regulated by OTE-related genetic factors.

Object With the gradual advancement of laparoscopic technology, surgeries can be successfully performed with the help of laparoscopy increasingly. This study initially explored the difference between laparoscopic right posterior sectionectomy (LRPS) and open right posterior sectionectomy (ORPS)of liver in our center, discussed the effectiveness, benefits and safety of LRPS and introduce some surgical techniques in our center. Materials and methods We retrospectively analyze 96 cases of liver tumor located in the right posterior lobe of liver in our institution from January 2015 to January 2018. There were 46 cases performed the LRPS surgery and 50 cases performed the ORPS surgery. Through analysis of the perioperative outcomes of these two groups by a case control study, we compare the differences between these two groups. Results There was no significant difference between the LRPS and ORPS group in demographic and baseline characteristics before surgery. Patients in the LRPS group were significantly superior to ORPS in terms of postoperative liver function recovery, postoperative inflammatory factor level, pain sensation (3.03 ± 0.79 vs 4.58 ± 1.25), abdominal incision length (6.25 ± 2.34 vs 32.15 ± 3.21), carrying abdominal drainage tube time (3.26 ± 0.77 vs 4.83 ± 0.76), recovery of bowel function time (1.6 ± 0.61 VS 3.05 ± 0.85)and postoperative hospital stay (5.73 ± 0.99 vs 7.16 ± 0.95) (P Conclusion Compared with the traditional ORPS, LRPS has the advantages of minor injury, faster recovery and mild inflammatory reaction. The LRPS is safe and feasible, and it should be gradually promoted in clinical practice.

Aging is associated with structural and functional changes in the hippocampus, and hippocampal dysfunction represents a risk marker of Alzheimer’s disease. Previously, we demonstrated age-related changes in reactive and proactive control in the stop signal task, each quantified by the stop signal reaction time (SSRT) and sequential effect computed as the correlation between the estimated stop signal probability and go trial reaction time. Age was positively correlated with the SSRT, but not with the sequential effect. Here, we explored hippocampal gray matter volume (GMV) and activation to response inhibition and to p(Stop) in healthy adults 18 to 72 years of age. The results showed age-related reduction of right anterior hippocampal activation during stop success vs. go trials, and the hippocampal activities correlated negatively with the SSRT. In contrast, the right posterior hippocampus showed higher age-related responses to p(Stop), but the activities did not correlate with the sequential effect. Further, we observed diminished GMVs of the anterior and posterior hippocampus. However, the GMVs were not related to behavioral performance or regional activities. Together, these findings suggest that hippocampal GMVs and regional activities represent distinct neural markers of cognitive aging, and distinguish the roles of the anterior and posterior hippocampus in age-related changes in cognitive control.

Introduction: Many new objective tests to assess the function of specific structures of the vestibular organ are currently adopted in vestibular clinics. One of the objective assessments include the video head impulse test (vHIT) where gain & velocity responses of eye relative to the head movements are recorded using an infrared camera. Methods: Thirty normal hearing subjects age between 18 to 25 years old participated in this study. At least ten Lateral, Left Anterior Right Posterior (LARP), and Right Anterior Left Posterior (RALP) responses were recorded for each participant by making small and rapid unpredictable head movements. Results: The average velocity gain for Lateral responses at 40 ms, 60 ms and 80 ms were 1.05 ± 0.003, 1.03 ± 0.002 and 1.01 ± 0.003 respectively. The LARP average velocity regression were 1.01 ± 0.24 for Left Anterior and 1.05 ± 0.25 for Right Posterior, with an average gain asymmetry of 5.13%. The RALP average velocity regression were 1.08 ± 0.31 for Right Anterior and 1.12 ± 0.30 for Left Posterior, with an average gain asymmetry of 5.87%. One sample T-test were conducted to compare Lateral responses to a previous study by Mossman et al. (2015) where significant differences in velocity gain at 60 ms and 80 ms between studies were found where, t (59) = 5.56, p < 0.01 respectively. Conclusion: This indicates the importance of establishing on-site norms for every clinical settings as techniques used and equipment differences could affect the results.

Introduction Ganglioneuroma is a rare benign nervous tumor arising from sympathetic ganglion which commonly occurs at posterior mediastinum, retroperitoneum and adrenal gland. Case We report a 6 year-old boy who presented with abdominal pain. CT scan and MRI showed one tumor at his right posterior mediastinum area measuring 8.3 × 6.3 × 5.3cm, and the other tumor at his right adrenal gland measuring 3.9 × 3.4 × 3.2 cm. A biopsy showed ganglioneuroma, and complete resection of both tumors was performed. Post operative biopsy confirmed definitive diagnosis as ganglioneuroma. The patient is well after surgery. Conclusion Ganglioneuroma is benign and treatment is complete surgical resection. Prognosis after surgical resection seems to be so good, without any recurrences or need for adjunct therapy.

Background Laparoscopic anatomical resection (LAR) is a highly challenging procedure. This study aimed to describe our experience of the LAR with an indocyanine green fluorescence negative staining (ICGNS) by the Glissonean pedicle transection (Takasaki) approach. Methods From April 2017 to December 2019, 43 consecutive patients underwent LAR with ICGNS strategy in our medical team. The details of the ICGNS strategy were described. The demographic and clinicopathological data of the included patients were retrospectively analyzed. Results The extent of resections included right hemihepatectomy (n = 12), left hemihepatectom (n = 4), left lateral sectionectomy (n = 3), Right anterior sectionectomy (n = 3), Right posterior sectionectomy (n = 6), central hepatectomy (n = 2), single anterolateral segmentectomy (n = 5), single posterosuperior segmentectomy (n = 6), and bisegmentectomy (n = 2). The mean operation time was 212 ± 53 min, and the median estimated blood loss was 200 (100–300) ml. The overall complication rate was 30.2% (grade I, 14%; grade II, 14%; grade III, 2.3%). The median duration of postoperative hospital stay was 6 (4–7) days. Conclusion ICGNS is a safe and feasible LAR strategy that greatly facilitates selecting the liver transection plane, although its benefits need to be verified by large-sample comparative studies.

The enlarged number of powerful vehicles in our country led to an increased speed of travel and hence the high number of traffic accidents with severe consequences, even death. Along with polytrauma caused by occupational accidents, these types of traumas require complex and often multidisciplinary surgical therapy against the clock, which places the surgeon in front of situations that are not found in the everyday practice. Injuries involving damage to the thoracic-phreno-abdominal region fall into this specific category that we have chosen to discuss in the present work. We will further present three clinical cases of patients with thoraco-phreno-abdominal injuries produced by different mechanisms. A work-accident wound produced by an angle grinder, causing left thoracoabdominal injuries; a polytrauma caused by a road accident, with a thoraco-phreno abdominal wound produced by a piece of wood that penetrated obliquely through the right thorax, in the 5th and 6th intercostal spaces, crossed the right lower lung lobe, the diaphragm, the 7th liver segment, and stopped in the right posterior costal grid, and a polytrauma following a fall from a height, with a torn diaphragm and mesentery.

A 55-year-old man with no comorbidities presented with sudden-onset holocranial headache, vomiting, and transient loss of consciousness. Examination was normal except for retinal arterio-venous malformations in the right eye (figure, A). MRI brain showed subacute hematoma in the right parieto-temporo-occipital region and frontal horn of the right lateral ventricle. Digital subtraction angiography showed arterio-venous malformations along the right ophthalmic artery and right posterior temporal region, suggestive of cerebrofacial arteriovenous metameric syndrome (CAMS) type 2 (figure, B–D). He was managed conservatively and is asymptomatic at 2 months follow-up. Fundus examination can be a diagnostic clincher for CAMS in adults with intracranial haemorrhages.1,2

Background Sodium oligomannate (GV-971), a marine-derived oligosaccharide, is a novel agent that may improve cognition in AD patients. Methods The 24-week multicenter, randomized, double-blind, placebo parallel controlled clinical trial was conducted in AD in China between 24 October 2011 and 10 July 2013. The study included a 4-week screening/washout period, followed by a 24-week treatment period. Patients were randomized in a 1:1:1 ratio to receive GV-971 900 mg, 600 mg, or placebo capsule in treatment period, respectively. The primary outcome was cognitive improvement as assessed by changes in Alzheimer’s Disease Assessment Scale-cognitive subscale 12-item (ADAS-cog12) scores from baseline to week 24. The secondary efficacy outcomes included CIBIC-Plus, ADCS-ADL, and NPI at 24 weeks after treatment compared with baseline. A subgroup study was assessment of the change in cerebral glucose metabolism by fluorodeoxyglucose positron emission tomography measurements. Results Comparing with the placebo group (n = 83, change − 1.45), the ADAS-cog12 score change in the GV-971 600-mg group (n = 76) was − 1.39 (p = 0.89) and the GV-971 900-mg group (n = 83) was − 2.58 (p = 0.30). The treatment responders according to CIBIC-Plus assessment were significantly higher in the GV-971 900-mg group than the placebo group (92.77% vs. 79.52%, p p = 0.05. The respective rates of treatment-related AEs were 5.9%, 14.3%, and 3.5%. Conclusions GV-971 was safe and well tolerated. GV-971 900 mg was chosen for phase III clinical study. Trial registration ClinicalTrials.gov, NCT01453569. Registered on October 18, 2011.

Sustained attention is supported by circuits in the frontoparietal attention network. In human and primate studies, the right posterior parietal cortex (PPC) shows dominance for sustained attention, and phase-amplitude coupling (PAC) throughout the frontoparietal network correlates with performance on attention tasks. Here we evaluate oscillatory dynamics of bilateral PPC in mice during the 5-Choice Serial Reaction Time Task (5-CSRTT). Right PPC theta-gamma PAC (TG-PAC) and gamma power were independently elevated to a greater degree than the left PPC during the period prior to a correct response and were significantly correlated with accuracy in both simple and difficult tasks. Greater task difficulty was also associated with greater hemispheric asymmetry in TG-PAC, favoring the right PPC. These findings highlight the engagement of PPC with sustained attention in mice, reflected by increases in TG-PAC and gamma power, with maximal expression in the right hemisphere.

The preference for taking risk troubles people across multiple domains including health, economics, and social well-being. Prior research has demonstrated that risk preference can be influenced by time perspective (TP). However, little is known about the neural substrates underlying the effect of TP on risk preference. Here, we used a voxel-based morphometry (VBM) method across two samples to address this question. In Sample 1, the behavioral results showed a positive correlation between present hedonistic TP (PHTP) and gambling rate (the index of risk preference), indicating the higher PHTP, the greater the preference for risk. Subsequently, the whole-brain VBM results found that gambling rate was negatively correlated with the gray matter (GM) volume of a cluster in the right posterior parietal cortex (rPPC). The PHTP score was also negatively related to the GM volume of another cluster in the rPPC. We then examined an overlapping region in the rPPC using a conjunction analysis method. The GM volume of this overlapping brain region was related to both PHTP score and gambling rate. Finally, the mediation analysis found that the GM volume of overlapping region in rPPC played a role in explaining the effect of PHTP on risk preference. This result was also reproduced and validated in another independent sample. Taken together, our findings manifest that the structural variation of rPPC can account for the influence that PHTP has upon the risk preference.

The clinical significance of the right posterior segment (RPS) graft in living donor liver transplantation (LDLT) is unknown because of its limited use and technical concerns. This study aimed to review published studies investigating outcomes of RPS grafts. The systematic literature search was conducted to retrieve data from Embase, Medline Ovid, Web of Science, Cochrane CENTRAL, and Google Scholar. Among the 388 articles, six retrospective studies from Asian countries were included. The overall incidences of major and minor complications after RPS graft procurement were 5.6% and 34.6%, respectively and no donor deaths were reported. RPS graft recipients had the following postoperative complications: overall mortality rate, 14.5%; bile leakage, 8.7%, biliary stenosis, 18.8%, hepatic artery thrombosis, 8.7%, and liver re-transplantation, 2.9%. The RPS graft can be considered as an option for a living liver graft respecting donor safety under strict selection criteria and surgical strategy. The precise evaluation and understanding of anatomical variations and volumetric analyses is critical for selecting donors and planning the surgical strategy in the RPS grafts procurement. The RPS grafts procurement requires carefully dissection of the hepatic artery and portal vein, safely confirmation of the bile duct, and precisely parenchymal transection. However, further experience is needed to clarify the significance of the RPS graft in LDLT. The special technical requirements should limit this donor procedure to centers with a high level of experience in LDLT.

Introduction: Adenosquamous carcinoma (ASC) of the head and neck is a rare malignant tumor, with one hundred cases diagnosed so far in the literature. Observation: A 66 years old female patient had a ASC of the right posterior floor of the mouth with a classification T1N0M0. Treatment consisted of surgical management and active surveillance. Discussion: Through this case report, we present this type of tumor and we discuss the main differential diagnosis from a clinical and histological point of view. Conclusion: This entity was described for the first time in 1968 by Gerughty. The CAS is defined by the World Health Organization as “a tumor of the upper respiratory tract, with two distinct squamous and glandular components.” The CAS is considered as an aggressive tumor with a redoubtable prognosis should not be ignored.