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Aberrant right gastric veins (ARGV) represent rare anatomical variations that can result in hepatic pseudolesions, mimicking malignancies due to their atypical drainage directly into the liver parenchyma. This case highlights a 44-year-old woman initially presenting with a breast mass incidentally found to have an ARGV-related pseudolesion in hepatic segment IVa. ARGV is clinically significant as it can alter hepatic blood flow dynamics, leading to hyperdense or hypodense regions on imaging. Recognizing these pseudolesions is essential to avoid misdiagnosis, unnecessary procedures, and to distinguish them from true hepatic lesions. This case emphasizes the importance of advanced imaging modalities in diagnosing such anomalies, ensuring accurate patient management.

Iliac artery aneurysms commonly present in patients with associated aortic disease. Isolated aneurysms of the iliac arteries are uncommon, mostly involving the common iliac artery. Isolated external iliac artery aneurysms are the rarest iliac aneurysmal pathology. We present the case of an asymptomatic isolated external iliac artery aneurysm with no other concomitant vascular disease in a middle-aged man, treated with a stent graft.

A limb shaking TIA is a less common form of TIA that manifests as involuntary movement and is frequently confused with focal motor epilepsy. A 64-year-old female presented with a 7-month history of episodic involuntary shaking movements affecting her left arm and leg before admission. These attacks primarily occurred after she rose from a sitting or lying down position to a standing position, and were relieved by simply returning to a sitting or lying position. A neurological examination revealed no motor or sensory deficits in either extremity. Her magnetic resonance angiogram (MRA) and carotid Doppler revealed right ICA stenosis in her brain. It is important to distinguish this limb shaking TIA from other conditions such as focal motor seizures. Importantly, early detection and treatment of the associated carotid artery occlusion can not only prevent the patient's TIA episode, but also lower the risk of future stroke.

A 17-year-old athlete was initially diagnosed with presumed hypertrophic cardiomyopathy, marked by deep inferolateral T-wave inversions and mild anteroseptal hypertrophy on electrocardiogram and imaging studies. Remarkably, 6 years later, following detraining, all diagnostic signs completely resolved. This case underscores the significance of vigilant athlete follow-up.

To evaluate retrospectively the incidence of central precocious puberty (CPP) during the COVID 19 lockdown and comparing the data with the corresponding data from the previous 2 years. The study included 23 girls with CPP and 14 patients with early puberty. Nineteen patients were newly diagnosed with CPP compared to 4 patients diagnosed with CPP during the previous 2 years. The number of new patients diagnosed with CPP was significantly higher than the mean during the previous 2 years ( P

Background:. Artificial intelligence (AI) leverages today’s exceptional computational powers and algorithmic abilities to learn from large data sets and solve complex problems. The aim of this study was to construct an AI model that can intelligently and reliably recognize the anatomy of cleft lip and nasal deformity and automate placement of nasolabial markings that can guide surgical design. Methods:. We adopted the high-resolution net architecture, a recent family of convolutional neural networks–based deep learning architecture specialized in computer-vision tasks to train an AI model, which can detect and place the 21 cleft anthropometric points on cleft lip photographs and videos. The model was tested by calculating the Euclidean distance between hand-marked anthropometric points placed by an expert cleft surgeon to ones generated by our cleft AI model. A normalized mean error (NME) was calculated for each point. Results:. All NME values were between 0.029 and 0.055. The largest NME was for cleft-side cphi. The smallest NME value was for cleft-side alare. These errors were well within standard AI benchmarks. Conclusions:. We successfully developed an AI algorithm that can identify the 21 surgically important anatomic landmarks of the unilateral cleft lip. This model can be used alone or integrated with surface projection to guide various cleft lip/nose repairs. Having demonstrated the feasibility of creating such a model on the complex three-dimensional surface of the lip and nose, it is easy to envision expanding the use of AI models to understand all of human surface anatomy—the full territory and playground of plastic surgeons.

Alkaptonuria is a rare autosomal recessive metabolic disorder. It is characterized by the accumulation of homogentisic acid in the body due to a lack of enzymes that degrade it. Over time, it results in joint degeneration and eventually leads to ochronosis. Ochronosis refers to bluish-black discoloration of connective and other tissues within the body. In this study, we present 5 distinct cases diagnosed with alkaptonuria. They have undergone 8 total joint replacement surgeries (4 hips and 4 knees) within 8 years (2010-2018). All patients had an excellent outcome over several years. The follow-up period ranged from 2 to 10 years. Although none of the presented cases had intraoperative or postoperative adverse sequelae, we must take care when dealing with patients with ochronotic arthropathy. They carry a higher risk of complications than other patients with osteoarthritis disease. These complications include fractures due to fragile bone quality, muscle or tendon rupture, joint instability, and anesthesia-related complications. Total joint arthroplasty is a valid and safe option in the management of hip and knee ochronotic arthropathy.

Retino- and neuroblastoma are primitive neuroectodermal tumors which share common histology, and embryological origin. However, no apparent correlation was found that can link them both such as common genes. Our patient had retinoblastoma which was surgically treated with low-dose chemotherapy. After three years, he evolved a neuroblastoma despite the chances for this concurrence being less than 1 in 10 billion for having both tumors in one patient. Therefore, a link was speculated with the chemotherapy as the patient might previously have a favorable, undetectable neuroblastoma and transformation occurred. Nevertheless, this is the second case in which a neuro- and retinoblastoma concurred. Keywords: Retinoblastoma, Neuroblastoma, Transformation

Background:. Middle Eastern women worldwide increasingly seek aesthetic treatment to enhance their beauty and improve self-esteem, but literature describing standards of beauty across the Middle East are scarce. Knowledge of facial anthropometry and Middle Eastern subregional beauty preferences and aesthetic weaknesses are key to develop an effective facial enhancement strategy that does not jeopardize ethnic identity or facial harmony. Methods:. Dermatologists and plastic surgeons from 8 Middle Eastern countries who had 7.5–25 (mean 13.5) years of experience in aesthetic medicine examined female Middle Eastern beauty in 4 geographic subregions: the Gulf (comprising Bahrain, Kuwait, Saudi Arabia, and the United Arab Emirates), Iran, Lebanon, and Egypt. They developed consensus opinions regarding facial beauty, aesthetic deficiencies, and injectable treatment solutions. Results:. Facial anthropometry differs between Middle Eastern and Western women, and also within the region. Although subregional differences are seen, beauty is generally recognized by an oval or round face; temple fullness; pronounced, elevated, arched eyebrows; large almond-shaped eyes; well-defined, laterally full cheeks; a small, straight nose; full lips; a well-defined jawline; and a prominent, pointed chin. The relative prominence of the nose necessitates attention to the lips and the shape and projection of the chin. Aging is often accompanied by midface sagging that leads to increased heaviness in the lower facial third. Conclusions:. Middle Eastern beauty is characterized by striking eyes, defined cheeks, and full lips. These consensus opinions inform aesthetic practitioners who treat Middle Eastern women worldwide about their aesthetic ideals and the implications for treatment.

Objective To assess the prevalence of laryngeal muscle tension patterns among patients with functional dysphagia. Study Design Retrospective study. Setting The study took place at a university medical center. Material and Methods The medical charts and laryngeal video recordings were reviewed for all patients who presented with dysphagia and who were referred for barium swallow between 2012 and 2017. A total of 170 cases were identified. Only those with normal findings on barium swallow and the absence of vocal fold pathology (exudative lesions, masses or tumors, paresis, and paralysis), referred to as functional dysphagia , were included in this study. Information retrieved included swallowing and phonatory symptoms in addition to patterns of laryngeal muscle tension. Results The mean ± SD age of the total group was 41.90 ± 15.10 years with a male:female ratio of 4:1. Seventy-five percent had evidence of at least 1 type of laryngeal muscle tension pattern. The most common pattern was type III, characterized by supraglottic anteroposterior compression (13 of 20), followed by type II, characterized by medial compression of the false vocal folds (5 of 20); only 1 patient had muscle tension pattern type IV, characterized as sphincter-like closure of supraglottic structures. The most common laryngopharyngeal symptom was throat discomfort when swallowing (35%), followed by throat clearing and choking/coughing when eating and drinking (25%). Conclusion The high prevalence of laryngeal muscle tension pattern among patients with functional dysphagia supports the notion that laryngeal tension may be one of the underlying causes of dysphagia.

Background: The incidence of adult patients with falls seeking medical assistance in the Salt Lake City area, Utah, is 28,000 per million adult inhabitants. Objective: We sought to evaluate the prevalence of cardiovascular risk assessment and cardiovascular abnormalities in patients presenting with nonaccidental falls at the University of Utah hospital and its affiliated clinics. Methods: We conducted a search of all patients in the University of Utah patient database as well as 9 affiliated primary care and family practice clinics in Utah who were evaluated for a “fall” during October 2009. We analyzed the records of 338 patients who had a fall within the previous 3 months. Nonaccidental falls were defined as falls unrelated to a contact incident or “slip or trip.” Results: Nonaccidental falls occurred in 81 (24%) patients, 39 of these being ≥65 years old. Cardiovascular risk assessment and specifically orthostatic testing were evaluated in 40% and 3% of the patients, respectively. In patients ≥65 years old, the prevalence of cardiovascular risk assessment, orthostatic testing, and carotid sinus massage were equally low at 56%, 5%, and 0%, respectively. Cardiovascular abnormalities were present in 17 (21%) patients, with 9 of them being referred for cardiac evaluation. Conclusion: Our results highlight the inconsistent assessment of potential cardiovascular risk factors in patients with nonaccidental falls, supporting the adoption of a standardized approach in these patients.

Background: Osteoarthritis (OA) is a degenerative joint disease that results in the destruction of cartilage. Edible Bird's Nest (EBN) extract contains important components, which can reduce the progression of osteoarthritis and helps in the regeneration of the cartilage. The present study aimed to investigate the effect of EBN extract on the catabolic and anabolic activities of the human articular chondrocytes (HACs) isolated from the knee joint of patients with OA. Methods: A single batch of EBN extract was prepared with hot-water extraction and coded as HMG. HACs were isolated from the knee joint cartilage removed during surgery. The optimum concentration of HMG for HAC cultures was determined using MTT assay. The effect of HMG on the catabolic and anabolic genes' expression in HACs was measured by real-time PCR. The total amount of prostaglandin E2 (PGE2) production was determined by ELISA method, and the total sulphated glycosaminoglycan (GAGs) production was quantified by 1,9-dimethylmethylene blue (DMMB) assay. Results: MTT assay showed 0.50% - 1.00% HMG supplementation promoted HACs proliferation. HMG supplementation was able to reduce the catabolic genes' expression in cultured HACs such as matrix metalloproteinases (MMP1 & MMP3), Interleukin 1, 6 and 8 (IL-1, IL-6 & IL-8), cyclooxygenase-2 (COX-2) and inducible nitric oxide synthase (iNOS). Prostaglandin E2 (PGE2) production was significantly reduced in HAC cultures supplemented with HMG. With regard to anabolic activity assessment, type II collagen, Aggrecan and SOX-9 gene expression as well as sGAG production was increased in the HMG supplemented groups. Conclusion: Edible Bird's Nest extract coded as HMG demonstrated chondro-protection ability on human articular chondrocytes in vitro. It reduced catabolic activities and increased cartilage extracellular matrix synthesis. It is concluded that HMG is a potential agent in the treatment of osteoarthritis. [ABSTRACT FROM AUTHOR]

Purpose: To develop a no-code artificial intelligence (AI) model capable of identifying primary proximal surface caries using bitewings among pediatric patients. Methods: One hundred bitewing radiographs acquired at pediatric dental clinics were anonymized and reviewed. The inclusion criteria encompassed bitewing radiographs of adequate diagnostic quality of primary and mixed-dentition stages. The exclusion criteria included artifacts related to sensors' quality, positioning errors, and motion. Sixty-six bitewing radiographs were selected. Images were uploaded to LandingLens™, a no-code AI platform. A calibrated consensus panel determined the presence or absence of proximal caries lesions on all surfaces (using ground truth labeling). The radiographs were divided into training (70 percent), development (20 percent), and testing (10 percent) subsets. Data augmentation techniques were applied to artificially increase the sample size. Sensitivity, specificity, accuracy, precision, F1-score, and receiver operating characteristic area under the curve (ROC-AUC) were calculated. Results: Among the 755 proximal surfaces identified from 66 bitewings, 178 were annotated as caries lesions by experts. The model achieved the following metrics: 88.8 percent sensitivity, 98.8 percent specificity, 95.8 percent precision, 96.4 percent accuracy, and an F1-score of 92 percent by surface. The ROC-AUC was 0.965. Conclusions: The developed model demonstrated strong performance despite the limited dataset size. This may be attributed to the exclusion of unsuitable radiographs and the use of expert-labeled ground truth annotations. The utilization of no-code artificial intelligence may improve outcomes for computer vision tasks.

Background: Special approval medicines (SAMs) are medicines used with approval from the Director General of Health Malaysia when the therapeutic options within regulatory and formulary boundaries appear unsuitable or ineffective to treat the patients., Objectives: To examine and characterize the use of SAMs among children in a Malaysian tertiary care hospital., Methods: The named-patient basis SAM application forms, cover letter, pharmacist review summary and patient monitoring forms available at the Pharmacy Department between 1st January 2019 and 31st December 2020 were reviewed. Unprocessed, unapproved and stock-basis applications were excluded. The outcome measures were categories, scope, off-label use and cost of SAM. Per-patient data were analyzed descriptively., Results: Overall, 1010 patients (mean age of 8.7 ± 5.6 years) were involved in 328 SAMs applications. The most common SAMs pharmacological groups were nervous system ( n = 371, 36.7%) and antineoplastic and immunomodulating agents ( n = 332, 32.9%). Top three SAMs were melatonin (11.5%), scopolamine (7.6%) and cholecalciferol (7.1%). A total of 837 (82.9%) and 513 (50.8%) patients were involved in the SAMs applications for non-formulary and unregistered medicines, respectively. Unregistered, non-formulary medicines were applied for 47.3% ( n = 478) of the patients. The majority of the scope for SAMs (64.7%) were to substitute the available alternatives in the national formulary which were ineffective or sub-optimal for the patients. Among the 262 patients with repeat applications, 93.8% reported disease or symptom improvement while 1.9% experienced side effects. Up to 17% of SAMs analyzed in this study were used for off-label indications. The total cost of the SAMs was RM8,748,358.38 (USD 2,090,418.86)., Conclusion: The use of SAMs among children in this hospital involved unregistered, non-formulary medicines used to substitute the available alternatives in the formulary. A concerted effort is warranted in exploring supplementary mechanisms to enhance the medicine registration process and formulary system towards facilitating enhanced provision of treatment for children., Competing Interests: The authors declare no competing interests., (© 2022 The Authors.)

Tumors of the head and neck can spread by direct extension, hematogenous spread, or lymphatic dissemination. However, a process known as perineural invasion (PNI) allows nerves to act as a direct conduit for tumor growth away from the primary site. Perineural invasion is a rare, atypical presentation of cutaneous squamous cell carcinoma of the head and neck that affects about 2.5%-14% of the population. It is known to be associated with an increased risk of local recurrent and distant metastasis, thus adversely affecting the patient's prognosis. The majority of PNI cases are asymptomatic, often discovered during pathological evaluation. We report the case of a patient who presented with a 1-year history of right-sided face pain and symptoms suggestive of trigeminal facial neuralgia. A skin biopsy taken from a lesion on his right cheek showed PNI secondary to cutaneous squamous cell carcinoma of the head and neck. We treated the patient with radiotherapy and chemotherapy and his clinical condition improved significantly. We are publishing this case report to increase awareness of practicing physicians and nurses to PNI as an atypical presentation of squamous cell carcinoma that may affect selection of treatment modality and the patient's prognosis., Competing Interests: The authors declare that they have no conflict of interest., (Copyright © 2021 International Society of Plastic and Aesthetic Nurses. All rights reserved.)

Background: The World Health Organization proclaimed the period between 2000 and 2010 as the Bone and Joint Decade (BJD). The BJD initiative set out to raise awareness regarding increasing incidence of musculoskeletal (MSK) conditions. The objective of this study was to assess the degree to which the BJD goals were met in Kuwait., Methods: A gap analysis methodology was used to identify differences between the ideal state, defined as achieving the BJD goals, and the current state, defined as the extent to which BJD goals were achieved., Results: Our gap analysis indicated that the majority of the BJD targets were not met in Kuwait; however, given the rising assumed incidence and prevalence of MSK disorders in Kuwait, it is critical to outline mechanisms for moving forward., Conclusions: The BJD goals are reachable in Kuwait. Attaining them requires a strong and sustainable commitment at many levels of government, provider organizations and the research community., (Copyright © 2013 Longwoods Publishing.)

Adenylyl cyclase (AC) signaling pathways have been identified in a model hair cell preparation from the trout saccule, for which the hair cell is the only intact cell type. The use of degenerate primers targeting cDNA sequence conserved across AC isoforms, and reverse transcription-polymerase chain reaction (RT-PCR), coupled with cloning of amplification products, indicated expression of AC9, AC7 and AC5/6, with cloning efficiencies of 11:5:2. AC9 and AC5/6 are inhibited by Ca(2+), the former in conjunction with calcineurin, and message for calcineurin has also been identified in the trout saccular hair cell layer. AC7 is independent of Ca(2+). Given the lack of detection of calcium/calmodulin-activated isoforms previously suggested to mediate AC activation in the absence of Gαs in mammalian cochlear hair cells, the issue of hair-cell Gαs mRNA expression was re-examined in the teleost vestibular hair cell model. Two full-length coding sequences were obtained for Gαs/olf in the vestibular type II-like hair cells of the trout saccule. Two messages for Gαi have also been detected in the hair cell layer, one with homology to Gαi1 and the second with homology to Gαi3 of higher vertebrates. Both Gαs/olf protein and Gαi1/Gαi3 protein were immunolocalized to stereocilia and to the base of the hair cell, the latter consistent with sites of efferent input. Although a signaling event coupling to Gαs/olf and Gαi1/Gαi3 in the stereocilia is currently unknown, signaling with Gαs/olf, Gαi3, and AC5/6 at the base of the hair cell would be consistent with transduction pathways activated by dopaminergic efferent input. mRNA for dopamine receptors D1A4 and five forms of dopamine D2 were found to be expressed in the teleost saccular hair cell layer, representing information on vestibular hair cell expression not directly available for higher vertebrates. Dopamine D1A receptor would couple to Gαolf and activation of AC5/6. Co-expression with dopamine D2 receptor, which itself couples to Gαi3 and AC5/6, will down-modulate levels of cAMP, thus fine-tuning and gradating the hair-cell response to dopamine D1A. As predicted by the trout saccular hair cell model, evidence has been obtained for the first time that hair cells of mammalian otolithic vestibular end organs (rat/mouse saccule/utricle) express dopamine D1A and D2L receptors, and each receptor co-localizes with AC5/6, with a marked presence of all three proteins in subcuticular regions of type I vestibular hair cells. A putative efferent, presynaptic source of dopamine was identified in tyrosine hydroxylase-positive nerve fibers which passed from underlying connective tissue to the sensory epithelia, ending on type I and type II vestibular hair cells and on afferent calyces., (Copyright © 2010 IBRO. Published by Elsevier Ltd. All rights reserved.)

Pituitary adenylyl cyclase-activating polypeptide (PACAP), via its specific receptor pituitary adenylyl cyclase-activating polypeptide receptor 1 (PAC1-R), is known to have roles in neuromodulation and neuroprotection associated with glutamatergic and cholinergic neurotransmission, which, respectively, are believed to form the primary basis for afferent and efferent signaling in the organ of Corti. Previously, we identified transcripts for PACAP preprotein and multiple splice variants of its receptor, PAC1-R, in microdissected cochlear subfractions. In the present work, neural localizations of PACAP and PAC1-R within the organ of Corti and spiral ganglion were examined, defining sites of PACAP action. Immunolocalization of PACAP and PAC1-R in the organ of Corti and spiral ganglion was compared with immunolocalization of choline acetyltransferase (ChAT) and synaptophysin as efferent neuronal markers, and glutamate receptor 2/3 (GluR2/3) and neurofilament 200 as afferent neuronal markers, for each of the three cochlear turns. Brightfield microscopy giving morphological detail for individual immunolocalizations was followed by immunofluorescence detection of co-localizations. PACAP was found to be co-localized with ChAT in nerve fibers of the intraganglionic spiral bundle and beneath the inner and outer hair cells within the organ of Corti. Further, evidence was obtained that PACAP is expressed in type I afferent axons leaving the spiral ganglion en route to the auditory nerve, potentially serving as a neuromodulator in axonal terminals. In contrast to the efferent localization of PACAP within the organ of Corti, PAC1-R immunoreactivity was co-localized with afferent dendritic neuronal marker GluR2/3 in nerve fibers passing beneath and lateral to the inner hair cell and in fibers at supranuclear and basal sites on outer hair cells. Given the known association of PACAP with catecholaminergic neurotransmission in sympathoadrenal function, we also re-examined the issue of whether the organ of Corti receives adrenergic innervation. We now demonstrate the existence of nerve fibers within the organ of Corti which are immunoreactive for the adrenergic marker dopamine beta-hydroxylase (DBH). DBH immunoreactivity was particularly prominent in nerve fibers both at the base and near the cuticular plate of outer hair cells of the apical turn, extending to the non-sensory Hensen's cell region. Evidence was obtained for limited co-localization of DBH with PAC1-R and PACAP. In the process of this investigation, we obtained evidence that efferent and afferent nerve fibers, in addition to adrenergic nerve fibers, are present at supranuclear sites on outer hair cells and distributed within the non-sensory epithelium of the apical cochlear turn for rat, based upon immunoreactivity for the corresponding neuronal markers. Overall, PACAP is hypothesized to act within the organ of Corti as an efferent neuromodulator of afferent signaling via PAC1-R that is present on type I afferent dendrites, in position to afford protection from excitotoxicity. Additionally, PACAP/PAC1-R may modulate secretion of catecholamines from adrenergic terminals within the organ of Corti.

Pituitary adenylyl cyclase-activating polypeptide (PACAP) is a neuropeptide originally isolated from the hypothalamus, named for its high potency in stimulating adenylyl cyclase in pituitary cells. PACAP acts through the specific receptor PAC1-R to modulate the action of neurotransmitters, and additionally, to regulate cell viability via autocrine/intracrine mechanisms. Evidence has now been obtained that PACAP and multiple splice variants of PAC1-R are expressed in the rat cochlea. mRNA for PACAP precursor protein is found by reverse transcription-polymerase chain reaction (RT-PCR) in microdissected cochlear lateral wall, organ of Corti, and spiral ganglion subfractions. A specific pattern of expression of mRNA for PAC1-R splice variants, which mediate the response to PACAP, has been revealed by RT-PCR and cloning for the cochlear subfractions. Transcript for the short form of PAC1-R is found in all three subfractions. Four additional splice variants -- hop1, hop2, hip, and a novel hop1 splice variant -- are expressed in the lateral wall. For the amino terminus splice region of PAC1-R, a new splice variant has been detected in the organ of Corti, representing a deletion of the first 7 of 21 amino acids detected in the PAC1-R very-short sequence. Overall, from message determinations in cochlear subfractions, there are five PAC1-R splice variants in the lateral wall, two in the organ of Corti and one in the spiral ganglion, indicating multiple possible responses to PACAP and/or mechanisms to modulate the response to PACAP in the cochlea. The variety of PAC1-R splice variants expressed may reflect the diversity in cell function between subfractions that is modulated by PACAP. The neuropeptide and its specific receptor have been immunolocalized in the lateral wall, the source of the largest number of cochlear PAC1-R splice variants. The receptor was targeted by primary antibodies which would elicit immunoreactivity for all splice variants of PAC1-R detected with RT-PCR, and evidence has been obtained with Western blot analysis suggesting that PAC1-R is glycosylated in vivo. Within the lateral wall, PACAP and PAC1-R were immunolocalized primarily to the stria vascularis, with immunoreactivity for both neuropeptide and receptor increasing from the basal to apical cochlear turns. Within the stria, PACAP immunoreactivity was localized to the basolateral extensions of marginal cells, while PAC1-R was clearly associated with tight junctions between the marginal cells close to the endolymphatic compartment. In addition, evidence was obtained that PAC1-R was associated with endothelial cells of the capillaries in the stria vascularis. The large number of splice variants expressed, coupled to the specificity in linkage between PAC1-R splice variants and G-protein-coupled second messenger pathways, could provide a mechanism to closely modulate tight junction integrity in the stria vascularis, impacting the endolymphatic potential.