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Distal femur fractures are about 7 % of all femur fractures.1 Being complex in nature management of these fractures is difficult; management is still a challenge in this technically advanced era. Fibular strut graft is one of the useful and simple options to manage defects in distal femur fractures. High velocity injuries causing open fractures may lead to infection and non-union of fracture if proper debridement and antibiotics are not used as per established protocol. Antibiotics can be given mixed with polymethyl-methacrylate (PMMA) cement formed in beads at the open fracture site or coated over a nail.2 This causes slow release of antibiotics and helps in control of infection. Local infection, damaged soft tissue, ischemia over fracture site, stabilisation of fracture, the hardware used and patient’s co morbidities all play a role in union and infection control of open fractures. Early detection of infection is important to avoid non-union and related complications. Distal femur juxta-articular fracture may develop infection due to fractures and unstable fixation more commonly. This may result in cavity formation and complications like osteomyelitis often leading to bone destruction and sequestrum formation. Its management becomes a challenging task for an orthopaedic surgeon.3- 9 The reconstructive methods are autogenous cortical bone, cancellous bone, allograft, bone substitutes like synthetic bone blocks and bone granules. Free bone transfer is crucial in reconstructing massive defects in distal femur fracture due to properties of rapid healing and being hypertrophic.7-13 Fibula is the best available option for grafting in massive defects of femur due to its characteristics like mechanical strength, length, minimum morbidity, and resistance to infection.3,11,13 A single fibula strut graft can give up to 26 cm of graft. The case reported here is of a patient of juxta-articular bone defect in an infected previously operated fracture distal femur using autologous fibular strut and iliac crest graft

Juxta-apical radiolucency (JAR) is a radiographic finding, which appears as a well circumscribed radiolucent area lateralto the root rather than at the apex of the mandibular third molars. Some authors suggested the presence of JAR beingassociated with the elevated risk of inferior alveolar nerve injury during wisdom tooth removal, while other studies failedto prove any correlations. The aim of the present study was to review the international literature and to describe the conceptof JAR for the Hungarian scientific literature. JAR is a common finding it is found in 33% of third molars. Based onliterature data it seems that the image of the JAR is created by the superimposition of cancellous bony architecture, andJAR per se is not a sign of increased risk for inferior alveolar nerve injury. However, knowledge of JAR is important forthe practicing dentists and oral surgeons both from a diagnostic and surgical point of view. Assessing the indication ofwisdom teeth removal or during dental foci examination a differential diagnostic problem may arise in connection withthe JAR. JAR may be an important factor when estimating the risk for inferior alveolar nerve injury since it may increasethe risk on its own and even make it more difficult to assess other risk factors.

Exploration of how U.S. military minority service members, including active-duty women, communicate personal and social identity remains an underexplored area of organizational communication resear...

Ligamentum flavum cyst of the lumbar spine has seldom been described. The mechanism of formation of these cysts remains unknown, but it is thought to be part of the degenerative process. Although they are clearly visible on imaging studies, these cysts are frequently wrongly diagnosed as ganglion or synovial cysts. Bone erosion is rarely associated with this pathology. Most common symptom is back and radicular pain due to nerve root compression. We report a case of ligamentum flavum cyst associated with bone remodeling presented with back and radicular pain. It was correctly diagnosed pre-operatively and treated surgically with satisfactory clinical outcome.

Early detection of all types of lung nodules with different characters in medical modality images using computer-aided detection is the best acceptable remedy to save the lives of lung cancer sufferers. But accuracy of different types of nodule detection rates is based on chosen segmented procedures for parenchyma and nodules. Separation of pleural from juxta-pleural nodules (JPNs) is difficult as intensity of pleural and attached nodule is similar. This research paper proposes a fully automated method to detect and segment JPNs. In the proposed method, lung parenchyma is segmented using iterative thresholding algorithm. To improve the nodules detection rate separation of connected lung lobes, an algorithm is proposed to separate connected left and right lung lobes. The new method segments JPNs based on lung boundary pixels extraction, concave points extraction, and separation of attached pleural from nodule. Validation of the proposed method was performed on LIDC-CT images. The experimental result confirms that the developed method segments the JPNs with less computational time and high accuracy.

Accidental injury of the internal carotid artery (ICA) remains one of the most challenging complications reported in the endoscopic endonasal transsphenoidal approaches (EETA) particularly, in sphenoid sinuses with ill-defined carotid bony landmarks. The purpose of this study was to describe an anatomical model for the endoscopic orientation of juxta-pituitary segment of ICA in relation to the lateral optico-carotid recess (OCR) as a nearby bony landmark. Cadaveric dissection was conducted progressively in twenty fresh adult cadavers simulating the EETA. After reducing posterior and lateral walls of sphenoid sinuses, various measurements were taken from both lateral OCRs to "contact points" of the juxta-pituitary segment of ICA and lateral margins of the pituitary gland. Current results have enabled us to divide the region between lateral OCRs into three compartments. Two lateral parasellar compartments contain juxta-pituitary segments of ICA showing a mean width of 8 mm; with a narrow range of 7–10 mm; and a central inter-carotid sellar compartment represents the safe region for bone drilling showing widely variable widths ranging between 9 to 20 mm. In all specimens; variation in the width of the inter-carotid compartment correlated with the distance between both lateral OCRs. This study improves surgeons’ awareness of the ICA course variations in the EETA through sphenoid sinuses with ill-defined bony landmarks. An appreciation of the measurements gathered from this study can help in operative training, and can also provide a base for future studies to confirm ICA courses associated with higher risk of injury.

Retroperitoneal schwannoma is a rare benign tumor of the peripheral nerve Schwann sheath. We, herein, report the case of a 74-year-old woman who presented with vague abdominal pain. Computed tomography imaging revealed a retroperitoneal mass that is medial to the right kidney. The patient underwent robotic excision of the tumor with the pathology revealing schwannoma. We report this case due to the scarcity of this disease entity, especially at this location and to emphasize the indication and value of robotic technology in different pathological processes retroperitoneally.

Objective This investigation compared the biomechanical properties of a 2.0 mm locking compression notched head T-plate (NHTP) and 2.0 mm straight locking compression plate (LCP), in a simple transverse juxta-articular fracture model. Study Design Two different screw configurations were compared for the NHTP and LCP, modelling short (configuration 1) and long working length (configuration 2). Constructs were tested in compression, perpendicular and tension non-destructive four point bending and torsion. Plate surface strain was measured at 12 regions of interest (ROI) using three-dimensional digital image correlation. Stiffness and strain were compared between screw configurations within and between each plate. Results The LCP was stiffer than the NHTP in all three planes of bending and torsion (p Conclusion In this experimental model, a 2.0 mm LCP with two screws in the short fragment was significantly stiffer and had lower plate strain than a 2.0 mm NHTP with three screws in the short fragment. Extending the working length significantly reduced construct stiffness and increased plate strain. These findings may guide construct selection.

Objective This investigation compared the biomechanical properties of a 2.0 mm locking compression notched head T-plate (NHTP) and 2.0 mm straight locking compression plate (LCP), in a compressed, short, juxta-articular fragment fracture model. Methods Two different screw configurations were compared for the NHTP and LCP, modelling short (configuration 1) and long working length (configuration 2). Constructs were tested in compression, perpendicular and tension four-point bending and torsion. Plate surface strain was measured at 12 regions of interest using three-dimensional digital image correlation. Stiffness and strain were compared. Results The LCP was stiffer than the NHTP in all three planes of bending (p Conclusion In this experimental model of a compressed transverse fracture with a juxta-articular 9 mm fragment, a 2.0 mm LCP with two hybrid screws in the short fragment was stiffer than a 2.0 mm NHTP with three locking screws in the short fragment in three planes of bending but not torsion. Extending the working length of each construct reduced construct stiffness and increased plate strain.

Intra- and juxta-articular osteoid osteoma (OO) is rare and can result in irreversible joint damage. Recently, arthroscopic surgery is being used more and more to avoid complications associated with other treatment modalities. On October 13, 2019, we conducted a systematic review of the literature available in PubMed and EMBASE regarding the arthroscopic management of OO involving the joints of the upper extremity. Predetermined inclusion criteria were used to include any relevant article published on and before that date for further analysis. Treatment success rate and tumor recurrence rate were considered the primary outcomes in our analysis. Out of 113 studies, 19 met our inclusion criteria. Of the 32 reported cases in these 19 articles, ten involved the shoulder joint, 19 involved the elbow joint and three involved the wrist joint. Overall treatment success rate was 93.8%. Tumor recurrence rate was 0.0%. No postoperative complications (0.0%) were reported among cases involving the shoulder joint. Two out of 24 (8.3%) patients with elbow OO failed arthroscopic treatment due to incomplete excision, and two (4%) experienced minor complications. Among the three cases of wrist OO, two (66.7%) patients had residual postoperative pain and decreased hand grip strength. Arthroscopic management of OO of the upper extremity joints is highly successful and results in no tumor recurrence; however, there is a risk of incomplete resection in areas more difficult to access by arthroscopy.

Purpose. Estimation the local efficacy of the combined treatment — brachytherapy (BT) with laser coagulation (LC) in choroidal melanomas of juxta and parapapillary localization in the long-term follow-up. Patients and Methods. In 2009–2013, 50 patients with choroidal melanoma of juxta and parapapillary localization were examined and treated, 32 women and 18 men aged from 32 to 76 years old (average — 53.8 ± 9.6 years). The averaged tumor height was 3.8 ± 1.3 mm, basal diameter — 11.2 ± 2.4 mm. The combined organ-preserving treatment included a LC from the optic disc with subsequent BT was performed. The indications for this method were choroidal melanomas of juxta and parapapillary localization (the distance between the optic disc and the central border of the tumor was no more than 1.5 pd), with the absence of subretinal exudate and retinal detachment in this zone. The follow-up period after the combined treatment ranged from 18 to 102 months (Me = 60 months). Results. Complete tumor resorption was achieved in the majority — 38 (76.0 %) of cases, partial — in 11 (22.0 %) patients, stabilization of the process — only in one (2.0 %) patient, continued growth was not observed in any patient. The initial size of melanoma in patients with complete and partial tumor resorption showed similar averaged values, amounting to 3.8 ± 1.3 mm and 3.6 ± 1.1 mm (p > 0.05), respectively, basal diameter — 11.1 ± 2.4 mm and 11.4 ± 2.4 mm (p > 0.05), respectively. According to the duplex scanning, an increase in the distribution density of bloodflow in the projection of the tumor focus was noted compared with the initial data. In the spectral Doppler flow analysis study, an increase in the linear characteristics of the blood flow in the tumor’s own vessels after LC was recorded. Complications included optic neuropathy (88 %), hemorrhage (36 %) and secondary glaucoma (6 %). Conclusions. The combined treatment allowed to achieve high therapeutic results — 76.0 % of the total resorption of choroidal melanomas, which have unfavorable localization for BT. Given the main focus of local treatment of the choroidal melanoma on its destruction, this technique can be used to increase the effectiveness of the BT of choroidal melanomas of juxta and parapapillary localization.

Eco-fashion brands strive to strike a balance between sustainability and product-related aspects. While much has been written on the branding of sustainable fashion, little is known about the posit...

BackgroundOsteoid osteoma (OO) is a common benign tumor in children and adolescents, but intra-and juxta-articular OO is rare and difficult to diagnose. The purpose of this study is to investigate the distinctions between intra- and juxta-articular OO, trying to avoid delaying diagnosis and optimize treatment strategies.MethodsThirty patients diagnosed with OO in the intra- and juxta joint at our institution who underwent surgical resection were included. Clinical and epidemiological factors, preoperative radiograph parameters, including CT, MRI, and bone scan, were documented. The outcomes of the involved extremity were evaluated at the final follow-up.ResultsMean age at diagnosis, interval time, and follow-up time was 8.37 ± 3.79 years old, 4.67 ± 5.88 months, 3.57 ± 2.18 years, respectively. Factors identified to be significantly associated with intra- and juxta-articular OO including pain with activity (p=0.004) and abnormal range of motion (p=0.00). The factor of abnormal range of motion (p=0.03) also influenced the existence of complications. Four children had a secondary operation to cure the recurrence.ConclusionIt is essential for clinicians and radiologists to be aware of the atypical clinical and radiographic features of intra- and juxta-articular OO, as the delayed diagnosis can lead to unnecessary pain and further complications after surgeries. The pain with activity and abnormal range of motion is helpful to identify the location of OO. The persistently abnormal range of motion also significantly leads to complications. The open surgeries to resect the nidus in juxta-articular OO were effective.Level of Evidence: Level IV-retrospective case series

Background Breast cancer is the most common cancer in women all over the world representing 18% of all women reported cases of cancer. It represents the leading cause of women mortality as representing 23% of all women cancer deaths. The decision in any breast cancer patient is taken by MDT that includes breast surgery consultant, pathology consultant, plastic surgery consultant, radiology consultant and medical oncology consultant. Breast conserving surgeries are now the standard technique for management of breast cancer patient. Oncoplastic techniques are replacing SWLE for their better cosmetic outcomes and better exposure of the tumor. Objective The aim of this work was to assess the round block technique as regard oncological safety, surgical outcomes and patients' satisfaction comparing results with standard wide local excision. Methods This is a retrospective study to assess the round block technique as an oncological procedure for management of early breast cancer near to nipple-areola complex as regard oncological safety, surgical outcomes and patients' satisfaction comparing results with standard wide local excision. It was conducted at general surgery department, Ain Shams university hospitals. Approval of the Ethical Committee and written informed consent from all participants were obtained. In our study 40 breast cancer patients are subdivided into group (A) 20 females which underwent round block technique and group (B) 20 femaleswhich underwent standard wide local excision. Patient and tumor criteria including age, co morbidities, tumor size and distance between tumor and nipple-areola complex were considered to be nonsignificant between 2 groups so the only difference is the surgical technique. Results The study shows that the round block technique and SWLE have the same results regarding hospital stay, post operative complications and oncological recurrence with the advantage to RBT because of its better cosmetic outcomes. So, the round block technique is superior to SWLE in selected cases. Conclusion The round block technique has comparable post operative parameters with better cosmoses as it is scarless operation without nipple and areola shift suggesting that the round block technique is superior to SWLE in selected cases.

Background Breast cancer is the most common cancer in women all over the world representing 18% of all women reported cases of cancer. It represents the leading cause of women mortality as representing 23% of all women cancer deaths. Objectives To compare aesthetic and surgical outcome of Round block technique and Grisotti technique in juxta areolar breast cancer. Patients and Methods In our study 20 breast cancer patients are subdivided into group (A) 10 females which underwent round block technique and group (B) 10 femaleswhich underwent grisotti technique. Patient and tumor criteria including age, co morbidities, tumor size and distance between tumor and nipple-areola complex were considered to be nonsignificant between 2 groups so the only difference is the surgical technique. Results The study shows that the round block technique and grisotti technique have the same results regarding operative time, intra-operative blood loss, post operative complications and re-excision rates with slight advantage to round block technique because of its slightly better cosmetic outcomes. So, the round block technique is slightly preferred for selected cases. Conclusion When to compare between round block technique and grisotti technique In treatment of juxta areolar breast cancer, there in no evident difference in operating time, post operative complications or need of re-excision between these two groups of patients

Background:Juxta-anastomotic stenosis is a common issue of arteriovenous fistulas. We aimed to evaluate the results of percutaneous transluminal angioplasty with drug-coated balloon versus plain balloon for the treatment of juxta-anastomotic stenoses of mature but failing distal radiocephalic arteriovenous fistulas.Methods:A total of 80 patients with a juxta-anastomotic stenosis of distal radiocephalic arteriovenous fistula in our clinic between January 2016 and September 2017 were retrospectively analyzed. Patients were divided into two groups according to the type of treatment as drug-coated balloon – percutaneous transluminal angioplasty (n = 44) and plain balloon – percutaneous transluminal angioplasty (n = 43). Intra- and post-procedural data were recorded. Target lesion primary patency rate was evaluated at 6 and 12 months. Of all patients, 48 were females and 39 were males with a mean age of 56.3 ± 10.4 (range, 24–75) years. Both groups had mature fistulas, and the mean age of fistula was 11.3 ± 9.1 months in the drug-coated balloon – percutaneous transluminal angioplasty group and 10.3 ± 8.8 months in the plain balloon – percutaneous transluminal angioplasty group (p = 0.24).Results:There was no significant difference in the target lesion stenosis rate and the median lesion length between the groups. Technical and clinical success were achieved in both groups. Target lesion primary patency was similar at 6 months between the two groups (93.1% vs 81.3%, respectively; p = 0.14) but significantly higher for the drug-coated balloon – percutaneous transluminal angioplasty group at 12 months (81.8% vs 51.1%, respectively; p = 0.01).Conclusion:Our study results suggest that the use of drug-coated balloon combined with percutaneous transluminal angioplasty is an effective treatment for juxta-anastomotic stenoses of mature but failing distal radiocephalic arteriovenous fistulas with significantly improved target lesion primary patency rates and reduced need for juxta-anastomotic reinterventions.

The aim of this study was to find out if juxta-apical radiolucency (JAR) is a reliable risk factor for injury to the inferior alveolar nerve (IAN) during removal of lower third molars. We designed a cohort study of patients whose dental panoramic tomograms (DPT) had shown JAR before complete removal of lower wisdom teeth. The outcome variable was postoperative permanent neurosensory disturbance of the IAN. A total of 39 patients (50 lower third molars) were identified and screened for permanent neurosensory disturbance. None reported any permanently altered sensation 18 months after the operation. Based on our group, the presence of JAR does not seem to be a reliable predictor of the risk of permanent injury to the IAN during removal of lower third molars.

Robotic repair of the ventricular septal defect was performed mainly for perimembranous type via right thorax approach. Minimally invasive strategies for doubly committed juxta-arterial ventricular septal defect were limited. Here, for the first time, we successfully repaired a doubly committed juxta-arterial ventricular septal defect with Da Vinci robotic system via left thorax approach. The technique could provide excellent exposure of surgical field and accurate repair, with the advantage of reducing trauma and shortening the overall length of stay.

Background: Juxta-apical radiolucency (JAR) has been presented as a radiographic sign, suggestive of the IAN injury through third molar surgery. This study aimed to evaluate the relation of JAR with paresthesia in cone-beam computed tomography (CBCT) images and to determine whether the presence of JAR is related to tooth angulation, proximity to the mandibular canal, position to the IAN and thinning of the cortical plates.Methods: Of an initial sample of 545 mandibular third molars, a total of 75 JAR and 75 control teeth were evaluated by CBCT. The association of JAR with the IAN, position to IAN, lingual cortical plate thinning, and tooth angulation was investigated in this study. Temporary and permanent paresthesia were also examined in the subjects. Descriptive statistics, Chi-square test, and Fisher’s exact test were performed for statistical analysis.Results: A significant relationship was found between JAR and temporary paresthesia (P=0.034). However, there was no case of permanent paresthesia. JAR showed no significant relationship with the tooth angulation, cortical plate thinning, position to IAN and proximity to the mandibular canal. The lingual position of JAR relative to the mandibular canal was related to the presence of paresthesia in the JAR group. Also, most cases of paresthesia showed some degree of lingual cortical plate thinning (P=0.012). Conclusion: JAR is generally in contact with the mandibular canal, and some degree of cortical thinning can be found in most cases. In this study, JAR was significantly related to temporary paresthesia. The present findings may indicate the increased risk of nerve injury during the surgical removal of third molars.

Background: Cortical lesions are highly inconspicuous on magnetic resonance imaging (MRI). Double inversion recovery (DIR) has a higher sensitivity than conventional clinical sequences (i.e. T1, T2, FLAIR) but is difficult to acquire, leading to overseen cortical lesions in clinical care and clinical trials. Objective: To evaluate the usability of artificially generated DIR (aDIR) images for cortical lesion detection compared to conventionally acquired DIR (cDIR). Methods: The dataset consisted of 3D-T1 and 2D-proton density (PD) T2 images of 73 patients (49RR, 20SP, 4PP) at 1.5 T. Using a 4:1 train:test-ratio, a fully convolutional neural network was trained to predict 3D-aDIR from 3D-T1 and 2D-PD/T2 images. Randomized blind scoring of the test set was used to determine detection reliability, precision and recall. Results: A total of 626 vs 696 cortical lesions were detected on 15 aDIR vs cDIR images (intraclass correlation coefficient (ICC) = 0.92). Compared to cDIR, precision and recall were 0.84 ± 0.06 and 0.76 ± 0.09, respectively. The frontal and temporal lobes showed the largest differences in discernibility. Conclusion: Cortical lesions can be detected with good reliability on artificial DIR. The technique has potential to broaden the availability of DIR in clinical care and provides the opportunity of ex post facto implementation of cortical lesions imaging in existing clinical trial data.

Accurate detection and segmentation of lung structures play a vital role in computer based lung cancer detection and diagnosis. Lung segmentation is challenging when the nodules are attached to the pleural walls of the lung boundary. This paper presents a novel methodology on detecting the lung structures to include the juxta-pleural nodules by calculating the shortest distance between two borders of the two consecutive slices. The proposed methodology is tested with some sample CT slices on Lung Image Database Consortium and Image Database Resource Initiative dataset. This work validates and demonstrates that the sequence based image processing is useful for detecting the nodules attached to the lung boundaries, juxta-pleural nodules.

A new epicopeiid species, Deuveia panda sp. n., is described from northeastern Sichuan, China. The new species differs from the sole congeneric species, D. banghaasi (Hering, 1936), in the remarkable black and white colouration pattern of the wings, the shape of the wings and the shape of the valva, juxta and aedeagus. The new species is geographically isolated from all known localities of D. banghaasi by highlands of the Min Mountains.

Background: Injuries to the lingual and inferior alveolar nerves (IAN) through third molar surgery are common and complicated clinical problems. Juxta-apical radiolucency (JAR) is one of the new radiographic signs, suggestive of IAN damage. Objectives: This study aimed to assess the relationship between JAR and IAN and to determine its effects on the cortical plate. Methods: In this cross-sectional study, after evaluating an initial sample of 450 cases, the cone-beam computed tomography (CBCT) images of 20 patients with JAR were compared with those of 20 age-matched patients without JAR in the axial and multi-planar images. The relationship between JAR and IAN was evaluated, and thinning of the mandibular cortical plates was also investigated. Statistical analysis was performed using descriptive tests and chi-square test in SPSS version 23. Results: The relationship between JAR and IAN was statistically significant (P = 0.001). The cortical plates were perforated in 75% of cases with JAR as opposed to 45% of cases without JAR (P = 0.06). The relationship between the location of JAR and IAN was also significant (P = 0.004). Conclusions: Based on the present results, JAR was associated with IAN in most cases. Thinning of the cortical plates was observed in all cases of JAR.

Background The unique and complex anatomical location of duodenal juxta-ampullary neoplasms complicates selection of the appropriate surgical strategy. For benign or borderline tumors, surgical local resection can be an appropriate treatment option, and robotic surgical systems can help perform minimally invasive local resection of these lesions. Methods Between December 2014 and December 2019, 10 patients who underwent robotic local resections for duodenal juxta-ampullary tumors were reviewed. Results All patients successfully underwent robotic local resection of the duodenum, preserving the ampulla of Vater without conversion. The mean tumor size was 2.2 cm. Final pathology consisted of gastrointestinal stromal tumor, neuroendocrine tumor, low grade and high grade dysplasia, ectopic pancreas, and well-differentiated adenocarcinoma (T1a). There were no postoperative complications or recurrences. Conclusion With accurate preoperative diagnosis and careful selection of patients, local resection of the duodenum for juxta-ampullary benign or borderline tumors using robotic surgical system is an attractive treatment option. This article is protected by copyright. All rights reserved.

Background: Epidermal grafting with an automatic harvesting system has been reported as a simple and efficacious procedure for stable vitiligo. However, no prospective cohort study has quantitatively evaluated the color matching and extent of repigmentation in the head and neck area by this method. Objective: To evaluate the color matching and extent of repigmentation after pixel array epidermal grafting by image analysis software and physicians’ naked eye. Methods: Ten Asian patients with head and neck vitiligo lesions stable for at least 6 months were treated with pixel array epidermal grafting with an automatic harvesting system and post-grafting phototherapy. The patients were evaluated 1, 3, and 6 months post grafting for the percentage of repigmentation by blinded physicians’ assessment and image analysis software. The color matching index of repigmentation was evaluated by measuring the melanin index in the grafted area and the juxta non-vitiliginous area. Results: The average blister harvest time was 46.3 ± 9.7 min. The area percentile of repigmentation by the image analysis software were 32.3 ± 26.8, 64.6 ± 29.4, and 76.5 ± 25.9 at 1, 3, and 6 months post grafting, respectively. There were no significant differences between the physicians’ assessments and the results from the image analysis software. The change in the area percentile of repigmentation between 3 and 6 months post grafting was only statistically significant using image analysis software. The grafted area achieved a color match of 83.1 ± 13.4% that of the juxta non-vitiliginous area 6 months after grafting. Three patients had repigmentation of leukotrichia. Conclusion: By quantitative measurement, uniform pixel array micrografts provide a very good extent of repigmentation and color match in the head and neck area. Image analysis software revealed a steady increase in repigmentation after POM3 until POM6, which was not detected by subjective assessment.

Background: Lung cancer is a greatest threat to people's health and life. CT image leads to unclear boundary segmentation. Segmentation of irregular nodules and complex structure, boundary information is not well considered and lung nodules have always been a hot topic. Objective: In this study, the pulmonary nodule segmentation is accomplished with the new graph cut algorithm. The problem of segmenting the juxta-pleural and juxta-vascular nodules was investigated which is based on graph cut algorithm. Methods: Firstly, the inflection points by the curvature was decided. Secondly, we used kernel graph cut to segment the nodules for the initial edge. Thirdly, the seeds points based on cast raying method is performed; lastly, a novel geodesic distance function is proposed to improve the graph cut algorithm and applied in lung nodules segmentation. Results: The new algorithm has been tested on total 258 nodules. Table 1 summarizes the morphologic features of all the nodules and given the results between the successful segmentation group and the poor/failed segmentation group. Figure 1 to Fig. (12) shows segmentation effect of Juxta-vascular nodules, Juxta-pleural nodules, and comparted with the other interactive segmentation methods. Conclusion: The experimental verification shows better results with our algorithm, the results will measure the volume numerical approach to nodule volume. The results of lung nodules segmentation in this study are as good as the results obtained by the other methods.

The aim of this study was to investigate the incidence of juxta-apical radiolucency (JAR) and its relations with surrounding structures using cone-beam computed tomography (CT). A total of 215 cone-beam CT images was analysed retrospectively to record the presence, site, and size of the JAR, and the relations between the JAR and the mandibular canal, buccal or lingual cortical plates, tooth position, and condition of root apex. Descriptive analyses were made, and relations between the categorical variables were tested with the chi squared test. JAR was detected in 71 (33%) (5 bilateral and 66 unilateral) of 215 patients (378 mandibular third molars) on cone-beam CT images. It was most commonly seen mesial to the tooth (43%) and above the third molars (55%), and was least common lingual to the tooth (3%) and at the distoangular third molar (3%) (p = 0.005). There was no significant relation between the JAR and the mandibular canal, but JAR was most likely to be detected superiorly to the mandibular canal (59% of cases). JAR can be seen and evaluated with cone-beam CT. It was most commonly seen mesial to the tooth and above the third molar. No significant relation was found between JAR and the mandibular canal, cortical plate, or condition of the apex. Future studies on the assessment of JAR should be done with a larger sample size as prospective cone-beam CT studies. (C) 2019 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

We describe a new species, Tischeria caucasica Klasiński & Stonis, sp. nov., a trumpet moth (Tischeridae) recently discovered from Georgia, the Caucasus. We briefly discuss the diagnostics of T.caucasica,an outstanding new species possessing an extremely long and distally bifurcated juxta. Thenew species is illustrated with photographs of the adults, male and female genitalia, and the type locality, Straipsnyje aprašoma mokslui nauja Tischeria caucasica Klasiński & Stonis rūšis, 2019 m. aptikta Centrinėje Gruzijoje. Trumpai aptariami esminiai diagnostiniai požymiai, leidžiantys identifikuoti šeriuotaūsių (Tischeriidae) taksonus. Pagal genitali-nių struktūrų (ypač juxta) morfologiją identifikuota nauja rūšis dydžiu ir forma ženkliai skiriasi nuo anksčiau žinomų giminiškų Tischeria ekebladella ir T. ekebladoides morfologinių struktūrų. Straipsnyje pateikiama išsami naujos rūšies suaugėlių patino ir patelių genitalinių struktūrų morfologijos dokumentacija. Nors naujos rūšies mitybos augalas nėra nustatytas, tačiau manoma, kad T. caucasica lervos, kaip ir kitų artimų Tischeria rūšių, yra ąžuolų lapų minuotojai, mitybos ryšiais galbūt susiję su tyrimų vietovėje aptiktais Quercus petraea (Matt.) Liebl., Q. macranthera Fisch. & C. A. Mey. ex Hohen. arba Q. robur L.

Irish literary gerontology has been slow to develop and this article aims to stimulate discussion by engaging with gerontologists' assertions that ageing in a community of peers is enriching. Juxtaposing the experience of ageing individuals in the novels of Iris Murdoch and John Banville with the more social experiences of John McGahern's protagonists, the article finds parallels between Murdoch's The Sea, The Sea (1978) and Banville's fiction with its emphasis on the ageing individual, invariably male, who attempts to fashion a coherent identity through narration. By contrast, McGahern's The Barracks (1963), is focused through the eyes of a female protagonist whose final months are shaped by interaction with the society around her, while in That They May Face the Rising Sun (2002) ageing is experienced through an entire community.

Introduction. In the structure of the general morbidity rate, trauma and diseases of the musculoskeletal system take the third place after diseases of the respiratory system and pathology of the gastrointestinal tract. In recent years, an intensive indices characterizing the trauma prevalence rate has increased by 1.9 times. Aim. to improve the results of the management of juxta- and intraarticular fractures in children by means of the use of biodegradable implants. Material and methods. Over the period from 2014 to 2016 in the Department of Traumatology of the Research Institute of Emergency Pediatric Surgery and Traumatology there were examined and treated 108 children with juxta- and intra-articular fractures of the upper and lower extremities aged from 5 to 17 years, with an average age of 13.3 ± 1.8, including 38 (34.96 %) girls and 70 (65.04%) boys. All patients underwent complex examination including laboratory and instrumental methods: complete blood count (CBC), Common Urine Examination (CUE), X-Ray, spiral computed tomography, MRI. Results. To describe injuries and determine the tactics of the treatment of juxta- and intra-articular fractures in children, there was used the fracture classification system delivered by Robert B. Salter and W. Robert Harris. All children with metaphyseal fractures of the second, third, and fourth types underwent surgical treatment with the use of biodegradable implants. The postoperative period proceeded without complications. Conclusion. The use of biodegradable screws in juxta- and intra-articular fractures in children is a safe and effective method of treatment, reducing its timing by eliminating repeated surgical intervention.

Purpose This study aimed to investigate the prevalence of juxta-apical radiolucency (JAR), assessing its association with third molar status and describing its radiologic features through panoramic radiography. Materials and Methods We evaluated 1,050 radiographs (1,830 third molars) for the presence of JAR. The JAR and control groups were classified according to the third molar's angulation, impaction, and root development. The presence of radiographic signs of proximity between the mandibular canal and third molar and the imaging features of JAR also were recorded. Results JAR was identified in 116 patients (11%) and 130 third molars (7.1%), being significantly associated with female patients and with the second and third decades of life. There also was an association with teeth with a vertical angulation and complete root formation. Radiographic signs of proximity to the mandibular canal were absent in 66.2% of JAR cases. In most cases, there was lamina dura in the juxta-apical area that appeared to overlap the mandibular canal and to have a cortical outline. Conclusions JAR is not a rare imaging finding. Given its possible relationship with nerve injuries and its differential diagnostic possibilities, knowing the characteristics of JAR is important to assist professionals in treatment planning and making the correct diagnosis.

Objective To retrospectively review surgical repair of juxta-articular distal femur fractures and posttraumatic conditions. Material and methods The review included 65 patients with juxta-articular distal femur fractures and posttraumatic conditions repaired with plating (n = 44), intramedullary nailing (n = 16) and transosseous osteosynthesis (n = 5) between 2009 and 2016. The patients were divided into 2 groups depending on time of injury. SOI-1 was used for outcome measure. Results Functional recovery was observed in 71 to 97 % (average, 89.1 ± 0.6 %) of the first group at short-term followup and an average of 94.7 ± 0.45 % of anatomical and function norm at a long term. Short-term anatomical and functional outcomes ranged from 63 to 93 scores in the second group and were an average of 82 ± 0.7 % of the norm. Conclusion Better outcomes were obtained in the first group (an average of 94.7 ± 0.45 % of anatomical and functional norm). Plating with accurate bone reduction and reliable fixation provided throughout consolidation phase showed better outcomes in both groups of patients. Intramedullary nailing was practical for straightforward supracondylar injuries type 33А1. Transosseous osteosynthesis could be advocated for open and gunshot injuries to minimize risk of infection and provide stable bone fixation.

Purpose: The snorkel technique is commonly used to preserve renal arteries in juxta renal aneurysm during endovascular repair. Herein, we present a patient who underwent bifurcated endograft implantation with snorkel technique for inferior mesenteric artery (IMA) in order to preserve the major source of bowel circulation. Case Report: A 69-year-old male patient was diagnosed with abdominal aortic aneurysm. His history revealed that he had bowel resection due to a car accident 30 years ago. In addition, he was given relaparotomy 4 times due to intestinal complications. Computed tomography showed fusiform aneurysm with a maximal diameter of 60 mm and chronical occlusion of the superior mesenteric artery. Inferior mesenteric artery was found to be hypertrophic. During EVAR, 6 mm × 10 cm covered VIABAHN Endoprosthesis (Gore Medical) was implanted to the IMA over a 0.018 guidewire via puncture of the left axillary artery. Initially, the main body of the aortic stent-graft (Gore C3, size 23-14-16) was implanted to the infra renal segment of the aorta (below the renal arteries and the orifice using VIABAHN) via the right femoral artery. Next, the contralateral leg (Gore, 14-12-00) was implanted. Computed tomography was examined at 1- and 32-month postoperatively, and no endoleak or patency of IMA stent was detected. Conclusion: In this case of IMA-dependent circulation of the intestinal system, the protection of IMA via snorkel technique was successful.

Background:Rheumatoid arthritis (RA) is characterised by inflammation of the synovial lining. In addition to synovitis, the tendon sheaths of small hand and foot joints are also frequently inflamed. This results in tenosynovitis, which is often missed at clinical evaluation in early RA but visible on imaging, such as MRI. A third anatomical structure surrounded by a synovial lining is formed by the intermetatarsal bursae in the forefeet. Inflammation of these bursae (intermetatarsal bursitis; IMB) was recently identified at MRI-studies and shown to be specific for early RA.[1] This suggests that IMB is also a feature of early RA.Objectives:We hypothesised that if IMB is indeed an RA-feature, then (1) at diagnosis its presence associates with other measures of local inflammation (synovitis, tenosynovitis and osteitis) and (2) it responds to DMARD therapy similarly as these other local inflammatory measures. These hypotheses were tested in a comprehensive MRI-study.Methods:157 consecutive early RA patients underwent unilateral contrast-enhanced 1.5T MRI of the forefoot at diagnosis. MRIs were evaluated for presence of IMB and for synovitis, tenosynovitis and osteitis in line with the RA MRI scoring system (summed as RAMRIS-inflammation). MRIs at 4, 12 and 24 months were evaluated for presence and size of IMB-lesions in patients who had IMB at baseline and received early DMARD-therapy. Logistic regression was used for analyses at patient-level; generalised estimating equations were used for bursa-level analyses. Stratification for ACPA was performed.Results:69% of RA patients had ≥1 IMB. In multivariable analyses on bursa-level, presence of IMB was independently associated with local presence of synovitis and tenosynovitis (OR 1.69 (95%CI 1.12–2.57) and 2.83 (1.80–4.44), respectively), but not with osteitis. On patient-level, presence of IMB was most strongly associated with tenosynovitis (OR 2.92 (1.62–5.24)). During treatment with DMARDs, the average size of IMB-lesions decreased (Figure 1). This decrease was associated with decrease in RAMRIS-inflammation scores; most strongly with a decrease in synovitis but not in osteitis. Within ACPA-positive and ACPA-negative RA similar results were obtained.Conclusion:IMB particularly accompanies inflammation of the synovial lining of joints and tendon-sheaths, both regarding simultaneous occurrence at diagnosis and simultaneous treatment-response. These findings suggest that IMB represents juxta-articular synovial inflammation and indeed is a hallmark of early RA.References:[1]Dakkak YJ et al. Increased frequency of intermetatarsal and submetatarsal bursitis in early rheumatoid arthritis: a large case-controlled MRI study. Arthritis Res Ther 22, 277 (2020).Disclosure of Interests:None declared.

Endovascular repair of abdominal aortic aneurysm has been the first choice of treatment over surgical repair if feasible due to many advantages such as short hospital stay, less peri-procedural complications and early recovery. Good bilateral vascular access with adequate sized arteries that are free of significant disease is essential for a successful EVAR. Endovascular repair has been deferred in as much as 40% of patients due to difficult vascular access. We present a patient who underwent percutaneous endovascular repair of a juxta renal abdominal aortic aneurysm using a unique single side access EVAR device who had severely diseased iliac arteries.

The male genitalic characters of Hexapoda are well known for their great taxonomic and systematic value. Despite insect male genitalia displaying large diversity, variation, and modification across orders, some structures are consistently present, and such characters can serve as the basis for discussion regarding homology. In the order Lepidoptera, a male genitalic structure widely known as the ‘juxta’ is present in many taxa and absence or modification of this character can be phylogenetically informative at the generic or higher level. We here focus on the systematics of the so-called ‘Taygetis clade’ within the nymphalid subtribe Euptychiina, and report an unusual case of ‘juxta loss’ in a single species, Taygetina accacioi Nakahara & Freitas, n. sp., a new species from Brazil named and described herein. Additionally, we describe another west Amazonian Taygetina Forster, 1964 species, namely Taygetina brocki Lamas & Nakahara, n. sp., in order to better document the species diversity of Taygetina. Our most up-to-date comprehensive molecular phylogeny regarding ‘Taygetis clade’ recovered these two species as members of a monophyletic Taygetina, reinforcing the absence of juxta being a character state change occurring in a single lineage, resulting in an apomorphic condition, which we report here as a rare case in butterflies (Papilionoidea).

Main teaching point: Low-dose cone-beam computed tomography (CT) may be of additional value to radiographs and magnetic resonance imaging (MRI) in preoperative characterization and local staging of juxta-cortical chondroma Juxta-cortical chondroma is a rare cartilaginous tumor originating from the periosteum. On conventional radiography, the lesion typically causes saucerization of the adjacent cortex with well-delineated sclerotic margins. Projection radiography may be less accurate than cross-sectional imaging to demonstrate the precise extent of pressure erosion and bone and soft tissue extent. Although magnetic resonance imaging (MRI) is the imaging technique of choice for further preoperative evaluation, cone-beam computed tomography (CT) may be of additional value. Due to its high spatial resolution, cone-beam CT may detect very tiny matrix calcifications and allows a more precise evaluation of the saucerized cortex at a low radiation dose.

Early detection of all kinds of lung nodules with different characters in patient’s medical modality images is the best acceptable remedy to save the life of lung cancer sufferers. Even though day by day the prominence of Computer-Aided Detection/Diagnosis (CADe/x) systems have been increasing as a part of medical routine in detection of different types of lung nodules, but detection rate performance depends on accuracy of lung parenchyma and nodule segmentation procedures. Segmentation of Juxta-Vascular nodules attached very complex. In this paper new fully automated CAD system is developed to detect and classify Juxta-Vascular nodules. In proposed methodology, lung parenchyma is segmented using iterative thresholding algorithm and lung nodules are segmented using proposed modified region growing algorithm. Since in vascular nodules, separation of blood vessel from nodule is difficult as intensity feature of attached blood vessel and nodule is same. Two new methods nodule segmentation method and vessel removal based on multi features to separate the vascular nodule part from the attached blood vessels are developed. To achieve the higher nodule-vessel separation accuracy, nodule-vessel attached region is refined. Validation of proposed method is performed on LIDC-CT lung images. A fully automated method segments the vascular nodules with less computational time and high accuracy.