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Background: Although the zygomatic arch is an important structure determining facial prominence and width, no consensus exists regarding the classification of isolated zygomatic arch fractures, and the literature on this topic is scarce. To date, five papers have subdivided zygomatic arch fractures; however, only one of those proposed classifications includes the injury vector, although the injury vector is one of the most important factors to consider in fracture cases. Furthermore, the only classification that does include the injury vector is too complicated to be suitable for daily practice. In addition, the existing classifications are clinically limited because they do not consider greenstick fractures, nondisplaced fractures, or coronoid impingement. In the present study, we present a rearrangement of the previously published classifications and propose a modified classification of isolated zygomatic arch fractures that maximizes the advantages and overcomes the disadvantages of previous classification systems.Methods: The classification criteria for isolated zygomatic arch fractures described in five previous studies were analyzed, rearranged, and supplemented to generate a modified classification. The medical records, radiographs, and facial bone computed tomography findings of 134 patients with isolated zygomatic arch fractures who visited our hospital between January 2010 and December 2019 were also retrospectively analyzed.Results: We analyzed major classification criteria (displacement, the force vector of the injury, V-shaped fracture, and coronoid impingement) for isolated zygomatic arch fracture from the five previous studies and developed a modified classification by subdividing zygomatic arch fractures. We applied the modified classification to cases of isolated zygomatic arch fracture at our hospital. The surgery rate and injury severity differed significantly from fracture types I to VI.Conclusion: Using our modified classification, we could determine that both the injury force and the injury vector meaningfully influenced the surgery rate and the severity of the injuries.

Jun Hyeong Song,1 Woo Yong Lee,2 Kyoung Rai Cho,3 Sang Hyun Nam,4 Ki Deok Park,5,&ast; Yongbum Park1,&ast; 1Department of Physical Medicine & Rehabilitation, Sanggye Paik Hospital, Inje UniversityCollege of Medicine, Seoul, Republic of Korea; 2Department of Anesthesiology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea; 3Department of Otorhinolaryngology Head and Neck Surgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea; 4Department of Plastic and Reconstructive Surgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea; 5Department of Rehabilitation Medicine, Gachon University, Gil Medical Center, Incheon, South Korea&ast;These authors contributed equally to this workCorrespondence: Yongbum ParkDepartment of Physical Medicine & Rehabilitation, Sanggye Paik Hospital, Inje University College of Medicine, Sanggye 7 Dong 761-7, Nowon-gu, Seoul, 139-707, KoreaEmail swc328@naver.comKi Deok ParkDepartment of Rehabilitation Medicine, Gachon University, Gil Medical Center, Namdong-Daero 774 Beon-gil, Namdong-gu, Incheon, Korea, 33 Tel +82-2-950-1145Fax +82-2-935-3076Email bduck@gilhospital.comIntroduction: This study is to compare advantages, safety and mid-term effects of fluoroscopy (FL)-guided transforaminal (TF) to caudal (CA) epidural steroid injection (ESI) for chronic pain after spinal surgery (CPSS) by assessing pain relief and improvement of functionality.Methods: Patients with radicular pain in CPSS who received FL-guided CA (n = 21) or TF (n = 28) ESI were included in this retrospective study. Complication frequencies, adverse events, treatment effects, and functional improvements for each procedure were compared at 1, 3, and 6 months following the last injection.Results: Both the Oswestry Disability Index (ODI) and verbal numeric pain scale scores (VNS) demonstrated improvement in both groups at all 1, 3, and 6 months following the last injection, without meaningful difference between groups (p < 0.05). Moreover, no meaningful difference was present between groups in terms of treatment success rate at every time point. The amount of time used for the injection procedure was shorter in CA group than in TF group (410.32 ± 25.73 seconds vs 640.65 ± 18.03 seconds, p < 0.05). Within 2 weeks of the injection treatment, the patient satisfactory scores were evaluated, with excellent being rated 85.7% (n = 18) among CA-ESI patients and 55.7% (n = 16) among TF-ESI patients (p < 0.05). Logistic regression analysis revealed that variables such as method of injection (CA or TF approach), sex, use of analgesics, pain duration, number of injections, and age were not significant variables for successful treatment results. There were no adverse complications after the procedure in both groups.Conclusion: The outcomes of FL-guided CA-ESI and TF-ESI for CPSS are similar in terms of pain reduction and functional improvements. CA-ESI is associated with lesser procedure time. In addition, compared with the TF-ESI, the patient experiences less discomfort during the injection, and the satisfaction with the injection treatment is confirmed to be better. Accordingly, both methods are effective; however, in the CA approach, patient satisfaction is higher and the procedure time is shorter.Keywords: epidural block, fluoroscopy, transforaminal, caudal, FL, CA, TF

Background Minimally-invasive methods to treat scars address a common pathway of altering collagen structure, leading to collagen remodeling. Objective In this study, we employed in situ redox chemistry to create focal pH gradients in skin, altering dermal collagen, in a process we refer to as electrochemical therapy (ECT). The effects of ECT to induce biochemical and structural changes in ex vivo porcine skin were examined. Methods During ECT, two platinum electrodes were inserted into fresh porcine skin, and following saline injection, an electrical potential was applied. pH mapping, high frequency ultrasonography, and two photon excitation microscopy and second harmonic generation (SHG) microscopy were used to evaluate treatment effects. Findings were correlated with histology. Results Following ECT, pH mapping depicted acid and base production at anode and cathode sites respectively, with increasing voltage and application time. Gas formation during ECT was observed with ultrasonography. Anode sites showed significant loss of SHG signal, while cathode sites showed disorganized collagen structure with fewer fibrils emitting an attainable signal. Histologically, collagen denaturation at both sites was confirmed. Conclusion We demonstrated the production of in situ acid and base in skin occurring via ECT. The effects chemically and precisely alter collagen structure through denaturation, giving insight on the potential of ECT as a simple, low-cost, and minimally-invasive means to remodel skin and treat scars.

Zea mays L. (Poaceae), also known as purple corn, is an annual herbaceous plant that is grown as food for human consumption in a variety of forms, including cooking oils and sweeteners in processed food and beverage products. The purpose of this study was to determine whether a novel purple corn extract, FB801, might have an anti-atopic dermatitis (AD) effect on AD-like skin lesions induced by 2,4-dinitrochlorobenzene (DNCB) in BALB/c mice. Topical sensitization (1%) and challenge (0.3%) by DNCB were performed on the dorsal skin and right ear of BALB/c mice to induce AD. Following FB801 and dexamethasone administered orally, the severity of skin lesions was examined macroscopically and histologically. Serum levels of immunoglobulin E (IgE) and various cytokines were determined by enzyme-linked immunosorbent assay. Oral administration of FB801 significantly reduced typical symptoms of AD (erythema/bleeding, swelling, molting/erosion and scaling/drying), scratching frequencies, and the recruitment of inflammatory and mast cells. In addition, FB801 suppressed serum levels of IgE and T helper (Th)2 type cytokines such as interleukin (IL)-4 and IL-10 in DNCB-treated BALB/c mice. Furthermore, FB801 reduced the degradation of inhibitor of nuclear factor-��B proteins (NF-��B) in tumor necrosis factor (TNF)-��-stimulated human keratinocyte (HaCaT) cells. These results suggest that FB801 inhibited the development of the AD-like skin symptoms by regulating Th1 and Th2 responses in the skin lesions in mice and suppressing TNF-�� induced NF-��B activation in HaCaT cells, suggesting that FB801 has potential application as an effective alternative therapy for the prevention and management of AD.

PURPOSE: Recent studies have compared the therapeutic efficacy and safety of the procedure using ultrasound and fluoroscopy. However, there are no published studies comparing the therapeutic efficacy and safety of fluoroscopy (FL)-guided cervical interlaminar epidural steroid injection (CIESI) with that of ultrasound (US)-guided selective nerve root block (SNRB). This study aimed to compare the mid-term effects and advantages of US-guided SNRB with FL-guided CIESI for radicular pain in the lower cervical spine through assessment of pain relief and functional improvement. METHODS: Patients with radicular pain in the lower cervical spine who received US-guided SNRB (n = 51) or FL-guided CIESI (n = 61) were included in this retrospective study. All procedures were performed using FL or US. The complication frequencies during the procedures, adverse events, treatment effects, and functional improvement were compared at intervals of 1, 3, and 6 months after the last injection. RESULTS: Both the neck disability index and verbal numeric scale showed improvements at 1, 3, and 6 months after the last injection in both groups, with no significant differences between groups (p

Botulinum toxin A (BoNT-A) is used clinically for various muscle disorders and acts by preventing the release of the neurotransmitter acetylcholine into the synapse space. Here, we compared the efficacy of prabotulinumtoxinA (PRA) and onabotulinumtoxinA (ONA) for the reduction in hypertrophy in myostatin-deficient (Mstn-/- ) mice. Two different BoNT-A products (2.5, 10 and 25 U/kg) were injected to paralyse the hindlimb for 2 months, after which sciatic nerve conduction study, 3D micro-CT, haematoxylin and eosin (H&E) and dystrophin staining were conducted. Administration of BoNT-A products induced denervation-mediated atrophy and alleviated muscle hypertrophy generated in Mstn-/- mice. The present study revealed that each BoNT-A regulates skeletal muscle size, myofibre number and myofibre diameter in Mstn-/- mice. The potential applicability of BoNT-A for the treatment of rare muscle hypertrophic diseases was demonstrated. Compared with ONA, PRA had a comparable ability to act in the local area.

In the present study, we constructed a new research model to understand the feedback effects of brand extension by applying expectation disconfirmation theory to a real-world case of brand extensio...

This study explored the factors affecting repeat theatrical viewing of movies. Integrating content, social influence, and access/competition variables, the analysis reveals that the drivers of theatrical repeat viewing are different from those for box office performance. For example, the effects of genre, transmedia content, and audience review were significant only for the latter and factors such as movie length, critics’ review, and level of news coverage actually played a negative role in the repeat consumption.

Background Blowout fracture is one of the most common facial fractures, and patients usually present with accompanying ocular complications. Many studies have looked into the frequency of persistent ocular symptoms, but there is no study on assault patients and related ocular symptoms. We evaluated the incidence of residual ocular symptoms in blow-out fractures between assaulted and non-assaulted patients, and sought to identify any connection among the degree of enophthalmos, defect size, and assault-related injury. Methods A retrospective review was performed for any patient who sustained a unilateral blowout fracture between January 2010 to December 2014. The collected data included information such as age, gender, etiology, and clinical ocular symptoms as examined by an ophthalmologist. This data was analyzed between patients who were injured through physical altercation and patients who were injured through other means. Results The review identified a total of 182 patients. Out of these, 74 patients (40.7%) have been struck by a fist, whereas 108 patients (59.3%) have sustained non-assault related injuries. The average age was 36.1 years, and there was a male predominance in both groups (70 patients [94.6%] in the assaulted group and 87 patients [80.6%] in the non-assault group). Diplopia and enophthalmos were more frequent in patients with assault history than in non-assaulted patients (p

As the mobile is recognised as a significant distribution platform for theatrical films, differences between mobile and theatrical platforms are of great interest to researchers and practitioners. ...

Meningiomas are a diverse set of tumors arising from the meninges, which are the membranous layers surrounding the central nervous system. Most meningiomas grow inward toward the brain as discrete, well-defined, dural-based masses and are spherical or lobulated. The borders between the tumor and the brain are usually smooth and clear because they preserve the histologic structures, such as the tumor capsule, cerebrospinal fluid, arachnoid mater, and pia mater [1]. Considering such a growth pattern, we report a rare case of transitional meningioma misdiagnosed as a soft tissue tumor. A 60-year-old female patient presented with a hard and fixed mass that grew spontaneously on her forehead within one year (Fig. 1). There was no history of trauma or exposure to carcinogens, and she was otherwise fit and well. Computed tomography (CT) showed frontal cortical thickening and swelling suggestive of a type of soft tissue tumor. To determine the character of the tumor-like mass, excision was performed (Fig. 2). The pathologist confirmed the mass as a transitional meningioma. Magnetic resonance imaging (MRI) which was taken after primary excision revealed an intracranial mass that was 3.0 cm in size, ovoid and well enhanced (Fig. 3). Wide-excision osteoplastic craniotomy via a bicoronal approach was performed under navigation guidance by neurosurgeon. Fig. 1 Preoperative photograph showing a lesion on the right forehead. Fig. 2 Gross appearance of the specimen. Fig. 3 Brain magnetic resonance imaging (T1) showing a soft tissue mass 3.0 cm in size, ovoid and well enhanced under the skull. The mass shows a dural tail sign. Transitional meningiomas are also called as mixed meningiomas, and these tumors have transitional between those of meningothelial and fibrous meningioma and they are common tumors with meningothelial, fibrous, psammomatous, and angioblastic meningiomas. 90% of meningiomas are consisting of those five types of meningiomas. The brain mass was also established as a meningothelial-type meningioma, 2.5×2.3 cm in size. Histologically, the tumor was lobulated by intersecting collagenous fibers. Immunohistochemical staining was positive for vimentin and epithelial membrane antigen and negative for pancytokeratin. There was no recurrence of meningioma during the 6-year follow-up period. Meningiomas are estimated to constitute between 13% and 26% of primary intracranial tumors, with an annual incidence rate of approximately 6 per 100,000 population. They are the most frequently diagnosed primary brain tumor, accounting for 33.8% of all primary brain and central nervous system tumors reported in the United States between 2002 and 2006 [2]. The exact causes of most of these tumors are not known. They result from abnormal patterns of growth that are most likely due to defects in the genetic material. The exact type of genetic defect or mutation has not been conclusively identified in meningiomas. Despite the lack of definitive evidence that clearly isolates possible causes, it has been suggested that meningiomas are associated with traumatic head injury, prolonged inflammation of the meninges following injury, viral infections, radiation, certain genes, Neurofibromatosis type 2, and hormones, particularly sex hormones, including estrogen, progesterone and androgens. Excessive use of cellular phones has also been implicated as a possible cause, but the evidence to conclusively link cell phone use to meningioma development is lacking [2]. The majority of meningiomas are benign, and they are seldom invasive. Wang et al. [1] studied 7,084 cases of meningiomas and examined the female: male ratio, patient age, subtypes, and locations. The female: male ratio of all types of meningioma is 2.34, while that of transitional meningioma is 2.11. The mean age of among all cases of meningioma is 51.45 years, and that of transitional meningioma is 50.54 years; the age of the patient in this case was 60 years. In their study, there were 323 cases of transitional meningioma among 7,084 cases, accounting for 4.56% of all meningiomas. There were 3 cases of extracranial meningioma among 7,084 cases, accounting for 0.04% of the total. Extracranial extension of meningiomas is very rare, and only a few cases have been reported [1]. Panchmatia et al. [3] reported an asymptomatic forehead lump that was initially diagnosed as an osteoid osteoma. CT was suggestive of an exostosis and an enostosis associated with frontal skull thickening. The mass was excised, and its histological features were consistent with intraosseous meningioma [4]. Nadarajan et al. [4] reported a similar case of unusual meningioma. An 82-year-old man was had a large deformity over the frontal area of his scalp. CT and MRI revealed an intracranial mass that extended across the frontal lobes. The mass permeated the skull and extended through the scalp. The histologic finding of the mass suggested a benign meningioma with low mitotic activity [3]. In cases of a protruding mass on the head, clinicians tend to diagnose the tumor as osteoma or lipoma because of their high prevalence. In this case, the manifestation of the mass was more similar to another soft tissue tumor rather than extracranial meningioma. Following excision, pathology and other radiologic studies such as MRI and ultrasonography indicated that the tumor was a meningioma instead of a soft tissue tumor. The high-power view reveals many whorling epithelioid cells and admixed spindle cells (Fig. 4A). Immunohistochemical staining for epithelial membrane antigen (EMA) disclosed diffuse positivity, which was strongly supportive of meningothelial differentiation. The tumor cells were composed of oval cells with occasional intranuclear inclusion bodies (Fig. 4B). To diagnose meningioma, initial investigations should include contrast-enhanced CT and MRI. In addition, angiography is a valuable tool that allows the surgeon to elucidate the relationship of the tumor with nearby vascular structures and to determine the vascularity of the tumor [3]. Fig. 4 (A) The high-power view reveals many whorling epithelioid cells (red arrow) and admixed spindle cells. The tumor cells are composed of oval cells with occasional intranuclear inclusion bodies (blue arrow) (H&E, ×400). (B) Immunohistochemical ... The meningioma in the present case was misdiagnosed as a soft tissue tumor because of its gross manifestation, and MRI study and punch biopsy were excluded. Unfortunately, nonenhanced brain CT cannot present characteristic feature of meningioma and gives little information to diagnose. The mechanism of extracranial extension was not yet established, but there are two possible theories. One is the proliferation of perineural cells or ectopic arachnoid tissue along the cranial nerve, and the other is misplaced embryonic rests of arachnoid cells and multipotent mesenchymal cells [5]. In conclusion, even if a mass on the forehead has an obvious clinical manifestation, thorough imaging studies are required and suspicions about rare tumors should be addressed before surgery.

This study empirically investigates the effect of mobile app types, and the moderating effects of gender and age on mobile apps usage through actual user experience and behaviour log data, as captured by metered software on 7,374 panellists comprised of mobile phone users in the United States in 2013. The apps usage variable is examined from both the width i.e., reach and depth i.e., time and frequency intensity aspects to capture the multiplicity of mobile apps usage behaviour. The results of this study demonstrated that all of the mobile apps usage dimensions reach, time usage intensity and frequency usage intensity were significantly affected by the type of mobile app, with the exception of specific mobile apps in each dimension, by utilising multiple regression with dummy variables. Furthermore, the effect of the mobile app type on its usage was mostly moderated by age alone.