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BACKGROUND: This study compared clinical and hemodynamic in-hospital outcomes of patients undergoing sutureless vs rapid deployment aortic valve replacement (SURD-AVR) in the large population of the Sutureless and Rapid Deployment International Registry (SURD-IR). METHODS: We examined 4695 patients who underwent isolated or combined SURD-AVR. The "sutureless" Perceval valve (LivaNova PLC, London, United Kingdom) was used in 3133 patients and the "rapid deployment" Intuity (Edwards Lifesciences, Irvine, CA) in 1562. Potential confounding factors were addressed by the use of propensity score matching. After matching, 2 well-balanced cohorts of 823 pairs (isolated SURD-AVR) and 467 pairs (combined SURD-AVR) were created. RESULTS: Patients who received Perceval and Intuity valves showed similar in-hospital mortality and rate of major postoperative complications. Perceval was associated shorter cross-clamp and cardiopulmonary bypass times. In the isolated SURD-AVR group, patients receiving Perceval were more likely to undergo anterior right thoracotomy incision. Postoperative transvalvular gradients were significantly lower for the Intuity valve compared with those of the Perceval valve, either in isolated and combined SURD-AVR. The Intuity valve was associated with a lower rate of postoperative mild aortic regurgitation. CONCLUSIONS: Our results confirm the safety and efficacy of SURD-AVR regardless of the valve type. The Perceval valve was associated with reduced operative times and increased anterior right thoracotomy incision. The Intuity valve showed superior hemodynamic outcomes and a lower incidence of postoperative mild aortic regurgitation. ispartof: ANNALS OF THORACIC SURGERY vol:114 issue:3 pages:758-+ ispartof: location:Netherlands status: published

Figuras A Y B: Radiografía de Tórax Anteroposterior (AP) y Lateral. Presencia de gran lesión al parecer del mediastino medio (Flechas blancas), con diámetros de 11 x 15 x 12 cm, de densidad homogénea, con efecto de masa y desviación de todas las estructuras (Flechas negras) y compresión sobre el lóbulo superior derecho (*), sin calcificaciones en su interior. Figura C. Tomografía computarizada de tórax con contraste corte coronal. En la región central del mediastino anterior, se identifica una masa hipodensa, heterogénea, con densidad de predominio de tejido blando, con algunas imágenes de densidad cálcica en su interior, de 14.3 x 10.2 x 12.6 (Línea amarilla) cm, que se encuentra desplazando la aorta ascendente, con trayecto tortuoso (Flecha azul), la flecha roja señala el tronco braquiocefálico. Figura D. Tomografía computarizada de tórax corte axial en ventana mediastinal. Masa hipodensa, heterogénea, con densidad de predominio de tejido blando, con algunas imágenes de densidad cálcica en su interior, la cual se encuentra desplazando y ocupando gran parte de la porción anterior del hemitórax derecho. Así mismo se encuentra desplazando estructuras mediastinales como el tronco de la pulmonar (Flecha azul), esta masa se encuentra generando atelectasia pasiva del lóbulo medio derecho (Flecha roja). Figures A and B: Anteroposterior (AP) and Lateral Chest X-ray. Presence of a large mass, apparently from the middle mediastinum (white arrows), diameters of 11 x 15 x 12 cm, homogeneous density, with the mass effect on other mediastinal structures (black arrows) and compression on the right upper lobe (*), without inner calcifications. Figure C. Chest Computed Tomography, coronal section. In the anterior mediastinum it shows a hypodense, heterogeneous mass, with predominance of soft tissue density, with some calcifications inside, diameters of 14.3 x 10.2 x 12.6 (yellow line) cm, displacing the ascending aorta (blue arrow), the red arrow indicates the brachiocephalic trunk. Figure D. Computed tomography of the chest, axial section. Hypodense, heterogeneous mass, with predominance of soft tissue density, with some calcifications inside, which occupying a large part of the anterior right hemithorax. It is also displacing mediastinal structures such as the trunk of the pulmonary artery (blue arrow), this mass is generating passive atelectasis of the right middle lobe (red arrow). Figuras A e B: Radiografia de tórax (anteroposterior (AP) e lateral). Presença de grande massa, aparentemente do mediastino médio (Setas brancas), diâmetros de 11 x 15 x 12 cm, densidade homogênea, com efeito de massa em outras estruturas mediastinais (setas pretas) e compressão no lobo superior direito (*), sem calcificações internas. Figura C. Tomografia computadorizada de tórax, corte coronal. No mediastino anterior, mostra uma massa hipodensa e heterogênea, com predominância da densidade de partes moles, com algumas calcificações internas, diâmetros de 14,3 x 10,2 x 12,6 (Linha amarela) cm, deslocando a aorta ascendente (seta azul), a seta vermelha indica o tronco braquiocefálico. Figura D. Tomografia computadorizada de tórax, corte axial. Massa hipodensa, heterogênea, com predominância da densidade de partes moles, com algumas calcificações internas, que ocupam grande parte do hemitórax anterior direito. Também está deslocando estruturas mediastinais, como o tronco da artéria pulmonar (Seta azul), essa massa está gerando atelectasia passiva do lobo médio direito (Sseta vermelha).

Background The ease of implantation of the rapid deployment (RD) and sutureless valves has contributed to the adoption of anterior right thoracotomy (ART) approach for aortic valve replacement (AVR). Aim of the study This study evaluates the safety and haemodynamic performance of minimally invasive AVR through ART using the RD valves. Methods This is a retrospective, single-center review of a total of 50 consecutive patients who received RD-AVR through ART. Results The median age of patients was 75 years (interquartile range [IQR]: 69-80), and median Euroscore II was 5.1 (IQR: 2.4-7.5). ART RD-AVR was successfully performed in all cases with no conversion to sternotomy, paravalvular leaks or need for valve explantation. The mean size of the implanted valve was 23.2 ± 2.3 mm. In-hospital mortality was 2%. The mean and maximum pressure gradients across the aortic prosthesis were 10 mm Hg (IQR: 9-12) and 19 mm Hg (IQR: 16-23). Conclusions Rapid deployment aortic valve replacement can be safely performed through anterior right thoracotomy wit excellent haemodynamic performance and low postoperative complications rate.

The goal of the medical practice and medical research may include the happiness and health of body and soul. The phrase “happy people live longer” has been known. Subjective Happiness Scale (SHS) can be used for the study for feeling of happiness. By functional magnetic resonance imaging (fMR), anterior right wedge region of the brain (precuneus) may be important for feeing happiness. Both of effective and functional connectivity of the right precuneus were positively associated with SHS scores. Consequently, happiness may be involved in SHS, structural neuroimaging, neurological study, positive psychological interventions, and so on.

A 37-year-old man with Brugada syndrome and frequent appropriate implantable cardioverter-defibrillator shocks received an epicardial substrate ablation. During the procedure to eliminate delayed potentials, transient, marked ST-segment elevation in lead V2 was observed, particularly in the anterior right ventricle with a borderline between normal and low-voltage areas. (Level of Difficulty: Intermediate.), Graphical abstract, A 37-year-old man with Brugada syndrome and frequent appropriate implantable cardioverter-defibrillator shocks received an epicardial substrate ablation…

Case Presentation A 27-year-old man from Eritrea presented to the ED complaining about a progressively worse blunt chest pain in the anterior right hemithorax. Chest pain started 4 years ago and was intermittent. During the last 6 months, symptoms got worse, and the patient experienced shortness of breath in mild exercise. For this purpose, he visited another institution, where a chest radiograph was performed ( Fig 1 ). He was advised to visit a pulmonologist for further evaluation, with the diagnosis of a loculated pleural effusion in the right upper hemithorax.

A 72-year-old man was referred to a chest X-ray due to persistent coughing, intermittent dyspnoea and atypical chest pain. The radiology report mentioned a 4 cm inhomogeneous opacity at the anterior right lower lung field ([figure 1A][1]). Subsequently, a CT scan of the thorax and upper abdomen

We present a case of an anterior capsular tear of the right knee in a previously healthy, active individual. The patient was a 31-year-old male seen one month after the onset of throbbing anterior right knee pain, which progressed to sharp suprapatellar pain over the next three months. Both dynamic ultrasound (US) and MRI were obtained. Dynamic US revealed a tear of the anterior capsule of the right knee complicated by a suprapatellar effusion communicating into the vastus intermedius fibers of the quadriceps tendon. However, these findings were not evident on MRI. In addition to discussing this unique pathology, we highlight the utility of both standard and dynamic US in establishing diagnoses for capsular pathologies.

Electrode placement in electroconvulsive therapy (ECT) has a major impact on treatment efficacy and cognitive side effects. Left Anterior Right Temporal (LART) is a lesser utilised bilateral montage which may produce more optimal clinical outcomes relative to standard bitemporal ECT. In this study we used computational modelling to explore how stimulation effects from LART and two novel variants (LART - F3 and LART - Frontal) compared to the more common bilateral placements of bitemporal and bifrontal ECT. High resolution finite element human head models were generated from MRI scans of three subjects with Major Depressive Disorder. Differences in regional stimulation were examined through parametric tests for regions of interest and subtraction maps. Compared to bitemporal ECT, LART - Original resulted in significantly greater stimulation of the left cingulate gyrus (hypothesised to be associated with treatment efficacy), and relatively reduced stimulation of the bilateral hippocampi (potentially associated with cognitive side effects). No additional clinical benefit was suggested with the novel LART placements compared to the original LART. The original LART placement is a promising montage for further clinical investigation.

Fil: de Valais, Silvina. Universidad Nacional de Río Negro. Instituto de Investigación en Paleobiología y Geología. Río Negro, Argentina. Fil: Díaz Martínez, Ignacio. Universidad Nacional de Río Negro. Instituto de Investigación en Paleobiología y Geología. Río Negro, Argentina Fil: Citton, Paolo. Universidad Nacional de Río Negro. Instituto de Investigación en Paleobiología y Geología. Río Negro, Argentina Fil: Maniel, Ignacio. CONICET, Museo de Historia Natural de San Rafael, Instituto de Evolución, Ecología Histórica y Ambiente (CONICET-IDEVEA-UTN FRSR); Argentina. Fil: de la Fuente, Marcelo. CONICET, Museo de Historia Natural de San Rafael, Instituto de Evolución, Ecología Histórica y Ambiente (CONICET-IDEVEA-UTN FRSR); Argentina. In the present contribution, we report the evidence of a predation attempt against a semi-aquatic pleurodire turtle who survived the attack. The almost complete shell of this adult turtle, the holotype of Rionegrochelys caldieroi, was found in the Upper Cretaceous Plottier Formation, El Anfiteatro area, Río Negro province, Patagonia. The shell displays two distinct but synchronously produced trace fossils in the anterior right portion of the plastron. One of the trace fossils is semicircular and indicates where the bone has been broken during the attack, as a consequence of a bite. The other one reflects the predator's teeth morphology, and suggests a crocodyliform as the best candidate. Computed tomography analysis reveals regenerated tissue associated with both trace fossils, indicating healing of the wound. No vital organ was seriously injured during the attack, and the turtle survived, lacking a fragment of the shell. Taking into account the evidence in the fossil record, the unambiguous predator-prey relationship between crocodyliforms and turtles is present from at least the Late Jurassic, and the Rionegrochelys caldieroi holotype and their trace fossils is a new evidence of this interaction.

OBJECTIVES The purpose of the present study was to analyse the effects of working posture, physical balance and work accumulation on shifts in plantar pressure in dental hygienists, by measuring REBA, which evaluates working posture, and plantar pressure, which evaluates physical balance. METHODS This study was conducted on 24 dental hygienists currently working in dental clinics. The ergonomic assessment method of the Rapid Entire Body Assessment was used to evaluate working posture in the dental hygienists, and a Gait Analyzer was used to measure plantar pressure. RESULTS The subjects' mean REBA score was 4.96 ± 1.04 points, and 87.5% of the subjects showed poor working posture, with a REBA score of at least four points. Among subjects with a REBA score of four points or more, seven of the eight parts of the sole of the foot showed significant differences in plantar pressure between the right and left feet (P

Background Lung ultrasound examination is becoming an even more important part of pulmonologists' clinical routine. As indicated in the literature, the coordinates of any findings on lung parenchyma are based on surface landmarks or conventional quadrants. In our experience we have noticed that lung fissures are clearly detectable as interruptions of the pleural line, but this has never been investigated previously. The aim of this study was to evaluate whether lung fissures are detectable under normal conditions in routine clinical practice. Methods Ten operators were enrolled from Pleural-Hub, a scientific discussion group. After compiling a prestudy survey to investigate whether they had observed fissures previously, they were asked to note if the following fissures were detectable: posterior right (PR) and left (PL), lateral right (LR) and left (LL), anterior right (AR), and anterolateral left (AL). Enrollment was competitive, aiming to reach 100 case subjects. Results We found that general fissure detection was 61.3%, in particular: PR, 59%; LR, 75%; AR, 69%; PL, 45%; LL, 64%; AL, 56%. Single operators yielded different detection rates ranging from 90% to 25%, showing strong operator dependency. Before being made aware of general results operators indicated operator's skill and rib shadow artifacts as the principal factors affecting fissure detection. Conclusions Lung fissures may be detected with ultrasound once adequate training is provided. This may allow the clinician a more precise anatomical delineation of pathology identified by lung ultrasound.

To examine whether two consecutive soccer matches would affect skin temperature (t sk) measured via infrared thermography (IRT) in under-20 (U-20) soccer athletes, as well as verify whether the t sk changes would be different between regions of interest. A cross sectional study. Ten under-20 soccer athletes [age 19.0 ± 1.0 years; height 181.3 ± 6.6 cm; body fat percentage (BF%) 9.0 ± 1.8%, body surface area 1.9 m2 and $$\dot{V}$$ O2max 56.4 ± 3.2 ml min−1 kg−1]. Skin thermal responses obtained by IRT and creatine kinase concentration (CK) were evaluated in response to two soccer matches with 3 days of recovery between each match. The t sk increased (≅1.0 °C) 24 h after the first match in all studied regions of interest (ROIs), returning to near pre-match values 48 h after the first match. However, after playing the second match, the t sk increased even more (≅1.5 °C) 24 h after in all the considered ROIs, not returning to pre-match values 48 h after. Regarding CK analysis, its course during the experiment was similar to t sk, with high values 24 h after (first match 763.8 ± 294.5 U/L; second match 784.1 ± 298.8 U/L) and recovering 48 h after (first match 526.4 ± 289.7 U/L; second match 672.2 ± 285.0 U/L) both matches. However, when the two matches are compared, CK showed a higher value 48 h after the second match in comparison to first match (P = 0.002). The t sk and CK were moderately correlated in all ROIs analyzed, with higher correlation in the anterior right leg (r = 0.425) and anterior left leg (r = 0.428). The t sk of lower limbs as well as CK markedly change in response to two consecutive matches separated by an interval of 3 days. There is indication of the highest inflammatory response after the second match, which was preceded by just a 3-day recovery. In addition, a general increase was obtained in thighs and legs in anterior and posterior views.

Purpose During the last decades, it has been established that there are numerous individual anatomical variations of the arterial blood supply in human liver. In the present study, we examined the liver vascularization of an intrahepatic cholangiocarcinoma patient. Methods For surgical planning, an enhanced CT scan was performed and a three-dimensional model of liver vascularization constructed. Results The patient was diagnosed as a Michel’s type VII hepatic artery variation. An accessory right hepatic artery arose from the superior mesenteric artery and had distributed into the right anterior liver to provide the blood supply of segments V and VIII, which was more medial than the territory of the right hepatic artery coming from the proper hepatic artery. At the same time, an accessory left hepatic artery originated from the left gastric artery. Conclusion We present a case in which an accessory right hepatic artery provided a territory more medial than a right hepatic artery coming from the proper right artery.

Context According to evo-devo theory, the embryonic development of the nasal organ mimics its phylontogenic formation: the lateral masses of the human ethmoid bone develop by curved “onion” stacking of the endoturbinals (the horizontal bone septa of the mammalian olfactory chamber) under the impact of facial and skull-base remodeling, rather than by pneumatization of cavities communicating via ostia. Objectives To assess the frequency of the onion structure on coronal CT. Material and methods Three independent examiners performed a retrospective descriptive study of coronal CT scans taken ahead of septorhinoplasty between June 2010 and December 2012 in adult patients without history of sinonasal surgery. Results Fifty patients were included. In the anterior right and left and posterior right ethmoid, an onion arrangement of the endoturbinals was systematically found on at least 1 view, and on 60% of views taking all ethmoid compartments together. Two endoturbinals were generally involved, but a rolling-up of 3 endoturbinals was also observed, significantly more frequently in the posterior compartments (P = 0.004 on the right side, P = 0.012 on the left). Conclusion The onion structure of the lateral masses of the ethmoid can be observed on coronal CT scans. This structure confirms evo-devo theory. The ethmoid thus appears fundamentally different from the paranasal sinuses, suggesting that the pathogenesis of nasal polyposis and ethmoidectomy techniques need to be reconsidered.

We report the case of a 55-year-old woman who developed a mass in the soft tissue of the anterior right proximal thigh. Microscopic findings in the biopsy specimen supported the diagnosis of sclerosing epithelioid fibrosarcoma (SEF). This entity is part of a spectrum of lesions that includes low-grade fibromyxoid sarcoma (LGFMS) and hyalinizing spindle cell tumor with giant rosettes (HSCTGR). It shares with LGFMS occasional overlapping histopathologic features and immunopositivity for MUC4. Although FUS and CREB3L2 gene rearrangements, characteristics of LGFMS, have been found in hybrid tumors (those with features of both SEF and LGFMS) and in examples of LGFMS with relapses showing SEF morphology, it appears that EWSR1 and CREB3L1 rearrangements predominate over FUS and CREB3L2 rearrangements among "pure" SEF tumors. Recent information about SEF is briefly reviewed.

Ventricular premature depolarizations (VPD) commonly arise from the septal anterior right ventricular outflow tract (sRVOT), the left coronary cusp (LCC) and the distal great cardiac vein (dGCV). The use of non-invasive electroanatomic mapping (NIEAM) is superior to the 12 lead ECG alone in

Vascular leiomyomas or angioleiomyomas are rare benign solitary smooth muscle tumors that origin usually in the extremities. Most of these tumors are composed of venous vessels. Here in, we report a rare case of subcutaneous vascular leiomyoma of the right knee of a 38 year old woman who was presented with recurrent anterior right knee pain and soft tissue swelling. Clinical findings, magnetic resonance imaging and histopathologic findings of the tumor is discussed. Leiomyomas are not mostly considered in the differential diagnosis by radiologist due to its rarity. Typical imaging and clinical findings of a tumor is an important clue for an accurate and early diagnosis.

We report a case of a 4-week-old female neonate who was admitted to the hospital for a anterior right lump of the neck, perceived by his mother the day before. The mother also noticed a preferential tilting of the head towards right. He was an otherwise full-term healthy baby, with a history of instrumented delivery. There was no fever, trauma or respiratory symptoms/signs. Family history was irrelevant. On examination, the neck swelling was a small firm, partially mobile, no warm on touch and apparently painless mass, with approximately 1.5–2 cm soft tissue mass, attached to the right sternocleidomastoid muscle. There was no restriction of neck movements. Ultrasonography (USG) revealed a 13 mm …

Background Long-term effects of ganglionated plexi (GP) ablation on sinoatrial node (SAN) and atrioventricular node (AVN) remain unclear. This study is to investigate the long-term effects of ablation of cardiac anterior right GP (ARGP) and inferior right GP (IRGP) on function and structure of SAN and AVN in canine. Methods Thirty-two dogs were randomly divided into an operated group (n = 24) and sham-operated group (n = 8). ARGP and IRGP were ablated in operated group which was randomly divided into three subgroups according to the period of evaluation after operation (1 month, 6 months, 12 months). The functional and histological characteristics of SAN and AVN, as well as the expression of connexin (Cx) 43 and Cx 45 in SAN and AVN, were evaluated before and after ablation. Results Resting heart rate was increased and AVN effective refractory period was prolonged and sinus node recovery time (SNRT) and corrected SNRT were shortened immediately after ablation. These changes were reverted to preablation level after 1 month. At 1 month, ventricular rate during atrial fibrillation was slowed, atria-His intervals were prolonged, and Cx43 and Cx45 expression in SAN and AVN were downregulated. At 6 months, all changes were reverted to preablation level. The histological characteristics of SAN and AVN did not change. Conclusion Ablation of ARGP and IRGP has short-term effects on function and structure of SAN and AVN rather than long-term effects, which suggests that ablation of ARGP and IRGP is safe. Atrioventricular conduction dysfunction after ablation may be related to downregulated Cx43 and Cx45 expression in AVN.

The autonomic nervous system (ANS) plays an important role in the initiation and maintenance of atrial fibrillation (AF), and modulation of the ANS function may contribute to AF control.Anesthetized dogs received either sham treatment (SHAM group, n = 8) or low-level carotid baroreceptor stimulation (LL-CBS) treatment (LL-CBS group, n = 8). The stimulation voltage was set at 80% below the threshold. To simulate focal AF, high-frequency stimulation (HFS) was applied to local nerves during the atrial refractory period. Multielectrode catheters were attached to the atria and all the pulmonary veins to determine the changes in the AF threshold (AF-TH), the atrial effective refractory period (AERP), and the window of vulnerability (WOV) during HFS in both groups. Microelectrodes were inserted into the anterior right ganglionated plexus (ARGP) to record neural firing.HFS induced sinus rate (SR) slowing in the superior left ganglionated plexus (SLGP). LL-CBS induced a progressive increase in AF-TH and AERP at all sites and a significant decrease in the sum of WOV at 2 hours (all P0.05). LL-CBS inhibited the ability of SLGP stimulation to slow the SR and the mean values of frequency and amplitude of ARGP neural activity compared with the SHAM group (all P0.05).LL-CBS suppressed AF inducibility by inhibiting the neural activity of ganglionated plexuses. LL-CBS may serve as a novel therapeutic modality to treat AF.

Schizophrenia has been proposed to result from impairment of functional connectivity. We aimed to use machine learning to distinguish schizophrenic subjects from normal controls using a publicly available functional MRI (fMRI) data set. Global and local parameters of functional connectivity were extracted for classification. We found decreased global and local network connectivity in subjects with schizophrenia, particularly in the anterior right cingulate cortex, the superior right temporal region, and the inferior left parietal region as compared to healthy subjects. Using support vector machine and 10-fold cross-validation, nine features reached 92.1% prediction accuracy, respectively. Our results suggest that there are significant differences between control and schizophrenic subjects based on regional brain activity detected with fMRI.

BACKGROUND Lower back pain has a lifetime prevalence of 80% for people in a modern society, and in recent years, spinal stabilization movement has been highlighted as a method to treat lower back pain and an unbalanced position. OBJECTIVE The objectives of this study were to assess the trunk muscle activities in accordance with the tilt angles (10∘, 20∘, 30∘, 40∘) during trunk tilt exercises with a 3D dynamic exercise device. METHODS Active tilt mode (a self-generated active movement in the angle and direction steered by the user) was used in this study. The rotation capability enabled the investigation of the anterior (A), anterior right (AR), right (R), posterior right (PR), posterior (P), posterior left (PL), left (L), and anterior left (AL) tilt directions. EMG signals of the trunk (3 global muscles: rectus abdominis, RA, external obliques, EO, latissimus dorsi, LD, and 1 local muscle: multifidus, MF) muscles were obtained. RESULTS The MF muscle activity was higher while the anterior tilt was maintained, and the abdominal muscle activity was higher while the posterior tilt was maintained. Also, as the tilt angle increased, the activity of the muscles opposite the tilt direction increased. CONCLUSIONS The results indicate that to maintain equilibrium through posture stabilization during whole body tilting, the human body maintains a proper interaction among the body segments as well as between the body and the execution environment. Moreover, stability is maintained through the co-contraction of antagonistic and agonistic muscles. In future studies, it will be important to conduct research on improving imbalance in the trunk muscles.

A Caucasian woman aged 56 years presented to emergency room (ER) department with leucorrhoea and fever since 48 hours. She was a smoker, had no diabetes history, no prosthetic material and denied use of injected drugs. A month before, the patient had a closed inguinal trauma due to fall from height with a muscle strain of the anterior right thigh. Despite rest and analgesics, she went to ER several times because of progressive local pain and swelling. After 3 weeks, a local ultrasound scan showed a 3 cm size haematoma associated with probable rupture of obturator internus and rectus femoris muscles. On the following days, she developed fetid leucorrhoea …

The objective of the study was to investigate the effect of 3-D stabilization exercise using a whole body tilt device. A musculoskeletal (MS) model of the whole body was developed, and used to calculate the forces in the spine, assisted by EMG measurement. The inverse dynamics was solved using the MS model of the whole body with the input data of the eight different directions of the tilt: anterior (A), posterior (P), anterior right (AR), posterior right (PR), anterior left (AL), posterior left (PL), right (R), and left (L), replicating the tilting directions of the whole body device. The anterior and posterior directions of tilt mainly induced superficial back and front muscle activations, respectively. However, deep muscles, such as the semispinalis and mulifidi, were activated in all directions of tilt. The joint resultant forces in the right and left direction of tilt were the least; but some higher activations and more diverse recruitments of muscles were demanded. In the present investigation, 3-D stabilization exercise can provide considerable muscle activation and exercise effect, with the minimum perturbation of structure. Therefore, the proposed direction of tilt can be used to strengthen the targeted muscles, depending on the patient’s muscle conditions.

The early Late Pleistocene late archaic human remains from Xujiayao, northern China, reveal several abnormalities of the neurocranial vault. The Xujiayao site is located on the northwestern boundary of the Nihewan Basin, and on the basis of various indicators, it dates to the early Late Pleistocene. Among the 15 human neurocranial elements found at Xujiayao in the 1970s, three elements show minor traumatic lesions of the external table: the largely complete Xujiayao 5a immature parietal bone, the Xujiayao 8 small piece of anterior right parietal bone and the Xujiayao 12 partial occipital bone. The lesions are all superior to the temporal or nuchal lines and hence were subcutaneous, covered only by the pericranium, the galea aponeurotica and the overlying skin. The external tables are variably concave with irregular bone within the bony depressions, and the diploe show varying degrees of involvement. The Xujiayao abnormalities join a series of minor neurocranial healed lesions among Pleistocene humans, as well as more pronounced healed neurocranial and facial trauma. Copyright © 2012 John Wiley & Sons, Ltd.

Individuals need feedback from the context to determine the success of their actions. In the present study, the explicit process of the feedback judgement (explicit response to feedback correctness) was examined by recording ERPs. A systematic mismatch between the expected feedback information and the observed feedback (incorrect feedback) linked to the subject's performance was used. Thirteen subjects participated in the study, and they were required to detect the correct vs. incorrect feedback with an explicit response. The experimental procedure included three main tasks: the subject's performance (spatial decisional task); the system's response to the performance (external feedback); and the subject's judgement of the external feedback (feedback monitoring). A FRN (feedback-related negativity) ERP effect with a higher amplitude was revealed in case of an explicit feedback monitoring for the incorrect feedback. Moreover, as shown by the cortical source analysis (LORETA), monitoring of an erroneous feedback produced a significant increased response by the right prefrontal area. This negative deflection may be viewed as a specific marker of the conscious monitoring functions. Considering the cortical distribution of this effect, whereas the anterior portion of the cingulate cortex could represent a more automatic cognitive processing of a mismatching, the anterior right dorsolateral area would intervene to reconfigure the subjective expectations when a violation is consciously detected. Generally, this system could explain the significance of the mechanism to the erroneous feedback and the necessity to restore the incoherent information.

We have previously shown that neurally-mediated syncope and inappropriate sinus bradycardia can be treated by cardio-neuromodulation (CardNM), which is a selective and tailored ablation of the anterior right ganglionated plexus (ARGP) [(1)][1]. In our first publication, the left-sided approach was

Aims The first seconds of ventricular fibrillation (VF) are well organized and can consist of just one to two rotating waves (rotors). New rotors are spawned when local propagation block causes wave fragmentation. We hypothesized that this process, which leads to fully developed VF, begins at a consistent anatomic site. Methods and results We initiated VF with a stimulus timed to the local T-wave in 10 isolated pig hearts. Hearts were stained with a voltage-sensitive dye and four video cameras recorded electrical propagation panoramically across the epicardium. In each VF episode, we identified the position of the first wavebreak event that produced new rotor(s) that persisted for at least one cycle. The first such wavebreak occurred along the anterior right ventricular insertion (ARVI) in 26 of 32 VF episodes. In these episodes, wavebreak sites were 6 ± 4 mm from the midline of the ARVI. In the remaining 6 episodes, wavebreak sites were 24 ± 5 mm from the midline on either the LV or RV. During rapid pacing, conduction speed was locally depressed at the ARVI when waves crossed parallel to the midline. Action potential duration (APD) was slightly longer (2.2 ± 2.1 ms) at the ARVI compared with other sites ( P < 0.01). Temporal APD alternans were small and not unique to the break site, suggesting that dynamic APD properties were not the cause of wavebreak. Conclusion The ARVI is the dominant site for wavebreak at the onset of VF in normal myocardium. This may be due to the anatomic complexity of the region.

Obturator type traumatic anterior hip dislocation in adult is rare of all type of hip dislocation. Here we described a case with same description. A patient 30 years male residing at Hoovina Hadagali, Bellary district, Karnataka met road traffic accident of his car while he was sitting in front seat with thigh abducted. He was brought to emergency room where he was diagnosed as obturator type of anterior right hip dislocation and closed reduction was achieved within 2 hours. Patient was posted for closed reduction of right hip under general anaesthesia which achieved by Alli’s maneuver followed by traction and immobilisation with Thomas splint. 3 weeks of immobilisation followed by progressive mobilisation and loading patient was able to walk without any complaint with normal range of movements after 6 months.

A new stylophoran (Ceratocystis prosthiakida sp. nov.) from the early Middle Cambrian of the Franconian Forest (north-east Bavaria, Germany) is described with the aid of computed tomography, a powerful means of visualizing fossil anatomy. Investigation in this manner enabled previously inaccessible, buried parts of the fossil to be imaged and studied. In addition, a procedure for digitally correcting plate articulations was implemented. Ceratocystis prosthiakida sp. nov. possesses a thin anterior right spine which clearly differentiates it from other species of Ceratocystis. Similar to other Ceratocystis species, C. prosthiakida sp. nov. lived in storm-dominated shallow marine conditions. The species is from the Galgenberg Formation, which has an early Agdzian age in the unified West Gondwanan chronostratigraphy. As a result, it represents the oldest stylophoran known to date.

The occurrence of Alexandrium taylori and Alexandrium peruvianum is reported for the first time in Malaysia waters. The Malaysian A. taylori isolates were pyriform in shape with a transdiameter range of 36‐40 mm and a cell length range of 33‐ 37 mm. The first apical plate (1 0 ) was pentagonal with two distinctive anterior margins. No direct connection between 1 0 and the apical pore complex was observed. The posterior sulcal plate (S.p.) was large, elongated and oblique to the right with anterior projections. The ventral pore (vp) was relatively large and situated at a confluence point of 1 0 , the second apical (2 0 ) and the fourth apical (4 0 ) plates. Cells of A. peruvianum were slightly anteriorly and posteriorly compressed. S.p. had an irregular pentagonal shape, with the anterior margin divided into 2 portions. 1 0 was boomerang-shaped with a large and truncated ventral pore in the middle right margin. The anterior right margin of 1 0 was straight. The sixth precingular plate (6 00 ) was wider than long. The anterior sulcal plate (S.a.) was triangular and lacked a left portion extension. In laboratory cultures, both A. taylori and A. peruvianum produced paralytic shellfish toxins, with GTX4 and GTX6 as the predominant toxin, respectively. This is the first report of PSP toxins production for both species as well as the occurrences in Malaysia waters. # 2004 Elsevier B.V. All rights reserved.

A 20-year-old woman presented with spontaneous onset of facial weakness. Examination revealed House-Brackmann grade IV1 right facial paresis and a contralaterally pigmented tongue (figure) from habitual sucking candy use. Contemporaneous taste loss on the anterior right tongue led her to keep the candy as far away from that area as possible—the posterior left tongue.

OBJECTIVE This study was designed to demonstrate that spinal cord stimulation (SCS) could suppress high-frequency stimulation (HFS)-induced focal atrial fibrillation (AF) at atrial and pulmonary vein (PV) sites by inhibiting atrial ganglionated plexus (GP) activity. METHODS Multielectrode catheters were attached to atria and all PV sites. SCS was performed at the T1-T5 spinal region for 1 hour. At the baseline state and the end of 1 hour of SCS, 40 milliseconds of HFS was delivered 2 milliseconds after atrial pacing to determine the AF threshold at each site. One electrode was attached to the superior left GP so that HFS to this site induced sinus rate slowing. Microelectrodes inserted into the anterior right GP recorded neural firing. RESULTS SCS induced a significant increase in AF threshold at all sites (all P < 0.05). The sinus rate slowing response induced by superior left GP stimulation was blunted by SCS (17% ± 3.6% vs. 39% ± 3.8%, P < 0.05). The frequency (32 ± 4 vs. 87 ± 6 impulses per minute, P < 0.05) and amplitude (0.16 ± 0.02 vs. 0.42 ± 0.04 mv, P < 0.05) of the neural activity recorded from the anterior right GP were markedly inhibited by SCS. CONCLUSIONS SCS may prevent episodic AF caused by rapid PV and non-PV firing through modulating GP activity.

Neurofibromas are rare, benign, nerve sheath tumors in the peripheral nervous system. The solitary type is found in those who do not have neurofibromatosis. Solitary neurofibromas are too rare in the giant type. We report a rare case of a solitary giant neurofibroma of the anterior right thigh. The diagnostic criteria, characteristics of imaging studies, and operative approach are represented.

Unilateral and bitemporal electrode placement has been the dominant mode of delivery in electroconvulsive therapy. We report 3 patients receiving maintenance electroconvulsive therapy where the use of dominant electrode placements was ineffective. Changing to left anterior right temporal electrode placement resulted in marked clinical improvement. This supports the limited literature on this electrode placement.

To diagnose posterior and anterior biventricular infarctions it is necessary to record from right and left thoracic and high abdominal unipolar leads. These supplementary leads are dependable, can be repeated as many times as needed and show the evolution from signs of myocardial injury to those of dead tissue (Q waves of 0.04 sec or more). This electrocardiographic evolution increases the diagnostic value of the electrical exploration, since the injury current can be observed also in other conditions. The diagnosis of right ventricular infarction can be established even in the presence of RBBB. Signs of a dead zone in the free right ventricular wall are more frequently observed in posterior biventricular infarctions than in anterior ones. In these cases, the signs of subepicardial injury are more accentuated in the right thoracic unipolar leads than in V3, indicating anterior right ventricular involvement. These signs are also observed in experimental studies made in animals. This electrocardiographic exploration opens a wide field for the diagnosis of myocardial infarction, particularly in biventricular involvement, including old myocardial scars, and in discarding signs of pericarditis manifested only by the upward displacement of the ST segment. A review of the medical literature concerning diagnosis of biventricular infarctions is presented.

The purpose of this study was to examine the usefulness of pulsed tissue Doppler imaging for diagnosing constrictive pericarditis. Motion velocities of the ventricular septum (VS) and left ventricular (LV) posterior wall along the short axis, and those of the anterior right ventricular (RV) wall, VS, and LV posterior wall along the long axis were recorded using pulsed tissue Doppler imaging in 12 patients with constrictive pericarditis, who were diagnosed by cardiac catheterization, and also in 20 normal subjects. Peak early diastolic and atrial systolic velocities (Ew and Aw, respectively) were calculated, and the time between the aortic component of the second heart sound and the peak of the early diastolic velocity (II a -Ew) was determined. The peak Ew and II a -Ew along the short and long axes were significantly higher and shorter, respectively, in the patient group than in the normal group. In the patient group, the motion velocity of the VS along the short axis showed a “backward” motion with a sharp and marked peak velocity immediately before Ew, or a biphasic early diastolic wave; a clear “downward” motion immediately after Ew was observed in the motion velocities of the anterior RV wall, VS, and LV posterior wall along the long axis. These distinctive backward and downward motions were not observed in any of the ventricular walls of the normal subjects. In conclusion, the early diastolic RV and LV wall motion velocity patterns along the short and long axes as measured by pulsed tissue Doppler imaging provide important information for the diagnosis of constrictive pericarditis.

Cardiac injuries remain the most challenging of all injuries seen in the field of trauma surgery. Penetrating injury to the heart generally occurs less frequently than blunt injury and most commonly injures the large anterior right ventricle. We present an unusual, and to our knowledge a previously unreported, cause of cardiac penetrating trauma in a child, involving a hooked needle (a 15 cm long, metallic device usually used for crocheting or lacemaking). A ventricular septal defect was managed conservatively shortly after the primary cardiorrhaphy. Evaluation methods for this rare presentation and its possible surgical treatments are discussed.

Totally laparoscopic liver resection (LLR), first described by Gagner et al. in 1992 [1], now appears to be safe and effective procedure to treat lesions located on left lateral (2 and 3), middle (4b), and anterior right (5, 6) segments. Tumors localized in the posterior and superior segments of the liver or masses requiring major liver resections (right hepatectomy, left hepatectomy, extended right or left hepatectomy) are still considered less frequent indications for the minimally invasive approach and should be reserved to centers with significant experience in laparoscopic liver surgery (LLS), open hepatic surgery, and intraoperative ultrasound (US) [2]. Indications for LLS, with particular reference to resection of segment 6 (S6), remain basically the same as in open surgery and, technical feasibility of S6 resection using a minimally invasive approach is increasing with surgeon skill [2]. On this basis, a liver lesion located on S6 should be routinely evaluated for LLR in high-volume centers.

The myocardium may be divided into distinct zones which act as functional units of the coronary vascular network. The basic principle of this functional systematization of cardiac blood vessels is a constant relationship between the "distributing" and the "delivering" vessels. Six arterial zones of the myocardium are identified under this scheme: anterior right ventricular, lateral left ventricular, posterior left ventricular, interventricular septal, posterior right ventricular, and atrial. The distributing vessels of functional myocardial zones are most frequently both arterial and venous. However, between the lateral and posterior left ventricular zones there is sometimes only the left marginal vein (24%) or left marginal artery (20%). Between the atrial and posterior right ventricular zones there is sometimes only the right coronary artery (52%), or only the small cardiac vein (14%) as a distributing vessel. Between the left and the right posterior ventricular zones there is sometimes an arterial and sometimes a venous distributing vessel (10%). Between the posterior and anterior right ventricular zones there is either the artery (21%) or the right marginal vein (8%) as a distributing vessel. The permanence of the six functional myocardial zones is determined not only by the arterial but also by the venous distributing vessels, and in some cases the venous vessels are the only distributing vessels between certain zones.

Presentation of Case A 69-year-old woman was admitted to the hospital because of a right orbital mass with chronic conjunctivitis. One month before admission she had noticed that her right eye was bloodshot. An ophthalmologist found a mass beneath the lateral aspect of the right lower lid with overlying conjunctival injection. Dexamethasone eye drops were prescribed. A computed tomographic (CT) scan of the orbits (Figure 1 and Figure 2) showed a slightly ill-defined, enhanced mass in the inferior and lateral anterior right orbit, without calcification or cavitation; there was no bone destruction, paranasal sinus disease, or evidence of an intraocular malignant tumor. . . .

The distribution of pacemaker cells and atrial working cardiomyocytes in the anterior right atrial wall was studied using intracellular glass microelectrodes under conditions of short-term culturing. It was shown that the dominant pacemaker region and the functional tail are located in the lateral area of the central part of the sinoatrial node, while the medial area is occupied by latent pacemaker cells.

Objective. Impaired left ventricular (LV) mechanics in human hypertension are strongly related to LV hypertrophy (LVH). In the present study, we investigated the relationship between LV mid-wall fractional shortening (MWS) and biventricular hypertrophy in uncomplicated essential hypertensives. Methods. A total of 328 hypertensive patients categorized in tertiles of MWS were considered for the analysis. All patients underwent routine and standardized echocardiographic examinations. Biventricular hypertrophy was defined by anterior right ventricular (RV) wall thickness ≥3.1 mm/m2 in men and ≥3.0 mm/m2 in women, combined with LV mass index (LVMI) ≥49 g/m2.7 in men and 45 g/m2.7 in women. Results. Biventricular hypertrophy was found in 21% of the study population. In the lowest MWS tertile, the likelihood of biventricular hypertrophy was 1.4- and 1.9-fold greater (p