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OBJECTIVES The objective of the study was to establish the repeatability of baseline diagnostic images of the dorsum of the hands acquired using a high resolution Laser Doppler imager in patients with Raynaud's phenomenon secondary to Systemic Sclerosis (SSc). METHODS The dorsal side of the hands of 22 patients (8 male 14 female) , age range 29-73, median 62, with SSc and secondary Raynaud's phenomenon were imaged over two consecutive days at approximately the same time using a Moor Instruments High Resolution Laser Doppler imaging unit. The images were analysed by taking regions of interest at discrete locations in the images to calculate dimensionless values of flux(PU). Repeatability of the diagnostic investigation was assessed by using methods described by Bland and Altman and by also plotting the results from visit 1 against visit 2 and calculating the line of best fit. RESULTS AND CONCLUSIONS Based on the criteria that 95% of all measurement differences should be within a factor of 1.96 of the standard deviations of the mean values, then high resolution Laser Doppler Imaging technique is probably repeatable when acquiring and analysing baseline images of patients with Raynaud's phenomenon secondary to SSc. However a larger study with more patients is required to prove this conclusively - as only data from 19 patients was analysed [3 patients were not included due to technical issues] - and was therefore susceptible to marked clinical variations in patients presenting on different days for the investigations.

Various surgical techniques have been described for the release of syndactylized fingers. In our experience, the omega flap technique, which includes a dorsal truncated flap and an anchor incision on the volar side, stands out as a good technique to release syndactyly. Incidentally, in symbrachydactyly also, the fused digits can be released using this technique. Despite this, we could find no reference in the recent years. We would like to stress the ease and importance of this technique, hoping many practicing hand surgeons will benefit from this. Our purpose was to revisit this technique and expose it to the younger generation of hand surgeons. We have operated on 20 cases of syndactyly of different types—simple, compound, and complex—and 5 cases of symbrachydactyly. In all cases, the omega flap on the dorsum and anchor incision on the volar aspect of the finger forming 2 lateral palmar flaps were used. The release of syndactyly was satisfactory in all patients. There was no flap necrosis. None of these cases have required secondary surgery because the primary releases were adequate. Release of syndactyly had been a problem for centuries. Awareness of the disability was insufficient in earlier days; currently, they seek early medical care. The release should be complete. These children must be able to achieve the form and function of the hand, and additionally precision to work. We believe that the use of omega flap and anchor flap is a good procedure for syndactyly release.

Detailed knowledge of the anatomy and different variations of the superficial branch of the radial nerve could be of great importance not only to anatomists but also to clinicians. A predominant radial nerve supply to the dorsum of the hand is rare. Herein, we present an unusual case of unilateral sensory innervation of the dorsal hand found during routine anatomical dissection of a 72-year-old at death male Caucasian cadaver. We also present a brief discussion of the reported variation and emphasize its potential clinical implications.

This retrospective case series aimed to identify whether trans-articular screws, dorsal bridging plates or if a 4-corner compression plate offers better functional outcome after B2 Lis Franc injuries. Thirty-eight patients underwent surgical fixation for these injuries over five years in a Level 1 Trauma Centre. Patients were treated in 1 of 3 treatment arms: trans-articular screw, dorsal bridge plate, or 4-corner compression plate fixation. The primary outcome measures were the Manchester Oxford Foot and Ankle Questionnaire and the Euroqol- 5DL score and surgical results included postoperative complications and further surgery. Injury type, energy of mechanism, open versus closed status were not significantly different within any fixation group. We achieved 94.7% (n=36) good anatomical reduction. Finding significant improvement between plate fixation (both types) versus trans-articular screw groups treatment functional outcomes. A clinically crucial improvement in Manchester Oxford Foot & Ankle Questionnaire scores, and improved Euroqol- 5DL outcomes between 4-corner compression plate and trans-articular screw group. Overall, there was no significant difference in metalware failure, metalware removal and soft tissue complications. This study concludes that functional outcomes after Lis Franc fractures are not just dependant on the quality of anatomical reduction but are affected by fixation type. Further studies are required to provide qualitative analysis and assessment of dorsal bridge plate fixation versus 4-corner compression plate. Significantly, we have seen the 4-corner compression plate group reached the minimum clinically meaningful difference in the Manchester Oxford Foot and Ankle Questionnaire when compared to trans-articular screw fixation. Level of Clinical Evidence: 4

Fin clips (complete fin removal) or punch marks (stamping of a hole) in fins or operculum are quick and inexpensive methods to identify individuals or groups of fish. This study evaluated the retention of 6 mm diameter punch marks on the operculum, caudal (upper and lower lobes), dorsal, pelvic, and anal fins, and fin clips on adipose, pectoral, pelvic, dorsal and anal fins of rainbow trout Oncorhynchus mykiss for 279 days. Growth and survival were not significantly different among fish with the different mark types or locations. At the end of the experiment, 100% of adipose clips, 97% of pectoral and anal fin clips, and 93% of dorsal clips and pelvic fin clips were retained. Retention of punch marks was 57% and 50% for the lower and upper caudal fin lobe locations respectively, 23% for the dorsal fin, and 3% for the operculum. No pelvic or anal fin punch marks were identified at the end of the trial. Significant differences in retention among the treatment groups did not occur until 125 days post marking, after which all fin clip treatments had significantly greater retention than pelvic and dorsal punch marks. Beyond 244 days, fin clips outperformed all punch mark locations.

Dorsal arachnoidal webs are condensations of arachnoidal tissue densely adherent to the pial surface of the posterior aspect of the dorsal spinal cord. Infrequently described in literature they disrupt the flow of CSF in the spinal subarachnoid space leading to syringomyelia and myelopathy. While there are several theories on their origin, the “scalpel sign” on magnetic resonance imaging is considered to be pathognomonic of this condition. An illustrative case of a 58 year old man with syringomyelia and dorsal cord indentation who presented with spastic paraparesis, gait instability, parasthesias and bilateral non radicular upper limb pain that resolved following excision of the web is described to highlight the importance of considering this diagnosis when cases of so called “idiopathic” syringomyelia are encountered.

Estudiamos el desarrollo del plumaje y crecimiento de los polluelos del colibrí barba negra (Archilochus alexandri) en el sureste de Arizona, EUA. Los polluelos vuelan después de 20-22 días de haber eclosionado y llegan a un peso máximo de 4.16 g antes de comenzar a volar; lo que representa aproximadamente el 126% del peso de los adultos. Los polluelos nacen con 11 pares de neossoptiles de color café claro, organizados en dos hileras dorsales. Las plumas del cuerpo comienzan a emerger de la piel a los 6 días de edad. Las plumas de las alas comienzan a emerger alrededor de los 12 días, y las plumas del cuerpo comienzan a emerger alrededor de los 9 días de edad. Aquí presentamos una guía fotográfica que será útil para estimar la edad de los polluelos en campo, con base en el desarrollo de las plumas, así como los primeros registros publicados de las tasas crecimiento de esta especie.

The Cambrian Fortunian Kuanchuanpu Formation and coeval strata in southern Shaanxi and northern Sichuan Provinces contain phosphatic carbonate that has yielded unambiguous body fossils of cycloneuralians. To date, six genera and species as well as nine indeterminate forms have been reported, and they provided information on the earliest known cycloneuralians and ecdysozoans. Among them, an indeterminate form is critical for understanding the evolution of the Fortunian cycloneuralians, and here I formally name it as Xinliscolex intermedius n. gen. n. sp. It has a series of at least seven longitudinal spinose sclerites on the dorsal side, and sensory structures such as pores and tubules distributed randomly among the annuli. The trunk end has two pairs of bilaterally arranged caudal spines. Micro-CT analysis reveals the preservation of a pharynx with inverted introvert with internally hollow scalids, an esophagus, midgut and hindgut, and a terminal anus. The digestive tract of Xinliscolex intermedius resembles that of modern priapulids, implying that the earliest known cycloneuralians have evolved a relatively derived digestive system, and this lays a foundation for their further diversification and evolution.

A 62-year-old female patient presented with left radial side wrist pain for the past 4 weeks. She denied any history of trauma. On physical examination, she had swelling and tenderness to palpation in the first dorsal compartment with a positive Finkelstein’s test. On ultrasound, the first

Resumen Antecedentes y objetivo Las infiltraciones de corticoides son efectivas en el tratamiento de los dedos en gatillo pero el dolor percibido por el paciente durante la inyeccion es un efecto acompanante siempre presente. El objetivo de este estudio fue evaluar la efectividad y el dolor percibido durante una infiltracion corticoidea depositada fuera de la vaina tendinosa utilizando la tecnica comisural dorsal. Material y metodo Se incluyeron 126 pacientes consecutivos. Se realizo una infiltracion esteroidea subcutanea (fuera de la vaina) a traves de la comisura dorsal. En los casos en que los signos o sintomas persistieron, se ofrecio una segunda infiltracion. Se registro el dolor percibido durante la infiltracion mediante la escala visual analogica, el cuestionario DASH antes del tratamiento y al final de seguimiento, la tasa de exito y las complicaciones. Resultados Fueron 86 mujeres y 40 hombres con una edad media de 61 anos. La puntuacion media del dolor durante la infiltracion fue de 3,8. Doce pacientes se perdieron durante el seguimiento. El exito global fue del 68% y el exito tras una unica inyeccion fue del 54%. El mejor resultado se obtuvo en el dedo anular. Los pacientes que no habian sido operados previamente del sindrome del tunel carpiano respondieron mejor. No se objetivaron complicaciones. Conclusiones La infiltracion esteroidea fuera de la vaina tendinosa y utilizando la tecnica comisural dorsal es efectiva y segura en el tratamiento de los dedos en resorte. Parece ser menos dolorosa que los resultados publicados para la tecnica palmar sobre la linea media, aunque esto debe evaluarse en un estudio disenado para ello.

Background: Dorsal preservation rhinoplasty (DPR) has recently received significant academic attention in part due to theoretical benefits over excisional surgical methods. The purpose of this study was to assess the global practice patterns regarding this technique. Materials and Methods: An 11-item questionnaire was electronically distributed to regional academies/societies representing rhinoplasty surgeons worldwide. Respondent exposure to and use of DPR were assessed based on geographic location. Results: Eight hundred thirty-six responses were received. Despite early publications on DPR originating largely from Western Europe and the United States, Turkey and Mexico have the greatest use of DPR techniques currently. The familiarity across many regions with preservation techniques appear to be secondary to courses and conferences rather than incorporation into training. Mexico demonstrates the greatest exposure to DPR during training. One hundred twenty-five respondents had previously used but abandoned dorsal preservation techniques. Poor results, less predictability, and complications (largely hump recurrence) are cited as common reasons for this. Conclusion: There is variability in the global practice of DPR across regions and this will likely continue to evolve.

Background: The purpose of this study was to investigate variations in radiographic metacarpal anatomy as it relates to intramedullary (IM) fixation of metacarpal fractures and to compare this anatomy with available headless screw dimensions. Methods: We radiographically analyzed posteroanterior and lateral (LAT) radiographs of 120 metacarpals across 30 patients without structural abnormalities. Primary outcomes included IM isthmus diameter, isthmus location, metacarpal cascade, and head entry point collinear with IM canal. Measurements were compared with a list of commercially available headless screws used for IM fixation. Results: The average largest isthmus diameter was in the small metacarpal (3.4 mm), followed by the index (2.8 mm), long (2.7 mm), and ring (2.7 mm) metacarpals. The average cascade angle between long and index, long and ring, and long and small metacarpals was 0°, 24°, and 27°, respectively. The appropriate head entry point ranged between 25% and 35% from the dorsal surface of the metacarpal head on a LAT view. The retrograde isthmus location of the index and long finger was 39.2 and 38.1 mm, respectively. Twenty-five screws from 7 manufacturers were analyzed with sizes ranging from 1.7 to 4.5 mm. Only 8 of 17 screws between 2.3 and 3.5 mm had a length range above 35 mm. Conclusions: Metacarpal head entry point and cascade angle can help identify the appropriate reduction with the guide pin starting point in the dorsal 25% to 35% of the metacarpal head. Surgeons should be mindful to choose the appropriate fixation system in light of the variations between metacarpal isthmus size, isthmus location, and available screw lengths.

Background: The recurrence rate after open excision of ganglion cysts is approximately 20%. However, this literature is based on a small series of subjects. This study aims to determine the rate and risk of recurrence after open excision of ganglion cysts in a large patient series. Methods: This study included 628 patients who had ganglion cyst excision from 2010 to 2018. A retrospective chart review recorded the following: age, sex, laterality, volar/dorsal location, and recurrence. An overall recurrence rate was calculated. In addition, a 1-way analysis of variance test was used to compare recurrence rates among the individual surgeons, and unpaired t tests were used to compare age of recurrence, dorsal cyst recurrence, laterality of cyst, and recurrence based on sex. Finally, a comparison of recurrence rate over time was conducted for surgeon 3. Results: The overall recurrence rate was 3.8% (24 of 628). The recurrence rates for each surgeon were 3% (9 of 353), 2% (3 of 167), and 11% (12 of 107), P = .02. The age of those with and without a recurrence did not differ (32 years vs 38 years), P = .06. The recurrence rate of dorsal ganglion cysts was 4.1% (14 of 341) compared with 3.5% (10 of 286) for volar ganglion cysts, P = .69. Male patients had a recurrence in 6.4% (13 of 204) of cases compared with 2.6% (11 of 424) of female patients, P = 0.01. There was a decrease in the rate of recurrence from 42.9% to 5.3% over 5 years for surgeon 3. Conclusion: In our sample, male sex and surgeon experience were significant risk factors in ganglion cyst recurrence.

Background Pes cavus can be defined as an abnormal elevation of the longitudinal arches, which is often secondary to a muscle imbalance. This deformity affects the foot’s three dimensions (3D) and our osteotomies are usually planned on a lateral (two-dimension) X-ray. Are we really considering all the spatial components of the deformity? The aim of this study is to present a technique tip to identify the apical plane of the pes cavus deformity and perform a midfoot dorsal-based wedge resection osteotomy by using customized 3D printed surgical guides. Methods Three patients underwent the presented technique, all for the indication of symptomatic neuromuscular pes cavus with both anterior and posterior deformity. Results 3D-printed patient-specific guides help the surgeon to minimize human error, improving intraoperative accuracy, while reducing surgical time and intraoperative X-ray exposure. Conclusions Closing wedge midfoot osteotomy to correct anterior pes cavus may be an interesting indication to use customized 3D printed surgical guides.

The temporo-parietal junction (TPJ) is a cortical area contributing to a multiplicity of visual, language-related and cognitive functions. In line with this functional richness, also the organization of the underlying white matter is highly complex and includes several bundles. The few studies tackling to date the outcome and neurological burdens of surgical operations addressing TPJ document the presence of language disturbances and visual field damages, with the latter hardly recovered in time. This observation advocates for procedures identifying the optic radiation (OR) bundles crossing the white matter (WM) below TPJ. In the present study we adopted a multimodal approach to address the anatomo-functional correlates of the dorsal loop (DL) of the OR. In particular, we combined cadavers’ dissection with tractographic and electrophysiological data collected in drug-resistant epileptic patients explored by stereoelectroencephalography (SEEG). Cadaver dissection allowed us to appreciate the position and geometrical properties of the DL. More surprisingly, both tractographic and electrophysiological observations converged on a unitary picture highly coherent with the data obtained by neuroanatomical observation.The combination of diverse and multimodal observations allows to overcome the limitations intrinsic to single methodologies, and to define a unitary picture which makes it possible to investigate DL presurgically and at the individual patient level, aiming at limiting the postsurgical damages. Notwithstanding, such a combined approach could serve as a model of investigation for future neuroanatomical inquiries tackling WM fibers anatomy and function through SEEG-derived neurophysiological data.

Purpose: Dorsal metacarpal artery (DMA) flaps have been used successfully for distal dorsal finger defects. Some studies have reported inconsistent DMA anatomy, and there have been no studies on the anatomic variation of DMAs in Asian cadavers. Therefore, we evaluated the anatomy of DMA using Korean fresh cadavers and reported the clinical outcomes of the DMA flaps.Methods: In the cadaver study, four human forearms from adult fresh cadavers were dissected. The dorsal metacarpal arteries and their communicating branches were identified. From July 2016 to June 2019, five patients with dorsal finger defects underwent a first DMA (FDMA) flap or a reversed DMA (RDMA) flap.Results: In our cadaver study, the ulnar branch of the FDMA and the second and third DMAs were absent in two of four (50%) of the cadavers. In our case series, five flaps survived, and one had partial necrosis, which healed by the second intention. The mean operation time was approximately 100 minutes, and the mean outpatient follow-up period was 6 months.Conclusion: DMA flaps are a reliable flap for the reconstruction of relatively large soft tissue defects of the dorsal finger. However, in our anatomical study, inconsistency of the anatomy of DMAs was identified. Therefore, preoperative Doppler examination is required to evaluate the anatomy of the DMA before considering the use of DMA flaps.

Iso-nitrogenous and iso-lipidic diets containing 0%, 3%, 6%, 9%, and 12% hydrolyzed porcine mucosa (namely, HPM0, HPM3, HPM6, HPM9, and HPM12) were prepared to evaluate their effects on the growth performance, muscle nutrition composition, texture property, and gene expression related to muscle growth of hybrid groupers (Epinephelus fuscoguttatus ♀ × Epinephelus lanceolatus ♂). Groupers were fed to apparent satiation at 08:00 and 16:00 every day for a total of 56 days. It was found that the weight gain percentage in the HPM0, HPM3, and HPM6 groups did not differ (P > 0.05). The cooking loss and drip loss of the dorsal muscle in the HPM3 group were lower than those in the HPM6 and HPM9 groups (P

During the analyses of several hundred prehistoric individuals from Austria, we observed that some women display a "Pelvic Pattern" at the innominate bones and the sacrum, i.e. specific combinations of pronounced expressions of pelvic features. We recorded classic pelvic features (dorsal pubic pitting, preauricular sulcus, extended pubic tubercle) as well as new ones (SPE: sacral preauricular extension, a ventrally pointing flat bone formation at the ventrosuperior margin of the ala ossis sacri; SPN: sacral preauricular notch, a loss of convexity at the same location; CF: corresponding facets at the ilium), and some less well-known features, i.e. the margo auricularis groove, ventral pubic exostoses and lesions. To quantify the assessed features, we developed a specific formula to calculate the 'Pelvic Pattern Index' (PPI). As pregnancies and/or parturitions are suspected to contribute to or be at least partly causative of the occurrence of pelvic features, we analyzed 48 well-preserved female individuals and 15 males from identified skeletal collections with obstetric information in Geneva and London. In these collections, we found a pelvic pattern of at least four out of ten distinctly expressed pelvic features only in multiparous females, but not in nulli- or primiparous females or in males. This pattern was found in 40.6% of the multiparous females and 29.2% of all females from the identified collections, compared to 56.1% of well-preserved prehistoric females with unknown parity status from Austria (n = 41). The mean PPI of the multiparae from the identified collections is 0.25, compared to a mean PPI of 0.19 for all women from the identified collections, and 0.28 for the prehistoric female individuals. We conclude from this that a high PPI (≥ 0.30), especially in cases where SPE or SPN are present, can give insights into past motherhood.

Objective : Angiolipomas are usually found in the subcutaneous tissue of the trunk and limbs. Spinal angiolipomas (SALs) are uncommon and have rarely been reported. We report a series of nine SALs patients who received surgical treatment in our department. To summarize the clinical characteristics of SALs, propose our surgical strategies, and evaluate the effects of the operation.Methods : This was a retrospective review of nine SALs patients who received surgical treatment from August 2015 to March 2020. Total or subtotal resection was determined by the axial localization (dorsal or ventral) and the extent of intervertebral foramen involvement. The outcomes were assessed based on the modified Japanese Orthopaedic Association (mJOA) scoring system utilized before surgery and at various follow-up points.Results : Among the nine patients, the mean mJOA score before surgery was 6.6±2.3, compared with 10.1±1.1 at the last follow-up time point (33.4±11.8 months). All patients achieved good outcomes, even in cases of subtotal resection.Conclusion : Early surgical resection of SALs is recommended, and the specific procedures should be determined by the axial localization (dorsal or ventral) and the extent of intervertebral foramen involvement. Most of the patients had a good prognosis, even in cases of subtotal resection.

Cavovarus deformity leads to increased peak pressure on the plantar lateral foot, which can lead to ulceration, and can potentially progress to amputation. Techniques have been suggested in the treatment of cavovarus deformity, such as peroneus brevis or longus tendon transfer, anterior tibial tendon lengthening, posterior tibial tendon transfer, or boney resection. This case series shows split anterior tibial tendon transfer as a surgical reconstruction of cavovarus pedal deformity. Our technique of split anterior tibial tendon in-phase transfer to the dorsal lateral foot, restores the eversion and dorsiflexory pull necessary to offset peroneal attenuation. The procedure can be performed primarily or staged, in order to achieve infection temporization prior to the transfer. A total of 14 patients underwent split anterior tibial tendon transfer, 57.14% (8/14) of which had preoperative ulcerations, and 42.86% (6/14) of which had preoperative hyperkeratotic pre-ulcerative lesions. The preoperative ulcerations were present for an average of 67.89 weeks (range 2-232), with an average area of 6.09 ± 7.44 cm2. The ulcerations healed in 75% (6/8) of the patients, at 19.67 weeks (range 1.57-76), with new ulceration occurrence in 7.14% (1/14) of patients, 7.14% (1/14) rate of ulceration recurrence. None of the patients went on to minor or major amputation. The goal of the tendon transfer is to decrease midfoot plantar pressures on the lateral foot and allow for resolution of pre-existing ulcerations and rebalancing the foot and ankle.

Dorsal hump reduction is one of the most common techniques used in modern rhinoplasty, yet it carries a high propensity for untoward aesthetic and functional sequelae, as evidenced by a nontrivial revision rate. Component dorsal hump reduction with stepwise deconstruction and manipulation of component parts allows for an adaptable and precise approach to variances in anatomy and in desired aesthetic result. Secondary changes must be anticipated and addressed at the index operation to avoid negative results and prevent the need for revision. Adequate reconstruction of the midvault is paramount to achieving optimal aesthetic and functional outcomes.

CASE DESCRIPTION A 12-year-old 32-kg neutered female crossbreed dog was treated for a large lumbosacral skin defect. CLINICAL FINDINGS The dog had sustained multiple, penetrating dog bite wounds to the lumbosacral and gluteal regions 5 days earlier. The referring veterinarian had initiated treatment with amoxicillin–clavulanic acid, which was continued at a dosage of 8.75 mg/kg, SC, every 24 hours at the referral hospital. Examination of the skin defect revealed a large subcutaneous abscess in the dorsal lumbosacral region with draining perimeter tracts at the wound margin. The partial-thickness wound measured 24 × 35 cm and had multifocal regions of necrosis extending caudally from the dorsal aspect of the T11 vertebra to the tail base. The skin defect was bounded by discolored and necrotic skin edges. TREATMENT AND OUTCOME The dog underwent extensive soft tissue wound reconstruction. A single, large, meshed full-thickness free skin graft was harvested from the left dorsolateral aspect of the thorax and grafted to the dorsal lumbosacral region, thereby enabling successful closure of the wound defect. Primary healing of the wound eventually occurred, without postoperative complications. CLINICAL RELEVANCE Use of a large, meshed full-thickness free skin graft led to a satisfactory outcome for this dog but required challenging postoperative management. Application of single, large, meshed full-thickness free skin grafts may be an option to manage large skin deficits in the lumbosacral area in dogs.

The dorsal subiculum (DSub) has reciprocal connections with the dorsal hippocampus, and these regions play a role in spatial representation in contextual fear conditioning (CFC). Recently, we used AP5 and muscimol infusions to show that the DSub is required for CFC consolidation. The CFC component can be present in other learning tasks, such as step-through inhibitory avoidance (ST IA), which requires the dorsal hippocampus for acquisition and consolidation. This suggests that the DSub may be also involved in ST IA if the CFC component of the protocol is strong enough. Therefore, this study tested whether the DSub participates in ST IA acquisition and consolidation in male Wistar rats. Our data showed that pre-or posttraining infusions of AP5 or muscimol into the DSub did not affect ST IA acquisition and consolidation. We discuss the present results in relation to our previous findings, which showed the involvement of the DSub in CFC consolidation, and highlight some reasons that may explain the divergent results between the tasks. First, we note the possibility to escape from the unconditioned stimulus that occurs in ST IA, but not in CFC. We also suggest that the instrumental component of ST IA seems to be more prominent than the CFC one. Finally, we consider the possible influence of aspects of anxiety present in the ST IA, but not in CFC. These possible interpretations provide a broad framework in respect of the present results and raise new questions that demand further studies exploring the DSub function in inhibitory avoidance. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A new species, Zographetus dzonguensis sp. nov., is described based on three male specimens from Upper Dzongu, North Sikkim District, Sikkim, India. The new species is closely similar to Z. pangi from Guangdong and Z. hainanensis from Hainan, China, from which it is distinguished based on the following combination of external characters: (a) forewing with the white spot at the base of space M3 being sharply pointed at the inner edge and conspicuously more elongated, and (b) on underside of hindwing, all chocolate-brown spots being smaller, in Z. dzonguensis sp. nov. compared with both Z. pangi and Z. hainanensis. In Z. dzonguensis sp. nov., the male genitalia may be distinguished as follows: (c) tegumen and uncus are almost equal in length, (d) the dorsal outline of tegumen is relatively flat, and (e) saccus is distinctly bent upward as angle between vinculum and saccus is more acute than in Z. pangi and Z. hainanensis.

Epipunctae are microscopic perforations that do not penetrate the shell but are confined to the outer layers of the shell. They have been known previously only in the orthidine family Plaesiomyidae. The striated walls of epipunctae are considered unique to brachiopods and thus of significance for the study of stem-group brachiopod. In this study, we report the first occurrence of epipunctae in a non-plaesiomyid brachiopod based on a well-preserved external mould of Cathaysiorthis yushanensis from the lower Silurian Shiyang Formation of Jiangxi, southeastern China. The species belongs to the Family Cathaysiorthidae which differs from the Family Plaesiomyidae in many aspects especially in dorsal internal structures. The new data imply that epipunctae may be more widespread in orthide brachiopods than previously thought, strengthening the notion that this is a plesiomorphic character of the brachiopod shell. The discovery of epipunctae, however, depends on excellent preservation of the outer surface of the shells as well as careful cleaning and observation.

Introduction Partial flap necrosis is a common complication after surgery. McFarlane flap model has been used for assessment of various agents' effects on random flap survival. The aim of this study was to review the methodology of studies using this flap model and reveal the most successful agents. Materials and methods PubMed, Scopus, and Web of Science databases were screened for words "McFarlane flap," "flap survival," and ("flap" and "rat") by using time limits between 1965 and 2019. A total of 71 original articles were reviewed. Dimensions and base (cranial/caudal) of the flap, treatment protocol, follow-up period, and survival rates were extracted. Modified survival rates were calculated. Coefficients of variation of cranial/caudally based control group flaps and most commonly used flap models were calculated to assess interstudy variability. Results A total of 165 different treatment regimens were studied. One-hundred twelve regimens (67.9%) were found to increase flap survival. Most common flap dimensions were 9 cm × 3 cm, followed by 10 cm × 3 cm, 8 cm × 2 cm and 6 cm × 2 cm. Studies using caudally based flaps showed less interstudy variability, but survival rates were similar. Pentoxifylline, sildenafil, chlorpromazine, phenoxybenzamine, and phentolamine were reported to be successful in multiple studies. Conclusions There are numerous agents found to be effective for treatment of partial flap necrosis, but further clinical research is needed. To overcome standardization problems, use of commonly used flap dimensions with a caudal base and interpretation of results after 7 days of follow-up seems appropriate.

Limb ischemia is a dreaded complication of large-bore access during prolonged Impella support. We report a novel technique to modify 14F Impella sheath by creating two perfusion holes in the dorsal sheath surface to enable distal limb perfusion via dead space surrounding 9F Impella catheter in flow-occlusive iliofemoral arteries.

The effects of ozone on hippocampal expression levels of brain-derived neurotrophic factor (BDNF) and c-fos protein (Fos) were evaluated in rats with chronic compression of dorsal root ganglia (CCD). Forty-eight adult female Sprague-Dawley rats were randomly divided into the following 4 groups ( n = 12 ): sham operation (sham group), CCD group, CCD with 20 μg/ml of ozone ( CCD + A O 3 group), and CCD with 40 μg/ml of ozone ( CCD + B O 3 group). Except the sham group, unilateral L5 dorsal root ganglion (DRG) compression was performed on all other groups. On days 1, 2, and 4 after the operation, the CCD + A O 3 and CCD + B O 3 groups were injected with 100 μl of ozone with concentrations of 20 and 40 μg/ml, respectively. Thermal withdrawal latencies (TWLs) and mechanical withdrawal thresholds (MWTs) were measured at various time points before and after the operation. BDNF and Fos expressions were examined in the extracted hippocampi using immunohistochemistry. The TWLs and MWTs of CCD model rats that received ozone were lower with decreased BDNF and increased Fos expression levels, on day 21 after the operation, compared to those of the sham group ( P < 0.05 ). The TWLs and MWTs of the CCD + A O 3 and CCD + B O 3 groups were higher with increased BDNF and decreased Fos expression levels, on day 21 after the operation, compared to those of the CCD group ( P < 0.05 ). The TWLs were longer and the MWTs were higher in the CCD + B O 3 group at each time point with increased BDNF and decreased Fos expression levels, on day 21 after the operation, compared to those of the CCD + A O 3 group ( P < 0.05 ). Our results revealed that ozone can relieve the neuropathic pain caused by the pathological neuralgia resulting from DRG compression in rats. The mechanism of action for ozone is likely associated with changes in BDNF and Fos expression levels in the hippocampus.

We retrospectively compared the results of volar plating and dynamic external fixation for acute unstable dorsal fracture-dislocations of the proximal interphalangeal joint with a depressed fragment. We treated 31 patients (31 fingers), 12 with volar buttress plating and 19 with dynamic external fixation. Follow-up averaged 35 and 40 months in the two groups, with a minimal 6-month follow-up. Average active flexion of the proximal interphalangeal joint was 95° after plate fixation and 87° after external fixation, with an active extension lag of –6° and –9°, respectively. Active flexion at the distal interphalangeal joint averaged 67° in the plate group and 58° in the external fixation group, with active extension lags of 0° and –5°, respectively. We conclude that both methods can obtain a good range of motion at the proximal interphalangeal joint. A limitation of the extension of the distal interphalangeal joint occurred with dynamic external fixation but not with volar buttress plating. Level of evidence: IV

BACKGROUND Diced cartilage glue (DG) grafts have been widely used in dorsal augmentation but can induce dorsal irregularities. The authors evaluated the postoperative feasibility of a crushed septal cartilage-covered diced cartilage glue (CCDG) graft. METHODS The medical records of 38 patients who underwent dorsal augmentation rhinoplasty with an open approach were retrospectively reviewed. DG graft was used in 18 patients (47.4%), and CCDG graft was used in 20 patients (52.6%). Surgical outcomes were assessed by comparing anthropometric data on facial photographs and satisfaction questionnaires on aesthetic outcomes and palpable irregularities on nasal dorsum before and after surgery. RESULTS Both groups showed successful aesthetic outcomes. Dorsal height, radix height, and tip projection were all increased postoperatively in both groups. Tip rotation did not significantly increase (p > 0.05). Both groups showed similar outcomes in terms of aesthetic satisfaction but a significant difference in palpable irregularity. CCDG graft group showed significantly better (p = 0.04) satisfaction with dorsal irregularities (4.15 ± 0.75) than the DG graft group (3.56 ± 0.92). CCDG graft group also showed significantly better mean values (p = 0.048) in the degree of irregularity by two surgeons (3.85 ± 0.65) than the DG graft group (3.25 ± 0.97). No patient had significant complaints about irregular dorsum, and none of them underwent a revision rhinoplasty. CONCLUSION CCDG graft can be a complementary option for avoiding postoperative irregular dorsum complications. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The author previously worked extensively on the broad problem of the evolution of the vertebrate pallium. He proposed various Bauplan models covering at least gnathostomes, based in the definition of a set of pallial sectors with topologically invariant positional relationships and distinct molecular profiles. Out of one of these models, presented as the “updated tetrapartite pallium model,” a modified definition of the earlier lateral pallium sector (LPall) concept emerged, characterizing it in mammals as an unitary claustro-insular transitional (mesocortical) complex intercalated between the neocortex or dorsal pallium (DPall) above and olfactory cortex or ventral pallium (VPall) underneath. A distinctive molecular marker of the early-born deep claustral component of the LPall was found to be the transcription factor Nr4a2, which is not expressed significantly in the overlying insular cortex or in adjoining cortical territories. Given that earlier comparative studies had identified molecularly and topologically comparable VPall, LPall, and DPall sectors in the avian pallium, an avian Nr4a2 probe was applied, aiming to identify the reportedly absent avian claustro-insular complex. An early-born superficial subpopulation of the avian LPall that expresses this marker selectively through development was indeed found. This was proposed to be a claustrum homolog, whereas the remaining Nr4a2-negative avian LPall cells were assumed to represent a possible insular homolog. This last notion was subsequently supported by comparable selective expression of the mouse insular marker Cyp26b, also found restricted to the avian LPall. Some published data suggested that similar molecular properties and structure apply at the reptilian LPall. This analysis was reviewed in Puelles et al. [The pallium in reptiles and birds in the light of the updated tetrapartite pallium model. 2017]. Four years on, the present commentary discusses some international publications accrued in the interval that touch on the claustro-insular homology hypothesis. Some of them are opposed to the hypothesis whereas others corroborate or support it. This raises a number of secondary issues of general interest.

Burns are one of the most prevalent and harmful types of trauma. Patients with critical thermal harm need immediate specialized care to minimize morbidity and mortality. This study aimed to assess the curing possibility of chitosan/guar gum/Aloe Vera hydrogel on the curing of full-thickness burn wounds in the Wistar albino model. Two full-thickness burn wounds were formed on the dorsum of each rat under general anesthesia. Burn wounds were cured with chitosan gel; chitosan/guar gum hydrogel; chitosan/Aloe Vera hydrogel; chitosan/guar gum/Aloe Vera hydrogel, respectively. Healing was investigated based on the percentage of wound shrinkage, and surface area as well as histopathological and histomorphological observations. A significant decrease in the wound area and the epithelial gap was noticed in all groups, especially the wounds treated with chitosan/guar gum. Maximum angiogenesis was observed in the chitosan/Aloe Vera treated group. Chitosan/guar gum/Aloe Vera treated wounds demonstrated an enhancement in the thickness and integrity of collagen fibers and the highest score among fibroblast cells accumulation. Furthermore, the inflammatory cellular response and hyperemia were significantly higher in the control group when compared with those of other chitosan-based groups. Chitosan/guar gum/Aloe Vera hydrogel has a curing possibility and has presented the best healing result compared to other treatments for the restoration of full-thickness skin burn wounds in rats.

A new species, Frullania tibetica Mamontov & J. J. Atwood, is described and illustrated from Tibet, China. The species is morphologically similar to F. parvistipula Steph. in its slender leafy shoots, caducous and broadly ovate dorsal lobes, consistently inflated and galeate lobules, and obcuneate underleaves with toothed lateral margins. The new species differs in its more parallel lobule position and unequally sized lobule mouth valves on well-developed shoots, broader styli, irregularly repand gynoecial lobes, lack of gemmae on the leaf margins, and perianths with a densely tuberculate and spinose ornamentation. Based on the combination of its size, presumptively dioicous sexuality, lobe, lobule, and underleaf morphology, terminal position of the gynoecia on the stem, and trigonous, conspicuously armed perianths, F. tibetica is referable to Frullania Raddi subg. Trachycolea Spruce sect. Trachycolea (Spruce) Grolle.

Background A car-tire friction injury on the dorsum of a child’s foot often results in hypertrophic scarring of the wound margins. This study describes the clinical appearance of the injured areas and surgical complications that occurred during the follow-up period in a series of children with car-tire friction injuries who were treated with split-thickness skin grafts (STSGs). We describe the clinical features that we believe need to be highlighted when initially treating car-tire injuries in children. Methods From May 2003 to June 2016, our retrospective study included 15 patients with car-tire injuries on the dorsum of the foot who were treated with surgical excision and STSG to cover the wound. Results A total of 15 patients with car-tire injuries were treated. The average age was 6.26 years old. The average injury grade was 3.26. Two patients were treated using delayed repair, and 13 patients received STSG for initial management. Four patients experienced no complications, while 11 patients had hypertrophic scars and/or scar contracture after surgery. Conclusions A car-tire friction injury on the dorsum of a child’s foot often results in hypertrophic scar formation or scar contracture even if proper management is undertaken. Since the occurrence of these complications in childhood can lead to a secondary deformity, it is important to properly treat car-tire friction wounds, inform patients and caregivers about potential complications, and ensure regular follow-up evaluations over a 12-month period following the initial surgery.