Elyns Group

The objective was to assess the usefulness of modified neutral β-glucosidase (NAG) assay procedure in the diagnosis of obstructive azoospermia. Ejaculates from 30 normozoospermic men, 27 azoospermic men and 24 men before and after vasectomy were analyzed. Relative NAG activity was determined at 30 and 90 minute time points during incubation of NAG assay on all ejaculates. The difference in relative NAG activity was calculated for each ejaculate compared within and between normozoospermic, azoospermic and before and after vasectomy groups respectively. The difference in the relative NAG activity obtained between the two assay time points were similar for all ejaculates after vasectomy and significantly different (p < 0.0001) when compared with normozoospermic and before vasectomy ejaculates. Thirteen of the 27 azoospermic ejaculates had difference in relative NAG activity similar to that of the vasectomized ejaculates. This suggest that the diagnosis of obstructive azoospermia would be confirmed if the difference in the relative NAG activity obtained between the 30 minute and 90 minute assay time points is similar.

Two women, ages 53 and 26, exposed to fungi in their water-damaged homes, presented with sinus and neurological symptoms. Sinus CT scans revealed bilateral fungal ethmoid sinusitis in both patients. The older patient also had a brain MRI that indicated probable microvascular inflammation in the grey and white matter junction. After maximal medical therapy, with no improvement in sinus or neurological symptoms, endoscopic sinusotomies were performed on both patients to remove polypoid sinus mucosa and possible mucosal mycotoxins. Samples of the extracted mucosa were then cultured on SDA agar plates. The cultured tissue was also tested for mycotoxins. The tissue from the 52-year-old woman was positive for mycotoxins as follows: Ochratoxin A (> 10 ppb), Macrocyclic trichothecenes (> 10 ppb), and Gliotoxin (> 10 ppb). The 26-year-old woman's extracted and cultured ethmoid mucosa was also positive for mycotoxins as follows: Gliotoxin (0.35 ppb). Gliotoxin, which was present in both tissue samples, is a mycotoxin consistent with Aspergillosis of the ethmoid sinuses. These findings are discussed with respect to sinus mucosal fungal mycotoxin presence, and translocation of toxins and fungal spores via accepted avenues, as well as through the olfactory nerve into the hypothalamus/pituitary axis. These findings give laboratory and case study proof of the following conjecture: Toxic mold exposure that results in chronic sinusitis and other systemic symptoms, and which fails to respond to maximum medical treatment, may require functional endoscopic sinus surgery (FESS) to remove sinus mucosal mycotoxins, as well as intraoperative Amphotericin-B irrigation to improve systemic symptoms.

Extensive studies on cell/extracellular matrix (cell/ECM) interactions in Hydra (an early divergent metazoan, dating back some 600 million years) indicate that in this animal model of cell-matrix interactions, an ECM is a critical and an absolute requirement for regeneration and morphogenesis to occur. This short review will highlight the data behind this statement and bring the reader up to date on our most current understanding of the molecular components and function of Hydra's ECM and its associated regulatory molecules.

Purpose: To demonstrate the management protocol in head and neck vascular malformation Methods: This is a retrospective review of 12 patients of arteriovenous malformation managed at a teaching hospital. Medical records were examined for age at first diagnosis, disease course, prior treatments, and age at presentation, management, therapeutic outcomes, impact on quality of life and photograph at time of presentation. Results: Twelve patients with head and neck arteriovenous malformation presented to our centre. There was equal distribution of males and females with an average age of presentation being 24 years (range 13-40 years). Ten patients out of 12 underwent embolization which was followed by surgery. Complete excision was achieved in eight cases while partial resection was achieved in two cases. Three patients had complications while getting treated. Conclusions: Head and neck AVM can be presented as expansile, invasive and locally aggressive lesions which require detailed evaluation and multidisciplinary approach for treatment.

Whether the angular artery is the continuation of the facial or the ophthalmic artery has been a matter of debate. In the case that the angular artery is the continuation of the facial artery, the blood flow runs upward from caudal to cranial. On the other hand, when the angular artery is the continuation of the ophthalmic artery, the blood flow runs in the reverse direction. We sought an uncomplicated, non-invasive and reliable method to detect angular vessels and trace the direction of their blood flow. Thirteen adult volunteers of both genders were included in the study. The patients were healthy individuals between 20 and 60 years of age. The examination and imaging of the angular artery was performed using a color Doppler ultrasound. The angular artery was present in all cases on the right side but absent in three cases on the left side. The source of the angular artery was the facial artery in eight cases on the right side and six cases on the left side. In all other cases, the source of the angular artery was the ophthalmic artery. An angular vein was always present but not running concomitant to the artery in seven cases. When the facial artery was compressed at the mandibular border, the flow persisted only in those angular arteries that arose from the ophthalmic artery with the exception of one case involving both sides. Our study revealed that color Doppler ultrasonography is a non-invasive and reliable method for detecting the angular artery and vein and determining the direction of their blood flow. Thus, color Doppler ultrasonography is an uncomplicated method for adequate planning of axial nasolabial and other axial angular artery flaps even in real time before or during surgery.

Background: Among the different operations for septoplasty, the extracorporeal septoplasty technique basically consists in the removal of all the nasal septum, the correction of bone and cartilage deformities, and their replacement with a particular suture technique to correct the markedly deviated nasal septum especially in the internal nasal valve area. The drawbacks of this surgery technique are as follows: swelling of the mucosa in the valve area and restenosis, the development of saddle nose and septal hematoma. The aim of this study is to describe our results with a modified suture technique of the extracorporeal septoplasty (ECS), taking into account the operative time and functional results.

Purpose: In recent years, facial plastic surgery has seen an increase in the number of Indian patients desiring rhinoplasty. It is crucial for the facial plastic surgeon to have a thorough understanding of this population's ethnic features. This article seeks to provide the reader with a cohesive overview of the anthropometric studies that have been conducted on the Indian nose, as well as a brief overview of surgical options. Methods: Using PubMed and Google Literature search, key terms such as " rhinoplasty, " " Indian, " " anthropometric, " and " measurements " were used in various combinations. Articles over the past 15 years were considered, and then analyzed by both of the authors of this paper for relevance, content, and applicability. Pertinent information was included, as well as information based on clinical knowledge. Results: Through anthropometric studies, the Indian nose has been described as being broader, shorter, and less rotated compared to Caucasian counterparts. Conclusions: Aesthetic and functionally minded rhinoplasty, while keeping in the acceptable anatomic confines of this ethnic group, can lead to successful outcomes with high levels of patient satisfaction.

Unintentional ingestion of foreign bodies is a common
occurrence in clinical practice. A potentially fatal event can increase
morbidity and occasionally even cause disastrous consequences
[1]. Despite the possibly fatal consequences, however, our literature
review revealed no available documented flowchart to guide
management of foreign body ingestion in the laryngopharynx.
Hence, we propose a flowchart illustrating suggested management
strategies for ingestion of foreign objects in the laryngopharynx. In
addition, we also report an extremely rare case of a dramatically
developing huge epiglottic abscess with airway compromise in a
patient who accidentally ingested a fish bone.

Nasopharyngeal carcinoma (NPC, figure 1) is the most common
type of tumor originating in the epithelium of the nasopharynx,
the narrow tubular passage that lies above the throat and behind
the nose. Compared with other parts of the world, Southeast Asia
is hyperendemic to NPC [1]. Indeed, epidemiological evidence has
shown that the incidence of NPC is more than 10 times higher in
Southeast Asia (including Taiwan, Hong Kong, and Singapore) than
in the United States and Western Europe.

The Middle Eastern nose has a unique number of characteristics. A thorough knowledge and mastery of these characteristics allow the rhinoplasty surgeon to achieve optimal aesthetic and functional results. Unfortunately, many novice surgeons adhere to the conventional rhinoplasty technique without paying particular attention to the patient's ethnicity creating an unharmonious face. Over rotation, feminization in male patients, excessive scarring, difficulty breathing, pinched tip and nostril notching are examples of some of the reasons for which many Middle Eastern patients seek revision surgery in our practices. These complications can be avoided by a careful nasal and facial analysis and applying ethnically balance techniques to the individual patient resulting in ideal cosmetic and functional outcomes. We hereby review some of unique nasal characteristics.

Introduction: Tinnitus is a complex disorder of hearing and, in its most common form, is presented as a phantom auditory sensation which is not associated with an external sound stimulus. The sudden hearing loss is often characterized by an abrupt idiopathic onset. In up to 80% of these patients tinnitus is present and becomes the main complaint. In this research corticosteroids are the used therapy for sudden hearing loss.

The management of early glottic cancer has evolved significantly over the past two decades, with transoral laser microsurgery and radiotherapy emerging as the two favored modalities of treatment. Although the role of Open partial conservative surgery has reduced but there are still some specific indications. The preference of one modality over another has generated lot of debate and continues to be controversial. As the survival outcomes are similar in all the modalities, we need to consider factors like professional needs, quality of life, vocal function and cost-effectiveness as regards the modality to be preferred. This manuscript aims at comprehensive overview of the contemporary literature comparing all the treatment modalities. Open conservative laryngeal surgery (CLS), transoral laser microsurgery (TOLMS) and radiation therapy are valid and effective options for treating Tis, T1, and T2 glottic lesions. Although the evidence favoring any of the single modality to another is globally low level, but there is considerable shift towards trans-oral laser microsurgery. Subjective selection bias and opinion affect the decision making. The opportunity for CLS and TOLMS depend on the experience and expertise of the surgical oncology specialists. Three important tumor factors have significant influence on decision making in early glottic cancer: T-stage, true vocal cord mobility and involvement of anterior commissure (AC). Main treatment goal in early laryngeal cancer is to optimize local control, while optimizing preservation of function and hence quality of life. For achieving this goal, a careful initial clinical evaluation is very important. The clinical examination is most often performed using fiberoptic or rigid endoscopy to assess the extent of lesion and laryngeal mobility, which is the main issue in treatment of early glottic cancer. Laryngeal mobility was the only predictor of minor thyroid cartilage invasion treated with conservation laryngeal surgery and for early-stage to mid stage tumors involving the AC [1,2]. AC must be thoroughly evaluated clinically, as the approach and outcomes differ with the disease extension to this critical site. Subglottic extension and proximity of the tumor to the cricoid cartilage must be ascertained in view of organ-preservation surgery, in which a stable cricoid is essentially preserved. Evaluation under general anesthesia with 30 degree angled rigid endoscope helps in assessing AC and subglottic extension. Initial workup should include CT and/or MRI of the larynx especially if there is AC or subglottic extension on laryngoscopy. Guidelines are not generally useful and do not provide detail for selection of optimal treatment modality for particular patient. To optimize patient outcome, current evidence must be combined with experience of the multidisciplinary team managing these patients. Emphasis should be on an honest and open discussion regarding all of the aspects of different treatment options.

Importance: Relapsing polychondritis is a rare immune mediated disease disorder characterized by episodic inflammation of cartilaginous tissues with sequelae affecting virtually every major organ system. Recurrent destruction of these cartilaginous tissues leads to eventual weakening, and may predispose the patient to complications requiring airway intervention. Observations: This case report details the management of an iatrogenic 10 cm membranous tracheal tear in 27-year-old female suffering from relapsing polychondritis. Conclusions and Relevance: Conservative management coupled with starplasty and cervical approach tracheopexy was successful in complete closure of a complex tracheal tear. To our knowledge this is the first case report of a tracheal perforation in the setting of active relapsing polychondritis.

Editorial Note In a recent original article published in New England Journal of Medicine D'Cruz et al., reported about the value of elective versus therapeutic neck dissection in node-negative oral cancer [1]. In a prospective, randomized, controlled trial the effect on survival of elective neck dissection (ipsilateral neck dissection at the time of the primary surgery) versus therapeutic node dissection (watchful waiting followed by neck dissection for nodal relapse) in patients with stage T1 or T2 oral squamous cell carcinomas was evaluated. In their article the authors suggested that elective neck dissection improves overall and disease-free survival compared to therapeutic neck dissection after nodal relapse. The results of this study should be discussed critically. The secure diagnosis of cervical lymph node metastases in head and neck cancer still represents a clinical problem. This is mainly due to the anatomic particularities of the lymph nodes in the head and neck area. In this area the close neighborhood of the primary tumor and the draining lymph nodes are characteristic as well as the dense lymphatic system and the high number of cervico-facial lymph nodes. Further, there is the problem of micrometastases and the fact that a high number of cervical metastases have a size of less than one centimeter. The sensitivity of the exclusive inspection and palpation for detection of the cervical lymph nodes amounts to about 60–70% while the according values for MRT and CT scan vary between 65 and 88% in the literature [2,3]. The most significant procedure for detection of lymph node metastases is currently B mode sonography, completed by Doppler sonography in combination with sonographically guided aspiration cytology. According to the results of a comparative meta-analysis it disposes of a sensitivity of 80% and a specificity of 98% and is thus superior to CT scan and to MRI [4]. While in the context of surgical intervention in cases of clinical suspicion of present lymph node metastases of squamous cell caricnomas of the head and neck a modified radical neck dissection with removal of all five cervical lymph node levels is performed, especially the management of occult metastases in clinical N0 neck is the topic of controversial discussions. The conception of conservative procedure with careful follow-up examination in the sense of wait-and-see policy is opposed to the performance of elective neck dissection. The problem of clinical N0 neck results from the partly insufficient sensitivity and specificity of non-invasive examination techniques. If neither clinically nor after performance of imaging diagnosis no hint for the presence of lymphogenic metastasis can be found, occult metastases must nonetheless be expected in 12-50% of the cases, depending o the location of the primary tumor [5]. Conservative procedures in the sense of wait and see policy bears the risk to overlook those subclinical metastases. Finally, it must be emphasized that the planning of selective neck dissection with different extent is only an appropriate therapy with adequate possibilities for follow-up in combination with ultrasound examinations.

Reconstructive surgery plays a key role in the recovery and improvement of abnormal body structures and functions induced by a variety of causes including birth defects, developmental abnormalities, trauma or injury, infection, tumors, and disease by using surgery. Reconstructive surgery has been widely performed in a wide range of medical fields such as plastic surgery, maxilla-facial surgery, gynecological surgery, pediatric surgery, cosmetic surgery, and podiatric surgery. Reconstructive surgery is classified into two different categories: congenital and acquired conditions. Congenital conditions include cleft lip and palate, vascular anomalies, prominent ears, constricted ears, microtia, hypospadias, craniofacial conditions, hand deformities and so on while acquired conditions cover tumors, cancers, injury, trauma, infection, burns, hand surgery, tissue transfer/transplant, and so on. The main goal of reconstructive surgery is to restore the defected or disrupted body parts and their lost functions. Among the wide range of reconstructive surgery, there is a strong need to focus on reconstructive surgery in otolaryngology. In the field of otolaryngology, it is widely accepted that reconstructive surgery helps patients to reform and recover their body from damages and improve their functions. Reconstructive surgery has showed its dramatic effects on pediatric and geriatric otolaryngology, rhinology and anterior skull base surgery, otology and neurotology, facial plastic surgery, head and neck oncology, maxillofacial rehabilitation, and head and neck surgery. New reconstructive surgery techniques have been developed in the last three decades and evolved in the field of otolaryngology, leading to a new understanding of the techniques and advance of related sciences. This inaugural issue of the journal is dedicated to reconstructive surgery and its therapeutic effects in otolaryngology. In this inaugural issue, we have collected original papers on therapeutic effects of new methods of reconstructive surgery in humans. We have welcomed not only papers showing various methods of reconstructive surgery but also those dealing with their basic mechanisms. Some papers provide valuable results on corticosteroids therapy and rhinoplasty. Using newly developed methods, these studies focus on how corticosteroids therapy can help patients with tinnitus associated with sudden hearing loss and how rhinoplasty can allow ideal cosmetic and functional outcomes for the Middle Eastern patients. As shown by M A Barreto and colleagues, corticosteroids therapy can be applied to patients with tinnitus associated with sudden hearing loss. Tinnitus is one of the common disorders affecting the quality of life in daily lives. Approximately, individuals of 50 millions in the USA and 70 millions in the European Union have experienced tinnitus, which corresponds to 10% of the population. Tinnitus is a ringing in the ears without sounds from outside and is classified into objective and subjective types of tinnitus. Sudden hearing loss is an unexplained and abrupt hearing loss occurring in 72 hours or less. Since it results from a number of causes, it has been known that its treatment is very challenging. In many cases, sudden hearing loss can be accompanied by tinnitus. The paper by M A Barreto and colleagues provides important evidence that tinnitus associated with sudden hearing loss can be treated by oral and intratympanic corticosteroid therapy. Their study showed significant improvement of both hearing and tinnitus, which indicates the efficacy of corticosteroid therapy in reducing tinnitus for sudden hearing loss. We hope that this inaugural issue of the journal will inspire a good insight and understanding of the importance of reconstructive surgery in otolaryngology to our readers and shed light on the development of new technologies and methods as well as various mechanisms involved in reconstructive surgery in otolaryngology. We are convinced that this inaugural issue significantly contributes to the development of new methods and tools that will encourage and improve reconstructive surgery in otolaryngology. Therefore, we are delighted to introduce this issue to the readers.

Bacterial cellulose (BC) can be used in several areas of applied
science, especially for tissue regeneration and regenerative
medicine, lately, bacterial cellulose mats are used in the treatment
of skin wound healing such as burns and ulcers, because of the
morphology of fibrous biopolymers serving as a support for cell
proliferation, its pores allow gas exchange between the organism
and the environment.

Tinnitus is a common but very heterogeneous symptom. It is
defined as the perception of a sound by an individual in the absence
of an external source or stimuli from the external environment.
There are various causes for tinnitus, which complicates its
understanding and study. There is also a great difference between
individuals who present this symptom: tinnitus can be unilateral
or bilateral, chronic or acute, associated with a specific medical
condition or of unknown origin. Furthermore, individuals present
different levels of psychological distress and intensity of tinnitus
signal.

Percutaneous Radiofrequency Thermal Ablation (PRFTA) is the method of choice to treat most of the cases of osteoid osteoma. The Good results on other benign bone tumors as osteoblastoma and chondroblastoma have been reported. The treatment for bone Giant Cell Tumor (GCT) is surgical resection. The PRFTA has not been previously described for recurrent GCT in the literature. We reported four recurrent GCTs from our institution, successfully treated with PRFTA (from 2009 to 2014), located in the lateral cuneiform bone, the distal epiphysis of tibia, the greater tuberosity of femur and the coxal bone involving the hip joint. The previous percutaneous CT guided 11G biopsy confirmed the diagnosis in all of the cases. The patients were under general anesthesia or deep sedation in the CT room. The radiofrequency electrode was inserted through a bone introducer needle and heated at 90°C for three to five minutes. There were no complications, with rapid recovery of the patients.

Objectives: Running is known to exert a positive impact on overall health. Its potential harm or benefit on knee osteoarthritis (OA) has, however, not been thoroughly explored, mainly due to lack of quantifiable metric to link running derived parameters with OA-related biomechanics. This study sought to investigate whether joint space width (JSW), an indicator of OA, is associated with a) acceleration magnitude at the knee level (associated with collision impact) and b) weekly running distance. Design: This was a cross-sectional study using an open-label design. Methods: We included 76 healthy volunteers (from sedentary individuals to trained runners). JSW was measured using standard fixed-flexion radiographs. A wearable 3-axial accelerometer was placed on the skin at the tibia plateau level to estimate acceleration magnitude during collision impact. An algorithm was designed to identify the exact instance of collision impact and measure its acceleration magnitude. Metaphysis density was assessed using tomodensitometry at the proximal tibia level (DENSISCAN). A multi-linear model was applied to assess whether running distance, collision acceleration, and metaphysis density were independent JSW predictors. Results: Lower tibia collision acceleration was a predictor of JSW, whereas no association was found between JSW and running distance or metaphysis density. Conclusions: Our results indicate that collision impact at the knee level (estimated by acceleration) may predict increased OA risk, while weekly running distance does not. While this collision impact may be related to running technique, further research is warrant to better understand the mechanism underlying high collision impact and its associated risks.

We present a rare but important case of IgG4 related sacroiliitis in a 52 year old woman, diagnosed during the follow up for IgG4 related retroperitoneal fibrosis. IgG4 related disease is an autoimmune condition that affects different organs, but it is not usually known to affect sacroiliac joint. Review of English literature shows only one reported case of IgG4 related Sacroiliitis. Reporting of more such cases would help in better understanding the axial-arthritic manifestations of IgG4 related diseases. IgG4 Related Sacroiliitis A 52 year old Caucasian woman, with a chronic history of smoking and significant past medical history of hypertension and benign ovarian cyst presented with acute abdominal pain after a screening colonoscopy. A Computed Tomography (CT) scan done to evaluate the abdominal pain revealed a mass compressing the right ureter with significant right hydronephrosis. On detailed history patient noted the presence of intermittent night sweats for five years, a recent unintentional weight loss of 15 lbs., Raynaud's phenomenon, malar rash and bilateral elbow joint pain. The mass was surgically removed. Biopsy of the mass compressing the right ureter was consistent with fibrosis and immunostaining showed focal areas of B lymphocytes, with no evidence of malignancy. IgG4 staining was not done for that biopsy. A diagnosis of Retroperitoneal Fibrosis (RPF) was made. Further testing was done to rule out secondary causes of RPF. She was not on medications such as beta-blocker, hydralazine, methyldopa, bromocriptine and ergotamine which are associated with RPF. Imaging of the chest (chest radiograph) and abdomen/pelvis (CT scan of abdomen/pelvis) did not show any lesions suggestive of malignancy. Serum protein electrophoresis did not show a monoclonal spike. Workups for infectious causes for RPF including histoplasmosis or tuberculosis were negative. She has no history of radiation to the pelvis. Autoimmune work up showed an elevated C-reactive protein (8.1 mg/dL) (normal range – 0.0.8 mg/dL), antinuclear antibody (ANA 11.7 units) (normal <1.0) and elevated double stranded DNA antibody (dsDNA-296 IU/mL) (normal-0.29 IU/mL). Extractable nuclear antigen panel (Ribonucleic protein IgG antibody, anti-Smith antibody, SSA, SSB, scl-70 antibody) (normal) and rheumatoid factor were all within normal limits. An early brewing systemic lupus erythematosus with overlapping RPF was suspected. Patient was started on Hydroxychloroquine (HCQ) 400 mg daily and prednisone taper (40 mg/day for two weeks, 30mg/day for two weeks, 20 mg/day for two weeks, 10 mg/day for two weeks). At two month follow-up visit, her night sweats disappeared but her musculoskeletal symptoms persisted. CT scan showed improvement in the size of the RPF mass. Patient was symptomatically stable for the next two years. Patient stopped HCQ as she was symptomatically doing well. Two years later patient presented again with worsening of polyarthralgia and also had low back pain. Creatinine was mildly elevated (1.08 mg/dL) (normal 0.50 – 1.05 mg/dL) and CT scan of abdomen/pelvis showed progression of the RPF with right sided

Anterior Cruciate Ligament (ACL) repair was first performed over a century ago, but reconstruction has overwhelmingly been the surgery of choice for operative ACL ruptures since the 1970s. However, high rates of osteoarthritis and low return to play rates following conventional ACL reconstruction have prompted clinicians to reexamine the utility of ACL repair with emphasis on biologic therapy, operative techniques and patient selection. The purpose of this review is to provide an in-depth summary of the most recent advances pertaining to primary ACL repair. A thorough literature search on studies published up to May of 2016 using Pubmed, Ovid Medline and Cochrane Review databases was performed. Full text articles were reviewed and information pertaining to our institution's experience was included. There are promising results with good short-term outcomes for primary repair with or without biologic augmentation and newer operative techniques performed on carefully selected patients. However, long-term follow-up is lacking, and therefore these studies cannot conclusively impact clinical practice. Long-term follow-up and further studies are needed to further elucidate the role of primary ACL repair.

Background: An anterior Cruciate Ligament (ACL) tear is a very common injury, especially in individuals who participate in pivoting sports like soccer. Many factors that contribute to the risk of anterior cruciate ligament injuries have been investigated, but there is no consensus among them yet.

This paper examines three cases of localized-type and diffuse-type tenosynovial giant cell tumor (TGCT) in the carpal joint. Usually, the site of the localized-type TGCT is the finger and the site of the diffuse-type TGCT is the knee joint. TGCT is rarely found in the carpal joint. In each case, there was only swelling in the carpal joint, but no pain or disturbance in wrist motion. X-rays and Computed Tomographic (CT) scans showed bony impressions in the carpal joint. Cases 1 and 2 had both intra-and extra-articular lesions. The intra-articular lesions were a diffuse-type TGCT and the extra-articular lesions were localized-type TGCT. Case 3 only had an intra-articular lesion, which was a localized-type TGCT. The tumors were completely excised under a surgical microscope. There were no recurrences at the follow-up examinations which took place one, four and five years later, because the tumors were completely excised. Although a localized-type TGCT is prominent out of the joint, a diffuse-type TGCT was carefully excised from the joint. We noticed that diffused-type TGCT often exists in a hand and finger joint lesion, and if these lesions are not excised completely, recurrence might occur.

Objective: To determine if the anterosuperior labrum can be accurately evaluated by ultrasound after an intra-articular injection, comparing it to same-day magnetic resonance arthrography. Methods: This retrospective study included patients referred for ultrasound-guided hip magnetic resonance arthrogram injections. Following injection, patients received ultrasound evaluation of the anterosuperior labrum. Images were retrospectively reviewed. The labrum was evaluated below the rectus femoris, between the rectus femoris and iliopsoas, and below the iliopsoas. In each location, presence or absence of abnormal morphology, labral clefts, or chondrolabral clefts was recorded. Arthroscopy reports were correlated when available. Results: Twenty six patients received same day injection and magnetic resonance arthrogram. Six patients had arthroscopy. Ultrasound and magnetic resonance arthrogram correlated in 53% of points. When each labrum was divided into three zones, ultrasound demonstrated sensitivity of 0.868 and specificity of 0.160 for labral pathology. Ultrasound showed pathology in all patients below the rectus femoris, and between the rectus femoris and iliopsoas tendons. When limiting evaluation to below the iliopsoas tendon, ultrasound had sensitivity and specificity for labral pathology of 0.650 and 0.667. For labral clefts, ultrasound had sensitivity and specificity of 0.741 and 0.451. For chondrolabral junction clefts, ultrasound reported sensitivity and specificity of 0.578 and 0.303 respectively. For abnormal pathology, ultrasound had sensitivity and specificity of 0.810 and 0.491 respectively. Conclusions: " Sonoarthrography " appears to be a sensitive examination for detecting labral substance tears and abnormal labral morphology. Post-injection ultrasound adds approximately three minutes to the examination and may supply additional useful diagnostic information.

The recognition of the pattern and severity of deformity in knee osteoarthritis has important implications in its management and prognosis. A number of methods can be used to assess and measure the coronal and sagittal knee alignment: clinical deformity measuring device like a goniometer, standard knee radiographs, hip-knee-ankle (HKA) radiographs, computer navigation systems, magnetic resonance scan, computerized tomographic scan or simply a surgeon's subjective measurement. Each of these methods has advantages and disadvantages. The aim of this study was to compare three methods of measurement: clinical measurement with a goniometer; HKA radiographs and computer navigation. This study included 54 patients with arthritic knees, who underwent total knee replacement with computer navigation. The deformity in both coronal and sagittal planes was measured using the three methods and the results compared using Bland Altman limits of agreement. The clinical measurement differed greatly from radiographic and computer navigation measurements. According to Bland Altman limits of agreement clinical measurements could be up to 10° away from the radiographic or computer navigated measurements in coronal plane. In the sagittal plane the clinical measurements could be up to 12° away compared to computer navigation measurements. A combination of these measurements methods should be taken into account when assessing the deformity of a knee especially in relation to posture and weight bearing status. The methodical clinical measurement of knee deformity as described in this paper gives too wide a margin of error and should not be relied upon in isolation.

This study investigated the repeatability and reproducibility of the F-scan system with regards to Peak Pressure Values (PP) and Pressure Time Integral (PTI) in healthy children, ranging between 5 to 18 years of age. Participants took part in two non-invasive clinical assessments, at baseline and one week later. Standardized footwear was supplied and each child was fitted with the equivalent F-scan insole size. A total of 3 trials of 7 meters distance each were conducted. Plantar pressure analysis was carried out using a novel approach of masking the recordings into 10 different areas; both peak pressure (PP) and pressure time integrals (PTI) values were investigated. The PP and PTI were investigated for the left, right and both feet analysed together. Interclass Correlation Coefficient (ICC) test was adopted for statistical analysis. Overall, 30 healthy children were recruited and 60 appointments were completed; 53.3% (n = 16) were female, mean age was 13.3 years (SD = 4.5). Results highlighted that overall the ICC for repeatability was > 0.75 for 95.8% (no = 115) and between 0.5 and 0.75 for 4.2% (no = 5); the ICC for reproducibility was > 0.75 for 85% (no = 51), and between 0.5 and 0.75 for 15% (no = 9). In conclusion, the F-Scan system can be utilised to record repeatable and reproducible data in paediatric gait analysis.

Background: Cell-based therapy for soft tissue injuries remains controversial. Adult mesenchymal stem cells (MSCs) are therapeutic candidates given their capacity for self-renewal, immunoprivilege, and differentiation capacity for chondrocyte and tenocyte lineages. Platelet rich plasma (PRP) has been reported to promote collagen synthesis and cell proliferation, influencing the healing of ligaments and cartilage. We hypothesize that allogeneic MSCs and PRP have additive effects on promoting ligament healing in an in-vivo rat medial collateral ligament (MCL) injury model.

Biomodelling is a new technology that allows computed
tomography (CT) and magnetic resonance imaging (MRI) data to
be used to generate solid plastic replicas of anatomical structures
known as Biomodels. These Biomodels were produced using
engineering manufacturing technology such as rapid prototyping
(RP) system and is used for diagnosis, pre-operative planning,
surgical simulation, surgical rehearsals and production of implant,
orthosis & prosthesis for specific deformity [1-4]. The term
biomodel is reserve for solid physical form and it has considerable
impact in the area of bioengineering [5]. The technique helps
to develop custom prosthetics, and orthotics that facilitate and
expedite the rehabilitation of physically impaired, enabling them
to lead more comfortable, functional and independent lives. The
technique is extensively used for pre-operative planning of complex
surgical cases such as separations of twins etc.

More than two decades ago, the concept of tissue engineering
predicted the healing of injured tissues and organs by the use of
living cells and/or smart functional materials. The approaches
taken to recreate tissues and organs have typically involved a
combination of cells, materials and bioactive molecules. Combining
all the components involved in tissue repair, the hypothesis that
“bench neo-created tissue”, upon implantation could lead to host
native tissue homeostatic state and by consequence restore from
the very first beginning functionalities lost with time due to trauma
or disease has gained more clear evidences.

Welcome to the inaugural issue of the Journal of Orthopedics,
Rheumatology and Sports Medicine. We hope to have a long-term
relationship with our authors and readers. The aim of our journal
is to publish high quality papers from researchers worldwide in
fields of orthopedics, rheumatology and sports medicine. We invite
all authors to share their latest research and expertise related with
rheumatology and orthopedics. In the first issue, articles were
accepted after a rapid peer-review process by international experts.
This rapid peer-review and publication process will continue in the
future.

Welcome to the inaugural issue of the Journal of Orthopaedics,
Rheumatology and Sports Medicine. We hope to have a long and
fruitful association with our readers. First and foremost this is very
much a journal that welcomes and encourages input from traineesacademia
is often a dying breed. Yet it is something we strongly
encourage. As a prior trauma trainee, the field has changed vastly
during my training. This journal looks to encourage and present
cutting edge changes in technology and clinical management.

Pediatricians play an important role in promoting the healthy development of all children. This involves addressing disparities in the environments of children that can affect their ability to grow and learn. Historically, pediatric primary care has included a variety of evidence-based strategies to prevent disease and disability including encouraging vaccination, counseling about safety risks, and promoting healthy diets and physical activity. The state of a child’s early language and literacy environment has also become a focus for pediatricians because of the connection between early exposures, brain development, educational achievement, and lifelong health.

We present the case of a 34-year-old male homozygous for sickle cell disease found to have asymptomatic bilateral paraspinal masses (PSM) on chest x-ray, further visualized on Chest Computer Tomography (CT) scan with intravenous (IV). The unusually large PSM were attributed to extremedullary hematopoiesis (EMH) owing to erythroid hyperplasia. Follow-up CT scan after five years showed no significant changes in the bilateral paravertebral masses consistent with the diagnosis of EMH.

Background: Anemia profoundly impairs bodily health, prolongs hospital stay, heightens healthcare costs and reduces overall quality of life. Very severe ane mia (particularly acute cases) portends a critical state, may progress to irreversible vital organ damage, thereby increasing mortalities. Thus, it is worthwhile to evaluate the occurrence of very severe anemia cases, its clinical/laboratory features, prevalent causes/associations and survival patterns in Benin City, Nigeria.

Background: To study cord blood HIF-1α levels in newborns and to correlate them with co-morbidities and placenta histological features.

Methods: Arterial samples were collected in the delivery room from 39 full-term and 23 preterm infants. A blood gas was made and the sample was stored to detect HIF-1α. In 42 cases the placentas had macroscopic reporting and in 27/42 histology was performed.

Results: Overall, group HIF values are related to hemoglobin and hematocrit (Rho 0.42, p = 0.003 and Rho 0.44 and p = 0.002 respectively). Median HIF-1α was 481.9 pg/ml in term, 390.3 pg/ml in preterm. In term HIF-1α correlated with pH, hematocrit and hemoglobin. In preterm HIF-1α inversely correlated with pH and Base Excess, while showing a positive correlation with hematocrit. No relation was found among HIF-1α and the placental infarcts or thrombi as well as the chorioamnionitis.

Conclusions: HIF-1α can be detected in the umbilical cord artery. A higher level identifies premature babies in a more unstable state at birth. Moreover, patients in a marked prenatal hypoxic state (higher HIF-1α) presented a higher hematocrit, in response to erythropoietin (EPO) synthesis up regulation. No correlation was found between HIF-1α and specific postnatal acute complications or placental lesions.

Tocotrienols and tocopherols are natural forms of vitamin E that exist in four isoforms (alpha, beta, gamma and delta). Gamma-tocotrienolis reported to possess many anti-cancer effects including anti-proliferative and pro-apoptotic activities. To date, the effects of treating K562, a human chronic myeloid leukemic cell line with gamma-tocotrienolis not well documented. The anti-cancer and pro-apoptotic effects of gamma-tocotrienol on the K562 cells were evaluated using cell-based assays. The effect of gamma-tocotrienol exposure of the expression of genes related to apoptosis was determined using a commercial quantitative real-time polymerase chain reaction array annotated with primers related to human apoptosis. The expression of some of the differentially expressed genes and proteins were confirmed using quantitative polymerase chain reaction technology and enzyme-linked immunosorbent assay, respectively. Treatment with gamma-tocotrienol induced effective cytotoxicity in the K562 cells mainly via the apoptosis pathway. Gene expression studies using the quantitative polymerase chain reaction array approach showed that gamma-tocotrienol induced expression of several pro-apoptotic genes related to the BCL-2, the death receptor and the Caspase families in the K562 CML cells. Gamma-tocotrienol is a potent inducer of apoptosis in K562 chronic myeloid leukemic cells via the intrinsic and extrinsic apoptotic pathways. It has the potential of being developed as a therapeutic agent for chronic myeloid leukemia. Further studies using experimental models or clinical studies are warranted to support these findings.

Composite propellant mainly contains hydroxyl-terminated poly (butadiene) (HTPB) based binder and oxidizer like ammonium perchlorate (AP). The mechanical properties requirement of composite propellant is very stringent. The mechanical properties of the final product is mainly depends on the microstructure of HTPB prepolymer binder. In HTPB, three different types of microstructures are possible like cis, trans and vinyl. In this article, three different grades of HTPB are subjected for experimentation. Quantification of cis, tans and vinyl microstructure were carried out by peak area calculation in characteristic Nuclear Magnetic Resonance (NMR) peak. Gel permeation chromatography (GPC), rheology and simultaneous thermal analysis (STA) were also carried out with different grades of prepolymer. The correlation of microstructures concentration with various properties like molecular weight, polydispersity, rhelogy and thermal properties were also established. The composite propellants processed from these various HTPB prepolymers, were also evaluated by means of physicochemical and internal ballistic properties. Composite propellant produced from prepolymer containing higher cis and trans concentration i.e. HTPB Grade II showed better tensile mechanical properties. Marginal variations were observed in internal ballistic properties.

The evidentiary value of bitemarks has been previously linked to that of fingerprints. We think that skin distortions would have an impact on the reliability of bitemark interpretation. The existing tattoos on 16 participating volunteers were substituted for bitemarks. Tattoos were photographed using an ABFO (American Board of Forensic Odontology) #2 reference scale, and measurements were taken at multiple locations. Changes in body position were photographed at each location. A representative maxillary arch width measurement of 40 mm was used for comparison. Maximum distortions of 52.5% and 76.3% were observed along the horizontal and vertical axes, respectively. Observed distortions were found to be nonuniform; therefore, the implication is that, skin distortions preclude the use of bitemarks for identifications.

Out of all metals, silver has been widely recognized for its antimicrobial activity over centuries of years. In more recent times, silver was found to be even more effective in antimicrobial activity when it was at nanoscale. A novel protocol was developed for green synthesis of silver nanoparticles and their anti-bacterial activity was experimentally validated. This protocol is different from the prior art in a way that the green synthesis from non-polar organic plant extracts is now possible for the first time. The raw material was the dichloromethane extract of Plectranthus zeylanicus, a widely used medicinal plant in Sri Lanka. Scanning electron microscopy (SEM) images of the formulation revealed that the synthesized objects were predominantly of spherical shape and approximately 100 nm in size. Energy dispersive X-ray (EDX) spectrum confirmed the presence of elemental silver in it. The presence of phytochemical classes that could be responsible for the green synthesis of nano silver was detected by standard qualitative phytochemical screening assays. The antibacterial activity of the compound was assessed by the agar well diffusion method against Gram positive and Gram negative bacteria including the methicillin resistant Staphylococcus aureus (MRSA). These new formulations exhibited profound antibacterial activity against all the tested microorganisms in comparison to aqueous silver ion solution and commercial disinfectants that contain silver ions as active ingredients. This is the first time the anti-MRSA potential of silver nanoparticles synthesized via a green route is documented. Present findings point towards the possible application of biogenic silver nanoparticles as an effective antimicrobial agent against nosocomial infections.

Lung Cancer is one of the major health problems worldwide. Nanomedicine is considered as one of the promising research applications nowadays. This is due to the unique physical and chemical properties of the nanoscale elements. Silver nanoparticles (Ag NPs) in specific has been extensively studied recently in many biomedical applications especially in cancers, since they possess multifunctional effects that make these nanostructures ideal candidates for biomedical applications. Ag NPs were proved to have anti-tumor activity with apoptotic cell death pathway. The goal of the current work was to investigate the degree of DNA damage that results from the usage of Ag NPs as a photosensitizer (PS) in photodynamic therapy (PDT), besides to evaluate the reactive oxygen species (ROS) yield that was associated. The results showed the occurrence of DNA damage in lung cancer cells (A549) through the generation of ROS via the detection of the mitochondrial membrane potential changes.

Purpose: Fatalities following TASER activation are rare, though there are case reports documenting this phenomenon. One prevailing theory for the mechanism behind these deaths involves the TASER pacing the heart into a fatal arrhythmia. We conducted a structured review of runaway implanted pacemakers to assess whether this theory is supported by the literature. Methods: This is a review of all available and applicable case reports on runaway pacemakers. All case reports where a patient experienced runaway pacing with a cardiac response of >100 BPM or VF or VT or a systole were included, excluding those cases that converted out of tachycardia. We recorded demographic data, in addition to cardiac parameters, interventions, outcomes, and duration of runaway pacing. Descriptive statistics are reported. Results: We identified 39 case reports of runaway pacemakers, with 26 meeting study criteria. The mean patient age was 64. The mean heart rate was 196 bpm (range 95–400). There were 4 (15%) deaths in the 26 patients. All patients experienced runaway pacing for at least 20 minutes, many for over 24 hours. There were no cases of cardiac arrest that occurred with less than 20 minutes of cardiac pacing. Conclusions: There was no published cases identified demonstrating that runaway pacemakers lead to cardiac arrest in less than 20 minutes. This is in contrast to case-reported TASER fatalities, which occur in less than 2 minutes. Thus, there appears to be no consistent data to support the published theory that TASERs lead to death through a runaway pacing mechanism. heart. Swine models using CEW discharges have concluded that this type of cardiac capture is possible [2]. Since its introduction, there has been controversy regarding the safety of CEWs (including the TASER ECD). DP Zipes proposed that the TASER ECD may theoretically pace the heart at a very rapid rate, leading to decreased cardiac filling times and subsequent cardiovascular collapse. This theory involved the review of eight legal cases involving cardiac arrest and death following TASER ECD activation and is based on the medical parallel of faulty exogenous pacemaker devices leading to extremely rapid overdrive pacing, cardiovascular collapse and death. The Zipes publication refers to the relationship between TASER ECD use and runaway pacemakers, but does not elaborate on the mentioned " outcome(s) of runaway pacemakers many years ago [3]. " Our study seeks to shed further light on the question of whether or not exogenous, runaway pacemakers can lead to cardiovascular collapse and death. If this phenomenon is possible, we hope to determine how long it takes for cardiac arrest to take place following the onset of rapid pacing. With this information, we seek to determine if the literature supports the published theory that TASERs cause death by pacing the heart into cardiac arrest. Methods This is a structured literature review on the outcomes of patients with runaway pacemakers. We utilized Pubmed and Google Scholar to conduct our search of all applicable literature from January 1960 to May 2016. The specific keywords employed included " runaway pacemakers " and " runaway pacing ". Following our primary search, we included all applicable references listed within our primary cohort of literature to assure that we included all associated materials on the topic of runaway pacemakers. We included all case reports, written in English, where we identified rapid exogenous pacing with an associated patient heart rate of >100 BPM or ventricular fibrillation (VF) or ventricular tachycardia (VT) or a systole. We excluded all case reports where patients experienced runaway pacing that spontaneously revered back to normal sinus rhythm or bradycardia. We included several predictor and outcome variables including demographics, co-morbid conditions, exogenous pacing rate, native heart rate, any physician interventions, duration of pacing, and final outcomes. We determined the duration of exogenous pacing by examining several aspects of the patient's case, including any specific documentation of pacing time, ambulance transport time, emergency department duration of care, time to pacemaker battery termination or extraction, and other interventions. Descriptive statistics are reported. As this is a literature review, it is exempt from IRB review.

Crouzon’s syndrome was first described by a French neurologist,
Octave Crouzon (1874-1938) in the year 1912 as one of the varieties
of craniosynostosis. It is also known as craniofacial dysostosis. It
has prevalence of 15–16% in one million new born and 4.5% of all
craniosystosis [1]. The known race or sex predilection exists [2]. It
may be transmitted as an autosomal dominant inheritance but 25%
of cases represent fresh mutations [3]. The vast majority of cases of
Crouzon syndrome are caused by a genetic mutation, specifically
in a gene called FGRF2 (fibroblast growth factor receptor 2) on
chromosome 10 and a mutation in FGRF3 on chromosome 4.
Cranial malformation in Crouzon syndrome depends on the order
and rate or progression of sutural synostosis.