Utilidad de los anticuerpos anti-células parietales gástricas y anti-factor intrínseco en el estudio de la deficiencia de vitamina B12 asociada a gastritis autoinmune y anemia perniciosa / Usefulness of anti-gastric parietal cell and anti-intrinsic factor antibodies in the study of vitamin B12 deficiency associated with autoimmune gastritis and pernicious anemia / Utilidade de anticorpos anti-células parietais gástricas e anti-fator intrínseco no estudo da deficiência de vitamina B12 associada à gastrite autoimune e à anemia perniciosa

Resumen La gastritis autoinmune (GAI) es una afección inflamatoria progresiva de la mucosa oxíntica caracterizada por la destrucción de células parietales, pérdida de factor intrínseco, malabsorción de vitamina B12 (cobalamina), hierro y otros micronutrientes y puede progresar hacia un estado avanzado de anemia megaloblástica conocida como anemia perniciosa (AP). El objetivo de este estudio fue determinar la deficiencia de vitamina B12 debida a malabsorción utilizando la detección de anticuerpos anti-células parietales gástricas (ACPG) y anti-factor intrínseco (AFI). Se analizaron 2050 sueros de pacientes con un inmunoanálisis quimioluminiscente para vitamina B12 total y 2,8% de éstos con las pruebas de inmunofluorescencia indirecta para ACPG y enzimoinmunoanálisis para AFI. La deficiencia de vitamina B12 (<200 ng/mL) fue del 13,1%. En la detección de anticuerpos se encontró: 2 doble positivos ACPG/AFI, 17 simple positivos ACPG y 4 simple positivos AFI. Todas las muestras ACPG y/o AFI positivas tuvieron valores de vitamina B12 total <200 ng/mL. En 5 pacientes con ACPG positivos se diagnosticó gastritis crónica confirmada por biopsia. En los 6 pacientes AFI positivos se realizó el diagnóstico de AP y en 2 de ellos se confirmó por histopatología. La positividad de ACPG y/o AFI permitió la clasificación de pacientes con sospecha de GAI en candidatos para la examinación histológica y la aplicación de esquemas terapéuticos adecuados. Se destaca la importancia de las pruebas de laboratorio como parte de una estrategia de diagnóstico temprano y vigilancia endoscópica, para evitar las manifestaciones relacionadas con la deficiencia de hierro y vitamina B12 y las complicaciones de la enfermedad avanzada.

Abstract Autoimmune gastritis (AIG) is a progressive inflammatory condition of the oxyntic mucosa, characterised by gastric parietal cell destruction, loss of intrinsic factor, and malabsorption of vitamin B12 (cobalamin), iron and other micronutrients; conditioning progress to a state of megaloblastic anemia known as pernicious anemia (PA). The aim of this study was to determine vitamin B12 deficiency due to malabsorption utilizing anti-parietal cell (APCA) and anti-intrinsic factor (IFA) antibodies detection. 2050 patient serum samples were analised by chemiluminescent immunoassay for vitamin B12. A total of 2.8% of them were tested for APCA by indirect immunofluorescence and for IFA by enzyme immunoessay. Vitamin B12 deficiency (<200 ng/mL) was 13.1%. Regarding antibody detection: 2 APCA/IFA double positives, 17 APCA simple positives and 4 IFA simple positives were found. APCA and/or IFA positive samples had total vitamin B12 values <200 ng/mL. Chronic gastritis confirmed by biopsy was diagnosed in 5 patients with positive ACPG antibodies. All 6 IFA positive patients were diagnosed with PA, while 2 of them also received histopatologic confirmation. APCA and/or IFA confirmation allowed for the classification of patients with suspicion of AIG as possible candidates for histologic examination and application of appropriate therapeutic schemes. Importance of laboratory testing is to be noted; as part of a strategy that enables early diagnosis and adequate endoscopic surveillance, to avoid manifestations related to iron and vitamin B12 deficiency and the complications of advanced disease.

Resumo A gastrite autoimune (GAI) é uma doença inflamatória progressiva da mucosa oxíntica, caracterizada pela destruição das células parietais gástricas, perda do fator intrínseco, má absorção de vitamina B12 (cobalamina), ferro e outros micronutrientes pode progredir para um estado avançado de anemia megaloblástica conhecida como anemia perniciosa (AP). O objetivo deste estudo foi determinar a deficiência de vitamina B12 por má absorção usando a detecção de anticorpos anti-células parietais gástricas (ACPG) e anti-fator intrínseco (AFI). Foram analisados 2050 soros de pacientes com um imunoensaio quimioluminiscente para vitamina B12 total, 2,8% deles com testes de imunofluorescência indireta para ACPG e enzimaimunoensaio para AFI. A deficiência de vitamina B12 (<200 ng/mL) foi de 13,1%. Na detecção de anticorpos foram encontrados: 2 duplo positivos ACPG/AFI, 17 simples positivos ACPG e 4 simples positivos AFI. Todas as amostras ACPG e/ou AFI positivas apresentaram valores de vitamina B12 total <200 ng/mL. Gastrite crônica confirmada por biópsia foi diagnosticada em 5 pacientes positivos para ACPG. Nos 6 pacientes AFI positivos o diagnóstico de AP foi feito e em 2 deles foi confirmado por histopatologia. A positividade para ACPG e/ou AFI permitiu a classificação de pacientes com suspeita de GAI em candidatos para exame histológico e a aplicação de esquemas terapêuticos adequados. Destaca-se a importancia dos testes laboratoriais, como parte de uma estratégia de diagnóstico precoce e vigilância endoscópica, para evitar manifestações relacionadas à deficiência de ferro e vitamina B12 e complicações da doença avançada.

Glomerular parietal epithelial expression of CD44 in minimal change nephrotic syndrome and primary focal segmental glomerulosclerosis: A clinico-pathological study

Introduction: Minimal change nephrotic syndrome (MCNS) and focal segmental glomerulosclerosis (FSGS) are the two common causes of nephrotic syndrome (NS) in both children and adults with overlapping clinical features, but with distinct prognostic and therapeutic implications. The distinction between these relies entirely on histopathology, which can sometimes be difficult. CD44 is expressed by activated parietal epithelial cells, plays a role in matrix deposition and thus in the pathogenesis of FSGS. Aims: To assess the expression of CD44 in MCNS and FSGS and to evaluate its association with the known clinical and histopathological prognostic factors. Materials and Methods: Thirty cases each of MCNS and FSGS were studied. The clinical, laboratory, histopathological, and CD 44 immunohistochemical data were recorded. The findings were analyzed and correlated. A P value of < 0.05 was considered statistically significant. Results: Statistical association was noted between CD44 positivity and serum creatinine (p = 0.031), estimated glomerular filtration rate (p = 0.040), segmental sclerosis (p < 0.001), tubular atrophy (p = 0.027), interstitial fibrosis (p = 0.027), and histological diagnosis (p < 0.001). The sensitivity, specificity, positive predictive, and negative predictive values were 90%, 76.67%, 79.41% and 88.46%, respectively. Conclusions: CD44 immunostain can effectively distinguish MCNS from FSGS. The congruent results of CD44 positivity with known prognostic factors support the possibility of using the CD44 marker as a predictive tool in selecting high-risk patients and offering appropriate therapeutic measures.

Osteological Study of the Parietal Foramen in the Adult Human Skull Bones and its Clinical and Surgical Correlations / Estudio Osteológico del Foramen Parietal en los Huesos del Cráneo Humano Adulto y sus Correlaciones Clínicas y Quirúrgicas

SUMMARY: Parietal emissary foramina (PEF) are small holes, which are localized between the middle and posterior thirds of the parietal bone posterior surface close to the sagittal suture. PEF are important structures that protect the parietal emissary vein, which passes through it. During neurosurgery procedures, parietal foramina (PF) knowledge is crucial. This work aimed to evaluate presence and location of the PF in the skull of an adult human. Moreover, measure the distance amidst PF and the sagittal suture's midline to ascertain its clinical repercussions. 74 adult human skulls, without gross pathology, were observed for the PF's existence. The PF's and sagittal suture's midline distance were measured. According to the PF patterns of presence, five groups were distributed. Finally, specimens were photographed and subjected to statistical analysis. The PF was absent in 7 skulls (9.5 %). There were 9 skulls (12.2 %) exhibited central parietal foramen where the parietal foramen lies on the sagittal suture. 17 skulls (23 %) showed right unilateral parietal foramen, whereas 15 skulls (20.3 %) demonstrated left unilateral parietal foramen. The final 26 skulls (35.1 %) exhibited bilateral parietal foramen. This descriptive study supplies valuable information of PF variations, which is crucial for neurosurgeons in modifying surgical techniques and procedures to alleviate injury to PF-emerging structures such as emissary veins.

Los forámenes emisarios parietales (FEP) son pequeños orificios que se localizan entre los tercios medio y posterior de la superficie posterior del hueso parietal, cerca de la sutura sagital. Los FEP son estructuras importantes que protegen la vena emisaria parietal, que lo atraviesa. Durante los procedimientos de neurocirugía, el conocimiento de los forámenes parietales (FP) es crucial. Este trabajo tuvo como objetivo evaluar la presencia y ubicación del FP en el cráneo de hombres adultos, además, medir la distancia entre el FP y la línea mediana de la sutura sagital para conocer su repercusión clínica. Se examinaron 74 cráneos humanos adultos, sin patología grave, para determinar la existencia del FP. Se midió la distancia de la línea mediana de la sutura sagital y del FP. De acuerdo con los patrones de presencia del FP, se distribuyeron en cinco grupos. Finalmente, los especímenes fueron fotografiados y sometidos a análisis estadístico. El PF estaba ausente en 7 cráneos (9,5 %). Hubo 9 cráneos (12,2 %) que presentaban un PF central localizándose en la sutura sagital. 17 cráneos (23 %) presentaban un FP unilateral derecho, mientras que 15 cráneos (20,3 %) se observó un FP unilateral izquierdo. Los 26 cráneos restantes (35,1 %) exhibieron FP bilaterales. Este estudio descriptivo proporciona información valiosa sobre las variaciones del FP, que es fundamental para los neurocirujanos en el momento de modificar las técnicas y los procedimientos quirúrgicos para aliviar las lesiones de las estructuras emergentes del FP, como las venas emisarias.

Comparison between the parietal foramina observed in samples of African and European population groups / Comparación entre los forámenes parietales observados en muestras de grupos de población africanos y europeos

SUMMARY: Parietal foramina of the human skull act as a passageway for emissary veins, connecting the superior sagittal sinus to the veins of the scalp. This passageway can lead to the spread of infection from the scalp to the dural venous sinuses, but may also assist in relieving intracranial pressure. However, variation in the prevalence of parietal foramina has been noted among population groups. This observational and descriptive study aimed to determine the incidence, size and location of parietal foramina by using osteological specimens of 252 African skulls from the Sefako Makgatho Health Sciences University, South Africa and 95 European skulls from the University of Leipzig, Germany. Parietal foramina were significantly more common in the African sample (61.9 %) compared to the European sample (55.8 %). Moreover, the Central European sample displayed more unilateral foramina (29.5 %), while the African sample exhibited more bilateral foramina (40.8 %). The diameter of the parietal foramen average 1.98 mm and 1.88 mm for the European and African samples, respectively. In this study, a median foramen on the sagittal suture was observed in 14 of the overall skull caps (4 %). This study demonstrated that parietal foramina are more prevalent than anticipated in both population groups. Findings of this study, indicating an increased prevalence, and the subsequent possibility of more emissary veins encountered, can be used to improve the understanding of the variations in the prevalence and clinical implications of the parietal foramen among various population groups located world-wide.

Los forámenes parietales del cráneo humano actúan como una vía para las venas emisarias, conectando el seno sagital superior con las venas del cuero cabelludo. Este pasaje puede conducir a la propagación de infecciones desde el epicráneo (calva) hasta los senos venosos durales, pero también puede ayudar a aliviar la presión intracraneal. Sin embargo, se ha observado una variación en la prevalencia de los forámenes parietales entre los grupos de población. Este estudio observacional y descriptivo tuvo como objetivo determinar la incidencia, el tamaño y la ubicación de los forámenes parietales mediante el uso de muestras osteológicas de 252 cráneos africanos de la Universidad de Ciencias de la Salud Sefako Makgatho, Sudáfrica, y 95 cráneos europeos de la Universidad de Leipzig, Alemania. Los forámenes parietales fueron significativamente más comunes en la muestra africana (61,9 %) en comparación con la muestra europea (55,8 %). Además, la muestra centroeuropea mostró más forámenes unilaterales (29,5 %), mientras que la muestra africana mostró más forámenes bilaterales (40,8 %). El diámetro del foramen parietal promedió 1,98 mm y 1,88 mm para las muestras europeas y africanas, respectivamente. En este estudio, se observó un foramen medio en la sutura sagital en 14 de los cráneos en general (4 %). El estudio demostró que los forámenes parietales son más frecuentes de lo previsto en ambos grupos de población. Los hallazgos de este estudio, que indican una mayor prevalencia y la subsiguiente posibilidad de que se encuentren más venas emisarias, pueden ser útiles para mejorar la comprensión de las variaciones en la prevalencia y las implicaciones clínicas del foramen parietal entre varios grupos de población ubicados en el mundo.

Necessity of Parietal Peritoneum Layer Closure to Prevent Severe Adhesion in Repeat Caesarean Section

Background: Repeated cesarean section involves various complication and one of the most common is adhesion. Some studies suggest that by closing the parietal peritoneum layer, the adhesion rate after surgery can might be decreased. The aim of this study was to assess the necessity of parietal peritoneum layer closure to prevent severe adhesion in repeat caesarean section.Material & Methods:This cross-sectional study was conducted in department of obstetrics and gynaecology, Care Medical College Hospital, Dhaka, Bangladesh from 2020 to 2022. Total 100 pregnant women were included in this study. These patients were divided into two groups where each groups contained 50 pregnant women. Here the two groups are parietal peritoneum layer closure and of parietal peritoneum layer non-closure.Results:Mean age of the pregnant women was 28.6 years (SD±4.50 years) in parietal peritoneum layer closure group and 30.4 years (SD±4.91 years) in parietal peritoneum layer non-closure group. 58% pregnant women in parietal peritoneum layer closure group and 60% in parietal peritoneum layer non-closure group had short inter delivery interval. The commonest comorbidity was hypertension in both groups (22% and 20%). Mean operating time was 35.6 minutes (SD±8.93 minutes) in parietal peritoneum layer closure group and 32.4 minutes (SD±9.50 minutes) in parietal peritoneum layer non-closure group. Mean hospital stay was 4.2 days (SD±1.01 days) in parietal peritoneum layer closure group and 4.8 days (SD±1.02 days) in parietal peritoneum layer non-closure group. The adhesion rate was 12% in parietal peritoneum layer closure group and 28% in parietal peritoneum layer non-closure group. The parietal peritoneum layer closure group had adhesion commonly in fascia to uterus (4%) and omentum to uterus (4%). The parietal peritoneum layer non-closure group had adhesion commonly in omentum to fascia (12%).Conclusion:Closure of the parietal peritoneum layer in caesarean section resulted in less adhesion formation. Thus, it is necessity to perform parietal peritoneum layer closure to prevent severe adhesion in repeat caesarean section.

Recurrent Appendicular Abscess-An Interesting Case Report

Background: Anorectal abscess, a common surgical condition, can rarely spread upwards to involve complex anatomical compartments leading to sepsis. A 45-year-old diabetic male presented in the ER with complaints of recurrent Right Iliac Fossa (RIF) pain with local swelling and dysuria, along with high-grade fever with chills and rigour for the last few days. He had been diagnosed with a case of recurrent appendicular abscess and treated with repeated Incision & Drainage during three previous hospitalizations. He also complained of simultaneous painful swelling in the left gluteal region during every episode of RIF pain. Methods: On examination, there was a parietal fluctuant swelling and tenderness in RIF over the previous appendicectomy scar. On Digital Rectal Examination (DRE), there was left-sided fullness and a tender induration at the 6 o'clock position on the dentate line, indicating some crypto-glandular disease. At the bedside, incision and drainage at RIF were performed, and pus was sent for C/S which came positive for an ESBL-producing strain of Escherichia coli. He was provisionally diagnosed with a case of the parietal abscess. Results: CECT W/A showed features of necrotizing fasciitis involving the anterior abdominal wall, forming an abscess, which crossed the midline along the pre-vesical space, extending to the pelvis and left ischio-anal fossa. Thus, the primary source of sepsis was a complex Ano-Rectal Abscess. Appropriate surgical management was done for source control. Conclusion: Unusual sources of infection should be suspected in patients with persistent sepsis or recurrent abscess and appropriate imaging modalities should be utilized before surgical intervention.

Refractory iron deficiency anemia as an early manifestation of autoimmune gastritis in a teenager / Anemia ferropénica refractaria como presentación temprana de gastritis autoinmune en un adolescente

Abstract Autoimmune gastritis is an underdiagnosed disease in the pediatric population due to the absence of specific signs and symptoms and late clinical manifestations. Iron deficiency anemia has recently been identified as an early hematological manifestation, allowing an early diagnostic approach. We present the case of a Colombian teenager, with no history of autoimmunity, with refractory iron deficiency. He underwent extension studies; biopsies and serology compatible with autoimmune gastritis were documented, requiring parenteral iron in its evolution. This pathology is underdiagnosed in our context since early diagnosis requires a high index of suspicion to prevent associated complications.

Resumen La gastritis autoinmune es una enfermedad subdiagnosticada en la población pediátrica. Lo anterior se debe a la ausencia de signos y síntomas específicos y manifestaciones clínicas tardías. Recientemente se ha identificado la anemia ferropénica como una manifestación hematológica precoz, lo que permite un enfoque diagnóstico temprano. Se presenta el caso de un adolescente colombiano, sin antecedentes de autoinmunidad, con ferropenia refractaria, en el que se realizaron estudios de extensión y se documentaron biopsias y serología compatible con gastritis autoinmune, con requerimiento de hierro parenteral en su evolución. Esta patología es subdiagnosticada en nuestro medio, ya que el diagnóstico temprano requiere un alto índice de sospecha, lo que permite la prevención de las complicaciones asociadas.

Injerto de hueso calvarial envuelto en colgajo pediculado de fascia temporo-parietal para reconstrucción de reborde cigomático-maxilar e infraorbitario: reporte de caso / Calvarial bone graft wrapped in temporo-parietal fascia pedicled flap for zygomatico-maxillary and infraorbital rim reconstruction: case report

La reconstrucción posterior a una cirugía oncológica resectiva maxilar es todo un desafío. Debido a esto, existen diversas técnicas quirúrgicas cuyo objetivo apunta a mantener no solo la funcionalidad, sino también la estética facial, especialmente en el área del reborde infraorbitario. El injerto de hueso calvarial es una opción segura y versátil para realizar una reconstrucción primaria en el reborde infraorbitario. Esta técnica está indicada en aquellos pacientes en los cuales la resección cutánea y exenteración orbitaria no son necesarias. Por este motivo, a continuación, analizaremos este tipo de injerto a propósito de un caso clínico en el que se usó asociado a un colgajo pediculado de fascia temporoparietal.

Reconstruction after maxillary resective oncological surgery is a challenge. Because of this, there are many surgical techniques whose objective is to maintain not only function but also facial aesthetics, especially in the infraorbital rim area. The calvarial bone graft is a safe and versatile option to perform a primary infraorbital rim reconstruction. This technique is indicated in those patients in whom skin resection and orbital exenteration are not necessary. For this reason, we will now analyze this type of graft in relation to a case in which it was used associated with a temporo-parietal fascia flap.

Cytodifferentiation of fundic part of glandular stomach in non descript breed of Indian prenatal goat

Though the anatomy and physiology of the adult caprine (Capra hircus L.) stomach have been investigated extensively, the early development of the abomasum has not yet been fully elucidated. The glandular part of abomasum plays an important role in digestion of ingested food by action of gastric juices. Very few studies have been conducted so far regarding histogenesis of goat foetal abomasum in India. In the present study, we have investigated the embryonic and early foetal development of the goat, Capra hircus L. fundic abomasum. We collected 36 developing abomasum of healthy and normal embryos/foeti of goat and assigned them into three group viz. Gr. I (0-50 days of gestation), Gr. II (51-100 days of gestation) and Gr. III (101-150 days of gestation). Small pieces of tissues were processed by routine paraffin. The wall of glandular stomach, the fundic part, was composed of epithelium, pleuripotent blastemic tissue and serosa up to 44 days of gestation. Tunica muscularis became separable at 46 days of gestation. The epithelium was stratified type up to 50 days and gradually changed to pseudo-stratified columnar to simple columnar type from 76 days of gestation. Primary and secondary abomasal folds were observed at 51 and 76 days of gestation, respectively. Gastric pit, the fore runner of gastric gland was reported first at 70 days. The gland became branched tubular type at 145 days. The cells found in the mucosa of the abomasum were surface epithelial cells, chief cells, parietal cells, mucous neck cells and undifferentiated cells. Chief and parietal cell were observed at 76 days and mucous neck cells at 82 days of gestation. Reticular, collagen and elastic fibers came into sight at 38, 76 and 100 days of gestation, respectively. The present study is expected to supplement known data and knowledge regarding histogenesis of goat fetal abomasum and help in diagnosis and treatment of related congenital anomalies.

The effect of mentalization-based family therapy on adolescents with depressive disorder and its related brain regions / 中华行为医学与脑科学杂志

Objective:To explor the effects of mentalization-based family therapy (MBFT) on the emotions of anxiety and depression, reflective functions, and related brain regions of adolescents with depression.Methods:Thirty-two adolescent patients with depression were selected in Beijing Huilongguan Hospital.Among them, fifteen patients treated with conventional drugs were defined as the control group, the other seventeen patients served as the observation group.On the basis of routine drug treatment, patients in the observation group were treated with 1.5 h MBFT once a week, for a total of 3 months.Among them, 10 patients underwent resting functional magnetic resonance imaging(rs-fMRI) scans before and after the intervention.SPSS 23.0 was used for statistical analysis of scale evaluation data by using chi-square test and repeated-measure analysis of variance, and pairwise Pearson correlation was used to construct a brain network matrix for the MRI results.The patient's brain network matrix was put into Gretna to calculate, and then use repeated measures analysis of variance and t test for judgment. Results:(1)Repeated measurement analysis of variance showed, over time and group, before and after intervention, the group×time interactions of patients' reflective function, anxiety, depression were statistically significant ( F=5.113, 9.350, 5.264, all P<0.05). Further simple effect analysis showed, in the observation group, there were statistically significant differences in patients' anxiety ((55.09±14.35) vs (30.58±3.62)), depression ((61.58±16.81) vs (31.00±3.48)) before and after intervention (all P<0.01). There was no significant difference in reflective function ((8.71±0.51) vs (8.87±0.50) ) in the observation group before and after intervention( P> 0.05). The reflective function((8.92±0.33) vs (8.73±0.35)) and anxiety((50.67±13.88) vs (45.78±12.89)) scores of the control group were not statistically significant different before and after intervention(all P>0.05), and the depression scores of the control group before and after inter-vention((69.33±9.11) vs (50.94±7.99)) were statistically significant different( P<0.01). (2)rs-fMRI showed that, using the posterior parietal lobe and the medial prefrontal lobe as seed points, the group×time interactions with right inferior frontal gyrus, right fusiform gyrus, right superior temporal gyrus, left middle temporal gyrus and right superior frontal gyrus were statistically significant ( F=29.56, 20.63, 8.69, 9.49, 8.62, all P<0.05). The further simple effect analysis showed in the observation group, the pre-test was less than the post-test, and the difference was statistically significant( P<0.05). In the control group, there were not statistically significant differences in the functional connection strength before and after the test(all P>0.05). (3)The brain network analysis of 264 regions of interest (ROIs) in the whole brain showed that the number of modules in the observation group was less than that in the control group, and the difference was statistically significant ( t=-2.64, P=0.046). Conclusion:MBFT can improve the anxiety and depression of adolescent patients with depression.It enhances the functional link between mentalization related brain regions and the whole brain, and enhances the activity of the whole brain link to become more integrated.

The morphometric study of parietal emissary foramen related with clinical implications in Thais / Estudio morfométrico del foramen emisario parietal relacionado con las implicaciones clínicas en tailandeses

SUMMARY: Parietal emissary foramina (PEF) are an important structure which the parietal emissary vein passes through. Aims of this study were to study morphometry of the PEF and its clinical implications. The present study examined in 800 parietal bones (400 Thai skulls; 200 males and 200 females). A total of 587 emissary foramina were found in 344 skulls. The PEF were found on the right side (298), left side (256). One hundred fifty-five unilateral, 189 bilateral, and 33 center of PEF were found in our study. The average of foramina to sagittal suture were 5.67 ? 2.73 mm on the right and 5.91 ? 2.37 mm on the left in male, while in female it was 5.28 ? 2.61 mm on the right and 5.48 ? 2.54 mm on the left. The shape was mostly circular with mean diameter of 1.27 ? 0.56 mm on the right, 1.23 ? 0.52 on the left and 1.11 ? 0.49 mm at the center in male. In female, the mean diameter of 1.19 ? 0.42 mm on the right, 1.12 ? 0.41 mm on the left and 1.60 ? 0.92 mm at the center. The ratio of distance from the external occipital protuberance (EOP)to PEF and to glabella in males on the right side is 0.342 cm. (3/8) and 0.349 cm. (3/8) on the left side. While the ratio of females is 0.367 cm. (3/8) and 0.388 cm. (3/8), respectively. Our finding obtained in this study scientists can be essentially benefited for anatomists, radiologists, neurosurgeons, and forensic to aware this anatomical structure.

RESUMEN: El foramen emisario parietal (FEP) es una importante estructura a través de la cual atraviesa la vena emisaria parietal. Los objetivos de este estudio fueron estudiar la morfometría del FEP y sus implicaciones clínicas. Se examinaron 800 huesos parietales (400 cráneos tailandeses pertenecientes a 200 hombres y 200 mujeres). Se encontró un total de 587 FEP en 344 cráneos, de los cuales 298 estaban presentes en el lado derecho y 256 en el lado izquierdo, siendo 155 FEP unilaterales, 189 bilaterales y 33 localizados en el centro. El promedio de la distancia de los FEP a la sutura sagital en los hombres fue de 5,67 ? 2,73 mm a la derecha y 5,91 ? 2,37 mm a la izquierda, mientras que en las mujeres fue de 5,28 ? 2,61 mm a la derecha y 5,48 ? 2,54 mm a la izquierda. La forma era mayoritariamente circular con un diámetro medio de 1,27 ? 0,56 mm en el lado derecho, 1,23 ? 0,52 en el lado izquierdo y 1,11 ? 0,49 mm en el centro en los cráneos de los hombres. En las mujeres, el diámetro medio del FEP en el lado derecho fue de 1,19 ? 0,42 mm, en el lado izquierdo 1,12 ? 0,41 mm 1,60 ? 0,92 mm en el centro. La relación de la distancia desde la protuberan- cia occipital externa al FEP y a la glabela en el lado derecho en los hombres fue de 0,342 cm (3/8) y en el lado izquierdo 0,349 cm (3/8). Mientras en las mujeres fue de 0,367 cm (3/8) y 0,388 cm (3/8), respectivamente. Nuestros hallazgos obtenidos en este estudio puede ser útil para que los anatomistas, radiólogos, neurocirujanos y científicos forenses conozcan esta estructura anatómica.

Cognitive training on the solving of mathematical problems: an EEG study in young men / Entrenamiento cognitivo en la resolución de problemas matemáticos: un estudio de EEG en hombres jóvenes

Abstract. Objective. This study characterized the electroencephalographic correlation (rEEG) between prefrontal and parietalcortices in young men while solving logical-mathematical problems after 18 sessions of cognitive training. Method. Two training groups were formed: one trained with gradually increased complexity (CT), the other with no increase in complexity (ST). Results. CT had a greater number of correct responses in the post-training evaluation than ST and showed a higher correlation between the left frontopolar-parietal cortices in almost all EEG bands, and between the dorsolateral-parietal cortices in the alpha1 band while solving math problems post-training. Results suggest that major functional synchronization between the left prefrontal and parietal cortices plays an important role in improving mathematical problem-solving after cognitive training.

Resumen Objetivo. El presente estudio caracteriza la correlación electroencefalográfica (rEEG) entre las cortezas prefrontal y parietal en hombres jóvenes durante la resolución de problemas lógico-matemáticos después de 18 sesiones de entrenamiento cognitivo. Método. Se formaron dos grupos de entrenamiento: uno entrenado con un incremento gradual de complejidad (CT) y el otro sin incremento de complejidad (ST). Resultados. El grupo CT presentó un mayor número de respuestas correctas que el grupo ST en la evaluación post entrenamiento, a su vez mostró un incremento en la correlación entre las cortezas frontopolar y parietal izquierdas en la mayoría de las bandas, así como entre las cortezas dorsolateral y parietal en la banda alfa1 durante la resolución de problemas posterior al entrenamiento. Los resultados sugieren que el incremento en la sincronización funcional entre las cortezas prefrontal y parietal izquierdas juega un rol importante en la resolución de problemas matemáticos después del entrenamiento cognitivo.

Effect of closure of anterior abdominal wall layers on early postoperative findings at cesarean section: A prospective cross-sectional study

Abstract Objective To investigate the effect of closure types of the anterior abdominal wall layers in cesarean section (CS) surgery on early postoperative findings. Methods The present study was designed as a prospective cross-sectional study and was conducted at a university hospital between October 2018 and February 2019. A total of 180 patients who underwent CS for various reasons were enrolled in the study. Each patient was randomly assigned to one of three groups: Both parietal peritoneum and rectus abdominis muscle left open (group 1), parietal peritoneum closure only (group 2), and closure of the parietal peritoneum and reapproximation of rectus muscle (group 3). All patients were compared in terms of postoperative pain scores (while lying down and duringmobilization), analgesia requirement, and return of bowel motility. Results The postoperative pain scores were similar at the 2nd, 6th, 12th, and 18th hours while lying down. During mobilization, the postoperative pain scores at 6 and 12 hours were significantly higher in group 2 than in group 3. Diclofenac use was significantly higher in patients in group 1 than in those in group 2. Meperidine requirements were similar among the groups. There was no difference between the groups' first flatus and stool passage times. Conclusion In the group with only parietal peritoneum closure, the pain scores at the 6th and 12th hours were higher. Rectus abdominismuscle reapproximations were found not to increase the pain score. The closure of the anterior abdominal wall had no effect on the return of bowel motility.

Anatomical observation of the left parietal peritoneum and its clinical significance in left retro-mesocolic space dissection / 中华胃肠外科杂志

Objective: To investigate the anatomic characteristics of the left parietal peritoneum and its surgical implementation while dissecting in left retro-mesocolic space. Methods: A descriptive case series research methods was used. (1) surgical videos of 35 patients who underwent laparoscopic radical resection (complete mobilization of splenic flexure) of colorectal cancer in Union Hospital of Fujian Medical University between January 2018 and December 2018 were reviewed; (2) four specimens after radical resection of rectal cancer performing in June 2020 were prospectively enrolled and reviewed; (3) five specimens of left parietal peritoneum from 5 cadaveric abdomen (3 males and 2 females) were enrolled and reviewed as well; Tissues of 3 unseparated regions, namely the root of the inferior mesenteric artery (IMA), the medial region and the lateral region (including kidney tissue), from above the 5 cadaveric abdominal specimens were selected to perform Masson staining and histopathological examination. Results: (1) Surgical video observation: "Staggered layer phenomenon" and typical left parietal peritoneum was found in 77.1% (27/35) of patients when the left retro-mesocolic space was separated from the lateral and central approaches. The left parietal peritoneum presented as a rigid fascia barrier between the lateral and central approaches, which was a translucent dense connective tissue fascia. After the splenic flexure were completely mobilized, the left parietal peritoneum stump continued to the cephalic side. (2) Observation of 4 surgical specimens: The dorsal side of the left mesocolon specimen was studied, and the left parietal peritoneum stump edge was identified. The outside of the stump edge was the left hemicolon dorsal layer, which was continuously downward to the rectal fascia propria. (3) Cadaveric abdominal specimens: The left retro-mesocolic space was separated through lateral and central approaches, and the rigid fascia barrier, essentially the left parietal peritoneum and Gerota fascia, was encountered. Cross-section view showed that the left parietal peritoneum could be further detached from the dorsal layer of the left mesocolon from the outside, but could not be further detached from the inside out. (4) Histological examination: There was no obvious fascia structure in the IMA root region, while outside the IMA root region, the left bundle of inferior mesenteric plexus penetrating Gerota fascia was observed. There were 4 layers of fascias in the medial region, including the ventral layer of the left mesocolon, the dorsal layer of the left mesocolon, left parietal peritoneum and Gerota fascia. Small vessels were observed between the dorsal layer of the left mesocolon and the left parietal peritoneum. In lateral region, renal tissue and renal fascia were observed. Three layers of fascia structures were observed clearly under high power field, including the dorsal layer of the left mesocolon, left parietal peritoneum, and Gerota fascia. Conclusions: The left parietal peritoneum is the anatomical basis of the "staggered layer phenomenon" from the lateral or central approaches during the separation of left retro-mesocolic space. The small vessels in the dissection plane are the anatomical basis of intraoperative microbleeding, which need pre-coagulation. The central part of Gerota fascia is penetrated by the branches of the inferior mesenteric plexus, which results in a relatively dense surgical plane. Thus, during the dissection through the central approach, it is easy to involve in wrong surgical plane by deeper dissection.

Estudo Comparativo da Doença Coronariana Microvascular Causada por Doença de Chagas e por Outras Etiologias / Chagas Cardiomyopathy as the Etiology of Suspected Coronary Microvascular Disease. A Comparison Study with Suspected Coronary Microvascular Disease of Other Etiologies

Resumo Fundamento A doença de Chagas (DC) constitui uma causa potencial negligenciada de doença microvascular coronariana (DMC). Objetivos Comparar pacientes com DMC relacionada à DC (DMC-DC) com pacientes com DMC ligada a outras etiologias (DMC-OE). Métodos De 1292 pacientes estáveis, encaminhados para angiografia coronária invasiva para elucidar o padrão hemodinâmico e a causa de angina, 247 apresentaram coronárias subepicárdicas normais, e 101 foram incluídos após aplicação dos critérios de exclusão. Desses, 15 compuseram o grupo de DMC-DC e suas características clínicas, hemodinâmicas, angiográficas, e cintilográficas foram comparadas às do grupo de 86 pacientes com DMC-OE. O nível de significância estatística para todas as comparações adotado foi de 0,05. Resultados Pacientes com suspeita de DMC-DC apresentaram características antropométricas, clínicas e angiográficas, além de alterações hemodinâmicas e de perfusão miocárdica estatisticamente comparáveis às detectadas nos 86 pacientes com DMC-OE. Disfunção ventricular diastólica, expressa por elevada pressão telediastólica do ventrículo esquerdo, foi igualmente encontrada nos dois grupos. Entretanto, em comparação a esse grupo com DMC-OE, o grupo com DMC-DC exibiu fração de ejeção ventricular esquerda mais baixa (61,1 ± 11,9 vs 54,8 ± 15,9; p= 0,049) e mais elevado escore de mobilidade da parede ventricular (1,77 ± 0,35 vs 1,18 ± 0,26; p= 0,02). Conclusão A cardiomiopatia crônica da doença de Chagas esteve associada à etiologia de possível doença microvascular coronariana em 15% de amostra de 101 pacientes estáveis, cujo sintoma principal era angina requerendo elucidação por angiografia invasiva. Embora os grupos DMC-DC e DMC-OE apresentassem características clínicas, hemodinâmicas, e de perfusão miocárdica em comum, a disfunção global e segmentar do ventrículo esquerdo foi mais grave nos pacientes com DMC associada à DC em comparação à DMC por outras etiologias. (Arq Bras Cardiol. 2020; 115(6):1094-1101)

Abstract Background Chagas disease (CD) as neglected secondary form of suspected coronary microvascular dysfunction (CMD). Objectives Comparison of patients with CMD related to CD (CMD-CE) versus patients with CMD caused by other etiologies (CMD-OE). Methods Of 1292 stable patients referred for invasive coronary angiography to elucidate the hemodynamic pattern and the cause of angina as a cardinal symptom in their medical history, 247 presented normal epicardial coronary arteries and 101 were included after strict exclusion criteria. Of those, 15 had suspected CMD-CE, and their clinical, hemodynamic, angiographic and scintigraphic characteristics were compared to those of the other 86 patients with suspected CDM-OE. Level of significance for all comparisons was p < 0.05. Results Patients with suspected CMD-CE showed most anthropometric, clinical, angiographic hemodynamic and myocardial perfusion abnormalities that were statistically similar to those detected in the remaining 86 patients with suspected CMD-OE. LV diastolic dysfunction, expressed by elevated LV end-diastolic pressure was equally found in both groups. However, as compared to the group of CMD-OE the group with CMD-CE exhibited lower left ventricular ejection fraction (54.8 ± 15.9 vs 61.1 ± 11.9, p= 0.049) and a more severely impaired index of regional wall motion abnormalities (1.77 ± 0.35 vs 1.18 ± 0.26, p= 0.02) respectively for the CMD-OE and CMD-CE groups. Conclusion Chronic Chagas cardiomyopathy was a secondary cause of suspected coronary microvascular disease in 15% of 101 stable patients whose cardinal symptom was anginal pain warranting coronary angiography. Although sharing several clinical, hemodynamic, and myocardial perfusion characteristics with patients whose suspected CMD was due to other etiologies, impairment of LV segmental and global systolic function was significantly more severe in the patients with suspected CMD related to Chagas cardiomyopathy. (Arq Bras Cardiol. 2020; 115(6):1094-1101)

MRI measurement of parietal lobe volume in different genders of Han Chinese / 中国医学影像技术

Objective: To measure the volume of parietal lobe of different genders of Han nationality in China. Methods A multi-center study was conducted with 100 healthy volunteers aged 18 to 70 years old. 3D T1W magnetization prepared rapid acquisition gradient echo sequence was used to perform whole-brain scan, and the volume of left and right parietal lobe and total brain volume were measured manually. After standardization, the differences of parietal volume were compared between male and female and between left and right sides, and the correlation between parietal volume and age was evaluated. Results In male, the left measured parietal volume was (113.05±11.14)cm3, the right was (111.75±10.61)cm3, and the total brain volume was (1 605.90±115.05)cm3. In female, the left measured parietal volume of female was (103.75±9.96)cm3, the right was (102.22±9.31)cm3, and the total brain volume was (1 444.56±93.26)cm3. There was no statistically significant difference of parietal volume between left and right sides in male (P>0.05), while there was a statistically significant difference in female (P0.05). Conclusion Both total brain volume and parietal volume of Han Chinese male are significantly larger than those of female. There is no difference between the left and right parietal lobes in male, while the left side is slightly larger than right side in female. A reduction in parietal volume with age is found in male.

Fear Network Model in Panic Disorder: The Past and the Future

The core concept for pathophysiology in panic disorder (PD) is the fear network model (FNM). The alterations in FNM might be linked with disturbances in the autonomic nervous system (ANS), which is a common phenomenon in PD. The traditional FNM included the frontal and limbic regions, which were dysregulated in the feedback mechanism for cognitive control of frontal lobe over the primitive response of limbic system. The exaggerated responses of limbic system are also associated with dysregulation in the neurotransmitter system. The neuroimaging studies also corresponded to FNM concept. However, more extended areas of FNM have been discovered in recent imaging studies, such as sensory regions of occipital, parietal cortex and temporal cortex and insula. The insula might integrate the filtered sensory information via thalamus from the visuospatial and other sensory modalities related to occipital, parietal and temporal lobes. In this review article, the traditional and advanced FNM would be discussed. I would also focus on the current evidences of insula, temporal, parietal and occipital lobes in the pathophysiology. In addition, the white matter and functional connectome studies would be reviewed to support the concept of advanced FNM. An emerging dysregulation model of fronto-limbic-insula and temporooccipito-parietal areas might be revealed according to the combined results of recent neuroimaging studies. The future delineation of advanced FNM model can be beneficial from more extensive and advanced studies focusing on the additional sensory regions of occipital, parietal and temporal cortex to confirm the role of advanced FNM in the pathophysiology of PD.

Remnant parietal serosa detection in a cat with true diaphragmatic hernia using computed tomography / 대한수의학회지

A 4-year-old cat was referred for a suspected pulmonary mass. True diaphragmatic hernia presence was diagnosed via computed tomography (CT). There was a thin membrane covering the diaphragmatic defect. The membrane was thinner than the diaphragm. After contrast injection, the membrane was less enhanced than that of the normal diaphragm. The membrane was identified as a remnant of the parietal pleura. In addition, contrast-enhanced CT images provided clarity in viewing the herniated liver and falciform fat. A thinner membrane, covering the diaphragmatic defect, and attached to the thicker normal diaphragm, is considered a unique CT feature of true diaphragmatic hernia.

A Functional Domain Based Approach in Neurocognitive Rehabilitation with Transcranial Direct Current Stimulation: A Case Report

Transcranial direct current stimulation (tDCS) is a novel brain stimulation technique which has kindled hope in alleviating motor, language as well as cognitive deficits in neuronal injury. Current case report describes application of tDCS in two phases using two different protocols in a patient with hypoxic injury. In the first phase anodal stimulation of dorsolateral prefrontal cortex improved the language fluency. Subsequently, after 6 months second phase application of anodal stimulation over posterior parietal region targeted arithmetic and working memory deficits. Individualising the treatment protocols of brain stimulation, based on the lesion and the functional deficits, for neuro-rehabilitation is emphasised.