The Anatomy and Anatomical Variations of the Round Window Prechamber and Their Implications on Cochlear Implantation: An Anatomical, Imaging, and Surgical Study

Abstract Introduction Over the last decades, there has been a tremendous increase in the number of cochlear implant recipients and, consequently, there is a recent increase of interest in the proper understanding of the anatomy of the round window (RW), which is the most important anatomical land mark during cochlear implant surgery. Objectives The present study was undertaken to assess the detailed surgical and radiological anatomy of the RW prechamber; its shape, directions, measurements, common anatomic variations, and its relationships with different surrounding structures as related to cochlear implantation. Methods A total of 20 cadaveric specimens of human temporal bone were microscopically dissected for the anatomical assessment of the measurements of the RW and its relation to surrounding structures in the tympanum. A total of 20 patients were subjected to cochlear implantation, and a radiological and surgical assessment of the anatomy of their RW prechambers was performed. Results The distances between the RW and the facial canal (FC), the jugular fossa (JF), the carotid canal (CC), and the oval window (OW) were measured. Among the cases subjected to cochlear implantation, the infracochlear tunnel was studied radiologically; the lengths of the anterior and posterior pillars were assessed, and the relation with the direction at which the RW faces was statistically analyzed. Conclusions Proper understanding of the topographic anatomy of the RW, including its direction of opening and the distances from different adjacent structures in the tympanum, is essential for a successful cochlear implantation surgery, since it can help decision-making before the surgery and is useful to avoid many complications, such as misplaced electrode and iatrogenic injury to the surrounding structures.

Cucumol A: a cytotoxic triterpenoid from Cucumis melo seeds

ABSTRACT Phytochemical investigation of the MeOH extract of Cucumis melo L. var. reticulates, Cucurbitaceae, seeds led to the isolation of a new triterpenoid: cucumol A (27-hydroxy taraxerol-3β-ol), along with three known compounds: α-spinasterol and D:B-friedoolean-5-ene-3-β-ol. Their structures were established by extensive 1D (1H, 13C, and DEPT) and 2D (1H–1H COSY, HMQC, and HMBC) NMR, as well as IR and HRESIMS spectral analyses. Compound 3 displayed cytotoxic activity against L5178Y and Hela cancer cell lines with ED50 of 1.30 and 5.40 µg/ml, respectively compared to paclitaxel (0.07 and 0.92 µg/ml, respectively).

Cardiogenic Shock Complicating Myocardial Infarction: An Updated Review.

The current review aimed to highlight the update management in patients with ischemic Cardiogenic shock (CS) and its impact on mortality. We reviewed the literature using search engine as MIDLINE, SCOPUS, and EMBASE from January 1982 to October 2012. We used key words: “Cardiogenic Shock”. This traditional narrative review did not expand to explore the mechanical complications or other causes of CS. There were 7193 articles assessed by 3 reviewers. We excluded 4173 irrelevant articles, 1660 non- English articles and 93 case-reports. The current review evaluated 888 articles (880 studies and 8 meta-analyses) that were tackling ischemic CS from different points of view before and after the era of SHOCK trial. Ischemic CS remains the most serious complication of acute MI, being associated with high mortality rate both in the acute and long-term setting, despite the advances in its pathophysiology and management. Further randomized trials and guidelines are needed to save resources and lives in patients sustained ischemic CS.

Relation between plasma leptin level and left ventricular function in obese females with insulin resistance

An association between obesity and cardiac mass has been recognized for almost two decades, whereas the precise nature of the association remains elusive Theoretical consideration have long suggested that it may be mediated at least in part by insulin resistance [Mc, Nutly ,2003].Several studies have found an association between insulin resistance and left ventricular hypertrophy. [Lacobellis et al, 2003]. In human, production of leptin[ an adipocyte - derived peptide], has been linked to obesity, insulin and insulin sensitivity [Leyva et al, 1998]. It was considered that alteration in plasma concentration could constitute an additional component of metabolic syndrome of cardio-vascular risk[Leyva et al, 1998]. The aim of this work was to evaluate the relationship between obesity, insulin resistance, leptin and left ventricular mass and function in young obese females with insulin resistance. Sixty five premenopausal females aged 25-45 years with no history of diabetes or hypertension was participated in this study. Twenty were non obese and forty five were obese .Fasting serum glucose, insulin and leptin were assessed and homeostatic model assessment HOMA-IR score was calculated. According to HOMA-IR obese premenopausal females were divided into 2 subgroups: - Subgroups 1: [Insulin sensitive group or IS group] included 20 obese females with HOMA-IR <3.8.And Subgroup 2: [insulin resistance group or IR group] included 25 obese females with HOMA-IR>/=3.8.Echocardiography was done for all females participated in the study to evaluate L.V mass and function. Waist circumference [WC], serum insulin, serum leptin and HOMA-IR were significantly higher in obese group compared to non obese group [p<0.05, <0.05, <0.001 and <0.00l respectively] and between IR and IS subgroups [p<0.05, <0.05, <0.001 and <0.00l respectively].As regard Echocardiographic studies left ventricular mass[LVM] and left ventricular mass corrected t height 2.7 [LVM/h2.7 ]were significantly higher in obese group compared to non obese group [p<0.05] and between IR and IS subgroups [p<0.05 for both],while the ratio between peak transmitral E and A wave velocity[E/A ratio] was lower in obese group compared to non obese group [<0.05], it was also lower in IR subgroup compared to IS subgroup [p<0.05].There was positive significant correlation between LVM and LVM/H2.7 and serum insulin [p<0.05]and serum leptin [p<0.05] in IS subgroup while the correlation was highly significant between both and fasting leptin [p<0.001] in IR subgroup. Obesity is a clinical syndrome associated with hyperinsulinemia, hyperleptinemia and insulin resistance Abnormalities of LV diastolic function and mass occur frequently in obese patients. Hyperleptinemia can be an early sign for left ventricular dysfunction in obese females

Effect of the colour of feeders and drinkers on development of some maintenance behaviors in newly hatched chicken

Colors of long wave lengths and color contrast can increase the responsiveness of chicken to stimuli. This study was designated to assess the effect of feeders and drinkers colors and their contrast on ingestion rate and development of some maintenance behaviors. This study includes z Experiment I: effect of different colors of feeders and drinkers on rates feeding rates and water intake during 6 weeks rearing period was examined in Ross broiler chicken. Experiment II: assessment of the effect of color contrast of feeders and drinkers with the floor on development of maintenance behaviors in newly hatched chicken. The results indicated that red colored feeders and drinkers increased the feed and water intake rates during the first week post hatching [P < 0.05]. But no such effect was observed in older ages. In addition, the presence of color contrast feeders and drinkers with the floor enhanced the appearance of certain behaviors necessary for survival in newly hatched chicks. Red colored feeders and drinkers attracted chicks, increased ingestion rate and color contrast accelerated the development of some maintenance behaviors and decreased distress calls. Thus using red colors and presence of contrast environment could enhance the development of maintenance behaviors in newly hatched chicken

Effect of denervation on rat soleus muscle: light morphometric and electron microscopic study

This study described the light, morphometric and ultrastructure of denervated rat soleus muscle, with a particular emphasis on understanding the ultrastructural changes and cellular basis for the reduced restorative capacity of denervated muscle. The right hind limbs of adult male Wister rats were denervated for periods of one, two, three and four weeks and the samples were processed for light and electron microscopy. Atrophy of muscle fibers was prominent from the first week. At further periods of denervation, atrophy of all muscle fibers was seen most clear with morphometry. As denervation progressed, the morphology of individual muscle fibers varied. Most of muscle fibers contained well-organized myofilaments; whereas in others, local areas of sarcomeric disorganization were evident. Mitochondria became smaller and rounded, the elements of the sarcoplasmic reticulum proliferated and became more disorganized, the autophagic vesicles were well present in the cytoplasm of atrophic muscle fibers. The satellite cells did not show signs of activation at four weeks after denervation

Plasma adrenomedullin and atrial natriuretic peptide concentrations in patients with essential hypertension

The aim of this study was to determine the changes of plasma concentrations of adrenomedullin [AM] and atrial natriuretic peptide [ANP] in patients with essential hypertension and the relation between plasma AM and some clinical, renal and cardiac function variables. Plasma AM and ANP were measured in 60 patients with essential hypertension and 30 normotensive control subjects. Hypertensive patients were classified according to the joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure [JNC-VI] into: 20 cases stage 1 [mild hypertension], 20 cases stage 2 [moderate] and 20 cases stage 3 [severe hypertension]. The concentrations of plasma AM and ANP were significantly increased in hypertensive patients compared to normotensive control subjects, although plasma AM values in normotensive subjects and stage 1 hypertensive patients were not statistically different. Plasma AM concentrations were positively correlated with the ANP, mean arterial blood pressure and serum creatinine levels and inversely correlated with glomerular filtration rate [creatinine clearance], left ventricular ejection fraction [LVEF] and left ventricular fractional shortening [LVFS]. It was concluded that plasma AM and ANP concentrations increased in proportion to the severity of hypertension in hypertensive patients and plasma AM levels correlated positively with ANP, serum creatinine, mean arterial blood pressure and inversely with creatinine clearance [GFR], LVEF and LVFS. The present findings suggested that these vasodilator peptides are involved in the pathogenesis of hypertension acting against further elevation of blood pressure in patients with essential hypertension

Effect of fixation of skin flaps on seroma formation after mastectomy

Post mastectomy seroma can lead to morbid sequelae. Thirty females, divided into 2 equal matched groups, were submitted to modified radical mastectomy for operable cancer breast in the surgical deprtment of the Medical Research Institute. For group I, dead space was reduced by suturing skin flaps to underlying chest wall muscles to determine its effect on post mastectomy seroma, while group II acted as control. Group I showed statistically significant better results than group II as regards mean total discharge [P<0.001] and mean discharge per day [P<0.001]. Wound discharge ceased within 2-4 days and 5-9 days in group [I] and [II] respectively. This technique is recommended to be used to reduce post-mastectomy seroma formation, moreover, it has beneficial clinical and economic effects

Comparative study of hysterosalpingography and chlamydia antibody testing in predicting tubal factor infertility

The purpose was to investigate the prevalence of Chlamydia trachomatis antibodies in the sera of infertile patients and to compare the diagnostic value of Chlamydia trachomatis antibody testing versus hysterosalpingography [HSG] in predicting tubal factor infertility. The study included 100 patients with primary infertility with no history of pelvic surgery or pelvic inflammatory disease. Patients were tested for Chlamydia trachomatis IgG antibody by an indirect microimmunofluoresence antibody technique. Hysterosalpingography [HSC] and laparoscopy were performed for all patients. An antibody titer of 1/8 was judged seropositive. Likelihood ratios [LRS] were used to compare the diagnostic value of Chlamydia trachomatis antibody testing with that of HSG in predicting tubal factor infertility. Twenty-four percent of patients were seropositive for Chlamydia trachomatis antibody, 18 of the seropositive patients [75%] had tuboperitoneal disease at laparoscopy, of the 76 seronegative patients only 4 [5.2%] had tuboperitoneal disease, a statistically highly significant difference [P < 0.0001]. The likelihood of the tuboperitoneal disease increased with the height of the titer. Both Chlamydia antibody testing and HSG had equal positive likelihood ratio of 8 indicating that a patient with tubal factor infertility to be 8 times more like to have positive serology and abnormal HSG than a patient without tubal factor infertility. Chlamydia antibody testing, however, had a higher sensitivity and lower negative likelihood ratio than HSG. The results of this study suggest that Chlamydia trachomatis plays an important role in tubal factor infertility in our community. In certain infertility population it compares well and even performs better than HSG in predicting that type of infertility. Chlamydia antibody testing is a simple and convenient test and should become a key part of the initial diagnostic work-up for infertile women

JR, uma nova proposta de mensuraçäo de referência incisal através da imagem do ângulo goníaco em telerradiografia lateral / JR, a new proposal of measures of incisal reference through image of goniac angle in lateral teleradiography

Estudou-se uma amostragem de 100 pacientes com idade variando entre 10 a 14 anos, sendo 50 do sexo masculino e 50 do sexo feminino, com a finalidade de determinar o desvio do incisivo inferior em relaçäo às referências incisais preconizadas por Andrade (Jr), Andrade (J), Interlandi (I), Vigorito (V), Ricketts (AP) e Telles (T). A análise mostrou existir diferença estatisticamente significante entre a técnica de Telles e as demais, permitindo, assim, concluir a grande influência da base do crânio na determinaçäo da referência incisal pela primeira técnica. As referências incisais traçadas pelas técnicas estudadas se organizaram ao redor do incisivo inferior na seguinte ordem: Jr, J, AP, V, I e T. Pelos dados encontrados Jr se mostrou eficiente e de maior aplicaçäo clínica pela sua proximidade com a referência incisal. Em relaçäo a porcentagem em todas as 5 amostras estudadas, Jr ficou ao nível de 2,5mm, acima de 90 por cento em média, J na faixa de 80 a 90 por cento, permanecendo as demais na faixa de 70 a 80 por cento