Craniofacial Features of Dwarfism in the Paintings of Velázquez.

This study describes the craniofacial features of achondroplastic dwarfism in the paintings of Velázquez. In a PubMed search, using [Velázquez] and [dwarf], 13 titles were found. In a Google Image search, [Velázquez] and [dwarf] retrieved 5 paintings. The craniofacial manifestations of the dwarfs depicted in the paintings were analyzed. Frontal bossing, antimongoloid slant, depressed nasal bridge (saddle nose), bulbous tip, malar hypoplasia, malocclusion, and chin asymmetry were observed. The presence of each manifestation was checked. In 5 paintings, portraits of 6 dwarfs having craniofacial deformities were found: Mariabárbola Asquin (left) in Las Meninas , Nicolasito Pertusato (right) in Las Meninas , Portrait of Sebastián de Morra, Portrait of Francisco Lezcano, The Jester Don Diego de Acedo, and Prince Balthasar Charles with a Dwarf. The most frequent craniofacial manifestation was malar hypoplasia (100%), followed by a bulbous tip (83.3%), saddle nose (66.7%), and frontal bossing (50%). Antimongoloid slant, malocclusion, and chin asymmetry were relatively rare (16.7% each). Through an analysis of 6 dwarfs in Velázquez's paintings, we can show that he realized and frequently expressed the craniofacial manifestations of achondroplasia: malar hypoplasia, bulbous tip, saddle nose, and frontal bossing. Despite the rarity of these presentations, he was also aware of antimongoloid slant, malocclusion, and chin asymmetry. Velázquez was a famous painter in the 17th century (i.e., during the Baroque period). Based on his excellent expression of the craniofacial manifestations of dwarfism, we can assume that he had a sound knowledge of anatomy, as well as malformations.

Meaning of the Skulls Depicted in Emblem Books of the 17th Century.

The aim of this study is to elucidate the meaning of the skulls depicted in emblem books of the 17th century. Three emblem books of the 17th century were reviewed and analyzed: (1) Rollenhagen emblem: Gabrielis Rollenhagii Selectorum emblematum centuria secunda (1613), (2) Quarles' emblems; illustrations engraved by William Marshall and others (1635), and (3) Wither's emblem: A collection of emblemes, ancient and moderne: quickened with metricall illustrations, both morall and divine: and disposed into lotteries (1635). Among the 100 illustrations in Rollenhagen's book, 4 (4.0%) had skulls. Among the 76 illustrations in Quarles' book, 6 (7.9%) had skulls. Among the 256 illustrations in Wither's book, 12 (4.7%) had skulls. Thereafter, 22 (5.1%) of 432 illustrations had skulls. Four emblems in Rollenhagen's book were exactly identical to those in Wither's book. Therefore, 18 emblems (6 Quarles' emblem, 12 Wither's emblem) were analyzed. The most frequent meaning of skulls in 18 emblems was death (12, 66.7%), followed by resurrection (2, 11.2%). Other meanings were grief, the brevity of life, vanity of love, and pain, respectively (1 each). The most frequent of the theme of the emblems, which included skulls, was 'Memento mori' (remember death, 6, 33.3%), followed by an earnest desire for salvation or resurrection (3, 16.7%), and importance of knowledge or learning (2, 11.1%). Since these emblem books were published after Vesalius' Fabrica (1543), the drawing of the bones of the arm and legs had anatomic correlations. However, skulls were not sufficiently precise, showing each part of the facial bones.

How Do the Faces of Kyrgyz Beauties Look? A Photogrammetric Analysis of Beauty Pageant Winners.

The aim of this study was to assess how the eyes of Kyrgyz beauties look through an anthropometric analysis of beauty pageant winners. Eleven winners of the Miss Kyrgyzstan contest (2011-2021) were included. Ten other beauty contest winners were added, resulting in a total of 21 beauties who were included. The horizontal corneal diameter, which is 11.75 mm, was used as a standard distance. Other distances were calculated in millimeters based on the proportions of the pixels measured. Twenty-six distances (face: 10, eyebrows: 2, eyes: 4, nose: 4, lips: 4, and chin: 2) and 9 angles (forehead-brow, cantal tilt, 5 face angles, the mandible angle, and the chin angle) were measured. Thereafter, 16 indices (forehead: 1, eyes: 5, nose: 4, lips and chin: 3, and contours 3) were calculated. The forehead-brow angle was 82.2±7.2 degrees. The canthal tilt was 9.0±2.0 degrees. The overall face angles 1 and 2 were 108.6±4.1 degrees and 69.6±2.3 degrees, respectively. The midface angles 1 and 2 were 129.9±3.8 degrees and 125.1±3.9 degrees, respectively. The lower face angle was 139.6±4.1 degrees. The mandible angle and chin angle were 136.9±4.0 degrees and 106.0±4.0 degrees, respectively. The ratio of forehead height to total face height was 0.33±0.03. The ratio of nose height to total face height was 0.25±0.02. The lower face width/face width ratio was 0.82±0.05. The ratio of face width to total face height was 0.72±0.03. The ratio of midface height to total face height was 0.34±0.02. The data from this study might serve as the recommended esthetic proportions for performing plastic surgical procedures.

Inflammatory bowel disease is associated with an increased risk of inflammatory skin diseases: A population-based cross-sectional study.

BACKGROUND: Inflammatory bowel disease (IBD) is a chronic disease of the gastrointestinal tract attributed to aberrant activity of the immune system. Increasing evidence suggests that patients with IBD are at an increased risk of inflammatory skin diseases (ISDs). OBJECTIVE: We sought to clarify the association between IBD and ISDs using a nationwide health claims database maintained in Korea. METHODS: We interrogated Korean health claim database data from 2009 to 2013. We enrolled all patients with IBD, and age- and sex-matched control subjects, and evaluated the risks of ISDs, including psoriasis, rosacea, and atopic dermatitis, and the risks of autoimmune skin diseases, including vitiligo and alopecia areata. We used multivariable logistic regression to this end. RESULTS: ISDs including rosacea, psoriasis, and atopic dermatitis were significantly associated with IBD, whereas the associations between IBD and autoimmune skin diseases including vitiligo and alopecia areata were less marked or nonexistent. Ulcerative colitis and Crohn's disease were both associated with ISDs. LIMITATIONS: We were unable to distinguish phenotypes and severities of skin diseases. CONCLUSION: IBD was significantly associated with ISDs, but less so or not at all with autoimmune skin diseases.

Effects of the Ultra-High-Frequency Electrical Field Radiofrequency Device on Mouse Skin: A Histologic and Molecular Study.

BACKGROUND: Radiofrequency technology is one of the most recently developed methods for noninvasive skin tightening and facial contouring, and works by generating thermal energy in the deep dermis. Although clinical improvements have been reported using radiofrequency devices, there are few histologic and molecular studies about the mechanisms of dermal collagen remodeling. The authors investigated the histologic effects of an ultra-high-frequency electrical field (40.68 MHz) radiofrequency device (Polargen) on collagen remodeling in hairless mouse skin and evaluated its relative molecular mechanism. METHODS: The radiofrequency was applied to the dorsal skin of hairless mice three times per week for 2 weeks. At 21 days after initial treatment, treated skin and nontreated control skin samples were excised for semiquantitative analysis of histologic features, including collagen. The authors also checked the mRNA expression levels of collagen type 1, transforming growth factor (TGF)-ß, matrix metalloproteinase-1, vascular endothelial growth factor, tumor necrosis factor-α, and interleukin-1. RESULTS: Histologic examination revealed epidermal hyperplasia, increased collagen staining, and fat atrophy in treated skin area compared with the nontreated skin area. In addition, mRNA expression of collagen type І, TGF-ß, and vascular endothelial growth factor in radiofrequency-treated areas was significantly increased compared with that in untreated control areas (p < 0.05, p < 0.05, and p < 0.01, respectively). CONCLUSIONS: These results suggest that the device may facilitate replacement of subcutaneous fat tissue with new collagen in association with the increased mRNA levels in TGF-ß and vascular endothelial growth factor. Therefore, this device may effectively reduce adipose tissue and achieve facial contouring in addition to skin tightening.

Analysis of medical student's book reports on Cronin's The Citadel: would young doctors give up ideals for prestige and wealth?

PURPOSE: The purpose of this study is to find what medical students think the reward for their future work should be and whether they would keep their ideals or abandon them for prestige and wealth by analyzing the book reports of Cronin's The Citadel. METHODS: Participants were 50 medical students of junior class. A month before the classroom lecture, the book and digital video disk were provided. Students had discussions in groups of seven and wrote book reports which include answers of three questions. RESULTS: Regarding what should be the reward for the medical doctor, two-thirds of students (66.7%) answered with spiritual compensation, while one-third (33.3%) chose material reward. In the situation presented to Manson, three-fifths (60.0%) answered they would keep their ideals (idealist), while the remaining two-fifths (40.0%) decided they would abandon them. Less than one-third of students (30.0%) answered they would reveal the corruptions of the doctor's society, while two-thirds (64.0%) would not. CONCLUSION: The larger number of idealists who prefer spiritual reward rather than a material reward represents the innocence of youth as in portrayed in The Citadel.

What is like to be a devoted doctor? An analysis of book reports on The Painted Veil.

PURPOSE: The aim of this study is to see what medical students think about the role of spouse of a devoted medical doctor through the book reports of The Painted Veil (1925). METHODS: The 53 medical students were asked to read Maugham's The Painted Veil and to have a discussion. In their book reports, following questions were asked to be included: What it is like to be married a devoted medical doctor? Do you think that patients realize, value, and respect the importance of doctor's work? In the outbreak of highly infectious and fatal disease, can you carry out a heroic fight to control it? RESULTS: Among the 53 respondents, seven students (13%) answered that they would be happy if they marry a devoted doctor and scientist and 34 (64%) unhappy. The remaining 12 (23%) could not make a decision. The six students (11%) answered that doctor is valued and respected by patients while 46 (87%) answered doctor is neither valued nor respected. The remaining one (2%) could not decide. The 20 students (38%) answered that they would fight for the infectious disease and the remaining 30 (57%) answered that they would not. The remaining three (5%) could not determine their mind. CONCLUSION: The Painted Veil induced a virtue of "life of balance and harmony" and "attitude of doctor who give superiority to responsibility and duty over prestige and wealth" from the medical students. It could be a good teaching material for medical humanity.

Origin of the Lower Orbicularis Oculi Muscle in Relation to the Nasojugal Groove.

The aim of this study was to clarify the location of the origin of the lower orbicularis oculi muscle (OOM) in relation to the nasojugal groove.In 45 lower eyelids of 44 patients, the origin of the lower OOM was identified. In 4 lower eyelids of 2 fresh cadavers, the breaking strength was measured. In 4 lower eyelids of 4 fixed cadavers, 3 parasagittal sections and 2 horizontal sections were made. In computed tomographic scans of 182 orbits of 99 patients, the maxillary attachment of the OOM was measured.The lower OOM originated along the orbital margin, and the mean (SD) width of the attachment was 10.5 (1.4) mm. The lower OOM ran obliquely laterally and downward. The force needed to tear the 3-mm-wide OOM was 8.40 (0.21) N. Histologically, the OOM was attached to the periosteum on the medial limbus line; however, it was not attached at the midpupillary line or the lateral limbus line. The most medial part of the lower OOM was attached to the periosteum. In the middle and lateral part of the lower eyelid, however, a fibrofatty tissue was found between the OOM and the periosteum. In computed tomographic scans, the OOM was almost always attached to the maxilla at the medial epicanthus (100%) and at the medial limbus line (92.3%). At the midpupillary line, fewer than half (45.6%) were attached. At the lateral limbus line (14.3%) and the lateral canthus (4.4%), they were rarely attached.In a relaxed state, the nasojugal groove is not evident because the attached portion does not pull at the wings. While squinting, the OOM contracts and the vertical width shortens, and thereafter, a surface puckering of the delicate periorbital skin appears.

Relation of the Vector Force Needed to Lift the Upper Eyelids and the Degree of Exophthalmos.

The aim of this study was to determine the relation of the vector force needed to lift the upper eyelids and the degree of exophthalmos (EX). In the 109 magnetic resonance imaging films, the degree of EX (the shortest distance from the cornea to the line connecting both lateral orbital rims), the anterior angle (θ, an angle formed from the lower margin of the upper eyelid-superior transverse ligament (STL)--with a parallel line connecting the supraorbital rim and the infraorbital rim in the sagittal film), the length from the STL to the upper eyelid margin (levator length [LL]), the thickness of the STL (WT), and the thickness the of levator palpebrae (LT) were measured.The average EX was 14.5 ±â€Š2.35  mm. The average θ was 33.84 ±â€Š2.15 degrees. The vector force needed to lift the upper eyelids (cos θ) was 0.83. The average LL was 21.0 ±â€Š1.54  mm. The average WT was 1.07 ±â€Š0.22  mm. The average LT was 1.69 ±â€Š0.30  mm. There was a significant positive relationship between the EX and age (P = 0.022). The EX in those younger than 20 years (12.8 ±â€Š2.06) was significantly lesser than that of the other age groups. There was no significant relationship between the EX and cos θ. However, there was a significant positive relationship between the EX and the LL. There was a significant positive relationship between LL and LT, and between LL and WT.The farther the eyeball protrudes, the longer the LL is needed. The longer the LL is, the thicker the levator muscle and STL.

Eyes of beautiful women and femme fatales depicted in Western portraits.

This study aimed to compare the eyes of beautiful women and femme fatales depicted in Western portraits. A total of 37 samples were collected; 19 beautiful women and 18 femme fatales. Nine aspects were measured in reference to the corneal horizontal diameter. The estimated corneal vertical diameter was calculated by a corneal horizontal diameter multiply constant, 1.11.The double-fold was observed in 89% (17 of 19) of the beautiful women and 83% (15 of 18) of the femme fatales. The eye-width ratio was 2.42 (SD, 0.28) in the beautiful women and 2.31 (SD, 0.34) in the femme fatales. The eye-height ratio was 0.91 (SD, 0.18) in the beautiful women and 0.84 (SD, 0.10) in the femme fatales. Eyebrow-to-upper lid distance was 0.92 (SD, 0.35) in the beautiful women and 0.89 (SD, 0.23) in the femme fatales. The interpupillary distance was 5.00 (SD, 0.46) in the beautiful women and 5.00 (SD, 0.71) in the femme fatales. The intercanthal distance was 2.72 (SD, 0.42) in the beautiful women and 2.78 (SD, 0.73) in the femme fatales The outer canthal distance was 7.32 (SD, 0.64) in the beautiful women and 7.20 (SD, 1.01) in the femme fatales. The ptosis amount was -0.01 (SD, 0.18) in the beautiful women and 0.06 (SD, 0.01) in the femme fatales. For the above 7 measurements, there were no significant differences between the 2 groups (P > 0.05, t test).It is noteworthy that the beautiful women and femme fatales have the same interpupillary distance (5.00). Also, the ptosis ratio was almost zero in both groups (-0.01 [SD, 0.18] in the beautiful women and 0.06 [SD, 0.01] in the femme fatales). The results of this study might be of some reference in performing eyelid surgeries especially in brow lifts or canthoplasties.

A Consideration of Breast Imagery in Art as Depicted through Western Painting.

The aim of this study is to consider breast imagery in art as depicted through western painting. Twenty western art paintings were collated. Most of the sample paintings were created from the mid-nineteenth century to the late twentieth century and some are from the Renaissance period. Ten anthropometric items were used to measure 15 distances between two landmarks and 3 angles between three points. The distance from the nipple to the sternal notch and to the midclavicular point was the same and they were 0.46 of the distance from the sternal notch to the umbilicus. The shape of the projection of the breast was almost an isosceles triangle and the altitude of the triangle was at a proportion of 0.45 of the bottom length and 0.16 of the distance from the sternal notch to the umbilicus. The distance between the lateral ends of the breasts was 2.14 times the facial width and the distance between nipples was 1.36 times the facial width. Proportions from works of art are more ideal and attractive than clinically measured proportions. The desirable ratios measured from historical paintings might be useful in planning breast surgeries.

Frequency of existence, numbers, and location of the accessory infraorbital foramen.

The aim of this study is to analyze the frequency of existence, numbers, and location of the accessory infraorbital foramen (AIOF).In a PubMed search, 166 articles resulted using the term infraorbital foramen (IOF). The abstracts were read, and 15 full-text articles were reviewed. Among them, 13 articles were analyzed.The frequency of the skull containing the AIOF varied (0.8%-27.3%). The overall frequency of the skull having AIOF was 16.9% ± 8.6% (17.0% ± 9.4% in dry skulls and 15.8% ± 3.6% in cadavers). Most (92.2%) of the AIOF were located on the superomedial side of the IOF, whereas 5 (7.8%) were located inferomedially. The AIOFs were found in similar frequency according to the laterality (right, 42.7%; left, 45%; bilateral, 12%; P = 0.794 [binominal test]). The frequency of the AIOF varied according to latitude. Skulls collected greater than 60 degrees had a higher frequency of an AIOF (28.7%) than between 30 and 60 degrees (19.0%) or less than 30 degrees (18.2%) (P = 0.000 [Pearson Chi-squared test], P = 0.000 [trend test]). There was a positive correlation between latitude and frequency of AIOF (y = 0.062x + 18.02, Pearson correlation coefficient = 0.140, P = 0.000).During anesthetization of the infraorbital area or in surgical maneuvering in the maxillofacial region, surgeons should remember the frequency of the AIOF (16.9% ± 8.6%) and its location (92.2% at the superomedial side of the IOF).

Medical doctors as the captain of a ship: an analysis of medical students' book reports on Joseph Conrad's "Lord Jim".

PURPOSE: In South Korean ferry disaster in 2014, the captain abandoned the ship with passengers including high school students still aboard. We noticed the resemblance of abandoning the ship with passengers still aboard the ferry (named the Sewol) and the ship Patna, which was full of pilgrims, in Joseph Conrad's novel "Lord Jim." The aim of this study is to see how medical students think about the role of a medical doctor as a captain of a ship by analyzing book reports on Conrad's "Lord Jim." METHODS: Participants included 49 third-year medical students. Their book reports were analyzed. RESULTS: If placed in the same situation as the character of Jim, 24 students of the 49 respondents answered that they would stay with the passengers, while 18 students indicated they would escape from the ship with the crew. Most of the students thought the role of a doctor in the medical field was like that of a 'captain.' The medical students reported that they wanted to be a doctor who is responsible for his or her patients, highly moral, warm-hearted, honest, and with high self-esteem. CONCLUSION: In conclusion, we found that "Lord Jim" induced the virtue of 'responsibility' from the medical students. Consequently, "Lord Jim" could be good teaching material for medical humanities.

Anthropometric comparison of the idealized youth and hideous old man of Leonardo's profile drawings.

The aim of this study is to compare the old and ugly with the young and beautiful in Leonardo's profile drawings using soft tissue anthropometry.Thirty-one of Leonardo's profile drawings and portraits of the lateral view were collected and scanned. Among the 29, 9 young and 20 hideous old man scans had a measurable nasion-subnasale (n-sn) distance, and 49 anthropometric items (43 distances and 6 angles) were used for measurement as relative distances to the n-sn distance.The measured distances or angles did not differ significantly between the young and old in the 39 anthropometric items. However, the remaining 10 items were statistically significant. The young group had a significantly greater (P < 0.05) upper face height (n-stomion [sto]), nasolabial angle, and upper lip height (sn-sto) compared with the old group. However, the supraorbital depth (glabella-tragion), mandible height (sto-gnathion), nasal bridge height (n-pronasale), cutaneous lower lip height (labiale inferius-sublabiale), ear length (superaurale-subaurale), Rickett line-upper lip distance, and facial inclination were significantly greater (P < 0.05) in the old group compared with the young group.The difference of soft tissue cephalometric results between the young and old subjects can be the index in rejuvenating surgeries.

Manikin model with breathing tube for wire-guided percutaneous cricothyrotomy in patients applying an intermaxillary fixation.

Jaw fracture surgery or orthognathic surgery usually involves the application of an intermaxillary fixation (IMF). Obstructions that cannot be relieved by suction require an immediate release of IMF wires, but releasing the IMF may damage the surgical alignment of the facial bones. The mean time taken to release the jaws was an average of 2 minutes 9 seconds by hospital staff involved in caring for these patients. The aims of this study were to introduce a training model for wire-guided percutaneous cricothyrotomy in the patients applying an IMF and to perform the procedure for medical students. Our model consisted of a facial mannequin, a plastic breathing tube, 2 rolls of tapes, and a reservoir bag. The inner parts of the 2 used rolls of tape represent tracheal/cricoid rings (1-inch width for thyroid and half-inch width for cricoid), and the space between them represents the cricothyroid membrane, which is wrapped with Peha-Haft. A surgeon demonstrated the technique on the model, and then, 60 medical students who had never attended airway-training courses applied the Melker cricothyrotomy kit on the model. All 60 students completed the procedure successfully. The mean (SD) time needed to insert a cricothyrotomy catheter of the medical students was 175 (50) seconds (range, 76-297 s). Most of the students (54; 90%) performed it within 4 minutes; more than half (33; 55%), within 3 minutes. With our manikin model and Melker cricothyrotomy kit, 60 medical students completed the procedure successfully. This model can be useful to cricothyrotomy training for medical personnel.

Brow archetype preferred by Korean women.

The aim of this study is to see which brow archetype is preferred by Korean women. The archetypes were chosen from a literature search, which contain detailed, replicable methods and have diagrams (Westmore, Lamas, Anastasia, Schreiber, and Hwang). A survey was conducted on 300 subjects (group A, 100 female medical students; group B, 100 women who had visited a plastic surgery clinic for periorbital rejuvenation; and group C, 100 women who visited the brow bar). They were asked whether they think there might be a method that yields an ideal brow archetype. In the cases where they said yes, they were asked to choose 1 of the illustrated 5 brow archetypes that they think is ideal. Among the 300 respondents, 232 (77.3%) thought there might be a method to yield an ideal brow archetype, whereas 68 (22.7%) answered they did not. The preference for the brow archetypes was different among the 5 archetypes (P = 0.0001, χ2). Anastasia was the most preferred (44.8%, brow starts on a perpendicular line drawn from the middle of the nostril, arches on a line drawn from the center of the nose through the center of the pupil, and ends on a line drawn from the edge of the corresponding nasal ala through the outer edge of the eye). Anastasia was followed by Lamas (22.0%). In group A, Anastasia (55.7%) was the most preferred, followed by Lamas (26.2%) and Westmore (13.1%). In group B, Anastasia (34.8%) was the most preferred, followed by Lamas (30.3%) and Westmore and Schreiber (both 13.5%). In group C, Anastasia (47.6%) was the most preferred, followed by Hwang (25.5%) and Westmore (11.0%). There was a significant difference (P < 0.001) among the 3 groups. There was a significant correlation between the preference of brow archetype and occupation (P = 0.0033). However, no significant differences were noted for the preference of brow archetype between the age groups of younger than 30 years and older than 30 years (P = 0.1374), level of education (P = 0.3403), marital status (P = 0.541), or monthly income (P = 0.1696, χ2). The result of this study might be useful in facial rejuvenation surgeries as well as in brow esthetics or tattooing of eyebrows.