Novel approach of ultrasound-guided lateral recess block for a patient with lateral recess stenosis: A case report

BACKGROUND Ultrasound guide technology,which can provide real-time visualization of the needle tip and tissues and avoid many adverse events,is widely used in mini-mally invasive therapy.However,the studies on ultrasound-guided Lateral recess block(LRB)are limited,this is probably because there is no recognized standard method for ultrasound scanning.This study aimed to evaluate the effect of ultrasound-guided LRB in patients with lateral recess stenosis(LRS).CASE SUMMARY A 65-year-old patient complained of low back pain accompanied occasionally by pain and numbness in the left lower limb.Physical examination showed ten-derness on the spinous process and paraspinal muscles from L1 to S1,extensor hallucis longus and tibialis anterior weakness(muscle strength:4-),and a positive straight leg raising test in the left lower limb(60°).Magnetic resonance imaging showed L4–L5 disc degeneration with left LRS and nerve root entrapment.Subsequently,the patient was diagnosed with LRS.This patient was treated with a novel ultrasound-guided LRB approach.The patient’s symptoms significantly improved without any complications at 1 wk postoperatively and at the 3-month follow-up.CONCLUSION This is the first report on the LRS treatment with ultrasound-guided LRB from the contralateral spinous process along the inner side of the articular process by out-plane technique.Further studies are expected to investigate the efficacy and safety of ultrasound-guided LRB for patients with LRS.

Comprehensive analysis of glacier recession(2000-2020)in the Nun-Kun Group of Glaciers,Northwestern Himalaya

Himalayan glaciers are shrinking rapidly,especially after 2000.Glacier shrinkage,however,shows a differential pattern in space and time,emphasizing the need to monitor and assess glacier changes at a larger scale.In this study,changes of 48 glaciers situated around the twin peaks of the Nun and Kun mountains in the northwestern Himalaya,hereafter referred to as Nun-Kun Group of Glaciers(NKGG),were investigated using Landsat satellite data during 2000-2020.Changes in glacier area,snout position,Equilibrium Line Altitude(ELA),surface thickness and glacier velocity were assessed using remote sensing data supplemented by field observations.The study revealed that the NKGG glaciers have experienced a recession of 4.5%±3.4%and their snouts have retreated at the rate of 6.4±1.6 m·a^(-1).Additionally,there was a 41%increase observed in the debris cover area during the observation period.Using the geodetic approach,an average glacier elevation change of-1.4±0.4 m·a^(-1)was observed between 2000 and 2012.The observed mass loss of the NKGG has resulted in the deceleration of glacier velocity from 27.0±3.7 m·a^(-1)in 2000 to 21.2±2.2 m·a^(-1)in 2020.The ELA has shifted upwards by 83.0±22 m during the period.Glacier morphological and topographic factors showed a strong influence on glacier recession.Furthermore,a higher recession of 12.9%±3.2%was observed in small glaciers,compared to 2.7%±3.1%in larger glaciers.The debris-covered glaciers showed lower shrinkage(2.8%±1.1%)compared to the clean glaciers(9.3%±5%).The glacier depletion recorded in the NKGG during the last two decades,if continued,would severely diminish glacial volume and capacity to store water,thus jeopardizing the sustainability of water resources in the basin.

Detection of Novel BEST1 Variations in Autosomal Recessive Bestrophinopathy Using Third-generation Sequencing

Objective:Autosomal recessive bestrophinopathy(ARB),a retinal degenerative disease,is characterized by central visual loss,yellowish multifocal diffuse subretinal deposits,and a dramatic decrease in the light peak on electrooculogram.The potential pathogenic mechanism involves mutations in the BEST1 gene,which encodes Ca2+-activated Cl−channels in the retinal pigment epithelium(RPE),resulting in degeneration of RPE and photoreceptor.In this study,the complete clinical characteristics of two Chinese ARB families were summarized.Methods:Pacific Biosciences(PacBio)single-molecule real-time(SMRT)sequencing was performed on the probands to screen for disease-causing gene mutations,and Sanger sequencing was applied to validate variants in the patients and their family members.Results:Two novel mutations,c.202T>C(chr11:61722628,p.Y68H)and c.867+97G>A,in the BEST1 gene were identified in the two Chinese ARB families.The novel missense mutation BEST1 c.202T>C(p.Y68H)resulted in the substitution of tyrosine with histidine in the N-terminal region of transmembrane domain 2 of bestrophin-1.Another novel variant,BEST1 c.867+97G>A(chr11:61725867),located in intron 7,might be considered a regulatory variant that changes allele-specific binding affinity based on motifs of important transcriptional regulators.Conclusion:Our findings represent the first use of third-generation sequencing(TGS)to identify novel BEST1 mutations in patients with ARB,indicating that TGS can be a more accurate and efficient tool for identifying mutations in specific genes.The novel variants identified further broaden the mutation spectrum of BEST1 in the Chinese population.

New recessive compound heterozygous variants of RP1L1 in RP1L1 maculopathy

AIM:To identify a maculopathy patient caused by new recessive compound heterozygous variants in RP1L1.METHODS:Comprehensive retinal morphological and functional examinations were evaluated for the patient with RP1L1 maculopathy.Targeted sequence capture array technique was used to screen potential pathologic variants.Polymerase chain reaction and Sanger sequencing were used to confirm the screening results.RESULTS:Fundus examination showed round macular lesions appeared in both eyes.Optical coherence tomography showed that the inner segment/outer segment continuity was disorganized and disruptive in the left eye,but it was uneven and slightly elevated in the right eye.Fundus autofluorescence showed patchy hyper-autofluorescence in the macula.Visual field examination indicates central defects in both eyes.Electroretinogram(ERG)and multifocal ERG showed no obvious abnormalities.Fundus fluorescein angiography in the macula showed obviously irregular hyper-fluorescence in the right eye and slightly hyper-fluorescence in the left eye.We found that the proband carried a missense variant(c.1972C>T)and a deletion variant(c.4717_4718del)of RP1L1,which were originated from the parents and formed compound heterozygous variants.Both variants are likely pathogenic according to the ACMG criteria.Multimodal imaging,ERG and detailed medical history are important diagnostic tools for differentiating between acquired and inherited retinal disorders.CONCLUSION:A maculopathy case with detailed retinal phenotype and new recessive compound heterozygous variants of RP1L1 is identified in a Chinese family,which expands the understanding of phenotype and genotype in RP1L1 maculopathy.

Square Logistic Model for the Appearance of Lethal Recessive Homozygous Genotype in Random Mating Population

From the random mating population of maize, the relationship between heterosis and albino seedling was analyzed by means of mathematical theory, further the square logistic model for the appearance of lethal recessive homozygous genotype was deduced. The model shows that heterosis can determine the genetic structure and proportion of population. It approves, that the proportion of aa in each generation of maize seedlings shows a similar Logistic curve in growth process till equilibrium, so long as Aa containins lethal gene a from mutation presents heterosis. The ratio of equilibrium state of aa is determined by the ratio of AA-Aa fitness. Heterosis is helpful for the keeping of genetic diversity of population.

Comparison of conventional and Hang-back methods of inferior oblique recession in V-pattern strabismus with inferior oblique overaction

AIM:To compare outcomes of conventional and Hangback methods of inferior oblique(IO)recession in V-pattern strabismus with inferior oblique overaction(IOOA).METHODS:Comparative randomized study was conducted consisting of 50 patients,age 6 to 35 y having V-pattern strabismus[>15 prism diopter(PD)]with IOOA.They were divided equally in two groups and underwent IO recession,group A by conventional method and group B by Hang-back method.Parameters evaluated were reduction in V-pattern and IOOA,shift in torsion,improvement in binocular status.Success was a residual V-pattern of less than 10 PD at 1 y of follow up.RESULTS:The mean V-pattern preoperatively and postoperatively at 1 y was 24±5.4 PD and 4.2±3.51 PD in group A and 23.44±6.44 PD and 5.76±3.8 PD in group B respectively.The mean reduction in V-pattern was 20±6.78 PD in group A and 18.2±5.48 PD in group B.The mean correction of IOOA was 18.48±3.13 PD in group A and 16±2.93 PD in group B.Mean shift in extorsion was 3.08±1.8 degree in group A and 3.72±2.14 degree in group B.CONCLUSION:Both the procedures achieve a significant and comparable reduction in V-pattern and IOOA.Hang-back recession being a landmark free surgery eliminates the need for intrascleral suturing thereby reducing the risk of scleral perforation with possible postoperative adjustment of muscle.It may be considered as a good alternative for IO recession in patients of V-pattern strabismus with mild to moderate amount of IOOA.

Drug Sensitive Test on Main Pathogenic Bacteria of Cow Recessiveness Mastitis Using Traditional Chinese Medicine Preparation “Zengrujianniusan”

According to the theory of Chinese veterinary medicine and characteristics of Chinese herbal medicine, four different preparations of compound Chinese medicine ＂Zengrujianniusan＂ were composed, and the prepared water decoction was used to carry on the bacteriostatic test on main pathogens of cow recessiveness mastitis. The results showed that the four different prescriptions of water decoction all had antibacterial effects. The prescription 3 was sensitive to Staphylococcus aureus and Streptococcus agalactiae, while the other three prescriptions showed high sensitivity, and the prescription 3 had the strongest bacteriostatic effects.

A Two-parameter Exponential Recession Model for Simulating Cropland Soil Moisture Dynamics

To simulate the soil moisture variation in cropland, a two-parameter exponential recession model was derived to depict the recession process of soil moisture in the root zone. The model is based on the assumption that the recession rate of soil water is proportional to the potential evapotranspiration rate and the difference of soil water content and steady soil water content. Two parameters in this model are soil texture-dependent recession constant and steady soil water content. The model was calibrated and validated with measured soil water data at two experiment sites in North China with different soil textures and cropping systems. Coefficients of determination between measured and model simulated soil water content were all greater than 0.7, indicating that both models gave satisfactory simulation results. Results showed that values of two parameters mentioned above are both larger for finer soil than those for coarser soil. At the same potential evapotranspiration rate and soil water content, the recession rate of finer soil is usually lower than that of coarser soil. The proposed model can be used in irrigation management to predict approximate date for irrigation, as well as be embedded into watershed hydrological models to estimate the antecedent precipitation index.

Comparison of bilateral/unilateral lateral rectus recession and unilateral recession-resection for intermittent exotropia:a Meta-analysis

AIM: To compare the effectiveness of unilateral recession-resection(R&R) and bilateral/unilateral recession(BLR/ULR) for treatment of basic type of intermittent exotropia [IX(T)].METHODS: A comprehensive literature search was performed using PubMed, EMBASE, and the Cochrane Library, to identify randomized controlled trials and comparative studies regarding the effectiveness of R&R and BLR/ULR for IX(T). Based on which, a Meta-analysis was then performed in terms of long-term success rate, overcorrection rate, and recurrence rate.RESULTS: Nine studies in total satisfy the specified eligibility criteria. BLR is at disadvantage to R&R at a short-term follow-up [<2 y, OR 0.56(0.33-0.94) for success rate; OR 2.11(1.17, 3.81) for undercorrection rate]. However, BLR achieved a higher success rate [OR 2.49(1.61, 3.86)] and a lower undercorrection rate [OR 0.40(0.23, 0.71)], compared to that of R&R at a long-term followup(>2 y). There is no significant difference was found in overcorrection rate, regardless of the length of follow-up time [OR 0.85(0.41, 1.75)]. In the treatment for small-angle IX(T), the final outcome was significantly different between the groups, demonstrating a more successful alignment [OR 0.37(0.18, 0.74)] and a lower undercorrection [OR 3.50(1.28, 7.26)] in the R&R group than in the ULR group. While for moderate-angle IX(T)(20 PD-25 PD), the effectiveness of R&R and ULR is quite equivalent with similar success rate [OR 1.08(0.65, 1.79)] and undercorrection rate [OR 0.89(0.54, 1.48)]. CONCLUSION: As regard to the effect of BLR and R&R, R&R shows an advantage over BLR at short term. But, BLR is more effective in the long term for the basic typeIX(T) in children. R&R surgery should be a better choice for the treatment of small-angle IX(T) of ≤20 PD than ULR. However, both of ULR and R&R are recommended for moderate-angle IX(T) from 20 PD to 25 PD.

Anterior lamellar recession for management of upper eyelid cicatricial entropion and associated eyelid abnormalities

AIM：To evaluate the functional and aesthetic outcomes of upper eyelid cicatricial entropion（UCE） correction using anterior lamellar recession（ALR） with addressing the associated conditions including dermatochalasis,brow ptosis,blepharoptosis,and lid retraction.METHODS：Chart review of patients with upper lid cicatricial entropion who had undergone ALR from 2013 to 2016 was reviewed.Success was defi ned as the lack of any lash in contact with the globe,no need for a second procedure,and acceptable cosmesis at the fi nal follow up.RESULTS：Sixty eight patients（97 eyelids） were operated by ALR with simultaneous correction of associated lid problems in each case when necessary.The mean followup time was 17.8 mo（range,6.0-24.0 mo）.Concomitantly,levator tucking was performed in 19 eyelids（19.6%）,upper lid retractor recession in 18 eyelids（18.6%）,and internal browpexy in 31 eyelids（32.0%）.In 95.8% of patients（95%CI：0.85-0.96）,satisfactory functional and cosmetic outcome was achieved with a single surgical procedure.CONCLUSION：Based on the principles of lamellar recession and concurrently addressing the associated lid problems,this approach is an effective and safe treatment of UCE.

Estimation of groundwater residence time and recession rate in watershed of the Loess Plateau

Groundwater residence time is an important indicator of hydrological cycle and essential for water resources development and utilization. In this paper, groundwater residence time in non-flood season, flood season and water year has been determined from daily streamflow hydrograph of ten hydrological stations in Wudinghe River Basin located in the middle reaches of the Yellow River Basin. Results have showed that： baseflow recession constant in Wudinghe River Basin ranges from 0.72 to 0.94 with a larger recession rate in flood season than that in non-flood season. Spatially, the recession rate of baseflow in loess area is the biggest, but is the smallest in the sandy area. The half-residence time of groundwater varies from 1.8 to 45.5 days while overall residence time of groundwater is between 34 and 342 days in different sub-basins of the Wudinghe River Basin. The annual average overall residence time of groundwater decreases from 117 days in the upper reaches to 73 days in the lower reaches.

Novel en-bloc resection of locally advanced hilar cholangiocarcinoma: the Rex recess approach

Loco-regional recurrence after potentially curative resection remains a problem in hilar cholangiocarcinoma. Hilar dissection risks local spillage of tumor cells leading to suboptimal disease free survival. We have developed a new technique of radical resection for hilar cholangiocarcinoma based on the distinctive anatomy of the Rex recess of the liver, which has been assessed in two patients with locally advanced hilar cholangiocarcinoma. This technique included a right hepatectomy with en-bloc resection of the hepatoduodenal ligament and portal venous reconstruction to the left portal vein at the Rex recess. Both patients had R0 resection and have been disease-free for 26 and 38 months, respectively.

Correlation of lumbar lateral recess stenosis in magnetic resonance imaging and clinical symptoms

AIM To assess the correlation of lateral recess stenosis(LRS) of lumbar segments L4/5 and L5/S1 and the Oswestry Disability Index(ODI).METHODS Nine hundred and twenty-seven patients with history of low back pain were included in this uncontrolled study.On magnetic resonance images(MRI) the lateral recesses(LR) at lumbar levels L4/5 and L5/S1 were evaluated and each nerve root was classified into a 4-point grading scale(Grade 0-3) as normal,not deviated,deviated or compressed.Patient symptoms and disability were assessed using ODI.The Spearman's rank correlation coefficient was used for statistical analysis(P < 0.05).RESULTS Approximately half of the LR revealed stenosis(grade 1-3;52% at level L4/5 and 42% at level L5/S1) with 2.2% and 1.9% respectively reveal a nerve root compression.The ODI score ranged from 0%-91.11% with an arithmetic mean of 34.06% ± 16.89%.We observed a very weak statistically significant positive correlation between ODI and LRS at lumbar levels L4/5 and L5/S1,each bilaterally(L4/5 left:rho < 0.105,P < 0.01;L4/5 right:rho < 0.111,P < 0.01;L5/S1 left:rho 0.128,P < 0.01;L5/S1 right:rho < 0.157,P < 0.001).CONCLUSION Although MRI is the standard imaging tool for diagnosing lumbar spinal stenosis,this study showed only a weak correlation of LRS on MRI and clinical findings.This can be attributed to a number of reasons outlined in this study,underlining that imaging findings alone are not sufficient to establish a reliable diagnosis for patients with LRS.

Systematic review of suicide in economic recession

AIM: To provide a systematic update of the evidence concerning the relationship between economic recession and suicide.METHODS: A keyword search of Ovid Medline, Embase, Embase Classic, PsycI NFO and PsycA RTICLES was performed to identify studies that had investigated the association between economic recession and suicide. RESULTS: Thirty-eight studies met predetermined selection criteria and 31 of them found a positive association between economic recession and increased suicide rates. Two studies reported a negative association, two articles failed to find such an association, and three studies were inconclusive. CONCLUSION: Economic recession periods appear to increase overall suicide rates, although further research is warranted in this area, particularly in low income countries.

Experimental study on energy characteristics and ignition performance of recessed multichannel plasma igniter

In the extreme conditions of high altitude,low temperature,low pressure,and high speed,the aircraft engine is prone to flameout and difficult to start secondary ignition,which makes reliable ignition of combustion chamber at high altitude become a worldwide problem.To solve this problem,a kind of multichannel plasma igniter with round cavity is proposed in this paper,the three-channel and five-channel igniters are compared with the traditional ones.The discharge energy of the three igniters was compared based on the electric energy test and the thermal energy test,and ignition experiments was conducted in the simulated high-altitude environment of the component combustion chamber.The results show that the recessed multichannel plasma igniter has higher discharge energy than the conventional spark igniter,which can increase the conversion efficiency of electric energy from 26%to 43%,and the conversion efficiency of thermal energy from 25%to 73%.The recessed multichannel plasma igniter can achieve greater spark penetration depth and excitation area,which both increase with the increase of height.At the same height,the inlet flow helps to increase the penetration depth of the spark.The recessed multichannel plasma igniter can widen the lean ignition boundary,and the maximum enrichment percentage of lean ignition boundary can reach 31%.

The impact of earlier flood recession on metacommunity diversity of wintering waterbirds at shallow lakes in the middle and lower Yangtze River floodplain

The hydrological regime in wetlands plays an important role in the process of wintering waterbird metacommunity assemblage.However,increasing frequency of extreme climate and the intensification of human activities,such as the construction of sluices and dams,have resulted in frequently abnormal hydrological regime in the middle and lower Yangtze River floodplain.In recent years,earlier flood recession has become one of the main hydrological problems faced in the shallow lakes,having a great impact on wetland biodiversity.It is necessary to understand the impact of earlier flood recession on waterbirds,an indicator of wetland biodiversity,and the metacommunity concept is helpful to elucidate the underlying mechanism involved in the processes of assemblage by waterbird communities.In this study,we surveyed the wintering waterbirds at three sub-lakes of Caizi Lakes during 2019-2020 and 2020-2021 and compared the richness,abundance,alpha and beta diversity of waterbirds in and among local metacommunities under earlier flood recession and normal hydrological regime.The results showed that the earlier flood recession reduced the species richness in the early stage and abundance in the late stage,it also reduced the Shannon-Wiener index in the early stage and increased the dissimilarity between and within waterbird metacommunities in the late stage.The partition of beta diversity showed that the turnover component played a major role in the process of waterbird metacommunity assemblage.It was found that the earlier flood recession reduced the richness,abundance in different stages of flood recession,which also increased the turnover of waterbirds.Metacommunities with high habitat heterogeneity had better resistance to abnormal hydrological regime,which resulted in high dissimilarity between and within metacommunities.The results of this study provide important information for waterbird conservation and water level management at shallow lakes in the middle and lower Yangtze River floodplain.

Relation between early postoperative deviation and long-term outcome after unilateral lateral rectus recession and medial rectus resection for adult exotropia

AIM： To evaluate the relationship between early postoperative deviation and long-term outcome after unilateral recession and resection surgery for adult exotropia, and to evaluate exotropic shift after surgery.METHODS： This was a retroprospective study involving adult patients with exotropia who underwent unilateral recession and resection surgery and were followed up for at least 2 y. The results were evaluated at 2 y and the final visit. Factors influencing a successful outcome were analyzed. Early postoperative deviation at 1 wk was used to evaluate relationship with long-term outcome. The longterm outcome was classified into 3 groups： successful, acceptable, and poor. Successful outcome was defined as a distance deviation between esodeviation 8 prism diopters（PD） and exodeviation 10 PD.RESULTS： Forty-two patients were enrolled. The mean age at surgery was 26 y（range, 15-49 y）. The median follow-up period was 30 mo（range, 24-108 mo）. Successful outcome was found in 81% of patients at 2 y and in 71% at the final visit. Overcorrection at 1 wk postoperatively was associated with a successful outcome at 2 y. Initial postoperative alignment between orthotropia and esodeviation of 8 PD had the highest chance of a successful outcome（RR=2.2）. The mean postoperative exotropic drift was 4.7 PD at the first month and 9.3 PD at 2 y.CONCLUSION： Initial postoperative deviation can predict long-term outcome after unilateral recession and resection surgery for adult exotropia. The most desirable outcome at 1 wk post-operatively was orthotropia to small esodeviation. Most patients have exotropic drift at a subsequent follow-up, especially in the first month after surgery.

Impact of symmetric gate-recess length on the DC and RF characteristics of InP HEMTs

We fabricated a set of symmetric gate-recess devices with gate length of 70 nm.We kept the source-to-drain spacing(L_(SD))unchanged,and obtained a group of devices with gate-recess length(L_(recess))from 0.4µm to 0.8µm through process improvement.In order to suppress the influence of the kink effect,we have done SiN_(X) passivation treatment.The maximum saturation current density(ID_(max))and maximum transconductance(g_(m,max))increase as L_(recess) decreases to 0.4µm.At this time,the device shows ID_(max)=749.6 mA/mm at V_(GS)=0.2 V,V_(DS)=1.5 V,and g_(m,max)=1111 mS/mm at V_(GS)=−0.35 V,V_(DS)=1.5 V.Meanwhile,as L_(recess) increases,it causes parasitic capacitance C_(gd) and g_(d) to decrease,making f_(max) drastically increases.When L_(recess)=0.8µm,the device shows f_(T)=188 GHz and f_(max)=1112 GHz.

Lateral rectus muscle recession and the vertical palpebral fissure height: to do or not to do inter-muscular septum dissection?

In this study, we aimed to evaluate changes of vertical palpebral fissure height （VPFH） after unilateral lateral rectus muscle recession. Twenty-five and twenty-six patients who were candidates for lateral rectus muscle recession were assigned into “with” and “without” intermuscular septum dissection study arms. The VPFH was measured at one-day before surgery and in two weeks and three months, postoperatively. Three months after surgery, significant increase of VPFH was observed in both groups （Paired t-test; P=0.005）. Also, less widening of VPFH was observed in “with intermuscular septum dissection” group （Change in VPFH in “with intermuscular septum dissection” vs “without intermuscular septum dissection” groups： 0.48 mm vs 1.34 mm; ANCOVA test; P〈0.001）. However, such results were not observed two weeks post-operatively （Change in VPFH in “with intermuscular septum dissection” vs “without intermuscular septum dissection” groups： -0.28 mm vs 0.28 mm; ANCOVA test; P=0.302）. Intermuscular septum dissection is recommended in lateral rectus muscle recession to partially prevent the undesirable increment of VPFH.

Gingival unit transfer using in the Miller Ⅲ recession defect treatment

The most significant factor for the success in soft tissue grafts is the synergistic relation between vascular configuration and involved tissues. In the soft tissue graft procedures, site specific donor tissue is assumed to have improved potential for function and aesthetic survive at recipient sites. On a clinical level, using site specific gingival unit graft that placed on traditionally prepared recipient site, results in predictable root coverage. In this case report the clinical effectiveness of gingival unit transfer(GUT) technique performed on Miller Ⅲ recession was presented and a similar recession case treated with free gingival graft(FGG) technique for comparison. Probing depth, recession depth, keratinized tissue width and clinical attachment level clinical parameters were measured at baseline and postoperative 8 mo. Percentage of defect coverage was evaluated at postoperative 8 mo. Creeping attachment was assessed at postoperative 1, 3, 6 and 8 mo. The GUT revealed better defect coverage and creeping attachment results than the FGG in the treatment of Miller Ⅲ defects.