Simple bone cysts of the proximal humerus presented with limb length discrepancy:A case report

BACKGROUND Simple bone cysts(SBC)are benign tumor-like bone lesions typically identified in children.While SBC may lead to growth disturbances or growth arrest,such cases are uncommon.The mechanisms behind these observations remain unclear.Additionally,research on the etiology of SBC remains inconclusive,and there has been no consensus on the appropriate timing and methodology for treatment.CASE SUMMARY Here,we present our experience in the successful surgical management of a 10-year-old girl with SBC,who presented with a pathological fracture complicated by malunion of the displaced fracture,varus deformity,and limb length discrepancy.We hypothesized two possible etiologies for the patient’s growth arrest and subsequent humerus varus deformity:(1)Direct disruption of the physis by fluid from the cyst itself;and(2)damage to the epiphysis due to repetitive pathological fractures associated with SBC.In addressing this case,surgical intervention was undertaken to correct the proximal humerus varus deformity.This approach offered the advantages of simultaneously correcting angular abnormalities,achieving mild limb lengthening,providing definitive SBC treatment,and reducing the overall treatment duration.CONCLUSION As per current literature,acute correction of acute angular deformity in proximal humeral SBC is not well comprehended.However,in this specific case,acute correction was considered an optimal solution.

Tumor size discrepancy between endoscopic and pathological evaluations in colorectal endoscopic submucosal dissection

BACKGROUND Tumor size impacts the technical difficulty and histological curability of colorectal endoscopic submucosal dissection(ESD);however,the preoperative evaluation of tumor size is often different from histological assessment.Analyzing influential factors on failure to obtain an accurate tumor size evaluation could help prepare optimal conditions for safer and more reliable ESD.METHODS This was a retrospective study conducted at a single institution.A total of 377 lesions removed by colorectal ESD at our hospital between April 2018 and March 2022 were collected.We first assessed the difference in size with an absolute per-centage of the scaling discrepancy.Subsequently,we compared the clinicopatho-logical characteristics of the correct scaling group(>-33%and<33%)with that of the incorrect scaling group(<-33%or>33%),which was further subdivided into the underscaling group(-33%or less of the discrepancy)and overscaling group(33%or more of the discrepancy),respectively.As secondary outcome measures,parameters on size estimation were compared between the underscaling and correct scaling groups,as well as between the overscaling and correct scaling groups.Finally,multivariate analysis was performed in terms of the following relevant parameters on size estimation:Pathological size,location,and possible influential factors(P<0.1)in the univariate analysis.RESULTS The mean of absolute percentage in the scaling discordance was 21%,and 91 lesions were considered to be incorrectly estimated in size.The incorrect scaling was significantly remarkable in larger lesions(40 mm vs 28 mm;P<0.001)and less experience(P<0.001),and these two factors were influential on the underscaling(75 lesions;P<0.001).Conversely,compared with the correct scaling group,16 lesions in the overscaling group were significantly small(20 mm vs 28 mm;P<0.001),and the small lesion size was influential on the overscaling(P=0.002).CONCLUSION Lesions indicated for colorectal ESD tended to be underestimated in large tumors,but overestimated in small ones.This discrepancy appears worth understanding for optimal procedural preparation.

A two-stage but time-saving reconstructive scheme to treat severe lower limb length discrepancy:Two case reports

Limb length discrepancy(LLD)is a common orthopedic condition that can result in significant functional impairment,pain,and cosmetic deformities.Current reconstructive techniques for severe LLD are primarily based on callus distraction,which is a time-consuming process that can lead to complications,such as significant infection,joint stiffness,and stress fractures.To reduce the therapeutic time and minimize the risk of complications,we investigated the use of vascularized bone flaps as a technical supplement to callus distraction in the reconstruction of short limbs.We present two cases of severe LLD in the upper and lower legs,in which a twostage reconstruction approach was used.In the first stage,external fixation was applied to the affected limb to correct the soft tissue length and convert the short deformity into a bone defect.In the second stage,the bone defect was reconstructed using bilateral(patient A)or unilateral(patient B)free vascularized fibula bone grafts.Both patients had complete survival of the fibular grafts without stress fractures,and bone consolidation took 8 months(patient A)and 4 months(patient B).Compared to the traditional callus distraction,the two-stage approach was found to be more time-saving and reliable.The entire reconstructive scheme required 18 and 4 months for patients A and B,respectively,whereas the traditional callus distraction required 41 and 17 months,respectively.These findings suggest that the use of vascularized bone flaps as a technical supplement for callus distraction may provide an effective and efficient alternative for the treatment of severe LLD.Further studies are needed to validate these results and assess the long-term outcomes of this approach.

Site discrepancy of synonymous codon usage in SARS coronavirus and other viruses in Coronaviridae

The synonymous codon usage in the translational initiation and termination regions of genes of severe acute respiratory syndrome (SARS) coronavirus and five other viruses in Coronaviridae was systematically analyzed.The results indicate that most minor codons for these coronaviruses are preferentially used in the initial and terminal region.The minor codons preferentially used in the initial region are thought to have a negative effect on gene expression,which can be explained by the minor codon modulator hypothesis.It also indicates that the minor codons preferentially used in the terminal region may regulate the level of gene expression.The proposed results strongly imply that the minor codon modulator hypothesis can be applied to both some bacteria and some viruses.

A Discrepancy between An Advocacy of Group Work and the Reality of Its Poor Implementation ELT Classrooms of Junior High Schools in China's Mainland

The paper investigates how group work was implemented in English teaching classrooms in a junior high school of China's Mainland as a case study. The research data was collected by classroom observations, a survey of the students and interviews with the classroom teachers. The research finds a mismatch between an advocacy of group work and the reality of its poor implementation. It has implications on English curriculum innovation and the advocacy of group work in ELT classrooms in China's Mainland.

NEW LOWER BOUNDS FOR LEE DISCREPANCY ON TWO AND THREE MIXED LEVELS FACTORIALS

The objective of this paper is to study the issue of uniformity on asymmetrical designs with two and three mixed levels in terms of Lee discrepancy. Based on the known formulation, we present a new lower bound of Lee discrepancy of fractional factorial designs with two and three mixed levels. Our new lower bound is sharper and more valid than other existing lower bounds in literature, which is a useful complement to the lower bound theory of discrepancies.

SOME PROPERTIES OF DOUBLE DESIGNS IN TERMS OF LEE DISCREPANCY

Doubling is a simple but powerful method of constructing two-level tractional factorial designs with high resolution. This article studies uniformity in terms of Lee discrepancy of double designs. We give some linkages between the uniformity of double design and the aberration case of the original one under different criteria. Furthermore, some analytic linkages between the generalized wordlength pattern of double design and that of the original one are firstly provided here, which extend the existing findings. The lower bound of Lee discrepancy for double designs is also given.

Does the discrepancy in histologic differentiation between a forceps biopsy and an endoscopic specimen necessitate additional surgery in early gastric cancer?

To investigate the clinicopathological variables in early gastric cancer (EGC) patients in relation to differentiation discrepancy. METHODSThe data of 265 specimens from 240 patients with EGC, who had undergone radical operation at Hallym University Sacred Heart Hospital from 2010 to 2015, were retrospectively analyzed. We evaluated clinical, endoscopic, and histopathological data according to histological discrepancy. RESULTSClinically significant discrepancy rate showed the difference in differentiated type (well and moderately differentiated) and undifferentiated type (poorly differentiated and signet ring cell) between endoscopic biopsies and postoperative specimens was 9.4% (25/265). There were no differences in tumor location, size, gross pattern, and number of biopsies. Specimens having histological discrepancy showed more submucosal invasion (72.0% vs 49.6%, P = 0.033) and lymph node involvement (24.0% vs 7.9%, P = 0.009) than specimens having non-discrepancy. The rate of a positive epidermal growth factor receptor status was higher in specimens having discrepancy than in specimens having non-discrepancy (81.0% vs 55.4%, P = 0.035). CONCLUSIONThe discordance of histologic differentiation is associated with higher submucosal invasion and lymph node metastases in EGC. Patients have histological discrepancy may require additional surgical treatments.

A Clinical Analysis of Tooth Size Discrepancy (Bolton Index) among Orthodontic Patients in Wuhan of Central China

The purpose of this study was to determine the total Bolton index （TBI） and anterior Bolton index （ABI）, evaluate the clinical significance of tooth size discrepancies and the influence of gender variation of mesiodistal tooth width on Bolton Index and estimate which tooth has the greatest influence on Bolton Index. A total of 110 pairs of pretreatment dental study casts （41 male and 69 female） were selected from patients treated in Department of Orthodontics of Union Hospital in Wuhan, China. A sliding dental Vernier caliper was used for the measurement of the mesiodistal tooth width. Descriptive statistical mean values, standard deviation, standard error of the mean values, coefficient of variance and the t-test were used for the statistical analysis of the data. The study found that TBI, ABI and the total sum of teeth width had no significant difference between male and female. Male group indicated that Bolton Index （BI） was mostly influenced by the width of lower right second premolar, whereas female group showed that BI was mostly influenced by the width of both the right and left maxillary lateral incisor.

The Current Concepts of Orthodontic Discrepancy Stability

There is a wide range of opinions on the best time to start orthodontic treatment but the vast majority is carried out on children who have lost all their baby (deciduous) teeth and have most of their adult teeth (except for wisdom teeth) present in the mouth. Stability of orthodontic discrepancy is one of the most important factors that determine when start orthodontic treatment of the dentofacial deformaties. This paper threw light on stability of orthodontic discrepancy, its classification, comparing between stable versus unstable orthodontic discrepancy and its impact on the timing of orthodontic treatment.

Development of Unilateral Piriformis Syndrome in a Female with Congenital Leg Length Discrepancy

Background: This is a rare case of piriformis syndrome. We discuss the patient’s symptoms, imaging study results, laboratory examination findings, and prescribed treatment in an attempt to determine the possible mechanisms or reasons for this patient’s development of piriformis syndrome. Methods: The patient is a 22-year-old female soldier who was admitted for lower back pain with soreness radiating to her right buttock and right lower extremity. We found that she had leg length discrepancy under X-ray finding. She was diagnosed piriformis syndrome by physical examination and Magenetic Resonance Image. Results: We performed scanography for lower extremities revealed a left femur length of 42.7 cm, a right femur length of 43.3 cm, a left tibia length of 33.2 cm, and a right tibia length of 33.6 cm;her left lower extremity was 1 cm shorter than her right. The MRI of sacrum also reveals hypertrophy of right piriformis muscle. Conclusions: Piriformis syndrome might be caused by short-term compensation in congenital leg length discrepancy. The patient with leg length discrepancy changed posture when standing, walking, and running. These compensation postures could lead to abnormality position of bones where there is insertion of the muscle.

Diagnostic discrepancy between colposcopy and vaginoscopy:A case report

BACKGROUND Colposcopy currently plays a vital role in the diagnosis and treatment of lower genital diseases.Exposure and biopsy are two key steps in colposcopy.When the whole transformation zone or all lesions cannot be observed,we judge colposcopy as unsatisfactory.Unsatisfactory colposcopic examination may lead to the misdiagnosis of more severe diseases.The combination of colposcopy and vaginoscopy may contribute to accurate diagnosis and clinical decisions.CASE SUMMARY Here,we introduce a case of posthysterectomy deep vaginal apex not fully exposed by colposcopy,and the biopsy result was a vaginal precancerous lesion.We adopted vaginoscopy to extend the observed area and expose the lesion thoroughly,and the biopsy result was vaginal squamous cancer.CONCLUSION The patient received a precise diagnosis and early surgery due to the combination of colposcopy and vaginoscopy.

On the Two-step Communication Concerning Cultural Discrepancy in Translating Foreign-Oriented Publicity

Cultural discrepancy constitutes a major obstacle in translating Chinese publicity materials to the outside world. This paper, viewed through the lens of communication and media studies, divides the transmission of cultural discrepancy into two stages, namely, the dialogues between the translator and the source text author and between the translator and the intended readership in the target language. Only with a two-step communication can a most appropriate strategy be adopted to deal with the cultural points.

Marginal discrepancy and microleakage in crown-copings fabricated by three CAD/CAM systems: An <i>in vitro</i>study

The purpose of this study was to evaluate and compare the microleakage and marginal discrepancy of ceramic crown-copings fabricated by three different CAD/CAM systems. Material and methods: Thirty extracted premolars were prepared for complete all-ceramic crowns with: total convergence 10-degree, 2 mm occlusal reduction, 4.5 mm height, 1.3 mm circular reduction and chamfer marginal preparation. They were divided into three groups and each group (n = 10) received a ceramic crown-coping fabricated by one of three CAD/CAM systems: Procera, KaVo Everest and Cerec inLab. The copings were cemented with Panavia F 2.0. After thermal cycling, the teeth were immersed in 2% basic fuchsine dye for 24 hours. Microleakage was scored using a five-point scale and evaluated under a stereomicroscope at ×18. Marginal discrepancies were assessed with scanning electronic microscope at ×150, with measurements at 50 different points. Data were subjected to a chisquare test, Kolmogorov-Smirnov test and using Rho Spearman’s correlation test (P 0.05). No significant differences were found in marginal discrepancies for the Procera (62.58 ± 8.98 μm) and KaVo Everest systems (65.54 ± 18.56 μm), (P = 0.941). Significant differences were found for Cerec inLab (132.18 ± 27.75 μm) compared with Procera and KaVo Everest (P = 0.0001). No correlation between the marginal discrepancies and microleakage for the three CAD/CAM crown-copings systems. Conclusions: Cerec inLab CAD/CAM crown-copings showed significantly higher values for microleakage and marginal discrepancy in comparison with Procera and KaVo Everest CAD/CAM crown-copings.

Ilizarov Femoral Limb Lenghtening in Lower Limb Discrepancy. Radio-Clinic Results. About 32 Cases

Introduction: The progressive osseous lengthening on a single site corticotomy such as described by Ilizarov is a reliable but difficult method in the treatment of limb length discrepancies. The objective of this study was to appreciate the results of the recent application of this method in a low-income country such as Senegal. Material and Method: It was a retrospective study on 32 patients among whom 19 were men (people) and 13 were women over one continuous period of 7 years. The mean age was of 19 years with extremes of 10 and 36 years. Etiologies were dominated by osteoarthritis of the hip in 77.8%, traumatic sequela in 16.7% and the aseptic osteonecrosis of femoral head in 5.6%. The average duration of treatment was of 232 days with extremes of 110 and 363 days. Results: On the anatomical plan, the average lengthening was 55.89 mm that is 12.03% of the initial length with extremes of 35 and 110 mm. The equalization, in terms of length of the members, was obtained in 33.3% of the cases. The average index of cure was of 56.29 days, six patients, which are 18.75% of the cases, complained about pain at the end of treatment and walking without crutches was possible in 83.33%. The complications, in the phase of lengthening, were either mechanics, with 5 subluxations (3 at the level of the hip and 2 at the level of the knee), or biological with 7 infections (superficial 5 and 2 deep), 2 premature consolidations and 1 bleeding. The complications in the consolidation phase were also mechanical with 32 articular stiffness, 8 plastic deformations, 7 subluxations, a fracture and a collapse of the regenerate, or biological with 8 infections among which an osteitis and bleeding. Conclusion: Despite a strong rate of complications and sometimes not reached objectives, the results of this first series of lengthening are encouraging and rich in education and do not seem to be a limiting factor for the implementation of the method in developing countries.

Reliability of a simple fluoroscopic image to assess leg length discrepancy during direct anterior approach total hip arthroplasty

BACKGROUND Direct anterior approach(DAA)total hip arthroplasty(THA)in a supine position provides a unique opportunity to assess leg length discrepancy(LLD)intraoperatively with fluoroscopy.Reported fluoroscopic techniques are useful but are generally complicated or costly.Despite the use of multiple techniques for leg length assessment,LLD continues to be a major post-operative source of patient dissatisfaction further emphasizing the importance of near-anatomic restoration.The utility of an alternative direct measurement of LLD on an intra-operative fluoroscopic pelvic image during DAA THA has not been reported.AIM To determine the reliability of a novel simple intra-operative measurement of LLD using a parallel line technique on a single fluoroscopic digital image of the pelvis.METHODS One hundred and seventy-one patients who underwent DAA THA were included for analysis.Intra-operative fluoroscopic and post-operative anterior-posterior radiographs were imported to TraumaCad and calibrated for LLD measurement.LLD was measured on each image using the right-left hip differences in lesser trochanter to pelvic reference line distances.Pelvic reference points included the teardrops and ischia.Fluoroscopic LLD was compared to the gold-standard measurement of LLD measured on a post-operative radiograph.RESULTS Mean absolute difference in teardrop referenced LLD between fluoroscopic and post-operative radiographs was 2.17 mm and based on the ischia mean absolute difference was 2.63 mm.Linear regression of fluoroscopic and post-operative radiograph LLD based on teardrop and ischia LLD found r2 values of 0.57 and 0.84,respectively.Mean absolute difference between fluoroscopic and postoperative x-ray LLD was within 5 mm in 95%of cases regardless of pelvic reference.CONCLUSION This study demonstrates that a single fluoroscopic view obtained during DAA THA for leg length assessment is clinically useful.

Detection of thinned corticospinal tract and corticoreticular pathway in a patient with a calf circumference discrepancy

In clinical practice, it is challenging to elucidate the location of the lesion in a patient＇s nervous system that is causing the neurologic symptoms, because lesions are often microscopic and cannot be revealed by conventional evaluation methods.

REMARKS ON BOUNDS ON THE DISCREPANCY OF APPROXIMATE SOLUTIONS CONSTRUCTED BY GODUNOV'S SCHEME

The bounds on the discrepancy of approximate solutions constructed by Gedunov's scheme to IVP of isentropic equations of gas dynamics are obtained, Three well-knowu results obtained by Lax for shock waves with small jumps for general quasilinear hyperbolic systems of conservation laws are extended to shock waves for isentropic equations of gas dynamics in a bounded invariant region with ρ=0 as one of boundries of the region. Two counterexamples are given to show that two iuequalities given by Godunov do not hold for all rational numbers γ∈(1, 3]. It seems that the approach by Godunov to obtain the forementioned bounds may not be possible.

Analysis on the Individual Discrepancy in English Teaching

Recently, a great tide of English teaching reform swept across China, advocating the innovation of educational concept and teaching mode. However, the phenomenon of rigid uniformity in teaching process is still commonly seen, neglecting the individual discrepancy of students. The individual discrepancy is manifested by both the congenital heredity and the acquired disposition. Supported by the Chinese traditional theory of teaching students in accordance with their aptitude and Vygotsky's "the zone of proximal development" theory, this paper illustrates the importance of paying attention to the individual discrepancy from the perspective of students' growing background and personality. In addition, standing on the point of view of relevant authority and English teacher, the author tries to put forward some countermeasures.

Inequality of Realization of a Stochastic Dynamics Based on the Erdos Discrepancy Problem

This paper proposes a stochastic dynamics model in which people who are endowed with different discount factors chose to buy the capital stock periodically with different periodicities and are exposed to randomness at arithmetic progression times. We prove that the realization of a stochastic equilibrium may render to the people quite unequal benefits. Its proof is based on Erd&ouml;s Discrepancy Problem that an arithmetic progression sum of any sign sequence goes to infinity, which is recently solved by Terence Tao [1]. The result in this paper implies that in some cases, the sources of inequality come from pure luck.