Neurodevelopmental outcome in complicated twin pregnancy: prospective observational study.

OBJECTIVE: Twin pregnancy is associated with increased perinatal mortality and morbidity, but long-term neurodevelopmental outcome remains underinvestigated. The primary objective of this study was to investigate the incidence of adverse neurodevelopment after 1 year of age in complicated monochorionic diamniotic (MCDA) twin pregnancies compared with uncomplicated twin pregnancies. METHODS: This was a prospective cohort study conducted at St George's University Hospital NHS Foundation Trust, London, UK. Women with a twin pregnancy culminating in at least one surviving child, aged between 12 and 60 months (corrected for prematurity) at the time of assessment, were invited to complete the relevant Ages and Stages Questionnaire® version 3 (ASQ-3) test. The two study groups were: (1) complicated MCDA twin pregnancies, including those with twin-twin transfusion syndrome, twin anemia-polycythemia sequence, selective fetal growth restriction, twin reversed arterial perfusion sequence and/or single intrauterine demise; and (2) uncomplicated MCDA and dichorionic diamniotic twin pregnancies. The primary outcome measure was an abnormal ASQ-3 score, defined as a score of more than 2 SD below the mean in any one of the five domains. Mixed-effects multivariable logistic regression analysis was performed to determine whether a complicated MCDA twin pregnancy was associated independently with an abnormal ASQ-3 score. RESULTS: The study included 174 parents who completed the questionnaire for one or both twins; therefore, 327 ASQ-3 questionnaires were available for analysis. Of those, 117 (35.8%) were complicated MCDA twin pregnancies and 210 (64.2%) were controls. The overall rate of an abnormal ASQ-3 score in children born of a complicated MCDA twin pregnancy was nearly double that of those from uncomplicated twin pregnancies (14.5% vs 7.6%; P = 0.056). Children born of a complicated MCDA twin pregnancy had a significantly higher rate of impairment in the gross-motor domain compared with the control group (8.5% vs 2.9%; P = 0.031). Complicated MCDA twin pregnancies that underwent prenatal intervention had a significantly higher rate of abnormal ASQ-3 score compared with those that did not undergo prenatal intervention (28.1% vs 1.7%; P < 0.001). On multilevel logistic regression analysis, complicated MCDA twin pregnancy was an independent predictor of abnormal ASQ-3 score (adjusted odds ratio, 3.28 (95% CI, 3.27-3.29); P < 0.001). CONCLUSIONS: This study demonstrates that survivors of complicated MCDA twin pregnancies have a higher rate of adverse neurodevelopmental outcome, independently of prematurity. Long-term neurodevelopmental follow-up in these pregnancies can ensure timely and optimal management of those affected. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

The effect of irisin on the ultrastructure of the thoracic aorta in rat: A morphometric study.

BACKGROUND: One of the most recent hormones to be identified and isolated is irisin, extracted from mouse skeletal muscle in 2012. Irisin has been proven to alter blood pressure, which has an impact on blood vessels, enhance endothelial functions, and prevent injury to endothelial cells. The current study aimed to study the effect of irisin on the ultrastructure of the rat thoracic aorta using the transmission electron microscope (TEM). MATERIALS AND METHODS: Twenty female rats were recruited for this study and divided into a control group (non-injected), and four experimental groups (injected groups) each consisting of 4 rats. The experimental groups were injected intraperitoneally with different doses of irisin (250ng/mL, 500ng/mL, 1000ng/mL, and 2000ng/mL) twice a week for 4weeks. Then, the descending thoracic aorta of all experimental rats were resected and proceeded with imaging. RESULTS: The results of this study showed a change in the thickness of the tunica intima, internal elastic lamina, elastic lamellae, and external elastic lamina concerning increasing injected irisin concentration. While there was a significant increase in the thickness of tunica media (P<0.0001) and smooth muscle cells (P<0.05). Also, the results showed a significant increase in the number of elastic lamellae in the tunica media (P<0.0001). CONCLUSION: Irisin had a major impact on the elasticity of the rat thoracic aorta wall, suggesting that it influences the growth factors of the wall and activates smooth muscle cells in addition to endothelial cells.

Functional and morphological study of the effects of carvacrol on smooth muscle of the thoracic aorta in the rat.

Background: The leaves of Origanum are widely used in herbal medicine hence of having many beneficial ingredients, one of these important compounds is Carvacrol. The inhibitory effect of Carvacrol was the core of this study by applying different kinds of stimulants to smooth muscles in the wall of thoracic aorta in rats. Aim: To investigate the pharmacological effects of Carvacrol, the main active ingredient present in the medicinal plant Origanum, on the contractile activity and morphology of the smooth muscle of the rat thoracic aorta. Materials and Methods: After the thoracic aorta arteries were isolated and prepared for the experiments, each thoracic aorta was cut into 5-mm ring segments; different stimulants were used (Potassium Chloride, Norepinephrine, U46619, and α,ß-methylene ATP) in the presence and absence of Carvacrol on four groups of rats. The isolated rings were placed and connected to a force transducer which in turn linked to a data acquisition system via an amplifier to record the effect of each stimulant. GraphPad Prism version 5.02 for Windows, one-way analysis of variance followed by Dunnett's multiple comparison test. Results: It was found out that Carvacrol obstructs the contractile responses elicited by exogenous NA, KCl, U46619, and α,ß-methylene ATP in a concentration dependent manner. Conclusion: The addition of Carvacrol in the experimental rats showed an increase in the thickness of tunica media as evident by the number of smooth muscle layers and laminae of elastic fibers. It was found that Carvacrol reduced the vascular smooth muscle contractility in the rat thoracic aorta. The mechanism of action is presumed to be achieved through interfering with the mobilization of both intracellular and extracellular Ca2+ through different receptors. Furthermore, it might be suggested that Carvacrol in high doses stimulates smooth muscles in the wall of aorta leading to an increase in the thickness of tunica media layer.

Sphenoid sinus pneumatization: the good, the bad, and the beautiful.

PURPOSE: To study different types of extension of sphenoid sinus pneumatization detected by CT and examine their correlation with other anatomical variants. METHODS: Sphenoid sinus pneumatization was characterized (780 hemi-sinuses) on CT scans. Its incidence and correlations with related anatomical variants were evaluated. Dimensions of surgical window were measured in the lateral type, where pneumatization extends beyond a line connecting Vidian (pteregoid) canal (VC) and foramen rotundum (FR). RESULTS: The lateral recess of the sphenoid sinus was pneumatized in 27.3% of patients with a mean width of 7.59 mm. The distance separating the FR and the VC correlated strongly with the depth of the lateral recess. There was significant positive correlation between pneumatization of lateral recess and Vidian nerve prominence to other pneumatization patterns (lesser sphenoid, frontal, and Maxillary sinuses) (p < 0.0001). Lateral recess pneumatization in coronal cuts was also significantly correlated with anterior-posterior sphenoid pneumatization in sagittal cuts (p < 0.0001). CONCLUSION: Pre-operative assessment of sphenoid sinus pneumatization is essential in the endoscopic approach to skull base structures to facilitate surgical access and avoid injury of the nearby structures. Our study showed significant correlation among anatomical variants and different measurements which allows the surgeon to predict abnormal anatomy with high accuracy.

Effect of nordihydroguaiaretic acid on spermatogenesis and fertility in rats.

Nordihydroguaiaretic acid (NDGA) is a naturally occurring lignan with potent antioxidant activity. Currently, it is in clinical trials as anticancer agent. As there is no earlier report on the effect of NDGA on spermatogenesis and fertility, this study was designed to investigate this aspect. Administration of NDGA to rats for 60 days produced degenerative changes in testis but had no effect on sperm DNA integrity test and androgen receptor expression. Ultrastructural studies revealed loss of integrity of cells in seminiferous tubules, vacuolation and presence of apoptotic bodies. Derangement of the outer dense fibres was noted in some sperm flagella. Acrosome formation appears to be normal. About 13.7% of epididymal spermatozoa had deformations like short tail or rounded head. This may explain the lower fertility index in NDGA-treated group. No external deformations in newborns were noted. In conclusion, NDGA may have adverse effects on spermatogenesis.

Frontal sinus pneumatisation: an isolated finding or a sign of concomitant anatomical variation?

OBJECTIVE: To determine the association between frontal sinus pneumatisation and concomitant anatomical variations in paranasal sinuses as seen on computed tomography. METHODS: A total of 403 patients who underwent paranasal sinus computed tomography were allocated to three groups according to the degree of frontal sinus pneumatisation (type 1 - hypoplasia; type 2 - medium size; and type 3 - hyperplasia). In this unique model, the prevalence of ipsilateral variations on paranasal sinuses on each side of the head were analysed separately within each pneumatisation group. RESULTS: The type 3 frontal sinus pneumatisation group showed a greater association with ipsilateral variations of the sphenoid bone. Variations included pneumatisation of the anterior clinoid process, lateral sphenoid recess, pterygoid process and greater wing, and exposure of Vidian canal. This group also showed significant associations with male gender, and the presence of frontal and Onodi cells. CONCLUSION: Interpretation of the paranasal sinus variations is imperative for pre-operative evaluation in functional endoscopic sinus surgery, particularly in patients with frontal sinus hyperplasia. Attention to variation on the ipsilateral side is informative.

The effects of irisin on the rat thoracic aorta: a histological study.

BACKGROUND: Irisin, a polypeptide hormone that is released from skeletal muscle in response to exercise, has been found to improve endothelial functions, protect against endothelial injuries and change blood pressure, which also affected blood vessels. The aim of this study was to assess the histological changes of the rat thoracic aorta in response to irisin injection. MATERIALS AND METHODS: Twenty-four rats were used. They were divided into two groups: the control group without irisin injection and the irisin-injected group subdivided into three subgroups treated with different irisin concentrations (20, 40 and 160 nM, respectively) twice a week for 4 weeks. The control group and irisin-treated subgroups consisted of 6 rats each. After 4 weeks all rats were sacrificed, and the descending thoracic aorta was treated for histological evaluation. Sections were stained with haematoxylin and eosin and orcein stains. Morphometric measurement included: intima-media thickness, number of elastic lamellae and number of smooth muscle cells' nuclei. RESULTS: Histological study showed that intraperitoneal injection of different concentrations of irisin (20, 40 and 160 nM) in rats increased intima-media thickness, the number of smooth muscle cell's nuclei and the number of elastic lamellae in media layer of the thoracic aorta in a dose-dependent manner. CONCLUSIONS: Irisin significantly affected the morphology of the wall of the rat thoracic aorta indicating a role of irisin in influencing the growth factors of the thoracic aorta walls and activating smooth muscle cells in the thoracic aorta layers.

Revisiting the anatomy of the cephalic vein, its origin, course and possible clinical correlations in relation to the anatomical snuffbox among Jordanian.

BACKGROUND: The cephalic vein is one of the most distinguished superficial veins of the upper limb. Its clinical value lies in venous access. There is little known about the variation of its formation in relation to the anatomical snuffbox. Hence, anatomical variants in the origin of the cephalic vein are important in clinical practice. Subsequently, this study was designed to examine the variation of the cephalic vein formation in relation to the anatomical snuffbox. MATERIALS AND METHODS: A cross-sectional study of 438 subjects (722 hands), was prepared to study the cephalic vein among Jordanian students and staff of one of the major governmental Medical College in Jordan, by using infrared illumination system. The obtained data was analysed according to; gender, sidedness, and handedness. RESULTS: Four sites for the formation of the cephalic vein in relation to the anatomical snuffbox were found. There was a significant relation between gender and sidedness, and the sites of formation of the cephalic vein (p < 0.0001 and p = 0.048, respectively). CONCLUSIONS: For the first time this study identified different sites for the formation of the cephalic vein in relation to the anatomical snuffbox. However, regardless of its sites of formation, the cephalic vein was running in 98% of the examined hands in the anatomical snuffbox.

Burnout among clinical dental students at Jordanian universities.

Dentistry is a profession demanding physical and mental efforts as well as people contact, which can result in burnout. The level of burnout among 307 clinical dental students in 2 Jordanian universities was evaluated using the Maslach Burnout Inventory survey. Scores for the inventory's 3 subscales were calculated and the mean values for the students' groups were computed separately. Dental students in both universities suffered high levels of emotional exhaustion and depersonalization. The dental students at the University of Jordan demonstrated a significantly higher level of emotional exhaustion than their counterparts at the Jordan University of Science and Technology.

Magnetic resonance imaging of normal lumbar intervertebral discs.

OBJECTIVE: To study changes in midpoint lumbar disc heights in an asymptomatic Jordanian sample relative to age, sex, lumbar level and midvertebral heights. METHODS: A total of 153 asymptomatic patients (87 males, age range 20-65 years; mean 43+/-12.1 and 66 females, age range 22-68 years; mean 47+/-13.7) were selected during the study period. All underwent midsagittal magnetic resonance imaging to measure the midpoint disc height and midvertebral height of all lumbar spines. Values were statistically analyzed to obtain the significance of differences in the means of midpoint disc heights at different levels in every age group and among other age groups. The relative height indices for every lumbar level in each age group for both males and females were determined. RESULTS: The results showed that a highly significant sex-independent cephalocaudal increase sequence of midpoint disc heights is evident, where maximum values are reached at lumbar 3/4 level in the younger age groups and at lumbar 5/sacral 1 level in older ones. In relation to age, midpoint disc heights displayed a non-linear, alternating increase/decrease pattern, which was of higher magnitude and statistically significant in males, but less evident and statistically insignificant in females. Maximum values were reached during the 6th decade in males while during the 5th decade in females. The relative height indices were similar in both sexes and remained fairly constant between age groups at all levels. CONCLUSION: The craniocaudal and age-dependent patterns could be termed physiological and interpreted as adaptation of the lumbar spine to changing functional demands. The utility of the relative height index is discussed.

Magnetic resonance imaging of normal lumbar intervertebral discs.

OBJECTIVE: To study changes in midpoint lumbar disc heights in an asymptomatic Jordanian sample relative to age, sex, lumbar level and midvertebral heights. METHODS: A total of 153 asymptomatic patients (87 males, age range 20-65 years; mean 43+/-12.1 and 66 females, age range 22-68 years; mean 47+/-13.7) were selected during the study period. All underwent midsagittal magnetic resonance imaging to measure the midpoint disc height and midvertebral height of all lumbar spines. Values were statistically analyzed to obtain the significance of differences in the means of midpoint disc heights at different levels in every age group and among other age groups. The relative height indices for every lumbar level in each age group for both males and females were determined. RESULTS: The results showed that a highly significant sex-independent cephalocaudal increase sequence of midpoint disc heights is evident, where maximum values are reached at lumbar 3/4 level in the younger age groups and at lumbar 5/sacral 1 level in older ones. In relation to age, midpoint disc heights displayed a non-linear, alternating increase/decrease pattern, which was of higher magnitude and statistically significant in males, but less evident and statistically insignificant in females. Maximum values were reached during the 6th decade in males while during the 5th decade in females. The relative height indices were similar in both sexes and remained fairly constant between age groups at all levels. CONCLUSION: The craniocaudal and age-dependent patterns could be termed physiological and interpreted as adaptation of the lumbar spine to changing functional demands. The utility of the relative height index is discussed.

Predictive Accuracy of Mandibular Ramus Flexure as a Morphologic Indicator of Sex Dimorphism in Jordanians / Exactitud Predictiva de la Flexura de la Rama Mandibular como Indicador Morfológico de Dimorfismo Sexual en Jordanos

The present study investigated the validity of mandibular ramus flexure in sex differentiation among young Jordanian adults using Orthopantomographic images in a double blind study. A normative sample comprised of 419 images was selected, of which 126 belonged to male patients and 293 images to females. The exclusion criteria used in the selection involved excluding images that showed marked loss of mandibular molars, over erupted, tilted, anomalous molars and teeth or mandibles associated with pathology. Each image was examined for the presence of a flexure on the posterior margin of the ramus at the occlusal plane. The posterior margin of the ramus was carefully traced graphically and the occlusal plane level was delineated as guided by the height of cusp tips at the occlusal surfaces of the mandibular molars. The ramus flexure was more accurately diagnostic for females (94.6%), than for males (47.6%); this gave rise to an overall diagnostic accuracy of 70.9% which is far below the reported 90.6-99.0% by Loth & Henneberg. Our results, however, agreed with some reported findings of other researchers. In conclusion, ramus flexure provides a moderately acceptable predictive accuracy and could be considered as a supplementary rather than a definitive mean of sex determination. In sexing unknown skeletal remains, it is necessary to employ as many methods or traits as possible instead of relying on one morphological trait.

El presente estudio investigó la validez de flexura de la rama mandibular en la diferenciación sexual entre adultos jóvenes jordanos utilizando imágenes de ortopantomografías, en un estudio doble ciego. Se seleccionó una muestra normativa compuesta de 419 imágenes, de las cuales 126 pertenecían a hombres y 293 a mujeres. Se excluyeron imágenes que mostraron una pérdida marcada de los molares mandibulares, dientes sobre erupcionados o inclinados, molares anómalos y los dientes o mandíbulas con enfermedad. Cada imagen fue examinada para detectar la presencia de un ángulo en el margen posterior de la rama en el plano oclusal. El margen posterior de la rama mandibular fue trazado gráficamente y el plano oclusal se delineó estableciendo como guía la altura de las puntas cuspídeas en las superficies oclusales de los molares mandibulares. La flexura de la rama mandibular fue más precisa en el diagnóstico de las mujeres (94,6%) que para los hombres (47,6%); con una precisión diagnóstica global del 70,9%, la cual es inferior a la reportada por Loth & Henneberg entre 90,6­99,0%. Nuestros resultados, concuerdan con algunos hallazgos reportados por otros investigadores. En conclusión, la flexura de la rama mandibular proporciona una exactitud de predicción moderadamente aceptable y podría ser considerada como un complemento en lugar de un medio definitivo de la determinación del sexo. En restos óseos desconocidos, es necesario emplear la mayor cantidad de métodos o rasgos posibles que depender de un solo rasgo morfológico.

Analysis of 100 patients with thermal injury treated in a new burn unit in Amman, Jordan.

This paper describes the treatment of patients with thermal injury in Jordan University Hospital. Between 1976 and 1980 inclusive 338 patients were treated in general surgical wards. More recently a new specialized burn unit has been built and between April 1985 and July 1986, 100 patients have been treated in this new unit. Compared with the earlier study there has been an increase in the number of patients admitted with more severe burns. Among these 100 patients scalds and fire-burn injury have a nearly equal incidence. Small children are especially vulnerable. The mortality rate, the incidence of disability and the duration of stay in hospital has decreased compared with the previous study.

Brachiocephalic veins: an overlooked approach for central venous catheterization.

Central venous access is important in both assessment and treatment of the patient. In modern clinical practice, a percutaneous approach is preferred. The well-established subclavian and internal jugular vein catheterization techniques, however, still carry the risk of major acute complications. In this article we describe a trial study of a percutaneous brachiocephalic vein catheterization technique conducted on a total of 74 cadavers undergoing autopsy. Relying on constant and easily recognizable anatomical landmarks, we performed a total of 128 catheterizations of the right and left brachiocephalic veins. The success of catheterization was ascertained by regional dissection. Our results show very high reproducibility with a success rate of about 97% on the first attempt of catheterization on both right and left sides. Equally important, collateral injury of neighboring structures was consistently absent. We propose the introduction of this rather overlooked approach into clinical practice.

Histological changes in radial forearm skin flaps in the oral cavity.

We reported previously that skin flaps transplanted to the oral cavity in reconstructive surgery for oral cancer frequently acquired the gross appearance of buccal mucosa. The changes were shown to be reactive in nature. The "changed" flaps generally had a heavier infiltration of leukocytes in the dermis and appeared to have thicker epithelium. The present study quantifies these parameters, as well as the numbers of intraepithelial leukocytes. The flaps that had acquired the gross appearance of oral mucosa had significantly thicker epithelium, larger numbers of dermal leukocytes, and more intraepidermal inflammatory cells per unit length than flaps that retained the gross appearance of thin skin. No correlation was found between these changes and radiotherapy.

Behavior of radial forearm skin flaps transplanted into the oral cavity.

Radial forearm skin flaps transplanted into the oral cavity in patients undergoing treatment for intra-oral tumors frequently acquire a gross appearance resembling that of buccal mucosa. This article reports studies of biopsies of the flaps in 53 patients, of which 21 showed changes at some stage in the follow-up period. The project aims to determine whether 1) the change in the epithelium to a mucosal form is genuine or reactive, 2) a creeping replacement of epidermis results from the surrounding buccal epithelium, 3) alterations in the epidermis could be associated with changes in the dermis, 4) the change is caused by radiotherapy. Examination of the biopsies by resin histology and transmission electron microscopy shows that the changes may be reversible: it suggests that they are reactive in nature, and related to the degree of dermal inflammation, rather than to the effect of radiotherapy. The dermis persists as such and is not replaced by buccal lamina propria.

Burnout among clinical dental students at Jordanian universities

Dentistry is a profession demanding physical and mental efforts as well as people contact, which can result in burnout. The level of burnout among 307 clinical dental students in 2 Jordanian universities was evaluated using the Maslach Burnout Inventory survey. Scores for the inventory's 3 subscales were calculated and the mean values for the students' groups were computed separately. Dental students in both universities suffered high levels of emotional exhaustion and depersonalization. The dental students at the University of Jordan demonstrated a significantly higher level of emotional exhaustion than their counterparts at the Jordan University of Science and Technology