Tracking anthropogenic nitrogen-compound sources of surface and groundwater in southwestern Nile Delta: hydrochemical, environmental isotopes, and modeling approach.

This research aims to assign the specific and potential sources that control migration and transformation mechanisms of ammonium/nitrate contaminants of surface and groundwater systems in the southwestern Nile Delta, Egypt. To achieve that, an integration of hydrogeochemistry, multiple environmental stable isotopes (δ2H-H2O, δ18O-H2O, δ15N-NH4, and δ15N-NO3) coupled with three-dimensional nitrogen transport numerical model (MODFLOW-MT3D) was done. A set of representative water samples (20 canals and drainage water) and 14 groundwater samples were collected and analyzed for physical, chemical, and stable isotope analysis. NH4+ and NO3- concentrations in surface water samples varied from 0.29 to 124 mg/l and 0.52 to 39.67 mg/l, respectively. For groundwater samples, NH4+ and NO3- concentrations varied from 0.21 to 1.75 mg/l and 0.33 to 32.8 mg/l, respectively. Total risk quotient (THQ) level of nitrate (oral and dermal effects) from drinking water exceeds unity for all water samples indicating a potential noncancer risk for the southwestern Nile Delta residents. The potential sources of nitrogen compound pollution are water from sewage treatment plants used for irrigation, sludge and animal manure, septic tanks, soil nitrogen, and artificial fertilizers according to results of δ15N values. Results of ammonium/nitrate modeling in shallow groundwater aquifers are compared with observed concentrations and are found to be in good agreement. Some recommendations are given to decrease nitrogen loads in the study area through suggested a need for adoption of N-fertilizer management practices and treatment of sewage water before to application in agricultural activities.

Comparative efficacy of lidocaine-prilocaine cream and vaginal misoprostol in reducing pain during levonorgestrel intrauterine device insertion in women delivered only by cesarean delivery: A randomized controlled trial.

OBJECTIVE: To compare efficacy of lidocaine-prilocaine (LP) cream versus misoprostol versus placebo before levonorgestrel-releasing intrauterine device (LNG-IUD) insertion. METHODS: This randomized controlled trial (RCT) was conducted in a tertiary referral hospital from April 30, 2020 to March 1, 2021 on 210 parous women willing to receive LNG-IUD and delivered only by elective cesarean delivery (CD). Participants received 200 µg vaginal misoprostol or 5 ml of LP cream 5% or placebo 3 h before LNG-IUS insertion. Primary outcome was pain during LNG-IUD insertion, while secondary outcomes were pain 10 min post-procedure, ease of insertion, patient satisfaction, insertion time, and drug side effects. RESULTS: Pain during LNG-IUS insertion was reduced in LP group and misoprostol group compared to placebo group (2.1 ± 1.0 vs 3.7 ± 1.6; p <0.001) and (2.3 ± 1.3 vs 3.7 ± 1.6; p <0.001), respectively. Ease of procedure and patient satisfaction were significantly higher in LP and misoprostol groups than placebo (P <0.001). Need for additional analgesia was significantly higher in placebo group than in the other two groups (P = 0.009). Adverse events were not significantly different between the three groups except vomiting and abdominal cramps, which were higher with misoprostol. CONCLUSION: LP cream and 200 µg of vaginal misoprostol administration before LNG-IUD insertion in women delivered only by elective CD effectively reduced pain during insertion and 10 min post-procedure with easier insertions, high patient satisfaction, and tolerable side effects. Pain reduction with LP cream was clinically significant.

Internal Morphology of the Odontoid Process: Anatomic and Imaging Study with Application to C2 Fractures.

OBJECTIVE: Fracture of the odontoid process is a critical injury to diagnose and often treat. The aim of this anatomic study was to present a comprehensive understanding of this part of the C2 vertebra. METHODS: We used 20 C2 vertebrae. Samples underwent imaging (computed tomography [CT] with and without three-dimensional reconstruction, micro-CT, 1.5T magnetic resonance imaging) and sagittal and coronal sectioning using a bone saw. Sectioned specimens were imaged under a digital handheld microscope, and transillumination of the bone was used to highlight its internal trabecular pattern. Three samples underwent infusion of the odontoid process with a hardening substance and were then decalcified. RESULTS: Internal trabecular patterns of the odontoid process of all specimens were discernible. In sagittal and coronal sections, trabecular patterns were highlighted with transillumination, but the patterns were much clearer using the digital microscope. Magnetic resonance imaging and CT provided the least detail of the imaging methods, but the trabecular patterns could be identified. Three-dimensional reconstruction of CT data was the preferred imaging method over magnetic resonance imaging and CT without three-dimensional reconstruction. The most distinct trabecular and cortical patterns were seen using micro-CT. Osteoporosis was seen in 2 specimens (10%). Five specimens (25%) were found to have a subdental synchondrosis. For most specimens, the trabeculae were found throughout the odontoid process. CONCLUSIONS: Improved knowledge of the anatomy, structural composition, and variations within the C2 vertebra may allow for better treatment options and patient care.

Neovaginal Construction with Pelvic Peritoneum: Reviewing an Old Approach for a New Application.

Transgender reassignment surgeries have become a major topic of interest within the last decade. Although there are numerous surgical techniques for male-to-female reassignment, a physician must assess each patient's anatomy and past medical history to determine the most suitable technique. Additionally, patient preference is important. The neovaginal constructive technique most commonly used in male-to-female reassignment surgery is penile skin inversion, but various other techniques and tissues can also be used including pelvic peritoneum, buccal mucosa, and bowel. Surgical text descriptions were enhanced by creating new anatomical illustrations. Donor and recipient site anatomies, and the surgical technique leading to creation of the neovagina, are demonstrated in detail with relevant illustrations. A review of the literature concerning the anatomy, procedure development, and outcomes is presented. The pelvic peritoneum was originally used in neovaginal construction for females with vaginal agenesis as a result of MRKH syndrome. The use of this technique to create a neovagina in male-to-female transgender reassignment surgery has become appealing owing to the relative ease of the procedure, low complication rates, and overall high patient satisfaction. This technique offers a potential new choice for transgender male-to-female neovaginal construction, but further studies are needed to confirm its successful use in transgender surgery. Clin. Anat. 31:175-180, 2018. © 2017 Wiley Periodicals, Inc.

Extraforaminal compression of the L5 nerve: An anatomical study with application to failed posterior decompressive procedures.

This anatomical study was performed to elucidate the pertinent foraminal and lateral L5 nerve anatomy to enhance our understanding of possible neurologic causes of failed decompression surgery. Persistent extraforaminal L5 nerve compression is a possible cause of persistent symptoms following lumbosacral surgery. The amount of extraforaminal space for the L5 ventral ramus was examined in fifty adult human skeletons (100 sides). Based on morphology, the specimens were then categorized (types I-IV) on the basis of the bony space available for the nerve at this location. Next, 25 embalmed adult cadavers (50 sides) underwent bilateral dissection of the lower lateral lumbar region. The type of bony extraforaminal outlet was documented for each cadaver on the basis of our skeletal analysis. Lastly, segments (intra- and extra-foraminal) of the L5 ventral ramus were excised and examined histologically. Types I-IV outlets were found in 43, 31, 20 and 6 skeletal sides, respectively. For cadavers, 22,15, 10 and 3 sides were found to have types I-IV bony outlets, respectively. In cadavers, all type IV outlets and 70% of the type III bony configurations adjacent to the L5 ventral ramus had signs of neural irritation/injury including vascular hyalinization and increased fibrosis distal to the intervertebral foramen. No distal segments of type I and type II outlets showed histological signs of neural compromise. Patients with symptoms referable to L5 nerve compression for whom no proximal pathology is identified could warrant investigation of the more distal extraforaminal segment of this nerve.

To cut or not to cut, that is the question: A review of the anatomy, the technique, risks, and benefits of an episiotomy.

Childbirth can be a traumatic experience on the female body. Some techniques may be implemented to make the process smoother and decrease the potential lacerations that can occur. Episiotomies have been used by obstetricians and midwives to help make the fetal decent down the vaginal canal less turbulent. A physician must use his best judgment on when it is necessary to make this incision and what form of incision to make. Before making an incision one must understand the female external and internal anatomy and thoroughly comprehend the stages of birth to understand how and what complications can occur. Even though an episiotomy is a minor incision, it is still a surgical incision nonetheless and as with any form of surgery there are both risks and benefits that are to be considered. Nevertheless, episiotomies have proven to help ease births that are complicated by shoulder dystocia, prevent severe lacerations, and decrease the second stage of labor. The following comprehensive review provides a description of the female anatomy, as well as an extensive description of why, when, and how an episiotomy is done. Clin. Anat. 30:362-372, 2017. © 2017 Wiley Periodicals, Inc.

The naming game: A discrepancy among the medical community.

As anatomists we rely on the nomenclature of structures in order to describe them appropriately, particularly their orientation in respect to their surrounding. The terminology used by the anatomist to describe an organ, muscle, or nerve within the body is taught to medical students as law. Students learn to describe structures in the "anatomical position", which has been accepted in the literature since the original Latin Nomina Anatomica. They therefore familiarize themselves with the use of terms such as superior, inferior, posterior and anterior to describe all anatomical structures, except in respect of the heart. The heart is still described in the original Valentine position. As anatomists we owe it to the medical and research community to correct the nomenclature to minimize confusion, and to describe the heart properly in respect to its surrounding structures.

Lumbar ribs: a comprehensive review.

BACKGROUND: To date, no single comprehensive review has been published regarding lumbar ribs. Therefore, the present review was conducted to better elucidate these variant anatomical structures, which can be confused with transverse process fractures or result in miscounting of spine segments for surgical procedures. METHODS: Using standard search engines, a review of lumbar ribs was performed. CONCLUSIONS: Lumbar ribs are uncommon but can be misinterpreted on imaging or cause confusion during surgery. Mutations of the FGD1 or Hox10 gene may be involved in the development of lumbar ribs. Knowledge of these structures can decrease misdiagnosis when they are present.