BACKGROUND Because the anatomic mechanisms underlying the formation of the midcheek groove are unclear, treatments to date have resulted in unsatisfactory outcomes. OBJECTIVE This study investigated the anatomical foundation of the midcheek groove and evaluated appropriate treatment methods. MATERIALS AND METHODS Six cadaver hemifacial specimens were subjected to gross anatomic dissection and 6 to P45 sheet plastination. Based on the anatomic results, the area under the orbicularis oculi muscle (OOM) was selected for deep filling. Patients were evaluated by measuring 3D depth, regrading, and self-assessment. RESULTS The medial band was observed to be an important structure of the OOM, with the facial projection overlapping the midcheek groove trace. Two of the 6 P45 specimens were found to have compact fibroelastic bundles (CFBs) between the medial band and the dermis. Deep filling of the area under the OOM significantly reduced the depth of each section in all 34 patients (p < .001). Grades 3 and 4 midcheek grooves were downgraded distinctively. Most subjects expressed satisfaction with outcomes. CONCLUSION Formation of the midcheek groove is associated with the passage of CFBs. Deep filling of the area under the OOM effectively improves the midcheek grooves.

To integrate the active advantages of 18β‐glycyrrhetinic acid (18β‐GA) and emodin, improve bioavailability, increase efficiency, and reduce toxicity, a one‐step innovative synthetic route was set up for the first time: 4‐dimethylaminopyridine (DMAP) was used as catalyst, 1‐ethyl‐(3‐dimethylaminopropyl)carboimide hydrochloride (EDCI) as condensation agent, dry dichloromethane (DCM) as solvent at 25 °C for 12 h, the three target products were obtained and purified by high performance liquid chromatography (HPLC), the chemical structures of them were characterized by nuclear magnetic resonance (NMR) technique and high resolution electron ionization mass spectrometry (HREI‐MS), namely, 18β‐glycyrrhetinic acid‐3‐emodin ester (1, yield 78.83 %, known), di‐18β‐glycyrrhetinic acid‐1‐emodin ester (2, yield 6.49 %, new), and di‐18β‐glycyrrhetinic acid‐8‐emodin ester (3, yield 1.81 %, new). To estimate their effects of the products on toxicity in zebrafish embryos and juvenile fishes, the two precursors and three target products were assayed involving in hatching rate, survival rate, morphology, heart rate, and apoptosis of cardiomyocytes. The results showed that the target products enhanced the hatching and survival rate of zebrafish embryos, decreased the malformation rate and the apoptosis of cardiomyocytes. It should be suggested that the one‐step synthesis route with high yield makes the industrial application of the target products possible due to significantly reduced toxicity. The two new by‐products provide potential candidates for the applications of pharmaceutical industry in the future.

Background: An isolated cervical or thoracic surgical approach provides insufficient exposure for achieving complete resection of tumors of the cervicothoracic junction. This study examines reverse "L" thoracotomy as a surgical approach to these tumors. Additionally, the feasibility, safety, and effectiveness of reverse "L" surgical incision for tumor resection was also analyzed.Methods: Patients with cervicothoracic tumors were identified from an internal database. Subjects were selected on the basis of undergoing reverse "L" thoracotomy from August 2014 to August 2018. The tumor characteristics, surgical technique, completeness of resection, morbidity, and patient outcome were reviewed.Results: All patients successfully underwent resection through reverse "L" surgical approach. No patients needed to undergo full sternotomy. There were 6 neurogenic tumors, 4 thyroid adenocarcinomas, 4 bronchogenic tumors, and 7 other cases in the study. The median operative time was 191.0 min (range, 113.0-348.0 min) and postoperative in-hospital stay ranged from 3 to 7 days. Horner syndrome was observed in 1 case. Hoarseness and lymphatic leakage were evident in 3 and 1 case(s), respectively. Hemidiaphragm paralysis was observed in 1 case. Three cases were unsuccessful in achieving R0 resection. The duration of follow-up ranged from 6 to 42 months. Eleven of 13 patients who underwent resection had no evidence of tumor recurrence. Two patients with metastatic disease died of distant progression within 15 months.Conclusions: Applying reverse "L" surgical approach is safe, feasible, and effective for the resection of giant tumors of the cervicothoracic junction.

This study was conducted to investigate the topographic relationship between the external laryngeal nerve (ELN) loop and the superior thyroid artery (STA), in order to provide the anatomical foundations for protecting the ELN during surgery. In the present study, 48 adult human cadavers were dissected and analyzed. For the 21 (21.9%) low-position ELN loops observed, the neurovascular relationship between the STA and the nerve was classified into four types: (1) the artery overlapped the nerve; (2) the artery passed through the ELN loop; (3) the muscular branch of the ELN loop and the laryngeal branch of the STA coursed together; and (4) the branches of the STA and the ELN loop were interlaced. Our study suggested that the patterns of ELN loops are so complicated that they have not been statistically defined in any previous study, which should be kept in mind when attempting to protect the nerve from injury. Also, because of the variable morphology of the ELN loop and its complicated topographic relationship to the STA, the vessels should be individually isolated and then ligated during thyroidectomy. When ligating the laryngeal branch of the STA during larynx surgery, special attention should be paid to avoiding damage to the muscular branch of the ELN/ELN loop.

StudyDesign. An anatomical study in 15 cadavers. Objective. To observe the anatomical relationship of the extrapedicular puncture approach with the spinal nerve and its branches, evaluate the risk of injury to these nerves and recommend a safe puncture path for lumbar extrapedicular percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP). Summary of Background Data. There have been no reports on the anatomical relationship of the extrapedicular approach with the spinal nerve and its branches. Methods. The positions, diameters, and paths of the anterior ramus (AR), medial branch (MB), and lateral branch (LB) outside the pedicles of L1-L4 were observed, and the related anatomical parameters were measured. Three types of extrapedicular puncture paths were simulated: puncture inside the MB, puncture outside the MB, and puncture outside the LB. By evaluating the risk of injury to the MB, LB, and AR, an appropriate puncture path was recommended. Results. During puncture inside the MB, the incidence of MB injury was 93.3% to 100%. During puncture outside the MB, the incidence rates of MB injury at L1 and L2 were 10.0% and 3.3%, respectively, and the incidence of LB injury at L4 was 10.0%. During puncture outside the LB, there were no cases of injury to the LB or MB. There was no incidence of AR injury during L1-L3 extrapedicular puncture, but the risk of AR injury was 3.3% when the procedure was performed at L4. The recommended technique is puncture outside the LB, where the needle vertically crosses the transverse process, slides inward, and advances while being held tightly against the bone. Conclusion. Extrapedicular puncture occurs adjacent to the spinal nerve and its branches, posing a risk of injury to these nerves. At the L1-L3 levels, puncture outside the LB can avoid damage to the spinal nerve and its branches.