Photoacoustic (PA) imaging is hybrid imaging modality with good optical contrast and spatial resolution. Portable, cost-effective, smaller footprint LEDs are rapidly becoming important PA optical sources. However, the key challenge faced by the LED-based systems is the low fluence that is generally compensated by high frame averaging; consequently reducing acquisition frame-rate. In this study, we present a simple deep learning U-Net framework that enhances the signal-to-noise ratio (SNR) and contrast of the low number of frame-averaged PA images. The SNR increased by approximately 4-fold for both in-class in vitro phantoms (4.39 ± 2.55) and out-of-class in vivo models (4.27 ± 0.87). We also demonstrate the noise invariancy of the network and discuss the downsides (blurry outcome and fails to reduce the salt & pepper noise). Overall, the developed U-Net framework can provide a real-time image enhancement platform for clinically translatable low-cost and low-energy light source-based PA imaging systems.
Objective: Approximately 50% women who give birth after Obstetric Anal Sphincter Injury (OASI) develop anal incontinence (AI) over their lifetime. We review current evidence for protective benefit of planned cesarean section (CS) to prevent AI after OASI. Design and setting: Systematic review and meta-analysis according to prospectively published methodology. Population and methods: All studies reporting outcomes after an OASI and subsequent birth by any mode. Main outcome measures: AI measurement after OASI and subsequent birth. Total AI, new/worsening AI, quality of life, satisfaction, regret. Results: 86 of 2472 screened studies met inclusion criteria. All studies contributing to meta-analyses were at high risk of bias. There was no evidence of difference in new or worsening AI after subsequent vaginal birth (VB) compared to subsequent CS after OASI across all time periods (p=0.53: CI 0.72-1.19; 9 studies, 2104 participants); ≤2y (p=0.83: CI 0.65-1.72; 7 studies, 569 participants) or ≥5y after subsequent birth (p=0.39: CI 0.65-1.18; 2 studies; 1535 participants). There was no difference between subsequent CS or VB in asymptomatic women or for other AI or QOL outcomes. There was no evidence of difference in AI in women who subsequently delivered vs those who did not (p=0.9: CI 0.71-1.34; 10 studies, 970 participants); or pre- subsequent birth vs post-subsequent birth (p=0.31; CI 0.51-1.25, 13 studies, 5496 participants). Conclusions: Due to evidence quality (majority non-randomised studies) we are unable to determine whether planned cesarean is protective against AI after OASI. Higher quality data is required to guide practice in this area, specifically in asymptomatic women and for long-term outcomes.
Pancreatic cancer (PC), a highly malignant tumor of the digestive system with poor therapeutic response and low survival rates. In recent years, immunotherapy have developed rapidly and achieved substantial results in many malignant neoplasms. However, responses to immunotherapy in PC are rare and its immunosuppressive and desmoplastic tumor microenvironment (TME) composes an important impediment to their efficacy in PC. Tumor-associated neutrophils (TANs) play a crucial role in the PC microenvironment, exerting a profound influence on PC immunotherapy through establishing a robust stromal shelter and restraining immune cells to assist PC cells in immune escape, which may subvert the current situation of immunotherapy for PC. The purpose of this review is to offer a thorough summary of the latest progress in comprehending the involvement of TANs in PC desmoplastic and immunosuppressive functions, as well as to emphasize the potential therapeutic consequences of focusing on TANs in the immunotherapy of this destructive ailment. Last but not least, we have provided an outlook for the future of TANs in PC immunotherapy.
Protein glycosylation is increasingly recognized as a common protein modification across bacterial species. Within the Neisseria genus O-linked protein glycosylation is conserved yet closely related Neisseria species express O-oligosaccharyltransferases (PglOs) with distinct targeting activities. Within this work, we explore the targeting capacity of different PglOs using Field Asymmetric Waveform Ion Mobility Spectrometry (FAIMS) fractionation and Data-Independent Acquisition (DIA) to allow the characterization of the impact of changes in glycosylation on the proteome of N. gonorrhoeae. We demonstrate FAIMS expands the known glycoproteome of wild type N. gonorrhoeae MS11 and enables differences in glycosylation to be assessed across strains expressing different pglO allelic chimeras with unique substrate targeting activities. Combining glycoproteomic insights with DIA proteomics, we demonstrate that alterations within pglO alleles have widespread impacts on the proteome of N. gonorrhoeae. Examination of peptides known to be targeted by glycosylation using DIA analysis supports alterations in glycosylation occupancy occurs independently of changes in protein levels and that the occupancy of glycosylation is generally low on most glycoproteins. This work thus expands our understanding of the N. gonorrhoeae glycoproteome and the roles that pglO allelic variation may play in governing genus-level protein glycosylation.
Metal Additive Manufacturing technologies provide new opportunities for manufacturing complex components. However, the limited and scattered data on damage tolerance behavior is hindering adoption in safe-critical applications. A design of experiments (DOE) is used in this study to provide an understanding of the Electron Beam Melted (EBM) Ti6Al4V fracture toughness properties. Three builds comprised of 150 compact tension samples were printed representative of the EBM build chamber, followed by surface machining, microstructural characterization, X-ray microcomputed tomography (µCT), and fracture toughness testing per ASTM E399. Analysis of Variance (ANOVA) statistics on the influence and interaction of intra-build design parameters on the As-Built and Machined samples showed orientation, build location, and geometry to contribute to property variation. EBM fracture toughness reported an average of 65 MPa√m, with an increase in build height and proximity to the center of the build envelope. The location- and size-dependent properties resulted from changes in microstructure and porosity throughout the build space. While intra-build design variation was present, the EBM Ti6Al4V fracture toughness properties reported a 10% overall variation comparable to wrought and cast alloys. The extensive experimental work in this study shows EBM Ti6Al4V to be a repeatable and reliable alloy for use in load-bearing applications.
In this study, we investigated a new structure of a protective meander line (ML): a meander microstrip line (MSL) with two passive conductors. The existing theory of ultra-short pulse (USP) attenuation in MLs is presented for the first time. Based on this theory, we determined the number of decomposed pulses at the output of the MSL line with two passive conductors, and, for the first time, formulated the conditions for pulse decomposition in the line. The folding of the MSL line into non-core turns was studied in detail. As a result of this study, we proposed a new theory that involves the utilization of additional groups of decomposed pulses for enhanced USP attenuation. These additional groups were thoroughly examined, and the delays of pulses from these groups were defined. This analysis allowed identifying the reason for their appearance. It was revealed that folding the meander line into non-core turns allows further attenuation of the USP amplitude, which increases with the increase of the number of non-core turns. To validate the obtained simulation results, we performed experimental measurements and obtained good consistency of the results. The N-norms analysis demonstrated that combined use of such folding and passive conductors reduces the probability of electrical breakdown, arc discharge, and dielectric breakdown. The maximum USP attenuation at the output was 24.9 dB. As a result of useful signal integrity analysis, it is proposed to use a folded meander microstrip line (MSL) together with a USB 2.0 “Full-speed” interface with a data transfer rate of 12 Mbit/s. In addition, it is proposed to use such MSLs in DC power circuits.
Regulatory cells are critical for maintaining immune homeostasis in the central nervous system. Regulatory cell populations have been reported to control neuroinflammation in neurodegenerative conditions like Parkinson’s disease, multiple sclerosis, myasthenia gravis, encephalomyelitis, and Alzheimer’s disease by protecting neurons through different mechanisms, including the production of cytokines such as IL-10 and TGF-β, promoting the expression of inhibitory receptors (PD1, TIM3, LAG3), and inducing tolerance through cell-cell interactions by CTLA-4. Various phenotypes of CD4+ and CD8+ regulatory T cells, Bregs, MDCS, and tolDCs have been described and, despite the great interest in their function, few studies have focused on elucidating their role in neurodegenerative diseases. Therefore, this review aims to describe the mechanisms of regulation and suppression of effector cells in neurodegenerative diseases. The study of these mechanisms has led to the development of therapeutic approaches targeting molecules with suppressive or regulatory activity in severe neurological disorders.
Rationale: A novel laser ablation-isotope ratio mass spectrometry (LA-IRMS) method for in situ sulfur isotope analysis of sulfides has been developed. Instead of the in situ reaction applied by the traditional laser microprobe, the analyte gas preparation in this method is separated temporally and spatially from the laser ablation, resulting in improved precision and accuracy. Methods: Our LA-IRMS system combines an ultraviolet (UV) LA system, an elemental analyzer (EA), a custom-built cryogenic concentration system, a continuous-flow interface and an IRMS. The sulfide aerosol particles generated from LA were transferred by a helium carrier gas from the ablation cell into the reaction tube and were converted into SO 2. Then SO 2 was enriched in two cold traps and was finally introduced into the ion source of an IRMS through a continuous-flow interface. Results: We measured three synthetic and four natural sulfide reference materials to test the performance of this method. Precisions of ±0.25-±0.64‰ (1SD, n=5) for δ 34S values can be obtained at a spot size of 64~80 μm. Measured values and their known true values for these sulfur isotope reference materials showed good linear relationship (R 2=0.998~0.9995) with slope of approaching unity (1.0509~1.1313). Conclusions: Data from the measurement of reference materials showed that the precision and accuracy of our method was satisfactory. This method is a powerful tool for in situ sulfur isotope measurement of sulfides, and can be further applied to in situ carbon and oxygen isotope analyses.
The mid-term impact of SARS-CoV-2 infection on senescence profile and immune checkpoints biomarkers in people living with HIV (PLWH) was assessed. Cross-sectional study in 95 PLWH on ART stratified by SARS-CoV-2 infection: a) 48 PLWH previously infected (PCR+) (HIV/SARS); b) 47 PLWH controls without previous infection (HIV). Plasma biomarkers (n=44) related to cell immune checkpoint molecules, associated with the Senescence-Associated Secretory Phenotype (SASP), and related to pro and anti-inflammatory cytokines were assessed by Procartaplex Multiplex Immunoassays (Xmap-Luminex technology). Differences between groups were analyzed using a generalized linear model, adjusted by sex and ethnicity and corrected by false discovery rate. Significant values were defined as the adjusted arithmetic mean ratio ≥1.2 or ≤0.8; q-value<0.1. The relationship between plasma biomarkers was evaluated by Spearman correlation (significant correlations rho≥0.3 and q-value<0.1). PLWH had a median age of 45 years and 80% were men. All PLWH infected by SARS-CoV-2 had a symptomatic infection, 83.3% as mild, and with a median of 12 weeks after diagnosis of SARS-CoV-2 infection. HIV/SARS group showed higher levels of the cell immune checkpoint plasma biomarkers CD80, PDCD1LG2, CD276, PDCD1, CD47, HAVCR2, TIMD4, TNFRSF9, TNFRSF18, and TNFRSF14 respect to HIV group. The SASP biomarkers LTA, CXCL8, and IL13 and the inflammatory biomarkers IL4, IL12B, IL17A, CCL3, CCL4, and INF1A showed significantly higher levels in the HIV/SARS group. SARS-CoV-2 infection in PLWH leads to significant medium-term disruption in plasma immune checkpoint molecules and inflammatory cytokines, highlighting SASP-related. This could be a risk factor for the emergence of complications in PLWH.
Epidemiological studies have explored the relationship between allergic diseases and cancer risk or prognosis in AllergoOncology. Some studies suggest an inverse association, but uncertainties remain, including in IgE-mediated diseases and glioma. Allergic disease stems from a Th2-biased immune response to allergens in predisposed atopic individuals. Allergic disorders vary in phenotype, genotype, and endotype, affecting their pathophysiology. Beyond clinical manifestation and commonly used clinical markers, there is ongoing research to identify novel biomarkers for allergy diagnosis, monitoring, severity assessment, and treatment. Gliomas, the most common and diverse brain tumours, have in parallel undergone changes in classification over time, with specific molecular biomarkers defining glioma subtypes. Gliomas exhibit a complex tumour-immune interphase and distinct immune microenvironment features. Immunotherapy and targeted therapy hold promise for primary brain tumour treatment, but require more specific and effective approaches. Animal studies indicate allergic airway inflammation may delay glioma progression. This collaborative European Academy of Allergy and Clinical Immunology (EAACI) and European Association of Neuro-Oncology (EANO) Position Paper summarizes recent advances and emerging biomarkers for refined allergy and adult-type diffuse glioma classification to inform future epidemiological and clinical studies. Future research is needed to enhance our understanding of immune-glioma interactions to ultimately improve patient prognosis and survival.
Background: This study aimed to compare patients with migraine and embolic stroke of undetermined source (ESUS) with known patent foramen ovale (PFO) in terms of echocardiographic and clinical features. Methods: In this observational single-center study, we obtained 2-dimensional (2D) and color Doppler images using parasternal short axis (PSAX), apical 4-chamber (A4C), and subcostal 4-chamber (SC4C) transthoracic echocardiography (TTE) views for patients with Migraine and ESUS. In cases where a PFO was suspected, patients underwent transthoracic contrast echocardiography and transesophageal echocardiography (TEE). We compared the anatomical and functional high-risk characteristics of PFO, as assessed by TEE and the RoPe score, in both patient groups. Results: This research involved a cohort of 720 individuals with ages ranging from 18 to 60, and 73.2% of the participants were female. Among the participants, 43.5% had Migraine, and 56.5% had ESUS. The most common comorbidity was diabetes (26.1%). PFO characteristics were measured, and high-velocity shunting through the interatrial septum was observed in 35.5% of patients. ESUS patients had a higher median age, with a similar gender distribution. ESUS patients had higher rates of diabetes and hypertension, while active smoking was more common in Migraine patients. Basic echocardiographic parameters were similar, except for higher pulmonary artery systolic pressure in ESUS. In the ESUS group, as compared to the migraine group, there was a more substantial occurrence of large microbubble passage through the interatrial septum, and the PFO showed increased length, while the PFO width remained similar. The RoPe and High-risk PFO scores were similar between the groups. Conclusions: ESUS patients were older with higher rates of diabetes and hypertension, while Migraine patients had a higher prevalence of active smoking. ESUS patients showed elevated pulmonary artery pressure, increased large microbubble crossings through the interatrial septum, and longer PFO lengths.
Transcriptomic Profiles of Well-Differentiated Airway Epithelial Cells in Response to Environmental Triggers of Asthma ExacerbationAntonella Marrocco1, Jennifer A. Mitchel1, Margaret Parker2, Maureen McGill1, Robert P. Chase2, Scott T. Weiss2, Diane R. Gold1,2, Peter J. Castaldi2, Jin-Ah Park1, Joanne Sordillo34Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA2Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA.3Division of Chronic Disease Research Across the Lifecourse (CoRAL), Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.Corresponding Author: Joanne E. SordilloEmail : [email protected]:Landmark Center West 401 Park Dr., 4th Floor Boston, MA 02115The authors have no conflicts of interest to disclose.Funding: R01HL148152, P30ES000002, T32HL007118, Francis Family FoundationKeywords: Bronchial epithelial cells, gene expression, RNAseq, asthma
In this article, we extend a previously developed globally optimal enumeration methodology for the synthesis of Heat Exchanger Networks to the simultaneous synthesis of the network and the basic design of Heat Exchangers. Our procedure guarantees global optimality, unlike previous approaches, such as Pinch Technology, metaheuristics, or mathematical programming that do not guarantee it and sometimes do not even guarantee local optimality. The procedure is not iterative, and does not present any convergence issues. To enumerate HEN structures, we use linear methods and for the HEX design we use Set Trimming followed by sorting. In addition, because some network structures are incompatible with single shell exchangers, we use multiple shell exchangers in series. The comparison of the results of the proposed approach with two solution alternatives from the literature in two different problems indicates that considerable cost reductions may be obtained.
Phytosterols usually have to be esterified to various phytosterol esters to avoid their disadvantages of unsatisfactory solubility and low bioavailability. The enzymatic synthesis of phytosterol esters in solvent-free system has advantages in terms of environmental friendliness, sustainability, and selectivity. However, the limitation of the low stability and recyclability of the lipase in the solvent-free system, which often requires a relatively high temperature to induce the viscosity, also increased the industrial production cost. In this context, a low-cost material, namely diatomite, was employed as the support in the immobilization of Candida rugosa lipase (CRL) due to its multiple modification sites. The Fe3O4 was also then introduced to this system for quick and simple separation via the magnetic field. Moreover, to further enhance the immobilization efficiency of diatomite, a modification strategy which involved the octadecyl and sulfonyl group for regulating the hydrophobicity and interaction between the support and lipase was successfully developed. The optimization of the ratio of the modifiers suggested that the -SO3H/C18 (1:1.5) performed best with an enzyme loading and enzyme activity of 84.8 mg·g-1 and 54 U·g-1, respectively. Compared with free CRL, the thermal and storage stability of CRL@OSMD was significantly improved, which lays the foundation for the catalytic synthesis of phytosterol esters in solvent-free systems. Fortunately, a yield of 95.0% was achieved after optimizing the reaction conditions, and a yield of 70.0% can still be maintained after 6 cycles.
Background: The importance of intra-articular corticosteroid treatment for osteoarthritis with its possible adverse effects requires a comprehensive review. Objectives: This review answers the following questions: 1) What evidence is available regarding the symptom-modifying and disease-modifying changes related to a single intra-articular corticosteroid injection for treating osteoarthritis? Moreover, 2) What evidence suggests corticosteroids are detrimental to equine joint health? Study design: Systematic review. Methods: A systematic search was conducted in June/2022 in PubMed, CAB, and the Web of Science. Inclusion criteria were applied to titles and abstracts. For each question, further criteria were applied. The risk of bias was assessed according to the study design. Results: We generated 6,417 titles, and 23 articles fit all inclusion criteria for single-injection corticosteroid treatments; 21 were included regarding corticosteroid effects on joint health. Studies were usually rated as having an unclear risk of bias. Single-injection protocols lead to short-term symptom-modifying osteoarthritic changes with conflicting results regarding disease-modifying osteoarthritis. Healthy joints demonstrated disturbances in metabolism and tissue changes, with dose-dependent effects found in vitro. Main limitations: There is a lack of studies regarding the topics–primarily for equine species. Conclusions: Symptom-modifying osteoarthritic changes after a single injection are short-term; however, a consistent disease-modifying osteoarthritis effect is yet to be established. Joint health appears to be disturbed by corticosteroids as their effects on normal joints show adverse changes in tissues and metabolism.
Objective To identify primary care recorded factors associated with the short-term human papillomavirus (HPV) vaccination among girls and female adolescents. Methods We used the Spanish Pharmacoepidemiological Research Database for Public Health System to identify girls aged 9-18 years in 2007-2016 with ≥1 year of primary care data (start date) and collect baseline characteristics and consultations. The link between those factors and the 1-year HPV vaccination was assessed through multivariate adjusted Odds Ratios (OR; 95% CI). Results Among 388,669 girls identified, 14,999 were vaccinated against HPV during the first year. The vaccination decreased among girls consulting for social (0.62; 0.55-0.70) or adaptation (0.60; 0.38-0.93) problems, prescriptions of benzodiazepines (0.58; 0.35-0.94) or drugs for gastrointestinal symptoms (0.58; 0.38-0.89), with recorded tuberculosis test (0.68; 0.52-0.87), B and C meningitis (0.46; 0.43-0.50) vaccination, consulting the doctor in the last 3 months (0.92; 0.87-0.98) and with severe thinness (0.68; 0.59-0.78) or obesity (0.88; 0.78-0.99). The odds increased among girls with abdominal pain (1.10; 1.04-1.16), prescriptions in the last 3 months (1.17; 1.10-1.25), and vaccinations against chickenpox (1.16; 1.07-1.27), influenza (1.23; 1.08-1.40), hepatitis (1.46; 1.35-1.58) and diphtheria-tetanus (1.91; 1.82-2.01). Conclusions The correlation between the HPV and other vaccinations suggested medical (contra)indications or willingness and knowledge/beliefs that might affect different vaccinations similarly. The higher frequency of the HPV vaccination among females requiring specific treatments or with abdominal pain suggested vulnerability to HPV complications. While a decreased HPV vaccination linked to certain social and personal situations (and benzodiazepines treatment) requires further research.
Accidental Finding Prior to Rhinoplasty: Rhinolith- A Rare Case ReportKey Clinical MessageThrough this case report, we review a rare radiopacity finding within the nasal cavity and its histopathological findings in order to emphasize the importance of familiarizing oneself with all radiographic findings, regardless of their rarity.Keywords: Rhinoplasty; Nasal Cavity; Nasal Obstruction; RhinolithIntroductionA rhinolith, also known as a nasal calculus, is a densely calcified mass, possibly formed around either external substances such as stones, batteries and plastic, or internal materials including dental epithelium and dried blood clots, within the nasal cavity (1-4). However, its exact etiology remains unknown (2). Typically, it is found either between the maxillary sinus wall and the inferior turbinate or between the nasal septum and inferior turbinate (1). Rhinoliths are generally single, unilateral and have an irregular shape (5). Various sizes and internal structures have been reported based on the nature of the rhinolith’s core, including homogeneous or heterogeneous radiopacities (6). The occurrence of rhinoliths in the oral and maxillofacial structures is rare (1). However, they are more commonly observed in young adults, females, and individuals with a low socioeconomic status (2). Symptoms such as headache, anosmia, nasal obstruction, discharge, swelling, unpleasant nasal odor, halitosis, epistaxis, localized pain, and fever have been reported in approximately 1 out of 10,000 patients visiting ear, nose, and throat (ENT) specialists in relation to rhinoliths, which may persist for months or even years (4, 6). Although rhinoliths are often asymptomatic (7) and may be detected incidentally through routine radiographic imaging (5). Conventional radiographs are useful in differentiating rhinoliths from other lesions and detecting their location, especially in cases where the foreign body has high radiodensity (5, 7). However, computed tomography (CT) is more effective in localizing rhinoliths with lower radiodensity in the core (3).In this case report, we present the incidental detection of a rhinolith through radiographic imaging in a 20-year-old patient who was a candidate for aesthetic rhinoplasty.Case presentationA 20-year-old female came to the outpatient department as a candidate for rhinoplasty. The patient’s general medical history and the head and neck examinations were unremarkable. There were no complaints of nasal obstruction or discharge. On extraoral examination, there was no sensory disturbance and the face was symmetrical except for the nasal septum deviation. Cone beam computed tomography (CBCT) was prescribed to the septum deviation. The CBCT revealed an s-type deviation of the nasal septum, open ostia, and clear maxillary sinus cavity. Additionally, a solitary, densely heterogenic calcified mass measuring 9.3 mm in width, 14.4 mm in height, and 8.7 mm in anteroposterior size was noted in the right nasal fossa between inferior turbinate and nasal septum. The mass was attached to the septum and the superomedial portion of inferior nasal concha and the inferomedial part of the middle nasal concha. The mass was well defined with mix, mostly opaque, and laminated internal view. (fig. 1)Based on the radiographic findings, three differential diagnoses were rhinoliths, paranasal osteoma, and nasal foreign body.The procedure entailed the removal of the lesion under general anesthesia. The lesion, which was attached to the perichondrium, was successfully excised using a nostril approach. Unilateral perforations on the mucosa of the septum and inferior and middle conchae, resulting from the lesion removal, were left unsutured due to their size, allowing them to heal through secondary intention. The excised lesion was sent for histopathological evaluation, and a routine septorhinoplasty was performed. For this purpose, a septal graft was harvested. However, the preserved L-strut proved inadequate in supporting the septal mucosa perforation due to its location and the amount of cartilage graft required. Turbinate outfracture or cauterization were not carried out, although turbinectomy was performed. An internal splint was applied as a routine measure, and follow-up sessions were scheduled for 1 week, 1 month, 3 months, and 6 months after the operation.The histological examination revealed the presence of vascular respiratory epithelium, with subepithelial glands displaying a bland appearance and mild chronic inflammation. Calcified foreign body fragments were also identified. No atypical cells or conclusive evidence of malignancy were detected. The histological findings were consistent with a diagnosis of rhinolith. (fig.2)The patient expressed satisfaction with the results and reported no nasal obstruction. Additionally, the patient noted improved breathing, despite having had no difficulties in breathing prior to the operation. No asymmetry was detected.A CBCT scan was ordered 3 months post-surgery to validate the histopathologic outcomes and confirm the complete removal of the lesion. The CBCT evaluation confirmed the successful and complete excision of the lesion, thus supporting the rhinolith diagnosis. Synechia was found to be limited. (fig.3)DiscussionRhinoliths are uncommon findings, likely caused by the deposition of mineral salts around a nidus, such as a foreign body (8). A high level of suspicion is necessary, and differential causative factors, including osteoma, calcified nasal polyps, and ossifying fibroma should be considered to choose the best treatment approach (9). A variety of symptoms may be reported, depending on the localization and size of the lesion, such as unilateral nasal obstruction, epistaxis, headache, anosmia, epiphora, and purulent rhinorrhea (2, 9). However, rhinoliths can also be asymptomatic (6). Therefore, in cases with no symptoms, radiographic scans can lead to a diagnosis of rhinolith (4). A radiopaque lesion with lesser radiopacity in the center, located in either the nasal cavity or maxillary sinus, is a good predictor for rhinolith (5). However, rhinoliths may also appear as a homogeneous radiopaque view due to the presence of a radiopaque nidus (2).In the present case, CBCT evaluations revealed a mixture of radiopaque and radiolucent radiographic findings. Furthermore, in the absence of any symptoms, a histopathological examination was conducted to establish a definitive diagnosis.In cases where there is a coexistence of septal deviation and rhinoliths, the septum is typically deviated towards the opposite side of the rhinolith (2). This is likely due to the influence of the rhinolith on the cartilaginous septum during mass growth (2). This finding is consistent with our case.Although previous studies have reported the concurrent performance of septoplasty or septorhinoplasty and removing rhinolith (2), the specific details of the septoplasty procedures used are unclear. In this case presentation, we have provided a detailed description of the septorhinoplasty procedure to assist surgeons in surgical planning.The defects in the intranasal mucosal lining may be asymptomatic and do not require additional treatment procedures (10). However, the intranasal exposure of the spreader grafts may occur due to the presence of a defect in the mucosa. Therefore, large defects may require covering the grafts using various techniques to protect them from intranasal exposure (11).A variety of surgical interventions have been introduced to manage perforations of the septal mucosa in cases where the underlying septum is also perforated. These procedures are categorized into local flaps only or incorporation of interposition grafts (10). The local flap may be used unilaterally or bilaterally, unipedicled or bipedicled, and with an anterior or posterior base (12). The interposition graft can also be harvested from various sites including temporalis fascia, conchal cartilage, and tragal cartilage (10). In the present case, despite the absence of supporting septal cartilage, the unilateral perforation of septal mucoperichondrial tissue was left unsutured because of the intact contralateral mucoperichondrial tissue of the septum. Moreover, the internasal splint was used to prevent synechia following the unsutured perforation of the mucosa of the septum and inferior and middle conchae. Favorable outcomes revealed the secondary intention was successfully performed.However, there is insufficient evidence regarding the critical limit of septal mucosa perforation that prevents synechiae and ensures secondary intention. This may also be influenced by many other factors, including the cite of the perforation. Therefore, further researches should be conducted in this matter.Based on the favorable outcomes and absence of complications, the introduced procedure may be useful for assisting surgeons in carrying out septorhinoplasty and successfully removing the rhinolith without concerns about synechia.Conflict of interest statementThe authors have no conflict of interest to declare.ConsentWritten informed consent was obtained from the patient to publish this report in accordance with the journal’s patient consent policy.References1. Orhan K, Kocyigit D, Kisnisci R, Paksoy CS. Rhinolithiasis: an uncommon entity of the nasal cavity. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2006;101(2):e28-e32.2. Aksakal C. Rhinolith: Examining the clinical, radiological and surgical features of 23 cases. Auris Nasus Larynx. 2019;46(4):542-7.3. Hsiao J-C, Tai C-F, Lee K-W, Ho K-Y, Kou W-R, Wang L-F. Giant rhinolith: a case report. The Kaohsiung journal of medical sciences. 2005;21(12):582-5.4. Ersözlü T, Gültekin E. Rhinolith in the concha bullosa as a rare location: a case report. Journal of International Medical Research. 2020;48(8):0300060520951019.5. Barros CA, Martins RR, Silva JB, Souza JB, Ribeiro-Rotta RF, Batista AC, et al. Rhinolith: a radiographic finding in a dental clinic. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology. 2005;100(4):486-90.6. Maheshwari N, Etikaala B, Syed AZ. Rhinolith: An incidental radiographic finding. Imaging Sci Dent. 2021;51(3):333-6.7. Manzi FR, Peyneau PD, Piassi FP, Machado VdC, Lopes AC. Radiographic and imaging diagnosis of rhinolith in dental clinics: A case report. Revista Odonto Ciência. 2012;27:170-3.8. Seyhun N, Toprak E, Kaya KS, Dizdar SK, Turgut S. Rhinolithiasis, a rare entity: Analysis of 31 cases and literature review. North Clin Istanb. 2021;8(2):172-7.9. Vedasalam S, Sipaul F, Hill A, Porter G. Nasendoscopy for unusual nasal symptoms. BMJ Case Rep. 2010;2010.10. Goh A, Hussain S. Different surgical treatments for nasal septal perforation and their outcomes. The Journal of Laryngology & Otology. 2007;121(5):419-26.11. Toriumi DM. Structure rhinoplasty: lessons learned in 30 years: DMT Solutions; 2019.12. Watson D, Barkdull G. Surgical management of the septal perforation. Otolaryngologic clinics of North America. 2009;42(3):483-93.Figure legends:Fig.1: pre-operative CBCT. (a) sagittal view; (b) coronal aspect; (c) axial section.Fig.2: histopathological micrograph. Note the fragments of calcified foreign bodies.Fig.3: post-operative CBCT. (a) sagittal aspect; (b) coronal view; (c) axial section. Note the limited synechiae in comparison with pre-operative CBCT.