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Purpose Rotation of the tibia relative to the femur was recently identified as a contributing risk factor for patellar instability, and correlated with its severity. The hypothesis was that in patellofemoral dysplastic knees, an increase in femorotibial rotation can be reliably detected on anteroposterior (AP) radiographs by an overlap of the lateral femoral condyle over the lateral tibial eminence. Methods Sixty patients (77 knees) received low-dose computed tomography (CT) of the lower extremity for assessment of torsional malalignment due to recurrent patellofemoral instability. Three-dimensional (3D) surface models were created to assess femorotibial rotation and its relationship to other morphologic risk factors of patellofemoral instability. On weight-bearing AP knee radiographs, a femoral condyle/lateral tibial eminence superimposition was defined as a positive winking sign. Using digitally reconstructed radiographs of the 3D models, susceptibility of the winking sign to vertical/horizontal AP knee radiograph malrotation was investigated. Results A positive winking sign was present in 30/77 knees (39.0%) and indicated a 6.3 ± 1.4° increase in femorotibial rotation ( p  < 0.001). Femoral condyle/tibial eminence superimposition of 1.9 mm detected an increased femorotibial rotation (> 15°) with 43% sensitivity and 90% specificity (AUC = 0.72; p  = 0.002). A positive winking sign (with 2 mm overlap) disappeared in case of a 10° horizontally or 15° vertically malrotated radiograph, whereas a 4 mm overlap did not disappear at all, regardless of the quality of the radiograph. In absence of a winking sign, on the other hand, no superimposition resulted within 20° of vertical/horizontal image malrotation. Femorotibial rotation was positively correlated to TT–TG ( R 2  = 0.40, p  = 0.001) and patellar tilt ( R 2  = 0.30, p  = 0.001). Conclusions The winking sign reliably indicates an increased femorotibial rotation on a weight-bearing AP knee radiograph and could prove useful for day-by-day clinical work. Future research needs to investigate whether femorotibial rotation is not only a prognostic factor but a potential surgical target in patients with patellofemoral disorders. Level of evidence III.

Brain Computer-Interface (BCI) technology plays a considerable role in the control of rehabilitation or peripheral devices for stroke patients. This is particularly due to their inability to control such devices from their inherent physical limitations after such an attack. More often than not, the control of such devices exploits electroencephalogram (EEG) signals. Nonetheless, it is worth noting that the extraction of the features and the classification of the signals is non-trivial for a successful BCI system. The use of Transfer Learning (TL) has been demonstrated to be a powerful tool in the extraction of essential features. However, the employment of such a method towards BCI applications, particularly in regard to EEG signals, are somewhat limited. The present study aims to evaluate the effectiveness of different TL models in extracting features for the classification of wink-based EEG signals. The extracted features are classified by means of fine-tuned Random Forest (RF) classifier. The raw EEG signals are transformed into a scalogram image via Continuous Wavelet Transform (CWT) before it was fed into the TL models, namely InceptionV3, Inception ResNetV2, Xception and MobileNet. The dataset was divided into training, validation, and test datasets, respectively, via a stratified ratio of 60:20:20. The hyperparameters of the RF models were optimised through the grid search approach, in which the five-fold cross-validation technique was adopted. The optimised RF classifier performance was compared with the conventional TL-based CNN classifier performance. It was demonstrated from the study that the best TL model identified is the Inception ResNetV2 along with an optimised RF pipeline, as it was able to yield a classification accuracy of 100% on both the training and validation dataset. Therefore, it could be established from the study that a comparable classification efficacy is attainable via the Inception ResNetV2 with an optimised RF pipeline. It is envisaged that the implementation of the proposed architecture to a BCI system would potentially facilitate post-stroke patients to lead a better life quality.

The Marcus-Gunn jaw-winking phenomenon (MGJWP) is an uncommon congenital oculofacial synkinesis resulting from abnormal innervation between the fifth cranial nerve (trigeminal, CN V) and the third cranial nerve (oculomotor, CN III). This case report presents a 5-month-old girl with characteristic left eyelid elevation during suckling movements, highlighting the importance of clinical observation in early diagnosis. The condition was confirmed based on clinical findings, with no associated neurological or structural abnormalities. Management involved observation and follow-up to monitor potential complications such as strabismus or anisometropia. MGJWP remains an essential consideration in cases of unusual eyelid movement, emphasizing the role of multidisciplinary consultation for comprehensive care.

Purpose: To report a rare case series of 14 patients of the Marcus-Gunn jaw-winking phenomenon (MGJWP) without ptosis. Methods: This was a retrospective noninterventional case series. The medical records of all patients diagnosed with MGJWP over the past 10 years were retrieved. Patients with documented evidence of absence of ptosis were segregated and analyzed for visual acuity, the severity of Marcus-Gunn, the presence of squint and amblyopia, and the presence of other aberrant regenerations. Results: A total of 207 patients were diagnosed with MGJWP, out of which 14 (6.76%) patients had isolated MGJWP without blepharoptosis. The mean age of presentation was 9.5 years and males and females were equally affected. The left eye was involved more commonly (57.2%) than the right eye. Twelve patients were congenital and two were presumed to be of traumatic origin. The most common refractive error in this cohort was astigmatism (10, 71.42%), followed by hyperopia (5, 35.71%). One patient had anisometropic amblyopia. Marcus-Gunn was found to be mild (≤2 mm of lid excursion) in all cases. None of the patients had strabismus or any other aberrant innervations. None of the patients underwent surgery and did not develop ptosis or worsening or improvement of Marcus-Gunn after a mean follow-up period of 2.3 years. Conclusion: Isolated MGJWP in the absence of ptosis is a very rare entity and this is the largest series to date to report such an occurrence. All patients had a mild form of MGJWP with no intervention required in any of the cases.

The winking earlobe sign is a sign of tricuspid regurgitation, characterized by the movement of the earlobe coincident with the pulse. The winking earlobe sign is a sign of tricuspid regurgitation, characterized by the movement of the earlobe coincident with the pulse.

Introduction The main purpose of this study was to investigate the cerebral areas responsible for winking by observing the activation pattern and learning effects on cerebral cortices by comparing differences in activation pattern during winking before and after learning. Methods Sixty‐three subjects were recruited, including 22 (11 males; 11 females) who could wink bilaterally and 41 (14 males; 27 females) who could wink unilaterally. Event‐related functional magnetic resonance was performed. The subjects were asked to blink and wink according to projected instructions as the events for image analysis. The activation pattern was obtained by contrasting with the baseline images without eyelid movements. Those who could only wink unilaterally were asked to train themselves to wink the other eye. For those who succeeded (n = 24), another imaging study was performed and the results were compared with those before training. Results and conclusion Left winking resulted in activation in the left frontal lobe, while right winking resulted in activation in bilateral frontal lobes with predominance on the right side. For the subjects capable of only winking unilaterally, learning to wink on the other side activated similar cortical areas to those in the subjects capable of bilateral winking without training. Winking one eye can be learned easily, so that winking may be a good model to investigate the learning effects of controlling facial muscles on the cerebral cortex. Left winking showed activation in the left frontal lobe, while right winking showed activation in the bilateral frontal lobes with predominance on the right side. For the subjects capable of only winking unilaterally, learning to wink on the other side activated similar cortical areas to those in the subjects capable of bilateral winking without training. Learning to wink is achieved through strengthening the activation of inherent cortical areas, not by recruiting and changing the function of other cortical areas.

Marcus Gunn jaw-winking syndrome (MGJWS) is a rare form of congenital blepharoptosis and one of the congenital cranial dysinnervation disorders (CCDD). In addition, morning glory disc anomaly (MGDA) is a congenital optic disc anomaly of unknown etiology. The present report is the first to describe an association between MGJWS and MGDA in an otherwise healthy 7-year-old boy. He also had counting finger vision, anisometropia, esotropia, and monocular elevation deficiency in the same eye. In the literature, both MGJWS and MGDA have been reported to be associated with Duane retraction syndrome, a form of CCDD.

Introduction: Marcus Gunn syndrome is a rare phenomenon with very less number of cases reported in literature. It may be congenital or acquired. Aim: The aim of this case report was to report the clinical characteristics of Marcus Gunn patient from our Clinic. Case report: A comprehensive opthalmologic examination, CDVA (corrected distance visual acuity), fundus examination and photography, was conducted in Marcus Gunn patient. Clinical findings of patient presented as - chin positioned slightly upwards, extraocular motility normal on both eyes, cover test with normal findings, pupillary examination normal on both eyes. Left upper eyelid was in a lower position than the right one. On right eye, rima interpalpebrarum was 9 mm with upgaze of 13mm. On the left eye, rima interpalpebrarum was 5 mm with upgaze of 6 mm, and with open mouth, left rima interpalpebrarum was 10 mm. Visual acuity on both eyes was 1.0. Cycloplegic refraction on both eyes was +0,75 diopters (D), and Lang test was normal. In the differential diagnosis of patients with ptosis, Marcus Gunn jaw winking syndrome should be considered especially if it improves during feeding, sucking, chewing, smiling or any kind of mouth movement. In case of ptosis always do the jaw test. Have the infant bottle-feed. An older child can chew gum. Have the patient open the mouth, move the jaw from side to side, or protrude the jaw forward. Conclusion: Address first to treatment of any amblyopia if present - eyeglasses, patching etc., or strabismus. Think twice before deciding to operate.

Jaw-winking or the Marcus Gunn phenomenon (MGP), a congenital uncommon condition characterized by involuntary elevation of a drooping upper eyelid concomitant with various movements of the mandible, is well-documented in medical literature, but very little information is available in dental literature. This is an interesting case report of a 17-year-old female with MGP, who reported for orthodontic treatment of her proclined upper anterior teeth, severe lower crowding, and mandibular micrognathia. Review of the literature revealed only two reported cases of dental anomalies in conjunction with MGP. The patient also gave a positive family history of MGP with a maternal cousin having a similar problem. Dentists and other oral health professionals can play a significant role in detection and diagnosis of this rare condition and should take protective measures during dental and oral surgical procedures.

Trigeminal-oculomotor synkinesis also known as the Marcus Gunn jaw winking phenomenon was first described by the ophthalmologist, Marcus Gunn, in 1883. It is one of the common congenital oculofacial synkinesis, and accounts for approximately 5% of all congenital ptosis. It is characterized by the involuntary winking of eyes during jaw movement, due to an aberrant connection between the mandibular division of the trigeminal nerve and one of the divisions of the occulomotor nerve. Here we report an unusual case of the Marcus Gunn jaw winking phenomenon, which was diagnosed accidentally.