Expression and functional characterization of tachykinin-related peptides in the blood-feeding bug, Rhodnius prolixus

Publication date: Available online 11 November 2017
Source:Peptides
Author(s): A.N.S. Haddad, M.S. Defferrari, S. Hana, S.G. Szeto, A.B. Lange
Tachykinins (tachykinin-related peptides, TRPs) are multifunctional neuropeptides that have widespread distribution in the central nervous system (CNS) and in the gastrointestinal tract of many insects, and most have been shown to stimulate contractions of visceral muscles. Invertebrate TRPs carry a characteristic conserved C-terminal pentapeptide (FXGXR-amide) and most of them share some amino acid sequence similarities (approx. 45%) with the vertebrate and mammalian tachykinin family. We have functionally characterized the tachykinins in R. prolixus (Rhopr-TKs) and partially cloned the transcript that encodes for the peptide precursor. The transcript encodes 8 Rhopr-TKs, 7 of which are unique with Rhopr-TK 5 having 2 copies. The spatial distribution analysis of the Rhopr-TK transcript indicates that the highest expression levels are in the CNS, but transcript expression is also associated with salivary glands, fat body, dorsal vessel, and the various gut compartments. Rhopr-TK 1, 2 and 5 significantly increase the frequency and amplitude of peristaltic contractions of the salivary glands. Hindgut muscle also displayed a dose-dependent increase in basal tonus in response to Rhopr-TK1, 2 and 5. TK-like immunoreactivity was seen in a small group of processes that are situated on the lateral margins of the hindgut. Interestingly, kinin-like immunoreactivity is seen in immunoreactive processes on the lateral margin of the hindgut as well as fine processes covering the entire hindgut. Co-localization studies show that TK-like staining is always co-localized with kinin-like immunoreactivity, whereas kinin-like staining is seen in the fine processes that are devoid of TK-like immunoreactivity indicating that TKs are most likely released together with kinins to act on the hindgut. Rhopr-Kinin 2 is a potent stimulator of hindgut muscle contraction in R. prolixus. Addition of Rhopr-Kinin 2 and Rhopr-TK 2 to the hindgut leads to a contraction that was additive of the effects of Rhopr-Kinin 2 and Rhopr-TK 2 alone.



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A systematic review of secondary cerebrospinal fluid leaks

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Beyond borders and sinuses: Rhinology and allergy research on a world stage

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The role of regulatory T cells in the regulation of upper airway inflammation

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Sinonasal T-cell expression of cytotoxic mediators granzyme B and perforin is reduced in patients with chronic rhinosinusitis

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Role of adenosine monophosphate‐activated protein kinase on cell migration, matrix contraction, and matrix metalloproteinase-1 and matrix metalloproteinase-2 production in nasal polyp‐derived fibroblasts

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Effectiveness of intranasal sodium hyaluronate in mitigating adverse effects of nasal continuous positive airway pressure therapy

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Gender-specific differences in serum immunoglobulin E levels and prevalence of fungus in sinonasal tissue noted in patients with chronic rhinosinusitis who underwent endoscopic sinus surgery

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The relationship between social determinants of health and utilization of tertiary rhinology care

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Biocompatibility and pharmacokinetics of fluticasone-eluting sinus implant in a rabbit model

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Role of exhaled nasal nitric oxide in distinguishing between chronic rhinosinusitis with and without nasal polyps

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Vitamin D3 deficiency and its association with nasal polyposis in patients with cystic fibrosis and patients with chronic rhinosinusitis

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Influence of chitosan-based dressing on prevention of synechia and wound healing after endoscopic sinus surgery: A meta-analysis

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Endonasal endoscopic management of frontal sinus cerebrospinal fluid leak

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Comparison of two concentrations of triamcinolone injection in the prevention of supratip edema after external rhinoplasty: A randomized trial

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Factors that contribute to disagreement in satisfaction between surgeons and patients after corrective septorhinoplasty

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Acute radiology rarely confirms sinus disease in suspected recurrent acute rhinosinusitis.

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Editorial Board ((ofc))

Publication date: October 2017
Source:Acta Histochemica, Volume 119, Issue 8





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Quercetin protects jejunal mucosa from experimental intestinal ischemia reperfusion injury by activation of CD68 positive cells

Publication date: Available online 10 November 2017
Source:Acta Histochemica
Author(s): Kristina Curgali, Stefan Toth, Zuzana Jonecova, Milan Maretta, Theodoros Kalpakidis, Ivana Petriskova, Matus Kusnier, Jan Soltes, Martin Svana, Martin Caprnda, Delian Delev, Luis Rodrigo, Eva Mechirova, Peter Kruzliak
The aim of our study was to analyse the possible protective effect of quercetin application during the jejunal ischemia-reperfusion injury (IRI) in rats. Quercetin was administered intraperitoneally 30min before 1h ischemia of superior mesenteric artery with following 24h lasting reperfusion period. The male specific pathogen-free (SPF) Charles River Wistar rats were used. In the group with applied quercetin, the significantly increased (p<0.001) levels of anti-inflammatory cytokine IL10 were observed both in the blood serum and jejunal tissue. The improvement of the mucosal tissue morphology and proliferating and DNA repairing cell number measured by PCNA activity were recorded by more than 30% higher in the quercetin group. Simultaneously, significant elongation of the intestinal glands (p<0.001) and increase in the number of CD68-positive cells in the lamina propria mucosae (p<0.001) in comparison with control group were found. Based on our results, the preventive application of quercetin before induction of jejunal IRI stimulates faster jejunal mucosa restoration and it seems to have immunomodulatory and anti-inflammatory effects as well. CD68-positive macrophages could have crucial role in this process since they work as both growth factor and cytokine producers.



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Differences in self-advocacy among hard of hearing and typical hearing students

Publication date: January 2018
Source:Research in Developmental Disabilities, Volume 72
Author(s): Rinat Michael, Haya Maroon Zidan
BackgroundSelf-advocacy is considered a protective factor of psychosocial and academic problems among students with special needs.AimsTo asses self-advocacy among students with hearing loss and compare it to that of typical hearing students.Methods and procedureThe current study examined 27 hard of hearing (hh) students and 27 typical hearing students, all studying in mainstream classes. They completed the Hope Scale, a self-esteem scale, a self-efficacy scale, and a measure of self-advocacy statements. Data regarding the hh participants' spoken language abilities were collected through their itinerant teachers.Outcomes and resultsHH students reported lower levels of self-esteem than the typical hearing students. Emotional self-efficacy was positively correlated with age among the hh students, and hope and effort were negatively correlated with age among typical hearing students. Some significant positive correlations emerged among the hh participants between their syntactic and pragmatic abilities and several self-advocacy indicators.Conclusions and implicationsInterventions aimed at enhancing self-advocacy among hh students should focus on intensifying their self-esteem as well as their syntactic and pragmatic abilities.



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Absence of delay in spontaneous use of gestures in spoken narratives among children with Autism Spectrum Disorders

Publication date: January 2018
Source:Research in Developmental Disabilities, Volume 72
Author(s): Miranda Kit-Yi Wong, Wing-Chee So
BackgroundGestures are spontaneous hand movements produced when speaking. Despite gestures being of communicative significance, little is known about the gestural production in spoken narratives in six- to 12-year-old children with Autism Spectrum Disorders (ASD).AimsThe present study examined whether six- to 12-year-old children with ASD have a delay in gestural production in a spoken narrative task, in comparison to their typically-developing (TD) peers.Methods and proceduresSix- to-12-year-old children with ASD (N=14) and their age- and IQ-matched TD peers (N=12) narrated a story, which could elicit spontaneous speech and gestures. Their speech and gestures were then transcribed and coded.Outcomes and resultsBoth groups of children had comparable expressive language skills. Children with ASD produced a similar number of pointing and marker gestures to TD children and significantly more iconic gestures in their spoken narratives. While children with ASD produced more reinforcing gestures than their TD counterparts, both groups of children produced comparable numbers of disambiguating and supplementary gestures.ConclusionsOur findings indicate that children with ASD may be as capable as TD children in gestural production when they engage in spoken narratives, which gives them spontaneity in producing gestures.



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Contrast-enhanced imaging features and differentiation of benign and malignant focal splenic lesions

Publication date: May–June 2018
Source:Clinical Imaging, Volume 49
Author(s): Fang Cao, Wei Qian, Yanqing Ma, Yinbo Wu, Jianguo Zhong
To assess the value of imaging features for differentiating malignant from benign focal splenic lesions, 79 pathologically proved cases with contrast-enhanced CT or MRI were retrospectively studied. The morphological characteristics were assessed and the enhancement patterns were classified into five categories. After multivariate logistic analysis, the lesion margin and enhancement patterns were significantly different between benign and malignant lesions. The combination of ill-defined margin and hypovascular enhancement for suggesting malignant lesions had a good specificity (94.9%) and accuracy (89.9%). Morphological and enhancement characteristics on CT/MRI may be valuable in differentiating malignant from benign focal splenic lesions.



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Benefit and clinical significance of retrospectively obtained spectral data with a novel detector-based spectral computed tomography - Initial experiences and results

Publication date: May–June 2018
Source:Clinical Imaging, Volume 49
Author(s): Prabhakar Rajiah, Rong Rong, Claudia Martinez-Rios, Negin Rassouli, Luis Landeras
ObjectivesTo evaluate the benefits and clinical significance of retrospectively generated spectral image-datasets with the novel detector-based Spectral CT (SDCT).MethodsA total of 118 body CTs from the SDCT prototype were included. Based on the clinical indication, two radiologists were asked if they would have opted for a dual-energy mode/scan if the patient was scanned in one of the other commercially-available dual-energy scanners, which need prospective selection of dual energy mode. They also reviewed the scans, identified cases that would benefit from spectral images and evaluated these images for clinical utility and significance on a five-point scale, with 1 being the least and 5 being the highest.ResultsDual-energy mode would have been prospectively selected in 20 cases (17%) for Reader 1 and 25 cases (21%) for Reader 2. Additional spectral images were requested for 94 cases (80%) and 96 cases (81%) respectively. A total of 196 and 206 spectral image-sets were utilized respectively with 97% and 96% of these image-sets useful retrospectively. The distribution of scores on the five-point scale for Readers 1 and 2 were, 1–7% & 6%; 2–26% & 30%; 3–36% & 36%; 4–27% & 21% and; 5–4% & 7%. Clinically significant score (≥4) was noted in 31% and 28% respectively.ConclusionsAdditional spectral datasets retrospectively reconstructed from SDCT enhanced the diagnostic capabilities by reducing artifacts, improving contrast and allowing lesion characterization.



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Author index∗∗July, pp. 1-196; August, pp. 197-390; September, pp. 391-590; October, pp. 591-794; November, pp. 795-994; December, pp. 995-1252.

Aboul-Fettouh N, Hinojosa J, Tovar-Garza A, Pandya AG. The majority of patients presenting with vitiligo have a clinical sign of activity. 2017;77:774-5 (Research letter)

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Subject index

Academic medical centers

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Editorial Board

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Topical 15% resorcinol for hidradenitis suppurativa: An uncontrolled prospective trial with clinical and ultrasonographic follow-up

To the Editor: Boer and Jemec first described the use of topical 15% resorcinol for hidradenitis suppurativa (HS) in a small retrospective study in 2010,1 reporting a marked decrease in pain and mean duration of the lesions. In this study we assessed the effects of resorcinol in a prospective open trial in HS by using both clinical measures and ultrasonography. Ultrasound examination in HS provides anatomic information that is clinically unavailable and may be helpful for follow-up.2,3 We recruited participants with Hurley stage I and II HS.

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The water-drop test for the diagnosis of koilonychia

Koilonychia is a common concave nail dystrophy in which the nail plate is depressed centrally and elevated laterally.1 The term has Greek origins, with koilos meaning spoon. The pathophysiology of koilonychia, or spoon nails, is poorly understood. It has been associated with dermatologic disorders such as alopecia areata, psoriasis, and lichen planus; endocrinopathies such as hypothyroidism, hyperthyroidism, and diabetes mellitus; nutritional deficiencies, notably iron deficiency anemia; genodermatoses; and traumatic and occupational exposures.

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Doctors' mental health, burnout, and suicidality: Professional and ethical issues in the workplace

This case scenario engenders multiple ethical and professional issues for practicing dermatologists and dermatology residents, the most central of which are mental health and suicidality among physicians. When a physician's mental health is compromised, so may the safety and quality of the medical care provided. If a physician's mental state deteriorates to the point that his or her practice becomes impaired and professional obligations cannot be safely carried out, and the physician refuses to seek help, there is an ethical responsibility for a colleague(s) to report the impaired practitioner to an appropriate body or licensing authority.

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Cover Sheet for Index

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Circumventing iPLEDGE: Circumventing ethical responsibility?

Prescribing isotretinoin in the United States is regulated through iPLEDGE, a program aimed at reducing the risk for fetal exposure to isotretinoin. Isotretinoin is a pregnancy category X medication and is associated with major birth defects affecting 4%-28% of exposed fetuses.1,2 This Food and Drug Administration—approved program strives to ensure that no woman of child-bearing potential starts the medication while pregnant or becomes pregnant while on the medication. It is a centralized pregnancy risk management program requiring registration from all parties involved in the chain of distribution: wholesalers, prescribers, pharmacies, and patients.

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Injection of filler for volume replacement of the whole face using a single-entry method

Many practitioners use the standard approach of injecting fillers through multiple points into the area of a defect. In the midface, physicians will inject the cheeks and the tear troughs through different sets of entry points. Although the results of this method are acceptable, the risk of bruising is high.

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Dermatology Calendar

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Iotaderma #286

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Lymphedema

Lymphedema is a localized form of tissue swelling resulting from excessive retention of lymphatic fluid in the interstitial compartment and caused by impaired lymphatic drainage. Lymphedema is classified as primary or secondary. Primary lymphedema is caused by developmental lymphatic vascular anomalies. Secondary lymphedema is acquired and arises as a result of an underlying systemic disease, trauma, or surgery. We performed PubMed and Google Scholar searches of the English-language literature (1966-2017) using the terms lymphedema, cancer-related lymphedema, and lymphatic complications.

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A novel clinical sign to aid in the diagnosis of superficial basal cell carcinoma

Basal cell carcinoma (BCC) is the most common type of skin cancer worldwide.1 The diagnosis of BCC is often made clinically and confirmed histologically. Superficial BCCs, which represent a common histologic subtype, characteristically present as bright pink plaques or patches with variable scale.2 Even for experienced dermatologists, some superficial BCCs might elude early detection because of their variable color, ranging from skin-colored to bright pink. Early superficial BCCs are easier to treat and associated with less morbidity.

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Inpatient dermatology consultations: Motivation and practice of requesting providers

To the Editor: Given limited access to inpatient dermatology services, inpatient dermatologic management is handled by primary teams.1-4 These teams (eg, medicine, intensive care services, surgery) must decide when it is necessary to request dermatologic expert opinion, though many hospitals lack access to inpatient dermatology consults.4 When available, the decision to call a consult is unique and complex, shaped by patient-driven and provider-driven factors. Our aim was to survey inpatient providers prospectively to capture the factors that inform their decision to request dermatology consults and to characterize the perceived utility of the inpatient consult service.

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The hungry caterpillar flap: A variant of the V-to-Y island pedicle flap

Subcutaneous and myocutaneous island pedicle flaps are versatile closure options that are able to close large surgical defects with robust vascular supply.1 However, one of the shortcomings of these closures is the formation of triangular scars. Straight lines are visually arresting and the triangular scars created by island pedicle flaps can be distinctly conspicuous.

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Information for Readers

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Correction of vermilion lip retraction after mucosal advancement flap: A countertraction technique

Squamous cell carcinoma of the lip accounts for a third of all oral cavity cancers in the United States, and the lower lip is the most frequent site of occurence.1 Surgical resection is the mainstay of treatment. Several size-dependent options can be utilized for repair: a small defect can be closed with a simple primary closure, whereas a local flap or skin graft is required for massive tissue loss. The mucosal advancement flap is a useful method with satisfactory results for large vermilion lip defects.

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High-risk category for early annual ophthalmology screening of patients receiving hydroxychloroquine

To the Editor: Although the recent article "Updated recommendations on the use of hydroxychloroquine in dermatologic practice" by Fernandez was overall both excellent and timely,1 I wish to offer a comment of clarification on the use of annual screening among hydroxychloroquine users. In the article, the author states, "Annual ocular toxicity screening is recommended to begin only after 5 years of use unless patients are considered high-risk or develop ophthalmologic symptoms." However, there are 2 caveats to this statement.

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November iotaderma (#285)

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Reply to: Comment on “Efficacy and safety of etanercept and adalimumab with and without a loading dose for psoriasis: A systematic review”

To the Editor: We would like to thank Dr Asahina and Dr Nakagawa1 for taking interest in our publication entitled "Efficacy and safety of etanercept and adalimumab with and without a loading dose for psoriasis: A systematic review."2 In our initial assessment of their clinical trial report (M04-688; NCT00338754), we were not able to infer any statistical difference in efficacy between the 2 dosing regimens, 40 mg every other week (EOW) and 80-mg loading dose followed by 40 mg EOW.3 However, we are pleased to learn that a statistical analysis directly comparing the efficacy of the 2 groups was completed and established a more rapid improvement of psoriatic plaques with the regimen including a loading dose.

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Rapid screening of starter cultures for maari based on antifungal properties

Publication date: Available online 11 November 2017
Source:Microbiological Research
Author(s): Donatien Kaboré, Mérilie Gagnon, Denis Roy, Hagrétou Sawadogo-Lingani, Bréhima Diawara, Gisèle LaPointe
Forty Bacillus isolates obtained from maari (used as condiment in Burkina Faso) including 17 B. subtilis, 4 B. circulans, 7 B. pumilus and 6 B. licheniformis were investigated for use as starter cultures in maari production. The isolates were screened by PCR for the sfp gene responsible for the production of the lipopeptide biosurfactant, surfactin. The sfp gene was detected in all of the seventeen B. subtilis isolates, in 2 out of 7 B. pumilus, in 4 out of 6 B. licheniformis whereas no B. circulans was positive for the sfp gene by PCR screening. Furthermore, all the 40 Bacillus spp. were screened for biosurfactant production and inhibitory activity against Aspergillus flavus, A. niger, A. versicolor and Rhizopus oryzae. Results demonstrated a relationship between the presence of the sfp gene and the antifungal activity and biosurfactant production of Bacillus isolates. In addition, molecular typing of the 17 B. subtilis isolates by Multilocus Sequence Typing (MLST) resulted in 15 Sequence Types, one of them included three strains. Randomly Amplified Polymorphic DNA-PCR (RAPD-PCR), used for B. licheniformis, B. megaterium, B. circulans and B. pumilus revealed that the inhibitory activity and biosurfactant production were strain-dependent. Finally, the detection of chitinase (chi) and β-glucanase (glu) biosynthesis genes was found to be associated with the antifungal activity for 16 B. subtilis isolates. The present work provides a greater understanding of the antifungal activity and biosurfactant production ability within the Bacillus spp. isolated from maari and contributes to the selection of Bacillus isolates to be used as starter cultures for controlled production of maari.



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Reintroducing the Sodium–Iodide Symporter to Anaplastic Thyroid Carcinoma

Thyroid , Vol. 0, No. 0.


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Are Evidence-Based Guidelines Reflected in Clinical Practice? An Analysis of Prospectively Collected Data of the Italian Thyroid Cancer Observatory

Thyroid , Vol. 0, No. 0.


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Reintroducing the Sodium–Iodide Symporter to Anaplastic Thyroid Carcinoma

Thyroid , Vol. 0, No. 0.


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Are Evidence-Based Guidelines Reflected in Clinical Practice? An Analysis of Prospectively Collected Data of the Italian Thyroid Cancer Observatory

Thyroid , Vol. 0, No. 0.


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Cortical Correlates of Binaural Temporal Processing Deficits in Older Adults.

Objectives: This study was designed to evaluate binaural temporal processing in young and older adults using a binaural masking level difference (BMLD) paradigm. Using behavioral and electrophysiological measures within the same listeners, a series of stimulus manipulations was used to evaluate the relative contribution of binaural temporal fine-structure and temporal envelope cues. We evaluated the hypotheses that age-related declines in the BMLD task would be more strongly associated with temporal fine-structure than envelope cues and that age-related declines in behavioral measures would be correlated with cortical auditory evoked potential (CAEP) measures. Design: Thirty adults participated in the study, including 10 young normal-hearing, 10 older normal-hearing, and 10 older hearing-impaired adults with bilaterally symmetric, mild-to-moderate sensorineural hearing loss. Behavioral and CAEP thresholds were measured for diotic (So) and dichotic (S[pi]) tonal signals presented in continuous diotic (No) narrowband noise (50-Hz wide) maskers. Temporal envelope cues were manipulated by using two different narrowband maskers; Gaussian noise (GN) with robust envelope fluctuations and low-noise noise (LNN) with minimal envelope fluctuations. The potential to use temporal fine-structure cues was controlled by varying the signal frequency (500 or 4000 Hz), thereby relying on the natural decline in phase-locking with increasing frequency. Results: Behavioral and CAEP thresholds were similar across groups for diotic conditions, while the masking release in dichotic conditions was larger for younger than for older participants. Across all participants, BMLDs were larger for GN than LNN and for 500-Hz than for 4000-Hz conditions, where envelope and fine-structure cues were most salient, respectively. Specific age-related differences were demonstrated for 500-Hz dichotic conditions in GN and LNN, reflecting reduced binaural temporal fine-structure coding. No significant age effects were observed for 4000-Hz dichotic conditions, consistent with similar use of binaural temporal envelope cues across age in these conditions. For all groups, thresholds and derived BMLD values obtained using the behavioral and CAEP methods were strongly correlated, supporting the notion that CAEP measures may be useful as an objective index of age-related changes in binaural temporal processing. Conclusions: These results demonstrate an age-related decline in the processing of binaural temporal fine-structure cues with preserved temporal envelope coding that was similar with and without mild-to-moderate peripheral hearing loss. Such age-related changes can be reliably indexed by both behavioral and CAEP measures in young and older adults. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Olivocochlear Efferent Activity Is Associated With the Slope of the Psychometric Function of Speech Recognition in Noise.

Objectives: The medial olivocochlear (MOC) efferent system can modify cochlear function to improve sound detection in noise, but its role in speech perception in noise is unclear. The purpose of this study was to determine the association between MOC efferent activity and performance on two speech-in-noise tasks at two signal-to-noise ratios (SNRs). It was hypothesized that efferent activity would be more strongly correlated with performance at the more challenging SNR, relative to performance at the less challenging SNR. Design: Sixteen adults aged 35 to 73 years participated. Subjects had pure-tone averages 0.05), contrary to hypothesis. However, contralateral suppression was significantly correlated with the slope of the psychometric function, computed as the difference between performance levels at the two SNRs divided by 3 (decibel difference between the 2 SNRs) for the coordinate response measure task (partial rs = 0.59; p = 0.04) and for the Institute of Electrical and Electronics Engineers task (partial rs = 0.60; p = 0.03). Conclusions: In a group of primarily older adults with normal hearing or mild hearing loss, olivocochlear efferent activity assessed using contralateral suppression of TEOAEs was not associated with speech-in-noise performance at a single SNR. However, auditory efferent activity appears to be associated with the slope of the psychometric function for both a word and sentence recognition task in noise. Results suggest that individuals with stronger MOC efferent activity tend to be more responsive to changes in SNR, where small increases in SNR result in better speech-in-noise performance relative to individuals with weaker MOC efferent activity. Additionally, the results suggest that the slope of the psychometric function may be a more useful metric than performance at a single SNR when examining the relationship between speech recognition in noise and MOC efferent activity. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Disturbances in the control of capillary flow in an aged APPswe/PS1ΔE9 model of Alzheimer's disease

Publication date: February 2018
Source:Neurobiology of Aging, Volume 62
Author(s): Eugenio Gutiérrez-Jiménez, Hugo Angleys, Peter M. Rasmussen, Mark J. West, Laura Catalini, Nina K. Iversen, Morten S. Jensen, Sebastian Frische, Leif Østergaard
Vascular changes are thought to contribute to the development of Alzheimer's disease, and both cerebral blood flow and its responses during neural activation are reduced before Alzheimer's disease symptoms onset. One hypothetical explanation is that capillary dysfunction reduces oxygen extraction efficacy. This study compares the morphology and hemodynamics of the microvasculature in the somatosensory cortex of 18-month-old APP^SWE/PS1ΔE9 (transgenic [Tg]) mice and wild-type (WT) littermates. In particular, the extent to which their capillary transit times homogenize during functional activation was measured and compared. Capillary length density was similar in both groups but capillary blood flow during rest was lower in the Tg mice, indicating that cortical oxygen availability is reduced. The capillary hemodynamic response to functional activation was larger, and lasted longer in Tg mice than in WT mice. The homogenization of capillary transit times during functional activation, which we previously demonstrated in young mice, was absent in the Tg mice. This study demonstrates that both neurovascular coupling and capillary function are profoundly disturbed in aged Tg and WT mice.



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Multimodal MRI quantification of the common neurostructural bases within the FTD-ALS continuum

Publication date: February 2018
Source:Neurobiology of Aging, Volume 62
Author(s): Chiara Crespi, Alessandra Dodich, Stefano F. Cappa, Nicola Canessa, Sandro Iannaccone, Massimo Corbo, Christian Lunetta, Andrea Falini, Chiara Cerami
The continuum hypothesis linking the behavioral variant of frontotemporal dementia (bvFTD) and amyotrophic lateral sclerosis (ALS) is supported by clinical, pathological, genetic, and neuroimaging evidence. In the present multimodal magnetic resonance study, we characterized the site and extent of shared neurostructural changes in gray and white matter in 20 bvFTD and 19 ALS patients without dementia. We found an overlap of macrostructural and microstructural damage in both patient groups compared with healthy controls, involving the right orbital and the bilateral anterior cingulate cortices, the corticospinal tract and corpus callosum. The quantification of gray and white matter damage within the areas of shared alterations highlighted a higher degree of atrophy in orbitofrontal and frontomedial regions in patients with more severe executive and/or behavioral symptoms, and a higher degree of degeneration in the motor pathway in patients with more severe motor neuron disorders. Our finding provides additional evidence confirming the FTD-ALS continuum hypothesis and supports the notion of a bimodal but convergent pattern of neurostructural changes characterizing bvFTD and ALS.



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Aposematism and crypsis are not enough to explain dorsal polymorphism in the Iberian adder

Publication date: November 2017
Source:Acta Oecologica, Volume 85
Author(s): Fernando Martínez-Freiría, Guillem Pérez i de Lanuza, António A. Pimenta, Tiago Pinto, Xavier Santos
Aposematic organisms can show phenotypic variability across their distributional ranges. The ecological advantages of this variability have been scarcely studied in vipers. We explored this issue in Vipera seoanei, a species that exhibits five geographically structured dorsal colour phenotypes across Northern Iberia: two zigzag patterned (Classic and Cantabrica), one dorsal-strip patterned (Bilineata), one even grey (Uniform), and one melanistic (Melanistic). We compared predation rates (raptors and mammals) on plasticine models resembling each colour phenotype in three localities. Visual modelling techniques were used to infer detectability (i.e. conspicuousness) of each model type for visually guided predators (i.e. diurnal raptors). We hypothesize that predation rates will be lower for the two zigzag models (aposematism hypothesis) and that models with higher detectability would show higher predation rates (detectability hypothesis). Classic and Bilineata models were the most conspicuous, while Cantabrica and Uniform were the less. Melanistic presented an intermediate conspicuousness. Predation rate was low (3.24% of models) although there was variation in attack frequency among models. Zigzag models were scarcely predated supporting the aposematic role of the zigzag pattern in European vipers to reduce predation (aposematism hypothesis). From the non-zigzag models, high predation occurred on Bilineata and Melanistic models, and low on Uniform models, partially supporting our detectability hypothesis. These results suggest particular evolutionary advantages for non-zigzag phenotypes such as better performance of Melanistic phenotypes in cold environments or better crypsis of Uniform phenotypes. Polymorphism in V. seoanei may respond to a complex number of forces acting differentially across an environmental gradient.



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Alignment Strategy for Constricted Maxillary Dental Arch in Patients With Unilateral Cleft Lip and Palate Using Fixed Orthodontic Appliance.

The purpose of this study was to compare the alignment pattern of the constricted maxillary dental arch by fixed orthodontic treatment (FOT) in the well-aligned and constricted arches of unilateral cleft lip and palate (UCLP) patients. 19 UCLP patients were divided into Group 1 (well-aligned arch, n = 9) and Group 2 (constricted arch, n = 10). After the cephalometric and maxillary dental arch variables before (T1) and after FOT (T2) were measured, statistical analysis was performed. There were no significant differences in the surgical timing of cheiloplasty, palatoplasty, and secondary alveolar bone grafting and in the surgical method of cheiloplasty between the 2 groups. However, Group 2 had a higher percentage of palatoplasty method, which could leave the denuded bone for secondary healing than Group 1 (P

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Firm Elevation of Reconstructed Auricle Using Polydactyly Digit in Microtia.

Total ear reconstruction for microtia is usually accomplished in 2 stages which is known as Nagata technique. After framework fabrication and implantation, the elevation procedure is required as a second step surgery. The authors are introducing a novel material for augmenting projection of rib cartilage framework in microtia treatment. (C) 2017 by Mutaz B. Habal, MD.

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Valgus Hindfoot Deformity Secondary to Neonatal Intravenous Infiltration.

Orthopedic complications of intravenous (IV) infiltration are rare, with only a handful of cases reported in the literature. Because of the relatively high rate of IV infiltration in neonates, however, such complications do occur and can include growth arrest, limb length discrepancy, and joint deformities that require surgical intervention. The risk of these complications is highest in preterm neonates. A 7-year-old girl presented to our institution with a severe valgus hindfoot deformity that developed secondary to a neonatal IV infiltration injury. Management consisted of a medial displacement calcaneal osteotomy followed 5 years later by a triple arthrodesis, Strayer procedure, and free flap transfer. (C) 2017 by Mutaz B. Habal, MD.

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Comparative Cost Analysis of Single and Mutli-Stage Temporal Deformity Correction Following Neurosurgical Procedures.

Purpose: Temporal hollowing deformity (THD) is a visible concavity/convexity in the temporal fossa; a complication often seen following neurosurgical/craniofacial procedures. Although numerous techniques have been described, no study to date has shown the healthcare costs associated with temporal hollowing correction surgery. Thus, the purpose here is to compare and contrast the direct costs related to temporal cranioplasty using various methods including: liquid poly-methyl-methacrylate (PMMA) implants with screw fixation, prebent, modified titanium mesh implants, and customized cranial implants (CCIs) with dual-purpose design. Understanding the financial implications related to this frequently encountered complication will help to motivate surgeons/healthcare facilities to better prevent and manage THD. Methods: This is a single-surgeon, single-institution retrospective review of 23 THD patients randomly selected from between 2008 and 2015. Cost analysis variables include length of hospital stay, facility/professional fees, implant material fees, payer information, reimbursement rate, and net revenue. Results: Of the 23 patients, ages ranged from 23 to 68 years with a mean of 48.3 years (SD 11.6). Within this cohort, 39.1% received dual-purpose PMMA CCIs (CCI PLUS), 17.4% received modified titanium mesh implants, and 43.5% received hand-molded, liquid PMMA implants with screw fixation. Total facility and/or professional charges ranged from $1978.00 to $126478.00. Average total facility charges per patient with dual-purpose CCIs were $34775.89 (SD +/- $22205.09) versus $35826.00 (SD +/- $23509.93) for modified titanium mesh implants and $46547.90 (SD +/- 81061.70) for liquid PMMA implants with screws. Mean length of inpatient stay was 5.7 days (SD = 8.1), and did not differ between implant types (P = 0.387). Conclusion: Temporal hollowing deformity is an expensive complication post-neurosurgery, and in the most severe form, requires a revision surgery for definitive correction. Therefore, surgeons should take further initiatives to employ reconstructive methods capable of minimizing risk for costly revision surgery, reducing morbidity related to visible deformity and accompanying social stigmata, and improving overall patient satisfaction. (C) 2017 by Mutaz B. Habal, MD.

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Internal Distraction Resulted in Improved Patient-Reported Outcomes for Midface Hypoplasia.

Background: Both internal and external distraction devices have been used successfully in correcting midface hypoplasia. Although the indication for surgery and the osteotomy techniques may be similar, deciding when to use internal versus external devices has not been studied. The authors studied patient-reported outcomes with FACE-Q and functional surveys for internal and external devices for midface distraction patients. Methods: Patients who underwent distraction advancement after Le Fort I and Le Fort III were surveyed using the FACE-Q survey and a functional survey. Equal groups of internal and external device patients were compared (n = 64). Data recorded included: sex, age, follow-up, diagnosis, operating room time, expected blood loss, length of stay, distraction length, consolidation time, and complications. Results: Internal and external device groups were similar with regards to patient diagnosis, operative time, expected blood loss, distraction length but consolidation times differed (internal = 3.6 versus external = 1.1 months). For FACE-Q appearance appraisal, there were similarities in domain and scale. For the functional survey (airway/breathing, ocular/vision, occlusion/eating, speech/articulation), there was also similar scoring. However, internal device patients had superior FACE-Q scores for Quality of Life: Social Function (80.9 versus 68.9), Early Life Impact (92.9 versus 62.4), Dental Anxiety (70.2 versus 48.3), Psychological Well-being (87.8 versus 68.6); and Decision Satisfaction (81.2 versus 56.9) and Outcome Satisfaction (91.0 versus 84.7). Conclusions: Internal and external midface distraction patients had similar patient-reported outcomes for appearance and functional improvement; however, internal device patients were more satisfied with their quality of life and their decision to undergo the procedure. (C) 2017 by Mutaz B. Habal, MD.

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Strengthening Evidence in Cleft and Craniofacial Surgery.

No abstract available

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A Novel Secretome Biotherapeutic Influences Regeneration in Critical Size Bone Defects.

Severe traumatic injuries often result in critical size bone defects, which are unable to heal without treatment. Autologous grafting is the standard of care but requires additional surgeries for graft procurement. Amnion-derived multipotent progenitor cells release a secretome of biomolecules identified as integral to the process of bone regeneration and angiogenesis. This secretome is currently under development as a biotherapeutic. The efficacy of this secretome biotherapeutic was evaluated in vitro on the proliferation and migration of mesenchymal stem cells and osteoprogenitor cells as well as in vivo using a critical size rat calvarial defect model. The secretome biotherapeutic was loaded onto a collagen scaffold and placed into the defect, which was allowed to heal for 4 and 12 weeks. The secretome biotherapeutic enhanced the proliferation and migration of mesenchymal stem cells and proliferation of osteoprogenitor cells. Further, the secretome biotherapeutic improved new bone volume and connectivity by 12 weeks and significantly improved angiogenesis at 4 weeks and bone density at 4 and 12 weeks with no deleterious effects. The improvement in new bone volume, connectivity, and angiogenesis suggests that the secretome biotherapeutic has beneficial effects for bone healing and a higher dose of the secretome biotherapeutic may further improve regeneration. (C) 2017 by Mutaz B. Habal, MD.

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Drug Release: Proper Control to Help Clinical Application.

No abstract available

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Review of "Outcomes of Concurrent Operations: Results From the American College of Surgeons' National Surgical Quality Improvement Program" by Liu JB, Berian JR, Ban KA, Liu Y, Cohen ME, Angelos P, Matthews JB, Hoyt DB, Hall BL, Ko CY in Ann Surg 266:411-420, 2017.

No abstract available

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Treatment of Maxillary Hypoplasia in Cleft Lip and Palate: Segmental Distraction Osteogenesis With Hyrax Device.

The objective of this work is to describe a segmental maxillary distraction osteogenesis (SDO) with segmental Lefort I with an inexpensive device. Four patients who presented severe class III and maxillary hypoplasia due to cleft lip and palate sequel were treated. A SDO was performed using a dental-anchored Hyrax device, achieving enlargement of the upper jaw without altering speech, with adequate and stable occlusion. Dental implants in a new formed bone were installed. The authors can conclude that SDO is a good treatment alternative for patients with maxillary hypoplasia. It preserves velopharyngeal function and is a stable treatment, maintaining the overjet achieved with distraction osteogenesis, without changes in posterior occlusion. The open bite generated with tooth-borne devices can be solved with temporary anchorage devices and intermaxillary elastics during consolidation phase. Modified Hyrax device allows expanding and moving forward the maxillary arch, with a low cost. (C) 2017 by Mutaz B. Habal, MD.

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Cone Beam Computed Tomography Assessment of Accessory Infraorbital Foramen and Determination of Infraorbital Foramen Position.

There is no evidence about evaluating accessory infraorbital foramen by 3-dimensional analysis like multi slice computed tomography or cone beam computed tomography (CBCT) in human subjects. To authors' best knowledge this is a first study to assess the accessory infraorbital foramen and position of infraorbital foramen in relation to crown of maxillary teeth using CBCT. This study primarily aimed to assess the location and number of accessory infraorbital foramen (AIOF), to measure the distance between main infraorbital foramen and AIOF and secondarily to determine the position of infraorbital foramen in relation to crowns of maxillary second premolar, first molar, and second molar. Cone beam computed tomography volumes of 200 patients were retrieved from the digital imaging and communications in medicine archive folder. Accessory infraorbital foramen was recognized in 29% of the patients among whom 46.6% were present on the right side, 31% on the left side, and 22.4% located bilaterally. The most frequent position of infraorbital foramen was found to be in line with crown of second premolar. The presence of AIOF and inability to recognize it in preoperative evaluation could be considered among the other reasons of failure or incomplete anesthesia. (C) 2017 by Mutaz B. Habal, MD.

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A Personal Approach to Bilateral Cleft Lip Repair.

Dr Michael B. Lewis has been using his personal approach to bilateral cleft lip (BCL) repair for 30 years to achieve a loose, pouting upper lip, a 90-degree columellar-labial angle, and a projecting nasal tip. This article describes technique and results. (C) 2017 by Mutaz B. Habal, MD.

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Use of Acellular Dermal Matrix in Craniosynostosis.

In craniofacial surgery, a wide spectrum of pathological conditions are usually treated. The aetiology of these could be congenital, traumatic, infective, post-tumor resection, postradiation, autoimmune, iatrogenic, or other miscellaneous conditions. The surgical approach for the procedures is usually via a coronal incision. In a large proportion of the patients, the frontal bone is removed to obtain intracranial access. The frontal bone is then replaced either in its original form or in a remodeled state. In congenital conditions the supraorbital bar and frontal bone is often also removed, remodeled, and replaced. One of the common late sequelae following craniofacial surgery is contour irregularities of the frontal region. These irregularities can vary in their extent. They are invariably palpable and often visible. Surgeons have attempted various methods to improve the contour irregularities. Despite these measures contour irregularities can still ensue. In the authors' unit, the authors have been using acellular dermal matrix in an attempt to diminish the contour irregularities in the frontal region following craniofacial reconstruction for craniosynostosis. This has been used in 35 patients undergoing craniosynostosis correction. Of the 35 patients, 12 were for plagiocephaly, 7 for brachycephaly, 10 for scaphocephaly, 4 for trigonocephaly, and 2 for combined coronal and metopic synostosis. The age of the patients ranged from 5 months to 12 years (mean 20.5 months). There were 21 males and 14 females. The follow-up ranged from 10 to 48 months (mean 23 months). (C) 2017 by Mutaz B. Habal, MD.

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Effect of Long-Term Use of Facemask With Miniplate on Maxillary Protraction in Patients With Cleft Lip and Palate.

The purpose of this retrospective study was to investigate the effect of a long-term use of facemask with miniplate (FM-MP) on maxillary protraction in cleft lip and palate (CLP) patients. The subjects were 21 CLP patients (16 unilateral CLP and 5 bilateral CLP patients), who were treated with identical lip and palate surgical method and FM-MP therapy performed by single surgeon and single orthodontist. Lateral cephalogram was taken before (T1; mean age, 11.1 years) and after maxillary protraction (T2; mean age, 16.9 years). The mean duration of FM-MP was 68.0 months. After 17 cephalometric variables were measured, statistical analysis was performed. During T1-T2, the maxilla showed significant forward movement ([DELTA]A-vertical reference plane, 4.8 mm, P 0.05). Long-term use of FM-MP is effective on maxillary protraction in adolescent CLP patients without clockwise rotation of the mandible, the main drawback of conventional facemask with tooth-borne anchorage. (C) 2017 by Mutaz B. Habal, MD.

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Oral-Health-Related Quality of Life After Surgical Treatment of Osteonecrosis of the Jaws.

The aim of this study is to analyze the clinical outcome and the change in oral-health-related quality of life (QoL) of osteoporotic patients affected by medication-related osteonecrosis of the jaws (MRONJ). Forty-one patients, consecutively treated for a 10-year period, were retrospectively analyzed. All the patients underwent a marginal osseous resective jaw surgery. A clinical 12 months postoperative evaluation has been performed and the complete mucosal healing, the absence of swelling and suppuration, and no signs of disease recurrence were defined like success parameters. Quality-of-life surveys tests like EORTC QQ-C30 and QLQ-HN35 appendices in conjunction with a perceived oral health visual analog scale (VAS) were administered before (time of diagnosis of MRONJ) and after surgery (at least 6 months) in order to record the different oral health status of the treated patients. The majority of MRONJ-diagnosed patients complained symptoms like pain, eating discomfort, and sense problems, with occasional involvement of the social dimension. There was a prevalence of troubles with social eating and social contact. The complete mucosal healing was achieved in 100% of the patients and the administered survey tests reported a significant improvement in all the investigated spheres. Similarly, an increased mean score of perceived oral health VAS was reported. Marginal-resective surgery of the necrotic jaw bone can be an effective treatment of osteoporotic patients affected by localized MRONJ. Quality-of-life parameters are demonstrated to be useful for recording the patient-centered outcome of MRONJ treatment. (C) 2017 by Mutaz B. Habal, MD.

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Image processing strategies based on saliency segmentation for object recognition under simulated prosthetic vision

Publication date: Available online 10 November 2017
Source:Artificial Intelligence in Medicine
Author(s): Heng Li, Xiaofan Su, Jing Wang, Han Kan, Tingting Han, Yajie Zeng, Xinyu Chai
Background and objectiveCurrent retinal prostheses can only generate low-resolution visual percepts constituted of limited phosphenes which are elicited by an electrode array and with uncontrollable color and restricted grayscale. Under this visual perception, prosthetic recipients can just complete some simple visual tasks, but more complex tasks like face identification/object recognition are extremely difficult. Therefore, it is necessary to investigate and apply image processing strategies for optimizing the visual perception of the recipients. This study focuses on recognition of the object of interest employing simulated prosthetic vision.MethodWe used a saliency segmentation method based on a biologically plausible graph-based visual saliency model and a grabCut-based self-adaptive-iterative optimization framework to automatically extract foreground objects. Based on this, two image processing strategies, Addition of Separate Pixelization and Background Pixel Shrink, were further utilized to enhance the extracted foreground objects.Resultsi) The results showed by verification of psychophysical experiments that under simulated prosthetic vision, both strategies had marked advantages over Direct Pixelization in terms of recognition accuracy and efficiency. ii) We also found that recognition performance under two strategies was tied to the segmentation results and was affected positively by the paired-interrelated objects in the scene.ConclusionThe use of the saliency segmentation method and image processing strategies can automatically extract and enhance foreground objects, and significantly improve object recognition performance towards recipients implanted a high-density implant.



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Editorial Board

Publication date: December 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery, Volume 28, Issue 4





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Contents

Publication date: December 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery, Volume 28, Issue 4





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Future and recent issues

Publication date: December 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery, Volume 28, Issue 4





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Information for authors

Publication date: December 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery, Volume 28, Issue 4





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Masthead

Publication date: December 2017
Source:Operative Techniques in Otolaryngology-Head and Neck Surgery, Volume 28, Issue 4





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In Pursuit of Fellowship: Results from a 2016 Survey of US Trainees

Publication date: Available online 10 November 2017
Source:Current Problems in Diagnostic Radiology
Author(s): Junjian Huang, Suhag Patel, Richard Scruggs, Dayna Levin
PurposeThe purpose of this study was to gauge radiology trainee perceptions regarding the fellowship selection process and survey their perceived level of preparedness and desire for a fellowship-oriented lecture.MethodsA survey, approved by APCR (Association of program coordinators in Radiology) was distributed via email to all APCR members for distribution to their residents.Results98.6%(n=261) of residents plan to pursue a fellowship. The most popular fellowships are IR, Body, MSK, and Neuro. For fellowship information, residents believe that fellowship directors in their field of intent were the most reliable (76%), followed by fellows (65%). Only about 50% of residents felt somewhat strongly that they were preparing for their fellowship application correctly. Lastly 44% of residents (n=94) replied extremely likely to attend a lecture series given by fellowship directors, and 36% (n=77) said somewhat likely.ConclusionThis survey demonstrates that most trainees plan to pursue fellowship training. Residents ranked certain resources as more important in fellowship selection, such as fellowship directors and fellows. Lastly, there is a high interest in a lecture series that would bring together fellowship directors and residents that are interested in that particular fellowship.



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Perioperative Internal Iliac Artery Balloon Occlusion, In the Setting of Placenta Accreta and its Variants: The Role of the Interventional Radiologist

Publication date: Available online 10 November 2017
Source:Current Problems in Diagnostic Radiology
Author(s): David A. Petrov, Benjamin Karlberg, Kamalpreet Singh, Matthew Hartman, Pardeep K. Mittal
Placenta accreta and its variants (increta and percreta) are conditions of variant placentation that are encountered with increasing frequency. The spectrum of placenta accreta (including placenta increta and percreta) involves abnormal attachment of the placental chorionic villi to the uterine myometrium. This attachment leads to increased adherence of the placenta to the uterus and abnormal placental-uterine separation at the time of delivery. Placental invasion into, or through the myometrium is associated with increased post-partum morbidity and mortality as a result of uterine hemorrhage during and following cesarean section.A multidisciplinary clinical approach to the treatment of patients with placenta accreta is recommended by the American College of Obstetricians and Gynecologists. As potential members of an interdisciplinary team, interventional radiologists can perform prophylactic internal iliac arterial balloon occlusion as an adjunctive therapy for reducing potentially life-threatening postpartum hemorrhage. The procedure involves placement of a balloon catheter into the internal iliac or common iliac arteries bilaterally prior to cesarean section. Following delivery, and prior to placental separation, the catheter balloons are inflated with a pre-determined volume of saline leading to transient occlusion of the internal iliac arteries and reduced uterine blood flow.



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The effect of mindful eating on subsequent intake of a high calorie snack

Publication date: 1 February 2018
Source:Appetite, Volume 121
Author(s): Lana Seguias, Katy Tapper
This study examined the effects of applying a mindful eating strategy during lunch on subsequent intake of a palatable snack. It also looked at whether this effect occurred due to improved memory for lunch and whether effects varied with participant gender, level of interoceptive awareness or sensitivity to reward. Participants (n = 51) completed a heartbeat perception task to assess interoceptive awareness. They were then provided with a lunch of 825 calories. Participants in the experimental group ate lunch while listening to an audio clip encouraging them to focus on the sensory properties of the food (e.g. its smell, look, texture). Those in the control group ate lunch in silence. Two hours later participants were offered a snack. They then completed a questionnaire assessing sensitivity to reward as well as other measures assessing various aspects of their memory for lunch. The results showed no significant difference in lunch intake between the two groups but participants in the experimental group consumed significantly less snack than those in the control group; mean = 112.30 calories (SD = 70.24) versus mean = 203.20 calories (SD = 88.05) respectively, Cohen's d = 1.14. This effect occurred regardless of participant gender or level of interoceptive awareness. There was also no significant moderation by sensitivity to reward although one aspect, reward interest, showed a trend towards significance. There was no evidence to indicate that the mindful eating strategy enhanced participants' memory for their lunch. Further research is needed to assess the long-term effects of this strategy, as well as establish the underlying mechanisms. Future work on the relationship between sensitivity to reward and the effects of mindful eating may also benefit from larger sample sizes.



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Highlights in immune response, microbiome and precision medicine in allergic disease and asthma

Milena Sokolowska | Cezmi A. Akdis

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Pendular Seesaw Nystagmus in a Patient With a Giant Pituitary Macroadenoma: Pathophysiology and the Role of the Accessory Optic System.

Seesaw nystagmus is characterized by cyclic eye movements with a conjugate torsional component and a dissociated vertical component. In the first half of the cycle, one eye elevates and intorts, whereas the other eye depresses and extorts. The pattern is reversed in the remaining half of the cycle. We describe a patient with a giant pituitary adenoma who developed pendular seesaw nystagmus. Disturbance in the visuovestibular system is postulated to contribute to this form of seesaw nystagmus. Lesions compressing the optic chiasm and the accessory optic system could interrupt the transmission of retinal error signals to the inferior olivary nucleus and the interstitial nucleus of Cajal, thus interfering with the adaptive mechanism of the vestibulo-ocular reflex and leading to pendular seesaw nystagmus. (C) 2017 by North American Neuro-Ophthalmology Society

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Neuro-Ophthalmology at a Tertiary Eye Care Centre in India.

Background: Neuro-ophthalmology as a specialty is underdeveloped in India. The aim of our study was to determine the spectrum and profile of patients presenting to a tertiary eye care center with neuro-ophthalmic disorders. Methods: A retrospective hospital-based study was conducted, and records of all patients seen at the neuro-ophthalmology clinic of Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India, over a 1-year period were retrieved and evaluated. Results: Of a total of 30,111 patients referred to various specialty clinics in a span of 1 year, 1597 (5%) were referred for neuro-ophthalmology evaluation. The mean patient age was 30.8 +/- 19.5 years, with a male dominance (M:F = 2.02:1). Among these patients, optic nerve disorders were noted in 63.8% (n = 1,020), cranial nerve palsy in 7% (n = 114), cortical visual impairment in 6.5% (n = 105), and others (eye/optic nerve hypophasia, blepharospasm, and optic disc drusen) in 6% (n = 95). Among the patients with optic nerve disorders, optic neuropathy without disc edema/(traumatic optic neuropathy, hereditary, tumor-related, retrobulbar neuritis, toxic, and idiopathic) was noted in 42.8% (n = 685) and optic neuropathy with disc edema (ischemic optic neuropathy, papilledema, post-papilledema optic atrophy, papillitis, neuroretinitis, and inflammatory optic neuropathy) in 20.9% (n = 335). Sixteen percent of patients (n = 263) were incorrect referrals. Conclusion: The neuro-ophthalmic clinic constitutes a significant referral unit in a tertiary eye care center in India. Traumatic and ischemic optic neuropathies are the most common diagnoses. Neuro-ophthalmology requires further development as a subspecialty in India to better serve the nation's population. (C) 2017 by North American Neuro-Ophthalmology Society

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Weighing the Risks and Benefits of Antidepressants in Idiopathic Intracranial Hypertension.

No abstract available

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Optic Nerve Head Drusen: The Relationship Between Intraocular Pressure and Optic Nerve Structure and Function.

Objective: To determine whether at the time of diagnosis, the intraocular pressure (IOP) in patients with optic nerve head drusen (ONHD) correlates with the perimetric mean deviation (PMD) and the mean retinal nerve fiber layer (RNFL) thickness on optical coherence tomography (OCT). Methods: This retrospective chart review included adults with ONHD from 2 academic medical centers. Inclusion criteria were age older than 18 years, definitive diagnosis of ONHD, measurement of IOP, and an automated visual field (VF) within 3 months of diagnosis. Exclusion criteria were unreliable VFs, use of IOP-lowering therapy, and visually significant ocular comorbidities. Data were collected from the initial visit. Age, IOP, method of diagnosis of ONHD, mean RNFL thickness, and PMD were recorded. Multiple and logistic regression models were used to control for potential confounders in statistical analyses. Results: Chart review identified 623 patients, of which 146 patients met inclusion criteria. Mean age was 44.2 years (range: 19-82 years). Average PMD of 236 eyes was -5.22 dB (range, -31.2 to +1.21 dB). Mean IOP was 15.7 mm Hg (range: 6-24 mm Hg). Forty eyes (16.9%) underwent RNFL measurement using OCT; mean RNFL thickness was 79.9 [mu]m (range: 43-117 [mu]m). There was no statistically significant association between IOP and PMD (P = 0.13) or RNFL thickness (P = 0.65). Eyes with ocular hypertension tended to have less depressed PMD than those without (P= 0.031). Stratified analyses of visible and buried subgroups yielded similar results. Conclusions: Lowering IOP in patients with ONHD has been proposed as a means to prevent progression of optic neuropathy. Our study demonstrated that among predominately normotensive eyes, higher IOP was not associated with greater VF loss or thinner RNFL at the time of presentation. This suggests that lowering IOP may not be beneficial in preventing visual loss in normotensive eyes with ONHD. (C) 2017 by North American Neuro-Ophthalmology Society

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Intraventricular vein thrombosis in a patient with cerebral venous thrombosis

José Luiz Ruiz-Sandoval, Juan Didier Parada-Garza, Erwin Chiquete, Ricardo Marian-Magaña, Gerardo Mauricio Figueroa-Sánchez

Neurology India 2017 65(6):1442-1443



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Nurturing Neurosurgery with basics and compassion …Some thoughts

Subhash R Dharker

Neurology India 2017 65(6):1208-1209



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Therapeutic plasma exchange in a patient of myasthenic crisis, refractory to intravenous immunoglobulin and immunosuppressive therapy

Satya Prakash, Rekha Hans, Ratti R Sharma, Vivek Lal, Neelam Marwaha

Neurology India 2017 65(6):1409-1412



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Founders of Indian Neurosciences: Professor Bimal Kumar Bachhawat and Professor Bal Krishan Anand

Prakash N Tandon

Neurology India 2017 65(6):1210-1212



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Lessons learnt from accidental spillage of glue between nerve and artery during microvascular decompression

Ishu Bishnoi, Yoko Kato, Shyam Durvu

Neurology India 2017 65(6):1391-1393



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“Against the tide, nothing to hide”- the saga of a community neurosurgeon

Ramesh C Mishra

Neurology India 2017 65(6):1213-1218



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Advanced magnetic resonance imaging in the diagnosis of primary intracranial malignant melanoma

A Saranya, Rajeswaran Rangasami, Anupama Chandrasekharan, Ganesh Krishnamurthy, Rajendran Swaminathan

Neurology India 2017 65(6):1427-1428



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Small vessel CNS vasculitis-optimism and challenges in imaging diagnosis

Rakesh K Gupta

Neurology India 2017 65(6):1219-1220



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The cover page

Neurology India 2017 65(6):1207-1207



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Central nervous system vasculitis imaging: Simplified

Harsh Rastogi

Neurology India 2017 65(6):1221-1222



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A longitudinal study of retinal nerve fibre layer profile in patients with multiple sclerosis and its significance

Sureshkumar Radhakrishnan, Minu George, Meenakshi Dhar, Niya Reny, Manoj Prathapan, A Anandkumar

Neurology India 2017 65(6):1402-1403



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Cardiomyopathy in acromegaly and the effect of trans-sphenoidal surgery

Subhash Yadav, Eesh Bhatia

Neurology India 2017 65(6):1223-1224



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Unexpected cause of leg pain in a patient with lower back pain

Marine Tanashyan, Polina Kuznetsova, Andrey Chechetkin, Natalia Vuytsik, Maria Zakharkina

Neurology India 2017 65(6):1418-1419



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Echocardiographic improvements following transsphenoidal surgery for acromegaly

Antonio Ribeiro-Oliveira, Márta Korbonits, Claudia M V Freire

Neurology India 2017 65(6):1225-1226



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Dorsolumbar fungal (aspergillus) epidural granuloma in an immunocompetent patient: Review of literature

Satyashiva Munjal, Anshu Warade, Srikant Balasubramaniam, Kedar Deogaonkar, RB Deshpande, Ketan Desai

Neurology India 2017 65(6):1435-1438



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Demonstration of autonomic dysfunction in traumatic brachial plexus injury using quantitative sudomotor axon reflex test

Vanessa Sammons, Rajiv Midha

Neurology India 2017 65(6):1227-1228



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Spinal model for teaching and training

Dattatraya Muzumdar

Neurology India 2017 65(6):1448-1449



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Assessment of autonomic dysfunction in traumatic brachial plexus injury: A regional pain management strategy or merely a research tool?

Manish Singh Sharma

Neurology India 2017 65(6):1229-1230



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The Department of Neurosurgery, G. B. Pant Hospital, New Delhi

Anita Jagetia, Daljit Singh, Arvind K Srivastava, AK Singh

Neurology India 2017 65(6):1366-1377

The history of the prestigious Department of Neurosurgery, Gobind Ballabh Pant Institute of Medical Education Institute and Research, New Delhi, a leading tertiary care centre, is presented. Its eminent faculty and outstanding patient care attracts patients and students from all over the country.The patients opt for this institution to get a standard of care that may be comparable with the highest standards prevalent; and, the students achieve their goal of getting excellent education in Neurosurgery at par with the best institutes of the world. The department has, therefore, over the years, established its place in the country as a premier training facility and an epitome of medical excellence.

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Neurological perspective of globus pallidus interna deep brain stimulation in dystonia

Vinay Goyal

Neurology India 2017 65(6):1231-1231



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Sleep Dentists Win Big With Project Rose

Project Rose Team: Gary Baxter, Dr. Rebecca Lauck, Dr. Brandon Hedgecock, Isiah Robertson, Dr. Harry Sugg, D. Gergen, Dr. Ed Hobbs, Eric Dickerson

As a country, we have satisfaction in being American, but each community also value's their own individual cultures. The American Sleep and Breathing Academy (ASBA) wants to release an official statement of support and pride for the communities in Florida and surrounding areas as well as Houston communities effected by Hurricane Harvey and Hurricane Irma. With different disasters in different areas come different recoveries but, nevertheless, recovery is inevitable.

The resilience of the communities damaged are stunning and marvelous, but not shocking. It is especially magnificent to see Houston rally behind the Houston Astros, major league contenders for the championship of America's pastime, and NFL legend/Rose of Texas Earl Campbell's Project Rose, a project dedicated to enhancing the safety of sports and improving sleep and wellness in communities throughout the country. After the devastating hurricane, Earl Campbell and Gary Baxter wanted to focus on adding to the local economy in Houston. They are doing so by launching sleep and wellness programs in 17 hospitals/clinics throughout Houston.

The wellness program is designed with an emphasis on preventive care and a healthier lifestyle. An ounce of prevention can save a pound of problems. That's why Project Rose Wellness Program is proudly offering the next generation of innovative lab testing, food/nutrition education, mental and physical health exercises, and providing a unique approach to understanding everyone's lifestyle requirements for better health.

Strengthening the ties of communities adds to the fortitude and unity of the entire country. The American Sleep and Breathing Academy thanks everyone involved for their contribution and unwavering capacity to recover quickly from difficult times.

Call David Gergen at 602-478-9713 to see how you can become involved.

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Eine seltene Differentialdiagnose des supraglottischen Larynxödems

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-121343

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

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Eine seltene Differentialdiagnose des supraglottischen Larynxödems

Laryngo-Rhino-Otol
DOI: 10.1055/s-0043-121343

Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Full text

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In vivo bioelectronic nose using transgenic mice for specific odor detection

Publication date: 15 April 2018
Source:Biosensors and Bioelectronics, Volume 102
Author(s): Keqiang Gao, Songmin Li, Liujing Zhuang, Zhen Qin, Bin Zhang, Liquan Huang, Ping Wang
The olfactory system is a natural biosensor since its peripheral olfactory sensory neurons (OSNs) respond to the external stimuli and transmit the signals to the olfactory bulb (OB) where they are integrated and processed. The axonal connections from the OSNs expressing about 1000 different types of odorant receptors are precisely organized and sorted out onto 1800 glomeruli in the OB, from which the olfactory information is delivered to and perceived by the central nervous system. This process is carried out with particularly high sensitivity, specificity and rapidity, which can be used for explosive detection. Biomimetic olfactory biosensors use various biological components from the olfactory system as sensing elements, possessing great commercial prospects. In this study, we utilized the genetically labeled murine M72 olfactory sensory neurons with the green fluorescent protein (GFP) as sensing components and obtained long-term in vivo electrophysiological recordings from the M72 OSNs by implanting the microelectrode arrays (MEAs) into the behaving mouse's OB. The electrophysiological responses showed high reliability, reproducibility and specificity for odor detection, and particularly, the high sensitivity for the detection of odorants that contain benzene rings. Furthermore, our results indicated that it can detect trinitrotoluene (TNT) in liquid at a concentration as low as 10⁻⁵M and can distinguish TNT from other chemicals with a similar structure. Thus our study demonstrated that the in vivo biomimetic olfactory system could provide novel approaches to enhancing the specificity and increasing working lifespan of olfactory biosensors capable of detecting explosives.



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High-purity capture of CTCs based on micro-beads enhanced isolation by size of epithelial tumor cells (ISET) method

Publication date: 15 April 2018
Source:Biosensors and Bioelectronics, Volume 102
Author(s): Na Sun, Xinpan Li, Zhili Wang, Yuzhi Li, Renjun Pei
In this paper, we develop a low-cost size-based microfluidic chip using conventional polycarbonate membrane to isolate CTCs from blood, and propose a strategy to increase the capture efficiency before cell filtration by a size enlargement method utilizing modified microbeads specifically binding to CTCs. Up to 91% of target cells were isolated from whole blood samples using our microfluidic capture system at a flow rate of 1mL/min. Moreover, a WBC depletion process is introduced which greatly decreases the WBC retaining on the filter membrane. The tests of immunofluorescence analysis of cells captured on the membrane were performed, which demonstrates that the device could provide a dependable CTC identification and CTC count in whole blood samples. Finally, the device was further validated in the detection of CTCs from blood samples of cancer patients, and it indicates a promising capability to detect CTC response to treatment.



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Aptamer-functionalized capacitance sensors for real-time monitoring of bacterial growth and antibiotic susceptibility

Publication date: 15 April 2018
Source:Biosensors and Bioelectronics, Volume 102
Author(s): Namgyeong Jo, Bongjun Kim, Sun-Mi Lee, Jeseung Oh, In Ho Park, Kook Jin Lim, Jeon-Soo Shin, Kyung-Hwa Yoo
To prevent spread of infection and antibiotic resistance, fast and accurate diagnosis of bacterial infection and subsequent administration of antimicrobial agents are important. However, conventional methods for bacterial detection and antibiotic susceptibility testing (AST) require more than two days, leading to delays that have contributed to an increase in antibiotic-resistant bacteria. Here, we report an aptamer-functionalized capacitance sensor array that can monitor bacterial growth and antibiotic susceptibility in real-time. While E. coli and S. aureus were cultured, the capacitance increased over time, and apparent bacterial growth curves were observed even when 10 CFU/mL bacteria was inoculated. Furthermore, because of the selectivity of aptamers, bacteria could be identified within 1h using the capacitance sensor array functionalized with aptamers. In addition to bacterial growth, antibiotic susceptibility could be monitored in real-time. When bacteria were treated with antibiotics above the minimum inhibitory concentration (MIC), the capacitance decreased because the bacterial growth was inhibited. These results demonstrate that the aptamer-functionalized capacitance sensor array might be applied for rapid ASTs.



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Organoselenium compounds from Purines: Synthesis of 6-arylselanylpurines with antioxidant and anticholinesterase activities and memory improvement effect

Publication date: Available online 10 November 2017
Source:Bioorganic & Medicinal Chemistry
Author(s): Luis Fernando B. Duarte, Renata L. Oliveira, Karline C. Rodrigues, Guilherme T. Voss, Benhur Godoi, Ricardo F. Schumacher, Gelson Perin, Ethel A. Wilhelm, Cristiane Luchese, Diego Alves
We describe here a simple method for the synthesis of 6-arylselanylpurines with antioxidant and anticholinesterase activities, and memory improvement effect. This class of compounds was synthesized in good yields by a reaction of 6-chloropurine with diaryl diselenides using NaBH4 as reducing agent and PEG-400 as solvent. Furthermore, the synthesized compounds were evaluated for their in vitro antioxidant and acetylcholinesterase (AChE) inhibitor activities. The best AChE inhibitor was assessed on the in vivo memory improvement. Our results demonstrated that the 6-((4-chlorophenyl)selanyl)-9H-purine and 6-(p-tolylselanyl)-9H-purine presented in vitro antioxidant effect. In addition, 6-((4-fluorophenyl)selanyl)-9H-purine inhibited the AChE activity and improved memory, being a promising therapeutic agent for the treatment of Alzheimer's disease.

Graphical abstract

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Design and synthesis of aminoester heterodimers containing flavone or chromone moieties as modulators of P-glycoprotein-based multidrug resistance (MDR)

Publication date: Available online 10 November 2017
Source:Bioorganic & Medicinal Chemistry
Author(s): Silvia Dei, Maria Novella Romanelli, Dina Manetti, Niccolò Chiaramonte, Marcella Coronnello, Milena Salerno, Elisabetta Teodori
In this study, a new series of heterodimers was synthesized. These derivatives are N,N-bis(alkanol)amine aryl esters or N,N-bis(ethoxyethanol)amine aryl esters carrying a methoxylated aryl residue combined with a flavone or chromone moiety. The new compounds were studied to evaluate their P-gp modulating activity on a multidrug-resistant leukemia cell line. Some of the new compounds show a good MDR reversing activity; interestingly this new series of compounds does not comply with the structure-activity relationships (SAR) outlined by previously synthesized analogs carrying different aromatic moieties. In the case of the compounds described in this paper, activity is linked to different features, in particular the characteristics of the spacer, which seem to be critical for the interaction with the pump. This fact indicates that the presence of a flavone or chromone residue influences the SAR of these series of products, and that flexible molecules can find different productive binding modes with the P-gp recognition site. These results support the synthesis of new compounds that might be useful leads for the development of drugs to control P-gp-dependent MDR.

Graphical abstract

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New routes of allergen immunotherapy

Publication date: Available online 10 November 2017
Source:Allergologia et Immunopathologia
Author(s): C.R. Juesas, C.M. Aguilar, S. Vieths




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Title Index

Publication date: December 2017
Source:The Kaohsiung Journal of Medical Sciences, Volume 33, Issue 12





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Keyword Index

Publication date: December 2017
Source:The Kaohsiung Journal of Medical Sciences, Volume 33, Issue 12





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Author Index

Publication date: December 2017
Source:The Kaohsiung Journal of Medical Sciences, Volume 33, Issue 12





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Reviewer Acknowledgement

Publication date: December 2017
Source:The Kaohsiung Journal of Medical Sciences, Volume 33, Issue 12





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Instructions to Authors

Publication date: December 2017
Source:The Kaohsiung Journal of Medical Sciences, Volume 33, Issue 12





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Checklist

Publication date: December 2017
Source:The Kaohsiung Journal of Medical Sciences, Volume 33, Issue 12





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Authorship and conflict statements

Publication date: December 2017
Source:The Kaohsiung Journal of Medical Sciences, Volume 33, Issue 12





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Permission request

Publication date: December 2017
Source:The Kaohsiung Journal of Medical Sciences, Volume 33, Issue 12





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Transversalis fascia scoring: a new adjunct to anterior component separation technique

Abstract

Background

Abdominal wall hernia is a significant cause for reoperation following laparotomy. Anterior component separation (ACS) is a widely used technique for closure of large abdominal wall defects. We propose that adding scoring of transversalis fascia to ACS can provide additional midline advancement of the anterior rectus sheath.

Methods

Open ACS was performed in eight cadavers. The medial advancement of the anterior rectus sheath was recorded at three points bilaterally during application of constant load, and again following scoring of the transversalis fascia. This technique was then used on two patients with recurrent, complex ventral hernias which could not be closed with ACS alone.

Results

In the cadaver model, transversalis fascia scoring provides additional 34.01, 27.12, and 25.05% advancement at each point compared to ACS. Results were significant. In both patients, primary fascial closure of defects over 20 cm width at midline was achieved.

Conclusions

Adding transversalis fascia scoring in a controlled standard fashion to ACS may help surgeons achieve closure of abdominal wall defects when ACS alone is not sufficient.

Level of Evidence: Level V, therapeutic study.

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Technical, hygiene, economic, and life cycle assessment of full-scale moving bed biofilm reactors for wastewater treatment in India

Abstract

Moving bed biofilm reactor (MBBR) is a highly effective biological treatment process applied to treat both urban and industrial wastewaters in developing countries. The present study investigated the technical performance of ten full-scale MBBR systems located across India. The biochemical oxygen demand, chemical oxygen demand, total suspended solid, pathogens, and nutrient removal efficiencies were low as compared to the values claimed in literature. Plant 1 was considered for evaluation of environmental impacts using life cycle assessment approach. CML 2 baseline 2000 methodology was adopted, in which 11 impact categories were considered. The life cycle impact assessment results revealed that the main environmental hot spot of this system was energy consumption. Additionally, two scenarios were compared: scenario 1 (direct discharge of treated effluent, i.e., no reuse) and scenario 2 (effluent reuse and tap water replacement). The results showed that scenario 2 significantly reduce the environmental impact in all the categories ultimately decreasing the environmental burden. Moreover, significant economic and environmental benefits can be obtained in scenario 2 by replacing the freshwater demand for non-potable uses. To enhance the performance of wastewater treatment plant (WWTP), there is a need to optimize energy consumption and increase wastewater collection efficiency to maximize the operating capacity of plant and minimize overall environmental footprint. It was concluded that MBBR can be a good alternative for upgrading and optimizing existing municipal wastewater treatment plants with appropriate tertiary treatment.

Graphical abstract

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Stabilization of Visual Function After Optic Nerve Sheath Fenestration for Optic Nerve Meningocele

A 10-year-old boy with bilateral colobomatous cavitary disc anomalies presented with a 3-month history of vision loss in his right eye. MRI of the head and orbit revealed bilateral tubular cystic enlargement of the optic nerve/optic sheath complex with thickening of the optic nerves without inflammation or neoplasm, suggestive of bilateral optic nerve meningocele. An optic nerve sheath fenestration was performed OD, and he experienced an improvement and stabilization of vision in his right eye during a 1-year follow-up period. The authors recommend that surgical decompression, particularly optic nerve sheath fenestration, should be considered in cases with progressive vision loss due to optic nerve meningocele.

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Transcanalicular Laser-Assisted Dacryocystorhinostomy With Endonasal Augmentation in Primary Nasolacrimal Duct Obstruction: Our Experience

Purpose: To evaluate and compare the success rate of transcanalicular laser-assisted dacryocystorhinostomy with endonasal augmentation, with and without intubation, in patients suffering from primary acquired nasolacrimal duct obstruction, at 1 year of follow up. Methods: A prospective, randomized interventional pilot study was conducted at a tertiary care center, in accordance with the guidelines of Declaration of Helsinki. Sixty eyes of 60 adult patients with primary acquired nasolacrimal duct obstruction were included. The participants were divided randomly into 2 equal groups (A and B-without and with bicanalicular intubation, respectively). An osteotomy was first created using 980 nm diode laser (set at 8W continuous mode) transcanalicularly and then enlarged intranasally using Blakesley's nasal forceps, followed by bicanalicular silicon intubation in group B patients. The tubes were removed at the end of 8 weeks. The ostium size was assessed endoscopically at 8 weeks and again at the end of follow up, at 1 year. A successful outcome was defined in terms of ostium patency at the end of 1 year. The results were analyzed at the end of a follow up of 1 year, using various statistical tests (p

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Imaging the Canaliculops With Ultrasound Biomicroscopy and Anterior Segment Ocular Coherence Tomography

Canaliculops is a noninflammatory and noninfectious ectasia of the canaliculus with serous fluid accumulation. Currently, the etiology is uncertain. To the best of the authors' knowledge only 6 confirmed cases have been published earlier; however, the imaging features were not described. The authors report the ultrasound biomicroscopic and ocular coherence tomography features of a histopathologically proven canaliculops.

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A Novel Method to Measure Artificial Eye Motility

Purpose: To measure objectively, reproducibly, and noninvasively artificial eye motility, a fundamental aspect in the (cosmetic) outcome of enucleation. Method: A gaze- and pupil-tracking system, the "iView X," was implemented to measure horizontal eye motility. The system, with adjusted software, was tested with patients wearing 1 prosthetic eye after enucleation for retinoblastoma. Measurements were repeated 5 times in every patient and analyses were performed twice by 2 independent observers. Reproducibility was tested via linear mixed models. After the implementation of the method, more data were obtained, including more patients with a history of enucleation for the treatment of retinoblastoma for eye tracker measurement, and differences in motility percentages between implant types and sizes were analyzed via Mann-Whitney U tests. Results: The intraclass correlation coefficient of the interobserver variable in the patient test group (n = 27, 6–53 years) was 0.98 and 0.96 for measurement of left gaze and right gaze, respectively. Intraobserver variation was

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Dermatofibroma of the Eyelid: Immunohistochemical Diagnosis

A 66-year-old man developed a painless 2 mm to 3 mm recurrent nodule at the left upper eyelid margin. Excision disclosed a spindle cell lesion without frank atypia or mitotic activity growing in a twisted fascicular pattern often referred to as storiform. All the surgical margins were involved with tumor. Immunohistochemistry demonstrated that many of the constituent spindle and dendritic tumor cells were CD34−, factor XIIIa+, and CD 163+, the latter 2 being biomarkers for monocytic lineage. The lesion was diagnosed as a dermatofibroma rather than a fibrous histiocytoma, a term that should be reserved for more aggressive lesions of deeper fascial planes. Facial dermatofibromas are rarer and more likely than those of the extremities to recur and therefore deserve wider local excision at first surgery with careful and frequent clinical follow ups. Eyelid dermatofibroma has probably often been misdiagnosed as another tumor in the past. Immunohistochemistry can supply valuable biomarker criteria for diagnosis.

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Orbital Perivenous Abscess Complicating the Diagnosis and Management of Orbital Cellulitis

An 11-year-old female presented with orbital cellulitis, bacterial sinusitis, enlarged left superior ophthalmic vein, dural venous sinuses, and internal jugular vein. The patient underwent endoscopic sinus surgery and was started on intravenous antibiotics and anticoagulation with limited improvement in orbital signs and symptoms. A magnetic resonance imaging/magnetic resonance venography of the orbits and brain revealed a dilated left superior ophthalmic vein with absence of flow but no clearly discernible orbital abscess. Intravenous corticosteroids resulted in dramatic improvement of pain, hypoglobus, proptosis, and extraocular motility, all of which rapidly recurred on discontinuation. Serial imaging revealed progression of what eventually manifested as a well-defined, rim-enhancing peri-superior ophthalmic vein abscess, which was incised and drained with prompt resolution of orbital cellulitis and complete visual recovery.

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Non-Exenteration Management of Sino-Orbital Fungal Disease

Purpose: To describe the non-exenteration management of sino-orbital fungal infection, a life-threatening condition for which orbital exenteration is generally considered a first-line treatment. Methods: A retrospective case series is presented of 7 orbits in 6 consecutive patients admitted and treated at 2 major metropolitan tertiary teaching hospitals in Sydney, New South Wales, Australia. Results: Seven orbits in 6 consecutive patients with sino-orbital fungal infection were treated conservatively with surgical debridement and intravenous antifungal agents. Four patients were immunosuppressed and the other 2 patients were otherwise healthy. All presented with pain, proptosis, or loss of vision. Causative organisms found were Mucormycoses, Aspergillus, and Scedosporium prolificans. Exenteration was avoided in all patients as part of their planned management and 5 patients, including 1 with bilateral disease, survived their disease without exenteration. Medical treatment included intravenous liposomal amphotericin B or voriconazole. A single immunosuppressed patient deteriorated and as a last resort, exenteration was performed, but this made no difference to his clinical course and in retrospect could have been avoided as he died of multiple cerebral metastases diagnosed shortly after his deterioration. Conclusion: The authors recommend that patients with sino-orbital fungal disease preferably be treated conservatively, without orbital exenteration.

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Facial Pyoderma Gangrenosum Presenting With Cranial Nerve VII Palsy and Cicatricial Ectropion

No abstract available

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