bluuebunny/crossref_metadata_2025 huggingface dataset:
Promoting sustainability through governance of eco-city indicators: a multi-spatial perspective
Authors: Deng Wu , Cheshmehzangi Ali , Ma Yuanli , Peng Zhen
Published: May 2020

The purpose of this paper is to present a case study of the latest practice on urban sustainability in China, focusing on the breakdown of city-wide overall indicators to a more controllable spatial level—i.e. individual land plots and individual buildings. We argue the importance of decomposing the indicators to smaller scales by understanding underlying principles such as indicators and their integration in the process of urban governance, i.e. enhancing multi-level policy coordination as an important and effective approach for developing eco-cities. This can provide a common ground of argument to monitor the progress at multiple spatial levels and form a collective effort to move a city towards sustainability. The novelty of this study is to highlight the role of eco-city development at multiple spatial levels and through urban governance. The local government needs to mobilize various stakeholders involved in the urban development process by providing sustainability targets in a transparent way. A collective effort from various stakeholder groups might be formed by linking them to a set of unified but spatial level-based targets.
Tumor Microenvironment Immune Response in Pancreatic Ductal Adenocarcinoma Patients Treated With Neoadjuvant Therapy
Authors: Michelakos Theodoros , Cai Lei , Villani Vincenzo , Sabbatino Francesco , Kontos Filippos , Fernández-del Castillo Carlos , Yamada Teppei , Neyaz Azfar , Taylor Martin S , Deshpande Vikram , Kurokawa Tomohiro , Ting David T , Qadan Motaz , Weekes Colin D , Allen Jill N , Clark Jeffrey W , Hong Theodore S , Ryan David P , Wo Jennifer Y , Warshaw Andrew L , Lillemoe Keith D , Ferrone Soldano , Ferrone Cristina R
Published: May 2020

Background

Neoadjuvant folinic acid, fluorouracil, irinotecan, and oxaliplatin (FOLFIRINOX) and chemoradiation have been used to downstage borderline and locally advanced pancreatic ductal adenocarcinoma (PDAC). Whether neoadjuvant therapy-induced tumor immune response contributes to the improved survival is unknown. Therefore, we evaluated whether neoadjuvant therapy induces an immune response towards PDAC.

Methods

Clinicopathological variables were collected for surgically resected PDACs at the Massachusetts General Hospital (1998-2016). Neoadjuvant regimens included FOLFIRINOX with or without chemoradiation, proton chemoradiation (25 Gy), photon chemoradiation (50.4 Gy), or no neoadjuvant therapy. Human leukocyte antigen (HLA) class I and II expression and immune cell infiltration (CD4+, FoxP3+, CD8+, granzyme B+ cells, and M2 macrophages) were analyzed immunohistochemically and correlated with clinicopathologic variables. The antitumor immune response was compared among neoadjuvant therapy regimens. All statistical tests were 2-sided.

Results

Two hundred forty-eight PDAC patients were included. The median age was 64 years and 50.0% were female. HLA-A defects were less frequent in the FOLFIRINOX cohort (P = .006). HLA class II expression was lowest in photon and highest in proton patients (P = .02). The FOLFIRINOX cohort exhibited the densest CD8+ cell infiltration (P < .001). FOLFIRINOX and proton patients had the highest CD4+ and lowest T regulatory (FoxP3+) cell density, respectively. M2 macrophage density was statistically significantly higher in the treatment-naïve group (P < .001) in which dense M2 macrophage infiltration was an independent predictor of poor overall survival.

Conclusions

Neoadjuvant FOLFIRINOX with or without chemoradiation may induce immunologically relevant changes in the tumor microenvironment. It may reduce HLA-A defects, increase CD8+ cell density, and decrease T regulatory cell and M2 macrophage density. Therefore, neoadjuvant FOLFIRINOX therapy may benefit from combinations with checkpoint inhibitors, which can enhance patients’ antitumor immune response.
An uncommon case of inferior vena cava injury during atrial fibrillation ablation
Authors: Pastoricchio Manuela , Dell’Antonio Andrea , Zecchin Massimo , Bianco Elisabetta , Zucca Annalisa , Biloslavo Alan , Bortul Marina
Published: May 2020

A 64-year-old man underwent catheter ablation (CA) of atrial fibrillation with intracardiac echocardiography (ICE) assistance. As the probe was advanced toward the right atrium, sudden abdominal pain was felt by the patient with hypotension and tachycardia requiring fluids and vasopressors for hemodynamic stabilization. The inferior vena cava (IVC) was injured by the passing probe and open repair was then performed. To our knowledge, this is the first reported case of symptomatic IVC laceration by the probe used for ICE during CA.
Minidumbbell structures formed by ATTCT pentanucleotide repeats in spinocerebellar ataxia type 10
Authors: Guo Pei , Lam Sik Lok
Published: May 2020

Spinocerebellar ataxia type 10 (SCA10) is a progressive genetic disorder caused by ATTCT pentanucleotide repeat expansions in intron 9 of the ATXN10 gene. ATTCT repeats have been reported to form unwound secondary structures which are likely linked to large-scale repeat expansions. In this study, we performed high-resolution nuclear magnetic resonance spectroscopic investigations on DNA sequences containing two to five ATTCT repeats. Strikingly, we found the first two repeats of all these sequences well folded into highly compact minidumbbell (MDB) structures. The 3D solution structure of the sequence containing two ATTCT repeats was successfully determined, revealing the MDB comprises a regular TTCTA and a quasi TTCT/A pentaloops with extensive stabilizing loop-loop interactions. We further carried out in vitro primer extension assays to examine if the MDB formed in the primer could escape from the proofreading function of DNA polymerase. Results showed that when the MDB was formed at 5-bp or farther away from the priming site, it was able to escape from the proofreading by Klenow fragment of DNA polymerase I and thus retained in the primer. The intriguing structural findings bring about new insights into the origin of genetic instability in SCA10.
Reinforcing the Racial Structure: Observed Race and Multiracial Internet Daters’ Racial Preferences
Authors: Feliciano Cynthia , Kizer Jessica M
Published: May 2020

Is the growing multiracial population changing the US racial structure? This study examines how self-identifying with more than one racial group relates to racial dating choices—an outcome that reveals multiracial individuals’ agency in the process of racial boundary-making and reduction. Quantitative analyses of profiles drawn from the largest online dating website, combined with observer racial classifications of profile photos, reveal divergent patterns in racial preferences among multiracials who self-identify as part-Black compared with those who do not. Non-Black multiracials express racial preferences that are more similar to Whites than to minorities, consistent with Whitening theories suggesting that these groups situate themselves closer to Whites and reinforce the existing racial hierarchy. In contrast, part-Black multiracials’ preferences are more similar to Blacks. However, regardless of racial self-identity, multiracial online daters’ exclusion of Whites as possible dates depends upon how they are racially perceived by others—their observed race. In particular, among self-identified part-Black multiracials, those whom others view as non-Black are much more accepting of Whites as dates than are those whom others classify as Black. Since preferences for dating Whites vary substantially among individuals who self-identify as part-Black depending upon their observed race, this suggests a decline in the salience of the one-drop rule, even while some aspects of Black exceptionalism persist among multiracials whom others classify solely as Black.
Autopilots in the Operating Room
Authors: Ruskin Keith J. , Corvin Chase , Rice Stephen C. , Winter Scott R.
Published: May 2020

Automated medical technology is becoming an integral part of routine anesthetic practice. Automated technologies can improve patient safety, but may create new workflows with potentially surprising adverse consequences and cognitive errors that must be addressed before these technologies are adopted into clinical practice. Industries such as aviation and nuclear power have developed techniques to mitigate the unintended consequences of automation, including automation bias, skill loss, and system failures. In order to maximize the benefits of automated technology, clinicians should receive training in human–system interaction including topics such as vigilance, management of system failures, and maintaining manual skills. Medical device manufacturers now evaluate usability of equipment using the principles of human performance and should be encouraged to develop comprehensive training materials that describe possible system failures. Additional research in human–system interaction can improve the ways in which automated medical devices communicate with clinicians. These steps will ensure that medical practitioners can effectively use these new devices while being ready to assume manual control when necessary and prepare us for a future that includes automated health care.
Dexmedetomidine Exerts an Anti-inflammatory Effect via α2 Adrenoceptors to Prevent Lipopolysaccharide-induced Cognitive Decline in Mice
Authors: Li Rong , Lai Ieng K. , Pan Jonathan Z. , Zhang Pengbo , Maze Mervyn
Published: May 2020

Background

Clinical studies have shown that dexmedetomidine ameliorates cognitive decline in both the postoperative and critical care settings. This study determined the mechanism(s) for the benefit provided by dexmedetomidine in a medical illness in mice induced by lipopolysaccharide.

Methods

Cognitive decline, peripheral and hippocampal inflammation, blood–brain barrier permeability, and inflammation resolution were assessed in male mice. Dexmedetomidine was administered in the presence of lipopolysaccharide and in combination with blockers. Cultured macrophages (RAW 264.7; BV-2) were exposed to lipopolysaccharide ± dexmedetomidine ± yohimbine; tumor necrosis factor α release into the medium and monocyte NFκB activity was determined.

Results

In vivo, lipopolysaccharide-induced cognitive decline and inflammation (mean ± SD) were reversed by dexmedetomidine (freezing time, 55.68 ± 12.31 vs. 35.40 ± 17.66%, P = 0.0286, n = 14; plasma interleukin [IL]-1β: 30.53 ± 9.53 vs. 75.68 ± 11.04 pg/ml, P < 0.0001; hippocampal IL-1β: 3.66 ± 1.88 vs. 28.73 ± 5.20 pg/mg, P < 0.0001; n = 8), which was prevented by α2 adrenoceptor antagonists. Similar results were found in 12-month-old mice. Lipopolysaccharide also increased blood–brain barrier leakage, inflammation-resolution orchestrator, and proresolving and proinflammatory mediators; each lipopolysaccharide effect was attenuated by dexmedetomidine, and yohimbine prevented dexmedetomidine’s attenuating effect. In vitro, lipopolysaccharide-induced tumor necrosis factor α release (RAW 264.7: 6,308.00 ± 213.60 vs. 7,767.00 ± 358.10 pg/ml, P < 0.0001; BV-2: 1,075.00 ± 40.41 vs. 1,280.00 ± 100.30 pg/ml, P = 0.0003) and NFκB–p65 activity (nuclear translocation [RAW 264.7: 1.23 ± 0.31 vs. 2.36 ± 0.23, P = 0.0031; BV-2: 1.08 ± 0.26 vs. 1.78 ± 0.14, P = 0.0116]; phosphorylation [RAW 264.7: 1.22 ± 0.40 vs. 1.94 ± 0.23, P = 0.0493; BV-2: 1.04 ± 0.36 vs. 2.04 ± 0.17, P = 0.0025]) were reversed by dexmedetomidine, which was prevented by yohimbine.

Conclusions

Preclinical studies suggest that the cognitive benefit provided by dexmedetomidine in mice administered lipopolysaccharide is mediated through α2 adrenoceptor–mediated anti-inflammatory pathways.

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Disseminated Histoplasmosis Diagnosed by “Touch Prep”
Authors: Kingsley Jacob , Clarey Dillon , Lauer Scott R. , Trowbridge Ryan M.
Published: May 2020

Disseminated histoplasmosis is a rare but serious complication of infection with the dimorphic fungus Histoplasma capsulatum. We report a case of disseminated histoplasmosis with cutaneous involvement diagnosed by touch wet preparation and confirmed with histopathology and culture. “Touch prep” performed from a lesional punch biopsy, prepared with Wright-Giemsa followed by chlorazol black containing KOH, revealed abundant yeast organisms localized within multinucleated giant cells, and a rapid diagnosis of disseminated histoplasmosis with cutaneous involvement was achieved. This report demonstrates the utility of wet prep techniques as an invaluable and rapid beside diagnostic tool in the setting of cutaneous histoplasmosis. In addition, we compare the distinguishing histopathologic features of the infectious organisms within the differential diagnosis of parasitized histiocytes.
Flame Figures in Linear Immunoglobulin A Bullous Dermatosis Secondary to Parvovirus B19 Infection
Authors: García-Gil Miguel Fernando , Franco Rubio José Ignacio , Álvarez-Salafranca Marcial , Monte Serrano Juan , Prieto-Torres Lucia
Published: May 2020

Flame figures represent a characteristic but nondiagnostic histological finding in eosinophilic dermatoses. Some bullous autoimmune diseases with a predominant eosinophilic infiltrate, such as bullous pemphigoid, pemphigoid gestationis, and pemphigus vegetans, may show them. However, it is rare to find them in predominant neutrophilic bullous dermatoses such as linear immunoglobulin A. We present a 60-year-old man with a history of chronic urticaria, which presented a bullous disease after an acute parvovirus B19 infection. The histological findings showed an exceptional linear immunoglobulin A bullous dermatosis with an eosinophilic infiltrate in the dermis forming “flame figures.” The clinical and histopathological findings for this entity may be identical to those of other dermatoses. For this reason, combining these findings with direct immunofluorescence analysis is essential for correct diagnosis of this bullous disease.
Balanitis Xerotica Obliterans Associated With Differentiated Penile Intraepithelial Neoplasia and “Bramble-Bush” Elastic Fibers Accumulation: A Finding Not Specific for Penicillamine Intake
Authors: Sabater-Marco Vicente , Navalon-Verdejo Pedro , Sabater-Abad Vicente Javier
Published: May 2020

We describe the association of balanitis xerotica obliterans and differentiated penile intraepithelial neoplasia (PeIN) with dermal elastosis and “bramble-bush” elastic fibers in a diabetic patient with no history of penicillamine intake. An 84-year-old man presented with urethral obstruction syndrome that required postectomy, meatotomy, and foreskin excision. Histopathological examination revealed changes of lichen sclerosus and differentiated PeIN. Orcein staining showed striking dermal elastosis and transepidermal elimination of elastic fibers. At higher magnification, multiple serrations and buds arising from the borders of the elastic fibers were observed giving the so-called bramble-bush appearance. Balanitis xerotica obliterans is considered a premalignant disease, and 14% of patients have evidence of PeIN. The differentiated subtype can be difficult to diagnose because of the minimal basal cell atypia, so a striking dermal elastosis, which may even occur before the neoplasm becomes invasive, may facilitate its diagnosis. The term “acquired perforating dermatosis” seems appropriate to describe those cases of perforating elastosis that occurs in adults with systemic diseases. The bramble-bush appearance of elastic fibers is not specific for penicillamine-induced elastopathy, and it may occur in other diseases, such as diabetes mellitus. This peculiar morphology of elastic fibers may be related to the enzymatic imbalance between matrix metalloproteinases and lysyl oxidase, an enzyme required for the cross-linking of elastic fibers.
Prospective Clinical Study of Keratoconus Progression in Patients Awaiting Corneal Cross-linking
Authors: Goh Yi Wei , Gokul Akilesh , Yadegarfar Mohammad E. , Vellara Hans , Shew William , Patel Dipika , McGhee Charles N. J. , Ziaei Mohammed
Published: May 2020

Purpose:

Keratoconus progression should be treated with corneal cross-linking (CXL) in a timely manner. This study aimed to investigate patient factors associated with keratoconus progression between time of listing and at time of CXL.

Methods:

Prospective observational study at a tertiary center. Ninety-six eyes of 96 patients with keratoconus. Demographic, clinical, and tomographic parameters were analyzed to determine the risk factors for keratoconus progression. Analyzed tomographic indices included steepest keratometry, average keratometry, cornea thinnest point, index of surface variance, index of vertical asymmetry, keratoconus index, center keratoconus index, index of height asymmetry, and index of height decentration.

Results:

A total of 38 eyes (39.6%) were found to have keratoconus progression during an average waiting time of 153 ± 101 days. There were significant differences in preoperative tomographic parameters such as index of surface variance (111.3 ± 36.6 vs. 88.3 ± 31.8; P = 0.002), index of vertical asymmetry (1.1 ± 0.4 vs. 0.9 ± 0.4; P = 0.005), keratoconus index (1.31 ± 0.12 vs. 1.22 ± 0.11; P < 0.001), and index of height decentration (0.16 ± 0.07 vs. 0.11 ± 0.06; P = 0.015) between eyes that progressed and those that remained stable. There were no significant differences in steepest keratometry, average keratometry, cornea thinnest point, and center keratoconus index. Multivariate analysis did not reveal age, presence of atopy/atopic keratoconjunctivitis, eye rubbing, or waiting time to be a significant risk factor for progression; however, Maori ethnicity was a risk factor (odds ratio = 3.89; P = 0.02).

Conclusions:

A significant proportion of eyes were found to be progressing while waiting for CXL. A risk stratification score for patients awaiting CXL may reduce the risk of progression.
Multimodal Imaging of Pre-Descemet Corneal Dystrophy Associated With X-Linked Ichthyosis and Deletion of the STS Gene
Authors: Boere Payton M. , Bonnet Clemence , Frausto Ricardo F. , Fung Simon S. M. , Aldave Anthony J.
Published: May 2020

Purpose:

To investigate the presence of pre-Descemet corneal dystrophy (PDCD) in association with X-linked ichthyosis (XLI) in an 11-year-old boy using multimodal imaging and genetic analysis.

Methods:

Corneal opacities were examined and imaged with slit-lamp biomicroscopy, anterior segment optical coherence tomography, noncontact specular microscopy, and in vivo confocal microscopy. Cytogenomic array analysis was performed using genomic DNA isolated from the patient.

Results:

Corneal opacities characteristic of PDCD located in the posterior corneal stroma just anterior to Descemet membrane were identified by slit-lamp biomicroscopy. A pre-Descemet hyper-reflective line, consistent with these opacities, was seen with anterior segment optical coherence tomography. Scheimpflug tomography revealed a bimodal peak light scattering. In vivo confocal microscopy findings were unremarkable. Copy number analysis identified a 4389 kbp hemizygous deletion on the X chromosome (chr. X: 6,540,898–8,167,604), resulting in the deletion of 4 genes, including the known locus of XLI, the STS gene.

Conclusions:

This report demonstrates that PDCD-associated XLI may present in children and that the diagnosis may be confirmed through multimodal imaging in conjunction with genetic analysis.
Legionnaires’ Disease in Pediatric Patients, Control Measures and 5-Year Follow-up
Authors: Fulová Miriam , Kotrbancová Martina , Bražinová Alexandra , Boledovičová Jana , Trnková Katarína , Špaleková Margita
Published: May 2020

Background:

Legionnaires’ disease (LD) occurs predominantly in adults and elderly people. Its incidence in Europe has been increasing in recent years. It is rare in younger age groups and prone to be reported as healthcare-associated infection with a higher risk of fatal outcome. Hospital-acquired LD is mostly associated with a colonized hospital water system. We describe 5 LD cases in a children’s hospital in Slovakia, subsequent environmental investigation, control measures, and 5-year monitoring of Legionella colonization in hospital’s water system.

Methods:

In 2014–2019, we tested clinical specimens from 75 hospitalized patients. Respiratory samples were cultured for Legionella, patient’s urine was tested for Legionella urinary antigens, and the microagglutination test was used for serologic testing. Samples of water were collected in 2015–2019 and processed according ISO11731.

Results:

We identified 5 Legionella infections in 2014–2015. Median age of patients was 15 years. All were high-risk patients hospitalized for their underlying diseases. All patients required admission to intensive care unit, and artificial ventilation due to general deterioration and respiratory failure. Legionella pneumophila was isolated from 72% of water samples. Chlorine dioxide dosing into water system above 0.3 ppm caused significant decrease of Legionella concentration in water samples. Samples taken from outlets with antimicrobial filter installed were legionellae-negative.

Conclusions:

Control measures led to decreased risk of infection, but not to eradication of Legionellae. It is necessary to extend the diagnostics for Legionella infection in hospitalized children with pneumonia, especially in hospitals with colonized water system.
The Harmful Consequences of Vaping
Authors: Douglass Brenda , Solecki Susan , Fay-Hillier Theresa
Published: May 2020

The vaping of nicotine products has overwhelmingly gained national attention as the new public health crisis. The use of electronic nicotine delivery systems and products such as electronic cigarettes, JUUL, pods, or vaporizers is now a worldwide multibillion dollar industry. Despite the notable gains decreasing harmful smoking behaviors of traditional cigarettes among youth, these public health initiatives have been significantly nullified by the indiscriminate exposure of these highly addictive products by nicotine manufacturers to the adolescent population. Although touted as a safer alternative to traditional tobacco smoking and an effective cessation method to quit traditional cigarette smoking, there are no definitive data, to date, substantiating that this is true. Currently, adolescents are the predominant population using electronic nicotine delivery systems and at the greatest risk to the negative effects of nicotine exposure (U.S. Department of Health & Human Services, 2016). The purpose of this article is to identify the health impact and potential dangers related to the vaping epidemic that conflict with teens' risk beliefs that vaping is harmless. To protect American youth, a comprehensive approach for harm reduction to this deadly problem is imperative, including product warnings and regulation, public media campaigns, economic and social strategies, and policy initiatives.
Cannabis Use as a Risk Factor for Depression, Anxiety, and Suicidality
Authors: Halladay Jillian E. , MacKillop James , Munn Catharine , Jack Susan M. , Georgiades Katholiki
Published: May 2020

Psychiatric disorders and substance use disorders commonly co-occur and are major public health concerns given the morbidity and mortality associated with them. Globally, cannabis is among the most commonly used drugs, and cannabis use frequently begins in adolescence or emerging adulthood, both important periods of development and periods in which psychiatric symptoms and disorders frequently emerge. Thus, the relationships between cannabis use and mental illnesses are essential for nurses and other healthcare professionals and researchers to explore and understand. This literature review examines the relationships between cannabis use and depression, anxiety, and suicide. It includes a primer on the neurobiology of cannabis effects; an overview on the epidemiological evidence on the associations between cannabis use and depression, anxiety, and suicide; and a discussion of implications for nurses, particularly important given changes in the medical and recreational cannabis legislation in North America. Overall, this review found consistent evidence showing a cross-sectional association between recreational cannabis use and depression, anxiety, and suicide, despite some limitations and conflicts in the literature. In addition, most evidence from longitudinal or case control studies suggested cannabis use preceded the development of depressive symptoms and suicidal behaviors, although the quality of this evidence was mixed. Implications for future research and nursing practice are discussed.
Transcutaneous Electrical Nerve Stimulation for Treatment of Tinnitus: A Systematic Review and Meta-analysis
Authors: Byun Young Jae , Lee Joshua A. , Nguyen Shaun A. , Rizk Habib G. , Meyer Ted A. , Lambert Paul R.
Published: May 2020

Objective:

To evaluate the treatment efficacy of transcutaneous electrical nerve stimulation (TENS) in patients with tinnitus.

Data Sources:

PubMed, Scopus, Web of Science, and Cochrane Library were searched for the following concepts: “Transcutaneous Electric Nerve Stimulation” and “Tinnitus.”

Study Selection:

Inclusion: 1) double- or single-blinded randomized controlled trials; 2) double- or single-blinded randomized comparison trials; 3) prospective or retrospective observational studies; and 4) case series. Exclusion: Non-English studies, nonhuman studies, case reports (n ≤ 5), and review articles.

Data Extraction:

Tinnitus Handicap Inventory (THI), the Visual Analog Scale (VAS), and perceived tinnitus suppression after treatment. Additional data collected included tinnitus laterality, duration of symptoms, location of electrode placement, time to follow-up, etiology of tinnitus, and treatment side effects.

Data Synthesis:

The literature search yielded 2941 unique articles. After reviewing 118 full-text articles, 17 studies reporting on 1,215 patients were included for final analysis. Four studies provided data available for meta-analysis of pre- and posttreatment THI and VAS (Cochrane Review Manager). TENS showed significant overall reduction on THI (–7.55 [–10.93 to –4.18], p < 0.0001) and VAS (–0.65 [–0.99 to –0.30], p < 0.0002). Subjective improvement of tinnitus was pooled across 13 studies using meta-analysis of proportions (MedCalc). Tinnitus suppression occurred in 40.0% [28.9–51.7%] patients. Among those who responded, 22.2% [12.2–29.7%] experienced complete suppression and 10.2% [0.2–31.9%] experienced persistent improvement at 3 months.

Conclusions:

TENS represents a safe and feasible treatment option for tinnitus and might be a worthy consideration among the spectrum of interventions developed for tinnitus.
Augmented Visualization Surgical Microscope Assisted Microvascular Decompression for Hemifacial Spasm
Authors: Roberts Daniel S. , Parikh Purven , Kashat Lawrence , Bulsara Ketan R.
Published: May 2020

Microvascular decompression (MVD) is curative treatment for primary Hemifacial Spasm, in cases where a vascular loop impinges on the facial nerve. Surgical techniques for MVD may be extended to MVD of the glossopharyngeal nerve and trigeminal nerve in cases of primary glossopharyngeal neuralgia and trigeminal neuralgia. Stroke is a rare complication of these procedures that may occur during the separation of a vascular loop from nervous tissue, particularly when materials such as Teflon are used to separate the structures. Use of an augmented visualization surgical microscope and in vivo fluorescence provides the opportunity to perform an intraoperative “angiogram” to confirm vascular integrity after decompression and enhanced visualization of complex neurovascular anatomy. We report the first description of this novel approach to microvascular decompression for Hemifacial Spasm.

SDC video link: http://links.lww.com/MAO/A998.
Early Detection of High-frequency Presbycusis Among Normal Hearing Individuals
Authors: Aziz Azliana , Md Daud Mohd Khairi , Nik Othman Nik Adilah , Abd Rahman Normastura
Published: May 2020

Background:

Presbycusis is an age-related sensorineural hearing loss and it may reduce quality of life. We conducted a study to establish the prevalence of high-frequency presbycusis in normal hearing individuals and to validate the role of extended high-frequency distortion product otoacoustic emission (DPOAE) in the screening.

Method: A cross-sectional study was conducted among 205 normal hearing adult participants with an age range between 25 and 54 years old. Hearing analysis with extended high-frequency pure-tone audiometry (PTA) and high-frequency DPOAE was carried out for all eligible participants. High-frequency presbycusis was considered to be present when the impairment of more than 25 dB occurs at higher than 8 kHz frequencies on both ears.

Results:

: Prevalence of high-frequency presbycusis using extended PTA was 31.7 (95% CI: 25.3, 38.1) and using high-frequency DPOAE was 57.4 (95% CI: 50.7, 64.4). The sensitivity and specificity of high-frequency DPOAE in detecting high-frequency presbycusis were 72.3 and 49.3% respectively with positive predictive value of 39.8% and negative predictive value of 79.3%. The association between age and high-frequency presbycusis was significant based on high-frequency DPOAE (p = 0.029).

Conclusions:

: The prevalence of high-frequency hearing loss is higher with increasing in age. High-frequency DPOAE may be used as a screening tool followed by confirmation using extended PTA. The early detection of presbycusis is important so that measures can be taken to prevent more severe problems developing.
Investigation of Free-Flap Transfer Reconstruction in Elderly Patients and Oral Intake Function
Authors: Onoda Satoshi , Kinoshita Masahito , Ariyoshi Yukino
Published: May 2020

The authors retrospectively examined 39 patients with head and neck reconstruction using a free-flap transfer with microsurgery in elderly patients aged over 80 years in our hospital. They investigated postoperative local complications, postoperative systemic complications, day of ambulation, the presence of delirium, the postoperative oral intake ratio, and the reconstructive method in mandibular reconstruction patients. There were 12 postoperative local complications. And postoperative systemic complications were detected in 19 patients; however, 17 of these were respiratory disorders due to pneumonia. There were 17 patients with postoperative delirium. Oral intake was resumed after an average of 14.9 days. Of these, 34 patients were eventually able to eat some kind of food. The incidence of local complications in elderly free-flap reconstruction patients was similar to that in young people. However, the rate of systemic complications was much higher in elderly patients. The authors suggest that free-flap reconstruction can be performed relatively safely in elderly people when a detailed preoperative surgical plan.
Anomalous Course of Facial Artery Through the Submandibular Gland and its Redundant Loop at the Base of Mandible
Authors: Nayak Satheesha B. , Vasudeva Soumya Kodimajalu , Pamidi Narendra , Sirasanagandla Srinivasa Rao
Published: May 2020

Knowledge of variant course and branching pattern of the facial artery gains importance in the surgeries of upper neck and face. The authors report a unilateral anomalous course and a redundant loop of right facial artery as seen in an adult male cadaver. The right facial artery had its origin from the external carotid artery. It pierced through the submandibular salivary gland and formed a redundant loop at the base of the mandible. Its further course and branching pattern was normal. This case could be important for radiologists, plastic surgeons and craniofacial surgeons.
Comparison of the Outcomes of Closed Reduction Nasal Bone Fractures With a Surgical Navigation System
Authors: Chung Jae-Ho , Yeo Hyun-Dong , Yoon Eul-Sik , Lee Byung-Il , Park Seung-Ha
Published: May 2020

Background:

The most prevalent form of facial bone fractures is nasal fractures. The surgical procedures used for these fractures are relatively simple, but complete correction is not easy because the nasal bone is small and identifying the fracture site by palpation is difficult. This study aimed to investigate the efficacy of intraoperative surgical navigation systems in nasal bone fracture surgery through a prospective analysis.

Methods:

Between February 2019 and July 2019, 25 navigation-assisted closed reductions of nasal fractures were performed. Preoperative computed tomography images were obtained at 1-mm intervals before surgery and the navigation was set by a simulation to have an error rate of less than 1. Then, the navigation system was used to identify the fracture site. Closed reduction was performed with Asch forceps and a Langenbeck elevator based on the previous markings made using the navigation system.

Results:

The degree of reduction was evaluated by plain X-rays and computed tomography scans, which were performed 1 month after surgery. In the navigation group, the average distance between the fragment and normal bony alignment was decreased from 2.38 to 0.49 mm and the modified Motomura score was an average of 2.40 points. The decrease in the mean distance was significantly different (P = 0.038) compared with the conventional group.

Conclusions:

Surgical navigation systems could be a useful tool for localizing fracture sites and guiding closed reductions. In particular, the system could be recommended for nasal bone fracture reductions in the tip or pyriform regions, which are difficult to correct.

Level of Evidence: II
The Role of Precedex in Post-Operative Pain Management Following Craniosynostosis Repair
Authors: Xu Hope , Bui Anthony , Brown Stav , Sanati-Mehrizy Paymon , Zackai Sheemon P. , Taub Peter J.
Published: May 2020

The application of dexmedetomidine (precedex) in pediatric settings has increased due to its superior safety and efficacy profile and it has been specifically suggested as an adjunct to IV acetaminophen and a substitute for morphine in craniosynostosis repair. However, reports of its use in pediatrics, let alone in craniosynostosis repair, remain limited and to date there are no studies addressing its use after craniosynostosis repair in children. This study is an IRB-approved retrospective case review of the use of dexmedetomidine following pediatric craniosynostosis repair as a postoperative analgesic/sedative agent at one institution.
Three-Dimensional Bioprinting: Role in Craniomaxillary Surgery Ethics and Future
Authors: Gupta Nimish , Agarwal Shreya
Published: May 2020

Three-dimensional (3D) printing and bioprinting is gaining lot of momentum, especially in surgical specialties. These two technologies have wide array of applications in presurgical, surgical, and in vitro scenarios. Bioprinting can generate customized patient specific tissue engineered from specialized cells. This technology can be a gold standard in reconstructive and regenerative surgeries, if used in regulated and ethical environment. This communication focuses on basics of these technologies, their role in surgical specialties, ethical issues specific to these technologies, and its future.
Facial Reconstruction Based on Combined Three-Dimensional Printing and Microsurgical Free Transfer
Authors: Horta Ricardo , Frias Francisca , Jarnalo Mariana , Teixeira Sergio , Silva Pedro , Oliveira Isabel , Silva Alvaro
Published: May 2020

There are patients with craniofacial deformity that can lead to extensive bone loss and severe disfigurement. Autologous reconstruction may be challenging in these patients, and it is usually associated with flap donor area morbidity and unfavorable aesthetic and functional results. A 51-year-old patient with human immunodeficiency virus infection, developed in the context of immunosuppression a fulminant fungal rhino-sinusitis with the need for surgical debridement, and in consequence extensive destruction of the nasal cavity and upper jaw, resulting in severe disfigurement due to nasal deformity and maxillary collapse. Human immunodeficiency virus disease was controlled and the complex craniofacial defect was posteriorly reconstructed with direct 3-dimensional (3D) printing combined with microsurgical free tissue transfer. The 3D facial implant, in titanium, was individualized and fabricated based on computed tomography images of the patient. A radial forearm free flap was used since a soft-tissue defect was anticipated after scar release and implant placement. It allowed simultaneous coverage of the palate, the anterior surface of maxilla and intranasal lining. The flap survived despite flap venous congestion in the postoperative period probably facilitated because of the complex 3D flap configuration and pedicle tunneling into the neck. After 9 months, the patient showed a tremendous aesthetic and functional improvement. The 3D printing was useful in our patient with craniofacial reconstruction. Its combination with free tissue transfer may improve the surgeon's armamentarium when dealing with complex patients.
Improvised Explosive Device Blast Injuries to the Craniofacial Region: Wound Characteristics and Management
Authors: Arya Saurabh , Jose Anson , Rawat Aditi
Published: May 2020

Improvised explosive device blast injuries frequently report at our center and showed the maximum amount of contamination and damage, both in the facial soft tissues and the skeletal tissues with impregnation of splinters with size ranging from 2 mm to 10 mm. Should splinters be always explored is questionable and varies with every case. The reconstruction in such cases was done with titanium mini-plates along with extensive use of local vascular flaps for soft tissue repair in majority of the cases. Soldier who sustained splinter injuries wrt orbital floor were managed with splinter exploration using C-arm and orbital floor reconstruction using titanium mesh.
Tenosynovial Giant Cell Tumor in an Infant
Authors: Shahriari Shawhin , Ederle Ashley , Botros James , Elwood Hillary , Shetty Anil
Published: May 2020

In this report, the authors describe a child presenting at 6 months old with a rapidly expanding extracranial left temporal mass concerning for malignancy. The mass was successfully treated at 16 months with radical surgical excision. The patient was found to have a tenosynovial giant cell tumor, diffuse type, completely encased by the temporalis muscle. To our knowledge, this is the first report of a case of diffuse type tenosynovial giant cell tumor in the temporalis muscle, without articular involvement, presenting in an infant.
Nasopharynx Hairy Polyp as a Cause of Stridor in Newborn
Authors: Freni Francesco , Nicastro Viviana , Costanzo Daria , Zagaria Annamaria , Galletti Bruno
Published: May 2020

Hairy polyps are histological benign lesions derived from 2 germinal layers which arise during fetal period, they can occur anywhere in the body. When they are localized in the oropharynx or nasopharynx can lead to upper airway obstruction in infants.

We describe a case of a 2-days-old full-term female with intermittent upper airway obstruction, stridor, and feeding difficulty. Endoscopic and radiologic exams show a mass localized in nasopharynx, which was excised with a transnasal endoscopic approach resolving her respiratory difficulties.

Histology confirmed the diagnosis of hairy polyp, a mass composed by an external layer of mature skin and a core with subcutaneous mature fibro fatty tissue, mature skeletal muscle, and cartilage.

This report has an important value for the readers because, for a good functional result and an excellent prognosis, an accurate clinic and radiologic diagnose, with subsequent surgical complete resection should be performed.
Repairing Cranial Defect With Autogenous Mandibular Outer Plate
Authors: Xu Shixing , Niu Feng , Chen Ying , Jin Qi , Gui Lai
Published: May 2020

Background:

Autogenous bone is the best material in cranioplasty because of biological advantages. Previously, skull, rib, ilium, and fibula have been used in the reconstruction of cranial defects. However, the application of autologous mandibular outer plate in the treatment of skull defect is rarely reported. This study evaluated the application of the autogenous mandibular outer plate in the reconstruction of cranial defect.

Methods:

Eleven patients who underwent cranioplasty with mandibular outer plate were recruited. Three-dimensional tomography data were collected to calculate the preoperative, immediate postoperative, and long-term follow-up volume of the bone graft area and donor bone site, and then the absorption rate and the regeneration rate of autogenous bone were analyzed.

Results:

The majority of the patients were satisfied with the reconstructive outcome. There are statistical differences in the volumetric measurements of the bone graft area and bone donor site at different time periods (P<0.05). The mean absorptivity of mandibular outer plate implanted in the cranial defect area was (17.30 ± 5.03)% after 3 to 24 months postoperatively, the average regeneration rate of mandibular outer plate volume was (41.65 ± 9.85)% at the same period.

Conclusion:

This report shows that the cranioplasty with mandibular outer plate bone graft may be an optional surgical procedure.
COVID-19 Pandemic and Otologic Surgery
Authors: Cetinkaya Erdem Atalay
Published: May 2020

All around world, the COVID-19 pandemic is accelerating, and any insight we can learn from our colleagues who have either encountered or are currently going through this will be used to protect our patients, our medical staff, and ourselves. No one knows to the best of our understanding whether or not COVID-19 includes the respiratory mucosal lining the middle ear and mastoid air cell system-but it seems probable they do. Since the rest of the airways are affected, and so is the nose and nasopharynx, it seems possible that the lining of the Eustachian tube, middle ear and mastoid air cell system would all be polluted. Viral particle aerosolization, which can occur otologic surgery using powered instruments and they remain in the air for at least 3 hours. Powered air purifying respirators are supplied even shorter than N95 masks, but strongly believed they are important for our team safety and protection. This mini review provides fundamental knowledge on otologic surgery feasibility in the COVID-19 pandemic from an objective perspective.
naturaList: a package to classify occurrence records in levels of confidence in species identification
Authors: Rodrigues Arthur Vinicius , Nakamura Gabriel , Duarte Leandro
Published: May 2020

There is a big volume of occurrence records available in biodiversity databases, but researchers should guarantee its quality before use it in scientific studies. A problem that might compromise the quality of occurrence data is species misidentification. We address this issue by presentingnaturaList, a R package designed to classify species occurrence data according to identification reliability.

naturaListallows to classify species occurrences up to six levels of confidence in species identification, and to filter occurrence data accordingly. The highest level of confidence is assigned to records identified by a specialist, whose name must be provided by the user. The other five levels of confidence are derived from the occurrence data. We demonstratenaturaListfunctions using occurrences ofAlsophila setosa, a tree fern species from Atlantic Forest, as example. We classified and filtered data in grid cells in order to maintain only the highest-level records in each cell. Then we selected only those records classified in the two highest levels of confidence.

From 323 occurrences ofAlsophila setosadisplaying geographic coordinates, 69 (21%) were identified by a specialist. After filtering the highest-level records inside grid cells, 102 records remained. From these grid cell filtered data, 38 occurrences (37%) were classified into the highest confidence level. Three records were removed using an interactive map module, due to falling in sea sites or outside the native range size of the species. Since we selected only records classified in the two highest levels of confidence, the final dataset contained 94 occurrence records.

naturaListguarantees the reproducibility of occurrence data processing and cleaning. Macroecologists, biogeographers and taxonomists might benefit from usingnaturaListpackage to evaluate the quality of species identification in occurrence data and by identify sites that need evaluation of taxonomic classification of species.
Hippocampal theta oscillations support successful associative memory formation
Authors: Kota Srinivas , Rugg Michael D. , Lega Bradley C.
Published: May 2020

1.

Models of memory formation posit that recollection as compared to familiarity-based memory depends critically on the hippocampus, which binds features of an event to its context. For this reason, the contrast between study items that are later recollected versus those that are recognized on the basis of familiarity should reveal electrophysiological patterns in the hippocampus selectively involved in associative memory encoding. Extensive data from studies in rodents support a model in which theta oscillations fulfill this role, but results in humans results have not been as clear. Here, we employed an associative recognition memory procedure to identify hippocampal correlates of successful associative memory encoding and retrieval in patients undergoing intracranial EEG monitoring. We identified a dissociation between 2– 5 Hz and 5–9 Hz theta oscillations, by which 2–5 Hz oscillations uniquely were linked with successful associative memory in both the anterior and posterior hippocampus. These oscillations exhibited a significant phase reset that also predicted successful associative encoding, distinguished recollected from familiar items at retrieval, and contributed to reinstatement of encoding-related patterns that distinguished these items. Our results provide direct electrophysiological evidence that 2–5 Hz hippocampal theta oscillations support the encoding and retrieval of memories based on recollection but not familiarity.

2.

Significance Statement

Extensive fMRI evidence suggests that the hippocampus plays a selective role in recollection rather than familiarity, during both encoding and retrieval. However, there is little or no electrophysiological evidence that speaks to whether the hippocampus is selectively involved in recollection. Here, we used intracranial EEG from human participants engaged in an associative recognition paradigm. The findings suggest that oscillatory power and phase reset in the hippocampus are selectively associated with recollection rather than familiarity-based memory judgements. Furthermore, reinstatement of oscillatory patterns in the hippocampus was stronger for successful recollection than familiarity. Collectively, the findings support a role for hippocampal theta oscillations in human episodic memory.