Versatile Approach to Septonasal Deformity: Skyscraper Construction Based on an Old Relic

xloma.fota13 shared this article with you from Inoreader Versatile Approach to Septonasal Deformity: Skyscraper Construction Based on an Old Relic Via Journal of Craniofacial Surgery - Published Ahead-of-Print Introduction: Severely deformed noses usually harbor a combination of both bony pyramid and septal deformities. In this retrospective study, the authors aimed to evaluate our results of repair in patients with severe nasal deformities and importance of a versatile approach in these cases. Materials and Methods: A total of 32 cases with congenital or acquired (traumas or surgeries) severe nasal deformity were included in this retrospective study. Gender, age, etiology, reconstruction methods, complications, and results were recorded. Preoperative and postoperative pictures were compared; additionally, patients' reviews on the esthetic and functional outcomes were noted. Open approach, weak L-strut template preparation attached to a strong keystone skeleton and reconstruction with a stable L- or T-strut on this template were carried out in all cases. In addition, glabellar flaps were used in 2 cases to restore the contracted skin envelope and wide-angle L-shape cartilage grafts in 7 cases for extensive alar cartilage reconstruction. Results: Favorable esthetic and functional results were obtained in most of the patients. The postoperative problems were recorded as intranasal synechiae; costochondral graft displacement; residual external deviation; nostril asymmetry; residual alar, columellar and tip problems; and prolonged edema. Conclusions: Sufficient sizes and amounts of skin, mucosa, cartilage, and bone tissue must be available to plan versatile repair using flaps and grafts according to the needs of each patient. Preserved stability of the keylock area is substantial. The authors advocate construction of a new structure based on the native weakened skeleton free from the extrinsic and intrinsic forces is an effective method. EBM LEVEL 4 Address correspondence and reprint requests to Omer R. Ozerdem, MD, A-Plast Esthetic Plastic Surgery Center, Akasya Kent Kule A-1 K:24 D:124 34660 Acibadem, Istanbul, Turkey; E-mail: ozerdemor@yahoo.com Received 6 August, 2020 Accepted 4 December, 2020 The authors report no conflicts of interest. © 2021 by Mutaz B. Habal, MD. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Self-Cross-Linked Hyaluronic Acid Hydrogel in Endonasal Endoscopic Dacryocystorhinostomy: A Randomized, Controlled Trial

xloma.fota13 shared this article with you from Inoreader Self-Cross-Linked Hyaluronic Acid Hydrogel in Endonasal Endoscopic Dacryocystorhinostomy: A Randomized, Controlled Trial Via Journal of Craniofacial Surgery - Published Ahead-of-Print Purpose: To investigate whether self-cross-linked HA hydrogel fill stimulates wound mucosal regeneration and its epithelialization around the ostia to improve long-term ostial patency in endonasal endoscopic dacryocystorhinostomy (En-DCR). Methods: One hundred and ninety-two patients with unilateral primary chronic dacryocystitis (PCD) were randomized divided into 2 groups: group A (the HA hydrogel group) and group B (the control group). All patients underwent En-DCR. The HA hydrogel group received HA hydrogel filling the ostium at the end of the surgery and the control group received no treatment. The mucosal epithelialization of the wound, the formation of granulation, the formation of scars, and the success rate of ostial patency were compared. Results: Our study included 82 patients in group A and 79 patients in group B. At the 2-week follow up, 74 patients (90.2%) in the group A had a healed ostium with a lining of intact epithelial mucosa. It was higher when compared with 56 patients (70.9%) in group B (X2 = 9.698, P  View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Lacrimal Duct Obstruction Caused by Nasomaxillary Fracture: A Retrospective Analysis of Consecutive 12 Patients by Computed Tomographic Dacryocystography

xloma.fota13 shared this article with you from Inoreader Lacrimal Duct Obstruction Caused by Nasomaxillary Fracture: A Retrospective Analysis of Consecutive 12 Patients by Computed Tomographic Dacryocystography Via Journal of Craniofacial Surgery - Published Ahead-of-Print Nasomaxillary fracture is a characteristic mid-facial fracture, and there are no reports showing the fracture damaging the nasolacrimal system (NLS). This report described nasomaxillary fracture cases with NLS damages, which were assessed by computed tomographic dacryocystography (CT-DCG). A retrospective co hort study of nasomaxillary fractures diagnosed by CT was conducted from 2007 to 2015. Twelve patients (mean age: 27.5 years) were found, and their clinical symptoms were as follows: nasal deformity in 10 patients, infra-orbital hypoesthesia in 7, epiphora in 5, and diplopia in one. CT-DCG was performed for 2 patients who complained epiphora, and obstruction was found in 1 patient. All patients underwent open reduction and internal fixation (ORIF), and epiphora in 5 patients was improved. One patient, however, complained epiphora postoperatively, which was supposed to be due to the unsuitable screw insertion. Since nasomaxillary fracture could give NLS obstruction, CT-DCG is useful for diagnosis. Although ORIF is an optimal treatment, attention is needed to avoid the lacrimal canal in screwing on the nasomaxillary buttress. Address correspondence and reprint requests to Yuki Hasegawa, MD, Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan; E-mail: hasegawa.yuuki@twmu.ac.jp Received 30 June, 2020 Accepted 10 December, 2020 The authors report no conflicts of interest. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jcraniofacialsurgery.com). © 2021 by Mutaz B. Habal, MD. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A Posterior Rotational Flap Technique Using Distraction Osteogenesis for Unilateral Lambdoid Craniosynostosis

xloma.fota13 shared this article with you from Inoreader A Posterior Rotational Flap Technique Using Distraction Osteogenesis for Unilateral Lambdoid Craniosynostosis Via Journal of Craniofacial Surgery - Published Ahead-of-Print Introduction: The craniofacial asymmetry seen in unilateral lambdoid craniosynostosis may not be effectively treated by posterior cranial vault remodeling, endoscopic suturectomy, and helmet therapy, or suturectomy and distraction osteogenesis alone due to limitations in soft-tissue envelope expansion and relapse of the deformity. The authors report a series of unilateral lambdoid craniosynostosis patients treated with a posterior rotational cranial-flap technique using internal distraction osteogenesis. Methods: Posterior cranial vault reconstruction combined with internal distraction was used, aided by preoperative virtual surgical planning. An in situ posterior rotational flap osteotomy was utilized to maximize dural preservation. Primary outcome measures included age-adjusted volume change and age-adjusted percent volume change per mm distraction. Distraction characteristics and perioperative characteristics were also assessed. Results: A total of 5 patients were identified. Mean predistraction intracranial volume was 1087.5 cc (SD  = 202.3 cc) and mean postdistraction included intracranial volume was 1266.1cc (SD  = 131.8cc). Mean age-adjusted percent included intracranial volume change was 14.1% (SD  = 9.6%), and mean percent intracranial volume change per mm distraction was 0.43%/mm distraction (SD  = 0.37%/mm distraction). One patient developed a distractor site infection postoperatively that was treated successfully with oral antibiotics. All patients had a Whitaker score of 1 at one year follow up. Conclusions: Posterior cranial vault remodeling using osteogenesis and a rotational cranial flap technique with dural preservation can be effectively used to maximize bone flap viability and limit postoperative relapse in patients with unilateral lambdoid craniosynostosis. Long term analysis as well as comparison to open techniques will need to be interrogated. Address correspondence and reprint requests to Amanda A. Gosman, MD, UC San Diego/Rady Children's Hospital, Division of Plastic Surgery, 7920 Frost Street, San Diego, CA 92123; E-mail: agosman@health.ucsd.edu Received 24 June, 2020 Accepted 3 December, 2020 The authors report no conflicts of interest. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jcraniofacialsurgery.com). © 2021 by Mutaz B. Habal, MD. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Predictors of the Size and Surgical Freedom of the Trans-Cribriform and Trans-Clival Corridors, a Radiographic Analysis

xloma.fota13 shared this article with you from Inoreader Predictors of the Size and Surgical Freedom of the Trans-Cribriform and Trans-Clival Corridors, a Radiographic Analysis Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0040-1722663 Introduction The transcribriform and transclival corridors are endoscopic endonasal approaches used to treat pathologies of the skull base. We present a predictive model that uses the clival length and ethmoidal width to predict the size and surgical freedom (SF) of these corridors. Methods Adult facial computed tomography scans were reviewed. Exclusion criteria included patients <18 years of age or radiographic evidence of trauma, neoplasm, or congenital deformities of the skull base. The images were analyzed using OsiriX MD (Bernex, Switzerland). Patients' demographics, clival length, ethmoidal width, surface area, and others were collected. Linear regression was used to create prediction models for the size and SF of the transclival and transcribriform corridors. Results A total of 103 patients were included with an average age of 44.9 years and 47% males. Females had a smaller clival surface area (8 vs. 9.2 cm2, p = 0.001). For transclival corridor, clival length correlated positively with SF in the sagittal plane (rho = 0.44, p < 0.05) and negatively with SF in the coronal plane (rho =  − 0.2, p < 0.05). For transcribriform corridor, ethmoidal width correlated positively with SF in the coronal plane (rho = 0.74, p < 0.05), and negatively with SF in the sagittal plane (rho =  − 0.2, p < 0.05). Conclusion A significant variability of the bony anatomy of the anterior and central skull base was found. The use of clival length and ethmoidal width as part of preoperative surgical planning might help to overcome the anatomical variability which could affect the adequacy of surgical corridors. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Anatomical Variations of the Jugular Foramen Region in Patients with Pulsatile Tinnitus

xloma.fota13 shared this article with you from Inoreader Anatomical Variations of the Jugular Foramen Region in Patients with Pulsatile Tinnitus Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0040-1722670 Objective Structural anomalies of the jugular foramen (JF) and adjacent structures may contribute to development of pulsatile tinnitus (PT). The goal of this study was to assess anatomical variants in the ipsilateral JF region in patients with PT and to explore possible predisposing factors for PT. Materials and Methods One hundred ninety-five patients with PT who underwent CT angiography and venography of the temporal bone were retrospectively analyzed. Anatomic variants including dominance of the ipsilateral JF, bony deficiency of the sigmoid sinus and internal carotid artery canal, high riding or dehiscent jugular bulb, dehiscence of the superior semicircular canal, tumors in the JF region, or cerebellopontine angle were assessed. Results Of 195 patients with PT, the prevalence of a dominant JF on the ipsilateral side of patients with PT was 67.2%. Furthermore, the dominant JF demonstrated a significant correlation with the presence of ipsilateral PT (p < 0.001). No anatomical variants were present in 22 patients (11.3%), whereas in patients with structural variants, bony deficiency of the sigmoid sinus was most common (65.6%), followed by high riding (54.9%) or dehiscent jugular bulb (14.4%). Dehiscent internal carotid artery canal (3.1%) and superior semicircular canal (4.1%) were occasionally identified, while arteriovenous fistula, arterial aneurysm and tumors arising from the JF region or cerebellopontine angle were rarely encountered. Conclusion Structural abnormalities of the JF and adjacent structures may predispose to the development of PT. Knowledge of these anatomical variants in the JF region may help establish a clinical strategy for addressing PT. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Aggressive Treatment Including Endonasal Surgical Sequestrectomy with Vascularized Nasoseptal Flap Can Improve Outcomes of Skull Base Osteoradionecrosis

xloma.fota13 shared this article with you from Inoreader Aggressive Treatment Including Endonasal Surgical Sequestrectomy with Vascularized Nasoseptal Flap Can Improve Outcomes of Skull Base Osteoradionecrosis Via Journal of Neurological Surgery Part B: Skull Base J Neurol Surg B Skull Base DOI: 10.1055/s-0040-1722669 Objective Skull base osteoradionecrosis (SB-ORN) is a serious, potentially lethal complication of radiation therapy. We aimed to review the clinical characteristics and outcomes of SB-ORN according to the extent of treatment. Design Retrospective analysis design was used for this study. Setting The study was conducted in two tertiary care hospitals. Participants Patients included who had been clinically diagnosed with SB-ORN from January 2006 to 2017. Main Outcome Measures Clinical characteristics, including demographics, predisposing factors, presenting symptoms, radiological findings, treatment modalities, and treatment outcomes, were reviewed. Treatment was classified into conservative and aggressive types. Aggressive treatment included radical surgical removal of soft tissue and bony sequestrum with the placement of vascularized tissue. Treatment outcome was analyzed in terms of clinical control, survival, and carotid artery blow out. Results Fifteen patients (11 males and 4 females) were identified during the study period. Eight patients were managed conservatively, whereas seven patients were managed with aggressive treatment. The 2-year survival was 75% in the aggressive treatment group and 15% in the conservative group (log-rank, p = 0.049). The estimated 2-year blow out free rate was 46.7% for the conservative group and 100% for the aggressive group (log-rank, p = 0.100). Conclusion In patients with SB-ORN, aggressive management, including surgical removal of sequestrum and coverage with a pedicled flap, is associated with increased survival. [...] Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Article in Thieme eJournals: Table of contents  |  Abstract  |  Full text View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Cognitive Pathways to Belief in Karma and Belief in God

xloma.fota13 shared this article with you from Inoreader Cognitive Pathways to Belief in Karma and Belief in God Via Cognitive Science Abstract Supernatural beliefs are ubiquitous around the world, and mounting evidence indicates that these beliefs partly rely on intuitive, cross‐culturally recurrent cognitive processes. Specifically, past research has focused on humans' intuitive tendency to perceive minds as part of the cognitive foundations of belief in a personified God—an agentic, morally concerned supernatural entity. However, much less is known about belief in karma—another culturally widespread but ostensibly non‐agentic supernatural entity reflecting ethical causation across reincarnations. In two studies and four high‐powered samples, including mostly Christian Canadians and mostly Hindu Indians (Study 1, N = 2,006) and mostly Christian Americans and Singaporean Buddhists (Study 2, N = 1,752), we provide the first systematic empirical investigation of the cognitive intuitions underlying various forms of belief in karma. We used path analyses to (a) replicate tests of t he previously documented cognitive predictors of belief in God, (b) test whether this same network of variables predicts belief in karma, and (c) examine the relative contributions of cognitive and cultural variables to both sets of beliefs. We found that cognitive tendencies toward intuitive thinking, mentalizing, dualism, and teleological thinking predicted a variety of beliefs about karma—including morally laden, non‐agentic, and agentic conceptualizations—above and beyond the variability explained by cultural learning about karma across cultures. These results provide further evidence for an independent role for both culture and cognition in supporting diverse types of supernatural beliefs in distinct cultural contexts. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Automation of Quantifying Axonal Loss in Patients with Peripheral Neuropathies through Deep Learning Derived Muscle Fat Fraction

xloma.fota13 shared this article with you from Inoreader Automation of Quantifying Axonal Loss in Patients with Peripheral Neuropathies through Deep Learning Derived Muscle Fat Fraction Via Journal of Magnetic Resonance Imaging Background Axonal loss denervates muscle, leading to an increase of fat accumulation in the muscle. Therefore, fat fraction (FF) in whole limb muscle using MRI has emerged as a monitoring biomarker for axonal loss in patients with peripheral neuropathies. In this study, we are testing whether deep learning‐based model can automate quantification of the FF in individual muscles. While individual muscle is smaller with irregular shape, manually segmented muscle MRI images have been accumulated in this lab; and make the deep learning feasible. Purpose To automate segmentation on muscle MRI images through deep learning for quantifying individual muscle FF in patients with peripheral neuropathies. Study Type Retrospective. Subjects 24 patients and 19 healthy controls. Field Strength/Sequences 3T; Interleaved 3D GRE. Assessment A 3D U‐Net model was implemented in segmenting muscle MRI images. This was enabled by leveraging a large set of manually segmented muscle MRI images. B1 + and B1 − maps were used to correct image inhomogeneity. Accuracy of the automation was evaluated using Pixel Accuracy (PA), Dice Coefficient (DC) in binary masks; and Bland‐Altman and Pearson correlation by comparing FF values between manual and automated methods. Statistical Tests PA and DC were reported with their median value and standard deviation. Two methods were compared using the ± 95% confidence intervals (CI) of Bland‐Altman analysis and the Pearson's coefficient (r 2). Results DC values were from 0.83 ± 0.17 to 0.98 ± 0.02 in thigh and from 0.63 ± 0.18 to 0.96 ± 0.02 in calf muscles. For FF values, the overall ± 95% CI and r 2 were [0.49, –0.56] and 0.989 in thigh and [0.84, –0.71] and 0.971 in the calf. Data Conclusion Automated results well agreed with the manual results in quantifying FF for individual muscles. This method mitigates the formidable time consumption and intense labor in manual segmentations; and enables the use of individual muscle FF as outcome measures in upcoming longitudinal studies. Level of Evidence 3 Technical Efficacy Stage 1 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Delivery of Anti‐microRNA‐712 to Inflamed Endothelial Cells Using Poly(β‐amino ester) Nanoparticles Conjugated with VCAM‐1 Targeting Peptide

xloma.fota13 shared this article with you from Inoreader Delivery of Anti‐microRNA‐712 to Inflamed Endothelial Cells Using Poly(β‐amino ester) Nanoparticles Conjugated with VCAM‐1 Targeting Peptide Via Advanced Healthcare Materials In this study, novel poly(β‐amino ester) (pBAE) nanoparticles (NPs) conjugated with VHPK peptides that target vascular cell adhesion molecule 1 are developed and used to deliver RNA interference drugs to inflamed endothelial cells (ECs). Specifically, these VHPK‐conjugated pBAE NPs successfully deliver anti‐microRNA‐712 to inflamed ECs both in vitro and in vivo and reduce expression of the pro‐atherogenic microRNA‐712. Abstract Endothelial cells (ECs) are an important target for therapy in a wide range of diseases, most notably atherosclerosis. Developing efficient nanoparticle (NP) systems that deliver RNA interference (RNAi) drugs specifically to dysfunctional ECs in vivo to modulate their gene expression remains a challenge. To date, several lipid‐based NPs are developed and shown to deliver RNAi to ECs, but few of them are optimized to specifically target dysfunctional endothelium. Here, a novel, targeted poly(β‐amino ester) (pBAE) NP is demonstrated. This pBAE NP is conjugated with VHPK peptides that target vascular cell adhesion molecule 1 protein, overexpressed on inflamed EC membranes. To test this approach, the novel NPs are used to deliver anti‐microRNA‐712 (anti‐miR‐712) specifically to inflamed ECs both in vitro and in vivo, reducing the high expression of pro‐atherogenic miR‐712. A single administration of anti‐miR‐712 using the VHPK‐conjugated‐pBAE NPs in mic e significantly reduce miR‐712 expression, while preventing the loss of its target gene, tissue inhibitor of metalloproteinase 3 (TIMP3) in inflamed endothelium. miR‐712 and TIMP3 expression are unchanged in non‐inflamed endothelium. This novel, targeted‐delivery platform may be used to deliver RNA therapeutics specifically to dysfunctional endothelium for the treatment of vascular disease. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A Colon‐Targeted Oral Probiotics Delivery System Using an Enzyme‐Triggered Fuse‐Like Microcapsule

xloma.fota13 shared this article with you from Inoreader A Colon‐Targeted Oral Probiotics Delivery System Using an Enzyme‐Triggered Fuse‐Like Microcapsule Via Advanced Healthcare Materials In the present work, an enzyme‐triggered fuse‐like microcapsule is constructed for the colon‐targeted oral probiotics delivery. By overcoming a series of physiological barriers, the microcapsule is detonated with the help of trypsin, which results in that the encapsulated probiotics can be released, then adhere, and colonize in the colon. Abstract Probiotics are closely related to human health. However, it is hard to find an appropriate disintegration mode for encapsulation to balance the survival, release, and adhesion of probiotics simultaneously during the current colon‐targeted oral delivery, which leads to limited colonization. In this study, an enzyme‐triggered fuse‐like microcapsule is constructed using alginate and protamine via the electrostatic droplet combined with the layer by layer self‐assembly. The multilayer microcapsule can protect the probiotics in the stomach and disintegrate layer by layer under the catalysis of trypsin in the intestine. The formulation with two protamine layers showed the best protection for Escherichia coli MG1655 (EM) during the oral delivery; as well the minimal release at the gastric pH value but a burst release after 1 h at the intestinal pH value. In particular, the adhesion strength of EM is improved with the increase of the layer number. In vivo experiments demons trate that the EM enters into the stationary phase within 12 h in the colon. Moreover, the blood biochemistry and histological analysis demonstrates the safety of the microcapsule formulation. It can be concluded that this microcapsule can help the probiotics survive during the delivery, then release and colonize in the colon. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.