Immediate lengthening temporalis myoplasty for facial palsy reconstruction following facial nerve inclusive total parotidectomy

Immediate lengthening temporalis myoplasty (Labbé procedure) for immediate dynamic facial reanimation after nerve-inclusive parotidectomy in the elderly population is undocumented in the literature. The aim of this work was to determine whether the Labbé approach could achieve immediate, good functional and static results in elderly patients with acquired facial palsy. A retrospective analysis of five patients with parotid malignancies involving the facial nerve who underwent parotidectomy and an immediate Labbé procedure was performed. The House-Brackmann and Sunnybrook scores for facial palsy were used as objective measurements of the functional outcome. All patients underwent total parotidectomy, neck dissection, Labbé procedure, immediate temporary tarsorrhaphy, brow lift, and postoperative radiotherapy. Mean patient age was 83 (range 73-87) years. The average resected tumour size was 3.54 cm. The mean duration of surgery was 324 min and length of hospital stay 4 days. All patients experienced an improvement in House-Brackmann of one grade postoperative (grade V to IV in four, grade VI to V in one); the Sunnybrook score improved by 31 points on average (mean preoperative 3.8 vs postoperative 34.8). An immediate Labbé procedure following ablative parotid malignancy resection is a reliable and safe reconstructive procedure in a carefully selected elderly population, providing acceptable immediate static and dynamic hemifacial mimetic function and eliminating an additional facial palsy correction procedure.

Modified transseptal approach in endoscopic transsphenoidal pituitary surgery

OBJECTIVE

Transsphenoidal pituitary surgery is commonly performed via a direct transostial approach with a posterior septectomy. However, a technique via an endoscopic transseptal route has been described that avoids a posterior septectomy, but it comes with its own disadvantages.

METHODS

This paper describes a modification, and discusses its pros and cons.

RESULTS

The initial incision in the mucosa is placed level with the anterior middle turbinate. The mucoperichondrial flap is raised ipsilaterally until the sphenoid sinus ostium. An incision is made at the osseocartilaginous junction, and the contralateral mucoperichondrial flap is raised. The bony septum and posterior aspect of this flap is excised. The size and position of this window can be adapted. At the end of the operation, the lateralised intact mucoperichondrial flap is moved back to the midline.

CONCLUSION

Excision or deflection of the cartilaginous septum is not required. It maintains an intact septal mucosa on one side and avoids a septal perforation.

A Pilot Study To Compare Nutrition Screening Tools: Customized Nutrition Screening Tool for Burn Patients (Nstb) and Malnutrition Universal Screening Tool (Must)

Nutrition screening is an initial procedure in which the risk of malnutrition is identified. It plays a role in and can incur costs to health systems and patients. A customized nutrition screening tool for burn patients (NSTB) was formulated and the nutritional risk score of 22 patients from a burn unit in Bahrain using NSTB and MUST was compared. The samples selected were adult patients aged 18 years or over; pregnant and mentally retarded patients were excluded. Mean age of the total sample was 29.40, and 90.9% were male. Mean BMI was 26.96. The mean and SD for NSTB was 2.18±1.65, and for MUST 2.0±0.0. A difference in the nutritional screening risk score of the same group of patients was observed. In the MUST group, 100% patients were classified as high risk, while in the NSTB group 50% patients were classified as high risk, 36.36% as moderate risk and 13.63% as low risk respectively. The variability of the risk score in the NSTB group helps prioritize the patients based on high, medium, and low risk, whereas MUST categorizes all patients as high risk. A unique screening tool for burns will be more effective in determining risk patients due to tailor-made characteristics. Even though the data sample is small, the difference gives scope for extensive study.

P10.04.A The development of a potent, tumour-specific heptamethine cyanine dye-palbociclib conjugate with novel mechanisms of action for the treatment of glioblastoma

Background

Glioblastoma is the most common and aggressive primary brain tumour in adults. The development of anti-cancer agents for brain tumours is challenged by the blood-brain barrier and the resistance conferred by the local tumour microenvironment. Heptamethine cyanine dyes (HMCDs) are a class of near-infrared fluorescence compounds that have recently emerged as promising agents for drug delivery

Material and Methods

We conjugated palbociclib, a cyclin-dependent kinase 4/6 inhibitor to the HMCD, MHI 148 for the treatment of GBM. Patient-derived GBM cell lines were established from surgically resected biopsy GBM tissue.

Results

High-throughput drug screening revealed an almost 100-fold increase in cytotoxicity of the palbociclib-MHI 148 conjugate compared to palbociclib alone. Moreover, the palbociclib-MHI 148 conjugate was synergistic with radiation, but not with temozolomide. Further analysis revealed the palbociclib-MHI 148 conjugate was superior to other cyclin-dependent kinase inhibitors in vitro. The shift of palbociclib from cytostatic to cytotoxic when conjugated to MHI 148 prompted further investigation. We revealed that palbociclib-MHI 148-dependent inhibition of cell-cycle progression resulted in increased DNA damage. This preceded increased transcription of key extrinsic apoptosis genes and caused a time-dependent upregulation of TNFR1 endocytosis-dependent cell death signalling. Notably, inhibition of endocytosis and siRNA knockdown of TNFR1 prevented palbociclib-MHI 148-induced cell death.

Conclusion:

These results highlight a novel mechanism of action of palbociclib when conjugated to MHI-148 that induced autocrine-driven TNFR1-mediated apoptosis. In addition, we highlight the potential application of HMCDs in repurposing tyrosine kinase inhibitors, to overcome the current limitations preventing the expansion of second-line treatment options for GBM.

Measuring the 15O(α,γ)19Ne Reaction in Type I X-ray Bursts using the GADGET II TPC: Software

15O(α,γ)19Ne is regarded as one of the most important thermonuclear reactions in type I X-ray bursts. For studying the properties of the key resonance in this reaction using β decay, the existing Proton Detector component of the Gaseous Detector with Germanium Tagging (GADGET) assembly is being upgraded to operate as a time projection chamber (TPC) at FRIB. This upgrade includes the associated hardware as well as software and this paper mainly focusses on the software upgrade. The full detector set up is simulated using the ATTPCROOTv 2 data analysis framework for 20Mg and 241Am.

Measuring the 15O(α, γ)19Ne reaction in Type I X-ray bursts using the GADGET II TPC: Hardware

Sensitivity studies have shown that the 15O(α, γ)19Ne reaction is the most important reaction rate uncertainty affecting the shape of light curves from Type I X-ray bursts. This reaction is dominated by the 4.03 MeV resonance in 19Ne. Previous measurements by our group have shown that this state is populated in the decay sequence of 20Mg. A single 20Mg(βp α)15O event through the key 15O(α, γ)19Ne resonance yields a characteristic signature: the emission of a proton and alpha particle. To achieve the granularity necessary for the identification of this signature, we have upgraded the Proton Detector of the Gaseous Detector with Germanium Tagging (GADGET) into a time projection chamber to form the GADGET II detection system. GADGET II has been fully constructed, and is entering the testing phase.

Levetiracetam-induced gingival hyperplasia

Levetiracetam is a new generation antiseizure medication which binds to synaptic vesicle protein SV2A and inhibits the release of neurotransmitters. Gingival hyperplasia is a common side effect of conventional antiseizure medications like phenytoin, but very rare with the newer ones. A 14-year-old boy was started on levetiracetam 250 mg twice daily after a generalized seizure. Five days later he presented with gingival swelling and painful oral aphthae, without lymphadenopathy or systemic symptoms. Blood investigations were normal. After one-month of stopping the drug, the lesions cleared. This case highlights the importance of maintaining good oral hygiene and periodic dental review in patients on antiseizure medications.

Synthesis and biological evaluation of novel 2 (4`-hydroxynaphthyl) chromen-4-one as a CK2 inhibitor

Protein kinase CK2 is a potential drug target for many diseases including cancer, inflammatory disorders, Alzheimer's disease, Parkinson's disease and viral infections. Significant efforts have been made for the discovery of potent inhibitors of this enzyme. Herein, we report on the synthesis, characterization, and biological evaluation of novel flavonoid compounds as CK2 inhibitors. The tested compounds were 2 (4`-hydroxynaphthyl) chromen-4-one which is a naphthyl backbone flavonoid with an IC50 value of 0.45±0.059 μM and 2(4-hydroxyphenyl)-4H-chromen-4-one a phenyl based derivative with an IC50 value of 0.33±0.048 μM. Cell viability was tested using MCF-7 cells. Both compounds were able to reduce the cell viability around 50 % in concentration of 100 μM after 48 h. Molecular modeling studies were performed to understand the binding mode of both compounds.

Revealing and Quantifying the Three-Dimensional Nano- and Microscale Structures in Self-Assembled Cellulose Microfibrils in Dispersions

Cellulose microfibrils (CMFs) are an important nanoscale building block in many novel biobased functional materials. The spatial nano- and microscale organization of the CMFs is a crucial factor for defining the properties of these materials. Here, we report for the first time a direct three-dimensional (3D) real-space analysis of individual CMFs and their networks formed after ultrahigh-shear-induced transient deagglomeration and self-assembly in a solvent. Using point-scanning confocal microscopy combined with tracking the centerlines of the fibrils and their junctions by a stretching open active contours method, we reveal that dispersions of the native CMFs assemble into highly heterogeneous networks of individual fibrils and bundles. The average network mesh size decreases with increasing CMF volume fraction. The cross-sectional width and the average length between the twists in the ribbon-shaped CMFs are directly determined and compared well with that of fibrils in the dried state. Finally, the generality of the fluorescent labeling and imaging approach on other CMF sources is illustrated. The unique ability to quantify in situ the multiscale structure in CMF dispersions provides a powerful tool for the correlation of process-structure-property relationship in cellulose-containing composites and dispersions.

Nonspherical armoured bubble vibration

In this paper, we study the dynamics of cylindrical armoured bubbles excited by mechanical vibrations. A step by step transition from cylindrical to spherical shape is reported as the intensity of the vibration is increased, leading to a reduction of the bubble surface and a dissemination of the excess particles. We demonstrate through energy balance that nonspherical armoured bubbles constitute a metastable state. The vibration instills the activation energy necessary for the bubble to return to its least energetic stable state: a spherical armoured bubble. At this point, particle desorption can only be achieved through higher amplitude of excitation required to overcome capillary retention forces. Nonspherical armoured bubbles open perspectives for tailored localized particle dissemination with limited excitation power.

Random three-dimensional jammed packings of elastic shells acting as force sensors

In a jammed solid of granular particles, the applied stress is in-homogeneously distributed within the packing. A full experimental characterization requires measurement of all the interparticle forces, but so far such measurements are limited to a few systems in two and even fewer in three dimensions. Particles with the topology of (elastic) shells are good local force sensors as relatively large deformations of the shells result from relatively small forces. We recently introduced such fluorescent shells as a model granular system in which force distributions can be determined in three dimensions using confocal microscopy and quantitative image analysis. An interesting aspect about these shells that differentiates them from other soft deformable particles is their buckling behavior at higher compression. This leads to deformations that do not conserve the inner volume of the particle. Here we use this system to accurately measure the contact forces in a three-dimensional packing of shells subjected to a static anisotropic compression and to shear. At small deformations forces are linear, however, for a buckled contact, the restoring force is related to the amount of deformation by a square root law, as follows from the theory of elasticity of shells. Near the unjamming-jamming transition (point J), we found the probability distribution of the interparticle forces P(f) to decay nearly exponentially at large forces, with little evidence of long-range force chains in the packings. As the packing density is increased, the tail of the distribution was found to crossover to a Gaussian, in line with other experimental and simulation studies. Under a small shear strain, up to 0.216, applied at an extremely low shear rate, we observed a shear-induced anisotropy in both the pair correlation function and contact force network; however, no appreciable change was seen in the number of contacts per particle.

Synthesis and biological evaluation of 2,6-di(furan-3-yl)anthracene-9, 10-dione as an inhibitor of human protein kinase CK2

Protein kinase CK2 is an emerging target for the therapeutic intervention in human diseases, in particular in cancer. Inhibitors of this enzyme are at current in clinical trials indicating its drug ability. Here we report on the synthesis of two derivatives of 2,6-diaryl-anthracene-9,10-dione, one of them, 2,6-di(furan-3-yl)anthracene-9,10-dione (3), turned out to be active towards CK2, and ATP competitive with an IC50 value of 2.35 μM and a K(i) value of 1.26 μM. Molecular modeling studies were performed to explain the binding affinity of compound 3 in comparison to emodin. These indicated that unlike emodin, compound 3 was not able to perform a hydrogen bond with Lys68, although the compound fits well in the active site of human CK2α, which explains the difference in the measured affinity between those two compounds.

Recurrent Warthin's tumour of the larynx

Warthin's tumours, or adenolymphomas, present commonly as masses of the parotid glands and salivary tissue. However, in the existing literature, few cases of laryngeal adenolymphomas are described. We report the case of a 60-year-old woman with a recurrent right-sided laryngeal adenolymphoma, and discuss the difficulties in diagnosis and management.

Interchannel coupling effects in the valence photoionization of SF6

The complex Kohn and polyatomic Schwinger variational techniques have been employed to illustrate the interchannel coupling correlation effects in the valence photoionization dynamics of SF6. Partial photoionization cross sections and asymmetry parameters of six valence subshells (1t1g, 5t1u, 1t2u, 3eg, 1t2g, 4t1u) are discussed in the framework of several theoretical and experimental studies. The complex Kohn results are in rather good agreement with experimental results, indicative of the fact that the interchannel coupling effects alter the photoionization dynamics significantly. We find that the dominant effect of interchannel coupling is to reduce the magnitude of shape resonant cross sections near the threshold and to induce resonant features in other channels to which resonances are coupled. The long-standing issue concerning ordering of the valence orbitals is addressed and confirmed 4t1u (6)1t2g (6)3eg (4)(5t1u (6)+1t2u (6)) 1t1g (6) as the most likely ordering.

Jammed elastic shells - a 3D experimental soft frictionless granular system

We present a new experimental system of monodisperse, soft, frictionless, fluorescent labeled elastic shells for the characterization of structure, universal scaling laws and force networks in 3D jammed matter. The elastic shells in a jammed packing are deformed in such a way that at each contact one of the shells buckles with a dimple and the other remain spherical, closely resembling overlapping spheres. Using confocal microscopy, we obtained 3D stacks of images of shells at different volume fractions which were subsequently processed in ImageJ software to find their coordinates. The determination of 3D coordinates involved three steps: locating the edges of shells in all 2D slices, analyzing their shape and subsequently finding their 2D coordinates, and finally determining their 3D centers by grouping the corresponding 2D coordinates. From this analysis routine we obtained particle coordinates with sub-pixel accuracy. In a contact pair we also identified the shell that underwent buckling forming a dimple by analyzing the intensity profile of a line that connects the centers of particle pairs. The amorphous structure of the packing was analyzed as a function of distance to the jamming threshold by investigating the radial distribution function, bond order parameters, contact numbers and the number of dimples per particle (buckling number), which is a unique property of this system. We find that the power law scaling of the contact number with excess volume fraction deviated from theoretical and computer simulation predictions. In addition, the buckling number also showed a similar scaling as that of the contact number with distance to the jamming transition.

Methods to calibrate and scale axial distances in confocal microscopy as a function of refractive index

Accurate distance measurement in 3D confocal microscopy is important for quantitative analysis, volume visualization and image restoration. However, axial distances can be distorted by both the point spread function (PSF) and by a refractive-index mismatch between the sample and immersion liquid, which are difficult to separate. Additionally, accurate calibration of the axial distances in confocal microscopy remains cumbersome, although several high-end methods exist. In this paper we present two methods to calibrate axial distances in 3D confocal microscopy that are both accurate and easily implemented. With these methods, we measured axial scaling factors as a function of refractive-index mismatch for high-aperture confocal microscopy imaging. We found that our scaling factors are almost completely linearly dependent on refractive index and that they were in good agreement with theoretical predictions that take the full vectorial properties of light into account. There was however a strong deviation with the theoretical predictions using (high-angle) geometrical optics, which predict much lower scaling factors. As an illustration, we measured the PSF of a correctly calibrated point-scanning confocal microscope and showed that a nearly index-matched, micron-sized spherical object is still significantly elongated due to this PSF, which signifies that care has to be taken when determining axial calibration or axial scaling using such particles.

Profile of incident chronic kidney disease related-mineral bone disorders in chronic kidney disease Stage 4 and 5: A hospital based cross-sectional survey

Chronic kidney disease related-mineral bone disorder (CKD-MBD) has been poorly studied in pre-dialysis Indian CKD patients. We aimed to study the clinical, biochemical and extra skeletal manifestations of untreated CKD-MBD in pre-dialysis Stage 4 and 5 CKD patients attending nephrology out-patient clinic at a tertiary care hospital in South India. A hospital based cross-sectional survey including, demographic profile, history of CKD-MBD symptoms, measurement of serum calcium, phosphate, parathyroid hormone, 25 hydroxy vitamin D (25(OH) D) and alkaline phosphatase; lateral abdominal X-rays for abdominal aortic calcification (AAC) and echocardiography for valvular calcification (VC) was carried out. Of the 710 patients surveyed, 45% had no CKD-MBD related symptom. Prevalence of hypocalcemia, hyperphosphatemia, hyperparathyroidism (>150 pg/mL) and 25(OH) D levels <30 ng/mL was 66.3%, 59%, 89.3% and 74.7% respectively. Echocardiography was carried out in 471 patients; 96% of whom had VC (calcification score ≥1). Patients with VC were older and had lower 25(OH) D levels than those without. Lateral abdominal X-rays were obtained in 558 patients, 6.8% of whom were found to have AAC, which was associated with older age. Indian patients with incident CKD-MBD have a high prevalence of hypocalcemia, 25(OH) D deficiency and VC even prior to initiating dialysis while AAC does not appear to be common. The association between 25(OH) D deficiency and VC needs further exploration.

Unloading and reloading colloidal microcapsules with apolar solutions by controlled and reversible buckling

We introduce a new experimental method to encapsulate and release oils and fluorescent molecules into preformed elastic colloidal microcapsules of polydimethylsiloxane (PDMS)-filled siloxane shells, which are cross-linked with tetraethoxysilane. The method uses controlled buckling, where the volume of the capsule is reduced by dissolving the PDMS oil inside the capsule by surfactant micelles. This results in a change in the morphology of the capsule that depends on the ratio of shell thickness to total particle radius (d/Rt). Microcapsules of d/Rt in the range 0.007-0.05 formed microbowls upon decreasing the inner volume. The amount of oil released or dissolved by the micelles can be directly related to the concentration of surfactant. By tuning the amount of oil released, we can make microbowls of variable depth. In addition, we demonstrate that the microbowls can be further used to load different oils like silicone oil, hydrocarbons, and apolar dyes. The elasticity of the capsule wall and the leftover PDMS oil inside the capsule provide the principal driving forces by which one can promote the uptake of different oils, including dissolved dye molecules.

First experiences of photoacoustic imaging for detection of melanoma metastases in resected human lymph nodes

BACKGROUND AND OBJECTIVE

Excision and histological assessment of the first draining node (sentinel lymph node) is a frequently used method to assess metastatic lymph node involvement related to cutaneous melanoma. Due to the time required for accurate histological assessment, nodal status is not immediately available to the surgeon. Hence, in case histological examination shows metastases, the patient has to be recalled to perform additional lymphadenectomy. To overcome these drawbacks we studied the applicability of photoacoustic tomographic imaging as an intra-operative modality for examining the status of resected lymph nodes.

MATERIALS AND METHODS

In melanoma patients undergoing lymphadectomy for metastatic disease, six suspect lymph nodes were photoacoustically (PA) imaged using multiple wavelengths. Histopathologal examination showed three nodes without tumor cells (benign nodes) and three nodes with melanoma cells (malignant nodes). PA images were compared with histology and anatomical features were analyzed. In addition, PA spectral analysis was performed on areas of increased signal intensity.

RESULTS

After correlation with histopathology, multiple areas containing melanoma cells could be identified in the PA images due to their increased response. Malignant nodes showed a higher PA response and responded differently to an increase in excitation wavelength than benign nodes. In addition, differences in anatomical features between the two groups were detected.

CONCLUSIONS

Photoacoustic detection of melanoma metastases based on their melanin content proves to be possible in resected human lymph nodes. The amount of PA signal and several specific anatomical features seem to provide additional characteristics for nodal analysis. However, it is as yet preliminary to designate a highly accurate parameter to distinguish between malignant and benign nodes. We expect to improve the specificity of the technique with a future implementation of an adjusted illumination scheme and depth correction for photon fluence.

Detection of membrane protein two-dimensional crystals in living cells

It is notoriously difficult to grow membrane protein crystals and solve membrane protein structures. Improved detection and screening of membrane protein crystals are needed. We have shown here that second-order nonlinear optical imaging of chiral crystals based on second harmonic generation can provide sensitive and selective detection of two-dimensional protein crystalline arrays with sufficiently low background to enable crystal detection within the membranes of live cells. The method was validated using bacteriorhodopsin crystals generated in live Halobacterium halobium bacteria and confirmed by electron microscopy from the isolated crystals. Additional studies of alphavirus glycoproteins indicated the presence of localized crystalline domains associated with virus budding from mammalian cells. These results suggest that in vivo crystallization may provide a means for expediting membrane protein structure determination for proteins exhibiting propensities for two-dimensional crystal formation.

Salting-out phenomenon and 1-octanol/water partition coefficient of metalaxyl pesticide

In this paper, we present the effect of inorganic cations such as Na+, K+, Ca2+, Mg2+ on the salting-out phenomenon of metalaxyl from pure water to aqueous salt solutions. Moreover the 1-octanol/water partition coefficient in pure water is presented. To accomplish this, aqueous solubility of metalaxyl was determined in pure water, in different salt solution (NaCl, KCl, CaCl2 and MgCl2), and at different concentration level ranging from 0.01 to 1.5 M. The 1-octanol/water partition coefficient was determined using the static shake-flask method. Solubility was determined using dynamic saturation method for pure water in the range of 298.15-325.15 K and at 298.15 K for different salt solutions. The solubility value in pure water for studied interval was found constant (m=3.118×10(-2) mol kg(-1)). Solubility values were used to calculate the standard molar Gibbs free energy of dissolution (ΔsolG°) and transfer (ΔtrG°) at 298.15 K. The values of ΔtrG° from pure to all studied aqueous salt solutions did not exceed 2 kJ mol(-1), the value of ΔsolG° of dissolution is 18.5 ±0.72 kJ mol(-1). The 1-octanol/water partition coefficient in pure water log Ko/w is equal to 1.69. The obtained results confirm the classification of the neutral metalaxyl as a slightly hydrophobic molecule.

Drug use in porphyria: a therapeutic dilemma

One of the most frequent precipitating factors for attacks of porphyria is the administration of drugs. Use of drugs with porphyrinogenic potential often worsens the condition and often poses a therapeutic dilemma. A 23-year-old female patient presented to the casualty room with abdominal pain, chest pain and vomiting. Her past medical history was significant with episodes of generalised abdominal pain. The patient was initially treated for her abdominal pain and vomiting. She developed seizures and was treated with diazepam and phenytoin. Based on the positive investigation reports (positive urine porphyrins, elevated urine ALA and positive porphobilinogen) and symptoms, a diagnosis of acute intermittent porphyria (AIP) was done. Before the diagnosis of AIP was made, the patient was treated with drugs which are not considered to be safe in porphyric patients, such as phenytoin, metoclopramide, and diclofenac. The use of these drugs probably contributed to the initial worsening of the patient's clinical condition. After the diagnosis of AIP was made, the patient was treated with safer alternatives; gabapentin as the antiepileptic agent, promethazine as antiemetic, and propanalol as the antihypertensive agent. Withdrawal of the unsafe agents and symptomatic management with the safer alternatives contributed to the recovery of the patient. Along with the case report and the observations made on the various drugs used in the patient, the importance of the various information sources available on the safety potential of these agents is discussed. The observations with the drugs used in our case will be a useful addition to the existing information on the safety of these agents.

Near-field observation of spatial phase shifts associated with Goos-Hänschen and Surface Plasmon Resonance effects

We report the near-field observation of the phase shifts associated with total internal reflection on a glass-air interface and surface plasmon resonance on a glass-gold-air system. The phase of the evanescent waves on glass and gold surfaces, as a function of incident angle, is measured using a phase-sensitive Photon Scanning Tunneling Microscope (PSTM) and shows a good agreement with theory.