Aggerholmaguirre0969

BACKGROUND The study aimed at assessing the variations in thickness of the supra-orbital bar in Crouzon (CS) and Apert syndromes (AS) before and after fronto-facial monobloc advancement (FFMBA) using CT-scan data. METHODS All CS or AS patients who underwent FFMBA between 2008 and 2018 with available clinical and CT-scan data were included. Frontal bone thickness was assessed at five locations of the supra-orbital bar using the Half-Maximum-Height protocol and plotted over the bone surface. RESULTS We included 210 CT-scans from 25 CS to 10 AS patients and 25 controls. Before FFMBA, CS children only had a significantly thicker frontal bone (+0.772 mm ± 0.312, p = 0.017). After FFMBA, a significant increase in frontal bone thickness was reported for CS at 3 months (+0.637 mm ± 0.141, p  less then  0.001), 6 months (+0.910 mm ± 0.120, p  less then  0.001) and 12 months (+1.099 mm ± 0.124, p  less then  0.001) post-operatively as well as in AS at 1 month (+2.069 mm ± 0.441, p  less then  0.001), 6 months (+1.247 mm ± 0.406, p = 0.003) and 12 months (+2.360 mm ± 0.284, p  less then  0.001) post-operatively. For both syndromes, age at FFMBA and specific FGFR2 mutations significantly influenced post-operative frontal bone thickness. CONCLUSIONS Craniofacial surgeons should be aware of the potential need for secondary surgery of the supra-orbital after FFMBA in CS and AS. Furthermore, a thicker supra-orbital bar is part of the CS phenotype, illustrating the role of FGFR2 in craniofacial growth. OBJECTIVE The aim of this study is to compare the balance ability, anxiety level and motion sickness susceptibility in Vestibular Migraine (VM) patients, migraineurs without history of vertigo (Migraine-only, MO) and healthy controls (HC). We tested the hypothesis that VM patients have worse balance performance and higher anxiety level and motion sickness than MO and HC group. METHODS This cross-sectional study included of 123 definite VM patients, 58 MO patients and 49 HCs. All subjects were evaluated with the Dynamic Gait Index (DGI), the modified Clinical Test of Sensory Integration and Balance (mCTSIB), the Motion Sickness Susceptibility Questionnaire Short-Form (MSSQ-Short), the Panic Agoraphobic Spectrum Self-Report version (PAS-SR) and the Dizziness Handicap Inventory (DHI). RESULTS The main balance outcomes indicated that DGI and mCTSIB scores were worse in VM than in MO patients and worse in MO patients than in HCs. Almost 50% of the VM patients fell in the most challenging mCTSIB conditions compared with 20% of MO patients and none of the HCs. VM patients had more marked motion sickness susceptibility, higher anxiety and DHI scores than MO patients and HCs. VM patients who fell had higher DHI and anxiety scores than those who did not. CONCLUSION Balance problems, motion sickness, anxiety, and disability are more marked in VM patients than in MO patients and more marked in MO patients than in HCs. Focused treatments of these problems which could help VM patients need further study. V.Non-recurrent inferior laryngeal nerve (NRILN) is rare but one of the important anatomical variations in thyroid and parathyroid surgery. Almost all cases were observed on the right side with aberrant right subclavian artery and left NRILN have been reported in only five cases so far. Here, we reported a 38 year-old Japanese male with left NRILN accompanying adenomatous goiter. He was referred to our hospital for the surgical treatment of left thyroid goiter. Preoperative computed tomography revealed right-sided aortic arch and aberrant left subclavian artery with no signs of complete situs inversus viscerum, suggesting possible left NRLN. Left hemithyroidectomy was performed using nerve monitoring system. Intraoperatively, left recurrent laryngeal nerve was not identified along tracheoesophageal groove, but directly originated from vagal nerve and was running horizontally to larynx. Mobility of vocal cords were not impaired and postoperative course was uneventful. During thyroid surgery for the patients with right-sided aortic arch, meticulous care should be taken using nerve monitoring system to avoid nerve injury. V.PURPOSE To characterize the effect of hepatic vessel flow using 4-dimensional (4D) flow magnetic resonance (MR) imaging and correlate their effect on microwave ablation volumes in an in vivo non-cirrhotic porcine liver model. MATERIALS AND METHODS Microwave ablation antennas were placed under ultrasound guidance in each liver lobe of swine (n = 3 in each animal) for a total of 9 ablations. Pre- and post-ablation 4D flow MR imaging was acquired to quantify flow changes in the hepatic vasculature. Flow measurements, along with encompassed vessel size and vessel-antenna spacing, were then correlated with final ablation volume from segmented MR images. RESULTS The linear regression model demonstrated that the preablation measurement of encompassed hepatic vein size (β = -0.80 ± 0.25, 95% confidence interval [CI] -1.15 to -0.22; P = .02) was significantly correlated to final ablation zone volume. The addition of hepatic vein flow rate found via 4D flow MRI (β = -0.83 ± 0.65, 95% CI -2.50 to 0.84; P = .26), and distance from antenna to hepatic vein (β = 0.26 ± 0.26, 95% CI -0.40 to 0.92; P = .36) improved the model accuracy but not significantly so (multivariate adjusted R2 = 0.70 vs univariate (vessel size) adjusted R2 = 0.63, P = .24). CONCLUSIONS Hepatic vein size in an encompassed ablation zone was found to be significantly correlated with final ablation zone volume. Although the univariate 4D flow MR imaging-acquired measurements alone were not found to be statistically significant, its addition to hepatic vein size improved the accuracy of the ablation volume regression model. Pre-ablation 4D flow MR imaging of the liver may assist in prospectively optimizing thermal ablation treatment. Spontaneous locomotor activity (SLA) is a useful parameter reflecting physical and mental status of experimental animals. Here we aimed to establish a novel and simple method to assess mouse SLA using motion picture. Movement of C57BL/6 mice was continuously recorded by an infrared video camera connected with a single board computer. The geometric center of mouse outline in each frame was calculated using an image processing library, OpenCV in a programming language Python. Moving distance of the geometric center every second was utilized as an index of mouse SLA. Twenty-four hours assessment of SLA showed that mice repeated active and resting phase. Mice moved more actively during the dark period compared with the light period. Time-frequency analysis of SLA followed by unsupervised clustering classified their active and resting phase. Administration of a sedative, chlorpromazine (5 mg/kg) abolished mouse SLA for 8 h. find more In contrast, administration of a central nervous stimulant, caffeine (25 mg/kg) increased SLA for 3 h. In conclusion, we here established the automatic measurement system of mouse SLA using motion picture. This system is composed of common equipment and analysis software written in freely available programming language. We also confirmed that it is applicable for drug assessment. Syphilis has become a serious issue for human immunodeficiency virus (HIV)-infected patients worldwide in recent years; however, the studies related to HIV coinfection and syphilis reinfections in Istanbul, Turkey, are limited. Our objective was to determine the seroprevalence of syphilis among HIV-infected men in the city which has one of the highest HIV prevalence rates in Turkey. Two hundred and forty four (244) HIV-positive men were evaluated at Istanbul Medical Faculty, Department of Medical Microbiology from March to June 2018. Serum samples were screened for the presence of antibodies against Treponema pallidum using the chemiluminescent microparticle immunoassay (CMIA). Samples found to be positive were investigated with the rapid plasma reagin (RPR) test and the T. pallidum hemagglutination assay (TPHA). The patients completed a questionnaire for sociodemographic data. The mean age was found to be 41.8 years; 35.6% were men who have sex with men (MSM). The overall seroprevalence of syphilis among the patients was 19.3%. MSM had a significantly higher seroprevalence than heterosexual patients (28.7%). In Turkey, there is a high seroprevalence of syphilis in HIV-infected patients, MSM being the most affected group. Therefore, HIV-infected patients should be screened for syphilis at least annually and should be informed about sexually transmitted diseases (STDs). Human trafficking is a pandemic human rights violation with an emerging paradigm shift that reframes an issue traditionally seen through a criminal justice lens to that of a public health crisis, particularly for children. Children and adolescents who are trafficked or are at risk for trafficking should receive evidence-based, trauma-informed, and culturally responsive care from trained health care providers (HCPs). The purpose of this article was to engage and equip pediatric HCPs to respond effectively to human trafficking in the clinical setting, improving health outcomes for affected and at-risk children. Pediatric HCPs are ideally positioned to intervene and advocate for children with health disparities and vulnerability to trafficking in a broad spectrum of care settings and to optimize equitable health outcomes. BACKGROUND Our objective was to describe trends and deaths in young children associated with opioid analgesics. METHODS Analysis of pediatric exposures using the RADARS System Poison Center Program from July 1, 2010 through December 31, 2018. Cases involving a child less then 6 years, with an exposure to one or more opioids buprenorphine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, oxycodone, oxymorphone, and tramadol. Poisson regression was used to model the shape of the time response curve. RESULTS 48,560 cases were identified, median age 2 years (IQR 1.4, 2.0), 52.4 % male. The most commonly involved opioid was hydrocodone (32.5 %); buprenorphine and methadone had the highest exposure rates when adjusted for dispensed prescriptions (0.84 and 0.73 per 10,000 prescriptions). There were 28 deaths, methadone being the most commonly involved opioid (16). Exposures decreased significantly accounting for population (from 8.39 to 4.19 exposures per 100,000 children) and per prescription (from 0.33 to 0.25 exposures per 10,000 prescriptions). After adjustment for prescriptions, the exposure rate for hydromorphone and fentanyl increased over the study period, while buprenorphine had the greatest decrease in exposure rate. Among 28 deaths, 11 (39 %) were known or suspected to have been exposed, but medical care was not sought or was delayed. CONCLUSION Pediatric opioid exposure rates by prescription and population decreased from July 2010 through December 2018. However, with over 48,000 exposures and 28 deaths, the opioid epidemic continues to impact young children. Many exposures including deaths were preventable. Continued improvements in prevention require a multifaceted approach. V.Cardiac metastases are an uncommon phenomenon associated with neoplasms from a variety of primary sites. Pulmonary involvement often accompanies metastases involving the left atrium or ventricle and clinical presentation may be associated with stroke or emboli involving distal sites. We report a patient who presented acutely to the Emergency Department with symptoms of a cerebrovascular accident and bilateral cold pulseless lower extremities. Computerized Tomographic (CT) angiogram of the chest, abdomen, pelvis and lower extremities disclosed pulmonary veins with large filling defects in the right superior and inferior vessels as well as the left atrium and atrial appendage. Mediastinal and hilar adenopathy was detected. The patient had a history of tonsillar squamous cell carcinoma eighteen months prior. The patient underwent operative intervention with removal of a large left intra-atrial mass, histologic evaluation of which demonstrated groups of malignant squamous cells meshed in fibrin clot. The patient died three days post operatively due to multiple brain infarctions.