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The sternocleidomastoid can be used as a pedicled flap in head and neck reconstruction. It has previously been associated with high complication rates, likely due in part to the variable nature of its blood supply.
To provide clinicians with an up-to-date review of clinical outcomes of sternocleidomastoid flap surgery in head and neck reconstruction, integrated with a review of vascular anatomical studies of the sternocleidomastoid.
A literature search of the Medline and Web of Science databases was conducted. Complications were analysed for each study. The trend in success rates was analysed by date of the study.
Reported complication rates have improved over time. The preservation of two vascular pedicles rather than one may have contributed to improved outcomes.
The sternocleidomastoid flap is a versatile option for patients where prolonged free flap surgery is inappropriate. Modern vascular imaging techniques could optimise pre-operative planning.
Background: SMA is a neurodegenerative disease caused by biallelic deletion/mutation of SMN1. Copies of a similar gene (SMN2) modify disease severity. In a phase 1 study, SMN GRT onasemnogene abeparvovec (AVXS-101) improved outcomes of symptomatic SMA patients with two SMN2 copies (2xSMN2) dosed ≤6 months. Because motor neuron loss can be insidious and disease progression is rapid, early intervention is critical. This study evaluates AVXS-101 in presymptomatic SMA newborns. Methods: SPR1NT is a multicenter, open-label, phase 3 study enrolling ≥27 SMA patients with 2–3xSMN2. Asymptomatic infants ≤6 weeks receive a one-time intravenous AVXS-101 infusion (1.1x1014 vg/kg). Safety and efficacy are assessed through study end (18 [2xSMN2] or 24 months [3xSMN2]). Primary outcomes: independent sitting for ≥30 seconds (18 months [2xSMN2]) or assisted standing (24 months [3xSMN2]). Results: From April–September 2018, 7 infants received AVXS-101 (4 female; 6 with 2xSMN2) at ages 8–37 days. Mean baseline CHOP-INTEND score was 41.7 (n=6), which increased by 6.8, 11.0, 18.0, and 22.5 points at day 14 (n=4), month 1 (n=3), 2 (n=3), and 3 (n=2). Updated data available at the time of the congress will be presented. Conclusions: Preliminary data from SPR1NT show rapid motor function improvements in presymptomatic SMA patients.
Infantile haemangiopericytoma is a rare childhood vascular tumour of borderline malignancy and unpredictable clinical course. It can present a diagnostic challenge due to indeterminate clinical, radiological and pathological features. This report presents the case of a large congenital haemangiopericytoma of the neck in a neonate, and discusses diagnosis, imaging, pathology and surgical management.
A full-term neonate presented with a large posterior neck mass at birth. Pre-operative radiological appearances were suggestive of teratoma, but following surgical excision the diagnosis of infantile haemangiopericytoma was confirmed on histological analysis. There were no signs of recurrence at 12-month follow up.
Haemangiopericytoma can follow an aggressive course in adults, including local recurrence and metastasis. The infantile variant is rare but typically follows a distinct clinical course, and is associated with more benign behaviour compared with similar tumours in adults and children over one year. Congenital haemangiopericytoma can be effectively treated with surgery, without requiring adjuvant therapy.
Campylobacter are zoonotic pathogens commonly associated with gastroenteritis. To assess the relevance of Campylobacter in Vietnam, an economically transitioning country in SE Asia, we conducted a survey of 343 pig and poultry farms in the Mekong delta, a region characterized by mixed species farming with limited biosecurity. The animal-level prevalence of Campylobacter was 31·9%, 23·9% and 53·7% for chickens, ducks and pigs, respectively. C. jejuni was predominant in all three host species, with the highest prevalence in pigs in high-density production areas. Campylobacter isolates demonstrated high levels of antimicrobial resistance (21% and 100% resistance against ciprofloxacin and erythromycin, respectively). Multilocus sequence type genotyping showed a high level of genetic diversity within C. jejuni, and predicted C. coli inter-species transmission. We suggest that on-going intensification of animal production systems, limited biosecurity, and increased urbanization in Vietnam is likely to result in Campylobacter becoming an increasingly significant cause of human diarrhoeal infections in coming years.
Non-typhoidal Salmonella are an important but poorly characterized cause of paediatric diarrhoea in developing countries. We conducted a hospital-based case-control study in children aged <5 years in Ho Chi Minh City to define the epidemiology and examine risk factors associated with Salmonella diarrhoeal infections. From 1419 diarrhoea cases and 571 controls enrolled between 2009 and 2010, 77 (5·4%) diarrhoea cases were stool culture-positive for non-typhoidal Salmonella. Salmonella patients were more likely to be younger than controls (median age 10 and 12 months, respectively) [odds ratio (OR) 0·97; 95% confidence interval (CI) 0·94–0·99], to report a recent diarrhoeal contact (8·1% cases, 1·8% controls; OR 5·98, 95% CI 1·8–20·4) and to live in a household with >2 children (cases 20·8%, controls 10·2%; OR 2·32, 95% CI 1·2–4·7). Our findings indicate that Salmonella are an important cause of paediatric gastroenteritis in this setting and we suggest that transmission may occur through direct human contact in the home.
Biologically relevant lipid bilayers supported on highly ordered pyrolytic graphite (HOPG) were probed both mechanically and electrically with a Conductive Atomic Force Microscope (C-AFM) capable of measuring ultra-low currents. Results show that these membranes undergo an elastic response up to 26 nN on average when compressed with an AFM tip. Measuring the films with a low contact force demonstrates that contact mode AFM can be used repeatedly to image without damaging the film. Based on current-voltage measurements made with the C-AFM, it is shown that apparently high resistances seen for the films could be the result of variable electrical contact between the tip and surface. As a result, the paper proposes that the deflection of the cantilever should always be measured in order to ensure knowledge of the location of the tip during all electrical measurements.
Most of the nearly zonal, multiple, alternating jets observed in the oceans are latent, that is, their amplitudes are weak relative to the ambient mesoscale eddies. Yet, relatively strong jets are often observed in dynamical simulations. To explore mechanisms controlling the degree of latency, we analyse solutions of an idealized, eddy-resolving and flat-bottom quasigeostrophic model, in which dynamically generated mesoscale eddies maintain and interact with a set of multiple zonal jets. We find that the degree of the latency is controlled primarily by the bottom friction: the larger the friction parameter, the more latent are the jets; and the degree of the latency is substantial for a realistic range of the oceanic bottom friction coefficient. This result not only provides a plausible explanation for the latency of the oceanic jets, but it may also be relevant to the prominent atmospheric multiple jets observed on giant gas planets, such as Jupiter. We hypothesize that these jets can be so strong because of the relative absence of the bottom friction. The mechanism controlling the latency in our solutions is understood in terms of the changes induced in the linear eigenmodes of the time–mean flow by varying the bottom friction coefficient; these changes, in turn, affect and modify the jets. Effects of large Reynolds numbers on the eddies, jets, and the latency are also discussed.
The apparent family clustering of avian influenza A/H5N1 has led several groups to postulate the existence of a host genetic influence on susceptibility to A/H5N1, yet the role of host factors on the risk of A/H5N1 disease has received remarkably little attention compared to the efforts focused on viral factors. We examined the epidemiological patterns of human A/H5N1 cases, their possible explanations, and the plausibility of a host genetic effect on susceptibility to A/H5N1 infection. The preponderance of familial clustering of cases and the relative lack of non-familial clusters, the occurrence of related cases separated by time and place, and the paucity of cases in some highly exposed groups such as poultry cullers, are consistent with a host genetic effect. Animal models support the biological plausibility of genetic susceptibility to A/H5N1. Although the evidence is circumstantial, host genetic factors are a parsimonious explanation for the unusual epidemiology of human A/H5N1 cases and warrant further investigation.
We investigated an outbreak of Salmonella Enteritidis (SE) infections linked to raw mung bean sprouts in 2000 with two case-control studies and reviewed six similar outbreaks that occurred in 2000–2002. All outbreaks were due to unusual phage types (PT) of SE and occurred in the United States (PT 33, 1, and 913), Canada (PT 11b and 913), and The Netherlands (PT 4b). PT 33 was in the spent irrigation water and a drain from one sprout grower. None of the growers disinfected seeds at recommended concentrations. Only two growers tested spent irrigation water; neither discarded the implicated seed lots after receiving a report of Salmonella contamination. We found no difference in the growth of SE and Salmonella Newport on mung beans. Mung bean sprout growers should disinfect seeds, test spent irrigation water, and discontinue the use of implicated seed lots when pathogens are found. Laboratories should report confirmed positive Salmonella results from sprout growers to public health authorities.
Dengue and Japanese encephalitis flaviviruses cause severe disease and are hyperendemic in southern Vietnam. This study assesses associations between sociodemographic factors and flavivirus seroprevalence in this region. Sera were collected from 308 community and hospital-based subjects between April 1996 and August 1997 and tested with an indirect ELISA. The factors associated with seroprevalence were assessed using multivariate logistic regression. In this first report of adjusted prevalence odds ratios (POR) for flavivirus infection in Vietnam, seropositivity was associated with increasing age in children (multiple regression coefficients for a child compared to an adult =−4·975 and for age in children = 0·354) and residence in the city compared to surrounding rural districts. The association with age indicates that subjects were most likely to have acquired infection in early childhood. This is key to the design of Vietnamese health education and immunization programmes.
We review four hypotheses for the control of carbon acquisition by roots, and conclude that the functional
equilibrium hypothesis can offer a good description of C acquisition by roots relative to shoots, but is deficient
mechanistically. The hypothesis that import into roots is solely dependent on export from the shoot, itself
determined by features of the shoot alone (the ‘push’ hypothesis), is supported by some but not all the evidence.
Similarly, the idea that root demand, a function of the root alone, determines import into it (the ‘pull’ hypothesis),
is consonant with some of the evidence. The fourth, general, hypothesis (the ‘shared control’ hypothesis) – that
acquisition of C by roots is controlled by a range of variables distributed between root and shoot – accords with
both experiment and theory. Top-down metabolic control analysis quantifies the control of C flux attributable to
root relative to source leaf. We demonstrate that two levels of mechanistic control, short-term regulation of phloem
transport and control of gene expression by compounds such as sugars, underlie distributed control. Implications
for the impact of climate change variables are briefly discussed.
We have explored the relationships between specific leaf area calculated for a whole plant and its individual leaves.
Barley was grown in hydroponics in controlled environment cabinets. Plants were harvested on the basis of
physiological age (defined as the number of days after full expansion of leaves on the main stem) and the area and
weight of whole, fully expanded, leaves measured and specific leaf area (SLA) of individual leaves or whole plants
calculated. Specific leaf area calculated for individual leaves (SLAL) varied with leaf position and with leaf age after
full expansion whereas SLA calculated for whole plants (SLAP) varied with plant age. The same conclusions were
reached whether the results were based on total dry weight or dry weight minus soluble carbohydrates (‘structural
weight’). Transferring plants to shade on the day of full expansion of the third leaf on the main stem increased
the SLAP, and also SLAL of leaves 3 and 4 on the main stem (leaf 4 being the younger leaf of the two), because
of a decrease in the ‘structural weight’ of these leaves. However SLAL of leaf 2 (which was older than leaf 3) was
not affected by shading; the effect was confined to leaves developing in the new conditions.
After cooling the roots and shoot apex of barley, there is a reduction
in sucrose export from, and an increased total
accumulation of carbohydrate and induction of fructan synthesis in, source
leaves. We investigated carbohydrate
accumulation in individual leaf cells. Using the microsampling technique and
microfluorometric enzymatic assay,
the amounts of various carbohydrates were measured in mesophyll, bundle
sheath and epidermal cells. Epidermal
cells take no part in carbohydrate partitioning and have very low
concentrations of sugars even when leaf export
is reduced. Even without cooling, however, there are remarkable changes in
sucrose concentration (up to 200 mM)
in mesophyll and bundle sheath cells during the photoperiod. The activity of
acid invertase in samples from
individual cells was very low, c. 3 μmol
sucrose (g f. wt)−1 h−1.
Interrelationships between these cell types and the
control of fructan metabolism are discussed.
Fasting plasma levels of tryptophan, kynurenine and the pteridines, neopterin and tetrahydrobiopterin were measured in seven patients with Gilles de la Tourette syndrome (GTS) and 10 healthy controls. Plasma kynurenine was significantly elevated in the GTS patients. The lowest patient value was higher than the highest control value. Values for tryptophan, neopterin and tetrahydrobiopterin were similar in TS patients and controls. However, in TS patients only, there was a significant negative correlation between tryptophan and neopterin and a significant positive correlation between kynurenine and neopterin when controlling for tryptophan. This finding indicates that activation of cellular immune processes is a possible explanation for the rise in plasma kynurenine.
The role of event knowledge in early language acquisition was investigated. Thirteen two-year-olds were observed interacting with their mothers over a five-week period. During weekly observational sessions, dyads interacted in both a familiar-event context and an unfamiliar-event context. Events were represented by complex toys (e.g. airport, marina, etc.). In the familiar-event, dyads interacted with the same event-toy during each observation period. In the unfamiliar-event, these same dyads interacted with a different novel toy during each observation period. The results indicated that children's increasing event knowledge facilitated their language development. Specifically, children's lexical type use, action verb use, and MLU increased in the familiar-event, but remained unchanged in the unfamiliar-event. Event knowledge also facilitated children's lexical token use. Results are discussed in terms of the role of event knowledge in language acquisition.