Spontaneous recovery of post-traumatic cerebrospinal fluid rhinorrhea following meningitis: A case report

The aim of the present report was to present the patient with an anterior cranial base fracture who developed post-traumatic cerebrospinal fluid rhinorrhea, which recovered after onset of meningitis complication. A 26-year-old male patient who had a traffic accident one week ago was sent to our clinic because of his rhinorrhea persisting for 4 days. On cranial computed tomography, fracture of the left frontal skull base and sinus walls, a fracture line on temporal bone, parenchymal bleeding in the vicinity of the frontal sinus, subarachnoidal bleeding and left temporal extradural hematoma were detected. Then he underwent sinus wall repair and extradural hematoma was drained through bifrontal craniotomy. However, rhinorrhea persisted which resulted a deterioration in consciousness and he entered into a deep somnolent state. When his symptoms of meningitis became apparent, rhinorrhea of the patient disappeared. The patient transferred in intensive care unit and re-connected to a lumbar drainage system. On cerebral magnetic resonance imaging, regression of contrast-enhanced lesions localized in the left anterotemporal and frontal and in the regions lateral to the right trigon and medial to the right thalamus and in the right posteroparietal regions was observed. Despite repair of the anterior cranial fracture and lumbar drainage, rhinorrhea may persist. Herein, development of meningitis caused disappearing of rhinorrhea symptoms without any need for surgical intervention

When increasing population density can promote the evolution of metabolic cooperation.

This is the author accepted manuscript. The final version is available from Nature Publishing Group via the DOI in this record.Microbial cooperation drives ecological and epidemiological processes and is affected by the ecology and demography of populations. Population density influences the selection for cooperation, with spatial structure and the type of social dilemma, namely public-goods production or self-restraint, shaping the outcome. While existing theories predict that in spatially structured environments increasing population density can select either for or against cooperation, experimental studies with both public-goods production and self-restraint systems have only ever shown that increasing population density favours cheats. We suggest that the disparity between theory and empirical studies results from experimental procedures not capturing environmental conditions predicted by existing theories to influence the outcome. Our study resolves this issue and provides the first experimental evidence that high population density can favour cooperation in spatially structured environments for both self-restraint and public-goods production systems. Moreover, using a multi-trait mathematical model supported by laboratory experiments we extend this result to systems where the self-restraint and public-goods social dilemmas interact. We thus provide a systematic understanding of how the strength of interaction between the two social dilemmas and the degree of spatial structure within an environment affect selection for cooperation. These findings help to close the current gap between theory and experiments.RJL and IG: European Research Council No. 647292 MathModExp. BJP: Engineering and Physical Sciences Research Council Doctoral training grant studentship

Killing by type VI secretion drives genetic phase separation and correlates with increased cooperation

By nature of their small size, dense growth and frequent need for extracellular metabolism, microbes face persistent public goods dilemmas. Genetic assortment is the only general solution stabilizing cooperation, but all known mechanisms structuring microbial populations depend on the availability of free space, an often unrealistic constraint. Here we describe a class of self-organization that operates within densely packed bacterial populations. Through mathematical modelling and experiments with Vibrio cholerae, we show how killing adjacent competitors via the Type VI secretion system (T6SS) precipitates phase separation via the ‘Model A' universality class of order-disorder transition mediated by killing. We mathematically demonstrate that T6SS-mediated killing should favour the evolution of public goods cooperation, and empirically support this prediction using a phylogenetic comparative analysis. This work illustrates the twin role played by the T6SS, dealing death to local competitors while simultaneously creating conditions potentially favouring the evolution of cooperation with kin

Challenges in microbial ecology: building predictive understanding of community function and dynamics.

The importance of microbial communities (MCs) cannot be overstated. MCs underpin the biogeochemical cycles of the earth's soil, oceans and the atmosphere, and perform ecosystem functions that impact plants, animals and humans. Yet our ability to predict and manage the function of these highly complex, dynamically changing communities is limited. Building predictive models that link MC composition to function is a key emerging challenge in microbial ecology. Here, we argue that addressing this challenge requires close coordination of experimental data collection and method development with mathematical model building. We discuss specific examples where model-experiment integration has already resulted in important insights into MC function and structure. We also highlight key research questions that still demand better integration of experiments and models. We argue that such integration is needed to achieve significant progress in our understanding of MC dynamics and function, and we make specific practical suggestions as to how this could be achieved

The effect of maternal body mass index on the placental thickness

WOS: 000474747400019Introduction: the increase in the placental thickness (mm) in the second trimester of pregnancy is associated with placenta-mediated pregnancy complications. the authors aimed to evaluate the effect of maternal BMI (kg/cm(2)) on the placental thickness in the second trimester. Materials and Methods: the second trimester is a prospective study in which 832 pregnant women (gestational age between weeks 18 and 24) were examined. the measurements of BMI and placental thickness of the participants were statistically evaluated by simple linear regression analysis. Results: the average chronological age of the 832 participating pregnant women was 28.64. the average placental thickness was 25.30 mm and the average BMI value was 26.46 kg/cm(2). Simple linear regression analysis was performed for evaluating the effect of BMI (independent variable) on the placental thickness (dependent variable). A regression equation in the form of [F (1.830) = 5.833; p = 6 < 0.05] and R-2 = 0.007 was obtained in the analysis. the placental thickness was 23.063 +/- 0.085 mm for the second trimester. Conclusion: A positively significant linear relationship was observed between the placental thickness and BMI. According to this, a one-unit increase in the BMI affects the placental thickness by 0.085 mm. the importance of these findings will be understood in a future result-oriented study. Using modifications according to the maternal BMI in calculating the placental thickness will contribute to the sensitive medicine approach as well

Controversy about the protective role of volume in the frontal sinus after severe head trauma: larger sinus equates with higher risk of death

Ozdemir, Dogukan/0000-0003-2008-163XWOS: 000528279500013PubMed: 31918887The "crumple zone" hypothesis suggests that the paranasal sinuses protect the brain as a zone to distribute and absorb energy after trauma to the head. We investigated the relation between the size of the frontal sinus and mortality in patients with cranial trauma. All patients with head trauma admitted to the ICU between 1 January 2016 and 20 December 2017 were reviewed retrospectively. They were divided into two groups (according to their outcome) : died and survived. the volumes of the frontal sinuses and other trauma-related variables were assessed on computed tomographs (CT) on admission. Admission CT of 33 patients (24 male, and nine female, aged between 18-92 years, mean 43) were obtained. Male patients had significantly larger frontal sinuses than female (10.24 compared with 6.6 cm3). Larger sinuses were significantly associated with a worse outcome (p = 0.005). the size of the frontal sinus correlates with mortality after cranial trauma. Our findings do not confirm the "crumple zone" hypothesis, and suggest that the larger the sinus, the greater the risk of death. To our knowledge this is a new finding that warrants further validation. (C) 2019 the British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved

Comparison of Subthalamic Nucleus vs. Globus Pallidus Interna Deep Brain Stimulation in Terms of Gait and Balance; A Two Year Follow-Up Study.

AIM: To compare the effects of subthalamic nucleus (STN) and globus pallidus interna (GPi) deep brain stimulation (DBS) on the motor outcome, gait and balance function, fall risk (FR), and non-motor symptoms in patients with advanced Parkinson's disease (PD). MATERIAL AND METHODS: We randomized patients with advanced PD with the indication of DBS to undergo either STN or GPi DBS and followed them for 2 years. We collected data at baseline and postoperative 6, 12, and 24 months. We compared changes in the Unified Parkinson's Disease Rating Scale (UPDRS) score, timed gait tests, posturography, non-motor symptom questionnaire (NMSQuest), hospital anxiety and depression (HAD) scale, and levodopa equivalent dose (LED). RESULTS: We enrolled and randomized 12 patients to receive either STN (n = 6) or GPi (n = 6) DBS. Postoperative motor outcomes were significantly improved in both groups (p < 0.05). In both groups, timed gait tests exhibited better performance in mobility; however, patients receiving GPi DBS performed better than those receiving STN DBS in the timed gait tests (p < 0.05). Furthermore, the posturographic evaluation demonstrated a significant elevation in the FR in the STN group (p < 0.05). CONCLUSION: Both STN and GPi DBS are equally effective in alleviating disabling motor complications. However, seemingly, STN DBS could cause more gait and balance problems; hence, a tailored approach seems to be more appropriate in the target selection

The Effect Of Acute Normovolemic Hemodilution And Acute Hypervolemic Hemodilution On Coagulation And Allogeneic Transfusion

Objective: In this study, acute normovolemic hemodilution (ANH) and hypervolemic hemodilution (HHD) were compared with no hemodilution with regards to the effectiveness in blood usage and coagulation parameters. Methods: The study was performed from February to August 2001 at Hacettepe University Hospital, Ankara, Turkey. Thirty patients undergoing hip arthroplasty surgery were prospectively randomized into: ANH group [autologous blood 15 mL kg(-1) was withdrawn and replaced by 6% hydroxyethyl starch (HES)] or HHD group (HES was administered without removal of any autologous blood) or the control group (no hemodilution). In all groups, blood was given when hemoglobin concentration was <9 g dl(-1). Results: Three groups were clinically similar regarding blood loss, mean arterial pressures and coagulation parameters. But allogeneic transfusion requirements were significantly less in hemodilution groups (20% in ANH, 40% in HHD) compared to the control group (100% of patients). Conclusion: We conclude that hemodilution (both ANH and HHD) decreases the demand for homologous blood without adversely affecting hemodynamics or coagulation parameters and HHD seems to be a simple and valuable alternative to ANH in orthopedic patient undergoing hip replacement.Wo