Concurrent Hiatal Hernia and Megaesophagus Secondary to a Nasopharyngeal Polyp in a 6-month-old Cat

Background: Nasopharyngeal polyps are benign and inflammatory masses assumed to arise from the middle ear or the eustachian tube with extension into the pharynx. The most common clinical signs associated with nasopharyngeal polyps include respiratory stertor, dyspnea, and otic discharge Neurological signs, including head tilt, facial nerve paralysis, and ataxia, might indicate concurrent involvement of the middle or inner ear. The objective of the current study is to describe a case of a feline nasopharyngeal polyp with a concurrent hiatal hernia and megaesophagus, both spontaneously resolved after removal of the polyp.Case: A 6-month-old, intact, female, domestic shorthair cat presented for evaluation of lethargy, anorexia, and upper respiratory signs, such as stridor, stertor, and dyspnea. A thoracic radiography revealed esophageal dilation caudal to the cardiac silhouette, suggestive of megaesophagus with gaseous filtration. An esophagram confirmed a hiatal hernia and megaesophagus. Computed tomography revealed a nasopharyngeal mass adjacent to the soft palate and a soft-tissue density in the right tympanic bulla. A tentative diagnosis of a nasopharyngeal polyp was made. After the ventral bulla osteotomy, the nasopharyngeal mass was removed by a gentle traction avulsion technique. Six days after the surgery, hiatal hernia and megaesophagus were spontaneously resolved. Based on histopathologic exam, the mass was found to be an inflammatory nasopharyngeal polyp. Two months after surgery, the owner reported that the patient’s condition had returned to baseline with a good appetite, and the thoracic radiography was within normal limit. Six months after the surgery, the owner reported the patient was completely recovered from the upper airway obstruction signs.Discussion: For successful treatment of a nasopharyngeal polyp, traction avulsion of the polyp with or without a ventral bulla osteotomy is recommended. However, in patients with otitis media, a ventral bulla osteotomy followed by traction avulsion of the polyp is recommended in order to reduce the rate of polyp recurrence. Common clinical signs of a nasopharyngeal polyp are stertor, stridor, dyspnea, dysphagia, and open-mouth breathing, which are identified in a chronic upper airway obstruction. A hiatal hernia secondary to a nasopharyngeal polyp has not been reported so far. However, a relationship between chronic upper airway obstruction and hiatal hernias has been proposed previously. Moreover, hiatal hernia resolved spontaneously after removal of the nasopharyngeal polyp suggests that the occurrence of the hiatal hernia was secondary to the nasopharyngeal polyp. In addition to the hiatal hernia, megaesophagus was also identified in the present case. Megaesophagus secondary to a chronic upper airway obstruction from a nasopharyngeal obstruction has been reported. However, megaesophagus is also thought to occur secondary to hiatal hernias. Therefore, in the current study, it is unclear whether the megaesophagus was solely a result of the obstructive nature of the nasopharyngeal polyp or a combination of the hiatal hernia and the nasopharyngeal polyp. In conclusion, any cat with clinical signs of an upper airway obstruction and a concurrent hiatal hernia and megaesophagus should be thoroughly investigated for a nasopharyngeal polyp, as well as other gastrointestinal and systemic causes. Furthermore, this case suggests that the prognosis for a concurrent hiatal hernia and megaesophagus is good in cats if the nasopharyngeal polyp is properly removed.Keywords: cat, hiatal hernia, megaesophagus, nasopharyngeal poly

Frontal Cystic Meningioma Removed by a Partial Transfrontal Craniotomy in a Cat

Background: Meningiomas are the most frequently reported intracranial tumors in cats. It is known to arise at the point of arachnoid cells project into the dural venous sinuses. Cats with intracranial meningiomas are treated by surgical management as the tumors are commonly delineated from normal brain tissue and are not likely to adhere to the cerebral parenchyma. Although meningioma is the most common intracranial tumor in cats, the incidence of cystic meningioma is low. The objective of the current study is to report a case of frontal cystic meningioma with peritumoral cystic structure removed by a partial transfrontal craniotomy. Case: A 10-year-old castrated British shorthair cat was referred to the Baeksan Feline Medical Center with a recent onset of seizures. On the physical examination, the patient was bright and alert. Neurological examinations were unremarkable at the time of presentation. Hematologic examinations were within normal limits. Thoracic and abdominal radiography, and abdominal ultrasonography revealed unremarkable findings. Magnetic resonance imaging revealed an extra-axial mass cranial to the frontal lobe. On the sagittal plane, a cystic structurewas identified in the frontal areaon post-contrast T1W images. No contrast enhancement of the cystic wall was identified after intravenous injection of contrast medium on T1W. On the transverse plane of T2W images, midline shift to the left due to peritumoral edema was observed. The mass was removed via partial transfrontal craniotomy. Postoperative radiography was performed to ensure appropriate placement of the mesh. The patient recovered uneventfully after anesthesia. After the surgery, the patient was closely monitored in an intensive care unit between 24 and 48 h. Based on the histologic findings, the final diagnosis was a fibroblastic meningioma. Nineteen months after the surgery, there was no seizure activity identified by the owner.Discussion: Depending on the location of the cyst, meningiomas can be classified into 4 types according to the human literature. In types 1 and 2, the whole cyst is located within the tumor, resulting in contrast enhancement of the cystic wall. In types 3 and 4, the cysts are located outside the tumor, and no contrast enhancement of the cystic wall is observed. In type 3, the cyst lies adjacent to the brain parenchyma rather than adjacent to the tumor and the meningioma is related to a cerebrospinal fluid cyst bordered by the arachnoid. It is important to classify the type of cystic meningioma prior to surgery in order to decide whether to remove the cystic wall. In type 2, the cystic wall is infiltrated by tumor cells, while the cystic wall of type 3 meningioma is composed of gliotic tissue without any tumor cells. Therefore, in type 2, the meningiomas with cystic walls should be removed for the prevention of recurrence, while in type 3 meningioma, the tumor can be managed by cyst decompression and excision of the solid component. Based on the Nauta classification, the cystic meningioma reported here was considered to be type 3. Therefore, the surgical procedure aimed to remove the solid component of the mass, leaving the cystic wall attached to the normal brain. As the solid part of the meningioma was located beneath the internal plate of the left frontal bone, the partial transfrontal craniotomy was sufficient to expose and remove the entire mass. To the author’s knowledge, this is first case report describing a patient with frontal meningioma with a peritumoral cyst removed by a partial transfrontal craniotomy based on the Nauta classification

Optimal Content-Sharing Strategy for Online Streaming Platforms

Many subscription-based video-on-demand (SVOD) platforms are currently focusing on creating exclusive content to attract more subscribers. However, it is not clear that an exclusive-content strategy will eventually increase the platforms\u27 profits and/or the number of the platforms\u27 subscribers. This research models two competing platforms\u27 choices between leasing and not leasing exclusive content investigating the impact of their choices on the SVOD market size and the competition results. We show the conditions under which the two platforms can increase their profits by sharing a certain amount of exclusive content

Urethral Reconstruction Combined with Modified Urethrostomy in a Cat after Prepubic Urethrostomy

Background: In cats, urethral obstruction is generally caused by various reasons, including feline idiopathic cystitis, urethral crystals, urethral trauma, mucous plug, congenital or acquired anatomical deformity, and urolithiasis, especially in male cats. Depending on the severity and duration of clinical signs, immediate management including conservative or surgical therapy for restoration of urethral patency is required. Repetitive urethral obstruction due to intraluminal plugs, obstruction that cannot be resolved by medical management, and urethral strictures, trauma, or neoplasia should be managed by surgery. When the penile or pelvic urethra is ruptured or not long enough to mobilize the pelvic urethra to the perineal skin by repetitive perineal urethrostomy, prepubic urethrostomy is indicated. Potential complications of prepubic urethrostomy include urinary incontinence, peristomal dermatitis. In such cases, management of the peristomal site or placement of an artificial urethral sphincter have been reported previously. However, to date, urethral reconstruction using pre-existing penis has not been reported after prepubic urethral stricture following prepubic urethrostomy. The objective of this report is to describe surgical procedure of the urethral reconstruction combined with modified perineal urethrostomy in a cat with prepubic urethral stricture after prepubic urethrosotmy. Case: A 3-year-old castrated Scottish straight cat presented with dysuria after prepubic urethrostomy. The owner reported that the patient was diagnosed with urethral rupture, had undergone prepubic urethrostomy 2 months prior to presentation, and had persistent dysuria despite repetitive surgical revision of the prepubic urethral stoma at a local hospital. On physical examination, the preputial orifice and the penis appeared grossly normal. On ultrasonography, pericystic and periurethral fat had an edematous, striated appearance with alternating hyperechoic and anechoic regions. A small amount of free fluid was visible around the urethra. Abdominal radiography revealed a mildly distended bladder and loss of serosal detail around the area of the urinary bladder neck, consistent with inflammation and free fluid observed on ultrasonography. The retrograde urethrogram showed no leakage in either sites of the prepubic urethral orifice or the penis. Hence, complete urethral reconstruction with modified perineal urethrostomy was performed. The patient had normal urination at the 15-month follow-up. Discussion: Prepubic urethrostomy is beneficial for the patients whose penile or pelvic urethra is ruptured or not long enough to mobilize the pelvic urethra to the perineal. Complications of prepubic urethrostomy include skin necrosis around the stoma; urinary incontinence; stricture of the urethral stoma due to several reasons such as surgical-site irritation; poor mucosa–skin apposition; failure to provide tension-free stoma; and failure to expose wider pelvic urethra. In these cases, surgical management of the level of prepubic urethral stoma has been recommended by previous studies. However, no studies have been reported urethral reconstruction using pre-existing penile urethra in a patient with prepubic urethral stricture so far. To the author’s knowledge, this case is the first report describing urethral reconstruction in a cat with urethral stricture after prepubic urethrostomy. Keywords: cat, modified urethrostomy, prepubic urethrostomy, urethral reconstruction

Pelvic Fracture in a Cat - Precontouring of the Plate Based on Allogenic 3D Model and its Application

Background: Pelvic fractures are commonly ecountered in cats. The ilium is included in approximately 50% of pelvic fractures in cats. Although conservative management of the pelvic fracture is known to have good prognosis, surgical fixation is recommended for the pelvic fractue with ilial fractures. 3D printing is an accurate digital modeling method by converting two-dimensional (2D) image into 3D model. 3D printing in veterinary medicine have been described in the various orthopedic diseases such angular limb deformities or fractures. The use of 3D model for presurgical planning is helpful to improve the results of complex surgical interventions. The objective of this study is to identify the usefulness of fabricating 3D models based on allogenic 2D data with aid of 3D printer program. Case: A 4-year-old spayed female domestic shorthair cat presented with hindlimb lameness. Radiography revealed left ilial body fracture with multiple fractures including left tuber ischium, pubic symphysis, and bilateral cranial ramuses of pubis. Digital imaging and communication in medicine (DICOM) files of the complete ilium were extracted from a CT scan of a healthy and castrated male cat of same breed. Volume rendering images were prepared by Slicer program based on DICOM files. After acquired 3D data were converted to STL (Standard Triangulation Language) file for the 3D printing machine, non-fracture involved area was removed except the left ilium using the Meshmixer® soft-ware and then data was stored as STL files again. The length of 3D model was adjusted to actual size using 3D printer firmware based on actual size of the ilial length. Subsequently, 3D modelling was performed using 3D printer. The plate was precontoured to conform to the lateral surface of the 3D model. Internal fixation using precontoured plate resulted in accurate bone alignment. The alignment of the ilium remained appropriate throughtout the follow-up period. Complete union was identified 6 months after surgery. Discussion: Although the most common method for the ilial fractures is the application of bone plates to the lateral side of the ilium, bone plate fixation is more challenging in cats owing to the small bone size and small surface area of the fracture sites compared to dogs. Therefore, it is important to make accurate presurgical planning for successful result of a surgery. 3D printing based on actual patient have several limitations including time for complete printing process and additional anesthetic episode to acquire computed tomography (CT) images. However, in simple cases, a presurgical CT scan may not be necessary if the plate can be precisely precontured based on the data from the other patient. In this way, the additional financial burden for CT examination also might be reduced. On the other hand, technical difficulty of utilizing hardware and software, and financial availability were another drawback. However, in this current study, most of limitations regarding conventional 3D printing based on actual patient were overcome by the application of the fused deposition modeling (FDM) technology with allogenic data. In the current study, total time for fabrication of 3D model based on FDM technology, was less than 3 h, which are much shorter than the time for conventional 3D printing. The difference of the ilial length between the actual patient and the 3D model was adjusted through the firmware program. Thus, differences of the conformation or size between the 3D model and the ilium of the patient was negligible during the surgery, although 2D images were not acquired from actual patient. Intraoperative contouring of the plate was not required. In conclusion, through presurgical plate contouring by the 3D bone template based on non-patient specific data, successful treatment of the ilial fracture was possible. Keywords: allogenic; cats; ilial fracture; 3D printing, 3D models, pilot study

Demystifying Tacit Knowledge in Graphic Design: Characteristics, Instances, Approaches, and Guidelines

Despite the growing demand for professional graphic design knowledge, the tacit nature of design inhibits knowledge sharing. However, there is a limited understanding on the characteristics and instances of tacit knowledge in graphic design. In this work, we build a comprehensive set of tacit knowledge characteristics through a literature review. Through interviews with 10 professional graphic designers, we collected 123 tacit knowledge instances and labeled their characteristics. By qualitatively coding the instances, we identified the prominent elements, actions, and purposes of tacit knowledge. To identify which instances have been addressed the least, we conducted a systematic literature review of prior system support to graphic design. By understanding the reasons for the lack of support on these instances based on their characteristics, we propose design guidelines for capturing and applying tacit knowledge in design tools. This work takes a step towards understanding tacit knowledge, and how this knowledge can be communicated

ARM MOTIONS FOR DIFFERENT TARGET POSITIONS DURING TAEKWONDO ROUNDHOUSE KICKS

The purpose of this study was to investigate arm motions for five different target positions during Taekwondo roundhouse kicks. Nine Taekwondo experts performed roundhouse kicks at a target. A 3D motion analysis was conducted. One-way repeated ANOVA was used to compare the arm motion among five conditions. This study reveals that a higher kick needs the increased vertical separation of the right and left arm (elbow and wrist) in release phase. For a longer kick at Body level, elbows should be more vertically apart and wrists should be more horizontally apart in the release phase. Both attackers and counter attackers in Taekwondo athletes can use the arm swing characteristics at different target heights and distances

GenQuery: Supporting Expressive Visual Search with Generative Models

Designers rely on visual search to explore and develop ideas in early design stages. However, designers can struggle to identify suitable text queries to initiate a search or to discover images for similarity-based search that can adequately express their intent. We propose GenQuery, a novel system that integrates generative models into the visual search process. GenQuery can automatically elaborate on users' queries and surface concrete search directions when users only have abstract ideas. To support precise expression of search intents, the system enables users to generatively modify images and use these in similarity-based search. In a comparative user study (N=16), designers felt that they could more accurately express their intents and find more satisfactory outcomes with GenQuery compared to a tool without generative features. Furthermore, the unpredictability of generations allowed participants to uncover more diverse outcomes. By supporting both convergence and divergence, GenQuery led to a more creative experience.Comment: 18 pages and 12 figure

Engineered external guide sequences are highly effective in inducing RNase P for inhibition of gene expression and replication of human cytomegalovirus

External guide sequences (EGSs), which are RNA molecules derived from natural tRNAs, bind to a target mRNA and render the mRNA susceptible to hydrolysis by RNase P, a tRNA processing enzyme. Using an in vitro selection procedure, we have previously generated EGS variants that efficiently direct human RNase P to cleave a target mRNA in vitro. In this study, a variant was used to target the overlapping region of the mRNAs encoding human cytomegalovirus (HCMV) essential transcription regulatory factors IE1 and IE2. The EGS variant was ∼25-fold more active in inducing human RNase P to cleave the mRNA in vitro than the EGS derived from a natural tRNA. Moreover, a reduction of 93% in IE1/IE2 gene expression and a reduction of 3000-fold in viral growth were observed in HCMV-infected cells that expressed the variant, while cells expressing the tRNA-derived EGS exhibited a reduction of 80% in IE1/IE2 expression and an inhibition of 150-fold in viral growth. Our results provide the first direct evidence that EGS variant is highly effective in blocking HCMV gene expression and growth and furthermore, demonstrate the feasibility of developing effective EGS RNA variants for anti-HCMV applications by using in vitro selection procedures