The transcervical approach for parapharyngeal space pleomorphic adenomas: indications and technique.

BACKGROUND: Head and Neck Parapharyngeal space tumors are rare. Pleomorphic Adenomas are the most common Parapharyngeal space tumors. The purpose of this study was to define preoperative criteria for enabling full extirpation of parapharyngeal space pleomorphic adenomas via the transcervical approach while minimizing functional and cosmetic morbidity. METHODS: The surgical records and medical charts of 19 females and 10 males with parapharyngeal space pleomorphic adenomas operated between 1993 and 2012 were reviewed. RESULTS: Fifteen patients were operated by a simple transcervical approach, 13 by a transparotid transcervical approach, and one by a transmandibular transcervical approach. Complications included facial nerve paralysis, infection, hemorrhage and first bite syndrome. There were three recurrences, but neither recurrence nor complications were associated with the type of surgical approach. CONCLUSION: A simple transcervical approach is preferred for parapharyngeal space pleomorphic adenomas with narrow attachments to the deep lobe of the parotid gland and for pleomorphic adenomas originating in a minor salivary gland within the parapharyngeal space

Analysis of Strain Distribution in Common Clinical Designs of Posterior Implant-Supported Fixed Partial Restorations: Comparison between Six Configurations

The configuration of implant-supported prostheses is considered to influence the magnitude of stress concentrations, affecting their survival rate. The purpose of this study is to determine, through strain gauge measurements during load application, the dispersion and magnitude of strain concentrations in different implant-supported prosthesis designs. All designs matched those commonly used in posterior partially edentulous states. Three implants were inserted into an epoxy resin model (PLM-4B Vishay Measurements Group Inc., Raleigh, NC, USA), allowing for the delivery of three- and four-unit crowns in different cemented configurations. Loads were applied at vertical and oblique directions over the cast crowns in six different configurations representing various posterior partially edentulous restorations. The readings from the strain gauges adhered to the implant necks’ presented data on implant strain. Prostheses including cantilevers showed the highest strain among the three-unit prostheses within the prosthetic complex, and three single units showed the least (8133 µs vs. 201 µs, respectively). Angulated load application also had a role in amplifying the strains recorded, resulting in total strains of between 3.5 and 20 times higher than during vertical loading in all configurations. It can be concluded that the configuration of implant-fixed partial prosthesis changes the loads engaging the restoration, the implant, and, probably, the supporting bone

Cranialization of the frontal sinus for secondary mucocele prevention following open surgery for benign frontal lesions.

OBJECTIVE: To compare frontal sinus cranialization to obliteration for future prevention of secondary mucocele formation following open surgery for benign lesions of the frontal sinus. STUDY DESIGN: Retrospective case series. SETTING: Tertiary academic medical center. PATIENTS: Sixty-nine patients operated for benign frontal sinus pathology between 1994 and 2011. INTERVENTIONS: Open excision of benign frontal sinus pathology followed by either frontal obliteration (n = 41, 59%) or frontal cranialization (n = 28, 41%). MAIN OUTCOME MEASURES: The prevalence of post-surgical complications and secondary mucocele formation were compiled. RESULTS: Pathologies included osteoma (n = 34, 49%), mucocele (n = 27, 39%), fibrous dysplasia (n = 6, 9%), and encephalocele (n = 2, 3%). Complications included skin infections (n = 6), postoperative cutaneous fistula (n = 1), telecanthus (n = 4), diplopia (n = 3), nasal deformity (n = 2) and epiphora (n = 1). None of the patients suffered from postoperative CSF leak, meningitis or pneumocephalus. Six patients, all of whom had previously undergone frontal sinus obliteration, required revision surgery due to secondary mucocele formation. Statistical analysis using non-inferiority test reveal that cranialization of the frontal sinus is non-inferior to obliteration for preventing secondary mucocele formation (P<0.0001). CONCLUSION: Cranialization of the frontal sinus appears to be a good option for prevention of secondary mucocele development after open excision of benign frontal sinus lesions

Subjective versus objective refraction in healthy young adults

Abstract Purpose To evaluate objective and subjective refraction differences in healthy young adults. Methods Data concerning candidates for the Israeli Air Force Flight Academy, as well as active air force pilots in all stages of service who underwent a routine health checkup between the years 2018 and 2019 were retrospectively analyzed. Objective refraction measured using a single autorefractometer was compared with subjective refraction measured by an experienced military optometrist during the same visit. The results were converted to power vectors (spherical equivalent [SE], J0, and J45). To interpret astigmatism using power vector values, the cylinder power (Cp) was determined. Results This study included 1,395 young adult participants. The average age was 22.17 years (range, 17–39, 84.8% males). The average SE was − 0.65 ± 1.19 diopter (D) compared with − 0.71 ± 0.91D in the auto- and subjective refraction, respectively (p = 0.001). Cp was 0.91 ± 0.52D and 0.67 ± 0.40D, respectively (p < 0.001). This difference was more common in older participants (p < 0.001). J0 and J45 value differences were not significant. The absolute SE value of subjective refraction was lower in the myopic (p < 0.001) and hyperopic (p < 0.001) patients. Conclusions Young hyperopic participants tended to prefer “less plus” in subjective refraction compared with autorefraction. Young myopic participants tended to prefer “less minus” in subjective refraction compared with autorefraction. All participants, but mainly older participants, preferred slightly “less Cp” than that measured using autorefraction; The astigmatic axis did not differ significantly between the methods

PPS PA with a broad attachment to the DLPG.

<p>PPS PA with a broad attachment to the DLPG.</p

Surgical Complications.

<p>NS  =  Non Significant, N  =  Nerve.</p

PPS PA with a narrow attachment to the DLPG.

<p>PPS PA with a narrow attachment to the DLPG.</p

Recurrences.

<p>NS  =  Non Significant, XRT =  Radiotherapy.</p><p>* One patient excluded due to prior XRT treatment.</p

Optimized small‐molecule pull‐downs define MLBP

Abscisic acid (ABA) receptors belong to the START domain superfamily, which encompasses ligand-binding proteins present in all kingdoms of life. START domain proteins contain a central binding pocket that, depending on the protein, can couple ligand binding to catalytic, transport or signaling functions. In Arabidopsis, the best characterized START domain proteins are the 14 PYR/PYL/RCAR ABA receptors, while the other members of the superfamily do not have assigned ligands. To address this, we used affinity purification of biotinylated proteins expressed transiently in Nicotiana benthamiana coupled to untargeted LC-MS to identify candidate binding ligands. We optimized this method using ABA–PYL interactions and show that ABA co-purifies with wild-type PYL5 but not a binding site mutant. The Kd of PYL5 for ABA is 1.1 μm, which suggests that the method has sufficient sensitivity for many ligand–protein interactions. Using this method, we surveyed a set of 37 START domain-related proteins, which resulted in the identification of ligands that co-purified with MLBP1 (At4G01883) or MLP165 (At1G35260). Metabolite identification and the use of authentic standards revealed that MLBP1 binds to monolinolenin, which we confirmed using recombinant MLBP1. Monolinolenin also co-purified with MLBP1 purified from transgenic Arabidopsis, demonstrating that the interaction occurs in a native context. Thus, deployment of this relatively simple method allowed us to define a protein–metabolite interaction and better understand protein–ligand interactions in plants

Patient Demographics.

<p>Not all subjects are currently in active follow-up.</p