Meatal Segment of facial nerve and cavernous hemangioma

Cavernous malformations of the internal auditory canal (IAC) are a rare clinical entity. We report a rare case of cavernous hemangioma involving the internal auditory canal and the meatal segment of the facial nerve without any evident lesion to the cerebello-pontine angle and geniculate ganglion. In English language literature several studies have described cavernous malformations of the IAC, but only a few authors have described a facial nerve origin for this type of lesion. Removal of the entire lesion was achieved via the surgical resection of the facial nerve and facial nerve continuity was restored using a great auricular nerve graft. Optimal postoperative facial function recovery was reported

Information Accountability Framework for a Trusted Health Care System

Trusted health care outcomes are patient centric. Requirements to ensure both the quality and sharing of patients’ health records are a key for better clinical decision making. In the context of maintaining quality health, the sharing of data and information between professionals and patients is paramount. This information sharing is a challenge and costly if patients’ trust and institutional accountability are not established. Establishment of an Information Accountability Framework (IAF) is one of the approaches in this paper. The concept behind the IAF requirements are: transparent responsibilities, relevance of the information being used, and the establishment and evidence of accountability that all lead to the desired outcome of a Trusted Health Care System. Upon completion of this IAF framework the trust component between the public and professionals will be constructed. Preservation of the confidentiality and integrity of patients’ information will lead to trusted health care outcomes

Subtotal petrosectomy and cerebrospinal fluid leakage in unilateral anacusis

Objective This study presents a group of patients experiencing recurrent cerebrospinal fluid (CSF) leakage associated with ipsilateral anacusis who underwent subtotal petrosectomies with the goal of stopping the CSF leak and preventing meningitis. Materials and Methods Eight patients with CSF leakage were enrolled: three patients with giant vestibular schwannomas had CSF leakage after gamma knife failure and subsequent removal via a retrosigmoid approach; two patients had malformations at the level of the inner ear with consequent translabyrinthine fistulas; two had posttraumatic CSF leakages; and one had a CSF leakage coexisting with an encephalocele. Two patients developed meningitis that resolved with antibiotic therapy. Each patient had preoperative anacusis and vestibular nerve areflexia on the affected side. Results The patients with congenital or posttraumatic CSF leaks had undergone at least one unsuccessful endaural approach to treat the fistula. All eight patients were treated successfully with a subtotal petrosectomy. The symptoms disappeared within 2 months postoperatively. No meningitis, signs of fistula, or other symptoms occurred during the follow-up. Conclusion A subtotal petrosectomy should be the first choice of treatment in patients with recurrent CSF leakage whenever there is associated unilateral anacusis

Arizona’s “Zombie” Uranium Mines: Lax Regulations Threaten Los Angeles Tap Water

In Center for Biological Diversity v. Salazar, the U.S. Court of Appeals for the Ninth Circuit held that the Bureau of Land Management (BLM) was not required to approve a new plan of operations before allowing a uranium mine to resume production after nearly two decades of cessation. The court reasoned that the reopening of an abandoned mine did not constitute the requisite major federal action required to trigger an environmental analysis under the National Environmental Policy Act (NEPA). This Comment argues that although the Ninth Circuit correctly affirmed that the BLM complied with NEPA, the ruling exposes an environmentally dangerous loophole that requires statutory revisions. The court’s holding essentially permits mining operators to restart production at mines dormant for decades without undertaking any new environmental reviews. The determination of whether a mine poses a significant threat to the environment is based upon an assessment that could potentially date back several decades

Spike Timing-Dependent Plasticity as the Origin of the Formation of Clustered Synaptic Efficacy Engrams

Synapse location, dendritic active properties and synaptic plasticity are all known to play some role in shaping the different input streams impinging onto a neuron. It remains unclear however, how the magnitude and spatial distribution of synaptic efficacies emerge from this interplay. Here, we investigate this interplay using a biophysically detailed neuron model of a reconstructed layer 2/3 pyramidal cell and spike timing-dependent plasticity (STDP). Specifically, we focus on the issue of how the efficacy of synapses contributed by different input streams are spatially represented in dendrites after STDP learning. We construct a simple feed forward network where a detailed model neuron receives synaptic inputs independently from multiple yet equally sized groups of afferent fibers with correlated activity, mimicking the spike activity from different neuronal populations encoding, for example, different sensory modalities. Interestingly, ensuing STDP learning, we observe that for all afferent groups, STDP leads to synaptic efficacies arranged into spatially segregated clusters effectively partitioning the dendritic tree. These segregated clusters possess a characteristic global organization in space, where they form a tessellation in which each group dominates mutually exclusive regions of the dendrite. Put simply, the dendritic imprint from different input streams left after STDP learning effectively forms what we term a “dendritic efficacy mosaic.” Furthermore, we show how variations of the inputs and STDP rule affect such an organization. Our model suggests that STDP may be an important mechanism for creating a clustered plasticity engram, which shapes how different input streams are spatially represented in dendrite

A 1-year follow-up study with C-VEMPs, O-VEMPs and video head impulse testing in vestibular neuritis

The aim of this paper was to evaluate prospectively, in a group of patients affected by VN, a diagnostic protocol employing C-VEMPs, O-VEMPs and vHIT together. The diagnosis of vestibular neurolabyrinthitis was based on the clinical history, absence of associated auditory or neurological symptoms, and a neuro-otological examination with an evaluation of lateral semicircular canal function using the Fitzgerald-Hallpike caloric vestibular test and ice test. Our series revealed an incidence of 55 % of superior and inferior vestibular neurolabyrinthitis, 40 % of superior vestibular neurolabyrinthitis and 5 % of inferior vestibular neurolabyrinthitis. These data, however, comprised different degrees of vestibular involvement considering the evaluation of each single vestibular end-organ with potential different prognosis. Four patients had only deficits of the horizontal and superior semicircular canals or their ampullary nerves. The implementation of C-VEMPs, O-VEMPs and vHIT in a vestibular diagnostic protocol has made possible to observe patients with ampullary VN, unidentifiable with other types of vestibular exams. The effect of age seems to have some impact on the recovery. When recovery firstly involves the utricular and saccular nerves and subsequently the ampullary nerves, it may be reasonable to expect a more favorable and successful outcome

Generalised Born-Infeld models, Lax operators and the TTˉ\textrm{T} \bar{\textrm{T}} perturbation

Surprising links between the deformation of 2D quantum field theories induced by the composite $\textrm{T} \bar{\textrm{T}}$ operator, effective string models and the $AdS/$CFT correspondence, have recently emerged. The purpose of this article is to discuss various classical aspects related to the deformation of 2D interacting field theories. Special attention is given to the sin(h)-Gordon model, for which we were able to construct the $\textrm{T} \bar{\textrm{T}}$-deformed Lax pair. We consider the Lax pair formulation to be the first essential step toward a more satisfactory geometrical interpretation of this deformation within the integrable model framework. Furthermore, it is shown that the 4D Maxwell-Born-Infeld theory, possibly with the addition of a mass term or a derivative-independent potential, corresponds to a natural extension of the 2D examples. Finally, we briefly comment on 2D Yang-Mills theory and propose a modification of the heat kernel, for a generic surface with genus $p$ and $n$ boundaries, which fully accounts for the $\textrm{T} \bar{\textrm{T}}$ contribution.Comment: 22 pages, 2 figures, v2: new comments, hyperlinks and minor typos correcte

Forensic application of isotope ratio mass spectrometry: development and validation of GC-C-IRMS based methods in doping analysis

The isotope ratio mass spectrometry coupled to gas chromatography (GC-C-IRMS) is a mandatory procedure in anti-doping analyses performed on urinary samples in which the concentration and/or the ratio concentrations of specific steroid profile markers overcome the limits defined by the World Anti-Doping Agency (WADA) or deviate from the population and individual reference range. It is a confirmatory investigation to establish whether these alterations, if not caused by physiological reasons, can be attributed to a synthetic steroids’ intake. Indeed, the determination of their 13C composition, which is typically more depleted for pharmaceutical preparations compared to their physiologically produced counterparts, allows disclosing the exogenous or endogenous origin of the steroid compounds. In this Thesis, novel approaches have been implemented to simplify, standardize the current operating protocols, and reduce the risk of misinterpreting the analytical findings. The benefits of performing a large volume injection by a programmed temperature vaporizer inlet have been proved in analyzing steroids showing low urinary levels and new methods for detecting the prednisolone/prednisone, and 19-norsteroids abuse have been developed and fully validated. In order to provide a detailed overview of the IRMS technique, some criticalities have been also emphasized, proposing, whenever possible, suitable troubleshooting

U.S. States' fiscal constraints and effects on budget policies

Abstract The article looks at fiscal constraints adopted by the U.S. States. It questions the ability of those rules to determine sound budgetary policies. To assess this point it analyses, in the general part, the major kind of constraints so far adopted. Of each major category the focus is upon institutional weaknesses that create the room for the adoption of circumventing practices. The following section focuses instead on three case studies, to show examples of the way in which the constraints influenced policy-making without mining the ability of government to adopt unbalanced budgetary policies. The weaknesses are combined with the adoption of a deferential approach by the Courts that generally legitimized the accounting devices adopted by the States. The outcome is a system in which budget policies are influenced by several factors that go beyond the institutional framework. On the other side, legal boundaries create distortions and unwanted effects in policies implemented by the States

Giant petrous bone cholesteatoma: combined microscopic surgery and an adjuvant endoscopic approach

Petrous bone cholesteatomas (PBCs) are epidermoid cysts, which have developed in the petrous portion of the temporal bone and may be congenital or acquired. Cholesteatomas arising in this region have a tendency to invade bone and functional structures and the middle and posterior fossae reaching an extensive size. Traditionally, surgery of a giant PBC contemplates lateral transtemporal or middle fossa microscopic surgery; however, in recent years, endoscopic surgical techniques (primary or complementary endoscopic approach) are starting to receive a greater consensus for middle ear and mastoid surgeries. We report the rare case of an 83-year-old Caucasian male affected by a giant cholesteatoma that eroded the labyrinth and the posterior fossa dura and extended to the infralabyrinthine region, going beyond the theca and reaching the first cervical vertebra. The giant cholesteatoma was managed through a combined approach (microscopic and, subsequently, complementary endoscopic approach). In this case report, we illustrate some advantages of this surgical choice