Transoral Approach to Excision of Massive Dermoid Cysts in Pediatric Patients: A Case Series

Floor of mouth (FOM) dermoid cysts are a rare but clinically significant lesion of the head and neck. Classically, large cysts have been excised via a transcervical approach, although the limits of the transoral approach are expanding. The majority of FOM dermoid cysts present in the midline, but true lateral cysts have been reported. In this case series, we describe 3 pediatric patients who all underwent successful transoral excision of massive dermoid cysts, along with a literature review. Massive cystic lesions were identified on preoperative imaging. The dermoid cysts averaged 6 × 4.3 × 5 cm and were successfully removed via a transoral approach. Two were removed via a median ventral FOM incision and one via a lateral trans-sublingual approach to the FOM. When needed, the geniohyoid muscle was divided to gain access to the cyst. All cysts were removed intact, although partial, controlled decompression was performed to aid in dissection. There were no post-operative complications. FOM dermoid cysts are a rare but important cause of pediatric neck masses that present a challenging but satisfying surgical opportunity. The transoral approach is a viable option for massive dermoid cysts superior to the mylohyoid

Congenital Nasal Pyriform Aperture Stenosis Repair: A Case Series and Discussion of Postoperative Care

Congenital nasal pyriform aperture stenosis (CNPAS) is a rare condition related to holoprosencephaly in which bony overgrowth of the medial nasal process of the maxilla narrows the pyriform aperture. CNPAS presents in neonates with signs of upper airway obstruction ranging from mild to severe respiratory distress and failure to thrive. Surgical intervention is indicated after failed conservative measures and generally includes temporary stent placement. We report a series of 3 cases of CNPAS treated surgically, examine postoperative care recommendations in the literature, and present a comprehensive postoperative care regimen with a novel method to maintain stent patency

Statements of Agreement From the Targeted Evaluation and Active Management (TEAM) Approaches to Treating Concussion Meeting Held in Pittsburgh, October 15-16, 2015

Conventional management for concussion involves prescribed rest and progressive return to activity. Recent evidence challenges this notion and suggests that active approaches may be effective for some patients. Previous concussion consensus statements provide limited guidance regarding active treatment

Pathways between Primary Production and Fisheries Yields of Large Marine Ecosystems

The shift in marine resource management from a compartmentalized approach of dealing with resources on a species basis to an approach based on management of spatially defined ecosystems requires an accurate accounting of energy flow. The flow of energy from primary production through the food web will ultimately limit upper trophic-level fishery yields. In this work, we examine the relationship between yield and several metrics including net primary production, chlorophyll concentration, particle-export ratio, and the ratio of secondary to primary production. We also evaluate the relationship between yield and two additional rate measures that describe the export of energy from the pelagic food web, particle export flux and mesozooplankton productivity. We found primary production is a poor predictor of global fishery yields for a sample of 52 large marine ecosystems. However, chlorophyll concentration, particle-export ratio, and the ratio of secondary to primary production were positively associated with yields. The latter two measures provide greater mechanistic insight into factors controlling fishery production than chlorophyll concentration alone. Particle export flux and mesozooplankton productivity were also significantly related to yield on a global basis. Collectively, our analyses suggest that factors related to the export of energy from pelagic food webs are critical to defining patterns of fishery yields. Such trophic patterns are associated with temperature and latitude and hence greater yields are associated with colder, high latitude ecosystems

Synchronous volcanic eruptions and abrupt climate change ∼17.7 ka plausibly linked by stratospheric ozone depletion.

Glacial-state greenhouse gas concentrations and Southern Hemisphere climate conditions persisted until ∼17.7 ka, when a nearly synchronous acceleration in deglaciation was recorded in paleoclimate proxies in large parts of the Southern Hemisphere, with many changes ascribed to a sudden poleward shift in the Southern Hemisphere westerlies and subsequent climate impacts. We used high-resolution chemical measurements in the West Antarctic Ice Sheet Divide, Byrd, and other ice cores to document a unique, ∼192-y series of halogen-rich volcanic eruptions exactly at the start of accelerated deglaciation, with tephra identifying the nearby Mount Takahe volcano as the source. Extensive fallout from these massive eruptions has been found >2,800 km from Mount Takahe. Sulfur isotope anomalies and marked decreases in ice core bromine consistent with increased surface UV radiation indicate that the eruptions led to stratospheric ozone depletion. Rather than a highly improbable coincidence, circulation and climate changes extending from the Antarctic Peninsula to the subtropics-similar to those associated with modern stratospheric ozone depletion over Antarctica-plausibly link the Mount Takahe eruptions to the onset of accelerated Southern Hemisphere deglaciation ∼17.7 ka

The WAIS Divide deep ice core WD2014 chronology - Part 2: Annual-layer counting (0-31 ka BP)

We present the WD2014 chronology for the upper part (0–2850 m; 31.2 ka BP) of the West Antarctic Ice Sheet (WAIS) Divide (WD) ice core. The chronology is based on counting of annual layers observed in the chemical, dust and electrical conductivity records. These layers are caused by seasonal changes in the source, transport, and deposition of aerosols. The measurements were interpreted manually and with the aid of two automated methods. We validated the chronology by comparing to two high-accuracy, absolutely dated chronologies. For the Holocene, the cosmogenic isotope records of ¹⁰Be from WAIS Divide and ¹⁴C for IntCal13 demonstrated that WD2014 was consistently accurate to better than 0.5% of the age. For the glacial period, comparisons to the Hulu Cave chronology demonstrated that WD2014 had an accuracy of better than 1% of the age at three abrupt climate change events between 27 and 31 ka. WD2014 has consistently younger ages than Greenland ice core chronologies during most of the Holocene. For the Younger Dryas–Preboreal transition (11.595 ka; 24 years younger) and the Bølling–Allerød Warming (14.621 ka; 7 years younger), WD2014 ages are within the combined uncertainties of the timescales. Given its high accuracy, WD2014 can become a reference chronology for the Southern Hemisphere, with synchronization to other chronologies feasible using high-quality proxies of volcanism, solar activity, atmospheric mineral dust, and atmospheric methane concentrations

Precise interpolar phasing of abrupt climate change during the last ice age

The last glacial period exhibited abrupt Dansgaard–Oeschger climatic oscillations, evidence of which is preserved in a variety of Northern Hemisphere palaeoclimate archives¹. Ice cores show that Antarctica cooled during the warm phases of the Greenland Dansgaard–Oeschger cycle and vice versa[superscript 2,3], suggesting an interhemispheric redistribution of heat through a mechanism called the bipolar seesaw[superscript 4–6]. Variations in the Atlantic meridional overturning circulation (AMOC) strength are thought to have been important, but much uncertainty remains regarding the dynamics and trigger of these abrupt events[superscript 7–9]. Key information is contained in the relative phasing of hemispheric climate variations, yet the large, poorly constrained difference between gas age and ice age and the relatively low resolution of methane records from Antarctic ice cores have so far precluded methane-based synchronization at the required sub-centennial precision[superscript 2,3,10]. Here we use a recently drilled high-accumulation Antarctic ice core to show that, on average, abrupt Greenland warming leads the corresponding Antarctic cooling onset by 218 ± 92 years (2σ) for Dansgaard–Oeschger events, including the Bølling event; Greenland cooling leads the corresponding onset of Antarctic warming by 208 ± 96 years. Our results demonstrate a north-to-south directionality of the abrupt climatic signal, which is propagated to the Southern Hemisphere high latitudes by oceanic rather than atmospheric processes. The similar interpolar phasing of warming and cooling transitions suggests that the transfer time of the climatic signal is independent of the AMOC background state. Our findings confirm a central role for ocean circulation in the bipolar seesaw and provide clear criteria for assessing hypotheses and model simulations of Dansgaard–Oeschger dynamics

What factors influence children\u27s activity?

The school environment has an essential role in encouraging children to exercise. This study explores variables which may contribute to increased activity levels on the playground