Rare Intraoperative Finding of the Spinal Accessory Nerve Piercing a Fenestration in the Internal Jugular Vein: A Case Report and Review of the Modern Literature.

Variations in the anatomy of venous structures in the neck are not uncommon, but fenestrations are extremely unusual. Here, we report a rare case of the spinal accessory nerve piercing a fenestration in the internal jugular vein, found during elective neck dissection of a patient undergoing hemiglossectomy. Further, we present a literature review of recent previously published cases of this intraoperative finding. This paper is intended to provide readers with an appreciation for this particularly rare variation and to highlight its existence to surgeons who perform neck dissection. This knowledge is important in order to minimise the possibility of intraoperative damage.

A Fibroblastic Reticular Cell Tumour Arising in the Oral Cavity: A Case Report and Review of the Literature.

BACKGROUND: Tumours of dendritic or histiocytic lineage are amongst the rarest tumours and probably account for < 1% of tumours affecting the lymph nodes or soft tissue. Because several of these entities were poorly recognised until recently, the true incidence is not determined. METHODS: We present what we believe is the first reported case report of a fibroblastic reticular cell tumour arising in the oral cavity as well as reviewing the current literature regarding this rare subset of tumours. RESULTS: We discuss the clinical and histopathological findings of our reported case and examine the literature regarding this entity. We discuss the key differential diagnoses to consider when making this diagnosis. CONCLUSION: Histiocytic and dendritic cell derived tumours are exceptionally rare within the head and neck region although a number of these tumours have been reported within the oral cavity. We present what we believe is the first reported case of a fibroblastic reticular cell tumour arising within the oral cavity.

Lymphangioma Formation Following Hyaluronic Acid Injection for Lip Augmentation.

Administration of hyaluronic acid (HA) filler for aesthetic lip augmentation is a routine and common procedure with a low rate of adverse reactions. This case report documents an extremely rare complication of lip augmentation with HA leading to the development of lymphangiomas. Lymphangiomas are uncommon hamartomas of the lymphatic system. Although usually congenital, they can be acquired due to trauma, inflammation, or lymphatic blockage. They may be in the deep or superficial tissues, with superficial forms being either lymphangioma circumscriptum or acquired lymphangioma, also referred to as lymphangiectasia. Acquired lymphangiomas are typically formed by blockage of lymphatic drainage leading to dilation of the lymphatic channels. The diagnosis in our case report is acquired lymphangioma. A 27-year-old female presented with a two-year history of linear swellings in her upper lip. These lumps followed the line where HA filler had been injected four years earlier. Hyaluronidase had previously been used unsuccessfully to remove these lumps. The patient was treated with surgery to excise the lesions. Five masses were excised, and histopathological analysis displayed the presence of variably ectatic lacunae, lined by cells with CD34 expression, a lymph-vascular-endothelial marker. There were also scattered macrophages with CD68 expression in the interstices. These are typical features of a lymphangioma. The patient was satisfied with the excellent aesthetic and functional outcome. To our knowledge this is the first case of a lymphangioma following HA lip augmentation. Although rare, this complication can have aesthetic implications for the patient which may require further treatment or surgery to correct.

Nodular Eruptions as a Rare Complication of Botulinum Neurotoxin Type-A: Case Series and Review of Literature.

Nodular eruption after botulinum neurotoxin type-A (BoNT-A) treatment is exceedingly rare, and the pathogenesis is poorly understood. This case series reports three patients that developed nodular eruptions following administration of Botox® (onabotulinum neurotoxin type A (ONA) injections). These patients had undergone multiple treatments before and after development of the eruptions which were uneventful. In addition to this, we have reviewed the published literature regarding this condition and have compared and contrasted the similarities and differences with regards to the clinical presentation and treatment with our patient cohort. This case series aims to raise awareness of this rare condition, its importance in relation to patient consent and provides a simplified management approach based on our experience. Further evaluation is needed to determine treatment consensus but conducting such research may prove to be challenging due to this condition being an infrequent encounter.

Potential Benefits from the Use of the Supraclavicular Artery Island Flap for Immediate Soft-Tissue Reconstruction During the COVID-19 Pandemic.

Introduction: The coronavirus disease 19 (COVID-19) pandemic has placed significant strains on healthcare resources including staff, theatre, high dependency and intensive care availability. Surgery remains the optimal treatment for the majority of oral malignancies, and primary reconstruction is often necessary to avoid significant morbidity as a result of ablative procedures. Description: The supraclavicular artery island flap (SCAIF) is increasingly finding a place as an alternative to free flap reconstruction of soft-tissue defects and has several specific advantages when compared to use of a soft-tissue free flap during the COVID-19 pandemic. It can be used for a range of head and neck defects. Results: We describe our experience with the SCAIF during the pandemic in five patients with a variety of tumour types and locations. All five patients had a successful outcome with none requiring further reconstruction and all had a functional swallow postoperatively, including a patient who underwent a total pharyngeal reconstruction with a SCAIF. Discussion: The use of a SCAIF during the current COVID-19 pandemic has significant advantages and is a reliable alternative to a soft tissue free flap.

The achievement of public health services in pharmacy practice: A literature review.

BACKGROUND: It is known that pharmacists are currently contributing to public health; however, the extent of this contribution as reported in the literature has not been examined. Investigating the ways that pharmacists are currently participating in public health is critical for the profession of pharmacy, pharmacy educators, and the public health community. OBJECTIVES: The purpose of this study was to determine the reported contributions of pharmacy to each of the ten essential services of public health, and which of the five core competencies of public health were most frequently utilized in those contributions. METHODS: A PubMed search was used to extract references that included both the words pharmacy and services in the title or abstract, and the words public health in any part of the document. A total of 247 references were extracted and categorized into the essential services and core competencies. RESULTS: The essential services Inform, Educate, and Empower, and Link to/Provide Care were more frequently represented in the literature, and the core competency of Health Policy and Administration was most frequently utilized. CONCLUSION: To further contribute to and integrate their contributions within population health, pharmacists must consider ways to strategically contribute to the essential services of public health and seek to increase competency in public health.

Effects of known phenoloxidase inhibitors on hemocyanin-derived phenoloxidase from Limulus polyphemus.

Inhibitors of phenoloxidase are used routinely to characterise the structural and functional properties of phenoloxidases. Hemocyanin-derived phenoloxidase activity is also sensitive to standard phenoloxidase inhibitors. In this study, we characterise the effects of a number of phenoloxidase inhibitors on hemocyanin-derived phenoloxidase activity from the chelicerate, Limulus polyphemus. Both inhibition type and K(i) values were similar to those observed for hemocyanin-derived phenoloxidase from another chelicerate, Eurypelma californicum. In addition, substrate inhibition was observed at concentrations above 2mM dopamine. The conformation in which two of the inhibitors, namely tropolone and kojic acid, would bind near the Cu(II) centre of hemocyanin is proposed.

Misleading and dangerous: the use of the precautionary principle in foreign policy debates.

Recent scholarly research has suggested that the Bush Administration embraced the Precautionary Principle (PP) to formulate its policy on Iraq before the coalition invasion in 2003. The article below challenges this argument. Demonstrating the Bush Administration's antipathy--and at times hostility--to the PP in environmental politics, the article outlines the similarities and differences between usage of the PP in foreign policy debates on the one hand, and the established risk strategies of pre-emption and prevention on the other. The article examines the Bush Administration's reaction to Saddam's alleged weapons of mass destruction (WMD) programme by drawing on earlier conceptual work of the PP in international affairs: an acceptance of the limits of the usefulness of intelligence assessments; an openness to alternative solutions; proportionality of response; and reversing the onus of persuasion. Based on these four strands the article argues that the Bush Administration's decision to invade Iraq was based less on the PP and more on the idea of fighting a preventive war.

Tapia's syndrome after repair of a fractured mandible.

A 41-year-old gentleman underwent surgical repair of the fractured right parasymphisis and left condyle of his mandible. Post-operatively he developed hoarseness of voice and dyspnoea during speech, with deviation of the tongue on protrusion. After excluding intracranial and surgical causes, a clinical diagnosis of Tapia's syndrome was made.

The management of risk in foreign and defence policy: the precautionary principle and decisions on war.

This article develops a concept that originated in environmental risk decision making, and investigates whether the Precautionary Principle (PP) may be usefully deployed by policymakers in the realm of foreign and defence matters. Drawing on the literature on precaution in the environmental arena, and in its weaker form, we develop an operational model of the PP, which has four main characteristics: an acceptance of the limits of knowledge on a given issue; an openness to alternative solutions; proportionality of response; and reversing the onus of proof. It concludes that the Precautionary Principle is a more inclusive way of deliberating on decisions on war, and the model we propose might provide a useful guideline for policy-makers in today's uncertain world.

Resolution of obstructive sleep apnoea after resection of a pleomorphic salivary adenoma.

We describe a 54-year-old man whose obstructive sleep apnoea was cured by resection of a pleomorphic salivary adenoma, and emphasise the importance of a full examination of the upper airway in the assessment of a patient with symptoms of sleep apnoea.

A kinetically trapped intermediate of FK506 binding protein forms in vitro: chaperone machinery dominates protein folding in vivo.

We have characterised the stability, binding and enzymatic properties of three human FK506 binding proteins (FKBP-12) differing only by the length and sequence of their N-terminus. One construct has a short hexa-his tag (6H-FKBP12); the second longer fusion protein (6HL-FKBP12) contains an additional thrombin protease cleavage site; the third has the long fusion tag removed and is essentially native FKBP-12 (cFKBP12). The proteins were purified both under native conditions and also using a refolding protocol. All three natively purified proteins have, within experimental error, the same peptidyl-prolyl isomerase (PPIase) activity (k(cat)/K(m) approximately 1 x 10(6)M(-1)s(-1)), and bind a natural inhibitor, rapamycin, with the same high affinity (K(d) approximately 6 nM). However, refolding of the protein containing the longer tag in vitro results in reduced PPIase activity (the k(cat)/K(m) was reduced from 1 x 10(6)M(-1)s(-1) to 0.81 x 10(6)M(-1)s(-1)) and a 6-fold affinity loss for rapamycin. Addition of both the long and short N-terminal his-tags slows the refolding kinetics of FKBP-12. However, the shorter his-tagged fusion protein regains fully native activity (> or =95%) while the longer regains only approximately 80-85% of native activity. Equilibrium urea denaturation titrations, isothermal titration calorimetry (ITC), analytical gel-filtration, and fluorescence binding data show that this loss of activity is not due to gross misfolding events, but is rather caused by the formation of a stable but subtly misfolded protein that has reduced peptidyl-prolyl isomerase (PPIase) activity and reduced affinity for rapamycin. The difference in behaviour between the in vitro refolded and native forms is due to the dominant role of the cellular chaperone/folding machinery.

A surface plasmon resonance-based assay for small molecule inhibitors of human cyclophilin A.

A simple protocol for generating a highly stable and active surface plasmon resonance (SPR) sensor surface of recombinant human hexahistidine cyclophilin A (His-CypA) is described. The sensor surface was sensitive and stable enough to allow, for the first time, the screening and ranking of several novel small-molecule (Mr approximately 250-500 Da) ligands in a competition binding assay with cyclosporin A (CsA). It also allowed us to accurately determine the kinetic rate constants for the interaction between His-CypA and CsA. His-CypA was first captured on a Ni2+-nitrilotriacetic acid (NTA) sensor chip and was then briefly covalently stabilized, coupling via primary amines. The significant baseline drift observed due to dissociation of weakly bound His-CypA from the Ni2+-NTA moiety was eliminated, resulting in a surface that was stable for at least 36 h. In addition, immobilized protein activity levels were high, typically between 85 and 95%, assayed by the interaction between His-CypA and CsA. The mean equilibrium dissociation constant for CsA (K(dCsA)) binding to the immobilized His-CypA was 23+/-6 nM, with on and off rates of 0.53+/-0.1 microM(-1) s(-1) and 1.2+/-0.1 (x 10(-2)) s(-1), respectively. These values agree well with the values for the corresponding binding constants determined from steady-state and kinetic fluorescence titrations in solution.