A Case of Chronic Intranasal Cocaine Abuse Masquerading and Exacerbating Underlying Orbital IgG4-Related Disease.

Chronic cocaine use may lead to widespread intranasal inflammation and necrosis. Cases of cocaine use affecting the orbit have been reported in the literature with a clinical spectrum ranging from inflammation-induced p-anti-cytoplasmic neutrophil autoantibodies positive vasculitis to severe midline destructive lesions resulting in orbital apex syndrome. Here, we present a case of chronic intranasal cocaine abuse with midline destruction that initially obscured diagnosis of, and is hypothesized to have exacerbated, underlying IgG4-Related Disease (IgG4-RD) of the orbit over a 2-year period.

Hydrodynamic Relaxation in a Strongly Interacting Fermi Gas.

We measure the free decay of a spatially periodic density profile in a normal fluid strongly interacting Fermi gas, which is confined in a box potential. This spatial profile is initially created in thermal equilibrium by a perturbing potential. After the perturbation is abruptly extinguished, the dominant spatial Fourier component exhibits an exponentially decaying (thermally diffusive) mode and a decaying oscillatory (first sound) mode, enabling independent measurement of the thermal conductivity and the shear viscosity directly from the time-dependent evolution.

Management of periocular cutaneous squamous cell carcinoma with perineural invasion: a case series and literature review.

PURPOSE: To review and elucidate the complex, multimodal management of periocular cutaneous squamous cell carcinoma (SCC) with perineural invasion (PNI), and offer practical, evidence-based patient care recommendations. METHODS: Three exemplary cases of high-risk periocular cutaneous SCC with PNI were selected from a single surgeon's experience. The clinical courses, management, and clinical outcomes, with follow-up intervals of 19, 19, and 24 months after presentation, were reviewed. The English-language literature on PNI, with attention to the management of cutaneous SCC of the head and neck (SCCHN), was reviewed. RESULTS: PNI of cutaneous SCCHN portends aggressive tumor behavior and a worsened prognosis. Treatment is multimodal, with varied combinations of surgical excision, radiotherapy (RT), and systemic chemotherapy. Retrospective reports from multiple institutions involve heterogenous patient populations, treatment strategies, and confounding variables that preclude formulation of a standardized treatment paradigm. Newer, comparative studies of advanced RT techniques (e.g., hyper-fractionation), novel systemic chemotherapeutic agents (e.g., cetuximab, cemiplimab), and varied integrative regimens are providing additional insights. Prompt initiation of adjuvant therapies (within 6-8 weeks of surgery), and careful evaluation of lymphatic basins can increase oncologic control. Utilizing deep-tissue fixation of advancement flaps and eyelid stabilization can enhance functional and aesthetic results. CONCLUSIONS: Management of cutaneous SCC with PNI remains complex and in most cases requires combined-modality therapy directed by a multidisciplinary tumor board. With novel therapies and new treatment patterns, optimal combinations and intensities of individual modalities require further elucidation. The oculofacial plastic surgeon plays a pivotal role - in diagnosis, coordination of interdisciplinary management, thoughtful surgical reconstruction, and postoperative surveillance.

Energy-Resolved Information Scrambling in Energy-Space Lattices.

Weakly interacting Fermi gases simulate spin lattices in energy space, offering a rich platform for investigating information spreading and spin coherence in a large many-body quantum system. We show that the collective spin vector can be determined as a function of energy from the measured spin density, enabling general energy-space resolved protocols. We measure an out-of-time-order correlation function in this system and observe the energy dependence of the many-body coherence.

Survival outcomes of elderly patients referred to the lower gastrointestinal 2-week wait service.

AIM: The benefit to elderly patients (≥80 years old) of referral to the resource-intensive lower gastrointestinal 2-week wait (LGI-2WW) pathway is unknown. The aim of this study was to investigate the survival outcome of elderly patients referred to a LGI-2WW service. METHOD: This study comprised a retrospective analysis of a prospectively gathered database of patients referred to a single-centre LGI-2WW service and conformed to STROBE guidelines. The primary outcome was all-cause mortality. Statistical analysis was performed with the chi-square test and Kaplan-Meier survival curves compared with the generalized log-rank test. RESULTS: A total of 10 155 patients referred to the LGI-2WW service between 1 January 2015 and 31 December 2018 were analysed; median follow-up was 37.0 months (range 0-66 months). Six hundred and ninety one cancers were diagnosed (6.8% detection rate); 551 (80%) of these were lower GI cancers (LGICas) [517 (75%) colorectal; 34 (5%) anal]. Forty per cent of LGICas were diagnosed via the LGI-2WW service. Patients aged ≥80 years with LGICa were more likely to be treated with palliative intent [age <80 years, 92/360 (26%) vs. age ≥80 years, 105/191 (55%); p < 0.001]. LGICa patients aged <85 years had a survival difference between those treated with curative intent (LGICa-Cur) or palliative intent (LGICa-Pal) (median survival for patients aged 80-84 years: LGICa-Cur 57 months vs. LGICa-Pal 15 months; p < 0.001). Patients aged ≥85 years did not have any survival difference by treatment intent (median survival for patients aged 85-89 years: LGICa-Cur 31 months vs. LGICa-Pal 16 months; p = 0.062; median survival for patients aged ≥90 years: LGICa-Cur 14 months vs. LGICa-Pal 16 months; p = 0.703). CONCLUSION: Patients with LGICa aged ≥85 years have similar survival whether treated with curative or palliative intent. This can inform management discussions with patients and LGI-2WW referral pathway prioritization approaches.

Electrostratigraphy and hydrogeochemistry of hyporheic zone and water-bearing caches in the littoral shorefront of Akwa Ibom State University, Southern Nigeria.

Ground-based electrical geophysical data calibrated with borehole information are conveniently used to delineate subsurface strata because of their inherent capability to assess the lateral and vertical variations in the pore water. In this study, joined geophysical approach of vertical electrical sounding (VES) and electrical resistivity tomography (ERT) has been steered to define the strata in the hyporheic zone and in the water bearing caches in the Akwa Ibom State University's littoral shorefront. Four ERTs with each using Wenner array with 5 m electrode spacing were conducted along four profiles at the same locations that VES were conducted. Twelve surface VES soundings were performed with maximum current electrode separations of (AB/2 = 150 m). The integration of formation resistivity with six boreholes reveals motley topsoil/dry strata with resistivity value greater than 200 Ω - m above water table; saturated clay/saline water depository with resistivity value less than 30 Ω - m below water table; fine-grained sand/brackish water depository with resistivity range spanning between 70 and 200 Ω - m below water table; medium-grained sand/freshwater depository with resistivity ranging from 500 to 800 Ω - m below water table and gravelly sand/freshwater depository with resistivity value greater 800 Ω - m below water table were inferred from top to bottom within the maximum current electrode separations. These ranges of resistivity show lithological diversity in subsurface layer. Geochemical analysis was performed for main cations (magnesium, sodium, potassium, calcium, iron and manganese), anions (bicarbonates, sulphates, chloride, and fluoride) and other physical parameters such as, pH, electrical conductivity, total dissolved solids, dissolved oxygen, biochemical oxygen demand and chemical oxygen demand. The results of the interpretation of hydrochemical species of the groundwater samples revealed that the groundwater in most locations within the study area is fresh, slightly alkaline to acidic based on the EC, pH and TDS values. The order of abundance for anions and cations is HCO3- > Cl- > SO42- > F- and Na+ > Ca2+ > Mg2+ > K+ > Fe2+ > Mn2+ respectively. The observation of elevated BOD with lower DO even in the muddy area suggests anoxic condition (DO < 5 mg/L) rather than oxic condition (DO > 5 mg/L), based on the measured DO values (00.12-2.61 mg/L). The elevated ferric iron concentrations on the surface water, which later seeps into the groundwater systems, are due to excessive accumulation of dissolved organic matter (DOM) and the consequent reduction reaction within the DOM in surface water.

Designer Spatial Control of Interactions in Ultracold Gases.

Designer optical control of interactions in ultracold atomic gases has wide applications, from creating new quantum phases to modeling the physics of black holes. We demonstrate wide tunability and spatial control of interactions in a two-component cloud of ^{6}Li fermions, using electromagnetically induced transparency. With two control fields detuned ≃1.5 THz from atomic resonance, megahertz changes in the frequency of one optical beam tune the measured scattering length over the full range achieved by magnetic control, with negligible (10^{-6}) effect on the net optical confining potential. A 1D "sandwich" of resonantly and weakly interacting regions is imprinted on the trapped cloud and broadly manipulated with sub-MHz frequency changes. All of the data are in excellent agreement with our continuum-dressed state theoretical model of optical control, which includes both the spatial and momentum dependence of the scattering amplitude.

Measuring the Hydrodynamic Linear Response of a Unitary Fermi Gas.

We directly observe the hydrodynamic linear response of a unitary Fermi gas confined in a box potential and subject to a spatially periodic optical potential that is translated into the cloud at speeds ranging from subsonic to supersonic. We show that the time-dependent change of the density profile is sensitive to the thermal conductivity, which controls the relaxation rate of the temperature gradients and hence the responses arising from adiabatic and isothermal compression.

Probing Energy-Dependent Feshbach Resonances by Optical Control.

Optical control enables new high resolution probes of narrow collisional (Feshbach) resonances, which are strongly dependent on the relative momentum of colliding atom pairs, and important for simulating neutron matter with ultracold atomic gases. We demonstrate a two-field optical vernier, which expands kHz (mG) magnetic field detunings near a narrow resonance into MHz optical field detunings, enabling precise control and characterization of the momentum-dependent scattering amplitude. Two-photon loss spectra are measured for the narrow resonance in ^{6}Li, revealing rich structure in very good agreement with our theoretical model. However, anomalous overall frequency shifts between the measured and predicted two-photon spectra are not yet explained.

Atom Pairing in Optical Superlattices.

We study the pairing of fermions in a one-dimensional lattice of tunable double-well potentials using radio-frequency spectroscopy. The spectra reveal the coexistence of two types of atom pairs with different symmetries. Our measurements are in excellent quantitative agreement with a theoretical model, obtained by extending the Green's function method of Orso et al. [Phys. Rev. Lett. 95, 060402 (2005)PRLTAO0031-900710.1103/PhysRevLett.95.060402] to a bichromatic 1D lattice with nonzero harmonic radial confinement. The predicted spectra comprise hundreds of discrete transitions, with symmetry-dependent initial state populations and transition strengths. Our work provides an understanding of the elementary pairing states in a superlattice, paving the way for new studies of strongly interacting many-body systems.

Upper Eyelid Response to Topical 0.5% Apraclonidine.

PURPOSE: To describe the change in upper eyelid position in a self-reportedly normal population after the administration of topical 0.5% apraclonidine in each eye. METHODS: One hundred self-reportedly normal subjects received a 1-time administration of topical 0.5% apraclonidine in each eye. Digital photographs were taken at baseline and then 30 and 45 minutes following apraclonidine instillation. Marginal reflex distance 1 was determined via image analysis of acquired digital photographs (image-derived measurements are given the prefix "i" in this study). The horizontal corneal diameter was used as a constant measurement scale in each photograph. RESULTS: The mean increase in i-marginal reflex distance 1 post-administration of 0.5% apraclonidine was +0.70 ± 0.60 mm (range, -0.94 to +2.66 mm) after 30 minutes and +0.68 ± 0.59 mm (range, -0.69 to +2.54 mm) after 45 minutes. Of the 200 total eyelids in 100 subjects, 181 (90.5%) had an increase in i-marginal reflex distance 1 at 30 minutes. Of the 100 subjects, 85 (85%) had a bilateral increase in i-marginal reflex distance 1, 4 (4%) had a bilateral decrease, and 11 (11%) had a unilateral increase with a contralateral decrease. CONCLUSIONS: Given its predominant small-amplitude upper eyelid elevating effect, topical apraclonidine may be a useful off-label alternative treatment for mild upper eyelid ptosis and in eyelid asymmetry due to eyelid retraction through use in the contralateral eye.

Hering's Law in Congenital Ptosis: Evaluation of the Contralateral Response to Unilateral Congenital Ptosis Repair.

PURPOSE: To determine the applicability and clinical relevance of Hering's law for the eyelids in cases of congenital ptosis. METHODS: A retrospective chart review and digital photograph analysis of patients who underwent unilateral congenital ptosis repair at a tertiary, university-based, Oculoplastics clinic was conducted. Pre- and postoperative eyelid height (marginal reflex distance), upper eyelid symmetry, and brow position were determined using ImageJ analysis software. Changes in these values, and the relationship between the change in ipsi- and contralateral eyelid heights and brow positions, were determined. RESULTS: In 51 patients, the mean change in contralateral upper eyelid position (marginal reflex distance) following unilateral repair was -0.5 mm with 29% (n = 15) demonstrating a greater than 1 mm contralateral descent. The contralateral brow position remained stable with a mean change of +0.1 mm. No significant differences were seen between the 15 patients who demonstrated a contralateral upper eyelid descent greater than 1 mm and the remainder of the cohort in terms of amblyopia rate (p = 0.71), mean preoperative marginal reflex distance (p = 0.14), mean change in ipsilateral marginal reflex distance (p = 0.32), mean change in contralateral brow position (p = 0.44), or mean postoperative upper eyelid asymmetry (1.3 mm vs. 1.2 mm). Overall, the mean upper eyelid asymmetry improved from 2.6 mm preoperatively to 1.2 mm postoperatively. None of the 51 patients underwent subsequent contralateral ptosis repair. CONCLUSIONS: Hering's law for the eyelids applies to cases of congenital ptosis but has little clinical significance due to improved upper eyelid asymmetry following unilateral surgery.

Rethinking Our Definition of Postoperative Success: A Comparative Analysis of Three Upper Eyelid Retraction Repair Techniques Using Novel Metrics to Capture Functional and Aesthetic Outcomes.

PURPOSE: To compare 3 upper eyelid retraction repair techniques and introduce novel metrics, which enhance the analysis of postoperative aesthetic outcomes. METHODS: Retrospective review with Image J 1.48 digital analysis of patients who underwent repair of thyroid-related upper eyelid retraction at the University of Iowa from 1996 to 2014 via 1 of 3 surgical techniques, septum-opening levator recession with Muellerectomy, modified septum-preserving levator recession with Muellerectomy, and modified septum-preserving full-thickness blepharotomy, was conducted. Photographs were obtained preoperatively, 3 to 6 months postoperatively, and at last follow up (>6 months) and evaluated by digital image analysis (denoted by "i"). Outcome measures assessed were marginal reflex distance (iMRD1), temporal-to-nasal ratio, tarsal platform show (iTPS), pupil to visible eyelid crease, brow fat span (iBFS), tarsal platform show to brow fat span ratio (iTPS:iBFS), and tarsal platform show minimizing power (iTPS-minimizing power). RESULTS: A total of 121 eyelids (28 septum-opening levator recession with Muellerectomy, 66 septum-preserving levator recession with Muellerectomy, and 27 septum-preserving full-thickness blepharotomy) from 74 patients were evaluated with a mean follow up of 24.2 months. There were no statistically significant differences between techniques in terms of iMRD1 or temporal-to-nasal ratio reduction at either time point (intertechnique p values of 0.17 to >0.99). The percentage of eyelids from subjects undergoing bilateral intervention that achieved a final iMRD1 between 2.50 mm and 4.50 mm was similar (intertechnique p value of 0.23), with no difference regarding the number of subjects demonstrating iMRD1 symmetry within 1 mm (intertechnique p value of 0.15). Though iTPS elongation was greater at 3 to 6 months with septum-opening compared with the combined septum-preserving techniques (p value of 0.04), this difference was not maintained at final follow up (p value of >0.99). There was no difference in terms of iTPS symmetry at time of final follow up (intertechnique p value of 0.69). The pupil to visible eyelid crease was unchanged in all techniques (p values >0.99). Mean changes in iBFS at final follow up were -1.27 mm, -0.44 mm, and +0.55 mm for septum-opening levator recession with Muellerectomy, septum-preserving levator recession with Muellerectomy, and septum-preserving full-thickness blepharotomy (p values of 0.01, 0.49, and >0.99, respectively). Mean iTPS:iBFS ratios at final follow up were not statistically different between techniques (intertechnique p value of 0.10) and no difference in symmetry was demonstrated (intertechnique p value of 0.47). Median values for iTPS-minimizing power were: -0.83, -0.93, and -1.01 for septum-opening levator recession with Muellerectomy, septum-preserving levator recession with Muellerectomy, and septum-preserving full-thickness blepharotomy, respectively (intertechnique p value of 0.54). CONCLUSIONS: Each technique appropriately lowered the eyelid and improved contour without intertechnique variability. Septum-preserving techniques demonstrated less iTPS elongation initially, but this difference was not maintained. The visible eyelid crease height (pupil to visible eyelid crease) remained stable in all techniques, indicating that the iTPS elongation seen with each technique was secondary to reduction in iMRD1 and the iBFS reduction seen with septum-opening levator recession with Muellerectomy was due to brow descent. No intertechnique differences in the amount of iTPS elongation relative to iMRD1 reduction (i.e., the novel iTPS-minimizing power) were seen. Given that each procedure evaluated yielded similar results, technique selection may be guided by surgeon experience and preference.

The occurrence of Trichinella species in the cougar Puma concolor couguar from the state of Colorado and other regions of North and South America.

Trichinella species are zoonotic nematodes that infect wild carnivores and omnivores throughout the world. We examined the prevalence and species of Trichinella infections in cougars (Puma concolor couguar) from Colorado, United States. Tongues from cougars were examined by pepsin-HCl artificial digestion to detect Trichinella spp. larvae. The species or genotype of individual worms was identified by multiplex polymerase chain reaction (PCR). Trichinella spp. larvae were detected in 17 of 39 cougars (43.6% (28.7-59.5%)). Five of the cougars (12.8%) were infected with T. murrelli, 3 (7.7%) were infected with T. pseudospiralis, and 1 (2.6%) had Trichinella genotype T6. Trichinella spp. larvae from eight cougars were not identified at the species level, due to degraded DNA. The high prevalence of Trichinella spp. in cougars from Colorado and reports of the parasite in other populations of Puma spp. suggest that this large predator is a key mammalian reservoir.

Optical Control of Magnetic Feshbach Resonances by Closed-Channel Electromagnetically Induced Transparency.

We control magnetic Feshbach resonances in an optically trapped mixture of the two lowest hyperfine states of a ^{6}Li Fermi gas, using two optical fields to create a dark state in the closed molecular channel. In the experiments, the narrow Feshbach resonance is tuned by up to 3 G. For the broad resonance, the spontaneous lifetime is increased to 0.4 s at the dark-state resonance, compared to 0.5 ms for single-field tuning. We present a new model of light-induced loss spectra, employing continuum-dressed basis states, which agrees in shape and magnitude with loss measurements for both broad and narrow resonances. Using this model, we predict the trade-off between tunability and loss for the broad resonance in ^{6}Li, showing that our two-field method substantially reduces the two-body loss rate compared to single-field methods for the same tuning range.

A Vector Force Model of Upper Eyelid Position in the Setting of a Trabeculectomy Bleb.

PURPOSE: A vector force model for the determination of upper eyelid position in the setting of a trabeculectomy bleb is presented. The model is used to explain the clinical courses of 5 patients with bleb-induced upper eyelid malposition and the efficacy of modalities previously described for the treatment of bleb-induced upper eyelid retraction. The novel use of botulinum toxin in the treatment of bleb-induced eyelid retraction and unique surgical considerations in patients with trabeculectomy blebs undergoing upper eyelid surgery are discussed. METHODS: A vector force analysis was conducted and a force diagram constructed. The clinical and surgical courses of 5 patients with trabeculectomy blebs and upper eyelid malposition were reviewed. The vector force model was applied to these cases and the previously described treatment modalities for bleb-induced upper eyelid retraction. RESULTS: Vector force analysis demonstrates that in the case of trabeculectomy bleb-induced upper eyelid retraction, the net force vector, which represents the sum of all the individual forces acting on the eyelid, has a positive vertical component resulting in superior displacement of the eyelid. In contrast, bleb-induced ptosis results when the net force vector has a negative vertical component. In 3 patients, alterations in the bleb resulted in resolution of upper eyelid malposition. Botulinum toxin was used to achieve a normal upper eyelid position in 1 patient with lateral canthal tendon disinsertion and unilateral eyelid retraction and 1 patient with bilateral eyelid retraction. One patient developed unilateral ptosis in concert with the emergence of a large Tenon cyst that resolved with the treatment of the cyst via eyelid massage. One patient with unilateral ptosis and an ipsilateral bleb underwent external levator advancement but was unable to achieve the desired upper eyelid height as retraction over the bleb occurred with any attempt to elevate the eyelid above a marginal reflex distance of 1.5 mm. The efficacy of previously reported modalities for the treatment of trabeculectomy bleb-induced upper eyelid retraction can be explained by either a reduction in the positive vertical component of the net force vector or augmentation of the negative vertical component. CONCLUSIONS: A vector force model systematically accounts for the multiple determinants of upper eyelid position in the setting of a trabeculectomy bleb. This model provides a framework for the evaluation of bleb-induced upper eyelid malposition and offers a logical, mathematical explanation for the occurrence of bleb-induced upper eyelid retraction and the usefulness of previously reported treatment modalities for this clinical entity.

Shear Viscosity of a Unitary Fermi Gas Near the Superfluid Phase Transition.

We measure the shear viscosity for a resonantly interacting Fermi gas as a function of temperature from nearly the ground state through the superfluid phase transition into the high temperature regime. Further, we demonstrate an iterative method to estimate the local shear viscosity coefficient α(S)(θ) versus reduced temperature θ from the cloud-averaged measurements ⟨α(S)⟩, and compare α(S) to several microscopic theories. We find that α(S) reveals features that were previously hidden in ⟨α(S)⟩.

Spin-imbalanced quasi-two-dimensional Fermi gases.

We measure the density profiles for a Fermi gas of (6)Li containing N(1) spin-up atoms and N(2) spin-down atoms, confined in a quasi-two-dimensional geometry. The spatial profiles are measured as a function of spin imbalance N(2)/N(1) and interaction strength, which is controlled by means of a collisional (Feshbach) resonance. The measured cloud radii and central densities are in disagreement with mean-field Bardeen-Cooper-Schrieffer theory for a true two-dimensional system. We find that the data for normal-fluid mixtures are reasonably well fit by a simple two-dimensional polaron model of the free energy. Not predicted by the model is a phase transition to a spin-balanced central core, which is observed above a critical value of N(2)/N(1). Our observations provide important benchmarks for predictions of the phase structure of quasi-two-dimensional Fermi gases.

Differing populations of endemic bacteriophages in cattle shedding high and low numbers of Escherichia coli O157:H7 bacteria in feces.

The objectives of this study were to identify endemic bacteriophages (phages) in the feedlot environment and determine relationships of these phages to Escherichia coli O157:H7 from cattle shedding high and low numbers of naturally occurring E. coli O157:H7. Angus crossbred steers were purchased from a southern Alberta (Canada) feedlot where cattle excreting ≥ 10(4) CFU · g(-1) of E. coli O157:H7 in feces at a single time point were identified as supershedders (SS; n = 6), and cattle excreting <10(4) CFU · g(-1) of feces were identified as low shedders (LS; n = 5). Fecal pats or fecal grabs were collected daily from individual cattle for 5 weeks. E. coli O157:H7 in feces was detected by immunomagnetic separation and enumerated by direct plating, and phages were isolated using short- and overnight-enrichment methods. The total prevalence of E. coli O157:H7 isolated from feces was 14.4% and did not differ between LS and SS (P = 0.972). The total prevalence of phages was higher in the LS group (20.9%) than in the SS group (8.3%; P = 0.01). Based on genome size estimated by pulsed-field gel electrophoresis and morphology determined by transmission electron microscopy, T4- and O1-like phages of Myoviridae and T1-like phage of Siphoviridae were isolated. Compared to T1- and O1-like phages, T4-like phages exhibited a broad host range and strong lytic capability when targeting E. coli O157:H7. Moreover, the T4-like phages were more frequently isolated from feces of LS than SS, suggesting that endemic phages may impact the shedding dynamics of E. coli O157:H7 in cattle.