Unraveling Polyphyly in Flourensia (Asteraceae, Heliantheae, Enceliinae) and the Establishment of a New Genus Austroflourensia.

The monophyly of Flourensia was examined for the first time by sequencing the nuclear ITS and plastid psbA- trnH regions in 18 species of the genus, analyzing them along with representatives of the remaining genera of subtribe Enceliinae. Results showed strong evidence for the polyphyly of Flourensia identifying two well-supported groups: Flourensia, a clade from North America including the type F. laurifolia, and another clade, here designed as the new genus Austroflourensia, containing the South American species. Austroflourensia is related to the other four genera composing the subtribe Enceliinae, whereas Flourensia s.s. is sister to all of them. Austroflourensia can be mainly distinguished by having a shrubby or subshrubby habit, capitula always radiate usually arranged in weakly cymose-corymbose capitulescences, phyllaries 2-3-seriate, and disc corollas shortly dentate. This paper proposes twelve new combinations to accommodate species previously described in the genus Flourensia and provides emended descriptions of Flourensia and the new genus Austroflourensia. The illustration of the type of the new genus, a distribution map, and a key to the genera of Enceliinae are also provided.

Alternative techniques in cochlear implant surgery: Subtotal petrosectomy.

OBJECTIVES: To report and analyze three cases of subtotal petrosectomy (SP) in cochlear implant surgery at our institution, and establish the indications, surgical technique and complications encountered. MATERIALS AND METHOD: A retrospective descriptive study is proposed, analyzing a series of three clinical cases of subtotal petrosectomy as surgical technique for cochlear implant surgery at San Ignacio University Hospital (Bogotá, Colombia) from year 2004 to 2019. RESULTS: A total of three cases of subtotal petrosectomy as surgical technique in cochlear implant candidates were analyzed. The indications were the presence of a wide mastoid cavity after canal wall down mastoidectomy, extrusion of the electrode into the external auditory canal with a wide mastoid cavity and erosion of the posterior wall of the ear canal, and the presence of cholesteatoma in a cophotic ear with previous surgery. The ear canal was defunctionalized in all three cases; in two of them with obliteration of the Eustachian tube and in none of the cases the mastoid was obliterated. There was a single complication associated with the procedure corresponding to a small retention cholesteatoma in the skin of the obliterated duct sac, that didn't required surgical intervention. CONCLUSION: Subtotal petrosectomy is a surgical alternative for cochlear implant surgery in patients with chronic ear pathology, wide cavities or cochlear implant extrusion, not associated to significant complications.

Long term cutaneous complications related to bone conduction hearing implants. A retrospective study (2004-2018).

OBJECTIVE: The aim of this study was to establish the frequency of cutaneous complications due to surgically implanted bone conduction hearing aids in recipients treated at a tertiary otolaryngology center. Additionally, based on the literature review, we propose a scale to standardize the report of cutaneous reactions related to transcutaneous systems to objectify future studies. METHODS: A retrospective chart review was conducted for patients who were implanted with bone conduction hearing systems between 2004 and 2018. Patients with minimum follow up of 6 months were included. Patient demographics, surgical characteristics and clinical course was analyzed by number and skin reactions. Transcutaneous and percutaneous systems were analyzed separately. The study was approved by the local IRB. RESULTS: A total of 104 devices were implanted on 88 patients with an average follow up of 4.04 (range of 0.5 - 10 years). Out of the total of patients, 49 (55.7%) developed at least one episode of inflammatory/infectious skin reaction at surgical incision site. A total of 148 episodes of local infections during the entire follow-up period were registered, mostly mild in severity with no triggering factors identified. The majority of the initial episodes of infection occurred within the first 3 years of follow-up. Out of the total of patients, 47 (53.4%) reported pain at the surgical site at some point throughout follow-up, not associated with clinically evident infection. CONCLUSION: The incidence of skin complications in our series seemed higher compared to previous reports. Minor complications were the most common and responded well to topical treatment. No triggering factors were identified as the cause of the infections, nor to explain the frequency or the severity of such an adverse reaction. Isolated pain was present in the majority of patients with conductive hearing devices, even without signs of active infection. Due to its high incidence it should be assessed in all patients that receive an implant. Based on a search of the literature, a scale to standardize cutaneous complications of transcutaneous implants was undertaken, but further studies are needed to validate such a scale.

Congenital meningocele associated with corpus callosum agenesis and midline superior labial cleft due to Tessier 0-14 facial fissure: A case report.

A case of a 31-day-old infant patient with a Tessier 0-14 deformity related to multiple midline deformities is presented. Although Transnasal endoscopic surgery is the mainstay for the treatment of anterior and middle skull base meningoceles, there are complex cases in which a combined and multidisciplinary approach is necessary. The surgical decisions and techniques are described. To date, this is the first patient reported with Tessier 0-14 deformity treated with a combined endoscopic and external surgical approach.

Detection of hearing loss in newborns: Definition of a screening strategy in Bogotá, Colombia.

OBJECTIVE: To describe the results from the hearing screening protocol adopted in a Hospital in Colombia emphasizing the importance of performing screening on an outpatient basis, when the newborn is more than 24 h old. METHODS: A prospective study at Hospital Universitario San Ignacio in Bogota, Colombia was carried out, from May 1st, 2016 to Nov 30th, 2017, the study sample included 2.088 newborns examined using transient otoacoustic emissions. RESULTS: We obtained written consent from the parents of 1.523 newborns and 24 individuals (1.6%) failed the first stage of the screening, nine cases unilateral and 15 bilateral. A total of nine neonates (0,6%) failed the second screening test, six cases unilateral and three bilateral. Four (0,3%) did not return to the second test. Our false altered screening rate was 0.7%. CONCLUSIONS: In a developing country with limited human and economic resources, in which newborn early discharge is the norm, a newborn hearing screening program linked to infants' check-ups, that uses otoacoustic emissions after 48 h of life, seems a feasible option compare to the standard US protocol aiming to conduct hearing screening prior to discharge.

Age at diagnosis, but not HPV type, is strongly associated with clinical course in recurrent respiratory papillomatosis.

BACKGROUND: Recurrent Respiratory Papillomatosis (RRP) is a rare disease characterized by the growth of papillomas in the airway and especially the larynx. The clinical course is highly variable among individuals and there is poor understanding of the factors that drive an aggressive vs an indolent course. METHODS: A convenience cohort of 339 affected subjects with papillomas positive for only HPV6 or HPV11 and clinical course data available for 1 year or more, from a large multicenter international study were included. Exploratory data analysis was conducted followed by inferential analyses with frequentist and Bayesian statistics. RESULTS: We examined 339 subjects: 82% were diagnosed prior to the age of 18 years, 65% were infected with HPV6, and 69% had an aggressive clinical course. When comparing age at diagnosis with clinical course, the probability of aggressiveness is high for children under five years of age then drops rapidly. For patients diagnosed after the age of 10 years, an indolent course is more common. After accounting for confounding between HPV11 and young age, HPV type was minimally associated with aggressiveness. Fast and Frugal Trees (FFTs) were utilized to determine which algorithms yield the highest accuracy to classify patients as having an indolent or aggressive clinical course and consistently created a branch for diagnostic age at ~5 years old. There was no reliable strong association between clinical course and socioeconomic or parental factors. CONCLUSION: In the largest cohort of its type, we have identified a critical age at diagnosis which demarcates a more aggressive from less aggressive clinical course.

Relict high-Andean ecosystems challenge our concepts of naturalness and human impact.

What would current ecosystems be like without the impact of mankind? This question, which is critical for ecosystem management, has long remained unanswered due to a lack of present-day data from truly undisturbed ecosystems. Using mountaineering techniques, we accessed pristine relict ecosystems in the Peruvian Andes to provide this baseline data and compared it with the surrounding accessible and disturbed landscape. We show that natural ecosystems and human impact in the high Andes are radically different from preconceived ideas. Vegetation of these 'lost worlds' was dominated by plant species previously unknown to science that have become extinct in nearby human-affected ecosystems. Furthermore, natural vegetation had greater plant biomass with potentially as much as ten times more forest, but lower plant diversity. Contrary to our expectations, soils showed relatively little degradation when compared within a vegetation type, but differed mainly between forest and grassland ecosystems. At the landscape level, a presumed large-scale forest reduction resulted in a nowadays more acidic soilscape with higher carbon storage, partly ameliorating carbon loss through deforestation. Human impact in the high Andes, thus, had mixed effects on biodiversity, while soils and carbon stocks would have been mainly indirectly affected through a suggested large-scale vegetation change.

Aspiration of an extracted molar: case report.

A case of aspiration of an extracted molar is presented. The main objective of this paper is to provide dental colleagues with an educational framework on foreign-body aspiration to help prevent delayed diagnosis of such events in the future.