Quality of life outcomes after transnasal endoscopic pituitary surgery using the Glasgow Benefit Inventory.

PURPOSE: This study assesses postoperative quality-of-life outcomes via the Glasgow Benefit Inventory (GBI) in patients undergoing transnasal endoscopic pituitary surgery for pituitary adenoma. METHODS: This was a retrospective cohort study in a UK tertiary referral centre. 145 patients who had undergone transnasal endoscopic pituitary surgery for pituitary adenoma over a 6-year period at one institution completed the GBI with at least 3 months' follow up. Patients with prior radiotherapy were excluded. The GBI is a patient-reported outcome measure that assesses post-intervention outcomes in three domains: 'general' functioning, 'social support' and 'physical' functioning. Pre- and post-operative visual loss scores were additionally assessed via a 1-5 Likert scale. GBI scores were assessed alongside these visual loss scores, clinical and surgical parameters and demographics. RESULTS: Mean age was 59.5 years (range 20-87 years) and mean follow up was 36 months. A total of 46 of 145 (31.7%) patients had secreting tumours. The most common primary symptom was visual loss. Mean total score for all patients was positive (+8.4); with 'general' domain score the most positive (+10.5). All patient groups had overall positive, 'general' and 'social support' domain scores. Patients with Cushing's disease reported significantly higher mean total scores (+29.6) than all other groups. Acromegaly (+7.9) and non-functioning adenoma (NFA) groups (+5.2) reported lower mean total scores. 'Physical' domain mean scores were negative for acromegaly and NFA groups. There was statistical significance between a pre- to post-operative improvement in visual score and mean total GBI score (p = 0.02) and mean 'general' domain GBI score (p = 0.02). CONCLUSIONS: These findings can aid preoperative counselling of patients undergoing this surgery. Those with NFA and no anticipated improvement to visual loss symptoms may be advised of possible worsened physical outcomes and of the option to delay the surgery until symptoms are present.

Experimental modelling of imposed upper airway obstruction in infants and children.

The interpretation of injuries to children and infants poses a number of difficulties to any medical practitioner involved in their care or tasked with the investigation their death. This includes differentiating accidental from non-accidental trauma and the consideration of medical factors making a child more prone to injury. Non-fatal but life-threatening upper airway obstruction is unfortunately a well-recognized pattern of abuse which may precede a fatal episode. In this experimental study, we aimed to model theoretical digit marks to the head using infant and young child resuscitation dummies, exposed to various methods of deliberate upper airway obstruction. This work has demonstrated that digit marks can be left anywhere on the head and face. However, the distribution of these marks varies dramatically based on how the airway was obstructed. Moreover, digit marks also appeared to be linked together in fairly reproducible patterns. Given the findings in this study, the identification of one or more fingertip type bruises anywhere on an infant or child's face or scalp, should raise the index of suspicion that the individual may have been subject to deliberate upper airway obstruction. This should prompt healthcare professionals to examine the child for markers of mechanical asphyxia, in order to accurately interpret any inadequately explained bruising to the head and face.

A subjective analysis of participants' views in a study of experimental modelling of imposed airway obstruction in infants and children.

Deliberate airway obstruction is a well-recognised form of child abuse and one of the most common causes of death in cases of child homicide. Although classical signs such as petechial haemorrhages can be helpful in raising the suspicion of mechanical asphyxia, they are not always present. Therefore, distinguishing between bruising caused by accidents, medical conditions or non-accidental injury remains challenging. We aimed to characterise bruising patterns which are potentially more consistent with deliberate airway obstruction by means of an experimental modelling study. The first results of our project were previously published and demonstrated that bruising anywhere on the head may be consistent with deliberate upper airway obstruction. In this paper, we present the findings of a questionnaire carried out during the modelling to assess participants' perception of force and consider how variables such as age, use of adjuncts and force distribution may affect bruising patterns in deliberate airway obstruction. Statistical analysis of our results showed that participants felt they were using less force in scenarios involving the infant rather than the child resuscitation dummy as well as when using adjuncts, meaning marks are likely to be more subtle. Therefore, in such cases it is important to examine for other signs of asphyxiation (such as petechiae) and consider the possibility that adjuncts might have been used which could make picking up localised injuries more difficult. Our results also showed that participants often felt force was not distributed evenly across the digits, reporting the greatest force through either the thumb in isolation or the thumb plus another digit in up to nearly 50% of cases. This suggests that just one or two bruises may be consistent with deliberate airway obstruction.

Total orbital exenteration with temporalis muscle transfer and secondary healing.

OBJECTIVE: To evaluate the outcomes of orbital exenteration with temporalis muscle flap repair of the socket and secondary healing of the anterior surface of the flap in ocular, conjunctival, and eyelid malignancies. DESIGN: Retrospective single-centre study. PARTICIPANTS: Consecutive patients who underwent total exenteration for malignancy with temporal muscle flap repair of the socket between December 2009 and January 2016. METHODS: We report the outcomes of this surgical technique in terms of healing without fistula formation and time to epithelialization. RESULTS: Twenty-nine patients underwent surgery using this technique. Diagnoses consisted of 18 conjunctival melanomas, 2 choroidal melanomas, 6 squamous cell carcinomas, 2 sebaceous cell carcinomas, and 1 basal cell carcinoma. Mean age at surgery was 70.7 years and mean follow-up was 27.4 months. On histological analysis, tumour excision was complete in 25 patients, of whom 3 had an orbital recurrence after exenteration (3 conjunctival melanomas). Four patients had incomplete tumour excision, of whom 3 underwent postoperative orbital radiotherapy with no subsequent orbital recurrences. Complete epithelialization of the socket occurred in mean 7.9 weeks (range 2-16 weeks). Flap necrosis occurred in 1 patient after postoperative radiotherapy (with sino-nasal fistula formation); 2 other patients developed sino-orbital fistulas. CONCLUSION: After orbital exenteration, spontaneous epithelialization of the socket may take up to several months. Use of a temporalis muscle flap can reduce the duration of socket healing postoperatively, even if left to heal by secondary intention. This may facilitate early postoperative radiotherapy when indicated. Aesthetic results are acceptable and local surgical complications are rare.

Acoustic neuroma presenting as a hypnic headache.

Hypnic headache (HH) is a rare, primary headache syndrome that invariably occurs during sleep and wakes the patient. Acoustic neuroma (AN) is a benign tumour that uncommonly presents with isolated headache. Here, we describe a patient with AN that presented with an HH-like syndrome. A 40-year-old woman presented with 4 months of generalised, throbbing, nocturnal headaches that woke her from sleep. Neurological examination was unremarkable. Retrospectively, she reported a 4-year history of mild, bilateral tinnitus. Neuroimaging demonstrated a large, left-sided AN in the cerebellopontine angle without obstructive hydrocephalus. Gamma knife radiosurgery controlled tumour growth. One year after radiosurgery, she became nocturnal headache-free. AN has not previously been described as presenting with an HH-like syndrome. There are four previous reports of an HH-like syndrome secondary to intracranial masses. In all cases, patients became headache-free following surgery. This advocates for neuroimaging to exclude structural causes.

Mesoscopic transport revisited.

Having driven a large part of the decade's progress in physics, nanoelectronics is now passing from today's realm of the extraordinary to tomorrow's commonplace. This carries the problem of turning proofs of concept into practical artefacts. Better and more sharply focused predictive modelling will be the ultimate guide to optimizing mesoscopic technology as it matures. Securing this level of understanding needs a reassessment of the assumptions at the base of the present state of the field. We offer a brief overview of the underlying assumptions of mesoscopic transport.

Anomalous conductance quantization in the inter-band gap of a one-dimensional channel.

We report on a singular departure from the canonical step sequence of quantized conductance in a ballistic, quasi-one-dimensional metallic channel. Ideally in such a structure each sub-band population contributes its conductance quantum independently of the rest. In a picture based exclusively on coherent single-carrier transmission, unitary back-scattering may lower a conductance step below ideal but it is not possible for it to enhance it beyond the ideal conductance quantum. Precisely such an anomalous and robust voltage-dependent enhancement has already been observed over the whole density range between sub-band thresholds (de Picciotto R et al 2004 Phys. Rev. Lett. 92 036805, de Picciotto R et al 2008 J. Phys.: Condens. Matter 20 164204), a phenomenon left unexplained till now. We show theoretically that the anomalous enhancement of the ideal conductance is the hallmark of carrier transitions coupling the discrete sub-bands.

Therapeutic Recreation in the Public Schools: A Community Partnership.

BACKGROUND: In 2002, the University of Southern Mississippi's Therapeutic Recreation Program and the Hattiesburg (MS) Public School District's Department of Exceptional Children and Health Services formed a partnership that has lasted (off and on) for 15 years. METHODS: The partnership was formed based on a shared mission of education and training, and grew in depth based on reciprocated respect and support. RESULTS: Early collaborative efforts included simple programming efforts that provided health and educational benefits for the students with disabilities in the public schools and training for the future professionals in therapeutic recreation at the university. As the program progressed, more complex programs were designed to teach students with disabilities to build the capacity for pursuing and maintaining personal health. CONCLUSIONS: Planned programming efforts for the near future focus on collecting data to support the development of an extracurricular athletic program for students with disabilities.

Total synthesis of hectochlorin.

Hectochlorin (1) is a marine natural product with significant fungicidal activity. A synthesis effort was initiated to develop a flexible route to hectochlorin which would allow access to analogues with potentially improved activity and/or attributes relative to the natural product. A successful total synthesis of hectochlorin is described. [structure: see text]

Optimizing managed care peer reviews: turning a "Doc to Doc" talk into better advocacy for psychiatric inpatients.

Clinicians often resent behavioral health managed care peer reviews. However, such reviews need not be onerous. This Open Forum, written by managed care physician reviewers, attempts to help attending psychiatrists, specifically those on inpatient units, achieve more satisfying outcomes for patients by adhering to a few basic principles. Beyond the level-of-care guidelines, attending psychiatrists are advised to focus on immediate acuity, along with specific life events that may have immediate impact on the patient's well-being. A clear diagnosis, relevant treatment plan, salient updates, and strategies for preventing readmission can justify additional treatment time. By contrast, "time-based treatments," dispositional issues, or a patient's lack of acceptance or effective use of treatment are harder to justify.

Nonequilibrium mesoscopic transport: a genealogy.

Models of nonequilibrium quantum transport underpin all modern electronic devices, from the largest scales to the smallest. Past simplifications such as coarse graining and bulk self-averaging served well to understand electronic materials. Such particular notions become inapplicable at mesoscopic dimensions, edging towards the truly quantum regime. Nevertheless a unifying thread continues to run through transport physics, animating the design of small-scale electronic technology: microscopic conservation and nonequilibrium dissipation. These fundamentals are inherent in quantum transport and gain even greater and more explicit experimental meaning in the passage to atomic-sized devices. We review their genesis, their theoretical context, and their governing role in the electronic response of meso- and nanoscopic systems.

The role of particle size of particulate nano-zinc oxide wood preservatives on termite mortality and leach resistance.

Historically most residential wood preservatives were aqueous soluble metal formulations, but recently metals ground to submicron size and dispersed in water to give particulate formulations have gained importance. In this study, the specific role nano-zinc oxide (ZnO) particle size and leach resistance plays in termite mortality resulting from exposure to particulate ZnO-treated wood was investigated. Southern yellow pine (SYP) sapwood impregnated with three concentrations of two particle sizes (30 and 70 nm) of ZnO were compared to wood treated with soluble zinc sulphate (ZnSO4) preservative for leach resistance and termite resistance. Less than four percent leached from the particulate nano-ZnO-treated specimens, while 13 to 25% of the zinc sulphate leached from the soluble treated wood. Nano-ZnO was essentially non-leachable from wood treated with 5% formulation for the 30-nm particle size. In a no-choice laboratory test, eastern subterranean termites (Reticulitermes flavipes) consumed less than 10% of the leached nano-ZnO-treated wood with 93 to 100% mortality in all treatment concentrations. In contrast, termites consumed 10 to 12% of the leached ZnSO4-treated wood, but with lower mortality: 29% in the 1% treatment group and less than 10% (5 and 8%, respectively) in the group of wood blocks treated with 2.5 and 5.0% ZnSO4. We conclude that termites were repelled from consuming wood treated with nano-ZnO, but when consumed it was more toxic to eastern subterranean termites than wood treated with the soluble metal oxide formulation. There were no differences in leaching or termite mortality between the two particle sizes of nano-ZnO.

Weatherability and Leach Resistance of Wood Impregnated with Nano-Zinc Oxide.

Southern pine specimens vacuum-treated with nano-zinc oxide (nano-ZnO) dispersions were evaluated for leach resistance and UV protection. Virtually, no leaching occurred in any of the nano-ZnO-treated specimens in a laboratory leach test, even at the highest retention of 13 kg/m(3). However, specimens treated with high concentrations of nano-ZnO showed 58-65% chemical depletion after 12 months of outdoor exposure. Protection from UV damage after 12 months exposure is visibly obvious on both exposed and unexposed surfaces compared to untreated controls. Graying was markedly diminished, although checking occurred in all specimens. Nano-zinc oxide treatment at a concentration of 2.5% or greater provided substantial resistance to water absorption following 12 months of outdoor exposure compared to untreated and unweathered southern pine. We conclude that nano-zinc oxide can be utilized in new wood preservative formulations to impart resistance to leaching, water absorption and UV damage of wood.

Where is the shot noise of a quantum point contact?

Reznikov et al. [Phys. Rev. Lett. 75, 3340 (1995)]] have presented definitive observations of nonequilibrium noise in a quantum point contact. Especially puzzling is the "anomalous" peak structure of the excess noise measured at constant current; to date it remains unexplained. We show that their experiment directly reveals the deep link between conservation principles in the electron gas and its low-dimensional, mesoscopic behavior. The keys to that connection are gauge invariance and the compressibility sum rule. These are central not only to the experiment of Reznikov et al., but to the very nature of all mesoscopic transport.