Understanding the nervous system: lessons from Frontiers in Neurophotonics.

The Frontiers in Neurophotonics Symposium is a biennial event that brings together neurobiologists and physicists/engineers who share interest in the development of leading-edge photonics-based approaches to understand and manipulate the nervous system, from its individual molecular components to complex networks in the intact brain. In this Community paper, we highlight several topics that have been featured at the symposium that took place in October 2022 in Québec City, Canada.

Factors Influencing Delay in Diagnosis of Head and Neck Cancer in Rwanda.

OBJECTIVE: Head and neck cancer is a significant contributor to global otolaryngologic disease burden, with a disproportionate impact on low- and middle-income countries. This study investigates the factors contributing to delays in head and neck cancer diagnosis at the University Teaching Hospital of Kigali (CHUK). METHODS: Cross-sectional study of all patients with a pathologic diagnosis of head and neck cancer presenting to CHUK between January 2021 and June 2022. Sociodemographic data, tumor characteristics, and reasons for delay were collected. Univariate and multivariable analyses were undertaken to evaluate risk factors for delays. RESULTS: Eighty-one patients met criteria for inclusion. Median duration from patient first reported symptoms to initial medical consultation was 52 weeks, from initial medical consultation to referral to CHUK was 4 weeks, and from referral to final pathologic diagnosis was 6 weeks. The most common reason for delay to referral to CHUK was financial (37.04%). Patients who visited traditional healers had higher odds of delay between symptom onset and medical consultation (OR 3.51, CI 1.05-11.70). Delays in final diagnosis after referral were most commonly due to OR availability for biopsy (37.04%) and time for pathology results after biopsy (35.80%). OR availability had a significant impact on duration to final diagnosis (OR 59.48, CI 7.17-493.67). Stage 4 disease had the shortest time to final diagnosis (OR 0.05, CI 0.01-0.45). CONCLUSION: Understanding the reasons for delayed diagnosis of head and neck cancer may help guide improvements in care, with the goal of reducing global head and neck burden of disease. LEVEL OF EVIDENCE: 3; prospective non-random follow-up study Laryngoscope, 134:1663-1669, 2024.

Facial Filler in Facial Paralysis: A Prospective Case Study and Multidimensional Assessment.

Background: Facial filler is emerging as a nonsurgical alternative for addressing static asymmetry in facial paralysis (FP). Objectives: To elucidate the patient experience for facial filler and to facilitate preprocedure counseling and education. Materials and Methods: Patients receiving hyaluronic acid filler for FP at a tertiary academic medical center were prospectively recruited. Primary outcomes included patient-reported pain, facial symmetry (on a visual analog scale), and the results of quality-of-life surveys (FACE-Q satisfaction with facial appearance [SFA], FACE-Q psychosocial distress [PSD], Patient Health Questionnaire-9 [PHQ-9], and Euro Quality of Life 5-Dimension [EQ5D]) preprocedure and at 1 and 14 days postprocedure. Results: Twenty patients (90% women, average age 55 ± 11) completed the study. Sites of filler included the cheek, lower lip, nasolabial fold, chin, and temple regions. Patients reported minimal pain at postprocedure days (PPDs) 1 and 14. Patient-perceived symmetry scores improved significantly (p < 0.0001), as did FACE-Q SFA and FACE-Q PSD scores (p < 0.0001, <0.0001) when comparing preprocedure with PPD 14. Depression, assessed by PHQ-9, and the anxiety/depression domain of EQ5D, decreased after treatment (p = 0.016, 0.014) but no change was observed in the other domains of EQ5D. Conclusion: Facial filler for FP can be performed with minimal morbidity (pain, impact on daily routine, and complications) and leads to improvements across multiple psychosocial domains.

Tutorial: multiphoton microscopy to advance neuroscience research.

Multiphoton microscopy (MPM) employs ultrafast infrared lasers for high-resolution deep three-dimensional imaging of live biological samples. The goal of this tutorial is to provide a practical guide to MPM imaging for novice microscopy developers and life-science users. Principles of MPM, microscope setup, and labeling strategies are discussed. Use of MPM to achieve unprecedented imaging depth of whole mounted explants and intravital imaging via implantable glass windows of the mammalian nervous system is demonstrated.

Health Utility Measures Among Patients with Androgenetic Alopecia After Hair Transplant.

BACKGROUND: Hair loss causes significant psychosocial distress to patients. Health utility measurements offer an objective, quantitative assessment of health-related quality of life (QOL). METHODS: We performed a prospective cohort study on patients with hair loss between January 1, 2018 and December 31, 2020. Patient metrics were compared with layperson perception of alopecia, prospectively collected between August 1 and December 31, 2017. Health utility measures were quantified using the visual analog scale (VAS), standard gamble (SG), and time trade-off (TTO) in quality-adjusted life-years (QALYs) and relative to the minimal clinically important difference (MCID). Bonferroni correction to the significance threshold was performed. RESULTS: Thirty-one patients with alopecia were compared with 237 laypeople. Patient metrics for female hair loss were all significantly lower than laypeople measures (VAS QALYs 0.65 ± 0.21 vs. 0.83 ± 0.18, p = 0.0001). Mean SG QALYs were lower for patients in the male alopecia state (0.86 ± 0.23 vs. 0.96 ± 0.12, p = 0.0278). Post-hair transplant improvement in TTO was significantly greater for patients (+ 0.08 ± 0.12 vs. + 0.02 ± 0.09, p = 0.0070) and significantly more often exceeded the MCID (45.2% vs. 16.9%, p = 0.0006). CONCLUSIONS: Alopecia negatively impacts QOL, and the true patient experience is more taxing than what is perceived by laypeople. Hair transplantation improves QOL more for male patients than common perception. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Effect of Filler Therapy on Psychosocial Distress in Facial Paralysis: Patients with Major Asymmetry Derive Greater Benefit.

Background: Facial filler is an effective nonsurgical treatment option for improving facial symmetry in patients with facial paralysis (FP). Objective: To compare the effects of filler among patients with FP that is self-perceived as major or minor asymmetry, by measuring psychosocial distress. Methods: In this prospective cohort study of patients with FP undergoing filler at a tertiary academic center, patients were classified as having minor or major self-perceived asymmetry using a visual analog scale (VAS). FACE-Q Appearance-Related Psychosocial Distress was administered before and after filler. Descriptive statistics and a random-effects generalized linear model assessed the relationship between perceived facial asymmetry and change in psychosocial distress. Results: A total of 28 patients participated. Twenty-five (89%) patients were female with median age of 54 (interquartile range [IQR]: 49-66). Median VAS score was 2 (IQR: 1-3.5, 0 = completely asymmetric, 10 = no asymmetry). Psychosocial distress improved in all patients after filler. In multivariable modeling, patients with major asymmetry experienced 2.45 (confidence interval: 0.46-4.44, p = 0.016) points more improvement in psychosocial distress than patients with minor asymmetry. Age, gender, and FP duration were not associated with change in psychosocial distress. Conclusion: Facial filler treatment was seen to improve psychosocial distress in patients with FP, especially by those with more self-perceived deficit.

Patterns of Reasons for Not Disclosing Personal Activities and Feelings to Mothers and Fathers among Ethnically Diverse Adolescents.

Adolescents' routine disclosure and self (non)disclosure to parents have been distinguished conceptually, but rarely empirically. Using latent profile analyses (LPA), these two types of (non)disclosure were operationalized and examined in terms of the patterns of reasons middle adolescents endorsed for not disclosing personal activities and personal feelings to mothers and fathers and their correlates. This was studied in a sample of 489 U.S. Chinese, Mexican, and European heritage middle adolescents (Mage = 16.37, SD = 0.77, 55% females). Three profiles emerged for both mothers and fathers: A majority profile for mothers consisting of adolescents who viewed personal activities and feelings as personal (i.e., private and not harmful), and much smaller sanction-driven and self-conscious profiles. With fathers, personal concerns were separated in the private profile, which also emphasized that fathers would not listen or understand, a harmless profile, and as with mothers, a sanction-driven profile. Overall, but varying in frequency for different profiles, middle adolescents emphasized personal concerns for not disclosing routine personal activities and psychological concerns for self nondisclosure. The profiles also differed by ethnicity/race, generational status, and trust in mothers and fathers. The father private profile and sanction-driven profiles with both parents were associated with more depressive symptoms and problem behavior relative to the other profiles. The results provide insight into why middle adolescents of diverse ethnicities do not disclose personal information to parents.

Septal Perforation Repair Using a Temporoparietal Fascia and Polydioxanone Plate Construct: A Multi-Institutional Analysis.

Background: Nasal septal perforations (NSPs) are notoriously difficult to fix and closure can paradoxically lead to worsening of symptoms, prompting numerous techniques for repair including temporoparietal fascia (TPF)-polydioxanone (PDS) plate interposition grafting. Objectives: To compare rates of NSP closure with TPF-PDS interposition grafting among a variety of institutions with diverse environmental influences and patient-specific factors. Methods: Retrospective review of patients undergoing TPF-PDS interposition grafting at seven different U.S. institutions over 5 years. Outcomes include closure rate, self-reported symptom improvement, change in Nasal Obstruction Symptomatic Evaluation (NOSE) score, and postoperative complications. Results: Sixty-two patients (39 female) with a mean age of 41.5 years were included. Most common perforation location was anterior (53%), and average size was 1.70 cm2. NSP closure with symptomatic improvement was achieved in 95% of participants. Postoperative NOSE scores decreased on average by 42 points. Residual crusting occurred in 29% of patients, independent of external factors. Conclusions: TPF-PDS interposition grafting is highly effective for NSP repair in a wide variety of settings, and NOSE scores correspond well with patient-reported outcomes.

Effect of Delay of Care for Patients with Craniomaxillofacial Trauma in Rwanda.

Objectives: Craniomaxillofacial (CMF) trauma represents a significant proportion of global surgical disease burden, disproportionally affecting low- and middle-income countries where care is often delayed. We investigated risk factors for delays to care for patients with CMF trauma presenting to the highest-volume trauma hospital in Rwanda and the impact on complication rates. Study Design: This prospective cohort study comprised all patients with CMF trauma presenting to the University Teaching Hospital of Kigali, Rwanda, between June 1 and October 1, 2020. Setting: Urban referral center in resource-limited setting. Methods: Epidemiologic data were collected, and logistic regression analysis was undertaken to explore risk factors for delays in care and complications. Results: Fifty-four patients (94.4% men) met criteria for inclusion. The mean age was 30 years. A majority of patients presented from a rural setting (n = 34, 63%); the most common cause of trauma was motor vehicle accident (n = 18, 33%); and the most common injury was mandibular fracture (n = 28, 35%). An overall 78% of patients had delayed treatment of the fracture after arrival to the hospital, and 81% of these patients experienced a complication (n = 34, P = .03). Delay in treatment was associated with 4-times greater likelihood of complication (odds ratio, 4.25 [95% CI, 1.08-16.70]; P = .038). Conclusion: Delay in treatment of CMF traumatic injuries correlates with higher rates of complications. Delays most commonly resulted from a lack of surgeon and/or operating room availability or were related to transfers from rural districts. Expansion of the CMF trauma surgical workforce, increased operative capacity, and coordinated transfer care efforts may improve trauma care.

How Do Chinese Youth in Hong Kong Evaluate Maternal Guilt and Shame Induction? Age, Form, and Domain Differences.

Although Chinese parents are seen as employing guilt and shame induction to socialize children's culturally appropriate behavior, research has focused primarily on Chinese parents' use of these inductions and their links with child adjustment rather than on children's evaluations of them. Furthermore, this research typically does not examine variations in children's appraisals based on the type of behavior being socialized. The present study addressed these gaps in the literature by examining 206 Hong Kong Chinese children's and early adolescents' (Ms = 9.76, 13.35 years, SDs = 0.78, 0.54; 50% and 61% female, respectively) appraisals of maternal guilt induction (act- vs. parent-focused) and shame induction (social comparison vs. denigration) following a hypothetical moral and academic transgression. Overall, act-focused guilt induction was evaluated as more appropriate, respectful, effective, and reflective of mothers' love and concern than parent-focused guilting, and in turn, social comparison shaming, and then denigration and more so overall for the moral than the academic transgression. Early adolescents judged act-focused guilting for the moral transgression as more effective and eliciting more positive feelings than did children. Although culturally valued, social comparison shame (and also denigration) were judged as less appropriate, less effective, as reflecting less maternal love and concern, and as eliciting less positive feelings (but only for social comparison shaming in response to lower-than-expected academic performance) by early adolescents as compared to younger peers, suggesting that youth become more critical of these culturally appropriate practices in the transition to adolescence.

American and Chinese children's evaluations of personal domain events and resistance to parental authority.

A total of 267 five-, seven-, and ten-year-olds (M = 7.62), 147 in Hong Kong and 120 in the United States, evaluated hypothetical personal (and moral) events described as either essential or peripheral to actors' identity. Except for young Chinese in the peripheral condition, straightforward personal events were overwhelmingly evaluated as acceptable based on personal justifications. Children primarily endorsed compliance, but attributed negative emotions to actors when mothers forbade personal choices, especially when described as essential to identity. Conventional justifications declined among Chinese children and pragmatic justifications for these judgments increased with age for all children, as did judgments that personal events were up to the child. Rules were seen as more legitimate and events were seen as more up to mothers to decide for moral than personal events.

Disclosure to parents about everyday activities among american adolescents from mexican, chinese, and European backgrounds.

Disclosure to parents and reasons for not disclosing different activities were examined in 489 Chinese, Mexican, and European American adolescents (M = 16.37 years, SD = 0.77). With generational status controlled, Chinese American adolescents disclosed less to mothers about personal and multifaceted activities than European Americans and less about personal feelings than other youth, primarily because these acts were considered personal, not harmful, or because parents would not listen or understand. Disclosure regarding prudential behavior was lower among Mexican American than among European American adolescents, primarily due to concerns with parental disapproval. Multigroup path analyses indicated that greater closeness to parents is associated with more disclosure for all youth and activities; associations between family obligation and disclosure varied by domain and ethnicity.

How much do I tell thee? Strategies for managing information to parents among American adolescents from Chinese, Mexican, and European backgrounds.

Strategies for managing information about activities to parents, including partial disclosure, avoidance, lying, and full disclosure, were examined in 479 American adolescents (M = 16.38 years, SD = 0.77) varying in generational status and from Mexican, Chinese, and European backgrounds. Information management strategies for personal, prudential, and overlapping (multifaceted) activities as defined within social domain theory were examined. With age, parental education, and generational status controlled, Chinese American adolescents partially disclosed more to mothers about personal and multifaceted activities than did Mexican American adolescents and more to fathers about personal activities than did European American teens. In contrast, European and Mexican American adolescents fully disclosed more to mothers about personal activities than did Chinese-origin adolescents. Strategies varied by generation among Chinese American youth; second-generation adolescents avoided discussing activities with parents more than did immigrants. Adolescents who fully disclosed about all activities and lied less about multifaceted and personal activities reported stronger endorsement of obligations to assist their families, more trust in parents, and less problem behavior. More depressed mood was associated with more lying about personal activities.

Conceptions of moral, social-conventional, and personal events among Chinese preschoolers in Hong Kong.

Sixty-one Chinese preschoolers from Hong Kong at 2 ages (Ms = 4.36 and 6.00 years) were interviewed about familiar moral, social-conventional, and personal events. Children treated personal events as distinct from moral obligations and conventional regulations. Children judged the child as deciding personal issues, based on personal choice justifications, whereas children judged parents as deciding moral and conventional issues. With age, children granted increased decision-making power to the child. In contrast, children viewed moral transgressions as more serious, generalizably wrong, and wrong independent of authority than other events, based on welfare and fairness. Punishment-avoidance justifications for conventional events decreased with age, whereas conventional justifications increased. Young Chinese preschool children make increasingly differentiated judgments about their social world.