Idiopathic hypopharyngeal perforation presenting as supraglottitis and parapharyngeal abscess: case report and literature review.

A 75-year-old healthy male reported odynophagia and severe neck pain with radiation to chest and shoulders. Cardiac causes were excluded. After re-presenting with dysphonia and complete dysphagia, he was treated for supraglottitis. Imaging showed a left parapharyngeal and retropharyngeal space abscess with mediastinal emphysema. Progressive emphysema prompted contrast swallow test followed by left neck exploration and pan-endoscopy, which confirmed mucosal hypopharyngeal perforations. Histopathology reported inflammation. Autoimmune and gastroenterological aetiologies were excluded. Following conservative management, healing was demonstrated on repeat pan-endoscopy. Two months' follow-up imaging showed complete resolution. Spontaneous hypopharyngeal perforation, atypical of Boerrhave's syndrome and without risk factors (iatrogenic, oesophageal disease and foreign body ingestion), is rare and often misdiagnosed, including masquerading as supraglottitis. Nasoendoscopy should be complemented by radiological imaging. Presence of deep neck space collections and surgical emphysema should prompt diagnostic pan-endoscopy. Although most rupture cases require surgery, conservative management of hypopharyngeal perforations can be considered when clinically appropriate.

Three-photon imaging of synthetic dyes in deep layers of the neocortex.

Multiphoton microscopy has emerged as the primary imaging tool for studying the structural and functional dynamics of neural circuits in brain tissue, which is highly scattering to light. Recently, three-photon microscopy has enabled high-resolution fluorescence imaging of neurons in deeper brain areas that lie beyond the reach of conventional two-photon microscopy, which is typically limited to ~ 450 µm. Three-photon imaging of neuronal calcium signals, through the genetically-encoded calcium indicator GCaMP6, has been used to successfully record neuronal activity in deeper neocortical layers and parts of the hippocampus in rodents. Bulk-loading cells in deeper cortical layers with synthetic calcium indicators could provide an alternative strategy for labelling that obviates dependence on viral tropism and promoter penetration, particularly in non-rodent species. Here we report a strategy for visualized injection of a calcium dye, Oregon Green BAPTA-1 AM (OGB-1 AM), at 500-600 µm below the surface of the mouse visual cortex in vivo. We demonstrate successful OGB-1 AM loading of cells in cortical layers 5-6 and subsequent three-photon imaging of orientation- and direction- selective visual responses from these cells.

African Orphan Crops Consortium (AOCC): status of developing genomic resources for African orphan crops.

MAIN CONCLUSION: The African Orphan Crops Consortium (AOCC) successfully initiated the ambitious genome sequencing project of 101 African orphan crops/trees with 6 genomes sequenced, 6 near completion, and 20 currently in progress. Addressing stunting, malnutrition, and hidden hunger through nutritious, economic, and resilient agri-food system is one of the major agricultural challenges of this century. As sub-Saharan Africa harbors a large portion of the severely malnourished population, the African Orphan Crops Consortium (AOCC) was established in 2011 with an aim to reduce stunting and malnutrition by providing nutritional security through improving locally adapted nutritious, but neglected, under-researched or orphan African food crops. Foods from these indigenous or naturalized crops and trees are rich in minerals, vitamins, and antioxidant, and are an integral part of the dietary portfolio and cultural, social, and economic milieu of African farmers. Through stakeholder consultations supported by the African Union, 101 African orphan and under-researched crop species were prioritized to mainstream into African agri-food systems. The AOCC, through a network of international-regional-public-private partnerships and collaborations, is generating genomic resources of three types, i.e., reference genome sequence, transcriptome sequence, and re-sequencing 100 accessions/species, using next-generation sequencing (NGS) technology. Furthermore, the University of California Davis African Plant Breeding Academy under the AOCC banner is training 150 lead African scientists to breed high yielding, nutritious, and climate-resilient (biotic and abiotic stress tolerant) crop varieties that meet African farmer and consumer needs. To date, one or more forms of sequence data have been produced for 60 crops. Reference genome sequences for six species have already been published, 6 are almost near completion, and 19 are in progress.

The draft genomes of five agriculturally important African orphan crops.

BACKGROUND: The expanding world population is expected to double the worldwide demand for food by 2050. Eighty-eight percent of countries currently face a serious burden of malnutrition, especially in Africa and south and southeast Asia. About 95% of the food energy needs of humans are fulfilled by just 30 species, of which wheat, maize, and rice provide the majority of calories. Therefore, to diversify and stabilize the global food supply, enhance agricultural productivity, and tackle malnutrition, greater use of neglected or underutilized local plants (so-called orphan crops, but also including a few plants of special significance to agriculture, agroforestry, and nutrition) could be a partial solution. RESULTS: Here, we present draft genome information for five agriculturally, biologically, medicinally, and economically important underutilized plants native to Africa: Vigna subterranea, Lablab purpureus, Faidherbia albida, Sclerocarya birrea, and Moringa oleifera. Assembled genomes range in size from 217 to 654 Mb. In V. subterranea, L. purpureus, F. albida, S. birrea, and M. oleifera, we have predicted 31,707, 20,946, 28,979, 18,937, and 18,451 protein-coding genes, respectively. By further analyzing the expansion and contraction of selected gene families, we have characterized root nodule symbiosis genes, transcription factors, and starch biosynthesis-related genes in these genomes. CONCLUSIONS: These genome data will be useful to identify and characterize agronomically important genes and understand their modes of action, enabling genomics-based, evolutionary studies, and breeding strategies to design faster, more focused, and predictable crop improvement programs.

Gardener-associated fibroma: an unusual cause of upper airway obstruction.

We present the first case of upper airway obstruction secondary to a retropharyngeal Gardner-associated fibroma (GAF). A 16-month-old infant presented with a 3-month history of worsening dyspnoea and apnoeic episodes. Examination revealed stridor and left-sided retropharyngeal asymmetry. MRI demonstrated a mass in the retropharynx. Tracheostomy and pharyngeal biopsy under anaesthesia were performed, and histology confirmed a diagnosis of GAF. The mass was excised using a transcervical approach, and postoperative recovery was unremarkable. GAF is associated with Gardner's syndrome (GS) and familial adenomatous polyposis (FAP), both of which are associated with multiple colonic polyps and increased risk of colorectal malignancy. Subsequent testing for an APC mutation seen in GS and FAP was negative in our patient. The details of this unusual presentation of a rare disease are given in addition to a review of the literature.

Routine leak testing in colorectal surgery in the Surgical Care and Outcomes Assessment Program.

OBJECTIVE: To evaluate the effect of routine anastomotic leak testing (performed to screen for leaks) vs selective testing (performed to evaluate for a suspected leak in a higher-risk or technically difficult anastomosis) on outcomes in colorectal surgery because the value of provocative testing of colorectal anastomoses as a quality improvement metric has yet to be determined. DESIGN: Observational, prospectively designed cohort study. SETTING: Data from Washington state's Surgical Care and Outcomes Assessment Program (SCOAP). PATIENTS: Patients undergoing elective left-sided colon or rectal resections at 40 SCOAP hospitals from October 1, 2005, to December 31, 2009. INTERVENTIONS: Use of leak testing, distinguishing procedures that were performed at hospitals where leak testing was selective (<90% use) or routine (≥ 90% use) in a given calendar quarter. MAIN OUTCOME MEASURE: Adjusted odds ratio of a composite adverse event (CAE) (unplanned postoperative intervention and/or in-hospital death) at routine testing hospitals. RESULTS: Among 3449 patients (mean [SD] age, 58.8 [14.8] years; 55.0% women), the CAE rate was 5.5%. Provocative leak testing increased (from 56% in the starting quarter to 76% in quarter 16) and overall rates of CAE decreased (from 7.0% in the starting quarter to 4.6% in quarter 16; both P ≤ .01) over time. Among patients at hospitals that performed routine leak testing, we found a reduction of more than 75% in the adjusted risk of CAEs (odds ratio, 0.23; 95% CI, 0.05-0.99). CONCLUSION: Routine leak testing of left-sided colorectal anastomoses appears to be associated with a reduced rate of CAEs within the SCOAP network and meets many of the criteria of a worthwhile quality improvement metric.

Reflexo inibitório retoanal: gradiente de pressäo e de duraçäo do relaxamento em canal anal após distensäo retal / Rectoanal inhibitory reflex: gradient of pressure and time in the anal canal during relaxation after rectal distension

A resposta fisiológica do canal anal à distensäo retal é o relaxamento de sua porçäo proximal (PPC). A preservaçäo da continência após este relaxamento se dá principalmente pela existência de um gradiente de pressäo em entre a porçäo de maior pressäo em canal anal (zona de alta pressäo, ZAP) e a PPC. A hipótese formulada neste estudo é que estaria envolvido no mecanismo de preservaçäo da continência, näo só um gradiente de pressäo mas também de duraçäo desse relaxamento. Métodos: Foram estudados 16 voluntários normais (10 do sexo masculino) com idade média de 41,5 anos (24 - 60 anos) com a realizaçäo de manometria anal, utilizando-se cateter flexível de oito canais, com orifícios de perfusäo dispostos axialmente, em intervalos de 1 cm, dotado de baläo em seu extremo distal. O relaxamento era produzido por distensäo retal com insuflaçäo do baläo com pequeno volume de ar (15 - 30 ml) e concomitantemente registrado até a recuperaçäo da pressäo anal de repouso (PAR) (duraçäo de relaxamento). A amplitude do relaxamento foi determinada entre os valores da PAR antes da distensäo retal e no ponto de relaxamento máximo (PAR - PRM). O gradiente de pressäo foi determinado pela comparaçäo entre PAR - PRM na ZAP e PPC. A ocorrência de contraçäo na porçäo distal do canal anal foi interpretada como contraçäo do esfíncter anal externo e foi comparada com a PAR - PRM da zona de alta pressäo. Resultados: O relaxamento foi maior no PPC do que na ZAP (50 por cento vs. 36 por cento, p = 0,001), enquanto que a RAP - PMR foi significantemente maior na ZAP do que na PPC (30,7 vs. 12,6 mmHg, p = 0,001). Contraçäo do esfincter anal externo ocorreu em seis casos e näo foi significantemente diferente da PAR - PRM na ZAP (39,7 mmHg vs. 36,3 mmHg, NS). O relaxamento começou ao mesmo tempo em todos os níveis do canal anal, mas teve maior duraçäo em PPC do que na zona de alta pressäo (13,5 seg vs. 9,4 seg, p = 0,003). Conclusäo: Relaxamento de canal anal induzido pela distensäo retal com pequenos volumes está associado näo somente a ocorrência de um gradiente de pressäo mas também de duraçäo do evento entre a PPC e ZAP. Nas condiçöes estudadas, a preservaçäo da continência após o relaxamento näo depende da contraçäo voluntária do esfíncter anal externo