Attenuated facial movement in depressed women is associated with symptom severity, and nucleus accumbens functional connectivity.

It is assumed that mood can be inferred from one's facial expression. While this association may prove to be an objective marker for mood disorders, few studies have explicitly evaluated this linkage. The facial movement responses of women with major depressive disorder (n = 66) and healthy controls (n = 46) under emotional stimuli were recorded using webcam. To boost facial movements, the naturalistic audio-visual stimuli were presented. To assess consistent global patterns across facial movements, scores for facial action units were extracted and projected onto principal component using principal component analysis. The associations of component for facial movements with functional brain circuitry was also investigated. Clusters of mouth movements, such as lip press and stretch, identified by principal component analysis, were attenuated in depressive patients compared to those in healthy controls. This component of facial movements was associated with depressive symptoms, and the strengths of resting brain functional connectivity between nucleus accumbens and both posterior insular cortex and thalamus. The evaluation of facial movements may prove to be a promising quantitative marker for assessing depressive symptoms and their underlying brain circuitry.

Solitary Sphenoid Sinus Lesion Presenting as Chronic Headache.

BACKGROUND AND OBJECTIVES: Headache is a common symptom with etiologies that are difficult to distinguish, 1 of which is sinusitis. A solitary sphenoid lesion, which is rare, can also cause acute or chronic headaches. The authors investigated whether endoscopic sinus surgery (ESS) for solitary sphenoid lesions could reduce headache symptoms. SUBJECTS AND METHODS: The authors reviewed the charts of patients who underwent ESS from 2012 to 2017, whose main symptom was a chronic headache for several years. There were no remarkable pathologic findings in the nasal cavity upon endoscopic examination. Medications for reducing headaches had transient effect. Brain magnetic resonance imaging or computed tomography scans showed a solitary sphenoid lesion and the patients underwent ESS by the same otolaryngologist. In total, 16 out of 547 ESS cases that met the above conditions were included in this study. The authors evaluated the duration, character, and degree of the headaches pre- and post-operatively. The authors also determined if there was a correlation between headaches, sphenoidal lesions, and pathologic outcomes. RESULTS: There were significant improvements in headaches after surgery. The pre- and post-operative mean visual analog scale score for headaches was 7.27 ±â€Š1.67 and 3.80 ±â€Š1.82, respectively. The pathologic outcomes revealed chronic inflammation in 11 patients, nasal polyp in 1 patient, inverted papilloma in 1 patient, and fungal infections in 3 patients, but there was no clinical correlation between the headache, lesion site, and pathology. CONCLUSIONS: A solitary sphenoid lesion can be the cause of acute or chronic headaches. Headaches from a solitary sphenoid sinus lesion, which were not controlled by medical treatments, could be improved by surgical procedures.

Comparing reliability between 3D imaging and 2D photography for external nasal anthropometry.

This study investigates and compares the reliability and reproducibility of two facial anthropometric methods about external nasal angles, 3D imaging and conventional 2D photography. 2D photograph images and 3D images about external nose of 30 volunteers were taken using digital camera and Morpheus 3D scanner. To evaluate intra-rater reliability, each images were taken over two different days for each subject by the same researcher. To evaluate inter-rater reliability, another researcher took each images for each subject on the first day. The reliability of each method for measuring 4 external nasal angle is obtained using intraclass correlation coefficient (ICC) and compared. Inter-rater and intra-rater reliability of both 3D imaging and 2D photography had excellent agreement in all 4 nasal angles. In the nasofacial angular parameter, Inter-rater ICC, 2D photography was significantly higher than 3D imaging. Result of intra-rater ICC also showed both 3D imaging and 2D photography had good reliability in all 4 nasal angles. Similar to those of inter-rater ICC, nasofacial angular parameter showed statistically significant differences between 3D imaging and 2D photography. In terms of reliability, both 2D and 3D showed appropriate anthropometric results and considering its own advantage, each methods can be used complementarily.

The Degree of Stress in Patients With Empty Nose Syndrome, Compared With Chronic Rhinosinusitis and Allergic Rhinitis.

BACKGROUND: Depression is a mental health disease of growing public health concern because depressive mood affects the sufferer's daily life and is also associated with productivity decline. Depression that is caused by other diseases or substances is referred to as secondary depression, which is an important distinction because curing the underlying cause could subsequently regulate depressive mood. Empty nose syndrome (ENS), also known as "paradoxical obstruction of the nose," is a condition in which the major symptom is difficulty breathing, despite having sufficient breathing space in the nose. Empty nose syndrome has been increasing in prevalence in Korea. We found that patients with this ENS have a tendency toward depressive mood, which can escalate so far as to lead to suicide attempts. Thus, herein, we aimed to investigate the psychological burden on patients with ENS. METHODS: We divided patients into 4 groups: ENS (group A), chronic rhinosinusitis with polyp (CRS c polyp, group B), chronic rhinosinusitis without polyp (CRS s polyp, group C), and allergic rhinitis (AR, group D). We estimated and compared Beck Depression Inventory (BDI) scores among the 4 groups, and we investigated the relationship between depression index and nasal cavity area in patients with ENS. RESULTS: The ENS group (A) had depression prevalence of 71% with varying severity, which was much higher than group B (19%), group C (15%), and group D (27%). The correlation between nasal cavity volume and BDI score for the ENS group was not statistically significant. CONCLUSION: The degree and severity of depression in patients with ENS was higher than in patients with CRS or AR. Furthermore, there was no relationship between depression severity and nasal cavity volume in the patients with ENS. Thus, physicians should be careful not to dismiss the accompanying mental health problems of patients with ENS.

The Role of Orthography in Lexical Processing of the Phonological Variants in Second Language.

There is evidence that orthographic knowledge can influence on-line spoken-word recognition. Interestingly, when graphic and phonetic codes are not congruent due to the application of phonological alternation processes, people report hearing sounds that are matched to graphic (underlying), not phonetic codes (Hallé et al. in J Mem Lang 43:618-639, 2000). It is, however, not known whether the same effect arises in the processing of a non-native language (L2). In the present study, advanced Mandarin learners of Korean as well as native Korean listeners performed a phoneme monitoring task using words undergoing obstruent nasalization in Korean. The results showed that orthographic information dominated the phonetic judgments of the native Korean listeners, while the Mandarin learners' judgments relied more on the phonetic input. These results suggest that even the lexical access of highly experienced L2 learners differs from that of native speakers and that advanced learners still have difficulty employing orthographic information to access the L2 lexicon.

Effects of Autonomous Sensory Meridian Response on the Functional Connectivity as Measured by Functional Magnetic Resonance Imaging.

Autonomous sensory meridian response (ASMR) is a sensory phenomenon in which audio-visual stimuli evoke a tingling sensation and is accompanied by a feeling of calm and relaxation. Therefore, there has been an increasing interest in using stimuli that elicit ASMR in cognitive and clinical neuroscience studies. However, neurophysiological basis of sensory-emotional experiences evoked by ASMR remain largely unexplored. In this study, we investigated how functional connectivity is changed while watching ASMR video, compared to resting state, and assessed its potential association with affective state induced by ASMR. 28 subjects participated in fMRI experiment consisting of 2 sessions (resting-state and task of viewing ASMR-eliciting video). Using a seed-based correlation analysis, we found that functional connections between the posterior cingulate cortex, and superior/middle temporal gyri, cuneus, and lingual gyrus were significantly increased during ASMR compared to resting state. In addition, we found that with the pregenual anterior cingulate cortex seed region, functional connectivity of the medial prefrontal cortex was increased during ASMR condition, relative to resting state. These results imply that ASMR can be elicited and maintained by ongoing interaction between regional activity that are mainly involved in the mentalizing and self-referential processing. We also found that ASMR-induced affective state changes (high activation negative and high activation positive state) were negatively correlated with functional connectivity involved in visual information processing, suggesting that visual information processing in response to high arousal states can be weakened by ASMR-eliciting stimuli.

Effectiveness of a school-based intervention in Guatemala to increase knowledge of sexual and reproductive health.

OBJECTIVES: Adolescent pregnancy in Guatemala is a multifactorial issue contributing to maternal and child mortality as well as negative social and economic outcomes. While multiple organizations have identified this as an important area for improvement, little has been published on methods for reducing rates of adolescent pregnancy in resource-limited settings. We characterized the effects of a brief intervention on the knowledge and attitudes towards sexual health of high schoolers in a rural Guatemalan community. METHODS: We created a condensed, 2-h sexual education course, which was taught to over 500 high school students in San Juan Sacatepequez, Guatemala. Students completed pre- and post-intervention surveys assessing their knowledge about pregnancy prevention and attitudes toward contraception use. Chi-square tests were used to assess the difference between the pre- and post-intervention responses as well as the responses between male and female participants. RESULTS: Analysis of the survey results revealed significant improvements in all questions assessing knowledge regarding pregnancy prevention (p<0.01). Our pre-intervention survey revealed that male participants possessed greater knowledge regarding pregnancy prevention (p<0.01). Following the intervention, several areas of initial difference between male and female students' knowledge disappeared, including knowledge of what a contraceptive is, awareness that one sexual relation is sufficient for pregnancy, and recognition that condoms can prevent sexually transmitted infections. CONCLUSIONS: This study demonstrates that brief, school-based sexual health courses are low-resource, feasible interventions to significantly increase knowledge about contraception and sexual health in resource-limited settings and improve the disparities in knowledge between male and female participants.

Changes in cortical thickness and volume of cerebellar subregions in patients with bipolar disorders.

BACKGROUND: Numerous studies have suggested that structural changes in the cerebellum are implicated in the pathophysiology of bipolar disorder (BD). We aimed to investigate differences in the volume and cortical thickness of the cerebellar subregions between patients with BD and healthy controls (HCs). METHODS: Ninety patients with BD and one hundred sixty-six HCs participated in this study and underwent T1-weighted structural magnetic resonance imaging. We analyzed the volume and cortical thickness of each cerebellar hemisphere divided into 12 subregions using T1-weighted images of participants. One-way analysis of covariance was used to evaluate differences between the groups, with age, sex, medication, and total intracranial cavity volume used as covariates. RESULTS: The BD group had significantly increased cortical thickness of the cerebellum in all cerebellar subregions compared to the HC group. The cortical thicknesses of the whole cerebellum and each hemisphere were also significantly thicker in the BD group than in the HC group. The volume of the left lobule IX was significantly lower in patients with BD than in HCs, whereas no significant differences in the volumes were observed in the other subregions. LIMITATIONS: Our cross-sectional design cannot provide a causal relationship between the increased cortical thickness of the cerebellum and the risk of BD. CONCLUSIONS: We observed widespread and significant cortical thickening in all the cerebellar subregions. Our results provide evidence for the involvement of the cerebellum in BD. Further studies are required to integrate neurobiological evidence and structural brain imaging to elucidate the pathophysiology of BD.

Saddle Deformity After Septoplasty and Immediate Correction.

OBJECTIVE: The aim of this study is to assess the saddle deformity after septoplasty and the usefulness of immediate correction. DESIGN: Retrospective study. SETTING: University medical center. PATIENTS: Of 658 patients who underwent endonasal septoplasty from January 2011 to July 2018, 14 underwent immediate cartilage dorsal augmentations following septoplasty for saddle deformity and were enrolled in this study. MAIN OUTCOME MEASURES: A total of 14 patients received immediate cartilage augmentation and were followed for >3 months after surgery. External nose status, patterns of septal deformity, and surgical results were investigated with profile view photographs, paranasal sinus computed tomography scans, and nasal endoscopy. Symptom improvement was measured using the Nasal Obstruction Symptom Evaluation scale. RESULTS: All patients had middle to high site septal deviation. Anterior deviation and central deviation have statistical significance compared to posterior part deviation (P = 0.025, P = 0.002) and mid part deviation has statistical significance compared to basal part deviation (P = 0.005). Postoperative subjective nasal symptoms of the 14 patients were improved from preoperation (18.54 ±â€Š2.46) to 1 month (7.54 ±â€Š2.16) and 3 months (1.72 ±â€Š1.55) postoperatively. CONCLUSIONS: Immediate endonasal cartilage augmentation for iatrogenic saddle deformity after septoplasty is easy, safe, and effective. Furthermore, this corrective treatment for post op complication is very important for both of surgeon and patient. Predispositions to postoperative saddle deformity included site and severity of preoperative nasal septal deviation.

Secretome analysis of patient-derived GBM tumor spheres identifies midkine as a potent therapeutic target.

Glioblastoma (GBM) is the most lethal primary brain tumor with few treatment options. The survival of glioma-initiating cells (GICs) is one of the major factors contributing to treatment failure. GICs frequently produce and respond to their own growth factors that support cell proliferation and survival. In this study, we aimed to identify critical autocrine factors mediating GIC survival and to evaluate the anti-GBM effect of antagonizing these factors. Proteomic analysis was performed using conditioned media from two different patient-derived GBM tumor spheres under a growth factor-depleted status. Then, the antitumor effects of inhibiting an identified autocrine factor were evaluated by bioinformatic analysis and molecular validation. Proteins secreted by sphere-forming GICs promote cell proliferation/survival and detoxify reactive oxygen species (ROS). Among these proteins, we focused on midkine (MDK) as a clinically significant and pathologically relevant autocrine factor. Antagonizing MDK reduced the survival of GBM tumor spheres through the promotion of cell cycle arrest and the consequent apoptotic cell death caused by oxidative stress-induced DNA damage. We also identified PCBP4, a novel molecular predictor of resistance to anti-MDK treatment. Collectively, our results indicate that MDK inhibition is an important therapeutic option by suppressing GIC survival through the induction of ROS-mediated cell cycle arrest and apoptosis.

Cartilage Trap-Door Flap Technique for Correction of High Nasal Septum Deflection.

OBJECTIVE: To introduce a novel cartilage trap-door flap technique in endonasal septoplasty to correct high dorsal deviation of the cartilaginous septum, and confirm its effectiveness. DESIGN: Prospective observational study. SETTING: Medical center. METHODS: 46 patients who had underwent septoplasty using the cartilage island flap technique to correct the high dorsal deviation from November 2014 to November 2015. The subjective symptoms were measured using the Nasal Obstruction Symptom Evaluation scale. The objective evaluations of the surgical results were analyzed using acoustic rhinometry. Post-operative status of the nasal septum was estimated by nasal endoscopic examination. RESULTS: Among 46 patients, 32 cases (69.57%) were "complete correction", 14cases (30.43%) were "improved" with residual deviation and there was not "no-change" or "even worse" case based on endoscopic examination. Minimal cross-sectional area in convex side of nasal cavity was significantly changed from 0.22cm to 0.56cm after the surgery, and nasal volume in narrower side of nasal cavity was significantly changed from 2.44mL to 6.22 mL. The patients' nasal obstruction symptoms significantly reduced from 10.43 before the surgery to 1.45 after the surgery. During the follow-up period, the authors have not experienced any obvious complications such as saddle nose, septal perforation, and bleeding. CONCLUSION: The proposed cartilage trap-door flap technique provides easy and effective results for dorsal deviations of the cartilaginous septum in selected cases without significant complications.

Three-Port Laparoscopic Right Colectomy Versus Conventional Five-Port Laparoscopy for Right-Sided Colon Cancer.

BACKGROUND: The purpose of the study was to evaluate the safety and effectiveness of three-port laparoscopic right colectomy (3-LRC) for right-sided colon cancer compared with conventional five-port laparoscopic right colectomy (5-LRC). MATERIALS AND METHODS: One hundred sixty-three patients diagnosed with right-sided colon adenocarcinoma underwent laparoscopic right colectomy (LRC) between April 2011 and December 2017. Seventy-four of these patients underwent 3-LRC procedure and 89 patients underwent 5-LRC. Clinical characteristics, perioperative short-term outcomes, and pathologic data were analyzed. RESULTS: There were no differences in TNM stage, tumor location, estimated blood loss, complications, and open conversion rates. The operation time was shorter in the 3-LRC group than in 5-LRC group (140.9 ± 27.5 minutes versus 178.2 ± 38.2 minutes; P = .001). The number of harvested lymph nodes (28.5 ± 13.9 versus 22.6 ± 11.7; P = .004) was also higher in the 3-LRC group. The first passage of flatus and first oral diet were significantly faster in the 3-LRC group than in the 5-LRC group (2.8 ± 1.0 days versus 4.0 ± 1.2 days; P = .001, 3.6 ± 2.9 days versus 5.0 ± 1.5 days; P = .001). The number of patients who required analgesics is less in the 3-LRC group (32.4% versus 43.8%; P = .583). CONCLUSION: 3-LRC for right-sided colon cancer is technically feasible and is associated with a short operation time. We believe that 3-LRC effectively reduces the costs associated with equipment and manpower and represents a standard procedure.

Metabolite signature associated with stress susceptibility in socially defeated mice.

OBJECTIVE: Social defeat represents a naturalistic form of conditioned fear and is often used as an animal model of depression. The present study aimed to identify the neurochemicals in select brain regions of mice exposed to social defeat stress. METHODS: Adult C57BL/6N mice were subjected social defeat stress for 10 days. Using high-resolution magic angle spinning 1H nuclear magnetic resonance (HR-MAS 1H NMR), untargeted metabolomes were measured in the amygdala (AMY), dorsal hippocampus (dHIP), dorsal striatum (dST), and prefrontal cortex (PFC). RESULTS: We observed perturbations of glutamine in the AMY; glutamate in the dHIP; glycine and myo-inositol in the dST; and aspartate, choline, and phosphoethanolamine in the PFC of susceptible and/or unsusceptible groups compared to the control group. The susceptible and unsusceptible groups significantly differed with regard to three metabolites: glutamine, glycine, and choline. CONCLUSION: These findings suggest that social defeat stress induces disturbances in the metabolism of amino acids, lipids, and neurotransmitters in several brain areas. The resulting susceptibility-related metabolites may provide new insights into the pathophysiology underlying stress-related mental illness.

Asxl1 exerts an antiproliferative effect on mouse lung maturation via epigenetic repression of the E2f1-Nmyc axis.

Although additional sex combs-like 1 (ASXL1) has been extensively described in hematologic malignancies, little is known about the molecular role of ASXL1 in organ development. Here, we show that Asxl1 ablation in mice results in postnatal lethality due to cyanosis, a respiratory failure. This lung defect is likely caused by higher proliferative potential and reduced expression of surfactant proteins, leading to reduced air space and defective lung maturation. By microarray analysis, we identified E2F1-responsive genes, including Nmyc, as targets repressed by Asxl1. Nmyc and Asxl1 are reciprocally expressed during the fetal development of normal mouse lungs, whereas Nmyc downregulation is impaired in Asxl1-deficient lungs. Together with E2F1 and ASXL1, host cell factor 1 (HCF-1), purified as an Asxl1-bound protein, is recruited to the E2F1-binding site of the Nmyc promoter. The interaction occurs between the C-terminal region of Asxl1 and the N-terminal Kelch domain of HCF-1. Trimethylation (me3) of histone H3 lysine 27 (H3K27) is enriched in the Nmyc promoter upon Asxl1 overexpression, whereas it is downregulated in Asxl1-deleted lung and -depleted A549 cells, similar to H3K9me3, another repressive histone marker. Overall, these findings suggest that Asxl1 modulates proliferation of lung epithelial cells via the epigenetic repression of Nmyc expression, deficiency of which may cause hyperplasia, leading to dyspnea.

Novel Application of Ultrasonic Bone Aspirator for Hump Nose.

OBJECTIVE: This study was conducted to introduce and evaluate the efficacy of an ultrasonic bony aspirator in rhinoplasty for hump removal. DESIGN: Retrospective study. SETTING: University medical center. PATIENTS: Twenty patients who underwent hump removal using an ultrasonic bone aspirator from October 2013 to November 2016 were enrolled in the study. MAIN OUTCOME MEASURES: Patients were followed for >3 months after surgery. External nose status and surgical results were investigated using photographs. Postoperative complications were evaluated. RESULTS: Of the 30 patients enrolled in this study, 11 were females and 19 were males. Preoperative nasal deformities of all patients were characterized as bony humps. Postoperative dorsal status was significantly improved. There were no obvious complications such as over or under correction, delayed healing, infection, soft tissue injury, or deformity of the nasal dorsum. CONCLUSION: Application of an ultrasonic bone aspirator to remove humps in rhinoplasty is easy, safe, and effective.

Computed tomography analysis of frontal cell prevalence according to the International Frontal Sinus Anatomy Classification.

BACKGROUND: The International Frontal Sinus Anatomy Classification (IFAC) is an international consensus document published in 2016 to standardize the nomenclature of cells in the region of the frontal recess and frontal sinus. The IFAC was designed to be surgically relevant and anatomically precise. The current study was undertaken to assess the prevalence of the frontal cell variants as defined by the IFAC, as well as to determine the interrater reliability of the IFAC. METHODS: Three independent reviewers examined triplanar nondiseased maxillofacial computed tomography (CT) scans to assess the anatomy of the frontal recess according to the IFAC system. The prevalence of each cell type was assessed and interrater reliability was measured using an intraclass correlation coefficient (ICC). RESULTS: One hundred CT scans (200 sides) were examined. Of the 200 sides, 96.5% contained an agger nasi cell (ICC, 0.82; 95% confidence interval [CI], 0.77-0.86), 30.0% contained a supra agger cell (ICC, 0.89; 95% CI, 0.86-0.92), 20.0% contained a supra agger frontal cell (ICC 0.80; 95% CI 0.74-0.84), 72.0% contained a supra bulla cell (ICC, 0.81; 95% CI, 0.76-0.85), 5.5% contained a supra bulla frontal cell (ICC, 0.71; 95% CI, 0.63-0.77), 28.5% contained a supraorbital ethmoid cell (ICC, 0.78; 95% CI, 0.72-0.83), and 30.0% contained a frontal septal cell (ICC, 0.80; 95% CI, 0.74-0.84). The ICC was good to excellent for identification of all frontal cell types. CONCLUSIONS: This study describes the normative distribution of frontal recess cells in a nondiseased population according to IFAC and demonstrates favorable interrater reliability of the classification system.

Effectiveness of hemostatic gelatin sponge as a packing material after septoplasty: A prospective, randomized, multicenter study.

OBJECTIVE: Although hemostatic gelatin sponge is a gelatin-based packing material with a powerful hemostatic effect, there were no studies in regard to its efficacy for packing material after septoplasty. The purpose of this study was to investigate the efficacy of hemostatic gelatin sponge nasal packing on patient's subjective symptoms, hemostasis, and wound healing following septoplasty. SUBJECTS AND METHODS: Seventy six adult patients with nasal septum deviation requiring septoplasty were included. Following surgery, one nasal cavity was packed with hemostatic gelatin sponge and the other one with polyvinyl acetate. Patients' subjective symptoms while the packing was in situ, hemostatic properties, patients' pain on removal, degree of bleeding on removal of the packing, time for hemostasis after removal, postoperative wound healing, and the cost of the pack were evaluated. RESULTS: Both packs were equally effective in the control of postoperative bleeding following septoplasty. However, hemostatic gelatin sponge packing was significantly more comfortable while in situ and less painful on removal of the pack. The polyvinyl acetate packing was associated with significantly more bleeding on removal, therefore much time was needed to control hemorrhage. There was no significant difference in the cost of the pack used and outcome of wound healing. CONCLUSION: The use of hemostatic gelatin sponge after septoplasty results in significantly less discomfort and greater patient satisfaction with no adverse reactions when compared with polyvinyl acetate packing. Therefore, hemostatic gelatin sponge may be a useful packing material after septoplasty.

Multiple primary malignancies of laryngeal cancer, small cell lung cancer and squamous cell lung cancer in a patient: how to approach MPMs.

Lung malignancies presenting in association with head and neck cancers are well documented, while laryngeal cancers presenting with simultaneous small cell lung cancer and squamous cell lung cancer have been rarely reported. We report a case of a man aged 65 years with a triple primary malignancy of the lung and larynx. Without a meticulous approach, the patients may not receive curative aim treatment due to incomplete staging. The patient underwent concurrent chemoradiotherapy for locally advanced laryngeal cancer, small cell lung cancer and squamous cell lung cancer followed by combination chemotherapy with etoposide and cisplatin for synchronous double primary lung cancer. Following this therapy, he achieved a complete response of larynx cancer, but a partial response of small cell lung cancer and a stable disease of squamous cell lung cancer. A meticulous diagnostic approach should be encouraged to pursue the possibility of curative treatment and achieve better outcomes for such patients.