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OBJECTIVES To highlight the feasibility and evaluate the outcomes of the transorbital endoscopic approach (TOEA) in the management of frontal sinus cerebrospinal fluid (CSF) leaks. STUDY DESIGN Retrospective case series. METHODS The database of patients with frontal sinus CSF leaks managed with TOEA from January 2017 through December 2019 at our institution was reviewed. Two videos of clinical case examples are presented. RESULTS Sixteen patients (10 males, 6 females, mean age 53; range 21-61 years) underwent TOEA through the superior eyelid corridor for the repair of frontal sinus CSF leak. The most common etiology of the CSF leak was trauma (nine cases; 56.3%), followed by injury from iatrogenic causes in six cases (37.5%), and spontaneous leak in one case (6.2%). Average defect size was 8.8 mm (range 2.0-20.8 mm). Ten patients were revision cases who had undergone prior nontransorbital CSF leak repair at outside institutions. All patients underwent successful repair via TOEA without postoperative complications. Complete resolution was maintained in all cases. Mean follow-up period was 11 months (range 6-22 months). CONCLUSIONS TOEA is a safe minimally disruptive alternative for definitive management of frontal sinus CSF leak in well-selected primary or revision cases. Further studies are necessary to define its indications and outcomes. LEVEL OF EVIDENCE 4 Laryngoscope, 131:1753-1757, 2021.

Introduction The impact of Vitamin D supplementation on weight loss has been demonstrated in several randomized controlled trials (RCT), but there is still lack of consensus regarding its efficacy. This study aims to assess the efficacy and safety of Vitamin D in weight reduction in terms of changes in weight loss, BMI, neck circumference, mid-upper arm circumference, waist circumference, waist-thigh ratio, waist-to-hip ratio, and percent body fat, as well as reported adverse effects. Methodology MEDLINE (PubMed), Google Scholar, WHO database, Herdin, Cochrane Database and EMBASE were searched for literature published from 2005–2020. A systematic search was conducted for RCTs on the efficacy of Vitamin D (alone or in combination with Calcium, or with a weight-loss program, or with both) in weight loss among participants 18–75 years old with above-normal BMI, and with a study duration of 4–12 weeks. Sixteen RCTs were included in this systematic review and meta-analysis. Screening and selection were based on the eligibility criteria, while appraisal included checking for the risk of bias, assessing the validity of the results of the study, and its methodological quality. Outcomes of eligible studies were obtained directly from the studies, if available, or summarized and calculated from the available data. For continuous data, mean differences were compared. Results When compared with placebo, Vitamin D supplementation showed a significant reduction in weight loss (mean difference [MD] = −0.92; 95% confidence interval [95% CI], −1.52 to −0.31; P=0.003), BMI (MD = −0.52; 95% CI: −0.73 to −0.31; P=0.02), waist circumference (MD = −1.35; 95% CI: −2.21 to −0.33 P=0.0006) and percent body fat (MD = −0.82; 95% CI; −1.40 to −0.25; P=0.005) but no significant effect on reduction of waist-to-hip ratio (MD = −0.01, 95% CI; −0.01 to 0.00; P=0.17). None of the studies reported outcomes for neck circumference, mid-upper arm circumference, and waist-thigh ratio. Heterogeneity was addressed using random effects model in analysis. Out of the 16 studies included, only two reported adverse events, which include constipation after intake of Vitamin D and calcium supplements and other multiple non-serious adverse events. Conclusion and recommendations Vitamin D as an adjunct showed a significant effect on weight loss, BMI reduction, decrease in waist circumference and percent body fat among adults after a short-term intake of oral Vitamin D, thus Vitamin D supplementation may be recommended as an adjunct treatment for weight loss among adults, but the study results should be used with caution as significant heterogeneity was observed. Further conduction of local RCTs and meta-analysis is recommended for further elucidation of data in order to determine its efficacy among Filipinos. Funding Acknowledgement Type of funding sources: None. Effect of Vit D on waist circumference

Objective Present a case of squamous cell carcinoma of the temporal bone (SCCTB) arising in a 61-year-old female with a prior history of cholesteatoma and persistent otologic symptoms and review the current literature regarding this disease presentation.Setting Tertiary academic center.Patient A 61-year-old female with a history of left ear cholesteatoma for which she had undergone surgery 54 years prior. The patient presented with a persistent history of otorrhea since first surgery and developed exacerbation of symptoms just prior to presentation at our department. The clinical picture was highly suspicious of cholesteatoma recurrence. However, the biopsy was consistent with squamous cell carcinoma.Intervention Surgical debulking of the lesion was followed by a brief course of radiation therapy later halted by the patient due to side effect intolerance.Conclusion SCCTB may arise from cholesteatoma. A high index of suspicion for SCCTB should be maintained in patients with a prior history of cholesteatoma and evidence of a temporal bone mass with persistent otologic symptoms.

BACKGROUND Numerous minimally invasive approaches to the skull base have been successively developed. Knowledge of the surgical nuances of a specific approach may facilitate approach selection. This study sought to compare the nuances of an extended version of the minipterional craniotomy (EMPT) with those of the transorbital endoscopic approach (TOEA) to the anterior and middle cranial fossae (ACF and MCF, respectively). OBJECTIVE To quantitatively analyze and compare the area of exposure and surgical freedom between EMPT and TOEA to the ACF and MCF. METHODS EMPT and TOEA were carried out in 5 latex-injected cadaveric heads, bilaterally (10 sides). For each approach, the area of exposure, surgical freedom, and angle of attack were obtained with neuronavigation and statistically compared. RESULTS No significant difference was found between the mean area of exposure of EMPT and TOEA at the ACF and MCF (P = .709 and .317, respectively). The mean exposure area at the ACF was of 13.4 ± 2.6 cm2 (mean ± standard deviation) and 13.0 ± 1.9 cm2 for EMPT and TOEA, respectively. Except for the crista galli, EMPT afforded a larger area of surgical freedom at all targets. EMPT also achieved significantly greater attack angles in vertical axis except to the crista galli. The horizontal attack angles to all targets were similar between approaches. CONCLUSION EMPT and TOEA offer a comparable area of exposure at the ACF and MCF in the cadaver; however, the instrument maneuverability afforded by EMPT is superior. Further studies are necessary to better define their precise surgical application.

BACKGROUND The catastrophic and rare nature of an internal carotid artery (ICA) injury during endonasal surgery limits training opportunities. Cadaveric and animal simulation models have been proposed, but expense and complicated logistics have limited their adoption. Three-dimensional (3D) printed models are portable, modular, reusable, less costly, and proven to improve psychomotor skills required for managing different lesions. In this study we evaluate the role of a simplified laser-sintered model combined with standardized training in improving the effectiveness of managing an ICA injury endoscopically. METHODS A 3-mm defect was created in the parasellar carotid canal of a laser-sintered model representing a sphenoid sinus. Artificial blood was directed to simulate the copious bleeding arising from an ICA injury. Twenty otolaryngologists and 26 neurosurgeons, with varying training and experience levels, were individually asked to stop the "bleeding" as they would in a clinical scenario, and provided no other instructions. This was followed by individualized formative training and a second simulation. Volume of blood loss, time to hemostasis, and self-assessed confidence scores were compared. RESULTS At the end of the study, time to hemostasis was reduced from 105.49 seconds to 40.41 seconds (p < 0.001). The volume of blood loss was reduced from 690 to 272 mL (p < 0.001), and the confidence scores increased in 95.7% of participants, from an average of 3 up to 8. CONCLUSION This ICA injury model, along with a formal training algorithm, appears to be valuable, realistic, portable, and cost-effective. Significant improvement in all parameters suggests the acquisition of psychomotor skills required to control an ICA injury.

Background Expanded endonasal approaches have the potential to injure the abducens nerve (cranial nerve [CN] VI). The nerve's root entry zone (REZ) and cisternal segment (CS) are particularly prone to injury during the clivus resection and dural incision of transclival approaches. Objective To investigate the role of the eustachian tube (ET) as a surgical landmark for the REZ and CS of CN VI. Methods Transclival expanded endonasal approaches were performed bilaterally in 6 fresh-frozen cadaveric specimens (12 sides). Anatomic relationships between ET and CN VI were documented with neuronavigation. Results The mean vertical distance from the inferior brainstem point to the horizontal projection of CN VI REZ, CS midpoint, and interdural segment (ID) were 26.38 mm (95% confidence interval [CI] 17.36-35.4), 38.61 mm (95% CI 25.61-51.61), and 42.68 mm (95% CI 30.14-55.22), respectively. The relative vertical distance from the ET to the horizontal projections of the REZ, CS midpoint, and its ID were 6.43 mm (95% CI 3.25-9.61), 18.66 mm (95% CI 11.52-25.8), and 22.72 mm (95% CI 16.02-29.42), respectively. In the axial plane the angles between the ET and (1) the REZ and its midline horizontal projection point, (2) the midpoint and its midline horizontal projection point, and (3) ID and its midline horizontal projection point were 9.81 ± SD 5.20°, 18.50 ± SD 4.87°, and 24.71 ± SD 6.21°, respectively. Conclusion The ET may serve as a constant landmark to reliably predict the position of the REZ and CS of CN VI.

OBJECTIVES/HYPOTHESIS Define the anatomic distribution of the olfactory filaments within specific mucosal regions of the nasal cavity. STUDY DESIGN Cadaveric study. METHODS Seventeen cadaveric specimens (34 sides) were dissected to study the anatomical distribution and density of olfactory fila within different regions of the nasal cavity. Olfactory fila were dissected retrogradely to their point of entry into the anterior cranial fossa through the cribriform plate. Anatomic relationships among various components of the olfactory system and their corresponding arterial supply were determined subjectively. RESULTS The highest density of olfactory fila was found at the mucosa of the ethmoid roof and superior turbinates. Olfactory fila were found at regions not previously considered to be part of the olfactory system: lateral wall of the nose, ethmoidal bullae, and between the os sphenoidale and arc of the posterior choana. Furthermore, at the septum, 20% of the olfactory fila crossed contralaterally before exiting the nose. The anterior ethmoidal arteries were the primary blood supply to the olfactory epithelium. CONCLUSIONS This study suggests that olfactory filaments extend beyond previously established boundaries. These findings may have clinical implications regarding oncologic resections and could serve as the foundation for the development of techniques that better preserve olfactory function. LEVEL OF EVIDENCE NA Laryngoscope, 2473-2477, 2018.

Background The origin of the ophthalmic artery is within the surgical field of endoscopic endonasal approaches (EEAs) to the suprasellar and parasellar regions. However, its anatomy from the endoscopic point-of-view has not been adequately elucidated. Objective To highlight the anatomy of the ophthalmic artery origin from an endoscopic endonasal perspective. Methods The origin of the ophthalmic artery was studied bilaterally under endoscopic visualization, after performing transplanum/transtubercular EEAs in 17 cadaveric specimens (34 arteries). Anatomic relationships relevant to surgery were evaluated. To complement the cadaveric findings, the ophthalmic artery origin was reviewed in 200 "normal" angiographic studies. Results On the right side, 70.6% of ophthalmic arteries emerged from the superior aspect, while 17.6% and 11.8% emerged from the superomedial and superolateral aspects of the intradural internal carotid artery, respectively. On the left, 76.5%, 17.6%, and 5.9% of ophthalmic arteries emerged from the superior, superomedial, and superolateral aspects of the internal carotid, respectively. Similar findings were observed on angiography. All ophthalmic arteries emerged at the level of the medial opticocarotid recess. Overall, 47%, 26.5%, and 26.5% of ophthalmic arteries (right and left) were inferolateral, inferior, and inferomedial to the intracranial optic nerve segment, respectively. On both sides, the intracranial length of the ophthalmic artery ranged from 1.5 to 4.5 mm (mean: 2.90 ± standard deviation of 0.74 mm). Conclusion Awareness of the endoscopic nuances of the ophthalmic artery origin is paramount to minimize the risk of sight-threatening neurovascular injury during EEAs to the suprasellar and parasellar regions.

Objectives/hypothesis To demonstrate anatomic relationships of the far-medial transoral endoscopic assisted approach (FMT-EAA) to the infratemporal fossa (ITF) and define the corridor dimensions, surgical freedom, and limitations associated with this approach. Study design Cadaveric study. Methods Twenty ITFs (10 specimens) were dissected with the assistance of 0 °, 30 °, and 45 ° rod-lens endoscopes. Image guidance was used to confirm and measure the corridors' structural boundaries and document the anatomical relationships encountered in this approach. Results Access to the ITF via the FMT-EAA can be divided into two secondary surgical corridors: the superomedial and inferolateral triangles, each of which provides access to different areas. The superomedial triangle is bounded medially by the lateral pterygoid plate and posterolateral maxillary sinus wall, superiorly by the greater sphenoid wing, and inferolaterally by the lateral pterygoid muscle. The inferolateral triangle is bounded superiorly by the lower head of the lateral pterygoid muscle, inferiorly by the medial pterygoid muscle, and laterally by the mandible. Using a standard 19-mm endoscope, the FMT-EAA achieves a mean surgical freedom of 231 mm and 161 mm in the vertical and horizontal planes, respectively. Conclusions FMT-EAA adequately exposes critical structures of the ITF. This technique is a viable option for the management of selected ITF lesions, either alone or in combination with alternative minimally invasive approaches to the region. Level of evidence NA Laryngoscope, 128:2273-2281, 2018.

BACKGROUND Transorbital endoscopic approach (TOEA) to the cavernous sinus (CS) is a novel surgical technique. However, the necessity of lateral orbital rim (LOR) osteotomy is questionable. OBJECTIVE To illustrate the surgical dissection of TOEAs to CS and to investigate the additional benefit of LOR osteotomy. METHODS Anatomic dissections were carried out in 7 cadaveric heads (14 sides). The TOEAs were performed before and after LOR osteotomy; herein referred as the lateral transorbital approach (LTOA) and the lateral orbital wall approach (LOWA), respectively. The stereotactic measurements of the area of exposure, surgical freedom, and angles of attack around CS were quantified. RESULTS LOWA increased larger area of exposure than LTOA at entry site (5.3 ± 0.6 cm2 and 2.6 ± 0.6 cm2, respectively; P < .001) but both of these techniques provided similar area of exposure at the surgical target site. With regard to the surgical freedoms, those afforded by LOWA were all significantly superior at all of the surgical targets with the difference ranged from 106.6% to 172.5%. No significant differences were found between the vertical angles produced by either approach. On the other hand, the horizontal angles achieved by LOWA were significantly more favorable. CONCLUSION The TOEAs, either with or without LOR osteotomy are feasible for CS exposure. Although the incremental effect of maneuverability is attained following the LOR osteotomy, it should be performed selectively. Additional research is needed to further validate the safety and efficacy, as well as for precisely defining the clinical application of these techniques.

Background Experimental studies have determined that higher strength values are associated with more efficient cognitive function and better academic performance. In spite of this, the universities in Colombia are decreasing the time available for physical activity in favour of increasing the time devoted to theoretical subjects. This is one of the reasons why in Colombia, only 18% of young people complied with the world recommendations of physical activity. To examine this problem, the objective of this research was to establish the relationship between strength and academic performance in university students. Methods A cross-sectional study was developed in 135 (21.8 ± 4.5 yr; 78.69 ± 9.1kg) students of the fifth semester of the Areandina University in Bogota, Colombia. Each participant developed incremental protocols to determine the maximum weight that he or she could move in six different exercises: squat in smith machine, leg press, leg extension, bench press, pull down and military press. The average of the results of these tests was taken as the value of maximum strength. To determine academic performance, the average of the scores accumulated in the five semesters of their university studies was evaluated. Pearson correlation coefficient was used to find the linear relationship between strength and academic performance. Results Overall, 70.3 % of the participants were men and 29.7% were women. The results of the maximum strength tests were significantly higher in the male group than in the female group (P < 0.05). Academic performance was similar in both genders (P > 0.05). A positive correlation was established between maximum strength and academic performance. (r = 0.64 P < 0.05). Conclusions The conclusion of this research was that there is a significant relationship between strength and academic performance. These results are fundamental to justify the inclusion of spaces for the promotion of physical activity in public and private universities. Key messages Universities are institutions that only focus on academic training and generate contexts in which sedentary behaviours are promoted. Sedentary lifestyles are a public health problem in Colombia.

Background Muscle strength is considered as a health indicator and an independent predictor of future disease. For this reason, the evaluation of this component in the young population is recognised as a fundamental strategy for the prevention of non-communicable diseases. Field tests are the techniques most commonly used to evaluate muscle strength. However, an alternative method that could be applied in epidemiological studies is self-report questionnaires. The aim of this research was to evaluate the ability of a self-report questionnaire to correctly rank the levels of muscle strength in college students. Methods A cross-sectional study was developed in 135 students from the Areandina University in Bogota, Colombia. For the evaluation of muscle strength, two tests were applied. The first was the application of the handgrip protocol using an adjustable handle Digital Grip Strength Dynamometer. The second was the application of protocols to a maximum repetition in 6 different exercises. For the assessment of self-perceived strength, the third question of the International Scale Fitness Questionnaire (IFIS) was applied. The IFIS response options are presented on a Likert scale with five possible answers: “very poor”, “poor”, “average”, “good” or “very good”. An analysis of variance (ANOVA) was applied to evaluate the ability of the IFIS questionnaire to rank muscle strength levels correctly. Results Overall, 70.3% of the participants were men, and 29.7% were women. The results of the field tests and the self-perception of muscle strength were significantly higher in the male group than in the female group (P < 0.001). Students who reported having good or very good muscle strength in the questionnaire had a better result in the field tests compared to those who reported average, poor or very poor muscle strength levels (P < 0.005). Conclusions The IFIS questionnaire was able to rank real muscle strength in university students correctly. Key messages The IFIS questionnaire is a valid alternative to detect students with a potential risk of chronic non-communicable diseases. The epidemiology surveillance systems in Colombia should include the application of self-report questionnaires that evaluate potential risk factors.

Introduction and objectives Up to 5% patients with acute chest pain present an acute coronary syndrome (ACS). This study aimed to compare peak exercise echocardiography (ExE) and multidetector computed tomography (MCT) in patients referred to a chest pain unit. Methods 203 patients with ≥1 cardiovascular risk factors, no ischemic ECG changes and negative biomarkers were randomized to ExE (n=103) or MCT (n=100). The endpoints were hard events (cardiovascular death and non-fatal myocardial infarction), combined events (hard events and revascularizations), and combined events plus readmissions during follow-up. Cost of either strategy was also investigated. Results Mean age was 64±11 years and 131 patients were male. Hypertension was seen in 71%, hypercholesterolemia in 74%, diabetes mellitus in 28%, and smoking in 21%. Most of the patients had a low TIMI risk score (68% TIMI I and 32% TIMI II). Mean follow-up was 4,7±2,7 years. Invasive angiography due to positive/nonconclusive results was performed in 34 of the patients, 103 submitted to SE and in 27 of the 100 submitted to MCT (33% vs. 27%, p=0.15). A final diagnosis of acute coronary syndrome was achieved in 53 patients (30 [88%] in the ExE group and 23 [85%] in the MCT group, p=0.12). There were no significant differences between groups in hard events (5 [5%] patients in the ExE group and 7 [7%] in the MCT group, p=0,42), combined events (35 patients [34%] in the ExE group and 29 [29%] in the MCT group), and combined events plus readmissions (43 [42%] patients in the ExE group and 41 [41%] in the MCT). The median stay in hospital was 7 (5–10) days in the ExE group and 8 (5–10,25) in the MCT group (p=NS). For patients with negative results by either technique the mean stay was less than 8 hours. There were no differences in the global cost, although it was lower for patients with negative ExE (557 € vs. 706 €, p Conclusions Both MCT and ExE are equally effective for the stratification of patients with low to moderate probability of ACS admitted to a chest pain unit. The cost was similar with both strategies, although significant lower in ExE when negative studies were compared.

Background The management of optic nerve sheath meningiomas (ONSMs) remains controversial. Surgical decompression through traditional resective techniques has been associated with significant morbidity. While radiation therapy, the current modality of choice is not exempt of risks.Transnasal endoscopic optic nerve decompression (EOND) offers a direct route to the orbit, optic canal, and orbital apex, providing a minimally invasive alternative. Objective The main objective of this article is to assess EOND as the initial management of symptomatic patients with primary ONSM. Methods Patients with ONSMs without a history of radiotherapy who underwent EOND were retrospectively reviewed. Postoperative imaging, duration of follow-up, and visual outcomes at the last ophthalmology visit were assessed. Results Four women (age range 25–63 years) with primary ONSMs that underwent EOND were identified. All patients displayed subjective and objective baseline signs of vision loss. Additionally, baseline proptosis, diplopia, optic nerve atrophy, and ocular pain were identified. In none of the cases, the optic nerve sheath was breached.Following EOND, all patients deferred treatment with adjuvant radiotherapy. At a mean postoperative follow-up of 14 months, all patients were clinically stable without evidence of disease progression on imaging or physical examination. At last ophthalmologic evaluation, three out of four showed objective improvements from baseline visual acuity and visual field (remaining patient had baseline optic nerve atrophy). Conclusion These results suggest that EOND could be a viable initial treatment modality of selected primary ONSM cases. Further studies are warranted to determine long-term efficacy and its role in a stepwise progression of management, preceding radiotherapy.

Background/Objective The inframeatal area represents a challenging region for skull base surgeons. Various surgical corridors have been described to access this area and frequently are used in combination. Recent studies describe the expanded endoscopic endonasal approach (EEA) as an established route for midline regions, particularly medial to the internal carotid arteries (ICA). We sought to evaluate the accessibility, maneuverability, and freedom of movement of the expanded endoscopic endonasal approach to the inframeatal region. Methods An EEA combining a middle and an inferior transclival corridor with an infrapetrous and a supracondylar lateral expansion was performed in 5 embalmed human cadaveric heads. The area of exposure and the surgical freedom to access the inframeatal area were calculated. The angle of attack and distances from the lacerum segment of the ICA to several anatomical targets also were measured. Our database was searched to select clinical case examples. Results The EEA provided an exposure area of 101.26 ± 16.66 mm2 and an area of surgical freedom of 1208.50 ± 507.01 mm2. The angles of attack in both the sagittal and axial planes were wider at the lacerum segment of the ICA and narrower at the dural entrance zone of cranial nerves VII/VIII. Three chondrosarcomas are presented as case illustrations. Conclusions The EEA is a feasible route to the inframeatal area. This approach provides a safe working corridor for lesions in this region, as shown by the anatomical and clinical findings presented here. Comparative studies and large case series are warranted to further establish its clinical value.

The catastrophic and rare nature of an internal carotid artery (ICA) injury during endonasal surgery limits training opportunities. Cadaveric and animal simulation models have been proposed, but expense and complicated logistics have limited their adoption. Three-dimensional (3D) printed models are portable, modular, reusable, less costly, and proven to improve psychomotor skills required for managing different lesions. In this study we evaluate the role of a simplified laser-sintered model combined with standardized training in improving the effectiveness of managing an ICA injury endoscopically.A 3-mm defect was created in the parasellar carotid canal of a laser-sintered model representing a sphenoid sinus. Artificial blood was directed to simulate the copious bleeding arising from an ICA injury. Twenty otolaryngologists and 26 neurosurgeons, with varying training and experience levels, were individually asked to stop the "bleeding" as they would in a clinical scenario, and provided no other instructions. This was followed by individualized formative training and a second simulation. Volume of blood loss, time to hemostasis, and self-assessed confidence scores were compared.At the end of the study, time to hemostasis was reduced from 105.49 seconds to 40.41 seconds (p 0.001). The volume of blood loss was reduced from 690 to 272 mL (p 0.001), and the confidence scores increased in 95.7% of participants, from an average of 3 up to 8.This ICA injury model, along with a formal training algorithm, appears to be valuable, realistic, portable, and cost-effective. Significant improvement in all parameters suggests the acquisition of psychomotor skills required to control an ICA injury.

To demonstrate anatomic relationships of the far-medial transoral endoscopic assisted approach (FMT-EAA) to the infratemporal fossa (ITF) and define the corridor dimensions, surgical freedom, and limitations associated with this approach.Cadaveric study.Twenty ITFs (10 specimens) were dissected with the assistance of 0 °, 30 °, and 45 ° rod-lens endoscopes. Image guidance was used to confirm and measure the corridors' structural boundaries and document the anatomical relationships encountered in this approach.Access to the ITF via the FMT-EAA can be divided into two secondary surgical corridors: the superomedial and inferolateral triangles, each of which provides access to different areas. The superomedial triangle is bounded medially by the lateral pterygoid plate and posterolateral maxillary sinus wall, superiorly by the greater sphenoid wing, and inferolaterally by the lateral pterygoid muscle. The inferolateral triangle is bounded superiorly by the lower head of the lateral pterygoid muscle, inferiorly by the medial pterygoid muscle, and laterally by the mandible. Using a standard 19-mm endoscope, the FMT-EAA achieves a mean surgical freedom of 231 mm and 161 mm in the vertical and horizontal planes, respectively.FMT-EAA adequately exposes critical structures of the ITF. This technique is a viable option for the management of selected ITF lesions, either alone or in combination with alternative minimally invasive approaches to the region.NA Laryngoscope, 128:2273-2281, 2018.

OBJECTThis study proposes a variation of the transorbital endoscopic approach (TOEA) that uses the lateral orbit as the primary surgical corridor, in a minimally invasive fashion, for the posterior fossa (PF) access. The versatility of this technique was quantitatively analyzed in comparison with the anterior transpetrosal approach (ATPA), which is commonly used for managing lesions in the PF.METHODSAnatomical dissections were carried out in 5 latex-injected human cadaveric heads (10 sides). During dissection, the PF was first accessed by TOEAs through the anterior petrosectomy, both with and without lateral orbital rim osteotomies (herein referred as the lateral transorbital approach [LTOA] and the lateral orbital wall approach [LOWA], respectively). ATPAs were performed following the orbital approaches. The stereotactic measurements of the area of exposure, surgical freedom, and angles of attack to 5 anatomical targets were obtained for statistical comparison by the neuronavigator.RESULTSThe LTOA provided the smallest area of exposure (1.51 ± 0.5 cm2, p = 0.07), while areas of exposure were similar between LOWA and ATPA (1.99 ± 0.7 cm2 and 2.01 ± 1.0 cm2, respectively; p = 0.99). ATPA had the largest surgical freedom, whereas that of LTOA was the most restricted. Similarly, for all targets, the vertical and horizontal angles of attack achieved with ATPA were significantly broader than those achieved with LTOA. However, in LOWA, the removal of the lateral orbital rim allowed a broader range of movement in the horizontal plane, thus granting a similar horizontal angle for 3 of the 5 targets in comparison with ATPA.CONCLUSIONSThe TOEAs using the lateral orbital corridor for PF access are feasible techniques that may provide a comparable surgical exposure to the ATPA. Furthermore, the removal of the orbital rim showed an additional benefit in an enhancement of the surgical maneuverability in the PF.

Protein kinase C delta (PKC-δ) protein levels are frequently low in chemically and UV-induced mouse skin tumors as well as in human cutaneous squamous cell carcinomas (SCCs). Furthermore, overexpression of PKC-δ in human SCC lines and mouse epidermis is sufficient to induce apoptosis and suppress tumorigenicity, making PKC-δ a potential tumor suppressor gene for SCCs. Here we report that PKC-δ is lost in human SCCs at the transcriptional level. We used laser capture microdissection to isolate cells from three normal human epidermis and 14 human SCCs with low PKC-δ protein. Analysis by quantitative reverse transcription-PCR revealed that PKC-δ RNA was reduced an average of 90% in the SCCs tested, consistent with PKC-δ down-regulation at the protein level. Analysis of DNA from nine of the same tumors revealed that PKC-δ gene was deleted in only one tumor. In addition, Ras-transformed human keratinocytes, which have selective down-regulation of PKC-δ at both protein and mRNA levels, had significantly repressed human PKC-δ promoter activity. Together, these results indicate that PKC-δ gene expression is suppressed in human SCCs, probably via transcription repression. Our results have implications for the development of topical therapeutic strategies to trigger the re-expression of pro-apoptotic PKC-δ to induce apoptosis in SCCs.

The main objective of this project about mobile team service extension to the socio-educational home of the whole Vaud canton targets to decompartmentalize the socio-educational and youth-psychiatry domains. 64 patient were assessed during this pilot phase (after one-year functioning). In addition, a satisfaction survey was done either at the end of the follow up or at the end of the pilot phase of the project (31.12.2012). This experience was very positive as highlighted by the vast majority of the person involved in the socio-educational and youth-psychiatric domains taking care of youth. A desire of extension of mobile team service to other institutional structure or other situations was expressed.

Purpose: To determine the predictors of all-cause mortality in patients with acute chest pain and negative troponin undergoing exercise echocardiography. Methods: A total of 1646 patients were referred to our chest pain unit for acute chest pain, nondiagnostic resting electrocardiograms and negative troponin I levels, and underwent exercise echocardiography within 24 hours of the chest pain episode. An abnormal exercise echocardiogram was defined as a peak wall motion score index (pWMSI) >1. The endpoint was all-cause mortality. Results: Mean age was 63.2±12.3 years, and 1068 patients were male. During an average follow-up of 2.35±1.50 years, 55 patients died. The 5-year mortality rate was 4.1% in patients with a normal exercise echocardiogram vs. 13.1% in those with abnormal results (p

A new nondestructive technique for monitoring the hydration process of cement within concrete and measurement of the compressive strength of concrete is presented. The technique called the Nuclear Magnetic Resonance (NMR) has so far been primarily used in the fields of chemistry and medicine. Its application to construction materials has been very limited or nonexistent. In this study, NMR is used to monitor the. hydration of cement paste in concrete with two different water cement ratios. The first objective of this study was to distinguish between the amounts of remaining free water, and water consumed in the hydration process during the 28 days monitoring period. The second objective was to relate the compressive strength of concrete to NMR signals. A number of standard compression tests were performed in parallel with the NMR tests. Correlation of the responses from nondestructive tests with NMR and those of standard compression tests indicated almost a linear relationship.

Protein kinase C delta (PKC-delta) protein levels are frequently low in chemically and UV-induced mouse skin tumors as well as in human cutaneous squamous cell carcinomas (SCCs). Furthermore, overexpression of PKC-delta in human SCC lines and mouse epidermis is sufficient to induce apoptosis and suppress tumorigenicity, making PKC-delta a potential tumor suppressor gene for SCCs. Here we report that PKC-delta is lost in human SCCs at the transcriptional level. We used laser capture microdissection to isolate cells from three normal human epidermis and 14 human SCCs with low PKC-delta protein. Analysis by quantitative reverse transcription-PCR revealed that PKC-delta RNA was reduced an average of 90% in the SCCs tested, consistent with PKC-delta down-regulation at the protein level. Analysis of DNA from nine of the same tumors revealed that PKC-delta gene was deleted in only one tumor. In addition, Ras-transformed human keratinocytes, which have selective down-regulation of PKC-delta at both protein and mRNA levels, had significantly repressed human PKC-delta promoter activity. Together, these results indicate that PKC-delta gene expression is suppressed in human SCCs, probably via transcription repression. Our results have implications for the development of topical therapeutic strategies to trigger the re-expression of pro-apoptotic PKC-delta to induce apoptosis in SCCs.

A linear Rayleigh-Taylor instability theory of double ablation (DA) fronts is developed for direct-drive inertial confinement fusion. Two approaches are discussed: an analytical discontinuity model for the radiation dominated regime of very steep DA front structure, and a numerical self-consistent model that covers more general hydrodynamic profiles behaviours. Dispersion relation results are compared to 2D simulations.

This study investigated age changes in risk perception and unrealistic optimism. Teenagers (n = 376) and parents (n = 160) evaluated the risk of experimental, occasional, and regular involvement in 14 health-related activities (e.g., getting drunk). Respondents also evaluated their comparative changes of encountering the leading causes of morbidity and mortality. Compared with adults, teenagers minimized the perceived risk of experimental and occasional involvement in health-threatening activities. Notably, teenagers were less optimistic about avoiding injury and illness than were their parents, and teenagers at greatest risk for such misfortunes were the least optimistic about avoiding them. These findings do not support traditional explanations of adolescent risk taking. The implications of these findings for understanding and preventing health-damaging behavior among adolescents are discussed.

"A survey of Spanish immigration in Argentina as compared to other Latin American destinations between 1860 and 1930 is presented here. Statistical sources are examined and compared (inclusions and omissions) and an estimation of migratory balance is presented. Regional differences in emigration flow and variations following shifts in economic trends and in migration policies are considered in [the] search for an explanation [of] the Spanish emigrants' preference for Argentina." (SUMMARY IN ENG)