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Introduction: Most smokers start smoking during their early adolescence, often with the idea that smoking is glamorous; the dramatic health consequences are too far in the future to fathom. We recently designed and tested an intervention that takes advantage of the broad availability of mobile phones as well as adolescents' interest in their appearance. A free photoageing mobile app (Smokerface) was implemented by medical students in secondary schools via a novel method called mirroring. The pupils' altered three-dimensional selfies on tablets were 'mirrored' via a projector in front of their whole grade. This is the first randomised trial to measure the effectiveness of the mirroring approach on smoking behaviour in secondary schools., Methods and Analysis: The mirroring intervention, which lasts 45 min, is implemented by Brazilian medical students in at least 35 secondary school classes with 21 participants each (at least 35 classes with 21 participants for control) in February 2018 in the city of Itauna, Brazil. External block randomisation via computer is performed on the class level with a 1:1 allocation. In addition to sociodemographic data, smoking behaviour is measured via a paper-pencil questionnaire before, 3 and 6 months postintervention plus a random carbon monoxide breathing test at baseline and end line. The primary outcome is cigarette smoking in the past week at 6 months follow-up. Smoking behaviour (smoking onset, quitting) and effects on the different genders are studied as secondary outcomes. Analysis is by intention to treat., Ethics and Dissemination: Ethical approval is obtained from the ethics committee of the University of Itauna in Brazil. Results will be disseminated at conferences, in peer-reviewed journals, throughout the Education Against Tobacco network social media channels and on our websites., Trial Registration Number: NCT03178227., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

This rare case report describes the diagnosis and treatment of an isolated left-sided orbital floor fracture with a complete dislocation of the globe into the maxillary sinus and briefly discusses the indications of surgery and recovery for orbital floor fractures in general. Complete herniation of the globe through an orbital blow-out fracture is uncommon. However, the current case illustrates that such an occurrence should be in the differential diagnosis and should be considered, especially following high speed/impact injuries involving a foreign object. In these rare cases, surgical intervention is required., Competing Interests: The authors have declared that no competing interests exist.

Introduction: Although Hans Chiari made significant and meaningful contributions to our understanding and classification of hindbrain herniations, others have also contributed to this knowledge. One figure who has been lost to history is Otto Mennicke. Herein, we discuss his role in our understanding of tonsillar ectopia and his life and connection to Hans Chiari., Conclusions: Our knowledge of what is now known as the Chiari malformations has been shaped by several clinicians including Otto Mennicke.

Introduction: Intramedullary brainstem tumors present a special challenge to the neurosurgeon. Unfortunately, there is no ideal part of the brainstem to incise for approaches to such pathology. Therefore, the present study was performed to identify what incisions on the lateral brainstem would result in the least amount of damage to eloquent tracts and nuclei. Case illustrations are also discussed., Materials and Methods: Eight human brainstems were evaluated. Based on dissections and the use of standard atlases of brainstem anatomy, the most important deeper brainstem structures were mapped to the surface of the lateral brainstem., Results: With these data, we defined superior acute and inferior obtuse corridors for surgical entrance into the lateral brainstem that would minimize injury to deeper tracts and nuclei, the damage to which would result in significant morbidity., Conclusions: To our knowledge, a superficial map of the lateral brainstem for identifying deeper lying and clinically significant nuclei and tracts has not previously been available. Such data might decrease patient morbidity following biopsy or tumor removal or aspiration of brainstem hemorrhage. Additionally, this information can be coupled with the previous literature on approaches into the fourth ventricular floor for more complex, multidimensional lesions., Competing Interests: The authors have declared that no competing interests exist.

We compare, on left and right side of human skulls, the length of Whitnall's tubercle as a relevant landmark and anchor point for the lateral retinaculum. Twenty human skulls were used in this study. A caliper was used to measure the length of Whitnall's tubercle, the distance from Whitnall's tubercle to the frontozygomatic suture and the height of the orbit. An overall mean for these three parameters was calculated using the data obtained. There were no significant differences between left and the right sides. The combined mean length of Whitnall's tubercle was 4.9 mm ± 23%. The combined mean distance from the frontozygomatic suture was 7.8 mm ± 25%. The orbital height was found to be the measurement with the highest congruence between the two sides having a combined mean of 32.3 mm ± 7%. Although 6 out of 20 skulls were found to have no tubercle, five out of twenty skulls had a tubercle only on one side. Even though human skulls develop from bilateral symmetric osteogenesis, surgeons should always be aware of possible asymmetry and possible absence of Whitnall's tubercle between sides or among individuals. The frontozygomatic suture was found to be a useful landmark in identifying the position of Whitnall's tubercle in the majority of specimens. Such information will be useful in realigning the lateral retinaculum following surgery.

Introduction: Smoking is the largest cause of preventable death globally. Most smokers smoke their first cigarette in early adolescence. We took advantage of the widespread availability of mobile phones and adolescents' interest in appearance to develop a free photoaging app which is promoted via a poster campaign in secondary schools. This study aims to evaluate its effectiveness regarding smoking prevalence and students' attitudes towards smoking., Methods and Analysis: A randomised controlled trial is conducted with 9851 students of both genders with an average age of 12 years in grades 6 and 7 of 126 secondary schools in Germany. At present, cigarette smoking prevalence in our sample is 4.7%, with 4.6% of the students currently using e-cigarettes (1.6% use both). The prospective experimental study design includes measurements at baseline and at 6, 12 and 24 months postintervention via a questionnaire plus a random cotinine saliva sample at 24 months postintervention. The study groups consist of randomised schools receiving the Smokerface poster campaign and control schools with comparable baseline data (no intervention). The primary end point is the difference of change in smoking prevalence in the intervention group versus the difference in the control group at 24 months follow-up. Longitudinal changes in smoking-related attitudes, the number of new smokers and quitters and the change in the number of never-smokers will be compared between the two groups as secondary outcomes., Ethics and Dissemination: Ethical approval was obtained from the ethics committee of the University of Gießen and the ministries of cultural affairs, both in Germany. Results will be disseminated at conferences, in peer-reviewed journals, on our websites and throughout the multinational Education Against Tobacco network., Trial Registration Number: NCT02544360, Pre-results., Competing Interests: There are no financial competing interests with regards to the Smokerface App. The Smokerface App is free and contains no advertising. It was designed for charitable causes., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Chronic postoperative neuralgias and headache following retrosigmoid craniotomy can be uncomfortable for the patient. We aimed to better elucidate the regional nerve anatomy in an effort to minimize this postoperative complication. Ten adult cadaveric heads (20 sides) were dissected to observe the relationship between the lesser occipital nerve and a traditional linear versus modified U incision during retrosigmoid craniotomy. Additionally, the relationship between these incisions and the occipital artery were observed. The lesser occipital nerve was found to have two types of course. Type I nerves (60%) remained close to the posterior border of the sternocleidomastoid muscle and some crossed anteriorly over the sternocleidomastoid muscle near the mastoid process. Type II nerves (40%) left the posterior border of the sternocleidomastoid muscle and swung medially (up to 4.5cm posterior to the posterior border of the sternocleidomastoid muscle) as they ascended over the occiput. The lesser occipital nerve was near a midpoint of a line between the external occipital protuberance and mastoid process in all specimens with the type II nerve configuration. Based on our findings, the inverted U incision would be less likely to injure the type II nerves but would necessarily cross over type I nerves, especially more cranially on the nerve at the apex of the incision. As the more traditional linear incision would most likely transect the type I nerves and more so near their trunk, the U incision may be the overall better choice in avoiding neural and occipital artery injury during retrosigmoid approaches., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: We hypothesized that by using coronal MRI, Chiari I malformation could be more precisely diagnosed, would provide simple anatomic landmarks, would provide information regarding asymmetry of hindbrain herniation, and would be a better method for analyzing the tonsillar herniation postoperatively when the opisthion has been removed., Methods: Fifty consecutive pediatric patients diagnosed with Chiari I malformation had comparison between the measurements of their caudally descended cerebellar tonsils on midsagittal and coronal MRI images., Results: On MRI coronal imaging, tonsillar asymmetry was found in 48 patients. Maximal left tonsillar descent was 20.9 mm, and maximal right tonsillar descent was 17.4 mm. On MRI sagittal imaging, tonsillar descent ranged from 5 to 27.4 mm. Fifty-eight % of patients had syringomyelia. Five patients (10 %) on coronal MRI were found to have both cerebellar tonsils that were less than 3 mm below the foramen magnum. However, all of these patients had greater than 3 mm of tonsillar ectopia on sagittal imaging. Nineteen patients (38 %) on coronal MRI were found to have one of the cerebellar tonsils that were less than 3 mm below the foramen magnum. Similarly, each of these had greater than 3 mm of tonsillar ecotpia as measured on midsagittal MRI. Also, based on these findings, Chiari I malformation is almost always an asymmetrical tonsillar ectopia., Conclusions: Sagittal MRI overestimates the degree of tonsillar ectopia in patients with Chiari I malformation. Misdiagnosis may occur if sagittal imaging alone is used. The cerebellar tonsils are paramedian structures, and this should be kept in mind when interpreting midline sagittal MRI.

Introduction: Neurosurgical approaches often involve the atlas. Therefore, the arterial relationships and anatomical variations are of paramount importance to the neurosurgeon., Methods: Using standard search engines, a literature review of arterial variants near the first cervical vertebra was performed., Conclusions: Arterial variations around the atlas are surgically significant. Awareness of their existence and course may provide better pre-operative planning and surgical intervention, potentially leading to better clinical outcomes. Three-dimensional computed tomography angiography (3D CTA) is an important tool for identifying and diagnosing such abnormalities and should be used when such vascular anomalies are suspected.

The presence of a human tail is a rare and intriguing phenomenon. While cases have been reported in the literature, confusion remains with respect to the proper classification, definition, and treatment methods. We review the literature concerning this anatomical derailment. We also consider the importance of excluding underlying congenital anomalies in these patients to prevent neurological deficits and other abnormal manifestations., (© 2016 Wiley Periodicals, Inc.)

Recent reports suggest that carbonyl stress might affect a subset of schizophrenia patients suffering from severe symptoms. Carbonyl stress protection is achieved by the glyoxalase system consisting of two enzymes, glyoxalase 1 and 2, which in humans are encoded by the genes GLO1 and HAGH, respectively. Glyoxalase 1 and 2 catalyze the detoxification of reactive alpha-oxoaldehydes such as glyoxal and methylglyoxal, which are particularly damaging components of carbonyl stress. Here, we investigated the role of the glyoxalase system in schizophrenia by performing association analyses of common genetic variants (n=12) in GLO1 and HAGH in a Japanese sample consisting of 2012 schizophrenia patients and 2170 healthy controls. We detected a nominally significant association with schizophrenia (p=0.020) of rs11859266, a SNP in the intronic region of HAGH. However, rs11859266 did not survive multiple testing (empirical p=0.091). The variants in HAGH, rs11859266 and rs3743852, showed significant associations with schizophrenia in males at allelic and genotype levels, which remained persistent after multiple testing with the exception of rs3743852 for the genotype model. We further measured the mRNA expression of both genes in postmortem brain, but did not detect any changes in transcript expression levels between case and control samples or in sex-specific comparisons. Therefore, our findings suggest that an explanation of elevated carbonyl stress in a substantial part (reported as ~20%) of patients with schizophrenia will require the examination of a much larger cohort to detect risk alleles with weak effect size and/or other risk factors., (Copyright © 2015 Elsevier Inc. All rights reserved.)

This study explores the degree to which GGA, meta-GGA, hybrid GGA, and hybrid meta-GGA functionals of density functional theory (DFT), when used with the 6-31+G(d) basis set, are able to reproduce the MP2/6-31+G(d) structures and energetics of the species involved in the reactions of halomethyllithium carbenoids with ethylene. While many popular DFT functionals have been parametrized and/or benchmarked using various databases, the scarcity of experimental structural and energetic information for organolithium compounds has resulted in their exclusion from these training and test sets. In this work, we first establish a set of practical benchmark reaction energetics against which the performance of DFT methods for larger molecules can be compared. Next, we examine the performance of 13 DFT functionals spanning the second, third, and fourth rungs of the "Jacob's ladder" using 84 molecules and 78 reactions. The main conclusions are (a) the meta-hybrid GGA M06-2X is the best functional among the set for organolithium chemistry, (b) the hybrid GGA PBE1PBE consistently yields equilibrium and transition-state geometries that are very close to the MP2 predictions, and (c) MP2//M06-L or MP2//PBE1PBE model chemistries are excellent low-cost alternatives to the costly MP2. However, this work also showed that the very popular B3LYP functional is a rather poor choice for these systems.

Background: Novel helicobacter infections and associated disease are being recognized with increasing frequency in animals and people. Yet, the pervasiveness of infection in distantly related animal taxa, genetic diversity of helicobacters, and their transmissability are not known., Aim: To better understand the ecology of helicobacters, we did a PCR survey and epidemiologic analysis of 154 captive or wild vertebrate taxa originating from 6 continents., Materials and Methods: One hundred twenty nine helicobacter 16s rRNA gene segments were amplified by PCR and sequenced from ninety-three mammalian, reptilian, avian, or amphibian host species. Prevalence estimates were generated, and univariate logistic regression analyses were used to explore relationships between infection status and the health and characteristics of the 220 individual animals., Results: One hundred and nineteen novel helicobacter DNA sequences were found. No significant relationship between infection and host health was found; however, multi-infection or infections with particular genotypes were associated with mild clinical signs. Phylogenetic and genetic comparisons of helicobacters suggested prolonged co-adaptation and niche-associated divergence as well as periodic inter-species transmission., Conclusion: The genus Helicobacter should accordingly be viewed as a collection of hundreds of organisms that have colonized most tetrapod taxa and have the potential to expand into new hosts as contact among animals and between animals and people increases.