Relationship Between Cortical Gyrification, White Matter Connectivity, and Autism Spectrum Disorder

Autism spectrum disorder (ASD) is a complex neurodevelopmental condition, which is accompanied by differences in gray matter neuroanatomy and white matter connectivity. However, it is unknown whether these differences are linked or reflect independent aetiologies. Using a multimodal neuroimaging approach, we therefore examined 51 male adults with ASD and 48 neurotypical controls to investigate the relationship between gray matter local gyrification (lGI) and white matter diffusivity in associated fiber tracts. First, ASD individuals had a significant increase in gyrification around the left pre- and post-central gyrus. Second, white matter fiber tracts originating and/or terminating in the cluster of increased lGI had a significant increase in axial diffusivity. This increase in diffusivity was predominantly observed in tracts in close proximity to the cortical sheet. Last, we demonstrate that the increase in lGI was significantly correlated with increased diffusivity of short tracts. This relationship was not significantly modulated by a main effect of group (i.e., ASD), which was more closely associated with gray matter gyrification than white matter diffusivity. Our findings suggest that differences in gray matter neuroanatomy and white matter connectivity are closely linked, and may reflect common rather than distinct aetiological pathways.

Expanding the dairy herd in pasture-based systems: The role of sexed semen within alternative breeding strategies

A simulation model was developed to determine the effects of sexed semen use in heifers and lactating cows on replacement heifer numbers and rate of herd expansion in a seasonal dairy production system. Five separate artificial insemination (AI) protocols were established according to the type of semen used: (1) conventional frozen-thawed semen (CONV); (2) sexed semen in heifers and conventional semen used in cows (SS-HEIFER); (3) sexed semen in heifers and a targeted group of cows (body condition score ≥3 and calved ≥63 d), with conventional semen used in the remainder of cows (SS-CONV); (4) sexed semen in heifers and a targeted group of cows, with conventional semen in the remainder of cows for the first AI and conventional beef semen used for the second AI (SS-BEEF); or (5) sexed semen in heifers and a targeted group of cows, with conventional semen in the remainder of cows for the first AI and short gestation length semen used for the second AI (SS-SGL). Each AI protocol was assessed under 3 scenarios of sexed semen conception rate (SS-CR): 100, 94, and 87% relative to that of conventional semen. Artificial insemination was used on heifers for the first 3 wk and on cows for the first 6 wk of the 12-wk breeding season. The initial herd size was 100 cows, and all available replacement heifers were retained to facilitate herd expansion, up to a maximum herd size of 300 cows. Once maximum herd size was reached, all excess heifer calves were sold at 1 mo old. All capital expenditure associated with expansion was financed with a 15-yr loan. Each AI protocol was evaluated in terms of annual farm profit, annual cash flow, and total discounted net profit. The SS-CONV protocol generated more replacement heifers than all other AI protocols, facilitating faster expansion, and reached maximum herd size in yr 9, 9, and 10 for 100, 94, and 87% SS-CR, respectively. All AI protocols, except SS-BEEF and SS-SGL at 87% SS-CR, reached maximum herd size within the 15-yr period. Negative profit margins were experienced for SS-CONV in the first 5, 4, and 3 yr of expansion for 100, 94, and 87% SS-CR, respectively. Total discounted net profit was greater in all sexed semen AI protocols compared with CONV. This study demonstrated that, for each SS-CR, the greatest rate of expansion is achieved when using sexed and conventional semen (SS-CONV). The combined use of sexed semen and beef (SS-BEEF) or SGL (SS-SGL) semen resulted in greater discounted net profit at 100, 94, and 87% SS-CR compared with CONV, but a similar net worth change at 87% SS-CR due to a lower inventory change because SS-BEEF and SS-SGL reached maximum herd size within 15 yr.

Odontogenic myxoma of the maxilla: surgical management and case report

BACKGROUND

Odontogenic myxoma is a benign odontogenic tumour of the jaw [1]. This tumour often presents as an asymptomatic expansile lesion without sensory nerve changes [2]. It is thought to arise from mesenchymal origin with cells of microscopic similarity to dental pulp and follicle [3]. Radiographically it presents most often as a multiloculated radiolucency [2]. It is a locally aggressive lesion which may require extensive treatment to prevent recurrence.

METHOD

The authors present the case of a 13-year-old boy with an extensive lesion in the maxilla.

CONCLUSION

We discuss various treatment approaches for management of this tumour.

Protocol for a multicentre randomiSed controlled TRial of IntraVEnous immunoglobulin versus standard therapy for the treatment of transverse myelitis in adults and children (STRIVE)

INTRODUCTION

Transverse myelitis (TM) is an immune-mediated disorder of the spinal cord which causes motor and sensory disturbance and limited recovery in 50% of patients. Standard treatment is steroids, and patients with more severe disease appear to respond to plasma exchange (PLEX). Intravenous immunoglobulin (IVIG) has also been used as an adjunct to steroids, but evidence is lacking. We propose the first randomised control trial in adults and children, to determine the benefit of additional treatment with IVIG.

METHODS AND ANALYSIS

170 adults and children aged over 1 year with acute first episode TM or neuromyelitis optica (with myelitis) will be recruited over a 2.5-year period and followed up for 12 months. Participants randomised to the control arm will receive standard therapy of intravenous methylprednisolone (IVMP). The intervention arm will receive the above standard therapy, plus additional IVIG. Primary outcome will be a 2-point improvement on the American Spinal Injury Association (ASIA) Impairment scale at 6 months postrandomisation by blinded assessors. Additional secondary and tertiary outcome measures will be collected: ASIA motor and sensory scales, Kurtzke expanded disability status scale, International Spinal Cord Injury (SCI) Bladder/Bowel Data Set, Client Services Receipt Index, Pediatric Quality of Life Inventory, EQ-5D, SCI Pain and SCI Quality of Life Data Sets. Biological samples will be biobanked for future studies. After 6-months' follow-up of the first 52 recruited patients futility analysis will be carried out. Health economics analysis will be performed to calculate cost-effectiveness. After 6 months' recruitment futility analysis will be performed.

ETHICS AND DISSEMINATION

Research Ethics Committee Approval was obtained: 14/SC/1329. Current protocol: v3.0 (15/01/2015). Study findings will be published in peer-reviewed journals.

TRIAL REGISTRATION NUMBERS

This study is registered with EudraCT (REF: 2014-002335-34), Clinicaltrials.gov (REF: NCT02398994) and ISRCTN (REF: 12127581).

Swarm motility of Salmonella enterica serovar Typhimurium is inhibited by compounds from fruit peel extracts

Controlling spread of human pathogens on fresh produce is a top priority for public health reasons. Isolation of compounds from agricultural waste that would control spread of human pathogens was explored using Salmonella enterica serovar Typhimurium as a model organism. In the environment, micro-organisms migrate as a 'community' especially when they move on moist surfaces. This type of motility is characterized as swarming motility. We examined extracts from agricultural waste such as soya bean husk, peels of orange, pineapple, avocado and pomegranate for antiswarming activity. Avocado and pineapple peels showed moderate (~40%) inhibition of swarming motility while pomegranate peel extract had high antiswarming activity (~85% inhibition) and was examined in further detail. Although the pomegranate peel extract was acidic, swarm-inhibitory activity was not due to low pH and the peel extract did not inhibit growth of Salmonella. Among the key swarm motility regulatory genes, class II (fliF, fliA, fliT and fliZ) and class III (fliC and fliM) regulators were downregulated upon exposure to pomegranate peel extract. Pomegranate peels offer great potential as a bioactive repellent for pathogenic micro-organisms on moist surfaces.

SIGNIFICANCE AND IMPACT OF THE STUDY

Controlling the spread of food-borne pathogens in moist environments is an important microbial food safety issue. Isolation of compounds from agricultural waste (such as fruit peels) that would control spread of human pathogens was explored using Salmonella enterica serovar Typhimurium as a model organism. Pomegranate peels offer great potential as a bioactive repellent for pathogenic micro-organisms.

Auditory canal exostoses in Irish surfers

AIM

Surfing is increasing in popularity in Ireland. Exostoses of the external auditory canal are a common finding in those who surf in cold water. The aim of this study was to examine the prevalence of external canal exostoses in a population of Irish surfers.

METHODS

A cross-sectional study of Irish surfers was carried out. Patients were examined and questioned on their knowledge of exostoses, surfing routine, use of barrier protection and symptoms experienced.

RESULTS

119 surfers were analysed. 66 % of the surfers examined exhibited exostoses and 88 % were unaware of their diagnosis. Those that developed exostoses had surfed for a mean of 5,028 h, those that did not had surfed for a significantly shorter mean of 1,909 h (p = 0.0002).

CONCLUSIONS

This is first study of this nature in the UK or Ireland. With a 5- to 6-year lag phase for exostoses to develop, these patients are likely to become an increasing part of Otolaryngologist's workload.

Response to MAPK pathway inhibitors in BRAF V600M-mutated metastatic melanoma

WHAT IS KNOWN AND OBJECTIVE

The management of metastatic melanoma has changed significantly in the past decade with the development of immunotherapies and targeted molecular therapies. Trials of targeted therapies have focused mainly on patients with the most common BRAF V600 mutations, namely V600E/K substitutions, with very little information available on the benefit of targeted therapies on less commonly occurring mutations such as V600R/D and M.

CASE SUMMARY

We present a 54-year-old man with metastatic melanoma harbouring a rare BRAF V600M mutation, who experienced clinical and radiological response to combined therapy with the BRAF inhibitor dabrafenib and MEK inhibitor trametinib.

WHAT IS NEW AND CONCLUSION

As our understanding of these therapies evolves and an increasing number of patients have mutational testing performed, there is a clear imperative--as highlighted by this case--to test for rarer mutations and facilitate their inclusion both in everyday practice and in future clinical trials.

Buccal mucosa urethroplasty: a 10-year retrospective review of maxillofacial and urological outcomes

BACKGROUND

Reconstruction of a urethral stricture poses a difficult surgical problem. Anastomotic repair remains the gold standard. Strictures longer than 2 cm may require substitution urethroplasty. This is a retrospective review of all patients who underwent urethral reconstruction with an autologous free buccal mucosa graft at a Regional hospital between 1998 and 2009.

METHODS

Variables recorded included; demographics: patient gender/age; follow-up period. Urology: pre-operative diagnosis/aetiology; presenting complaint; previous urological surgery, pre-operative retrograde urethrogram, stricture length, graft size, operative time/blood loss, morbidity, complications. Maxillofacial: pre-/post-operative inter-incisal opening, patency of Stenson's parotid duct, ipsilateral parotid swelling, sensory nerve deficit.

RESULTS

A total of eight male patients were included. Mean age was 33 years. Two patients had one-stage dorsal onlay urethroplasty, and the remaining six had a two-stage BMG urethroplasty. All patients underwent a urethrogram 20 days post-operatively, which demonstrated no leak, and a good caliber grafted urethra in all cases. A flexible cystoscopy scope was accommodated in all patients 8 weeks post-operatively. Mean follow-up was 42 months. At long-term follow-up, there was no evidence of stricture formation, and all patients were voiding well. There were no long-term intra-oral complications.

CONCLUSION

This study suggests that anterior urethral strictures up to 6 cm in length may be predictably and safely managed with buccal mucosal urethroplasty. The buccal mucosa is easy to harvest, and can be used successfully in one- and two-stage grafting procedures. The rate of complications, from both a urological and maxillofacial perspective, in the group of patients studied was low.

Design and initial characterization of a compact, ultra high vacuum compatible, low frequency, tilt accelerometer

A compact tilt accelerometer with high sensitivity at low frequency was designed to provide low frequency corrections for the feedback signal of the Advanced Laser Interferometer Gravitational Wave Observatory active seismic attenuation system. It has been developed using a Tungsten Carbide ceramic knife-edge hinge designed to avoid the mechanical 1/f noise believed to be intrinsic in polycrystalline metallic flexures. Design and construction details are presented; prototype data acquisition and control limitations are discussed. The instrument's characterization reported here shows that the hinge is compatible with being metal-hysteresis-free, and therefore also free of the 1/f noise generated by the dislocation Self-Organized Criticality in the metal. A tiltmeter of this kind will be effective to separate the ground tilt component from the signal of horizontal low frequency seismometers, and to correct the ill effects of microseismic tilt in advanced seismic attenuation systems.

Orbital cellulitis in Scotland: current incidence, aetiology, management and outcomes

PURPOSE

Orbital cellulitis is a potentially blinding and life-threatening condition. There are little published data on the incidence of orbital cellulitis and little is known about the differences between children and adults affected. The purpose of this study was to identify the incidence, aetiology, management and outcome of orbital cellulitis in children and adults in Scotland.

METHODS

This study was a 1-year prospective observational study using the Scottish Ophthalmic Surveillance Unit reporting system among Scottish ophthalmologists.

RESULTS

The response rate from ophthalmologists was 66.4%. There were 15 children and 5 adults reported giving an incidence of 1.6 per 100 000 and 0.1 per 100 000 in children and adults, respectively. 47% of children had a preceding upper respiratory tract infection with 87% having radiological evidence of sinus disease. Within the adult group, there was preceding immunosuppression and trauma. Streptococcus (66%) and Haemophilus (46%) species were the most commonly isolated pathogens in children. Respiratory pathogens were less predictable in adults. All patients were treated with intravenous antibiotics. All children with orbital and subperiosteal abscesses had surgery; one adult with orbital abscess did not have surgery. There were two cases of series morbidity: one intracranial spread of infection and one evisceration.

DISCUSSION

The incidence of orbital cellulitis is higher in children than in adults. In children, it commonly follows upper respiratory infection and sinus disease; however, in adults, preceding illness and trauma are more common. Respiratory pathogens are common in affected children. Intravenous antibiotics and surgical treatment of abscesses remain the preferred management.