The rational of forehead lifting in patients with chronic facial paralysis

Background

The incidence of permanent facial sequels in patients with Bell’s palsy is about 30 % and results in impaired mimic expression of both midface and forehead in varying degrees. Even at rest, most patients experience an imbalance of their facial features. In this article, static correction of brow imbalance was evaluated in patients with sequels after unilateral facial palsy.

Methods

Thirty-one patients with sequels of Bell’s palsy underwent surgery with endoscopic forehead lift. Brow position was geometrically assessed pre- and postoperatively. The validated self-assessment instrument for quality of life [Short Form 36(SF-36)] was completed prior to and after surgery. The follow-up period was 12 months.

Results

A notable improvement in the position of the brows was demonstrated over time with lasting results. All patients experienced an improvement in facial symmetry and balance at rest. However, no significant difference could be shown using SF-36 pre- and postoperatively.

Conclusion

Endoscopic forehead lift combined or as an isolated procedure is a valuable instrument to correct sequels of Bell’s palsy. Level of Evidence: Level IV, therapeutic study.     

Endoscopic neurosurgery in preterm and term newborn infants—a feasibility report

Objective

Neuroendoscopic procedures became essential in neurosurgical treatment of disturbed cerebrospinal fluid dynamics. While a vast number of papers report on the neuroendoscopic experience for adults and children, no series so far reported on techniques and indications for neonate infants. We present our experience for the feasibility of neuroendoscopic procedures in preterm and term newborn infants.

Methods

All preterm and term infants who underwent an endoscopic neurosurgical intervention prior to the 28th day after the previously estimated date of delivery were identified by retrospective review. Surgical procedures and techniques, complications, and further follow-up data are reported.

Results

During the study period, 14 infants (median age at surgery, 36+²/7 weeks of gestation) underwent 20 endoscopic procedures. The performed procedures included endoscopic septostomy (n?=?3), endoscopic shunt placement for multiloculated hydrocephalus (n?=?4), endoscopic transaqueductal stenting for isolated fourth ventricle (n?=?3), and endoscopic lavage for ventriculitis (n?=?4) or for intraventricular hemorrhage (n?=?6). No severe complications were seen, while two patients necessitating unexpected interventions during further follow-up (10 %).

Conclusions

Despite the fragility of preterm and term newborn infants, neuroendoscopic procedures may play an important role in the treatment of disturbed cerebrospinal fluid (CSF) dynamics also in this patient population. The neuroendoscopic approach may be curative in conditions like isolated lateral ventricle, may facilitate simplified and effective CSF diversion in multiloculated hydrocephalus or isolated fourth ventricle, and may be beneficial in the course of ventriculitis and intraventricular hemorrhage. Further studies must verify our experience with a bigger cohort of patients and on a multicenter basis.     

Biphasic <Superscript>68</Superscript>Ga-PSMA-HBED-CC-PET/CT in patients with recurrent and high-risk prostate carcinoma

Purpose

Binding of ⁶⁸Ga-PSMA-HBED-CC (⁶⁸Ga-PSMA) at prostate cancer (PC) cells increases over time. A biphasic protocol may help separating benign from tumor lesions. The aim of this study was the retrospective evaluation of a diagnostic incremental value of a dual-time point (biphasic) ⁶⁸Ga-PSMA-PET/CT in patients with prostate cancer.

Methods

Retrospective analysis of 35 consecutive patients (49–78 years, median 71) with newly diagnosed PC (12/35) or recurrence of PC (23/35). PET/CT (Gemini TF16, Philips) was acquired 1 h and 3 h p. i. of 140–392 MBq (300 MBq median) ⁶⁸Ga-PSMA, followed by a diagnostic contrast CT. PET findings were correlated with histology or unequivocal CT findings. Semiquantitative PET data (SUVmax, SUV mean) were acquired and target-to-background-ratios (T/B-ratio) were calculated for benign and malign lesions for both time points. Size of lymph nodes (LN) on diagnostic CT was recorded. Statistical analysis was performed for assessment of significant changes of semiquantitative PET-parameters over time and for correlation of size and uptake of lymph nodes.

Results

One hundred and four lesions were evaluated. Sixty lesions were referenced by histology or unequivocal CT findings, including eight (13.3 %) histopathologically benign lymph nodes, 12 (20 %) histopathologically lymph node metastases, 12 (20 %) primary tumors, three (5 %) local recurrences, and 25 (41.7 %) bone metastases. Forty-four lesions were axillary LN with normal CT-appearance. Benign lesions had significantly lower SUVmax and T/B-ratios compared with malignant findings. Malign lesions showed a significant increase of both parameters over time compared to benign findings. There was no correlation between LN size and SUVmax. The sensitivity, specificity, the positive predictive value and negative predictive value of PET/CT regarding pelvic LN was 94 %, 99 %, 89 %, and 99.5 %, respectively.

Conclusions

In contrast to benign tissues, the uptake of proven tumor lesions increases on ⁶⁸Ga-PSMA-PET/CT over time. A biphasic PET-study may lead to a better detection of tumor lesions in unequivocal findings.

     

The electrophysiological correlate of contour integration is similar for color and luminance mechanisms

Contour integration perceptually links together similarly oriented line elements hidden between randomly oriented distracters. To investigate how contour integration depends on early sensory processing, we compared the electrophysiological correlate of contour integration of elements defined by luminance (black-and-white) or isoluminant color (red-and-green) contrasts. Detection performance for color- and luminance-defined contours (both open and closed) was matched. Detectable contours elicited a negative shift over posterior electrodes starting 220 ms after stimulus onset. The shift occurred for both color and luminance contrasts, even when possible luminance artifacts in red-and-green stimuli were masked. This indicates a common physiological processing stream for orientation-based contour integration of red-and-green and black-and-white elements.     

Effects of irrelevant stimulus orientation on visually guided grasping movements

The present study investigated the effects of irrelevant stimulus orientation on visually guided grasping movements. Participants had to grasp a rectangular object at either the ends or the sides, depending on the color of a visual stimulus. In this task, correspondence between stimulus orientation and object orientation (stimulus-object congruency) and correspondence between stimulus orientation and hand orientation (stimulus-hand congruency) varied independently. Two experiments, with different sets of object orientations, revealed a consistent pattern of results. In particular, there were significant effects of stimulus-hand congruency, suggesting that perceiving an object activates congruently oriented hand movements. However, stimulus-object congruency had no effects, indicating that participants did not benefit from a preactivation of object orientation in the present task. The pattern of congruency effects implies that the cognitive representation, which is affected by irrelevant visual information, entails only those object or response features that are needed to select and control a response.     

Tolerogenic effect of fiber tract injury: reduced EAE severity following entorhinal cortex lesion

Despite transient, myelin-directed adaptive immune responses in regions of fiber tract degeneration, none of the current models of fiber tract injuries evokes disseminated demyelination, implying effective mechanisms maintaining or re-establishing immune tolerance. In fact, we have recently detected CD95L upregulation accompanied by apoptosis of leukocytes in zones of axonal degeneration induced by entorhinal cortex lesion (ECL), a model of layer-specific axonal degeneration. Moreover, infiltrating monocytes readily transformed into ramified microglia exhibiting a phenotype of immature (CD86+/CD80−) antigen-presenting cells. We now report the appearance of the axonal antigen neurofilament-light along with increased T cell apoptosis and enhanced expression of the pro-apoptotic gene Bad in cervical lymph nodes after ECL. In order to test the functional significance of such local and systemic depletory/regulatory mechanisms on subsequent immunity to central nervous system antigens, experimental autoimmune encephalomyelitis was induced by proteolipid protein immunization 30 days after ECL. In three independent experiments, we found significantly diminished disease scores and infiltrates in lesioned compared to sham-operated SJL mice. This is consistent with a previous meta-statistical analysis (Goodin et al. in Neurology 52:1737–1745, 1999) rejecting the O-hypothesis that brain trauma causes or exacerbates multiple sclerosis. Conversely, brain injuries may involve long-term tolerogenic effects towards brain antigens. Leman Mutlu, Christine Brandt, Jon D. Laman, and Ingo Bechmann have contributed equally.     

Psychosocial work environment of hospital workers: validation of a comprehensive assessment scale

BACKGROUND: Studies have shown that adverse workplace factors can increase the risk of ill-health in hospital workers, but more comprehensive measures of the psychosocial work environment are needed. OBJECTIVES: To test a comprehensive and theory-based psychosocial work environment questionnaire and analyze associations with mental health in a sample of Danish hospital workers. DESIGN AND PARTICIPANTS: Questionnaire-based cross-sectional study with 343 female employees from a large Danish hospital, including patient care workers (nurses, nurse assistants, midwives) and laboratory technicians. METHODS: The psychosocial work environment was measured with 14 scales from the Copenhagen psychosocial questionnaire, version I, covering three main areas: demands at work, work organization and interpersonal relations at work. We further measured self-rated mental health and sociodemographic and employment characteristics of the participants. Cronbach's alphas, analyses of covariance, one-sample t-tests, partial correlations and linear regression models were used to analyze data. RESULTS: Of the 14 work psychosocial workplace scales 12 showed a satisfactory internal consistency (alpha>0.70). Patient care workers had more quantitative, emotional and cognitive demands (all p-values <0.001), higher work pace (p<0.001) and more role conflicts (p=0.01) than laboratory technicians, but also better work organization, including more influence at work, better possibilities for development and a higher meaning of work (all p-values <0.001). Both patient care workers and laboratory technicians had substantially higher scores on the demand scales and lower scores on the influence at work scale than the general Danish working population. Further analyses showed that high levels of demands at work and low levels of work organization and problematic interpersonal relations at work were associated with lower self-rated mental health. CONCLUSION: The Copenhagen psychosocial questionnaire is a suitable instrument to measure the psychosocial work environment of hospital workers. The comprehensive assessment of the psychosocial work environment helps tailoring interventions to the specific needs of different occupational groups.