Navigational area of the cranio-orbital foramen and its significance in orbital surgery

The cranio-orbital foramen (COF) is located on the lateral wall of the orbit. It is a potential source of hemorrhage during deep lateral orbital dissection, since it functions as an anastomosis between the lacrimal artery and the middle meningeal artery. The aim of this study was to guide and facilitate the surgical procedures in the orbit, so as to determine a navigational area and the precise location of the COF and to standardize certain anatomical marks. The navigational area of the COF and topographical features were studied in 75 craniums with presented COF. 33 bilateral main COFs, 41 (18 on the right, 23 on the left) unilateral main COFs at the main cranium and 19 accessory COFs were studied for their navigational features on the orbit. The distances between the COF and the fronto-zygomatic suture, supraorbital notch, lateral angle of the superior orbital fissure (SOF) and Whitnall’s tubercle were measured. The mean distance of the COF from the fronto-zygomatic suture, supraorbital notch, lateral angle of the SOF and Whitnall’s tubercle was 26.3, 37.3, 92 and 27.1 mm, respectively. For the navigational area signs of the COF, areas of the orbit that form the transversal and vertical lines are generated on the reference points. Whilst the upper outer area of the orbit contains a potential bleeding risk, the bottom section of the outer column is identified as safe for the surgical operations of the lateral orbital wall. The fronto-zygomatic suture and Whitnall’s tubercle are recommended as the most reliable navigational landmarks for identifying the COF. Hence, the transversal and vertical orientation of the COF should be mastered by the surgeons reconstructing the anterior base of the skull and the orbit.     

Risk Factors of Germinal Matrix Intraventricular Hemorrhage in Premature Infants

Objective

To determine whether some clinical parameters can be used to predict the hemorrhage and whether the relationship between these clinical variables and the grades of hemorrhage is linear.

Methods

A total of 230 premature infants, born at a gestational age less than 34 weeks were retrospectively reviewed. Germinal matrix-intraventricular hemorrhage (GM-IVH), the grade of the hemorrhage, and clinical data were assessed with a checklist. Variables were analyzed by using Mann Whitney U and Fisher’s exact tests and then multiple logistic regression analysis was used to evaluate the independent risk factors.

Findings

Resuscitation, gestational age, hypotension, multiple birth, and birth weight were found to be independent risk factors. We determined non-linear relationship between the grades of hemorrhage and the clinical parameters. But when we classified hemorrhages as grade 1, grade 2-3 and grade 4, the relationships were found linear.

Conclusion

Premature infants who had resuscitation, low gestational age, hypotension, multiple birth, and low birth weight are more likely to have GM-IVH. The relationship between the clinical variables and the grades of GM-IVH does not seem to be linear.     

Pseudomonas aeruginosa triggers CFTR-mediated airway surface liquid secretion in swine trachea

Cystic fibrosis (CF) is an autosomal recessive genetic disorder caused by mutations in the gene encoding for the anion channel cystic fibrosis transmembrane conductance regulator (CFTR). Several organs are affected in CF, but most of the morbidity and mortality comes from lung disease. Recent data show that the initial consequence of CFTR mutation is the failure to eradicate bacteria before the development of inflammation and airway remodeling. Bacterial clearance depends on a layer of airway surface liquid (ASL) consisting of both a mucus layer that traps, kills, and inactivates bacteria and a periciliary liquid layer that keeps the mucus at an optimum distance from the underlying epithelia, to maximize ciliary motility and clearance of bacteria. The airways in CF patients and animal models of CF demonstrate abnormal ASL secretion and reduced antimicrobial properties. Thus, it has been proposed that abnormal ASL secretion in response to bacteria may facilitate the development of the infection and inflammation that characterize CF airway disease. Whether the inhalation of bacteria triggers ASL secretion, and the role of CFTR, have never been tested, however. We developed a synchrotron-based imaging technique to visualize the ASL layer and measure the effect of bacteria on ASL secretion. We show that the introduction of Pseudomonas aeruginosa and other bacteria into the lumen of intact isolated swine tracheas triggers CFTR-dependent ASL secretion by the submucosal glands. This response requires expression of the bacterial protein flagellin. In patients with CF, the inhalation of bacteria would fail to trigger ASL secretion, leading to infection and inflammation.The human airway is normally protected from injury caused by microbial colonization and viral infection by a complex immune defense system. The cornerstone of airway defense is mucociliary clearance. Particles, including bacteria, are captured in mucus and removed by an efficient mucociliary clearance mechanism. Airway host defense is compromised in individuals with cystic fibrosis (CF), whose lungs are thus prone to chronic bacterial infections, frequently with Pseudomonas aeruginosa, and inflammation that may eventually cause lung tissue damage and respiratory failure (1, 2). The events leading from cystic fibrosis transmembrane conductance regulator (CFTR) gene mutation to airway disease are incompletely understood, but accumulating evidence suggests that CF airway disease results from abnormal microbial clearance (3, 4).Although chronic inflammation is a major aspect of CF lung disease, recent data show that the initial consequence of CFTR mutation is impaired ability to eradicate bacteria. In previous studies, lungs from animal models of CF (F508del and CFTR^−/− pigs) (5, 6) did not eradicate bacteria as effectively as lungs from WT littermates before the development of inflammation (3, 4). These results suggest that impaired bacterial elimination is the pathogenic event that initiates a cascade of inflammation and pathology in CF lungs (4).The failure to clear bacteria likely results from abnormal airway surface liquid (ASL) secretion and properties (6–10). The ASL consists of a layer of mucus that traps inhaled particles and a periciliary liquid layer that keeps the mucus an optimum distance from the underlying epithelia to maximize ciliary mobility (10, 11). The mucus layer is a complex mixture of water, salts, gel-forming mucins, and antimicrobial compounds that helps inactivate, kill, and trap pathogens and facilitates mucociliary clearance (10, 11). In CF airways, both the bacteria-killing properties and ASL secretion are abnormal (3, 9). The airway liquid produced by CFTR^−/− swine has weaker bactericidal properties compared with that produced by WT littermates, owing to abnormal pH (3, 4). In addition, human CF airways, 1-d-old CF piglets, newborn CFTR^−/− ferrets, and CFTR^−/− mice fail to respond to stimulatory signals that normally elicit strong ASL secretion (6–9). Consequently, it has been proposed that abnormal secretion of fluid and mucin in response to bacterial infection may contribute to the pathogenesis of CF lung disease (7–10, 12–15); however, the central questions of whether bacteria trigger ASL secretion in the airways, and the role of CFTR in such a process, have not been explored previously, owing to the lack of a suitable experimental technique.We have developed a novel synchrotron-based method to measure the height of the ASL layer covering the epithelium of intact, isolated swine trachea. We show that the introduction of P. aeruginosa into the lumen of intact isolated swine tracheas triggers CFTR-dependent ASL secretion by the submucosal glands. This is a local response that affects only the glands in close proximity to the bacteria and requires expression of the bacterial protein flagellin. We also show that Staphylococcus aureus and Haemophilus influenzae trigger CFTR-dependent ASL secretion, indicating that this response is not unique to P. aeruginosa. In patients with CF, the inhalation of bacteria would fail to trigger ASL secretion by submucosal glands, facilitating infection and inflammation.     

MicroRNAs bind to Toll-like receptors to induce prometastatic inflammatory response

MicroRNAs (miRNAs) are small noncoding RNAs, 19-24 nucleotides in length, that regulate gene expression and are expressed aberrantly in most types of cancer. MiRNAs also have been detected in the blood of cancer patients and can serve as circulating biomarkers. It has been shown that secreted miRNAs within exosomes can be transferred from cell to cell and can regulate gene expression in the receiving cells by canonical binding to their target messenger RNAs. Here we show that tumor-secreted miR-21 and miR-29a also can function by another mechanism, by binding as ligands to receptors of the Toll-like receptor (TLR) family, murine TLR7 and human TLR8, in immune cells, triggering a TLR-mediated prometastatic inflammatory response that ultimately may lead to tumor growth and metastasis. Thus, by acting as paracrine agonists of TLRs, secreted miRNAs are key regulators of the tumor microenvironment. This mechanism of action of miRNAs is implicated in tumor-immune system communication and is important in tumor growth and spread, thus representing a possible target for cancer treatment.     

An unusual co-presentation of rhinolithiasis and squamous cell carcinoma in the nasal cavity

Rhinoliths are nasal stones that result from mineralisation of salts around an endogenous or exogenous nidus within the nasal cavity. They are uncommon nasal masses and usually unilateral and single, situated in the floor of the nose. The patient typically presents with nasal obstruction, facial pain and foul-smelling nasal secretion. To the best of our knowledge, the occurrence of squamous cell carcinoma with rhinolithiasis has not been previously reported in the English-language literature. In this article, we present a 63-year-old man, who had unilateral rhinolithiasis with squamous cell carcinoma within the nasal cavity.     

Investigation of the incidence of stylohyoid ligament calcifications with panoramic radiographs

Aim: This study examined and classified patients who were treated at the Faculty of Dentistry at Ankara University Dentistry to determine the incidence of different types of stylohyoid ligament calcification (SLC) using panoramic radiographs. In addition, it also assessed the possible causative symptoms and Eagle’s syndrome in cases of styloid process elongation. Methods: The study consisted of 2000 patients (1161 females and 839 males), aged 3–88 years, who were treated at our clinic. The panoramic radiographs were evaluated as part of this study. Results: Panoramic radiography examination revealed SLC in 1350 patients. Both‐sided (right and left), type 1 SLC was observed in 345 patients, while types 2–4 were found in 203, 418, and 384 patients, respectively. Conclusion: The incidence of SLC was found to be higher in female patients when compared to male patients. In addition, calcifications were seen more often at age 50–59 years, and the incidence of calcification was found to increase with age. Two Eagle’s syndrome cases were diagnosed among a total of 2000 patients. Finally, it was determined that the incidence of calcified stylohyoid ligament is higher in patients with systemic diseases.