Diagnostic Approach to Macrocephaly in Children

Macrocephaly affects up to 5% of the pediatric population and is defined as an abnormally large head with an occipitofrontal circumference (OFC) >2 standard deviations (SD) above the mean for a given age and sex. Taking into account that about 2–3% of the healthy population has an OFC between 2 and 3 SD, macrocephaly is considered as “clinically relevant” when OFC is above 3 SD. This implies the urgent need for a diagnostic workflow to use in the clinical setting to dissect the several causes of increased OFC, from the benign form of familial macrocephaly and the Benign enlargement of subarachnoid spaces (BESS) to many pathological conditions, including genetic disorders. Moreover, macrocephaly should be differentiated by megalencephaly (MEG), which refers exclusively to brain overgrowth, exceeding twice the SD (3SD—“clinically relevant” megalencephaly). While macrocephaly can be isolated and benign or may be the first indication of an underlying congenital, genetic, or acquired disorder, megalencephaly is most likely due to a genetic cause. Apart from the head size evaluation, a detailed family and personal history, neuroimaging, and a careful clinical evaluation are crucial to reach the correct diagnosis. In this review, we seek to underline the clinical aspects of macrocephaly and megalencephaly, emphasizing the main differential diagnosis with a major focus on common genetic disorders. We thus provide a clinico-radiological algorithm to guide pediatricians in the assessment of children with macrocephaly.

Performance of Lettuce (Lactuca Sativa L.) Genotypes with Respect to Morphological, Yield and Quality Traits at Two Localities of Nepal

Lettuce is cultivated as minor crop in Nepal. However, people are becoming more health conscious in these days and demand for salad is increasing in food. The demand of lettuce is also gradually increasing but relatively few farmers are involved in this crop due to the lack of high-yielding and good quality genotypes. The research was conducted at two locations of Nepal; Kavre and Kaski with the aim of evaluating the performance of seven different hybrid lettuce genotypes in terms of its morphology, yield, and quality. The research was laid out on Randomized Complete Block Design with three replications at each location. Two types of lettuce were used on the research i.e. head type and leaf type. Among the head type, genotype Iceberg performed better with more plant spread (51 cm), head diameter (14.7 cm) and yield (738.4 g at Kavre and 725.8 g at Kaski) than other head type lettuce genotypes and among leaf type variety Green Oak was recorded with highest numbers of leaves (67 at Kavre and 40 at Kaski) and yield (572.3 g at Kavre and 641.9 g at Kaski). So, among head type lettuce genotypes Iceberg performed better as this had better plant spread, large head diameter, more yield and sweet flavor. Among leaf type genotypes Variety Green Oak was found most suitable for Nepali Market as this variety had highest number of leaves and yield among leaf type lettuce genotypes.

Perinatal Exposure of Bisphenol A Differently Affects Dendritic Spines of Male and Female Grown-Up Adult Hippocampal Neurons

Perinatal exposure to Bisphenol A (BPA) at a very low dose may modulate the development of synapses of the hippocampus during growth to adulthood. Here, we demonstrate that perinatal exposure to 30 μg BPA/kg per mother’s body weight/day significantly altered the dendritic spines of the grownup rat hippocampus. The density of the spine was analyzed by imaging of Lucifer Yellow-injected CA1 glutamatergic neurons in adult hippocampal slices. In offspring 3-month male hippocampus, the total spine density was significantly decreased by BPA exposure from 2.26 spines/μm (control, no BPA exposure) to 1.96 spines/μm (BPA exposure). BPA exposure considerably changed the normal 4-day estrous cycle of offspring 3-month females, resulting in a 4∼5 day estrous cycle with 2-day estrus stages in most of the subjects. In the offspring 3-month female hippocampus, the total spine density was significantly increased by BPA exposure at estrus stage from 2.04 spines/μm (control) to 2.25 spines/μm (BPA exposure). On the other hand, the total spine density at the proestrus stage was moderately decreased from 2.33 spines/μm (control) to 2.19 spines/μm (BPA exposure). Thus, after the perinatal exposure to BPA, the total spine density in males became lower than that in females. Concerning the BPA effect on the morphology of spines, the large-head spine was significantly changed with its significant decrease in males and moderate change in females.

Prevalence of groin pain after primary dual-mobility total hip arthroplasty

Background: Instability remains a challenging problem following total hip arthroplasty (THA). Dual-mobility (DM) components are used with increasing frequency to mitigate this potential complication. As has been shown with larger metal-on-metal (MoM) THA, the larger size femoral head may pose an increased risk of groin pain. This study aims to evaluate the prevalence of groin pain following primary DM THA compared to other THA constructs. Methods: We identified 190 primary THAs (183 patients) performed with DM components at a single academic institution from 2008 to 2017. We retrospectively reviewed standardised patient questionnaires and the electronic medical record to determine the prevalence of groin pain. DM patients were compared to historical controls of 39 MoM hip resurfacing, 26 large-head MoM THA, and 217 conventional THA. Mean age was 64 years, 58% were female, mean body mass index was 30 kg/m2, and mean follow-up was 3.5 years (range 2–8 years). Results: The prevalence of groin pain in patients with DM components was 5%, similar to the prevalence reported by patients with conventional THA (7%). There was a decreased prevalence of groin pain in DM patients compared to hip resurfacing (18%) and MoM THA (15%). Among the 9 DM patients with groin pain, 1 was treated with iliopsoas injection, and 1 underwent radiofrequency ablation of the articular nerve. Conclusions: This study documents a relatively low prevalence of groin pain among primary DM THA patients. This is comparable with historical controls of conventional THA and decreased compared to hip resurfacing and large head MoM THA.

On-scalp magnetoencephalography for childhood epilepsies

Magnetoencephalography (MEG) is an established method to investigate epilepsy. Current MEG systems house hundreds of cryogenic sensors in a rigid, one-size-fits-all helmet, which results in several limitations, particularly in children. On-scalp MEG based on optically-pumped magnetometers (OPMs) may alleviate these limitations.We report on five children (5–11 years old) with self-limited focal (n=3) or structural (n=2) epilepsy who underwent cryogenic (102 magnetometers) and on-scalp (32 OPMs) MEG. We compared the two modalities for the detection and localization of interictal epileptiform discharges (IEDs).We identified IEDs in all children with comparable sensor topographies for both MEG devices. IED amplitudes were 2.3-4.8 times higher with on-scalp MEG and signal-to-noise ratio (SNR) was also 27-60% higher with on-scalp MEG in all but one patient with large head movement artifacts. The neural source of averaged IEDs was located at about 5 mm (n=3) or higher (8.3 mm, n=1; 15.6 mm, n=1) between on-scalp and cryogenic MEG.Despite limited number of sensors and scalp coverage, on-scalp MEG detects IEDs in epileptic children with higher SNR than cryogenic MEG. This technology, which is in constant development, should become a reference in the diagnostic workup of epilepsy and replace cryogenic MEG in the near future.

Dual-Mobility Cups in Primary Total Hip Arthroplasty

Dual-mobility cups (DMCs) were introduced in France more than 40 years ago and are increasingly used not only in hip revision but also primary hip arthroplasty. Due to a simulated large-head articulation and increased jumping distance, DMCs can contribute to a high range of motion in the hip joint and reduce the risk of instability. Numerous studies have reported low dislocation rates and high survival rates in the mid-term follow-up. Nevertheless, long-term data, especially on primary hip replacement, remain limited, and the effect of recent designs and material innovations is still unclear. Therefore, primary DMCs are mainly proposed in patients at high risk for dislocation (i.e. pelvitrochanteric insufficiency, compromised spinopelvic mobility, neuromuscular disorders, obesity and femoral neck fractures). Based on a review of recently published studies referring to these indications, the current study discusses the advantages and disadvantages of DMCs.

Factors Affecting the Penetration of Niosome into the Skin, Their Laboratory Measurements and Dependency to the Niosome Composition: A Review

Skin, the most significant protective organ in the body, may face serious problems, including cancer, infectious diseases, etc., requiring different drugs for the treatment. However, most of these drugs have poor chemical and physical stability, and insufficient penetration through the skin layers. In recent years, with the development of nanotechnology, it has been possible to load a variety of drugs into nanocarriers, to effectively targeted drug delivery. The unique structure of niosome presents an effective novel drug delivery system with the ability to load both hydrophilic and lipophilic drugs, having many potential therapeutic applications including skin treatment. However, surveying and discussing these recent, rapidly growing reported studies, along with their theoretical principals, are required for the full understanding and exploring the great potential of this approach in skin diseases and cosmetic treatments. To this aim, an emphasis has been given to the factors affecting the penetration of niosome into the skin and their laboratory measurements and dependency on the niosome composition. In sum, longer tail surfactants for storing hydrophobic drugs and intracellular passing and surfactants with a large head group for penetrating hydrophilic drugs are more suitable. Cholesterol and oleic acid are commonly used lipids to gain more stability and permeability, respectively. The ionic component in the niosome interrupts cellular connectivity, thus making it more permeable, but it may cause relative cell toxicity. Herbal oils have been used in the structure to make the nanoparticles elastic and allow them to pass through pores without changing the size of the particles.

Grammatonotus bianchi, a new species of splendid perch (Percoidei: Callanthiidae) from Myanmar, northeastern Indian Ocean

A new splendid perch, Grammatonotus bianchi sp. nov. is described on the basis of two specimens (45.9–68.7 mm SL) collected at 184 m depth in the Andaman Sea off the coast of Myanmar during bottom surveys conducted by the R/V Dr Fridtjof Nansen in 2018. The new species can be distinguished from all congeners by its large head (37.7–38.6% SL), large orbit (14.4–15.3% SL), caudal-fin shape, and fresh coloration. A key to Indian Ocean species of Grammatonotus is provided.

Comparison of the long-term cause of failure and survivorship of four hundred and twenty seven metal-on-metal hip arthroplasties: resurfacing versus large head total hip arthroplasty

Introduction Comparison of mid- to long-term cause of failure and survivorship of metal-on-metal (MoM) resurfacing hip arthroplasty (RHA) and large head total hip arthroplasty (THA) remains sparse. This study aimed to identify and compare the cause of failure and survivorship of MoM RHA and THA at a minimum ten year follow-up. Methods Four hundred twenty-seven MoM hip arthroplasties (286 THA and 141 RHA) were retrospectively analyzed at a mean follow-up of 13 ± three years. Causes of failure were reported as MoM specific (i.e., adverse reaction to metal debris (ARMD) and painful hip with ion elevation) or MoM non-specific (i.e., fracture, infection, and dislocation). Chromium (Cr) and cobalt (Co) ion levels and Co/Cr ratio were compared. Survivorship was compared according to the cause of failure with revision as the endpoint. Results The rate of ARMD was significantly higher in THA (OR = 2.9 [95%-CI: 1–7]; p = 0.02). No significant difference was detected in failure rate due to other causes between the two groups (p = 0.2–0.9). Ion levels and Co/Cr ratio were both significantly higher in THA (p < 0.01). Survivorship was significantly lower in THA compared to RHA at ten years [89% (95%-CI: 85%–91%) vs 96% (95%-CI: 91%–98%); p = 0.01] and 15 years [73% (95%-CI: 67%–78%) vs 83% (95%-CI: 73%–90%); p = 0.01]. Conclusion RHA survivorship was significantly higher at any time point. Failure rate due to ARMD was significantly higher in THA while no significant difference in other causes of failure was observed between the two groups. This result emphasizes the role of fretting corrosion at the head-neck junction (i.e., trunnionosis) with significantly higher ion levels and Co/Cr ratio dissociation in THA.

Anesthesia Management in Achondroplasia: A Case Report

Achondroplasia is the result of a mutation in the gene encoding the type 3 receptor for a fibroblast growth factor. This abnormality results in malformation endochondral ossification. Achondroplasia is characterized by disproportionately short stature, lumbar lordosis, large head, midface hypoplasia, short hands, and normal cognitive development. Our report is about a 28-year-old patient with achondroplasia who underwent surgery for correction of kyphosis due to spinal canal stenosis. In this present case we study management anesthesia.