Frontal Sinusitis Management: Intact Ethmoidal Bulla Technique Vs Ethmoidal Bullectomy

Introduction Conventional functional endoscopic sinus surgery (FESS) for frontal sinusitis treatment involves ethmoidal bullectomy, that is associated with damage to the surrounding structures. These complications can be overcome by minimally invasive FESS anterior to the ethmoidal bulla that allows ease in locating the sinus ostium, eliminating risk of injury to anterior skull base and nearby structures. This study aims to compare the efficacy of ethmoidal bullectomy versus intact ethmoidal bulla technique as an adjunct to FESS in frontal sinusitis management. Materials and Methods Forty patients, clinically and radiologically diagnosed with frontal sinusitis, were randomly divided into 2 groups: Group A (n=20; treated with FESS keeping the ethmoidal bulla intact) and Group B (n=20; treated using FESS with ethmoidal bullectomy). After detailed history and clinico-radiological examinations, diagnostic nasal endoscopy was performed, followed by FESS. Pre- and post-operative endoscopic and clinical assessment was done using Modified Lund-Kennedy Endoscopy (MLKE) Score and Sino-Nasal Outcome Test-22 (SNOT-22) Questionnaire, respectively. Data was analyzed using software R version 3.6.3. Results Significant reductions in SNOT-22 (clinical improvement) and MLKE scores (endoscopic improvement) were seen within the groups from baseline to each follow-up visit and between the successive recall visits (p<0.001). The SNOT-22 and MLKE scores were insignificant at any visit between the groups, along with age distribution, gender and intra-operative complications (p>0.05). Complications were seen only in Group B. Conclusion Both, ethmoidal bullectomy and intact ethmoidal bulla technique, when used as adjuncts to FESS, showed similar improvements in frontal sinusitis patients. However, bullectomy was associated with greater risk of intra-operative complications.

Germinal centers in human lymph nodes contain reactivated memory B cells

To reveal migration trails of antigen-responsive B cells in lymphoid tissue, we analyzed immunoglobulin (Ig)M-VH and IgG-VH transcripts of germinal center (GC) samples microdissected from three reactive human lymph nodes. Single B cell clones were found in multiple GCs, one clone even in as many as 19 GCs. In several GCs, IgM and IgG variants of the same clonal origin were identified. The offspring of individual hypermutated IgG memory clones were traced in multiple GCs, indicating repeated engagement of memory B cells in GC reactions. These findings imply that recurring somatic hypermutation progressively drives the Ig repertoire of memory B cells to higher affinities and infer that transforming genetic hits in non-Ig genes during lymphomagenesis do not have to arise during a single GC passage, but can be collected during successive recall responses.

Does Hypnotic Amnesia Dissipate with Time?

Two interrelated experiments investigated the hypothesis that hypnotic amnesia dissipates “spontaneously” over time. After the administration of a hypnotic amnesia suggestion for a previously learned word list, Retest subjects in Experiment 1 received two successive recall challenges before cancellation of the suggestion. Delay subjects received only one challenge. It occurred at the same time that Retest subjects received their second challenge. No differences in amount of amnesia were found between the Delay trial and either of the Retest trials, thereby failing to provide support for the dissipation hypothesis. Experiment 2 manipulated subjects' expectations concerning the amount of amnesia typically shown on a second challenge. Subjects in the “Remember More” or “Remember Less” conditions were led to believe that they would recall either more or less critical material on the second amnesia challenge. Both Retest (no expectancy) and Remember More subjects recalled significantly more words on the second challenge than on the first. However, a significantly greater proportion of Remember More subjects than Retest subjects showed recall increments on the second challenge. Remember Less subjects showed no significant difference in the amount recalled on the two challenges. These results do not support the dissipation hypothesis of hypnotic amnesia. Instead, they are consistent with theoretical accounts of amnesia as a strategic enactment carried out by subjects in response to the unfolding social demands of the testing situation.

Retention as a Function of Successive Recall Trials following Original Learning

2 experiments, using paired adjectives, examined the effect of successive recall trials (SRC) that occurred immediately after OL on retention. Retention was measured after 0-, 24-, and 48-hr. retention intervals. The first experiment varied SRC trials (0 vs 10) following OL, and retention interval (0 vs 24 hr.). Exp. II extended the first by increasing the amount of post-OL SRC (0, 10, and 20 trials) and by increasing the retention interval (24 vs 48 hr.). Both experiments measured retention over 10 SRC trials. Correct recall was facilitated by post-OL SRC and increased during SRC trials after 24- and 48-hr. retention intervals. The results suggest that both associative and warm-up processes operate during SRC.

Auditory Prompting in Assessing Availability of Responses in Recall

A measurement procedure was described for assessing response-availability in a quantitatively continuous fashion, based upon the use of auditory prompts and the assumption that the greater the amplitude of prompting required the less available is the response. Experimental data showed the signal-to-noise ratio of auditory prompts required for recall was inversely related to the number of practice trials. Those items which Ss never correctly anticipated during training required a higher prompting level than those which had been anticipated at least once. Successive recall opportunities without prompting did not improve the level of recall.