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Trichotillomania is a form of impulsive disorder characterized by repetitive, deliberate, and irresistible pulling of one’s own hair resulting in traumatic alopecia that is commonly seen in children. It has a fluctuating course that waxes and wanes in association with a stressful or emotional event. It produces non-scarring alopecia at the onset and if not addressed on time, it may lead to permanent scarring alopecia. In this article, we report a case series of trichotillomania with a review of the literature. [ABSTRACT FROM AUTHOR]

Objective: Severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) causing coronavirus disease 2019 (COVID‑19) is highly contagious. The use of other barrier techniques, in addition to personal protective equipment (PPE), to limit aerosolization and protect against contamination may also be helpful. Design: This is a prospective, randomized, single‑blind, comparative study to compare the efficacy of aerosol box with the Mayo trolley containment setup during intubation. Materials and Methods: The two setups were compared for ease and time taken for intubation, restriction of hand movement, difficulty in accessing equipment, difficulty in railroading of endotracheal tube (ETT) over a bougie, and general satisfaction of operator during intubation using the C‑MAC video laryngoscope. The mean time taken for endotracheal intubation (ETI) was compared using the unpaired t‑test, and the rest of the categorical variables were presented as proportions and percentages. Results: The mean time taken for ETI using the Mayo trolley was 42.6 seconds as compared to 54.5 seconds with an aerosol box. The operator was more satisfied with the Mayo trolley setup. Conclusion: The Mayo trolley containment setup is an inexpensive and readily available alternative to the aerosol box in any setting, with a lesser time taken to intubation and lesser restriction of hand movement, easy accessibility of equipment, and easy railroading of ETT over a bougie. [ABSTRACT FROM AUTHOR]

Intraductal papilloma of the breast is a rare benign tumour. The polypoid lesions arising from the nipple surface include papillomas and fibroepithelial stromal polyps. These lesions must be distinguished from malignant nipple lesions, such as Paget's disease of the nipple or malignant breast conditions involving the nipple. Solitary papillomas (solitary intraductal papillomas) are single tumours that often grow in the large milk ducts near the nipple. They are a common cause of clear or bloody nipple discharge, especially when it comes from only one breast, and can be felt as a small lump behind or next to the nipple. Papillomas may also be found in small ducts in areas of the breast farther from the nipple. Multiple papillomas, which are growths that are less prone to generate nipple discharge, were present in this case. In papillomatosis, there are very small areas of cell growth within the ducts, but they aren't as distinct as papillomas are. In order to distinguish between these disorders, a thorough clinical examination and imaging are essential. This case report describes a 36-year-old female who presented with swelling from the left nipple. Sonography of the left breast revealed a dilated duct in the left retro-areolar region with a focal isoechoic component within the duct {American College of Radiology Breast Imaging Reporting and Data System (ACR BI-RADS 4B)}. The patient underwent core excision of the duct, and histopathological analysis confirmed the diagnosis of papilloma with changes of adenosis without atypia. [ABSTRACT FROM AUTHOR]

Hematohidrosis is a rare disease characterized by blood exudation from the intact skin or mucosa. It occurs mostly in healthy adolescents as an unusual reaction to anxiety. It has a benign course but must be known to avoid unnecessary family concerns and laboratory tests. A case was reported in a 14-year-old boy, its differential diagnosis was discussed and a diagnostic algorithm was proposed. [ABSTRACT FROM AUTHOR]

Lumbar incisional hernia is an uncommon complication that affects the abdominal wall integrity, accounting for approximately 3.5% of all cases. It typically occurs following open nephrectomy or aortic aneurysm repair surgeries. Although rare, lumbar hernias can lead to discomfort, aesthetic issues, or even intestinal obstruction. In extremely rare cases, lumbar herniation of the liver can occur. Here, the authors present a case of a 60-year-old female patient with liver herniation through a lumbar incisional hernia and a history of pyelolithotomy for renal calculi. The authors performed an open hernia repair with meshplasty. Lumbar incisional hernias are rare and still difficult to manage. Computed tomography is the diagnostic method of choice in the evaluation of the parietal wall defect to choose the appropriate therapeutic management. Surgical management modalities are still poorly codified, with no precise recommendations, and this is probably due to the relative rarity of the cases. [ABSTRACT FROM AUTHOR]

Foreign body retention in the neck may be either traumatic or iatrogenic. Penetrating neck injuries with retained bodies are critical, as the neck serves as a passage for structures essential to life. Therefore, prompt detection and retrieval of the foreign body are paramount in preventing mortality. Here, authors present a case in which a successful surgical retrieval was performed without any postprocedural complications, despite the patient presenting relatively late after the injury. In this case report, a 23-year-old male labourer presented with a right-sided neck swelling two months after a workplace injury involving a shattered metal plate. Imaging confirmed a 15x5 mm hyperdense metallic object penetrating the sternocleidomastoid muscle. Successful open exploration extracted a 1.5 cm metallic shard at the C6 vertebral level, with no major vessel or airway damage. Postoperatively, the patient exhibited no movement restrictions, highlighting the atypical presentation of a retained metallic foreign body and the importance of timely intervention and comprehensive imaging for successful management. [ABSTRACT FROM AUTHOR]

Acne vulgaris is one of the most common disorders of the pilosebaceous unit, affecting around 9.4% of the global population. The principal or preliminary lesions of acne are comedones, which represent the follicular dilation and hypercornification secondary to androgen hypersensitivity. Although the diagnosis of acne is rarely difficult for an experienced dermatologist, we rarely come across various other dermatoses that clinically resemble comedones yet have a different pathophysiology and poorly respond to treatment. Not all disorders that have comedone-like lesions are acne. These disorders should be kept in mind when comedones occur in an unusual site, age, or pattern. This review article mainly focuses and highlights the salient features of multiple non-acne disorders that present with open comedone-like lesions along with an approach to the diagnosis and its management. [ABSTRACT FROM AUTHOR]

Myxofibrosarcoma is an aggressively malignant soft-tissue neoplasm of the upper or lower extremities that occurs in adults. At the time of diagnosis, upto 73% of cancer patients complain of varying degrees of pain. The ultimate goal of treatment is pain relief and functional recovery. The authors describe the case of a 59-year-old female patient who presented with complaints of excruciating brachialgia of the right upper limb. She had a pain score of 10 based on the Visual Analogue Scale (VAS 0-10). Her pain was initially managed conservatively with systemic analgesics but it failed to offer adequate relief. Often, there is an inadequate response to conservative treatment. These patients may benefit from various interventional modalities. Hence, epidural neurolysis with phenol was done by slowly injecting 2 mL of 6% aqueous phenol into the epidural space under Computed Tomography (CT) and fluoroscopy guidance. Upon follow-up, the patient's Visual Analog Scale (VAS) was recorded as one, morphine consumption decreased with eventual discontinuation, and paraesthesia had reduced by 50%. This patient was suffering from chronic pain, which significantly reduced her Quality of Life (QoL). The injection of phenol into the appropriate space resulted in satisfactory sustained analgesia. She did not have any sensory or motor loss. Her pain was adequately controlled by paracetamol 500 mg as needed. The patient remained pain-free for five months after the procedure but eventually succumbed to her illness. [ABSTRACT FROM AUTHOR]

Comparison of Efficacy between Dexmedetomidine and Lignocaine for Attenuation of Extubation Responses Introduction: Tracheal extubation is associated with haemodynamic changes due to reflex sympathetic discharge resulting in hypertension, tachycardia and arrhythmias. Extensive research has been done to attenuate hemodynamic responses to intubation, but a reliable technique for rapid and smooth extubation is still not fully evolved. The aim of this study was to compare the effect of single-dose dexmedetomidine and lignocaine on the attenuation of circulatory and airway response to endotracheal extubation. Methods and Materials: This observational comparative study was conducted on 60 patients in the age group of 18-65years posted for surgery under general anaesthesia. Inclusion criteria: Patients in ASA grade I or II, Hemodynamically stable patients with all routine investigations within normal limits, and duration of surgery less than 3hrs. Exclusion criteria: Pregnant Women, patients with heart diseases like congestive heart failure, coronary heart disease, any degree of heart block and cardiogenic shock, patients taking drugs like β-blockers, digoxin, α2-agonists, patient with pre-operative heart rate < 45 beats/minute, Patient with renal insufficiency and liver impairment, Patient with coagulopathy and psychiatric disorders, patient with known allergy to studied drugs and patients who required postoperative mechanical Ventilation. Clinical monitoring parameters included were non-invasive blood pressure measurement, heart rate, and oxygen saturation. Hemodynamics were recorded preoperatively (baseline), and intra-operatively (for every 15 mins), until the completion of surgery. Bolus doses of study drugs were given 10 minutes before extubation. Primary outcome namely the smoothness of extubation was noted by four-point scale 5 minutes after extubation. Secondary outcomes namely the level of sedation during suction and extubation assessed using observer assessment sedation score and airway response under direct laryngoscopy to suction noted by a five-point scale. Results: Airway response for suctioning and extubation was better in dexmedetomidine group and it was also associated with better sedation score than lignocaine group. Conclusion: Single dose of 0.75 μg/kg dexmedetomidine given 15 min before extubation provides smooth extubation when compared to lignocaine bolus. [ABSTRACT FROM AUTHOR]

This project examines how state broadband policies diffused among the states in the United States over the last 30-year period utilizing a network approach and the State Broadband Explorer dataset curated by the Pew Charitable Trusts' Broadband Access Initiate. The 621 valid state broadband policies in the U.S. (until January 2021) have been categorized into six main themes: broadband programs, competition and regulation, definitions, funding and financing, infrastructure access, and legislative intent. Our analytical strategy follows a two-step process: (1) to identify the latent network of broadband policy diffusion across the states using the NetInf algorithm; (2) to identify the nodal and dyadic variables that predict the observed diffusion flows. Our objective for the second step is to test out two competing hypotheses: the geographic learning model and the (co-)partisan learning model, which privilege geographic proximity and ideological affiliation respectively as the primary drivers of policy diffusion. The results show that geographic contiguity is the most significant factor predicting broadband policy diffusion. However, the results also identify the low salience of political factors in predicting broadband policy diffusion. Among nodal factors, only one namely divided government (of sender states) is a significant predictor of a diffusion tie. Among dyadic factors, there is one variable that supported political homophily as a significant predictor of diffusion flows (i.e., both states sharing the same type of legislative control). Partisanship appears to be much less of a driver of broadband policy in the U.S. context. • This study is the first attempt to infer the latent network of state broadband policies diffusion in the U.S. • It empirically examines state broadband policies diffusion network, identifying key innovators, facilitators, and adopters. • Geographic proximity is still the most significant factor predicting state broadband policies diffusion in the U.S. • Partisanship appears to be much less of a driver of state broadband policies diffusion in the U.S. context. [ABSTRACT FROM AUTHOR]

In a world where the firms have employed diverse strategies to market themselves, social media has been one the most important strategy. Despite its fame, there has been less information and connection between the social media activity and profitability of the banks, especially in UAE. Most research have been done in large industries and have not been focused on specific profitability metrics. This paper explains how the social media activity (SMA) affects the profitability metrics. Facebook, Instagram and twitter data from social bakers like the number of fans, posts have been taken to measure the activity. A list of 16 banks and their annual reports have been taken for 2020, to measure the effects on the performance metrics. Regression and correlation analysis have been done to find the effects of SMA on both profitability metrics and other bank performance. The result has indicated a positive and a significant effect of the SMA on these metrics. Although some parameters of the risk factors like Asset quality, liquidity risk have a negative correlation with the SMA. The research can be good tool and reference for the bank managers and administrators in UAE to understand how important SMA is to enhance bank’s performance and profitability and help them to have strong intensions to increase their customer base and have a timely update on these social media platforms. [ABSTRACT FROM AUTHOR]

Objective: To describe the characteristics of pediatric intensive care neurologists and their practice in the United States and Canada. Methods: We performed a survey-based study of child neurologists who self-identify as 'intensive care neurologists'. The survey included questions about demographics, training, pediatric neurocritical care service and job structure, teaching, academics, challenges, and views on the future of pediatric neurocritical care. Results: We analyzed 55 surveys. Most respondents were 31-50 years of age with ≤10 years of practice experience. Fifty-four percent identified as female. Most completed subspecialty training after child neurology residency. The majority practice at highly resourced centers with >45 intensive care unit beds. Respondents cover a variety of inpatient (critical and noncritical care) services, at times simultaneously, for a median of 19.5 weeks/y and work >70 hours/wk when on service for pediatric neurocritical care. The top 3 challenges reported were competing demands for time, excess volume, and communication with critical care medicine. Top priorities for the "ideal pediatric neurocritical care service" were attendings with training in pediatric neurocritical care or a related field and joint rounding with critical care medicine. Conclusion: We report a survey-based analysis of the demographics and scope of practice of pediatric critical care neurologists. We highlight challenges faced and provide a framework for the further development of this rapidly growing field. [ABSTRACT FROM AUTHOR]

Choledochal cyst is a congenital disease of the biliary tract with extrahepatic and/or intrahepatic biliary tree dilatation. There is a female majority (4:1). Controlling biliary sepsis and curing pancreatitis are prerequisites of surgery. Here, a 35-year-old female patient, came with complaints of epigastric and right upper abdominal pain for three days. On examination per abdomen was soft, non distended, right hypochondriac tenderness was present, no guarding, bowel sounds were audible. Magnetic Resonance Cholangiopancreatography (MRCP) was done which showed fusiform dilatation of Common Bile Duct (CBD), Common Hepatic Duct (CHD), right and left hepatic duct, along with mild dilatation of central intrahepatic biliary radicals (4.8-5 mm)- suggestive of choledochal cyst type IVA. Hepatico-duodenostomy was done. The entire extrahepatic biliary tree should be removed when the choledochal cyst is diagnosed whether or not symptoms are present. Despite being congenital, the condition is typically discovered in adulthood as well. The treatment of choledochal cysts has evolved. The current standard of care is cyst excision and hepaticojejunostomy. [ABSTRACT FROM AUTHOR]

Immune-mediated necrotizing myopathy is an uncommon but debilitating disease that can be triggered by drugs, toxins, or cancer. It is similar to polymyositis in presentation but is differentiated by findings on muscle biopsy. We present a case of a 79-year-old male on statin therapy who presented with proximal muscle weakness and elevated creatinine kinase (CK) levels. He had a confirmatory muscle biopsy for immune-mediated necrotizing myopathy. Unfortunately, the patient's condition eventually escalated, involving respiratory and esophageal muscles in spite of prompt diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Context: Lung transplantation (LT) is now being performed for end-stage lung and heart-lung disease in a few centers in India. Experience in multidetector computed tomography (MDCT) evaluation of posttransplant complications is currently limited and evolving. Aims: This study analyses the early experience in our center regarding the imaging features of complications following LT with clinical outcome correlation and identify the role of MDCT. Methodology: A retrospective study of patients who underwent LT and had MDCT imaging from January 2017 to March 2019 was performed. There were 22 patients in this period whose clinical course and CT scans were studied. Results: The complications encountered include pleural effusions, atelectasis, bronchostenosis, and reperfusion injury. Rare complications included pulmonary thromboembolism and rejection. The accuracy of computed tomography (CT) imaging in airway evaluation was high but was limited in characterization of consolidation as either infective or noninfective. Conclusions: CT is the noninvasive imaging modality of choice in evaluating chronic rejection, airway complications such as bronchostenosis and pulmonary thromboembolism. Clinical, laboratory, and biopsy correlation are needed to diagnose infection or acute rejection, both of which can present with consolidation. Temporal evaluation of events is critical. Familiarity and awareness by the radiologist are crucial for good clinical outcome. [ABSTRACT FROM AUTHOR]

This paper examines the audiovisual programming and production expenditures of leading US media distributors, in the context of the market entry of Over-The-Top content distributors such as Netflix. Using data from the annual SEC filings of publicly traded audiovisual production companies over 2008–2017, it seeks to provide insights into how production expenditures figure as part of a competitive strategy in the context of new media growth. The results suggest that, despite media accounts to the contrary, established audiovisual producers have not materially altered their investment strategies in response to OTT video distribution. [ABSTRACT FROM AUTHOR]

Allopregnanolone (3α5α-P), pregnanolone, and their synthetic derivatives are potent positive allosteric modulators (PAMs) of GABAA receptors (GABAARs) with in vivo anesthetic, anxiolytic, and anti-convulsant effects. Mutational analysis, photoaffinity labeling, and structural studies have provided evidence for intersubunit and intrasubunit steroid-binding sites in the GABAAR transmembrane domain, but revealed only little definition of their binding properties. Here, we identified steroid-binding sites in purified human α1β3 and α1β3γ2 GABAARs by photoaffinity labeling with [³H]21-[4-(3-(trifluoromethyl)-3H-diazirine-3-yl)benzoxy]allopregnanolone ([³H]21-pTFDBzox-AP), a potent GABAAR PAM. Protein microsequencing established 3α5α-P inhibitable photolabeling of amino acids near the cytoplasmic end of the β subunit M4 (β3Pro-415, β3Leu-417, and β3Thr-418) and M3 (β3Arg-309) helices located at the base of a pocket in the β+-α- subunit interface that extends to the level of αGln-242, a steroid sensitivity determinant in the αM1 helix. Competition photolabeling established that this site binds with high affinity a structurally diverse group of 3α-OH steroids that act as anesthetics, anti-epileptics, and anti-depressants. The presence of a 3α-OH was crucial: 3-acetylated, 3-deoxy, and 3-oxo analogs of 3α5α-P, as well as 3β-OH analogs that are GABAAR antagonists, bound with at least 1000-fold lower affinity than 3α5α-P. Similarly, for GABAAR PAMs with the C-20 carbonyl of 3α5α-P or pregnanolone reduced to a hydroxyl, binding affinity is reduced by 1,000-fold, whereas binding is retained after deoxygenation at the C-20 position. These results provide a first insight into the structure-activity relationship at the GABAAR β+-α- subunit interface steroid-binding site and identify several steroid PAMs that act via other sites. [ABSTRACT FROM AUTHOR]

Summary: Objective: We aimed to investigate the current practices guiding surgical resection strategies involving epileptogenic zones (EZs) near or in eloquent cortex (EC) at pediatric epilepsy surgery centers worldwide. Methods: A survey was conducted among 40 respondents from 33 pediatric epilepsy surgery centers worldwide on the weight assigned to diagnostic tests used to define the EZ and EC, how EC is viewed, and how surgeries are planned for foci near or in eloquent cortex. Results: A descriptive analysis was performed that revealed considerable variation in the use of diagnostic tests and resective strategies toward EZ and EC. Significance: The wide variation in strategies may contribute to undesirable outcomes characterized by poor seizure control with added deficits and underscores the need to establish best practices in pediatric epilepsy surgery. The survey data were used to formulate a set of recommendations to help minimize deficits and to report them consistently. [ABSTRACT FROM AUTHOR]

Introduction: Psoriasis is estimated to affect 0.44–2.8% of the Indian population. Moisturizers are a key adjuvant psoriasis treatment strategy, but data regarding their effectiveness, safety and compliance pattern in an Indian context are lacking. Hence, this real-world study on an intensive plant-based butter moisturizing cream (Venusia ® Max) was conducted among Indian patients with psoriasis. Methods: This was an observational, patient-reported outcomes (PRO) study in patients with psoriasis aged 18–75 years who were prescribed the cream in routine clinical practice, as per clinician's discretion, over 4 weeks. The primary outcome measure was improvement from baseline in quality of life assessed using the Dermatology Quality of Life Index (DLQI) at 4 weeks of the study period. The secondary outcome measures were improvement in dryness using the Dry Skin/Ichthyosis Area and Severity Index (DASI) score at 4 weeks, safety and compliance. The DLQI and DASI scores were recorded by the clinicians at baseline and after 2 (optional) and 4 weeks of starting the cream. Safety was assessed throughout the study. Results: The study included 400 patients from 9 outpatient dermatology centers across India. Of 400 patients, 384 completed the study. A significant reduction in both the mean DLQI score (66.7%; p < 0.001) and mean DASI score (84.6%; p < 0.001) was observed at week 4 after starting the cream vs. baseline in the overall population. Overall, the cream showed a good safety and compliance profile during the study period. There were no serious adverse events or deaths. Conclusions: The evidence from the PRO study suggests that use of the intensive plant-based butter moisturizing cream in a real-world scenario has a noticeable impact on improving the quality of life and reducing the skin dryness associated with psoriasis over 4 weeks. The moisturizing cream may serve as a valuable adjuvant treatment option for the management of psoriasis. Trial Registration Number: CTRI/2017/03/008023. Funding: Dr. Reddy's Laboratories Ltd. [ABSTRACT FROM AUTHOR]

Introduction: Although hydroxyzine is widely used for symptom relief in pruritus, its clinical safety and efficacy data in the Indian setting are scarce. We conducted a study to assess the effectiveness and tolerability of hydroxyzine in the management of Indian patients with chronic pruritus in a real-world setting. Methods: This was a prospective, observational, patient-reported outcomes (PRO) study in patients with chronic pruritus due to dermatological causes treated with hydroxyzine as per the clinician's discretion for a period of up to 12 weeks. The primary outcome was improvement in quality of life from baseline, assessed using the 10-point Dermatology Quality of Life Index (DLQI) at week 12 of the study period. Secondary outcomes were improvement in the pruritus scores (5-D itch scale) at 12 weeks, improvements in the DLQI and 5-D itch scores at 2, 4 and 8 weeks and safety. Results: The study included 400 patients (179 males, 221 females) from 7 dermatology centres across India. Of the 400 patients recruited, 391 patients completed at least 2 weeks of treatment. There was significant (p < 0.0001) improvement from baseline in the DLQI scores and 5-D itch scores at 2, 4, 8 and 12 weeks; 189/391 (48.34%) patients had symptom relief leading to early termination. Overall, the treatment was well tolerated with a total of 11 mild-to-moderate adverse events reported during the study, which included dizziness, constipation, drowsiness, dry mouth and sedation. All events resolved without any intervention. There were no serious adverse events. Conclusion: This real-world, observational, PRO study demonstrates that hydroxyzine significantly improves symptoms of pruritus and quality of life in patients with chronic pruritus due to dermatological causes over 12 weeks. Despite the sedating potential of the drug, hydroxyzine is well tolerated in real-world settings. Trial Registration: CTRI/2017/06/008847. Funding: Dr. Reddy's Laboratories. [ABSTRACT FROM AUTHOR]

Abstract This paper considers whether common national standards for determining participants' eligibility and designating service providers in the Lifeline program are preferable to a decentralized system where state utility commissions have greater influence over these program parameters. Two recent decisions of the Federal Communications Commission (FCC), a 2016 Order and its reversal in March 2017, on the designation of Eligible Telecommunications Carriers to provide broadband Lifeline service, centered on this question. Statistical analysis of program data demonstrates that state-by-state variations in enrollment may be attributed to state-level policy actions, after controlling for alternative demographic and economic explanations. This paper concludes that national standards may reduce state-by-state variations in program participation rates. Highlights • Investigates why Lifeline participation rates vary from state to state. • Uses 2012 Lifeline reforms as natural experiment to study effects of de-enrollments. • State-by-state variations in enrollment attributable to state-level policy actions. • National standards may reduce state-by-state variations in participation rates. [ABSTRACT FROM AUTHOR]

Abstract Pregnanolone and allopregnanolone-type ligands exert general anesthetic, anticonvulsant and anxiolytic effects due to their positive modulatory interactions with the GABA A receptors in the brain. Binding sites for these neurosteroids have been recently identified at subunit interfaces in the transmembrane domain (TMD) of homomeric β3 GABA A receptors using photoaffinity labeling techniques, and in homomeric chimeric receptors containing GABA A receptor α subunit TMDs by crystallography. Steroid binding sites have yet to be determined in human, heteromeric, functionally reconstituted, full-length, glycosylated GABA A receptors. Here, we report on the synthesis and pharmacological characterization of several photoaffinity analogs of pregnanolone and allopregnanolone, of which 21-[4-(3-(trifluoromethyl)-3H-diazirin-3-yl)benzoxy]allopregnanolone (21-pTFDBzox-AP) was the most potent ligand. It is a partial positive modulator of the human α1β3 and α1β3γ2L GABA A receptors at sub-micromolar concentrations. [3H]21-pTFDBzox-AP photoincorporated in a pharmacologically specific manner into the α and β subunits of those receptors, with the β3 subunit photolabeled most efficiently. Importantly, photolabeling by [3H]21-pTFDBzox-AP was inhibited by the positive steroid modulators alphaxalone, pregnanolone and allopregnanolone, but not by inhibitory neurosteroid pregnenolone sulfate or by two potent general anesthetics and GABA A R positive allosteric modulators, etomidate and an anesthetic barbiturate. The latter two ligands bind to sites at subunit interfaces in the GABA A R that are different from those interacting with neurosteroids. 21-pTFDBzox-AP's potency and pharmacological specificity of photolabeling indicate its suitability for characterizing neurosteroid binding sites in native GABA A receptors. Graphical abstract Image 1 Highlights • Three photoreactive neurosteroid modulators of GABA A R were synthesized and evaluated. • The ligand modified at the 21-position displayed strong binding. • This ligands interacts with GABA A R at a site distinct from etomidate or barbiturate site. • It photolabels predominantly β-subunit in α1β3γ2-GABA A R. • Photolabeling was strongly inhibited by other neurosteroid modulators. [ABSTRACT FROM AUTHOR]

Background: To better understand upper airway tissue regeneration, the exposed cartilage and bone at donor sites of tissue flaps may serve as in vivo “Petri dishes” for active wound healing. The pedicled nasoseptal flap (NSF) for skull‐base reconstruction creates an exposed donor site within the nasal airway. The objective of this study is to evaluate whether grafting the donor site with a sinonasal repair cover graft is effective in promoting wound healing. Methods: In this multicenter, prospective trial, subjects were randomized to intervention (graft) or control (no graft) intraoperatively after NSF elevation. Individuals were evaluated at 2, 6, and 12 weeks postintervention with endoscopic recordings. Videos were graded (Likert scale) by 3 otolaryngologists blinded to intervention on remucosalization, crusting, and edema. Scores were analyzed for interrater reliability and cohorts compared. Biopsy and immunohistochemistry at the leading edge of wound healing was performed in select cases. Results: Twenty‐one patients were randomized to intervention and 26 to control. Subjects receiving the graft had significantly greater overall remucosalization (p = 0.01) than controls over 12 weeks. Although crusting was less in the small intestine submucosa (SIS) group, this was not statistically significant (p = 0.08). There was no overall effect on nasal edema (p = 0.2). Immunohistochemistry demonstrated abundant upper airway basal cell progenitors in 2 intervention samples, suggesting that covering grafts may facilitate tissue proliferation via progenitor cell expansion. Conclusion: This prospective, randomized, controlled trial indicates that a porcine SIS graft placed on exposed cartilage and bone within the upper airway confers improved remucosalization compared to current practice standards. [ABSTRACT FROM AUTHOR]

The article discusses on the rare bleeding disorder acquired haemophilia A (AHA). The diagnosis of the disease confirms the inhibitory antibodies and low factor VIII activity detected by Bethesda assay. The disease is characterized by the production of neutralizing autoantibodies to factor VIII. The treatment of AHA can be done through immunosuppressive therapy and prohemostatic therapy.

Background: Empty nose syndrome (ENS) is a debilitating disorder thought to arise as a postsurgical phenomenon from excessive loss of nasal tissues. Affected patients often report a profound impact on all aspects of life, but the extent of this burden has not been quantified. We sought to determine the association of ENS with mental health and functional impairments. Methods: A cross‐sectional study was performed of individuals with ENS recruited from online ENS forums. ENS status was validated based on a positive 6‐item Empty Nose Syndrome Questionnaire (ENS6Q) score and sinus computed tomography imaging or supporting medical documentation. Subjects completed the ENS6Q, the 9‐item Patient Health Questionnaire (PHQ‐9) for depression, the 7‐item Generalized Anxiety Disorder questionnaire (GAD‐7), the Epworth Sleepiness Scale for daytime somnolence (ESS), the Work Productivity and Impairment questionnaire (WPAI), and the 5‐dimension EuroQol General Health State Survey (EQ‐5D‐5L). Pearson correlation analysis was performed with α = 0.05 to determine significance. Results: Fifty‐three ENS individuals were included in the study. Overall, participants reported symptoms consistent with moderate anxiety (μ = 12.7; standard deviation [SD], 5.9) and moderately severe depression warranting treatment (μ = 17.9; SD, 6.8). Participants also noted a 62% reduction in productivity at work (n = 24) and 65% in all other activities (n = 53). ENS6Q symptom severity was correlated with more severe depression (p < 0.001), anxiety (p < 0.001), overall pain/discomfort (p = 0.002), and impairment in activities of daily living (p = 0.003). Conclusion: ENS individuals carry a clinically significant psychological burden and experience marked difficulties with many activities of daily living. A multimodal approach to address the tissue loss with surgery and cognitive‐behavioral therapy for the psychological burden may provide the most optimal outcome. [ABSTRACT FROM AUTHOR]

Aim: To compare the health of 4- to 6-year-old children in out-of-home care (OOHC) in Southern Tasmania with their peers.Methods: Demographic and health data collection and prospective health assessment of all 4- to 6-year olds in OOHC in Southern Tasmania on 30 August 2011 was undertaken. Data were compared to Tasmanian and/or Australian peers.Results: A total of 109 of 129 children aged 4 to 6 years were included in the study. Time in OOHC was on average 38 (range 0-76) months. Premature birth (18%), low birthweight (20%) and congenital malformations (10%) were more common compared to peers. Antenatal exposure to illicit or abused substances (71%), alcohol (51%) and cigarettes (79%) were very high. Vertically acquired hepatitis C was diagnosed in 2% with 33% exposed. Immunisation completion was 78% compared to 92.9% of Tasmanian peers. Obesity (11% vs. 6% Tasmanian children), hearing impairment (7% vs. 1% Tasmanian children) and dental caries (61% vs. 45% Tasmanian children) were all higher than peers. Hospitalisation due to injury was more than twice that of Tasmanian peers (32.1 vs. 12.6 per 1000 per year). Developmental delay was 50% on screening. Emotional or behavioural difficulties were seen in 54%.Conclusions: Children in OOHC have high health needs. Comprehensive health assessments offer an opportunity to better identify and manage these needs. High hepatitis C exposure in utero was unexpected. This study highlights the need for comprehensive health screening assessments for all children in OOHC. OOHC clinic data can be helpful in planning broad interventions for children in OOHC. [ABSTRACT FROM AUTHOR]

Alopecia areata incognita is a particular variant of alopecia areata that presents with widespread hair loss without the classic patchy pattern. It is more frequent in the third and fourth decades and must be differentiated from female pattern hair loss and telogen effluvium. A case of diffuse alopecia areata in a 12-year-old girl simulating androgenetic alopecia and treated with tofacitinib was presented. [ABSTRACT FROM AUTHOR]

Prediction of response to erythropoietin stimulating agents (ESAs) in anemic MDS patients is often based on the Nordic score. We wished to validate the Nordic score (IWG 2006 response criteria) in a larger cohort and determine if other variables such as IPSS/IPSS-R, ferritin, LDH, and a novel European ESA response score (Santini 2013) were of prognostic importance. We analyzed 208 ESA-treated MDS patients (WHO 2008 criteria) from a prospective registry. Ninety-four and 93% had lower risk scores by IPSS (low/int - 1) and IPSS-R (low/very low), respectively. Erythroid response was achieved in 94 patients (47%); responses were similar with erythropoietin (50%) and darbepoetin (39%; p = 0.2). The Nordic and European scores were both validated on univariate analysis. Variables independently predictive of response in multivariate analysis were low-risk IPSS score (OR 0.1, p = 0.0016) and serum EPO level < 100 mIU/mL (OR 8.7, p < 0.0001). We propose a new ESA response score, consisting of (a) IPSS low score (1 point) and (b) serum EPO levels < 100 mIU/ml (2 points), yielding scores ranging from 0 to 3, with response rates varying from 17 to 81%. The Nordic score has validity but we observed lower than the expected response rates in the best risk group. Our proposed scoring system appears more discriminating but needs validation. [ABSTRACT FROM AUTHOR]

Many patients with medically refractory epilepsy now undergo successful surgery based on noninvasive diagnostic information, but intracranial electroencephalography ( IEEG) continues to be used as increasingly complex cases are considered surgical candidates. The indications for IEEG and the modalities employed vary across epilepsy surgical centers; each modality has its advantages and limitations. IEEG can be performed in the same intraoperative setting, that is, intraoperative electrocorticography, or through an independent implantation procedure with chronic extraoperative recordings; the latter are not only resource intensive but also carry risk. A lack of understanding of IEEG limitations predisposes to data misinterpretation that can lead to denying surgery when indicated or, worse yet, incorrect resection with adverse outcomes. Given the lack of class 1 or 2 evidence on IEEG, a consensus-based expert recommendation on the diagnostic utility of IEEG is presented, with emphasis on the application of various modalities in specific substrates or locations, taking into account their relative efficacy, safety, ease, and incremental cost-benefit. These recommendations aim to curtail outlying indications that risk the over- or underutilization of IEEG, while retaining substantial flexibility in keeping with most standard practices at epilepsy centers and addressing some of the needs of resource-poor regions around the world. [ABSTRACT FROM AUTHOR]

Objective: Arthroscopy for acetabular labral tears has minimal impact on pain and function in older patients, especially in the setting of concomitant osteoarthritis. Still, many physicians seek this diagnosis with MR arthrography. Our purpose is to assess the frequency of acetabular labral tears in older patients with hip pain and correlate likelihood of labral pathology with severity of osteoarthritis as visualized on conventional radiograph.Materials and Methods: From 2004 to 2013, 208 hip MRI arthrograms and corresponding radiographs on patients aged 50 years and older were identified. Age, gender, grade and location of labral tear, alpha angle, Tönnis grade, and joint space width were documented. Labral tears and alpha angle were identified and measured on MR arthrogram. Tönnis grade and joint space width were measured on radiographs.Results and Conclusions: On MR arthrography, true labral tearing was identified in 73 % of patients. There was some degree of labral pathology in 93.3 % of patients, and this increased to 100 % in patients with moderate to severe osteoarthritis, as defined by Tönnis grade 2-3 or joint space width ≤ 2 mm. There were no statistically significant correlations between labral tear grade and Tönnis grade or joint space width. Given the high frequency of labral pathology and the questionable efficacy of arthroscopic surgical intervention in older patients, MR arthrography should be primarily for those with minimal arthritis on radiograph and potential to benefit from surgery. If further imaging beyond radiographs is necessary in these patients, standard MRI may be a more appropriate imaging tool. [ABSTRACT FROM AUTHOR]

Competitive pressures created by the global market, and the demonstration of market potential in one country influences the incentives to adopt successful technologies and business models in similar countries. In this paper, we explore how mobile payment operation models might evolve in China, using the more mature Japanese and South Korean markets for comparison. Comparing existing business models in the three countries, we argue that regulation has affected both the industry structure and the vertical linkages of the different participants in the mobile payments ecosystem. We predict that rather than converging onto the mobile payment models of Japan or South Korea, the Chinese mobile payment industry is likely to see the coexistence of competing business models in the intermediate term. We attribute this to the contradictory incentives created by Chinese financial sector regulation for the participants in the mobile payments industry. [ABSTRACT FROM AUTHOR]

This comparative case study investigates the contrasting approaches to telecommunications standard-setting adopted by two developing countries, China and India, using the 3G standard as a case study. Despite facing comparable opportunities in the form of fast-growing markets, and comparable challenges in terms of meeting consumer demand and fostering industrial development, the two countries adopted sharply different standards strategies, with China investing heavily in its home-grown Time Division Synchronous Code Division Multiple Access standard, and India allowing operators to choose any international standard. In this paper, we trace the antecedents of this divergence to the different policy approaches that the two countries adopted to their respective electronics industries in the early to mid-1990s. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to investigate the utility of three-dimensional electroencephalography source imaging (3D- ESI) with low-resolution electroencephalographic data in the pediatric noninvasive presurgical evaluation, and to compare the findings with positron emission tomography ( PET) and ictal single-photon emission computed tomography (i SPECT). Methods We retrospectively selected 60 patients from a database of 594 patients who underwent excisional surgery for drug-resistant epilepsy. Patients were <18 years at time of surgery, had at least one presurgical volumetric brain magnetic resonance imaging ( MRI), and at least 1 year of outcome data. 3D- ESI was performed with NeuroScan software CURRY V.7.0. For each patient the surgical resection was planned utilizing 3D- ESI as an adjunctive tool to supplement MRI and electrocorticographic data. Our analyses addressed three critical variables: pathology (focal cortical dysplasia vs. other pathologies), imaging ( MRI negative vs. positive cases), and surgery (temporal resection vs. extratemporal and multilobar resections). We also compared the localizing utility and surgical outcome of 3D- ESI findings with PET, iSPECT, and the colocalized surgical resection. Statistical analyses were performed using the Statistical Package for the Social Sciences, Version 20. Results Mean age at surgery was 11.18 years (range 1-18 years). 3D- ESI showed a strong correlation with the surgical resection cavity (65.0%), particularly within the temporal lobe. 3D- ESI demonstrated better localization in MRI-negative cases (78.6%), which was not statistically significant. 3D- ESI also correlated with a superior surgical outcome profile compared to PET and iSPECT. Significance Our findings demonstrate that 3D- ESI data obtained with low-resolution electroencephalography achieves reasonably accurate noninvasive localization of epileptic spikes in pediatric focal epilepsy, especially in temporal lobe and MRI-negative cases, and is comparable to i SPECT and PET. Given its lesser expense and lack of radiation exposure, 3D- ESI is a useful and efficient tool for evaluating surgical candidacy in pediatric epilepsy surgery centers, particularly if PET and i SPECT are unavailable. [ABSTRACT FROM AUTHOR]

Context.--The highly invasive properties demonstrated by head and neck squamous cell carcinoma (HNSCC) are often associated with locoregional recurrence and lymph node metastasis in patients and is a key factor leading to an expected 5-year survival rate of approximately 50% for patients with advanced disease. It is important to understand the features and mediators of HNSCC invasion so that new treatment approaches can be developed. Objectives.--To provide an overview of the characteristics, mediators, and mechanisms of HNSCC invasion. Data Sources.--A literature review of peer-reviewed articles in PubMed on HNSCC invasion. Conclusions.--Histologic features of HNSCC tumors can help predict prognosis and influence clinical treatment decisions. Cell surface receptors, signaling pathways, proteases, invadopodia function, epithelial-mesenchymal transition, microRNAs, and tumor microenvironment are all involved in the regulation of the invasive behavior of HNSCC cells. Identifying effective HNSCC invasion inhibitors has the potential to improve outcomes for patients by reducing the rate of spread and increasing responsiveness to chemoradiation. [ABSTRACT FROM AUTHOR]

In the process of developing safer general anesthetics, isomers of anesthetic ethers and barbiturates have been discovered that act as convulsants and inhibitors of γ-aminobutyric acid type A receptors (GABAARs) rather than potentiators. It is unknown whether these convulsants act as negative allosteric modulators by binding to the intersubunit anesthetic-binding sites in the GABAAR transmembrane domain (Chiara, D. C., Jayakar, S. S., Zhou, X., Zhang, X., Savechenkov, P. Y., Bruzik, K. S., Miller, K. W., and Cohen, J. B. (2013) J. Biol. Chem. 288, 19343-19357) or to known convulsant sites in the ion channel or extracellular domains. Here, we show that S-1-methyl-5-propyl-5-(m-trifluoromethyl- diazirynylphenyl) barbituric acid (S-mTFD-MPPB), a photoreactive analog of the convulsant barbiturate S-MPPB, inhibits α1β3γ2 but potentiates α1β3 GABAAR responses. In the α1β3γ2 GABAAR, S-mTFD-MPPB binds in the transmembrane domain with high affinity to the γ+-β- subunit interface site with negative energetic coupling to GABA binding in the extracellular domain at the β+-α- subunit interfaces. GABA inhibits S-[3H]mTFD-MPPB photolabeling of γ2Ser-280 (γM2-15') in this site. In contrast, within the same site GABA enhances photolabeling of β3Met-227 in βM1 by an anesthetic barbiturate, R-[3H]methyl-5-allyl-5-(m-trifluoromethyl- diazirynylphenyl)barbituric acid (mTFD-MPAB), which differs from S-mTFD-MPPB in structure only by chirality and two hydrogens (propyl versus allyl). S-mTFD-MPPB and R-mTFD-MPAB are predicted to bind in different orientations at the γ+-β- site, based upon the distance in GABAAR homology models between γ2Ser-280 and β3Met-227. These results provide an explanation for S-mTFD-MPPB inhibition of α1β3γ2 GABAAR function and provide a first demonstration that an intersubunit-binding site in the GABAAR transmembrane domain binds negative and positive allosteric modulators. [ABSTRACT FROM AUTHOR]

Despite the promise of broadband to improve the lives of persons with disabilities, there are wide disparities in access and usage between disabled and nondisabled populations. This article examines ten case studies of policies and programs promoting ICT and broadband access for persons with disabilities in the leading economies of the Asia-Pacific region, in order to identify factors behind programs that succeed on the basis of effectiveness and cost efficiency. [ABSTRACT FROM PUBLISHER]

Summary: Dermatoglyphic traits which are reported to be largely determined by genes could be considered as phenotypic characterestics and if the same are expressed through generations in schizophrenic families it can be speculated to serve as genetic markers for schizophrenia. Another factor that might be influenced by genes is the age of onset of the illness in the offspring and the parent of origin. Objective: This study was aimed to elucidate the occurrence of identical finger patterns in the schizophrenic patients and their affected parents. The other objective was to assess the age of onset of the illness in them. Methods: Forty six schizophrenic patients in whom one of the parents was also affected with schizophrenia or related disorders were recruited. Of these pairs 29 were taken up for finger patterns analysis, with an equal number of control group pairs. 35 proband and parent pairs were investigated for the age of onset of the illness. Results: The frequency of occurrence of identical patterns in the right thumbs of proband and their affected mother pairs was significantly more than between the proband and their affected father pairs. Additionally, the number of identical patterns was also more in the right thumbs of proband and their affected mother pairs compared with the control group. The difference between the mean age of onset of the illness in the probands and their affected fathers was more than between the probands and their affected mothers. Conclusion: The genetic association of schizophrenic patients with the affected maternal side appear to be more stronger than with the paternal side. [ABSTRACT FROM AUTHOR]

A new reverse phase high performance liquid chromatography method has been developed for the simultaneous estimation of Etizolam and propranolol from their tablet formulation . The developed method was carried out on a C18(250x4.6mm) 5.0 µm column using a mobile phase of 0.02M sodium phosphate w/v : acetonitrile. (60:40) pH 6.5 with triethylamine. The flow rate was 1.0 ml/min with detection at 240 nm. The retention time for Etizolam 3.183 mins and for propranolol hydrochloride 4.863 mins.Etizolam and propranolol showed a linear response in the concentration range 4-50µg/mL, 4.5-50µg/mL respectively. The result of analysis have been validated statiscally and by recovery studies. The mean recoveries foµnd for Etizolam was 99.98% and for propranolol was 100.09%. The developed method was found to be simple, accurate, precise and selective for simultaneous estimation of Etizolam and propranolol Hcl in tablets. [ABSTRACT FROM AUTHOR]

Key Clinical Message: We report two, genotypically identical but phenotypically distinct cases of Schaaf‐Yang syndrome and propose the early use of Genome Sequencing in patients with nonspecific presentations to facilitate the early diagnosis of children with rare genetic diseases and improve overall health care outcomes. [ABSTRACT FROM AUTHOR]

Pituitary adenylate cyclase-activating polypeptide (PACAP) is a pleiotropic neuropeptide found at synapses throughout the central and autonomic nervous system. We previously found that PACAP engages a selective G-protein coupled receptor (PAC 1 R) on ciliary ganglion neurons to rapidly enhance quantal acetylcholine (ACh) release from presynaptic terminals via neuronal nitric oxide synthase (NOS1) and cyclic AMP/protein kinase A (PKA) dependent processes. Here, we examined how PACAP stimulates NO production and targets resultant outcomes to synapses. Scavenging extracellular NO blocked PACAP-induced plasticity supporting a retrograde (post- to presynaptic) NO action on ACh release. Live-cell imaging revealed that PACAP stimulates NO production by mechanisms requiring NOS1, PKA and Ca 2 + influx. Ca 2 + -permeable nicotinic ACh receptors composed of α7 subunits (α7-nAChRs) are potentiated by PKA-dependent PACAP/PAC 1 R signaling and were required for PACAP-induced NO production and synaptic plasticity since both outcomes were drastically reduced following their selective inhibition. Co-precipitation experiments showed that NOS1 associates with α7-nAChRs, many of which are perisynaptic, as well as with heteromeric α3*-nAChRs that generate the bulk of synaptic activity. NOS1–nAChR physical association could facilitate NO production at perisynaptic and adjacent postsynaptic sites to enhance focal ACh release from juxtaposed presynaptic terminals. The synaptic outcomes of PACAP/PAC 1 R signaling are localized by PKA anchoring proteins (AKAPs). PKA regulatory-subunit overlay assays identified five AKAPs in ganglion lysates, including a prominent neuronal subtype. Moreover, PACAP-induced synaptic plasticity was selectively blocked when PKA regulatory-subunit binding to AKAPs was inhibited. Taken together, our findings indicate that PACAP/PAC 1 R signaling coordinates nAChR, NOS1 and AKAP activities to induce targeted, retrograde plasticity at autonomic synapses. Such coordination has broad relevance for understanding the control of autonomic synapses and consequent visceral functions. [ABSTRACT FROM AUTHOR]

Propofol acts as a positive allosteric modulator of γ-aminobutyric acid type A receptors (GABAARs), an interaction necessary for its anesthetic potency in vivo as a general anesthetic. Identifying the location of propofol-binding sites is necessary to understand its mechanism of GABAAR modulation. [³H]2-(3-Methyl-3H-diaziren-3-yl)ethyl 1-(phenylethyl)-1H-imidazole-5-carboxylate (azietomidate) and R-[³H]5-allyl-1-methyl-5-(m-trifluoromethyl-diazirynylphenyl)barbituric acid (mTFD-MPAB), photoreactive analogs of 2-ethyl 1-(phenylethyl)-1H-imidazole-5-carboxylate (etomidate) and mephobarbital, respectively, have identified two homologous but pharmacologically distinct classes of intersubunit-binding sites for general anesthetics in the GABAAR transmembrane domain. Here, we use a photoreactive analog of propofol (2-isopropyl-5-[3-(trifluoromethyl)-3H-diazirin-3-yl]phenol ([³H]AziPm)) to identify propofol-binding sites in heterologously expressed human α1β3 GABAARs. Propofol, AziPm, etomidate, and R-mTFD-MPAB each inhibited [³H]AziPm photoincorporation into GABAAR subunits maximally by ~50%. When the amino acids photolabeled by [³H]AziPm were identified by protein microsequencing, we found propofol-inhibitable photolabeling of amino acids in the β3-α1 subunit interface (β3Met-286 in β3M3 and α1Met-236 in α1M1), previously photolabeled by [³H]azietomidate, and α1Ile-239, located one helical turn below α1Met-236. There was also propofol-inhibitable [³H]AziPm photolabeling of β3Met-227 in βM1, the amino acid in the α1-β3 subunit interface photolabeled by R-[³H]mTFD-MPAB. The propofol-inhibitable [³H]AziPm photolabeling in the GABAAR β3 subunit in conjunction with the concentration dependence of inhibition of that photolabeling by etomidate or R-mTFD-MPAB also establish that each anesthetic binds to the homologous site at the β3-β3 subunit interface. These results establish that AziPm as well as propofol bind to the homologous intersubunit sites in the GABAAR transmembrane domain that binds etomidate or R-mTFD-MPAB with high affinity. [ABSTRACT FROM AUTHOR]

Propofol acts as a positive allosteric modulator of γ-aminobutyric acid type A receptors (GABAARs), an interaction necessary for its anesthetic potency in vivo as a general anesthetic. Identifying the location of propofol-binding sites is necessary to understand its mechanism of GABAAR modulation. [³H]2-(3-Methyl-³H-diaziren-3-yl)ethyl 1-(phenylethyl)-1H-imidazole-5-carboxylate (azietomidate) and R-[³H]5-allyl-1-methyl-5-(m-trifluoromethyl-diazirynylphenyl)barbituric acid (mTFD-MPAB), photoreactive analogs of 2-ethyl 1-(phenylethyl)-1H-imidazole-5-carboxylate (etomidate) and mephobarbital, respectively, have identified two homologous but pharmacologically distinct classes of intersubunit-binding sites for general anesthetics in the GABAAR transmembrane domain. Here, we use a photoreactive analog of propofol (2-isopropyl-5-[3-(trifluoromethyl)-³H-diazirin-3-yl]phenol ([³H]AziPm)) to identify propofol-binding sites in heterologously expressed human α1β3 GABAARs. Propofol, AziPm, etomidate, and R-mTFD-MPAB each inhibited [³H]AziPm photoincorporation into GABAAR subunits maximally by ~50%. When the amino acids photolabeled by [³H]AziPm were identified by protein microsequencing, we found propofol-inhibitable photolabeling of amino acids in the β3-α1 subunit interface (β3Met-286 in β3M3 and α1Met-236 in α1M1), previously photolabeled by [³H]azietomidate, and α1Ile-239, located one helical turn below α1Met-236. There was also propofol-inhibitable [³H]AziPm photolabeling of β3Met-227 in βM1, the amino acid in the α1-β3 subunit interface photolabeled by R-[³H]mTFD-MPAB. The propofol-inhibitable [³H]AziPm photolabeling in the GABAAR β3 subunit in conjunction with the concentration dependence of inhibition of that photolabeling by etomidate or R-mTFD-MPAB also establish that each anesthetic binds to the homologous site at the β3-β3 subunit interface. These results establish that AziPm as well as propofol bind to the homologous intersubunit sites in the GABAAR transmembrane domain that binds etomidate or R-mTFD-MPAB with high affinity. [ABSTRACT FROM AUTHOR]

Background Detailed knowledge of the surgical anatomic landmarks of the lateral nasal wall is important for safe and successful endoscopic sinonasal surgery. We sought to determine the relationship of major landmarks to the nasolacrimal duct (NLD). Methods Twenty mid-sagittal head sections of 10 fresh frozen cadavers were studied after removal of the nasal septum. The insertion of the alar cartilage into the maxilla was taken as a fixed point and all measurements were performed in a defined axial plane at the level of the maxillary sinus natural ostium. Two surgeons independently recorded each measurement 3 times with an average of the readings used for statistical analysis. Results The overall agreement index was excellent ( r = 0.84) between the observers. At the level of maxillary ostium, the mean distance from the alar rim to the NLD was 43.05 ± 4.76 mm on the right and 41.25 ± 4.56 mm on the left. The most anterior projection of the middle turbinate head was noted to be anterior to the NLD in 70% of specimens. In positional relationship, the maxillary line was posterior to the NLD in 55%, whereas the bulla ethmoidalis and the free edge of uncinate process were uniformly posterior to the NLD in all the specimens. Conclusion This study provides useful anatomic and positional relationships between the NLD and major lateral wall landmarks. Although the maxillary line and the head of the middle turbinate are often considered useful guides to the position of the ipsilateral NLD, their spatial relationship to the NLD is not consistent. These landmarks, therefore, cannot be solely relied upon during surgery to avoid injury to the NLD. [ABSTRACT FROM AUTHOR]

Epilepsy surgery is highly successful in achieving seizure freedom in carefully selected children with drug-resistant focal epilepsy. Advances in technology have aided presurgical evaluation and increased the number of possible candidates. Many of the tests employed are resource intense, and in specific cases they may be unhelpful or have adverse effects. Some standardization of the evaluation process is thus considered timely. Given the lack of class 1 or 2 evidence defining the relative utility of each test in specific clinicopathologic cohorts, a set of expert recommendations was attempted using consensus among members of the Pediatric Epilepsy Surgery Task Force of the International League Against Epilepsy (ILAE) Commissions of Pediatrics and Diagnostics These recommendations aim to limit fringe over or underutilization of use while retaining substantial flexibility in the use of various tests, in keeping with most standard practices at established pediatric epilepsy centers. A PowerPoint slide summarizing this article is available for download in the Supporting Information section . [ABSTRACT FROM AUTHOR]

Abstract: This paper examines the contrast between China's and India's universal service policies as manifestations of the two states' differing self-conceptualizations and legitimation strategies. We examine the timeline of universal service policies in the two countries, differentiating between the territorial, demographic and layered dimensions of universal service. The analysis reveals many similarities between the two countries, as well as some differences primarily related to the mode of funding universal service programs and the lead China has taken in deploying informatization services. We identify some of the proximate causes that resulted in these policy decisions. But in addition, we also examine how universal service policies are related to contrasting models of state legitimation. [Copyright &y& Elsevier]