Search

Objective. Epilepsy is one of the most common neurological disorders and can have a devastating effect on a person’s quality of life. As such, the search for markers which indicate an upcoming seizure is a critically important area of research which would allow either on-demand treatment or early warning for people suffering with these disorders. There is a growing body of work which uses machine learning methods to detect pre-seizure biomarkers from electroencephalography (EEG), however the high prediction rates published do not translate into the clinical setting. Our objective is to investigate a potential reason for this. Approach. We conduct an empirical study of a commonly used data labelling method for EEG seizure prediction which relies on labelling small windows of EEG data in temporal groups then selecting randomly from those windows to validate results. We investigate a confound for this approach for seizure prediction and demonstrate the ease at which it can be inadvertently learned by a machine learning system. Main results. We find that non-seizure signals can create decision surfaces for machine learning approaches which can result in false high prediction accuracy on validation datasets. We prove this by training an artificial neural network to learn fake seizures (fully decoupled from biology) in real EEG. Significance. The significance of our findings is that many existing works may be reporting results based on this confound and that future work should adhere to stricter requirements in mitigating this confound. The problematic, but commonly accepted approach in the literature for seizure prediction labelling is potentially preventing real advances in developing solutions for these sufferers. By adhering to the guidelines in this paper future work in machine learning seizure prediction is more likely to be clinically relevant.

To probe the distribution of electrical properties in tumor-bearing human hepatic tissues with metastatic colorectal cancer.Electrochemical impedance spectroscopy (EIS) and a non-contact electromagnetic probe were used for distinguishing spatial heterogeneities in fresh, unfixed human hepatic tissues ex vivo from patients with metastatic colorectal cancer (CRC).Point-wise EIS measurements reported over a frequency range of 100 Hz-1 MHz showed that the interface tissue between visible tumor and normal tissue exhibits an electrically different domain (p0.05) from both normal tissue (over 100 Hz-100 kHz) and tumor tissue (over 100 Hz-1 MHz). Observations of the microstructure on tumor-bearing hepatic tissue from hematoxylin and eosin stained images and the equivalent circuit modelling were used to validate the impedance measurements and characterize previously unidentified interfacial domain between normal and tumor tissue. Lastly, in a proof of concept study, a new in-house designed non-contact electromagnetic probe, as opposed to the invasive EIS measurements, was demonstrated for distinguishing tumor tissue from the normal tissue in a hepatic tissue specimen from a patient with metastatic CRC.EIS measurements, correlated with histological observations, show potential for mapping electrical properties in tumor-bearing human hepatic tissue.

We report on an innovative, fabric-based conformable, and easily fabricated electroceutical wound dressing that inhibits bacterial biofilm infections and shows significant promise for healing chronic wounds. Cyclic voltammetry demonstrates the ability of the electroceutical to produce reactive oxygen species, primarily HOCl that is responsible for bacterial inhibition. In vitro investigation with the lawn biofilm grown on a soft tissue mimic assay shows the efficacy of the dressing against both Gram-positive and Gram-negative bacteria in the biofilm form. In vivo, the printed electroceutical dressing was utilized as an intervention treatment for a canine subject with a non-healing wound due to a year-long persistent polymicrobial infection. The clinical case study with the canine subject exhibited the applicability in a clinical setting with the results showing infection inhibition within 11 days of initial treatment. This printed electroceutical dressing was integrated with a Bluetooth® enabled circuit allowing remote monitoring of the current flow within the wound bed. The potential to monitor wounds remotely in real-time with a Bluetooth® enabled circuit proposes a new physical biomarker for management of infected, chronic wounds. [2020-0129]

This report outlines a case in which cranial gunshot trauma was suspected, but a large portion of the cranium was not recovered from the scene, so the precise nature and etiology of the fractures could not be determined with certainty. Scanning electron microscopy (SEM) coupled with energy dispersive x-ray spectroscopy (SEM-EDS) is widely accepted as a reliable method for detecting gunshot residue (GSR) on the hands of shooters and on fleshed remains, and experimental research has shown that the technique is applicable to skeletal remains. Therefore, SEM-EDS was utilized to analyze several cranial fragments and a control fragment from a thoracic vertebra for gunshot residue. The technique enables the examination of particle morphology and elemental composition of the inorganic compound. Barium, antimony, and lead were detected on four of the five cranial fragments, confirming the presence of gunshot residue. The fifth fragment had barium and lead, but no antimony. No trace elements were detected on the control fragment from the thoracic vertebra. SEM analysis of the bone surface revealed the presence of characteristic GSR spherical deposits on three of the fragments. The combined presence of signature trace elements and spherical surface deposits on the cranial fragments are consistent with the presence of gunshot residue. The cause of death was certified as disruptive head trauma, and given the circumstances of the case the manner of death was certified as homicide. The SEM-EDS analysis confirmed and supported the pathologist’s and anthropologist’s assessment of the circumstances surrounding the death. KEYWORDS: forensic anthropology, forensic science, gunshot wounds, skeletal trauma, gunshot residue, scanning electron microscopy, energy-dispersive x-ray spectroscopy

Humans tend to learn complex abstract concepts faster if examples are presented in a structured manner. For instance, when learning how to play a board game, usually one of the first concepts learned is how the game ends, i.e. the actions that lead to a terminal state (win, lose or draw). The advantage of learning end-games first is that once the actions which lead to a terminal state are understood, it becomes possible to incrementally learn the consequences of actions that are further away from a terminal state - we call this an end-game-first curriculum. Currently the state-of-the-art machine learning player for general board games, AlphaZero by Google DeepMind, does not employ a structured training curriculum; instead learning from the entire game at all times. By employing an end-game-first training curriculum to train an AlphaZero inspired player, we empirically show that the rate of learning of an artificial player can be improved during the early stages of training when compared to a player not using a training curriculum., Comment: Draft prior to submission to IEEE Trans on Games. Changed paper slightly

We present a method for designing and optimizing an in-house designed electromagnetic probe for distinguishing morphological differences in biological tissues. The probe comprises concentric multi-wound coils, the inner being the primary coil and the outer being the detector coil. A time-varying voltage is imposed on the primary coil, resulting in an induced current in the detector coil. For highly conductive samples, eddy currents are induced in the sample and inductively couple with the electromagnetic probe. However, in weakly conducting samples, the primary coupling mechanism is found to be capacitive though there can be a non-negligible inductive component. Both the mutual inductive coupling and the capacitive coupling between the sample and the probe are detected as a change in the induced voltage of the detector coil using lock-in detection. The induced voltage in the detector coil is influenced more by the morphological structure of the specimen rather than by changes in electrical conductivity within different regions of the sample. The instrument response of the lock-in amplifier is also examined with simulated input voltage signals to relate its output to specific changes in inductive and capacitive coupling, in order to relate sample characteristics to a single voltage output. A circuit element model is used to interpret the experimental measurements. It is found that the sensitivity of the measurement for a given set of probe characteristics (resistances, inductances, and capacitances) can be optimized by adding a small amount of capacitance in the external circuit in parallel with the detector coil. Illustrative measurements are presented on animal (porcine and bovine) tissue and on human liver tissue containing a metastatic tumor to demonstrate the capabilities of the probe and measurement method in distinguishing different tissue types despite having similar electrical conductivities. Since biological tissues are multi-scale, heterogeneous materials comprising regions of differing conductivity, permittivity, and morphological structure, the electromagnetic method presented here has the potential to examine structural variations in tissue undergoing physical changes due to healing or disease.

Point-wise ex vivo electrical impedance spectroscopy measurements were conducted on excised hepatic tissue from human patients with metastatic colorectal cancer using a linear four-electrode impedance probe. This study of 132 measurements from 10 colorectal cancer patients, the largest to date, reports that the equivalent electrical conductivity for tumor tissue is significantly higher than normal tissue (p < 0.01), ranging from 2–5 times greater over the measured frequency range of 100 Hz–1 MHz. Difference in tissue electrical permittivity is also found to be statistically significant across most frequencies. Furthermore, the complex impedance is also reported for both normal and tumor tissue. Consistent with trends for tissue electrical conductivity, normal tissue has a significantly higher impedance than tumor tissue (p

We interpret three strands of social movement theory (social threat, opportunity structure, and resource mobilization) to understand religious congregations' political activity related to same-sex marriage. Using a unique, national data set from the 2008 presidential election, we show the importance of the anti-same-sex marriage discursive opportunity structure (DOS) for facilitating, and occasionally constraining, congregational political activity. Other theoretical factors influence congregations under limited, although important, conditions. Our research develops a nuanced understanding of congregations' roles in social movements that prioritize institutionalized political activity and expands DOS theory in relation to local religious organizations.

We present a method to induce electric fields and drive electrotaxis (galvanotaxis) without the need for electrodes to be in contact with the media containing the cell cultures. We report experimental results using a modification of the transmembrane assay, demonstrating the hindrance of migration of breast cancer cells (SCP2) when an induced a.c. electric field is present in the appropriate direction (i.e. in the direction of migration). Of significance is that migration of these cells is hindered at electric field strengths many orders of magnitude (5 to 6) below those previously reported for d.c. electrotaxis and even in the presence of a chemokine (SDF-1α) or a growth factor (EGF). Induced a.c. electric fields applied in the direction of migration are also shown to hinder motility of non-transformed human mammary epithelial cells (MCF10A) in the presence of the growth factor EGF. In addition, we also show how our method can be applied to other cell migration assays (scratch assay) and by changing the coil design and holder, that it is also compatible with commercially available multi-well culture plates.

We have developed a methodology we call ROMA (representational oligonucleotide microarray analysis), for the detection of the genomic aberrations in cancer and normal humans. By arraying oligonucleotide probes designed from the human genome sequence, and hybridizing with “representations” from cancer and normal cells, we detect regions of the genome with altered “copy number.” We achieve an average resolution of 30 kb throughout the genome, and resolutions as high as a probe every 15 kb are practical. We illustrate the characteristics of probes on the array and accuracy of measurements obtained using ROMA. Using this methodology, we identify variation between cancer and normal genomes, as well as between normal human genomes. In cancer genomes, we readily detect amplifications and large and small homozygous and hemizygous deletions. Between normal human genomes, we frequently detect large (100 kb to 1 Mb) deletions or duplications. Many of these changes encompass known genes. ROMA will assist in the discovery of genes and markers important in cancer, and the discovery of loci that may be important in inherited predispositions to disease.

The oxygen evolution reaction (OER), the first step of the two-step electrolysis process used to split water into hydrogen and oxygen, is plagued by poor kinetics and requires catalysts to limit energy loss and improve efficiency. Precious metals and their alloys (Au, Pt, Ir) exhibit excellent catalytic behavior, but high material costs and concerns about the environmental impact caused by their production have led to intense investigation of period four transition metal oxides (manganese, iron, cobalt, and nickel oxides) as catalyst for OER.[1] In addition to their natural abundance and high electrochemical activity, manganese oxides represent a wide library of chemical compositions and morphologies that are stable in aqueous solutions allowing them to be utilized as OER catalysis. Tunnel manganese oxides are a family of manganese oxides composed of MnO6 octahedra that form tunnels around stabilizing ions and water molecules. α-MnO2 nanowires with square structural tunnels formed by two MnO6 octahedra on each side and potassium ions inside the tunnels were shown to have superior performance among various structurally diverse manganese oxide. [2]Additionally, high aspect ratio nanowire morphologies with diameters less than 100 nm and lengths on the order of microns, exhibiting high surface area, are attractive for catalytic applications. In this work, we investigated post synthesis treatment approaches for improving catalytic activity of α-MnO2 nanowires in OER. More specifically, acid leaching and cobalt doping were applied to modify α-MnO2 nanowires synthesized by hydrothermally treating a KMnO4 and NH3Cl solution at 150oC for 50 hours. During the acid leaching process, samples were dispersed in concentrated nitric acid for 72 hours under vigorous mixing. Such treatment is believed to produce vacancies in potassium, manganese, and oxygen crystallographic sites (Figure 1.a).[3,4] Cobalt ions were introduced into the crystal structure via hydrothermal treatment of 20 mg of α-MnO2 nanowires in 5 ml of Co(NO3)2 melt at elevated temperatures (T= 80-100oC, Figure 1.a). Electrochemical activity of Co-doped α-MnO2 nanowires (α-CoxMnO2 x=0.02;0.03;0.05), was evaluated in comparison with the electrochemical activity of pristine material (Figure 1.b). In addition, the effect of acid leaching and cobalt doping in conjunction was examined for α-MnO2 nanowires containing 0.02 mol % of cobalt (α-Co0.02MnO2, AL-α-Co0.02MnO2) and compared to that of α-MnO2 and AL-α-MnO2 nanowires (Figure 1.c). Synthesized materials were tested as OER catalysts using a Pine Research Instrumentation modulated speed rotator (MSP). Tests were performed at 1600 RPM in 0.1 M KOH electrolyte over a voltage window of 1 to 1.9 V vs RHE. Active electrodes were fabricated via ink casting of a 1:1 active material: carbon black ink prepared in ethanol with a Nafion® binding agent and mass loaded to have 0.05 mg of active material. Acid leaching for 72 hours resulted in the increase of electrocatalytic activity up to 26.6 mA/cm2 compared to that of pristine α-MnO2 nanowires (21.6 mA/cm2, Figure 1.c). For Co-doped samples, catalytic performance improved linearly with the increase of the cobalt content. The highest OER performance of 48.7 mA/cm2 was exhibited by α-Co0.05MnO2, which is a 125% increase as compared to the activity of pristine α-MnO2 (Figure 1.b). The defect rich sample (AL-α-Co0.02MnO2) that underwent both post synthesis treatments showed an increased activity when compared to materials individually modified by acid leaching or Co-doping (Figure 1.c). For example, cobalt doped 72-hour acid leached samples exhibited current densities of 35.0 mA/cm2, 20% higher than doped samples of the same chemical composition (29.4 mA/cm2). The increased catalytic activity of the acid-leached α-MnO2 was attributed to newly formed oxygen vacancies and a change in oxidation state of manganese. In manganese oxides, an average manganese oxidation state of +3.5 has been shown to result in the highest catalytic activity [5]. Acid leaching is believed to reduce the average oxidation state of manganese in α-MnO2. Co-doping potentially could further favorably affect the oxidation state of manganese while simultaneously creating additional active site for the oxygen evolution reaction leading to more efficient electrochemical water splitting. Acid leaching and cobalt doping both separately and in tandem were observed to have positive impacts on the OER catalytic activity of environmentally friendly and cost-efficient α-MnO­2 catalysts while also suggesting that they could be applied to other catalytically active tunnel manganese oxides. Yi Cheng et al. Progress in Natural Science: Materials International. 25, 6. 2015 545-553. Frey, Carolin E et al. Chemistry – A European Journal21 (42) 2015 14958-68. Yuan, YF, et al. NATURE COMMUNICATIONS, vol. 7, 2016, 13374 Lee, Jin-Hyon, et al. Energy & Environmental Science, 5, 11, 2012, 9558-9565 S.Y. Lee MS thesis. University of Freiburg, 2015. Figure 1

Background: Current guidelines discourage aortic stenosis (AS) evaluation by direct pressure measurement if echocardiography (echo) is adequate. However several studies show sizable discrepancies between echo and catheterization (cath) lab measurements. We wanted to investigate the impact of both

An expanded GGGGCC repeat in C9orf72 is the most common genetic cause of frontotemporal dementia and amyotrophic lateral sclerosis. A fundamental question is whether toxicity is driven by the repeat RNA itself and/or by dipeptide repeat proteins generated by repeat-associated, non-ATG translation. To address this question we developed in vitro and in vivo models to dissect repeat RNA and dipeptide repeat protein toxicity. Expression of pure repeats in Drosophila caused adult-onset neurodegeneration attributable to poly-(glycine-arginine) proteins. Thus expanded repeats promoted neurodegeneration through neurotoxic proteins. Expression of individual dipeptide repeat proteins with a non-GGGGCC RNA sequence showed both poly-(glycine-arginine) and poly-(proline-arginine) proteins caused neurodegeneration. These findings are consistent with a dual toxicity mechanism, whereby both arginine-rich proteins and repeat RNA contribute to C9orf72-mediated neurodegeneration.

Analysis of the genetic changes in human tumors is often problematical because of the presence of normal stroma and the limited availability of pure tumor DNA. However, large amounts of highly reproducible “representations” of tumor and normal genomes can be made by PCR from nanogram amounts of restriction endonuclease cleaved DNA that has been ligated to oligonucleotide adaptors. We show here that representations are useful for many types of genetic analyses, including measuring relative gene copy number, loss of heterozygosity, and comparative genomic hybridization. Representations may be prepared even from sorted nuclei from fixed and archived tumor biopsies.

Measurement of the electromagnetic (EM) properties of tissue such as electrical conductivity, permittivity, and eddy current characteristics can be used in clinical medicine for characterizing and distinguishing soft tissue morphology. Such measurements can yield complementary information to what can be obtained using analysis with an optical microscope. An example is the assessment of margins during the surgical resection of occult tumors. In current practice, the surgeon relies on pre-operative imaging modalities, sight and palpation to locate and attempt to fully resect the tumor(s). Frozen section pathological assessment offers the only other resource available to the surgeon for margin analysis, but it is incomplete because only a small fraction of the resected tissue is examined and it is often not feasible to wait for the results of the frozen section analysis before completing the surgery. This paper describes a characterization and imaging method based on variations in electromagnetic tissue properties to assess the surgical margins of resected tissues. This is noteworthy because accurate margin assessment has been shown to significantly improve long term patient outcomes[1].Copyright © 2013 by ASME

Current guidelines discourage aortic stenosis (AS) evaluation by direct pressure measurement if echocardiography is adequate due to potential stroke risk reported in old studies. Patients with both low gradient (Gradient < 40 mm HG) and/or flow (Stroke Volume Index SVI < 35) with normal ejection

Real-time and non-invasive imaging of tissues and detection of diseases on millimeter to centimeter scales can be useful in some clinical applications such as determination of margins during cancer surgery and image-guided pathology. In this paper, we describe an eddy current measurement method for characterizing soft tissues. The device consists of a pair of concentrically wound coils, a primary coil excited by a low frequency ( Experimental measurements on porcine muscle tissue examine the effects of varying tissue macrostructure and conductivity on the eddy current detector. Three sets of experiments are presented. First, muscle samples cut into different sized grids simulating the restriction of eddy current domains show that morphological structure has a strong influence on the detector signal. Second, eddy current measurements made on porcine muscle samples at varying degrees of dehydration show that as conductivity decreases, eddy current signals also decrease. Finally, measurements on porcine muscle samples soaked overnight in deionized water complement the dehydration experiments and confirm detector voltage and phase changes decrease with decreasing conductivity.

In current clinical practice, a patient usually undergoes a diagnostic computer tomography (CT) scan for evaluation of specific presenting symptoms. The presence of cancer is then confirmed by a diagnostic biopsy or at surgical exploration by histopathologic analysis. Suspicious finding on the diagnostic CT scan may be followed by an 18F FDG (Fluorodeoxyglucose radiolabeled with 18F) positron emission tomography (PET) scan. In a majority of cases, these pre-operative CT and PET scans are used to identify the approximate location of the tumor(s) before surgical intervention. Surgery remains the most effective means of treating solid malignancies despite advances in chemotherapy and radiation therapy [1].Copyright © 2011 by ASME

Objective.Glucocorticoid-induced osteoporosis is the most common iatrogenic form of osteoporosis. We evaluated the efficacy and safety of once-weekly bisphosphonate therapy for prevention and treatment of bone loss in patients on glucocorticoid therapy.Methods.We conducted a 12-month, multicenter, randomized, double-blind, placebo-controlled trial with 114 and 59 patients in the treatment and placebo arms, respectively. Participants were stratified according to the duration of prior oral glucocorticoid therapy at randomization. Participants received alendronate 70 mg once weekly (ALN OW) or placebo; all received supplemental daily calcium (1000 mg) and 400 IU vitamin D. Clinical evaluations were performed at baseline, 3, 6, 9, and 12 months.Results.At 12 months, there was a significant mean percentage increase from baseline in the ALN OW group for lumbar spine (2.45%), trochanter (1.27%), total hip (0.75%), and total body (1.70%) bone mineral density (BMD). Comparing ALN OW versus placebo at 12 months, a significant treatment difference for the mean percentage change from baseline was observed for lumbar spine (treatment difference of 2.92%; p ≤ 0.001), trochanter (treatment difference 1.66%; p = 0.007), and total hip (treatment difference 1.19; p = 0.008) BMD. Biochemical markers of bone remodeling also showed significant mean percentage decreases from baseline.Conclusion.Over 12 months ALN OW significantly increased lumbar spine, trochanter, total hip, and total body BMD compared with baseline among patients taking glucocorticoid therapy. A significant treatment difference versus placebo was observed at 12 months for the mean percentage change from baseline for lumbar spine, trochanter, and total hip.

The carbapenem antibiotic ertapenem has been shown to be safe, well tolerated and effective in treating adults with complicated urinary tract infection, skin and soft-tissue infection and community-acquired pneumonia. In this study, we evaluated ertapenem for treating these infections in children in a randomised, double-blind, active-controlled clinical trial. The primary outcome was the incidence of clinical and laboratory drug-related serious adverse events (AEs). Children were randomised in a 3:1 ratio (ertapenem:ceftriaxone) stratified by index infection and age to receive ertapenem or ceftriaxone; 303 children received ertapenem and 100 children received ceftriaxone. The median duration of parenteral therapy was 4 days for both treatments. The most commonly reported drug-related clinical AEs during parenteral therapy were diarrhoea (5.9% ertapenem, 10% ceftriaxone), infusion site erythema (3% ertapenem, 2% ceftriaxone) and infusion site pain (5% ertapenem, 1% ceftriaxone). One child in each group reported a serious drug-related clinical AE. No serious drug-related laboratory AEs were reported. In children aged 3 months to 17 years, ertapenem was well tolerated and had a comparable safety profile to that of ceftriaxone.

Although vitamin D supplementation is a fundamental part of osteoporosis treatment, many patients do not regularly take adequate amounts. A once-weekly (OW) alendronate (ALN) preparation that includes 2800 IU of vitamin D3 in a single combination tablet (ALN+D2800) is available for treating patients and ensuring intake of vitamin D that is consistent with existing guidelines. This randomized, double-blind study extension was conducted to evaluate the safety and tolerability of ALN+D2800 and ALN+D2800 plus an additional 2800 IU vitamin D3 single tablet supplement (ALN+D5600) administered for 24 weeks in men and postmenopausal women with osteoporosis previously treated OW for 15 weeks with either ALN or ALN+D2800. The primary endpoint was the proportion of participants who developed hypercalciuria (defined as a 24-hour urine calcium >300 mg in women or >350 mg in men and an increase of >25% versus randomization baseline) at week 39. The key secondary endpoint was the proportion of participants with vitamin D insufficiency (serum 25(OH)D

We describe a method to make physical maps of genomes using correlative hybridization patterns of probes to random pools of BACs. We derive thereby an estimated distance between probes, and then use this estimated distance to order probes. To test the method, we used BAC libraries from Schizzosaccharomyces pombe. We compared our data to the known sequence assembly, in order to assess accuracy. We demonstrate a small number of significant discrepancies between our method and the map derived by sequence assembly. Some of these discrepancies may arise because genome order within a population is not stable; imposing a linear order on a population may not be biologically meaningful.

In this work, we explore the use of representations in conjunction with DNA microarray technology to measure gene copy number changes in cancer. We demonstrate that arrays of DNA probes derived from low-complexity representations can be used to detect amplifications, deletions, and polymorphic differences when hybridized to representations of genomic DNA. The method is both reproducible and verifiable, and is applicable even to microscopic amounts of primary tumors. We also present a mathematical model for array performance that is useful for designing and understanding DNA microarray hybridization protocols. The future applications and challenges of this approach are discussed.

Control over the current during electrophoretic drawing of continuous fibers of single-walled carbon nanotubes (SWCNTs) is shown to be critical in producing long fibers with specific diameters. In the process, as-produced SWCNTs are first dispersed in N,N-dimethylformamide (DMF) by sonication. A tungsten probe tip is then immersed in the SWCNT∕DMF solution, and a dc bias is applied between the tip and another electrode at the bottom of the beaker containing the solution. After a dark cloud several millimeters in diameter develops around the tip, the electrode is withdrawn to form continuous macroscopic fibers of SWCNTs. The resulting fiber length and diameter are found to be principally determined by the magnitude of the current. Under constant voltage conditions where the current is allowed to vary, the fibers are short (several millimeters long) and their diameters vary drastically along their lengths. Of significance is the fact that when the current is maintained at constant values, fibers several cen...

Management of penetrating wounds of the mandible caused by civilian firearms differs from military injuries primarily because of the difference in missile velocity. Most reports are based upon war-time experience. Since civilian gunshot wounds of the mandible have been recorded in isolated case reports, a review of our experience managing 20 patients is reported. All fractures were initially managed by closed reduction reserving open reduction for those cases that failed to respond to closed reduction. Eighteen had displaced fractures and two were undisplaced. Only two patients required open reduction, both had the displaced type. Airway obstruction occurred in six out of 20 and were associated with injuries to the floor of the mouth or tongue. Five of these patients received tracheotomy while one, in whom a tracheostomy was not performed, died. Only one patient developed infection. Osteomyelitis in this case responded to antibiotics.