Cryobiology

Local cryostimulation acutely preserves maximum isometric handgrip strength following fatigue in young women Publication date: April 2019 Source: Cryobiology, Volume 87 Author(s): Massimo De Nardi, Sara Silvani, Piero Ruggeri, Livio Luzi, Antonio La Torre, Roberto Codella Abstract Several types of cryostimulation have been recently proposed to rapidly lower skin temperature therefore gaining a possible neuro/muscular recovery after strenuous exercise or, more generally, in sports. Local cryostimulation may be a viable and relatively portable tool to obtain physiological benefits in previously-efforted muscular districts. However, cohesive and standardized cryo-exposure protocols are lacking as well as the righteous procedure to efficaciously combine duration, treatments and temperature in relation to desirable effects on muscular strength. In this randomized-controlled study, fifty young women were tested for maximum isometric handgrip strength, before and after exhausting contractions. Following the fatiguing protocol, the intervention group (cryo, n = 25, 24.7 ± 2.5 years, BMI 21.7 ± 1.8 kg/m2) underwent a 6-min local cryostimulation (−160 °C) on the extensor-flexor muscles of the dominant arm, while control-matched peers sat rested in a thermo-neutral room (22 ± 0.5 °C). Handgrip tests were repeated at baseline (T0), after cryostimulation (T1), and 15 min after T1 (T2). Throughout the protocol, the AUC of the strength performance was significantly higher in the cryo- compared to control group (P = 0.006). In particular, following fatigue and cryostimulation, the cryo group preserved higher strength at T1 with respect to controls (26.8 ± 2.8 vs 23.9 ± 2.8 kg, Bonferroni's post-hoc, P < 0.01). Likewise, ventral and dorsal temperature, recorded with a thermal camera, were lower in cryo- than control group (P < 0.0001). In conclusion, a brief session of local cryostimulation may acutely preserve maximal isometric force in young women following a fatiguing protocol. These findings may have implications in orchestrating strategies of district muscular recovery.

Circulating soluble intercellular adhesion molecule-1 (sICAM-1) after exercise-induced muscular damage: Does the use of whole-body cryostimulation influence its concentration in blood? Publication date: April 2019 Source: Cryobiology, Volume 87 Author(s): F. Bieuzen, C. Hausswirth, B. Dugué Abstract As soluble intercellular adhesion molecule-1 (sICAM-1) was recently hypothesized to be a key player in the mechanisms involved in exercise-induced muscular damage (EIMD), we investigated its circulating concentration changes in athletes before and after EIMD with and without the use of whole-body cryostimulation (WBC; 3 min at −110 °C) at the exercise end and repeated once a day during 4 days. We previously characterized plasma specimens from 11 endurance athletes who performed twice (randomized crossover design) strenuous running leading to EIMD, followed by passive recovery or WBC. Muscle soreness and inflammatory response were observed in both cases but the use of WBC induced a significant reduction in these responses (PlosOne 2011; 6:e22748). We now found that sICAM-1 concentration slightly increased in both circumstances and remained elevated for 24 h (p < 0.01). However, no significant WBC effect was observed concerning sICAM-1 changes indicating that this compound is not a major player both in EIMD and WBC physiological impacts.

A preliminary study on the use of jenny colostrum to improve quality in extenders for freezing donkey semen Publication date: April 2019 Source: Cryobiology, Volume 87 Author(s): Cristina Álvarez, Victoria Luño, Noelia González, Lydia Gil Abstract Sperm quality in donkeys (Equus asinus) after freezing thawing is still considered lower than that from other animals, including horses. The aim of this study was to test a new freezing extender supplemented with jenny colostrum on donkey sperm. After thawing, we evaluated sperm motility by means of computer-assisted analysis, viability by SYBR-14 and propidium iodide (PI), membrane functional integrity by HOS-test and acrosome integrity by isothiocyanate conjugated with peanut agglutinin (FITC-PNA) and PI. Ejaculates were collected from five fertile Donkeys. Sperm samples were pooled, diluted and cryopreserved into three experimental extender groups: BotuCrio®, lactose-extender supplemented with egg yolk (20%) and lactose-extender supplemented with jenny colostrum (20%). The results demonstrated that lactose-jenny colostrum samples displayed significantly higher values in almost all parameters evaluated (p < 0.05) compared with the other two extenders after thawing (BotuCrio® and lactose-egg yolk based extender, respectively) –Total Motility, Viability, HOS test, VCL, VSL and VAP. Acrosome status, LIN, STR and WOB despite showing lower values, none of them were statistically significant (p > 0.05). In conclusion, the extender containing jenny colostrum can be successfully used for donkey semen crypreservation and could effectively improve donkey sperm qualities after freezing -thawing. Graphical abstract Schema of the experimental design.

Production of mouse fetuses using spermatozoa exposed temporarily to high temperature or continuously to room temperature after freeze-drying in Na+-free/K+-rich EGTA buffer Publication date: April 2019 Source: Cryobiology, Volume 87 Author(s): Hirokazu Kusakabe Abstract Present study aimed to determine to what extent freeze-dried spermatozoa were able to withstand high-temperature conditions: transient increase in storage temperature and long-term exposure to room temperature. Mouse spermatozoa were freeze-dried in EGTA/Tris-HCl buffered solution alkalinized using KOH (K-ETBS, pH 7.7), and then stored for up to 7 months at 4 °C or 25 °C. After 2 months' storage, some of the 4°C-stored spermatozoa were exposed to 40 °C for 1 week or 1 month, then again stored at 4 °C for the remaining storage period. Following storage, rehydrated spermatozoa were injected into mouse oocytes. The resulting zygotes were assessed for chromosome damage, in vitro development up to the blastocyst stage, and post-implantation development to normal fetuses on day 18 of gestation. In storage at 4 °C, one-week exposure to 40 °C had no adverse effect on the chromosome integrity and developmental competence compared to non-exposure to 40 °C (continuous storage at 4 °C). In contrast, one-month exposure to 40 °C caused an increasing level of chromosome damage (36%, P < 0.05) and reduced frequencies of blastocysts (54%, P < 0.05) and normal fetuses (36%, P < 0.05) compared to the frequencies obtained by continuous storage at 4 °C (15%, 82% and 52%, respectively). Storage at 25 °C resulted in accumulation of chromosome damage (27%, P < 0.05), leading to decreased blastocyst formation (63%, P < 0.05). But, the frequency of normal fetus (44%) was not significantly different from that obtained by continuous storage at 4 °C. Consequently, mouse spermatozoa freeze-dried in K-ETBS withstood temporary exposure to 40 °C for 1 week. Chromosome damage accumulated in spermatozoa during storage at 25 °C.

CT-guided percutaneous cryoablation combined with systemic chemotherapy for liver metastases from esophageal carcinoma: Initial experience Publication date: April 2019 Source: Cryobiology, Volume 87 Author(s): Yan Wang, Wei-Hao Zhang, Xu Chang, Fei Cao, Hai-Peng Yu, Wen-Ge Xing, Xue-Ling Yang, Zhi Guo Abstract Objective To explore the feasibility, safety and effectiveness of percutaneous cryoablation combined with systemic chemotherapy in the treatment of liver metastases from esophageal carcinoma (ECLM). Materials and methods We retrospectively collected data of 16 patients who received CT-guided percutaneous cryoablation concurrent systemic chemotherapy for liver metastases after primary esophageal carcinoma resection. Functional Assessment of Cancer Therapy-General (FACT-G) was used for the assessment of quality of life (QOL), and overall survival (OS), progression-free survival (PFS) and complications were also evaluated. Results The technical success rate was 96%, and no major complications related to cryoablation procedure were detected. Median OS and PFS after cryoablation were 14.5 months (range, 4–51 months) and 7.5 months (range, 1–31 months), respectively. The 1-year, 2-year, and 3-year survival rates were 56.3%, 31.3%, and 18.8%, respectively. The PFS rate at 6-month, 1-year, and 2-year after procedure were 68.8%, 31.3% and 18.8%, respectively. Furthermore, the QOL of patients was improved after cryoablation therapy compared with preoperative scores (P < 0.05). Conclusions Percutaneous cryoablation combined with systemic chemotherapy is a safe, feasible and effective method to treat liver metastases from esophageal carcinoma. And to a certain extent, this approach is very efficacious in improving the QOL of patients with ECLM.

Vitrification of murine mature metaphase II oocytes perturbs DNA methylation reprogramming during preimplantation embryo development Publication date: April 2019 Source: Cryobiology, Volume 87 Author(s): Zubing Cao, Meiling Zhang, Tengteng Xu, Zhen Chen, Xu Tong, Dandan Zhang, Yiqing Wang, Ling Zhang, Di Gao, Lei Luo, Ibrar Muhammad Khan, Yunhai Zhang Abstract Accurate reprogramming of DNA methylation occurring in preimplantation embryos is critical for normal development of both fetus and placenta. Environmental stresses imposed on oocytes usually cause the abnormal DNA methylation reprogramming of early embryos. However, whether oocyte vitrification alters the reprogramming of DNA methylation (5 mC) and its derivatives in mouse preimplantation embryo development remains largely unknown. Here, we found that the rate of cleavage and blastocyst formation of embryos produced by IVF of vitrified matured oocytes was significantly lower than that in control counterparts, but the quality of blastocysts was not impaired by oocyte vitrification. Additionally, although vitrification neither altered the dynamic changes of 5-hydroxymethylcytosine (5hmC) and 5-formylcytosine (5 fC) before 4-cell stage nor affected the levels of 5 mC and 5-carboxylcytosine (5caC) throughout the preimplantation development, vitrification significantly reduced the levels of 5hmC and 5 fC from 8-cell stage onwards. Correspondingly, vitrification did not alter the expression patterns of Tet3 in preimplantation embryos but apparently reduced the expression levels of Tet1 in 4-cell and 8-cell embryos and increased the expression levels of Tet2 at morula stage. Taken together, these results demonstrate that oocyte vitrification perturbs DNA methylation reprogramming in mouse preimplantation embryo development.

PD-1 blockade enhances the anti-tumor immune response induced by cryoablation in a murine model of renal cell carcinoma Publication date: April 2019 Source: Cryobiology, Volume 87 Author(s): Chenzhuang Zhu, Sihao Lin, Junhao Liang, Yingjian Zhu

Preservation of female genetic resources of common carp through oogonial stem cell manipulation Publication date: April 2019 Source: Cryobiology, Volume 87 Author(s): Roman Franěk, Tomáš Tichopád, Christoph Steinbach, Xuan Xie, Jelena Lujić, Zoran Marinović, Ákos Horváth, Vojtěch Kašpar, Martin Pšenička Abstract Several experiments were conducted in order to develop an optimal protocol for slow-rate freezing (−1 °C/min) and short-term storage (−80 or 4 °C) of common carp ovarian tissue fragments with an emphasis on oogonial stem cells (OSCs). Dimethyl sulfoxide (Me2SO) with concentration of 1.5 M was identified as the best cryoprotectant in comparison to propylene glycol and methanol. When comparing supplementation of sugars (glucose, trehalose, sucrose) in different concentrations (0.1, 0.3, 0.5 M), glucose and trehalose in 0.3 M were identified as optimal. Short-term storage options for ovarian tissue pieces at −80 °C and 4 °C were tested as alternatives to cryopreservation and storage in liquid nitrogen. The presence of OSCs was confirmed by immunocytochemistry and viability after storage was determined by the trypan blue exclusion test. This study identified the optimal protocol for OSC cryopreservation using slow rate freezing resulting in ∼65% viability. The frozen/thawed OSCs were labelled by PKH-26 and transplanted into goldfish recipients. The success of the transplantation was confirmed by presence of fluorescent cells in the recipient gonad and later on by RT-PCR with carp dnd1 specific primers. The results of this study can facilitate long-term preservation of common carp germplasm which can be recovered in a surrogate recipient through interspecific germ cell transplantation.

Use of trehalose in the semen cryopreservation of Amazonian catfish Leiarius marmoratus Publication date: April 2019 Source: Cryobiology, Volume 87 Author(s): Stela Mari M. Gheller, Carine D. Corcini, Camila R.C. de Brito, Izani B. Acosta, Geórgia C. Tavares, Sara Lorandi Soares, Alessandra C. Silva, Diego M. Pires, Antonio Sergio Varela Junior Abstract The current study assessed a semen cryopreservation protocol in the Amazonian catfish Leiarius marmoratus, a freshwater fish, of rheophilic behavior, and of great importance for Brazilian fish farming. Eight males (n = 8) were stripped and the semen was cryopreserved if total motility in fresh semen was higher than 80%. The external cryoprotectant Trehalose was then diluted in Beltsvile Thawing Solution (BTS) extender in the following concentrations: 50, 100, 150, and 200 mM. Semen samples were diluted in the media (1:9 v/v) being tested, then frozen in a container with nitrogen vapor (dryshipper), and stored in liquid nitrogen at −196 °C. Motility parameters assessed post-thawing were performed by CASA-system and sperm cell integrity analyses (membrane integrity, DNA integrity, and mitochondrial function) were performed through fluorescence microscopy. As a result, no significant statistical difference was observed between treatments, independently of Trehalose concentrations tested in the following post-thawing analysis: membrane integrity, DNA integrity, mitochondrial functionality, and sperm motility duration. As of total and progressive motilities, the treatment containing 50 mM trehalose (15.6 and 9.5%, respectively), exhibited inferior results when compared to treatments with 150 mM (22.9 and 17.7%, respectively) and 200 mM (31.4 and 26.3%, respectively) trehalose concentrations (P < 0.05); however, it did not differ from the treatment with 100 mM trehalose (18.6 and 15.3%, respectively). Therefore, treatments with trehalose at higher concentrations exhibited superior results when compared to other treatments in in vitro motility parameters for L. marmoratus.

Effect of insulin on functional parameters of human cryopreserved sperms Publication date: April 2019 Source: Cryobiology, Volume 87 Author(s): Saeed Shokri, Seyyed Meisam Ebrahimi, Sanaz Ziaeipour, Reza Nejatbakhsh Abstract Cryopreservation of sperms is common therapy but with multiple damages to sperms. The aim of this study was to assess the effect of insulin as a prosurvival factor on the most important functional parameters of human spermatozoa during cryopreservation. Semen samples were obtained from 15 normozoospermic men at age 25–40 years of old through masturbation. Cryopreservation of sperms was conducted along with adding 10, 100, 500 and 1000 (ng/ml) insulin and a control group was also considered by adding distilled water. Samples were cryopreserved for 2 weeks in liquid nitrogen. Then, after thawing sperm motility; cytosolic/mitochondrial reactive oxygen species (ROS) levels; and DNA fragmentation were analyzed. Data were analyzed by SPSS software using one-way ANOVA. Results showed that insulin at all doses significantly decreased cytosolic ROS especially in 10 ng/ml group (P˂0.05). Mitochondrial ROS also decreased by adding insulin in comparison to the control group, although unmeaningfully (P˃0.05). Insulin at 1000 (ng/ml) decreased DNA fragmentation, significantly (P˂0.05). Also, the number of motile sperms increased in all insulin groups but it wasn't meaningful (P˃0.05). Based on our findings adding insulin to semen leads to protecting effects against cryopreservation damages and increases sperms motility. Therefore, using insulin for human semen seems to could be suggested for future clinical applications.

Magnetic Resonance Imaging

Tales from the Night:: Emergency MR Imaging in Pediatric Patients after Hours Publication date: May 2019 Source: Magnetic Resonance Imaging Clinics of North America, Volume 27, Issue 2 Author(s): Michael P. George, Wendy G. Kim, Edward Y. Lee

PET/MR Imaging:: Current Updates on Pediatric Applications Publication date: May 2019 Source: Magnetic Resonance Imaging Clinics of North America, Volume 27, Issue 2 Author(s): Neha S. Kwatra, Ruth Lim, Michael S. Gee, Lisa J. States, Arastoo Vossough, Edward Y. Lee

MR Imaging Evaluation of Pediatric Lymphatics:: Overview of Techniques and Imaging Findings Publication date: May 2019 Source: Magnetic Resonance Imaging Clinics of North America, Volume 27, Issue 2 Author(s): Raja Shaikh, David M. Biko, Edward Y. Lee

MR Imaging of Pediatric Musculoskeletal Tumors:: Recent Advances and Clinical Applications Publication date: May 2019 Source: Magnetic Resonance Imaging Clinics of North America, Volume 27, Issue 2 Author(s): Mi-Jung Lee, Avneesh Chhabra, Joseph G. Pressey, Charles L. Dumoulin, Hee Kyung Kim

Discoid Meniscus in the Pediatric Population:: Emphasis on MR Imaging Signs of Instability Publication date: May 2019 Source: Magnetic Resonance Imaging Clinics of North America, Volume 27, Issue 2 Author(s): Ricardo Restrepo, Miriam D. Weisberg, Rachel Pevsner, Stephen Swirsky, Edward Y. Lee

MR Imaging Evaluation of Pediatric Genital Disorders:: MR Technologic Overview and Interpretation Publication date: May 2019 Source: Magnetic Resonance Imaging Clinics of North America, Volume 27, Issue 2 Author(s): Jennifer K. Son, Sumera Ali, Noor Al Khori, Edward Y. Lee

MR Imaging Evaluation of Inflammatory Bowel Disease in Children:: Where Are We Now in 2019 Publication date: May 2019 Source: Magnetic Resonance Imaging Clinics of North America, Volume 27, Issue 2 Author(s): Gary R. Schooler, Nathan C. Hull, Alisha Mavis, Edward Y. Lee

Pediatric Renal Neoplasms:: MR Imaging–Based Practical Diagnostic Approach Publication date: May 2019 Source: Magnetic Resonance Imaging Clinics of North America, Volume 27, Issue 2 Author(s): A. Luana Stanescu, Patricia T. Acharya, Edward Y. Lee, Grace S. Phillips

Hepatobiliary MR Imaging in Children:: Up-to-Date Imaging Techniques and Findings Publication date: May 2019 Source: Magnetic Resonance Imaging Clinics of North America, Volume 27, Issue 2 Author(s): Nathan C. Hull, Gary R. Schooler, Edward Y. Lee

Pediatric Cardiac MR Imaging:: Practical Preoperative Assessment Publication date: May 2019 Source: Magnetic Resonance Imaging Clinics of North America, Volume 27, Issue 2 Author(s): Giuseppe Muscogiuri, Pal Suranyi, Marwen Eid, Akos Varga-Szemes, Lewis Griffith, Gianluca Pontone, Uwe Joseph Schoepf, Carlo N. De Cecco

Assessment of vocal cord movements at extubation following total thyroidectomy

Efficacy of dexmedetomidine as an adjunct in aiding video laryngoscope-assisted assessment of vocal cord movements at extubation following total thyroidectomy
Santhosh Djearadjane, Sunil Rajan, Jerry Paul, Lakshmi Kumar

Anesthesia: Essays and Researches 2019 13(1):25-30

Background: Assessment of vocal cord movements following total thyroidectomy diagnoses recurrent laryngeal nerve injury. Use of videoscope along with sedatives may blunt hemodynamic responses seen with the conduct of direct laryngoscopy for assessing vocal cord mobility. Aims: The primary objective of this study was to assess changes in mean arterial pressure (MAP) during vocal cord assessment following total thyroidectomy using video laryngoscope, with and without the use of dexmedetomidine as an adjunct. Secondary objectives included assessment of changes in heart rate (HR), patient reactivity score along with ease of laryngoscopy and vocal cord visibility. Settings and Design: This randomized, prospective, unblinded study was conducted in 54 patients at a tertiary care center. Materials and Methods: Group D received dexmedetomidine 0.5 μg/kg, once the thyroid was removed. Group S did not receive dexmedetomidine. Hemodynamic response at extubation, patient reactivity, ease of laryngoscopy, and ease of vocal cord assessment were noted. Statistical Analysis Used: Chi-square test and Independent t-test. Results: Baseline HR, systolic blood pressure (SBP), and MAP were comparable between the groups. However subsequently, Group D had significantly lower HR and SBP at the time of extubation and at 3 and 6 min later. MAP at extubation and at 3 min later was comparable, but at 6 min, Group D had significantly lower values. In both groups, patient reactivity scores, ease of laryngoscopy, and vocal cord visibility were comparable (P > 0.05). Conclusion: Dexmedetomidine 0.5 μg/kg when used as an adjunct clinically improved conditions for assessing vocal cord mobility with significant attenuation of associated hemodynamic responses. 

Human Evolution

A new interpretation of Madagascar's megafaunal decline: The "Subsistence Shift Hypothesis" Publication date: May 2019 Source: Journal of Human Evolution, Volume 130 Author(s): Laurie R. Godfrey, Nick Scroxton, Brooke E. Crowley, Stephen J. Burns, Michael R. Sutherland, Ventura R. Pérez, Peterson Faina, David McGee, Lovasoa Ranivoharimanana Abstract Fundamental disagreements remain regarding the relative importance of climate change and human activities as triggers for Madagascar's Holocene megafaunal extinction. We use stable isotope data from stalagmites from northwest Madagascar coupled with radiocarbon and butchery records from subfossil bones across the island to investigate relationships between megafaunal decline, climate change, and habitat modification. Archaeological and genetic evidence support human presence by 2000 years Before Common Era (BCE). Megafaunal decline was at first slow; it hastened at ∼700 Common Era (CE) and peaked between 750 and 850 CE, just before a dramatic vegetation transformation in the northwest that resulted in the replacement of C3 woodland habitat with C4 grasslands, during a period of heightened monsoonal activity. Cut and chop marks on subfossil lemur bones reveal a shift in primary hunting targets from larger, now-extinct species prior to ∼900 CE, to smaller, still-extant species afterwards. By 1050 CE, megafaunal populations had essentially collapsed. Neither the rapid megafaunal decline beginning ∼700 CE, nor the dramatic vegetation transformation in the northwest beginning ∼890 CE, was influenced by aridification. However, both roughly coincide with a major transition in human subsistence on the island from hunting/foraging to herding/farming. We offer a new hypothesis, which we call the "Subsistence Shift Hypothesis," to explain megafaunal decline and extinction in Madagascar. This hypothesis acknowledges the importance of wild-animal hunting by early hunter/foragers, but more critically highlights negative impacts of the shift from hunting/foraging to herding/farming, settlement by new immigrant groups, and the concomitant expansion of the island's human population. The interval between 700 and 900 CE, when the pace of megafaunal decline quickened and peaked, coincided with this economic transition. While early megafaunal decline through hunting may have helped to trigger the transition, there is strong evidence that the economic shift itself hastened the crash of megafaunal populations.

Tools, trails and time: Debating Acheulian group size at Attirampakkam, India Publication date: May 2019 Source: Journal of Human Evolution, Volume 130 Author(s): Shanti Pappu, Kumar Akhilesh Abstract Estimating Acheulian group sizes based on a fragmentary archaeological record is fraught with difficulties, more so in regions like India, where lithics form the primary source of information. Here, we review current approaches towards modeling group size in Indian archaeology. We then examine to what extent one may address issues related to seasonality, fission-fusion strategies and group size in the context of Acheulian sites, drawing on our research along the southeastern coast of India. We move between multiple scales of analysis: from the regional Acheulian archaeological record to specific studies at the site of Attirampakkam (ATM). We consider aspects of site distribution, sizes, artefact densities and Acheulian lithic reduction strategies, factoring in issues related to geomorphology, taphonomy and chronology. Acheulian hominins occupied the study region over the early to middle Pleistocene, and the fragmented lithic reduction sequence noted on landscape scales suggests diverse site functions structured by ease of access to quartzite raw material for large flake production in addition to other resources. In contrast to most sites, the absence of raw material at ATM necessitated groups to anticipate this, and organize their behavior on landscape scales, and on-site, to resolve this issue. We show how successive groups were attracted to the site over the early Pleistocene, potentially aiming at exploiting seasonally predictable biological resources in a riparian environment, knowledge of which was transmitted across generations. Considerations of the spatial and temporal variability in artefact densities across a vast site area, along with aspects of the lithic reduction sequences suggests a short-duration occupation by a potentially large group, possibly resulting from aggregation of several small groups as noted in some ethnographic examples of hunter-gatherer fission-fusion strategies. We show drastic changes in behavioral organization in the succeeding Middle Palaeolithic phases at the site and in the region.

Mandibular molar root and pulp cavity morphology in Homo naledi and other Plio-Pleistocene hominins Publication date: May 2019 Source: Journal of Human Evolution, Volume 130 Author(s): Kornelius Kupczik, Lucas K. Delezene, Matthew M. Skinner Abstract The craniomandibular morphology of Homo naledi shows variable resemblances with species across Homo, which confounds an easy assessment of its phylogenetic position. In terms of skull shape, H. naledi has its closest affinities with Homo erectus, while mandibular shape places it closer to early Homo. From a tooth crown perspective, the smaller molars of H. naledi make it distinct from early Homo and H. erectus. Here, we compare the mandibular molar root morphology of six H. naledi individuals from the Dinaledi Chamber to those of African and Eurasian Plio-Pleistocene fossil hominins (totalling 183 mandibular first, second and third molars). The analysis of five root metric variables (cervical plane area, root length, root cervix volume, root branch volume, and root surface area) derived from microCT reconstructions reveals that the molar roots of H. naledi are smaller than those of Homo habilis, Homo rudolfensis, and H. erectus, but that they resemble those of three Homo sp. specimens from Swartkrans and Koobi Fora in size and overall appearance. Moreover, though H. naledi molar roots are similar in absolute size to Pleistocene Homo sapiens, they differ from H. sapiens in having a larger root volume for a given cervical plane area and less taurodont roots; the root cervix-to-branch proportions of H. naledi are comparable to those of Australopithecus africanus and species of Paranthropus. H. naledi also shares a metameric root volume pattern (M2 > M3 > M1) with Australopithecus and Paranthropus but not with any of the other Homo species (M2 > M1 > M3). Our findings therefore concur with previous studies that found that H. naledi shares plesiomorphic features with early Homo, Australopithecus, and Paranthropus. While absolute molar root size aligns H. naledi with Homo from North and South Africa, it is distinguishable from these in terms of root volumetric proportions.

Brain size growth in Australopithecus Publication date: May 2019 Source: Journal of Human Evolution, Volume 130 Author(s): Zachary Cofran Abstract Postnatal growth is one of the proximate means by which humans attain massive adult brain size. Humans are characterized by the maintenance of prenatal brain growth rates into the first postnatal year, as well as an overall extended period of growth. The evolution of this pattern is difficult to assess due to its relatively brief duration and the underrepresentation of well-preserved fossil individuals who died during this short period. In this study, I use Monte Carlo methods to reconstruct postnatal brain growth rates in Australopithecus afarensis and Australopithecus africanus, based on estimates of neonatal brain size and of likely brain size and age at death of infant specimens (A.L. 333-105, DIK-1-1, and Taung). Neonatal brain size is reconstructed from the empirical scaling relationship among catarrhines which humans follow, and conservative estimates of fossils' chronological ages and brain sizes are drawn from the literature. Simulated distributions of these values are used to calculate average annual rates (ARs) of brain growth and proportional size change from birth (PSC), which are compared to resampled statistics from humans, chimpanzees and gorillas of known age and sex. Simulated ARs and PSCs for A. afarensis are significantly lower than those of chimpanzees and gorillas. Both ARs and PSCs for A. africanus are similar to chimpanzee and gorilla values. These results indicate that although these early hominins were derived in some aspects of brain anatomy, high rates of brain growth did not appear until later in human evolution. Moreover, findings also imply that brain growth rates are not a simple function of adult brain size. This study provides important new information about the evolution of brain growth, despite limitations inherent in fossil samples.

The mechanical origins of arm-swinging Publication date: May 2019 Source: Journal of Human Evolution, Volume 130 Author(s): Michael C. Granatosky, Daniel Schmitt Abstract Arm-swinging is a locomotor mode observed only in primates, in which the hindlimbs no longer have a weight bearing function and the forelimbs must propel the body forward and support the entirety of the animal's mass. It has been suggested that the evolution of arm-swinging was preceded by a shift to inverted quadrupedal walking for purposes of feeding and balance, yet little is known about the mechanics of limb use during inverted quadrupedal walking. In this study, we test whether the mechanics of inverted quadrupedal walking make sense as precursors to arm-swinging and whether there are fundamental differences in inverted quadrupedal walking in primates compared to non-primate mammals that would explain the evolution of arm-swinging in primates only. Based on kinetic limb-loading data collected during inverted quadrupedal walking in primates (seven species) and non-primate mammals (three species), we observe that in primates the forelimb serves as the primary propulsive and weight bearing limb. Additionally, heavier individuals tend to support a greater distribution of body weight on their forelimbs than lighter ones. These kinetic patterns are not observed in non-primate mammals. Based on these findings, we propose that the ability to adopt arm-swinging is fairly simple for relatively large-bodied primates and merely requires the animal to release its grasping foot from the substrate. This study fills an important gap concerning the origins of arm-swinging and illuminates previously unknown patterns of primate locomotor evolution.

Temporal shifts in the distribution of murine rodent body size classes at Liang Bua (Flores, Indonesia) reveal new insights into the paleoecology of Homo floresiensis and associated fauna Publication date: May 2019 Source: Journal of Human Evolution, Volume 130 Author(s): E. Grace Veatch, Matthew W. Tocheri, Thomas Sutikna, Kate McGrath, E. Wahyu Saptomo, Jatmiko, Kristofer M. Helgen Abstract Liang Bua, the type locality of Homo floresiensis, is a limestone cave located in the western part of the Indonesian island of Flores. The relatively continuous stratigraphic sequence of the site spans the past ∼190 kyr and contains ∼275,000 taxonomically identifiable vertebrate skeletal elements, ∼80% of which belong to murine rodent taxa (i.e., rats). Six described genera are present at Liang Bua (Papagomys, Spelaeomys, Hooijeromys, Komodomys, Paulamys, and Rattus), one of which, Hooijeromys, is newly recorded in the site deposits, being previously known only from Early to Middle Pleistocene sites in central Flores. Measurements of the proximal femur (n = 10,212) and distal humerus (n = 1186) indicate five murine body size classes ranging from small (mouse-sized) to giant (common rabbit-sized) are present. The proportions of these five classes across successive stratigraphic units reveal two major changes in murine body size distribution due to significant shifts in the abundances of more open habitat-adapted medium-sized murines versus more closed habitat-adapted smaller-sized ones. One of these changes suggests a modest increase in available open habitats occurred ∼3 ka, likely the result of anthropogenic changes to the landscape related to farming by modern human populations. The other and more significant change occurred ∼60 ka suggesting a rapid shift from more open habitats to more closed conditions at this time. The abrupt reduction of medium-sized murines, along with the disappearance of H. floresiensis, Stegodon florensis insularis (an extinct proboscidean), Varanus komodoensis (Komodo dragon), Leptoptilos robustus (giant marabou stork), and Trigonoceps sp. (vulture) at Liang Bua ∼60–50 ka, is likely the consequence of these animals preferring and tracking more open habitats to elsewhere on the island. If correct, then the precise timing and nature of the extinction of H. floresiensis and its contemporaries must await new discoveries at Liang Bua or other as yet unexcavated sites on Flores.

Speeding in the slow lane: Phylogenetic comparative analyses reveal that not all human life history traits are exceptional Publication date: May 2019 Source: Journal of Human Evolution, Volume 130 Author(s): Ian F. Miller, Steven E. Churchill, Charles L. Nunn Abstract Humans are thought to exhibit an unusual suite of life history traits relative to other primates, with a longer lifespan, later age at first reproduction, and shorter interbirth interval. These assumptions are key components of popular hypotheses about human life history evolution, but they have yet to be investigated phylogenetically. We applied two phylogenetic comparative methods to investigate whether these human life history traits differ from expectations based on other primates: one fits and selects between Brownian and Ornstein-Uhlenbeck models of trait evolution; the other tests for phylogenetic outliers by predicting phenotypic characteristics based on trait covariation and phylogeny for a species of interest. We found that humans have exceptionally short interbirth intervals, long lifespans, and high birth masses. We failed to find evidence that humans have a delayed age at first reproduction relative to body mass or other covariates. Overall, our results support several previous assertions about the uniqueness of human life history characteristics and the importance of cooperative breeding and socioecology in human life history evolution. However, we suggest that several hypotheses about human life history need to be revised in light of our finding that humans do not have a delayed age at first reproduction.

Efficacy of diffeomorphic surface matching and 3D geometric morphometrics for taxonomic discrimination of Early Pleistocene hominin mandibular molars Publication date: May 2019 Source: Journal of Human Evolution, Volume 130 Author(s): José Braga, Veronika Zimmer, Jean Dumoncel, Chafik Samir, Frikkie de Beer, Clément Zanolli, Deborah Pinto, F. James Rohlf, Frederick E. Grine Abstract Morphometric assessments of the dentition have played significant roles in hypotheses relating to taxonomic diversity among extinct hominins. In this regard, emphasis has been placed on the statistical appraisal of intraspecific variation to identify morphological criteria that convey maximum discriminatory power. Three-dimensional geometric morphometric (3D GM) approaches that utilize landmarks and semi-landmarks to quantify shape variation have enjoyed increasingly popular use over the past twenty-five years in assessments of the outer enamel surface (OES) and enamel–dentine junction (EDJ) of fossil molars. Recently developed diffeomorphic surface matching (DSM) methods that model the deformation between shapes have drastically reduced if not altogether eliminated potential methodological inconsistencies associated with the a priori identification of landmarks and delineation of semi-landmarks. As such, DSM has the potential to better capture the geometric details that describe tooth shape by accounting for both homologous and non-homologous (i.e., discrete) features, and permitting the statistical determination of geometric correspondence. We compare the discriminatory power of 3D GM and DSM in the evaluation of the OES and EDJ of mandibular permanent molars attributed to Australopithecus africanus, Paranthropus robustus and early Homo sp. from the sites of Sterkfontein and Swartkrans. For all three molars, classification and clustering scores demonstrate that DSM performs better at separating the A. africanus and P. robustus samples than does 3D GM. The EDJ provided the best results. P. robustus evinces greater morphological variability than A. africanus. The DSM assessment of the early Homo molar from Swartkrans reveals its distinctiveness from either australopith sample, and the "unknown" specimen from Sterkfontein (Stw 151) is notably more similar to Homo than to A. africanus.

A missing piece of the Papio puzzle: Gorongosa baboon phenostructure and intrageneric relationships Publication date: May 2019 Source: Journal of Human Evolution, Volume 130 Author(s): Felipe I. Martinez, Cristian Capelli, Maria J. Ferreira da Silva, Vera Aldeias, Zeresenay Alemseged, William Archer, Marion Bamford, Dora Biro, René Bobe, David R. Braun, Jörg M. Habermann, Tina Lüdecke, Hilário Madiquida, Jacinto Mathe, Enquye Negash, Luis M. Paulo, Maria Pinto, Marc Stalmans, Frederico Tátá, Susana Carvalho Abstract Most authors recognize six baboon species: hamadryas (Papio hamadryas), Guinea (Papio papio), olive (Papio anubis), yellow (Papio cynocephalus), chacma (Papio ursinus), and Kinda (Papio kindae). However, there is still debate regarding the taxonomic status, phylogenetic relationships, and the amount of gene flow occurring between species. Here, we present ongoing research on baboon morphological diversity in Gorongosa National Park (GNP), located in central Mozambique, south of the Zambezi River, at the southern end of the East African Rift System. The park exhibits outstanding ecological diversity and hosts more than 200 baboon troops. Gorongosa National Park baboons have previously been classified as chacma baboons (P. ursinus). In accordance with this, two mtDNA samples from the park have been placed in the same mtDNA clade as the northern chacma baboons. However, GNP baboons exhibit morphological features common in yellow baboons (e.g., yellow fur color), suggesting that parapatric gene flow between chacma and yellow baboons might have occurred in the past or could be ongoing. We investigated the phenostructure of the Gorongosa baboons using two approaches: 1) description of external phenotypic features, such as coloration and body size, and 2) 3D geometric morphometric analysis of 43 craniofacial landmarks on 11 specimens from Gorongosa compared to a pan-African sample of 352 baboons. The results show that Gorongosa baboons exhibit a mosaic of features shared with southern P. cynocephalus and P. ursinus griseipes. The GNP baboon phenotype fits within a geographic clinal pattern of replacing allotaxa. We put forward the hypothesis of either past and/or ongoing hybridization between the gray-footed chacma and southern yellow baboons in Gorongosa or an isolation-by-distance scenario in which the GNP baboons are geographically and morphologically intermediate. These two scenarios are not mutually exclusive. We highlight the potential of baboons as a useful model to understand speciation and hybridization in early human evolution.

Late Middle Pleistocene hominin teeth from Tongzi, southern China Publication date: May 2019 Source: Journal of Human Evolution, Volume 130 Author(s): Song Xing, María Martinón-Torres, José María Bermúdez de Castro Abstract In 1972 and 1983, four hominin teeth were recovered from Yanhui Cave, Tongzi, southern China and assigned to later Homo erectus or archaic Homo sapiens. The teeth can be dated to approximately 172,000–240,000 years before present. Here, in addition to the standard morphological comparisons, we reevaluate the morphology of the hominin teeth using geometric morphometric analyses and micro-computed tomography (micro-CT) scans. The Tongzi teeth were primarily compared to hominins from the same chronological period (late Middle Pleistocene) and/or the same geographic area (East Asia), although a wide range of hominins were included in the comparative sample. This study reveals that the Tongzi teeth do not fit the morphological pattern of classic H. erectus, and expands our understanding of the morphological diversity of the Asian Middle Pleistocene hominins. Overall, our results point to the existence of more than one paleodeme in East Asia during this period: one that can be taxonomically classified as H. erectus sensu stricto (represented by fossils such as Zhoukoudian, Hexian, and Yiyuan) and a second that is characterized by the expression of derived traits more commonly found in later Homo (such as the crown symmetry, lingual reduction, and simplified EDJ surface of the third premolar). More fossil and genetic findings will help assess the taxonomy of the "non-erectus" Asian Middle Pleistocene populations, like the Tongzi hominins.

Otolaryngology

Clinical and audiometric outcomes of palisade cartilage myringoplasty under local anesthetic in an office setting Publication date: Available online 29 March 2019 Source: American Journal of Otolaryngology Author(s): Nael M. Shoman Abstract Objective Assess clinical and functional outcomes of a modified palisade cartilage-perichondrium graft myringoplasty under local in an office setting. Study design Retrospective case series. Setting Tertiary care facility. Patients Patients with a tympanic membrane perforation presenting between March 2013 and October 2017. Inclusion criteria included age ≥ 7 years, entire perforation margin visualized through a transcanal view, and the ability to lie supine for up to 45 min. Exclusion criteria included a conductive hearing loss larger than expected, and presence of active infection. Intervention In-office modified myringoplasty technique under local anesthesia without sedation. Main outcome measures Complete perforation closure rate and audiometric outcomes. Results 250 patients underwent the procedure, of whom 13 had bilateral sequential procedures (total 263 ears). Of those, 197 were primary and 66 revision. Average age was 46.3 years. Perforation sizes were categorized as small (32), moderate (109), large (78), and subtotal (44). Complete perforation closure was evident in 219 of the 250 cases (88%). Preoperative mean air pure tone average (PTA) was 56.7 dB and mean bone PTA was 27.5 dB (pre-operative ABG 29.2 dB). AC-PTA significantly improved to 35.0 dB (p < 0.0001), and ABG to 9.6 dB (p < 0.0001). Only subtotal perforations showed a statistically significant negative relationship with outcome (p = 0.04). Conclusion The modified palisade cartilage-perichondrium graft myringoplasty under local anesthetic is a highly successful procedure well tolerated by adult and pediatric patients with variable perforation sizes. This may have significant potential patient benefits, as well as cost savings to the health care system.

Sex-specific enlarged vestibular aqueduct morphology and audiometry Publication date: Available online 29 March 2019 Source: American Journal of Otolaryngology Author(s): Jeremy Ruthberg, Mustafa S. Ascha, Armine Kocharyan, Amit Gupta, Gail S. Murray, Cliff A. Megerian, Todd D. Otteson Abstract Objective Enlargement of the vestibular aqueduct (EVA) is one of the most common congenital malformations in pediatric patients presenting with sensorineural or mixed hearing loss. The relationship between vestibular aqueduct (VA) morphology and hearing loss across sex is not well characterized. This study assesses VA morphology and frequency-specific hearing thresholds with sex as the primary predictor of interest. Materials and methods A retrospective, longitudinal, and repeated-measures study was used. 47 patients at an academic tertiary care center with hearing loss and a record of CT scan of the internal auditory canal were candidates, and included upon meeting EVA criteria after confirmatory measurements of vestibular aqueduct midpoint and operculum widths. Audiometric measures included pure-tone average and frequency-specific thresholds. Results Of the 47 patients (23 female and 24 male), 79 total ears were affected by EVA; the median age at diagnosis was 6.60 years. After comparing morphological measurements between sexes, ears from female patients were observed to have a greater average operculum width (3.25 vs. 2.70 mm for males, p = 0.006) and a greater average VA midpoint width (2.80 vs. 1.90 mm for males, p = 0.004). After adjusting for morphology, male patients' ears had pure-tone average thresholds 17.6 dB greater than female patients' ears (95% CI, 3.8 to 31.3 dB). Conclusions Though females seem to have greater enlargement of the vestibular aqueduct, this difference does not extend to hearing loss. Therefore, our results indicate that criteria for EVA diagnoses may benefit from re-evaluation. Further exploration into morphological and audiometric discrepancies across sex may help inform both clinician and patient expectations.

Cricoarytenoid joint abscess associated with rheumatoid arthritis Publication date: Available online 28 March 2019 Source: American Journal of Otolaryngology Author(s): Megan J. Foggia, Henry T. Hoffman Abstract Cricoarytenoid joint arthritis is an uncommon manifestation of rheumatoid arthritis. We encountered a 68-year-old woman with rheumatoid arthritis who presented with odynophagia, dysphagia, and progressive shortness of breath. Examination findings showed diminished mobility of the left vocal cord and right arytenoid swelling associated with an immobile right vocal cord. Computed tomography (CT) imaging identified a ring-enhancing lesion of the right lateral cricoarytenoid joint. Microdirect laryngoscopy with drainage of the cricoarytenoid abscess and tracheotomy were performed. Development of a laterally based cricoarytenoid joint abscess is identified as a complication of chronic rheumatoid arthritis with successful management described.

Delayed laryngeal implant infection and laryngocutaneous fistula after medialization laryngoplasty Publication date: Available online 27 March 2019 Source: American Journal of Otolaryngology Author(s): Joseph B. Meleca, Paul C. Bryson Abstract Background Medialization laryngoplasty is a common procedure for voice rehabilitation in patients with unilateral vocal fold paralysis. Complications are uncommon and delayed infections involving implants are rare. We report a delayed infectious complication following an animal scratch resulting in a laryngocutaneous fistula. Methods Case report. Results A 73-year-old female underwent a successful and uneventful medialization laryngoplasty for idiopathic unilateral vocal fold paralysis using a silastic implant. More than one year after surgery, she presented with an anterior neck infection following an animal scratch with CT neck findings of a left strap muscle abscess. After incision and drainage, cultures grew methicillin-resistant Staphylococcus aureus. Despite culture-directed antibiotic therapy, the neck continued to drain persistently. Laryngoscopy with stroboscopy revealed a medialized vocal fold with no obvious granulation tissue and normal mucosal pliability. The patient underwent neck exploration revealing a laryngocutaneous fistula. Thus, both the fistulous tract and implant were removed. The wound was closed with a strap muscle advancement into the laryngoplasty window. One month after surgery and antibiotics, the patient had no signs of recurrent neck infection, with a well-healing wound and stroboscopic findings of complete glottic closure, symmetric vocal fold oscillation and acceptable phonation with mild supraglottic compression. Conclusions Delayed complications of medialization laryngoplasty are rarely reported. This case demonstrates a delayed infection of a laryngeal implant after an animal scratch requiring implant removal, local tissue reconstruction, and culture-directed antibiotic therapy.

Conservative thyroidectomy for papillary thyroid microcarcinoma Publication date: Available online 21 March 2019 Source: American Journal of Otolaryngology Author(s): Hyun Joo Nahm, Sung Jun Choi, Young Chang Lim Abstract Objective According to American Thyroid Association (ATA) guideline, thyroid lobectomy is recommended for the management of papillary thyroid microcarcinomas (PTMC) with a diameter lesser than 1 cm. However, this procedure is associated with a risk of potential complications such as vocal cord palsy. Thus, we considered the applicability of conservative thyroidectomy, involving partial removal of the thyroid cancer lesion, not the entire ipsilateral thyroid lobe. Methods A retrospective analysis of all PTMC patients who underwent conservative thyroidectomy at Konkuk University Hospital between August 2008 and February 2014 was performed. Oncologic results of these patients along with the incidence of postoperative complications were evaluated. Seventy-nine patients who underwent conservative thyroidectomy for the treatment of PTMC were enrolled in the present study. Results Four of the 79 patients (5.0%) showed recurrence, 2 local (2.5%) and 2 regional (2.5%), respectively. All of these patients consequently underwent surgery alone and were salvaged. Temporary postoperative complications such as vocal cord palsy and hypocalcemia developed in 1 and 1 case, respectively, but completely recovered over time. Conclusions Conservative thyroidectomy is an oncologically and functionally safe procedure for surgical treatment of PTMC and can be considered as an alternative to thyroid lobectomy for the surgical management of PTMC.

Histopathologic analysis in chronic rhinosinusitis: Impact on quality of life outcomes Publication date: Available online 21 March 2019 Source: American Journal of Otolaryngology Author(s): Feng Wang, Yang Yang, Qihan Wu, Haihong Chen Abstract Objective This study investigates the impact of histopathologic parameters on quality of life outcomes in patients with chronic rhinosinusitis. Setting Hospital of Zhejiang University. Study design Retrospective analysis of collected data. Subjects and methods One hundred and twenty patients with chronic rhinosinusitis (CRS) who underwent endoscopic sinus surgery were recruited. Clinical features, CT evaluation, pre and postoperative SNOT-22 scores and histopathologic findings were collected. Tissue eosinophils and mucosal remodeling were analyzed relative to clinical features and outcomes 12 months postoperatively. Results Symptom improvement was seen for the entire population. Eosinophilic CRS had significantly worse preoperative and postoperative SNOT-22 scores than non- eosinophilic CRS. Symptom improvement in eosinophilic CRS after surgery was less than that of non-eosinophilic CRS. There was no significant association between preoperative and postoperative SNOT-22 scores and remodeling markers. However, patients with basement membrane thickening showed less reductions of SNOT-22 score postoperatively. Conclusions Presence of mucosal eosinophilia and basal membrane thickening appear to be the main factors adversely affect the symptom control of surgical intervention. Routine histopathology analysis can provide meaningful information for prognostication of surgical outcome.

Vestibulotoxicity in a patient without renal failure after inhaled tobramycin Publication date: Available online 19 March 2019 Source: American Journal of Otolaryngology Author(s): Adam C. Kaufman, Steven J. Eliades Abstract Aminoglycoside antibiotics have a long history of use in the control of gram-negative bacterial infections, but their systemic use has been complicated by known ototoxicity and nephrotoxicity. Because of the utility of these medications in patients with frequent pulmonary infections, there has been a move towards the use of inhaled agents, in particular tobramycin, due to a lower rate of systemic complications. Inhaled tobramycin is generally consider to be safe from otologic complications, with only two previous reports of ototoxicity, both in patients who had underlying chronic renal disease. Here we present the first case of a patient developing isolated vestibular toxicity, without associated hearing loss or evidence of renal insufficiency, in a patient receiving inhaled tobramycin. This is an extremely rare complication of an inhaled aminoglycoside and underscores the importance of careful monitoring despite perceived safety.

Transdermal lidocaine as treatment for chronic subjective tinnitus: A pilot study Publication date: Available online 18 March 2019 Source: American Journal of Otolaryngology Author(s): Daniel C. O'Brien, Aaron D. Robinson, Nancy Wang, Rodney Diaz Abstract Objective To assess the efficacy of transdermal lidocaine as a treatment for chronic subjective tinnitus as measured by the Tinnitus Functional Index (TFI). Study design Pilot, prospective efficacy trial. Setting Tertiary care hospital. Patients Men and women, over the age of 18 with chronic subjective tinnitus for >6 months. Intervention Daily application of commercially available transdermal lidocaine patch. Outcome measure Change in the TFI. Results The average pre-treatment TFI score was 56.2. After 1 month the average TFI decreased to 41 (p < 0.05). The scores dropped to 34 and 35 after 2 and 3 months of treatment respectively. Despite improvement in symptoms of tinnitus, most patients did not continue the study after the first month, dropping out due to the size, discomfort, and appearance of the lidocaine patch, failure to follow-up and lack of perceived benefit from treatment. Conclusions In this preliminary study, 5% transdermal lidocaine appears to be a potential treatment for chronic subjective tinnitus. The majority of subjects who completed 1 month of treatment had clinically significantly improved tinnitus. These findings are confounded however by the small sample size and significant drop out rate.

PEAK PlasmaBlade versus monopolar electrocautery tonsillectomy in adults: A prospective double-blinded randomized controlled trial Publication date: Available online 18 March 2019 Source: American Journal of Otolaryngology Author(s): Alvin Tan Kah Leong, Sanjay Ganhasan, Peter Lu Kuo Sun, Yuen Heng Wai, Ian Loh Chi Yuan, Hsu Pon Poh, Chan Yiong Huak Abstract Objective To evaluate the efficacy and compare postoperative pain and recovery following PEAK PlasmaBlade and monopolar electrocautery tonsillectomy in adults. Study design Prospective double-blinded randomized controlled trial. Methods Fifty-eight patients were recruited and randomized into 2 groups: PEAK PlasmaBlade (n = 29) or monopolar electrocautery (n = 29) tonsillectomy. Postoperative pain, complications, patient satisfaction, number of tablets of analgesia taken and days taken to return to soft diet, normal diet, normal activities and achieve pain-free swallowing were compared and analysed, with the aid of a pain diary given to patients. Statistical analysis was performed with SPSS 13.0 with statistical significance set at P < 0.05. Results Patients in the PEAK PlasmaBlade group were able to achieve pain-free swallowing in a shorter time compared to the electrocautery group (13.28 versus 15.76 days, P = 0.035). Patients were also more satisfied with PEAK PlasmaBlade tonsillectomy (P = 0.046). No significant differences in the incidence of postoperative haemorrhage, daily visual analog score for pain, number of tablets of analgesia taken and time taken to return to soft diet, normal diet and activities were seen for both groups. Conclusions This study showed that PEAK PlasmaBlade tonsillectomy has a faster recovery period in terms of time taken to achieve pain-free swallowing and may offer advantages when compared to monopolar electrocautery tonsillectomy. Level of evidence 1b.

Mild hypothermia is associated with improved outcomes in patients undergoing microvascular head and neck reconstruction Publication date: Available online 16 March 2019 Source: American Journal of Otolaryngology Author(s): Benjamin M. Laitman, Yue Ma, Bryan Hill, Marita Teng, Eric Genden, Samuel DeMaria, Brett A. Miles Abstract Objective Microvascular free tissue transfer has become the standard for reconstruction for large defects. With long operative times and an increased surface area exposed, transient hypothermia is common, but it is unclear how this impacts surgical outcomes. This study evaluated the impact of core body temperature on free tissue flap outcomes in patients undergoing microvascular reconstruction. Study design Retrospective data analysis. Setting Mount Sinai Hospital; NYC, NY; 2007–2016. Subjects and methods Demographic information, mean/minimum/maximum body temperatures, and the presence of flap complications (venous thrombosis, arterial insufficiency, flap death, wound infection/dehiscence, fistula, chyle leak, hematoma/seroma) of 519 free tissue transfer patients were documented. Binomial logistic regression was used to examine associations between the presence of flap complications and mean temperature. Statistical analysis used SPSS, with p-values ≤0.05 deemed statistically significant. Results 393 soft-tissue and 125 osteocutaneous flaps were included. 19.8% (n = 103) patients had the presence of ≥1 flap complication, while 80.2% (n = 416) did not. Average temperature for all patients was 36.12 ± 0.84 °C, with minimum at 34.43 ± 0.97 °C and maximum at 37.24 ± 1.23 °C. After controlling for several factors including: tumor stage, radiation, diabetes, BMI, age, sex, and flap type, there was a significant association between flap complications and mean intraoperative temperature (Exp(B) = 1.559, p = 0.004). Conclusion Higher intraoperative temperatures were associated with worse outcomes. A mild relative hypothermia may improve flap outcomes in this population. This represents the largest study to date evaluating the impact of intraoperative temperature on free tissue transfer outcomes.

Anesthesia: Essays and Researches

Peritubal infiltration of fentanyl compared to dexmedetomidine with ropivacaine in percutaneous nephrolithotomy: A randomized comparative analysis Sumit Soni, Kalpesh Parmar, Shyam Meena Charan, Sameer Sethi, Naveen B Naik Anesthesia: Essays and Researches 2019 13(1):1-6 Context: Dexmedetomidine has been found as an effective adjuvant in various nerve blocks. Despite several studies on dexmedetomidine with ropivacaine, there is no study on comparing with fentanyl in peritubal infiltration in percutaneous nephrolithotomy (PCNL). Aims: The aim of this study was to compare the effect of the addition of dexmedetomidine or fentanyl in peritubal local anesthetic infiltration on pain scores and analgesic consumption in patients who underwent PCNL. Settings and Design: This was a prospective, randomized, double-blind, tertiary care center-based study. Subjects and Methods: A total of 60 American Society of Anesthesiologists Class I, II, and III patients were selected and randomly divided into two groups: Group RF ropivacaine and fentanyl (n = 30) and Group RD ropivacaine and dexmedetomidine (n = 30). Balanced general anesthesia was given. After completion of the surgery, peritubal infiltration was given at 6 and 12 O'clock positions under fluoroscopic guidance. Postoperative pain was assessed using the visual analog scale and dynamic visual analog scale rating 0–10 for initial 48 h. Postoperative sedation was assessed using five-point sedation score. Time to first rescue analgesic, number of doses of tramadol, and total consumption of tramadol required in 48 h were noted. Statistical Analysis Used: Descriptive data were expressed in mean and standard deviation for between-group comparisons; the Chi-square and Fisher's exact tests were used for categorical variables, whereas t-test and Mann–Whitney U-test were used to compare continuous variables between two groups. Results: Duration of analgesia in group RD (12.87 ± 3.85) is more prolonged than group RF (8.13 ± 3.28) h. Total dose of rescue analgesia required in 48 h in group RF was higher as compared to group RD. Conclusions: Addition of dexmedetomidine to ropivacaine is more effective than fentanyl in terms of prolongation of analgesic efficacy of local anesthetic in peritubal block along with short-lived mild sedation.

Intra-articular morphine versus dexmedetomedine for knee arthroscopy under local anesthesia Doaa Galal Diab, Alaaeldin Adel Elmaddawy, Abdelrahman Elganainy Anesthesia: Essays and Researches 2019 13(1):7-12 Background: Knee arthroscopy has both diagnostic and therapeutic applications which can be performed under general, regional, or local anesthesia. Morphine is used as an additive to local anesthetics. Dexmedetomedine, the highly selective alpha-2 (α2)-adrenoceptor agonist with the sedative and analgesic effect can be used also to augment local anesthetic effect. Patients and Methods: Sixty patients submitted for elective knee arthroscopy whose age between 25 and 45 years, of either sex, the American society of anethesiologists physical status Classes I and II at a university hospital were enrolled in this study. Patients were classified into two groups. Morphine Group (M) (n = 30): Patients received 20 ml of 0.5% bupivacaine plus 5 ml of 0.2% lidocaine with epinephrine 1:200,000 plus 1 mg morphine. Dexmedetomedine Group (D) (n = 30): Patients received 20 ml of 0.5% bupivacaine plus 5 ml of 0.2% lidocaine with epinephrine 1:200,000 plus 1 μg/kg dexmedetomedine. Results: Demographic data of patients showed no significant difference among the studied groups. Heart rate (HR) was significantly lower in (D) Group compared to that of (M) Group 5 min from the start of procedure to immediately postoperatively. Moreover, (D) Group showed a significant decrease in HR 10 min up to 35 min intraoperatively compared to the basal value. Furthermore, mean arterial blood pressure (MBP) was significantly lower in (D) Group compared to that of (M) Group 15 min from the start of surgery up to 1 h postoperatively. Furthermore, (D) Group showed a significant decrease in MBP 15 min intraoperative up to 2 h postoperatively compared to the basal value. While there was no significant difference in (visual analogue score [VAS], onset and total consumption of ketorolac, surgeon and patients' satisfaction, side effects in (D) Group compared to (M) Group, respectively. Conclusion: Addition of either morphine or dexmedetomidine to bupivacaine intraarticularly improved both intraoperative anesthesia and postoperative analgesia with minimal side effects or complications in knee arthroscopy, with superiority of dexmedetomidine compared to morphine on hemodynamic stability.

A comparison of stress response between insertion of gastro-laryngeal tube and endotracheal intubation in patients undergoing upper gastrointestinal endoscopic procedures for endoscopic retrograde cholangiopancreatography Josemine Davis, Deepak Kumar Sreevastava, Deepak Dwivedi, Siddaramesh Gadgi, Saurabh Sud, Puja Dudeja Anesthesia: Essays and Researches 2019 13(1):13-18 Background: Complex gastrointestinal (GI) endoscopic procedures like endoscopic retrograde cholangiopancreatography (ERCP) require deep sedation or general anesthesia. Comorbidities with the poor physiological condition warrant endotracheal intubation to prevent hypoxia and aspiration. The gastro-laryngeal tube (GLT), a new supraglottic airway device with a separate channel for endoscope looks promising. Aims: The aim of the study is to compare the stress response during insertion of GLT and endotracheal intubation (ETT) in patients undergoing upper GI endoscopic procedures like ERCP. Subjects and Methods: This control versus comparison study comprised two groups with 30 patients each who underwent ETT and GLT insertion. The standard general anesthesia technique was used. In GLT group, the device was inserted without neuromuscular blocker. In ETT group, injection atracurium 0.5 mg/kg intravenous was administered as muscle relaxant for aiding endotracheal intubation. Hemodynamic parameters and time taken for the insertion of GLT/ETT were recorded. Statistical Analysis: Data were analyzed using SPSS version 20. Student's t-test was used to compare quantitative data between the groups. ANOVA test was applied for intragroup comparisons between GLT and ETT groups. Categorical variables were analyzed using the Chi-square test. Results: Heart rate and mean arterial pressure increased from baseline in ETT group, following laryngoscopy and endotracheal intubation as well as with GLT insertion. However, the stress response caused by endotracheal intubation was significantly greater than that caused by GLT insertion. Conclusion: GLT as an airway device is a safe alternative with decreased stress response compared to endotracheal intubation for upper GI endoscopy procedures.

The effect of forced-air warmer, ondansetron or their combination on shivering in pregnant women coming for elective cesarean section under spinal anesthesia: A prospective, randomized controlled comparative study KS Ram Kiran, Kalyani Surya Dhana Lakshmi Sangineni Anesthesia: Essays and Researches 2019 13(1):19-24 Context: Perioperative shivering can occur in up to 85% of patients undergoing cesarean section under spinal anesthesia. It has many detrimental effects and disrupts early mother-child bonding. Therefore, it should ideally be prevented by either pharmacologic or nonpharmacological means. Aims: The primary aim of this study was to evaluate the efficacy of intraoperative forced-air warming, ondansetron or their combination in preventing perioperative shivering in patients undergoing elective cesarean section under spinal anesthesia. Settings and Design: A prospective randomized controlled comparative study done at the tertiary care center. Subjects and Methods: A total of 120 patients undergoing elective cesarean section under spinal anesthesia were randomly assigned to three groups. Group O received ondansetron 4 mg intravenously (i.v.) after giving block with no forced air warming. Group W received forced-air warming intraoperatively. Group C received ondansetron 4 mg i.v. after giving block plus intraoperative forced-air warming. Core temperature (tympanic membrane) and the arm skin temperature were measured and shivering was graded simultaneously. Statistical Analysis Used: Parametric data were analyzed using one-way ANOVA and Student's paired t-test where ever appropriate. Nonparametric data were analyzed using the Kruskal–Wallis and the Chi-square test. Values of P < 0.05 were considered statistically significant. Results: Shivering incidence was higher in Group O and Group W being 17.5% and 20%, respectively, and least in Group C being 5%. The incidence of Grade ≥3 shivering requiring rescue drug was lower in Group C (2.5%) compared to that of the Groups W (5%) and O (10%) but was not statistically significant (P = 0.21). Conclusions: Combined use of ondansetron and forced- air warmer was more effective in reducing the incidence of shivering in pregnant women during elective cesarean section than when used individually.

Efficacy of dexmedetomidine as an adjunct in aiding video laryngoscope-assisted assessment of vocal cord movements at extubation following total thyroidectomy Santhosh Djearadjane, Sunil Rajan, Jerry Paul, Lakshmi Kumar Anesthesia: Essays and Researches 2019 13(1):25-30 Background: Assessment of vocal cord movements following total thyroidectomy diagnoses recurrent laryngeal nerve injury. Use of videoscope along with sedatives may blunt hemodynamic responses seen with the conduct of direct laryngoscopy for assessing vocal cord mobility. Aims: The primary objective of this study was to assess changes in mean arterial pressure (MAP) during vocal cord assessment following total thyroidectomy using video laryngoscope, with and without the use of dexmedetomidine as an adjunct. Secondary objectives included assessment of changes in heart rate (HR), patient reactivity score along with ease of laryngoscopy and vocal cord visibility. Settings and Design: This randomized, prospective, unblinded study was conducted in 54 patients at a tertiary care center. Materials and Methods: Group D received dexmedetomidine 0.5 μg/kg, once the thyroid was removed. Group S did not receive dexmedetomidine. Hemodynamic response at extubation, patient reactivity, ease of laryngoscopy, and ease of vocal cord assessment were noted. Statistical Analysis Used: Chi-square test and Independent t-test. Results: Baseline HR, systolic blood pressure (SBP), and MAP were comparable between the groups. However subsequently, Group D had significantly lower HR and SBP at the time of extubation and at 3 and 6 min later. MAP at extubation and at 3 min later was comparable, but at 6 min, Group D had significantly lower values. In both groups, patient reactivity scores, ease of laryngoscopy, and vocal cord visibility were comparable (P > 0.05). Conclusion: Dexmedetomidine 0.5 μg/kg when used as an adjunct clinically improved conditions for assessing vocal cord mobility with significant attenuation of associated hemodynamic responses.

A prospective study of comparison of analgesic efficacy of dexamethasone as an adjuvant in supraclavicular block with intravenous dexamethasone after supraclavicular block in patients undergoing forearm surgeries Madhavi Rahul Godbole, Seema Shreepad Karhade, Priya P Parihar Anesthesia: Essays and Researches 2019 13(1):31-35 Context: Brachial plexus block is a preferred anesthesia technique for upper limb surgeries below the shoulder joint. Drugs used as adjuvants in block enhance the postoperative analgesia significantly. Aim: We aimed to evaluate the analgesic efficacy, of perineural dexamethasone used as an adjuvant to supraclavicular block as against systemic dexamethasone after supraclavicular block. Time for rescue analgesia was also noted in both groups. Subjects and Methods: In our randomized study, 60 patients belonging to the American Society of Anesthesiologist physical status Classes I and II were randomly allocated in two groups of thirty. Group BD received supraclavicular block with local anesthetic and dexamethasone 0.05 mg/kg as an adjuvant. Group BI received supraclavicular block with local anesthetic and intravenous (IV) dexamethasone 0.05 mg/kg after the block. In both groups, the comparison of postoperative analgesia and time for first rescue analgesic was noted. Statistical Analysis Used: Data analysis was done using SPSS version 20.0. Demographic data and continuous variables were analyzed by independent sample t-test. Categorical data were analyzed by unpaired t-test. Results: Group BD showed significantly prolonged postoperative analgesia as compared to Group BI. Time for rescue analgesic in Group BD was (15.8 ± 2.6) H as compared to Group BI (10.3 ± 1.07) H. Conclusions: Dexamethasone, when used in supraclavicular block significantly, prolongs the duration of analgesia as against IV dexamethasone after supraclavicular block.

A prospective crossover study evaluating the efficacy of king vision video laryngoscope in patients requiring general anesthesia with endotracheal intubation Ramachandra R Avula, Nagendra Nath Vemuri, Rambabu Tallapragada Anesthesia: Essays and Researches 2019 13(1):36-39 Background: Direct laryngoscopy used for tracheal intubation requires aligning the pharyngeal, laryngeal and oral axes to achieve a line of sight. Video laryngoscopy provides a better view of the glottis without the need for aligning the three axes. Aims: To evaluate the effectiveness of King vision laryngoscope over Macintosh laryngoscope in visualizing the glottis and intubating the trachea, when used on a same patient as in a cross over manner. Settings and Design: Department of Anaesthesia, Mediciti Institute of Medical Sciences, prospective crossover study conducted over a period of six months. Subjects and Methods: Sixty adult patients belonging to ASA physical status class I-II, requiring tracheal intubation were randomly assigned to intubation by King vision or Macintosh laryngoscope. Improvement, if any, in the Cormack-Lehane grading using the King vision scope, following initial grading with the Macintosh blade in the same patient was analyzed. Statistical Analysis: Mean and Standard deviation were calculated for different parameters under the study. Where appropriate, results were analyzed using the Mc Nemar χ2 test. A ‘p’ value less than 0.05 was considered statistically significant. Results: In the King Vision group, Cormack and Lehane grade improved in the majority (9/12) of patients in whom the initial Cormack and Lehane grade was >1 using the Macintosh blade. Conclusions: The use of the King vision blade significantly improved the laryngoscopic view over the Macintosh blade but the time for intubation was prolonged.

A comparative study between the efficacy of fentanyl, antihistamines, and dexmedetomidine in suppressing photic sneeze reflex during peribulbar block Karim YK Hakim, Mohammed Awad Alsaeid Anesthesia: Essays and Researches 2019 13(1):40-43 Background: The photic sneeze reflex (autosomal dominant) is a condition that causes sneezing in response to numerous stimuli, such as looking at bright lights or periocular (surrounding the eyeball) injection. Unexpected or sudden sneezing during injection can be a dangerous side effect in periocular injection, in which abrupt head movement may cause globe injury. Aims: We intended to evaluate the efficacy of adding fentanyl, dexmedetomidine, and antihistamines on the incidence of the sneeze reflex associated with propofol sedation during periocular local anesthesia injections. Settings and Design: Our study was a randomized, prospective, double-blinded and controlled clinical study. Patients and Methods: This study was conducted in Ain Shams and Fayoum university hospitals at the ophthalmic surgery department. After obtaining approval from our universities ethical committee and written informed valid consents from the patients, 90 patients were included in this study. The study population included patients of both sex, ASA grade 1 and 2, in the age ranging from 18-65 years. Patients were scheduled for cataract extraction surgeries and received peribulbar block. Then patients were randomly divided into three groups (30 patients each) using a computer- generated table of random numbers. Patients were preoxygenated with supplemental oxygen by nasal cannula, all 90 patients received intravenous propofol 1mg.kg- 1 bolus for sedation and were randomized to receive adjunctive drug 2 to 4 minutes prior to propofol injection: 30 patients received intravenous fentanyl 1 μmg.kg-1 (Group F), 30 patients received dexmedetomidine 1μmg.kg-1 (Group D), and 30 patients received antihistamine (pheniramine 22.75 mg) (Group H). The same local anesthetic admixture, consisting of 5 mL 2% lidocaine with 90 IU hyaluronidase, combined with 5 mL 0.5% plain bupivacaine in a 10-mL syringe at room temperature was administered to all patients using peribulbar block technique. A masked observer (surgeon or anesthesia assistant) recorded whether the patient had a sneezing event. Continuous cardiorespiratory monitoring was performed intraoperatively. Intraoperative and postoperative medication side effects were recorded including bradycardia (HR <55 beats/min), hypotension (MAP <50 mmHg sustained for >10 min), oxygen desaturation (SpO2<90%), nausea, vomiting and prolonged sedation using Ramsay Sedation Score (RSS). Statistical Analysis Used: Student's t-test and Chi-square test were used for analysis. Results: The demographic data of the three study groups revealed non-significant differences between the three study groups as regards age, sex distribution, and the duration of surgery. No patient was excluded after inclusion to the study. All patients were able to complete the entire study and their data were included in the final analysis. Five events of sneezing had occurred in 90 patients. Two in (D) group and three in (H) group with is no statistically significant difference between the three groups as regard sneezing. Bradycardia, hypotension and sedation had occurred significantly in group (D) compared to group (F) and group (D). No patient suffered from nausea, vomiting or oxygen desaturation in all studied groups. No statistically significant difference as regards patient satisfaction between the three studied groups. Conclusion: Fentanyl, dexmedetomidine and antihistamines with propofol sedation suppress photic sneeze reflex during peribulbar block.

Evaluation of neuromuscular blockade with vecuronium during general anesthesia with oxygen, nitrous oxide, isoflurane versus oxygen, air, isoflurane: A randomized controlled study Vishanth Boddu, Srinivasan Swaminathan, Hemavathy Balachander, Ranjith Kumar Sivakumar Anesthesia: Essays and Researches 2019 13(1):44-49 Background: The use of air oxygen mixture with isoflurane has become more common in the place of nitrous oxide, especially in laparoscopic and abdominal surgeries. With a varied mixture of gases and isoflurane used in general anesthesia, the exact dosing requirement and time duration of action have not been precisely studied with vecuronium when given as a bolus, as is given routinely. Purpose: This study was undertaken to evaluate and compare the neuromuscular effect of vecuronium during anesthesia with oxygen, nitrous oxide and isoflurane versus oxygen, air and isoflurane. Methodology: The study was a prospective, randomized controlled trial on 70 patients allocated into two groups as follows: Group N (nitrous oxide group) and Group A (medical air group). The primary objective was to measure and compare the posttetanic count (PTC1) – train of four (TOF1) interval, to evaluate the time taken for recovery from the intense blockade in both groups. The secondary objectives were to compare time duration for twitch height depression to be 30% of baseline after administering vecuronium, time duration from vecuronium administration to appearance of the first PTC1, PTC (n) at the reappearance of the 1st twitch, time interval between TOF1 and TOF3 and time from vecuronium administration to appearance of TOF3 in both the groups. Results: There is no significant difference between both the groups with reference to the block onset time using 30% depression of single twitch and recovery time from neuromuscular blockade using PTC, PTC1-TOF1 and TOF1-TOF3 time intervals. Conclusion: Measuring and comparing neuromuscular transmission monitoring parameters such as the onset time(ST depression to 30%), and recovery using PTC, PTC1-TOF1 and TOF1-TOF3 time intervals, it is concluded that the character of neuromuscular block with vecuronium is unaffected and not prolonged with or without nitrous oxide when used with isoflurane.

Evaluation of ultrasound-guided erector spinae plane block and oblique subcostal transversus abdominis plane block in laparoscopic cholecystectomy: Randomized, controlled, prospective study Serkan Tulgar, Mahmut Sertan Kapakli, Halil Cihan Kose, Ozgur Senturk, Onur Selvi, Talat Ercan Serifsoy, David Terence Thomas, Zeliha Ozer Anesthesia: Essays and Researches 2019 13(1):50-56 Background: Oblique subcostal transversus abdominis plane block (OSTAP) is a recently described regional anesthetic technique used in upper abdominal surgeries such as laparoscopic cholecystectomy (LC). Erector spinae plane block (ESPB) has also been reported for postoperative analgesia in LC. Aim: We aimed to compare the effectiveness of OSTAP and ESPB in providing postoperative analgesia in patients undergoing these surgeries. Setting and Design: This study was designed as a double-blinded, prospective, randomized, efficiency study in a tertiary university hospital, postoperative recovery room, and ward. Materials and Methods: A total of 72 patients were recruited and 60 patients were randomized into three equal groups (ESPB, OSTAP, and control group). Pain intensity between groups was compared using Numeric Rating Scale (NRS) scores. In addition, consumption of paracetamol and tramadol and additional rescue analgesic requirement were measured. Standard multimodal analgesia was performed in all groups, while ESPB block was also performed in Group ESPB and OSTAP block was also performed in group OSTAP. Statistical Analysis Used: Descriptive statistics were expressed as mean ± standard deviation. Independent t-test, Mann–Whitney U-test, Chi-square test, Fisher's exact test, Shapiro–Wilk test, one-way ANOVA, and post hoc Tukey's analysis were used for statistical analysis. Results: NRS was lower in block groups during the first 3 h. There was no difference in NRS scores at other hours. Analgesic consumption and rescue analgesic requirement were lower in groups ESPB and OSTAP when compared to those of control group. Block groups were similar. Conclusion: Bilateral ultrasound-guided ESPB and OSTAP performed at the end of LC lead to akin analgesia requirement and improve the quality of multimodal analgesia.