Permanent Loss Research Articles

Poor semen quality is associated with impaired antioxidant response and acute phase proteins and is likely mediated by high cortisol levels in Brucella-seropositive dromedary camel bulls.

Brucellosis in dromedary camel bulls leads to either temporary or permanent loss of fertility. Camel brucellosis is associated with both orchitis and epididymitis. However, the clinical signs of camel brucellosis are not clear as those in cattle. Therefore, this study aimed to diagnose camel brucellosis based on a serological screening using Rose Bengal plate test (RBPT) followed by competitive ELISA. To understand the impact of brucellosis on camel bull fertility, this study aimed to examine the semen characteristics, evaluate the testicular histopathology, examine hormonal profile, antioxidants and acute phase proteins (APP). A total of 150 mature bulls were used in this study. Blood samples were collected for serological, hormonal, and biochemical analysis. This study revealed that 6.6% and 7.3% of the examined bulls were Brucella-seropositive using RBPT and competitive ELISA, respectively. The Brucella-seropositive dromedary bulls showed poor semen quality, pathological changes orchitis, and lower testosterone. Moreover, our findings showed a higher cortisol level, and significant impairments in the measured APP and antioxidants in Brucella-seropositive bulls. In conclusion, the Brucella-seropositive dromedary bulls showed lower fertility due to poor semen quality and lower testosterone levels. Such lower fertility is likely mediated by high cortisol levels, and impaired APP and antioxidants' defense response.

Comprehensive Management of Cholesteatoma in Otitis Media: Diagnostic Challenges, Imaging Advances, and Surgical Outcome

Background: This study presents a comprehensive analysis of cholesteatoma of the middle ear, focusing on its clinical presentation, diagnostic imaging, and treatment outcomes. Cholesteatomas are defined by the keratinized squamous epithelium within the middle ear, leading to significant bone erosion, often affecting the ossicular chain and surrounding structures. Methods: The study explores various mechanisms involved in cholesteatoma progression, including enzymatic lysis, inflammatory responses, and neurotrophic disturbances. The study conducted a retrospective clinical and statistical review of 580 patients over a 20-year period (2003–2023), highlighting the role of advanced imaging, including computed tomography (CT) and diffusion-weighted magnetic resonance imaging (DWI), in preoperative planning and postoperative follow-up. Results: Findings revealed that early detection and intervention are crucial in preventing severe complications such as intracranial infection and hearing loss. Surgical treatment primarily involved tympanoplasty and mastoidectomy, with a recurrence rate of 1.55% within two years. The study underscores the importance of integrating imaging advancements into clinical decision-making to enhance patient outcomes and suggests further investigation into molecular mechanisms underlying cholesteatoma progression and recurrence. Histopathological and microbiological analysis was performed to identify pathological patterns and microbial agents. Conclusions: The study highlights the importance of early diagnosis and intervention to prevent complications such as intracranial infections and permanent hearing loss, while also emphasizing the role of advanced imaging techniques in the management and long-term monitoring of cholesteatoma patients.

Improved intracochlear biopolymeric drug delivery system: an in vivo study

Background The delivery of drugs into the inner ear is a challenging field of study due to the complex cochlear anatomy and physiology. The creation of an intracochlear device that allows for short- and long-term intracochlear delivery of the drugs with a minimal invasive technology is needed to prevent or treat conditions that can potentially prevent the development of permanent hearing loss. Aim This study intends to test the efficacy of DXM-infused PLGA microneedles created in our laboratory in an in vivo animal model of acute ototoxic injury. Material and Methods Twenty-four male Norway Brown rats were randomized into four groups, three of which groups received an intratympanic injection of ethacrynic acid and kanamycin. Two of these groups underwent the placement of an intracochlear microneedle blended or not with dexamethasone, and two groups underwent implantation of a plain microneedle, one of without prior exposure to the ototoxic agent to confirm in vivo biocompatibility. Animals were then followed with a weekly auditory brainstem response testing until day 28 after surgical intervention. Result and Conclusion Our intracochlear device demonstrated biocompatibility and produced no hearing changes after its implantation in the control group. Inserted DXM-blended microneedles prevented hearing deterioration in those animals exposed to an ototoxic environment.

Pediatric open-globe injury: Current perspectives, surgical principles, and literature review

Abstract Open-globe injury (OGI), referring to the full-thickness violation of the eye wall, is a severe consequence of ocular trauma which can lead to permanent vision loss. Here, we review the current literature on pediatric OGI including a focused review of studies published in the past 10 years. Scoring systems for final visual prognosis, important aspects of clinical examination, and imaging at the point of care are discussed. We furthermore provide an overview of primary and secondary surgical management of the initial OGI and sequelae. Amblyopia management differentiates pediatric from adult visual rehabilitation following OGI, and we discuss the current state-of-the-art approaches for the prevention of vision loss.

Challenges in managing severe homozygous protein c deficiency: a case report.

Protein C deficiency is a rare autosomal recessive disorder associated with a high risk of thromboembolic complications. This case report describes the challenges in managing a 23-year-old woman with severe homozygous protein C type 1 deficiency diagnosed since early infancy. Her medical history included misdiagnosed cellulitis, recurrent thrombosis, and permanent vision loss in one eye. The laboratory workup confirmed a diagnosis of severe protein C deficiency. Management involved a combination of fresh frozen plasma (FFP), protein C concentrate, warfarin, and heparin, with ongoing challenges due to recurrent thrombosis and anaphylaxis to FFP. This case highlights the challenges in the diagnosis and management of severe protein C deficiency. Although current treatment options provide partial control, further research is crucial to develop safer and more effective therapies to improve long-term outcomes for affected patients.

PKHD1L1 is required for stereocilia bundle maintenance, durable hearing function and resilience to noise exposure

Polycystic Kidney and Hepatic Disease 1-Like 1 (PKHD1L1) is a human deafness gene, responsible for autosomal recessive deafness-124 (DFNB124). Sensory hair cells of the cochlea are essential for hearing, relying on the mechanosensitive stereocilia bundle at their apical pole for their function. PKHD1L1 is a stereocilia protein required for the formation of the developmentally transient stereocilia surface coat. In this study, we carry out an in depth characterization of PKHD1L1 expression in mice during development and adulthood, analyze hair-cell bundle morphology and hearing function in aging PKHD1L1-deficient mouse lines, and assess their susceptibility to noise damage. Our findings reveal that PKHD1L1-deficient mice display no disruption to bundle cohesion or tectorial membrane attachment-crown formation during development. However, starting from 6 weeks of age, PKHD1L1-deficient mice display missing stereocilia and disruptions to bundle coherence. Both conditional and constitutive PKHD1L1 knockout mice develop high-frequency hearing loss progressing to lower frequencies with age. Furthermore, PKHD1L1-deficient mice are susceptible to permanent hearing loss following moderate acoustic overexposure, which induces only temporary hearing threshold shifts in wild-type mice. These results suggest a role for PKHD1L1 in establishing robust sensory hair bundles during development, necessary for maintaining bundle cohesion and function in response to acoustic trauma and aging.

Repercussion of Primary Nucleation Pathway: Dementia and Cognitive Impairment.

Neurodegenerative diseases, such as Alzheimer's, Parkinson's, and prion disease, are characterized by the conversion of normally soluble proteins or peptides into aggregated amyloidal fibrils. These diseases result in the permanent loss of specific types of neurons, making them incurable and devastating. Research on animal models of memory problems mentioned in this article contributes to our knowledge of brain health and functionality. Neurodegenerative disorders, which often lead to cognitive impairment and dementia, are becoming more prevalent as global life expectancy increases. These diseases cause severe neurological impairment and neuronal death, making them highly debilitating. Exploring and understanding these complex diseases offer significant insights into the fundamental processes essential for maintaining brain health. Exploring the intricate mechanisms underlying neurodegenerative diseases not only holds promise for potential treatments but also enhances our understanding of fundamental brain health and functionality. By unraveling the complexities of these disorders, researchers can pave the way for advancements in diagnosis, treatment, and ultimately, improving the lives of individuals affected by neurodegenerative diseases.

Early Surgery and High Dose Steroids in Treating Patients with Indirect Traumatic Optic Neuropathy: A Meta-Analysis and Systematic Review

Introduction: Optic nerve injury is a devastating cause of permanent visual loss after blunt or penetrating injury occurring in up to 7% of head trauma cases. No single treatment strategy and timing of intervention has proved optimal. Timely and appropriate management is key to improving visual outcomes. We compared whether immediate surgical decompression or steroids would lead to improvement of visual outcomes in individuals with indirect traumatic optic neuropathy. Methods: We searched from several online databases and included studies of patients with direct Optic nerve injury, those who received combined treatment with surgery and steroids, and those with delayed initiation of treatment were excluded. Results: The final search yielded eleven eligible studies. Both interventions showed similar results in improvement of visual function (RR 2.35, 95% CI 0.87 to 6.34, p=0.09, I2 0%). Both early and late intervention also showed similar results in improvement of visual function (RR 1.72, 95% CI 0.89 to 3.35, p=0.11, I2 61%). Among patients who underwent early surgical decompression, the rate of visual acuity improvement was 73% with those who underwent transcranial surgery and 69% with those who underwent endoscopic surgery. Conclusion: This study shows that immediate surgical decompression and early high dose steroid administration are equally effective in improving visual function. Patients with no light perception (NLP) and light perception (LP) pre treatment resulted to better visual improvement with steroids while those with counting fingers (CF) and more than CF pre treatment, resulted to better visual improvement with surgical decompression.

Evaluation of Permanent Nipple-Areola Complex Sensitivity Loss Following Reduction Mammoplasty.

Predictors for permanent nipple-areola complex (NAC) insensitivity after reduction mammoplasty are sparsely defined. We analyze factors associated with NAC insensitivity over a long-term follow-up. A retrospective analysis of reduction mammoplasties on 1598 breasts performed by four surgeons from March 2015-February 2023 was conducted. Data on patient demographics, intraoperative factors, and postoperative complications were collected from patient records. Analysis was conducted by breast, separated into breasts with NAC insensitivity (permanent and transient) and those without. Wilcoxon rank sum test for continuous variables and Fisher's exact test or Pearson's Chi-square test for categorical variables evaluated differences between the groups. Univariate and multivariate logistic regression analyzed the association of pedicle choice with NAC insensitivity onset and permanence. Of 1598 breasts, 9.8% had loss of NAC sensation, of which 49.0% had permanent loss. 51.0% regained sensitivity, taking an average of 116 days (median 64, range 6-798) to regain sensation. NAC-insensitive breasts had a longer sternal notch-NAC (p<0.001) and NAC-IMF (p<0.001) measurements, greater weight removed (p<0.001), and fat necrosis co-complication (p=0.022). Greater weight removed (p=0.044) and longer sternal notch-NAC measurements (p=0.011) were associated with permanent insensitivity. The superomedial pedicle was associated with an increased rate of transient NAC insensitivity, while the inferior pedicle with a decreased rate. There was no significant association between pedicle choices and permanent insensitivity. Transient loss of NAC sensitivity is associated with pedicle choice, while breasts with permanent insensitivity were more likely to have longer breast measurements and a greater amount of tissue removed.

Direct in vivo cardiac reprogramming with circular RNA of single transcription factor delivered by fibroblast-targeting lipid nanoparticles

Abstract Background Adult mammalian cardiomyocytes (CMs) hold limited capacity for self-regeneration, thus leading to permanent loss of functional myocardium once suffering from injury, especially myocardial infarction (MI). Therefore, cardiac regeneration therapy has been regarded as a potential path to help restore damaged tissue. Direct cardiac reprogramming is one of the most promising ways to boost cardiac regeneration as it could convert resident cardiac fibroblasts into functional induced cardiomyocytes (iCMs). However, difficulty of delivery has been one of the biggest problems that hinder the further clinical translation of this technique such as concerns of mostly used retrovirus vectors and lack of fibroblast-specific targeting ability. In our previous research, we have found that after knocking down of Ybx1 gene, single transcriptional factor Tbx5 could induce cardiac reprogramming of fibroblasts without adding traditional Mef2c and Gata4. But whether this cocktail could achieve in vivo direct cardiac reprogramming still remains to be explored. Objective We planned to develop fibroblast-targeting lipid nanoparticles (LNP) to delivery circular RNA(circRNA) of Tbx5 and small interfering RNA(siRNA) of Ybx1 to realize in vivo cardiac reprogramming in a mouse model of myocardial infarction. Results We first screened different formulations of tdTomato mRNA delivered-LNP both in primary neonatal cardiac fibroblasts and in the myocardial infarction model and found that formulation XF4d could realize specific selectively uptake by cardiac fibroblasts instead of cardiomyocytes. Then we succeeded in synthesizing XF4d LNP delivering Tbx5 circRNA and Ybx1 siRNA (LNPXF4d@Tbx5+siYbx1) and validated its stability at 4°C. Next, after infecting LNPXF4d@Tbx5+siYbx1, primary neonatal CFs and mouse embryonic fibroblasts could be reprogrammed into functional iCMs. We further measured the protein expression of Tbx5 and Ybx1 in CFs after LNPXF4d@Tbx5+siYbx1 treatment. What’s more, we used fibroblast-specific lineage tracing mice (Fsp1Cre/tdTomato mice) to prove the successful conversion of resident CFs into iCMs in the mouse model of myocardial infarction by intramyocardial injection of LNPXF4d@Tbx5+siYbx1. At last, we found that LNPXF4d@Tbx5+siYbx1 could help improve cardiac function after injury and reduce fibrosis, as measured by echocardiography and Masson’s trichrome staining. Conclusion We suggest that our fibroblast specific LNPs delivering single transcriptional factors could a promising method to realize in vivo cardiac reprogramming and help treat myocardial injury, with high possibility of clinical translation and less biosafety concerns.Graphical Abstract

Omiganan-Based Synthetic Antimicrobial Peptides for the Healthcare of Infectious Endophthalmitis.

Bacterial endophthalmitis is a severe infection of the aqueous or vitreous humor of the eye that can lead to permanent vision loss. Due to the rapid emergence of antibiotic resistance and dose-limiting toxicities, the standard treatment of bacterial endophthalmitis via the intravitreal injection of broad-spectrum antibiotics remains inadequate. Membrane active cationic antimicrobial peptides (AMPs) have emerged as a promising class of effective and broad-spectrum antimicrobial agents with potential to overcome antibiotic resistance. In this work, we investigate, for the first time, the use of omiganan (IK-12), a 12-amino acid indolicidin derivative for the treatment of bacterial endophthalmitis. Additionally, IK-12 was used as a template to perform amino acid rearrangements, without altering the length or type of amino acids, to yield a series of new derivative AMPs with varying extents of secondary structure formation under membrane mimicking conditions. IK-12 and its derivatives demonstrated strong and broad-spectrum antibacterial activities against a panel of clinically isolated Gram-positive and Gram-negative bacteria, including methicillin-resistant Staphylococcus aureus commonly implicated in bacterial endophthalmitis. Interestingly, two of the new IK-12 derivatives, IP-12 and WP-12, showed lower geometric mean minimum inhibitory concentration and higher 50% hemolysis concentration values, which effectively translated into 2- to 3.4-fold higher bacterial selectivity than the parent IK-12. Furthermore, the intravitreal injection of IK-12, IP-12, and WP-12 in a rabbit model of MRSA-induced endophthalmitis led to considerably improved clinical presentation and reduced recruitment of inflammatory cells. In all, these results demonstrate the potential of IK-12 and its derivatives, IP-12 and WP-12, as promising candidates for the treatment of bacterial endophthalmitis.

Sustainability of Groundwater Exploitation Under Climate Change Scenarios in a Mountainous Area of South Korea

The excessive extraction of groundwater is a globally significant issue, as it can lead to the permanent loss of groundwater system sustainability. Sustainable groundwater requires development that appropriately balances the needs of both humans and the environment. In this study, the exploitable groundwater (EGW) of the So-Yang-gang Dam (SYD) Basin was estimated based on simulated groundwater recharge rates using SWAT, and the sustainability of future groundwater development was evaluated under different climate change scenarios. The EGW in each sub-watershed of the SYD was estimated to range from 60 to 240 mm/year, with higher values in the upstream watersheds. A sustainability index (SI) was evaluated, ranging from 0.56 to 1.0 across various GCMs. The analysis revealed that uniform EGW across a watershed is overestimated value in sub-watersheds with low recharge rates, potentially accelerating groundwater depletion in those areas. Thus, a flexible EGW estimation approach is essential to balance groundwater conservation with human water demands.

A Unique Case of Hypervirulent Klebsiella Pneumoniae Invasive Syndrome with Endogenous Endophthalmitis and Left Renal Vein Thrombosis without Liver Abscess.

This case report presents a rare instance of hypervirulent Klebsiella pneumoniae invasive syndrome (KPIS) without hepatic involvement. It highlights an atypical presentation as this syndrome is characterized by liver abscesses. A 54-year-old female of South Asian descent presented to the emergency department with abdominal pain, fever, chills, nausea, and vomiting. Lab investigations showed hyperglycaemia, leukocytosis, and elevated procalcitonin. Imaging revealed bilateral acute pyelonephritis with early abscess formation in the left kidney, bilateral pleural effusions, diffuse multi-lobar consolidations, minimal ascites, and left renal vein thrombosis. The patient was treated as a case of septic shock secondary to hypervirulent K. pneumoniae with complications evolving into acute pyelonephritis and endogenous endophthalmitis. K. pneumoniae, known for its polysaccharide capsule, can lead to severe complications in immunocompromised patients, such as endogenous endophthalmitis, liver abscess, and pyelonephritis. Endophthalmitis, a critical ocular emergency, can result in permanent vision loss. The patient's ocular outcomes remain uncertain due to a lack of follow-up, but prompt interdisciplinary intervention led to the resolution of other comorbidities. This case highlights the importance of considering hypervirulent K. pneumoniae as a cause of severe infection without liver abscess. It also underscores the importance of immediate multidisciplinary management to address the systemic complications associated with this infection and the importance of connecting different symptoms to one aetiology. Klebsiella pneumoniae invasive syndrome (KPIS) should be considered in patients with positive Klebsiella pneumoniae infection affecting more than one organ system.KPIS may present atypically, such as in the absence of liver abscesses and with the presence of thrombosis.Hypervirulent and hypermucoviscous strains of Klebsiella pneumoniae should be considered in cases of KPIS.

Spectral Discrimination of Common Karoo Shrub and Grass Species Using Spectroscopic Data

Rangelands represent about 25% of the Earth’s land surface but are under severe pressure. Rangeland degradation is a gradually increasing global environmental problem, resulting in temporary or permanent loss of ecosystem functions. Ecological rangeland studies aim to determine the productivity of rangelands as well as the severity of their degradation. Rigorous in situ assessments comprising visual identification of plant species are required as such assessments are perceived to be the most accurate way of monitoring rangeland degradation. However, in situ assessments are expensive and time-consuming exercises, especially when carried out over large areas. In situ assessments are also limited to areas that are accessible. This study aimed to evaluate the effectiveness of multispectral (MS) and hyperspectral (HS) remotely sensed, unmanned aerial vehicle (UAV)-based data and machine learning (random forest) methods to differentiate between 15 dominant Nama Karoo plant species to aid ecological impact surveys. The results showed that MS imagery is unsuitable, as classification accuracies were generally low (37.5%). In contrast, much higher classification accuracies (&gt;70%) were achieved when the HS imagery was used. The narrow bands between 398 and 430 nanometres (nm) were found to be vital for discriminating between shrub and grass species. Using in situ analytical spectral device (ASD) spectroscopic data, additional important wavebands between 350 and 400 nm were identified, which are not covered by either the MS or HS remotely sensed data. Using feature selection methods, 12 key wavelengths were identified for discriminating among the plant species with accuracies exceeding 90%. Reducing the dimensionality of the ASD data set to the 12 key bands increased classification accuracies from 84.8% (all bands) to 91.7% (12 bands). The methodology developed in this study can potentially be used to carry out UAV-based ecological assessments over large and inaccessible areas typical of Karoo rangelands.

ATP-gated P2x7 receptor is a major channel type at type II auditory nerves and required for hearing sensitivity efferent controlling and noise protection.

Hearing sensitivity and noise protection are mediated and determined by negative feedback of the cochlear efferent system. Type II auditory nerves (ANs) innervate outer hair cells (OHCs) in the cochlea and provide an input to this efferent control. However, little is known about underlying channel information. Here, we report that ATP-gated P2x7 receptor had a predominant expression at type II ANs and the synaptic areas under inner hair cells and OHCs with lateral and medial olivocochlear efferent nerves. Knockout (KO) of P2x7 increased hearing sensitivity with enhanced acoustic startle response (ASR), auditory brainstem response (ABR), and cochlear microphonics (CM) by increasing OHC electromotility, an active cochlear amplifier in mammals. P2x7 KO also increased susceptibility to noise. Middle level noise exposure could impair active cochlear mechanics resulting in permanent hearing loss in P2x7 KO mice. These data demonstrate that P2x7 receptors have a critical role in type II AN function and the cochlear efferent system to control hearing sensitivity; deficiency of P2x7 receptors can impair the cochlear efferent suppression leading to hearing oversensitivity and susceptibility to noise.

First report of uncommon mycobacteria in post LASIK keratitis: Mycobacterium wolinskyi

Laser assisted in situ keratomileusis (LASIK) surgery is the leading and most performed refractive surgery nowadays. A possible complication of LASIK surgery is infectious keratitis which can lead to disastrous corneal damage and result in permanent loss of vision. LASIK procedures have become increasingly accessible, and the demand for refractive surgery has risen among patients, challenging the medical field to improve the prevention of post-operative infections. Nevertheless, a wide range of pathogens have been described as responsible for post-LASIK keratitis. However, non-tuberculous mycobacterial keratitis remains an infrequent occurrence and is poorly described in the literature. To the best of our knowledge, this is the first ever reported case of post-LASIK keratitis caused by Mycobacterium wolinskyi. We describe the clinical and microbial characteristics, leading to its challenging treatment choice.

Evaluation of the Environmental Risk Factors and Comorbidities in Patients with Lichen Planopilaris: A Case-Control Study

Introduction: Lichen planopilaris (LPP) is an uncommon cicatricial alopecia clinically characterized by follicular hyperkeratosis, perifollicular erythema, and permanent hair loss. The association of LPP with certain underlying diseases and environmental factors has been evaluated but there are limited data about this association. This study was designated to evaluate the environmental risk factors and comorbidities in LPP patients. Method: This case-control study was performed on LPP patients referred to two dermatology referral centers from 2019 to 2022. A group of non-LPP healthy individuals referring for cosmetic concerns was recruited as control group. Data collection was performed using two questionnaires: a general questionnaire, including demographic information, comorbidities, environmental risk factors, and disease-related information, and the lichen planopilaris activity index (LPPAI) questionnaire. Results: One hundred LPP patients as case group were compared with 100 healthy people without LPP as control group. Unemployment, history of major stressful events, thyroid disorder, history of hair dyeing, using face soaps, taking supplements, postmenopausal status, and family history of LPP or other types of alopecia had significant relationship with LPP (all p values <0.05). Conclusion: LPP has associations with environmental and non-environmental risk factors and, also, genetic component.

An Empirical Study on Indian Economy Over COVID-19 Pandemic

The infectious disease coronavirus disease 2019 (COVID-19) emerged as a human pathogen and contributed to a pandemic around the world. According to the reports released as of February 2021, around 103 million confirmed cases and 2,247,917 deaths are registered. The pandemic of COVID-19, or coronavirus, has exposed several global system vulnerabilities. Even after having all the abilities to handle hazards, the sudden outbreak of COVID-19 isolated every one of us from others. COVID-19 has caused the Indian economy to experience considerable disruption. The current pandemic of the coronavirus may lead to a permanent loss of 4 per cent of real Indian gross domestic product (GDP). Some key sectors such as tourism and aviation, telecommunication, automobiles and transport are negatively impacted. The other sectors such as e-learning, e-retail, logistics, pharmaceuticals and so on benefit from COVID-19. The present research is intended to study the positive and negative effects of COVID-19 in different industries, taking into account data of a secondary type. The survey also concludes with the initiatives, schemes and market effects for five important sectors using various relevant statistical instruments and techniques for analysis and conclusion.

A qualitative exploration of the assessment process to cochlear implantation for children with hearing loss

Objective To explore the process of paediatric cochlear implant assessment, from referral to implantation, from the perspective of parents, cochlear implant professionals, and through observations of clinics. Design Qualitative approach, using grounded theory methodology. Study sample Twelve families with children under 5 years with permanent hearing loss referred for a cochlear implant or received an implant in the past year, and six professionals who refer or assess children for cochlear implants. Data collection involved interviews and ethnographic observations of assessment clinics. Results The core theme derived from interview and observation data related to the work of the cochlear implant assessment for families. The relationship between the work generated by the assessment process and capacity of parents to do the work provides a model to examine access to early implantation, consistent with the Burden of Treatment theory. We identified variation in terms of workload, relating to factors such as a child’s additional needs or number of appointments required, and in terms of capacity, relating to factors such as social circumstances or health literacy. Social, peer and professional support and information helped families manage the workload. Conclusions Findings have implications for delivery of paediatric cochlear implant services.

Peripheral nerve grafting

Peripheral nerve lesions often lead to significant and permanent loss of motor and sensory function. The aim of peripheral nerve grafting is to bridge nerve defects. When tension-free nerve repair is not possible, peripheral nerve grafting is indicated. Local infection, insufficient soft tissue coverage, significant muscle atrophy or joint contraction in case of "motor" nerve grafting, lack of microsurgical instruments or experience, life-threatening injuries. Exposure and preparation of the nerve stumps. Choosing and preparation of the donor nerve. Approximation. Nerve repair. Nerve reconstruction must always be tension-free as nerve repair with tension frequently leads to disruption of nerve healing and poor functional outcome. Autologous nerve grafting from various donor sites leads to excellent functional results with little sensory deficits at the donor regions. Limited immobilization, physiotherapy, ergotherapy, regular clinical and neurological assessments. Outcome of peripheral nerve grafting may, for example, depend on defect length, caliber and quality of the injured nerve, quality of the donor nerve, microsurgical expertise of the surgeon, time of reconstruction, and age of the patient.