Incidence of cervical branch injury with "marginal mandibular nerve pseudo-paralysis" in patients undergoing face lift

The anatomy of the cervical and marginal mandibular branches of the facial nerve is reviewed. In the senior author's practice, "pseudoparalysis of the marginal mandibular nerve" due to cervical branch injury occurred in 34 of 2002 superficial musculoaponeurotic system-platysma face lifts (1.7 percent) and was associated with a full recovery in 100 percent of cases within a time period ranging from 3 weeks to 6 months. Cervical branch injury can be distinguished from marginal mandibular nerve injury by the fact that the patient will be able to evert the lower lip because of a functioning mentalis muscle.     

Alterations in marginal zone macrophages and marginal zone B cells in old mice

Marginal zones (MZs) are architecturally organized for clearance of and rapid response against blood-borne Ags entering the spleen. MZ macrophages (MZMs) and MZ B cells are particularly important in host defense against T-independent pathogens and may be crucial for the prevention of diseases, such as streptococcal pneumonia, that are devastating in older patients. Our objective was to determine whether there are changes in the cellular components of the MZ between old and young mice. Using immunocytochemistry and a blinded scoring system, we observed gross architectural changes in the MZs of old mice, including reduction in the abundance of MZMs surrounding the MZ sinus as well as disruptions in positioning of mucosal addressin cell adhesion molecule 1 (MAdCAM-1)(+) sinus lining cells and metallophilic macrophages. Loss of frequency of MZMs was corroborated by flow cytometry. A majority of old mice also showed reduced frequency of MZ B cells, which correlated with decreased abundance of MZM in individual old mice. The spleens of old mice showed less deposition of intravenously injected dextran particles within the MZ, likely because of the decreased frequency in MZMs, because SIGN-R1 expression was not reduced on MZM from old mice. The phagocytic ability of individual MZMs was examined using Staphylococcus aureus bioparticles, and no differences in phagocytosis were found between macrophages from young or old spleens. In summary, an anatomical breakdown of the MZ occurs in advanced age, and a reduction in frequency of MZM may affect the ability of the MZM compartment to clear blood-borne Ags and mount proper T-independent immune responses.     

Spatiotemporal dynamics in marginal populations

Population dynamics across a mortality gradient at an ecological margin are investigated using a novel modeling approach that allows direct comparison of stochastic spatially explicit simulation results with deterministic mean field models. The results show that demographic stochasticity has a large effect at population margins such that density profiles fall off more sharply than predicted by mean field models. Substantial spatial structure emerges at the margin, and spatial correlations (measured parallel to the margin) exhibit a sharp maximum in the tail of the density profile, indicating that spatial substructuring is greatest at an intermediate point across the ecological gradient. Such substructuring may have a substantial impact on Allee effects and evolutionary processes in marginal populations.     

The marginal valuation of fertility

Substantial theoretical and empirical evidence demonstrates that fertility entails economic, physiological, and demographic trade-offs. The existence of trade-offs suggests that fitness should be maximized by an intermediate level of fertility, but this hypothesis has not had much support in the human life-history literature. We suggest that the difficulty of finding intermediate optima may be a function of the way fitness is calculated. Evolutionary analyses of human behavior typically use lifetime reproductive success as their fitness criterion. This fitness measure implicitly assumes that women are indifferent to the timing of reproduction and that they are risk-neutral in their reproductive decision-making. In this paper, we offer an alternative, easily-calculated fitness measure that accounts for differences in reproductive timing and yields clear preferences in the face of risky reproductive decision-making. Using historical demographic data from a genealogically-detailed dataset from 19th century Utah, we show that this measure is highly concave with respect to reproductive effort. This result has three major implications: (1) if births are properly timed, a lower-fertility reproductive strategy can have the same fitness as a high-fertility strategy, (2) intermediate optima are far more likely using fitness measures that are strongly concave with respect to effort, (3) we expect mothers to have strong investment preferences with respect to the risk inherent in reproduction.     

Displacement of a mandibular incisor--an infrequent complication of mandibular fracture

A case of a mandibular fracture with an unusual complication is reported. A 13-year-old boy was admitted four years after conservative treatment of a symphyseal fracture. He complained of recurrent swelling. A radiographic evaluation showed a horizontally laid permanent mandibular left lateral incisor (PMLLI) that had probably slid into the fracture line and provoked repetitive infection episodes. After a surgery, a clinical and radiological analysis showed satisfactory healing.     

Testing for conditional multiple marginal independence

Survey respondents are often prompted to pick any number of responses from a set of possible responses. Categorical variables that summarize this kind of data are called pick any/c variables. Counts from surveys that contain a pick any/c variable along with a group variable (r levels) and stratification variable (q levels) can be marginally summarized into an r x c x q contingency table. A question that may naturally arise from this setup is to determine if the group and pick any/c variable are marginally independent given the stratification variable. A test for conditional multiple marginal independence (CMMI) can be used to answer this question. Since subjects may pick any number out of c possible responses, the Cochran (1954, Biometrics 10, 417-451) and Mantel and Haenszel (1959, Journal of the National Cancer Institute 22, 719-748) tests cannot be used directly because they assume that units in the contingency table are independent of each other. Therefore, new testing methods are developed. Cochran's test statistic is extended to r x 2 x q tables, and a modified version of this statistic is proposed to test CMMI. Its sampling distribution can be approximated through bootstrapping. Other CMMI testing methods discussed are bootstrap p-value combination methods and Bonferroni adjustments. Simulation findings suggest that the proposed bootstrap procedures and the Bonferroni adjustments consistently hold the correct size and provide power against various alternatives.     

A marginal model of tolerated theft

Using marginal analysis to represent Blurton Jones's concept of tolerated theft, I show how equilibrium resource transfers among individuals might be affected by foraging behavior, resource qualities, and number of participants. The model applies to hominids and other species that exchange or share food or other resources. Among the results: Tolerated theft enhances the value to be derived from resources, packets intermediate in size are most likely to be subjected to tolerated theft, packet division is more likely to be unequal than equal, division is a function of group size, and tolerated theft is most likely in small groups. The model also suggests that among reciprocators the widest possible exchange or sharing is in the self-interest of the individual procuring the resource. In general, evolutionary cost-benefit accounting should track marginal changes in the value (fitness or utility) of resources. Marginal valuation is conceptually primary and may produce results that differ from direct measures of quantity.     

Analysis of longitudinal marginal structural models

In this article we construct and study estimators of the causal effect of a time-dependent treatment on survival in longitudinal studies. We employ a particular marginal structural model (MSM), proposed by Robins (2000), and follow a general methodology for constructing estimating functions in censored data models. The inverse probability of treatment weighted (IPTW) estimator of Robins et al. (2000) is used as an initial estimator and forms the basis for an improved, one-step estimator that is consistent and asymptotically linear when the treatment mechanism is consistently estimated. We extend these methods to handle informative censoring. The proposed methodology is employed to estimate the causal effect of exercise on mortality in a longitudinal study of seniors in Sonoma County. A simulation study demonstrates the bias of naive estimators in the presence of time-dependent confounders and also shows the efficiency gain of the IPTW estimator, even in the absence such confounding. The efficiency gain of the improved, one-step estimator is demonstrated through simulation.