The Nuss procedure is the most minimally invasive and commonly used surgical correction for pectus excavatum (PE) by using a pre-bent pectus bar to elevate the deformed chest wall. However, there exist some complications such as postoperative pain as well as surgical uncertainties due to human judgement. It is therefore important to understand the biomechanical effect of the pectus bar on PE thoraces undergoing an operation to alleviate the postoperative pain as well as to improve surgical outcome.
https://ift.tt/2JoZs6y
Σάββατο 9 Ιουνίου 2018
Feasibility of using computer simulation to predict the postoperative outcome of the minimally invasive Nuss procedure: Simulation prediction vs. postoperative clinical observation
Should Planned/Desired Pregnancy be Considered an Absolute Contraindication to Breast Reconstruction with Free Abdominal Flaps? A Retrospective Case Series and Systematic Review
Autologous breast reconstruction is considered by many to be the gold standard reconstructive modality following mastectomy. Despite the advantages of autologous reconstruction, however, surgeons have been cautious in recommending this approach to patients who desire to becoming pregnant postoperatively due to concerns related to abdominal wall morbidity. While intuitive, this approach does not appear to be based on robust data. Hence, the authors examined the clinical outcome in patients who became pregnant following autologous breast reconstruction.
https://ift.tt/2HAZYbx
Long-Distance Care of Face Transplant Recipients in the United States
Promising aesthetic and functional outcomes in facial transplantation have fueled the interest of patients and providers alike. However, there are currently only 11 active face transplant centers in the United States, and only five have accumulated operative experience to date, resulting in an extremely unbalanced geographical distribution of providers. Since face transplant recipients must receive life-long follow-up, this presents unique challenges for face transplant candidates and provider teams, as long-distance travel may add considerable difficulty to pre- and post-transplant care.
https://ift.tt/2JoZnzM
“Immediate breast reconstruction with a Wise pattern mastectomy and NAC-sparing McKissock vertical bipedicle dermal flap”
Preservation of the nipple-areola complex (NAC) in immediate reconstruction of ptotic and large breasts is surgically challenging. This article presents a modification of the inferior dermal flap ("dermal sling") to a vertical bipedicle flap with NAC preservation. The flap is well described in breast reductions, but has never been described in a mastectomy setting. The study reviews data for a case series of 17 breasts in 11 women who were reconstructed with the new technique. The complication rate was 12 percent and the vertical bipedicle NAC-sparing flap has to be considered a feasible option in women with ptotic and/or large breasts.
https://ift.tt/2LE5Y5I
Risk factors for developing capsular contracture in women after breast implant surgery A systematic review of the literature
Capsular contracture is the most frequent complication in breast augmentation or reconstruction with breast implants. The exact mechanism for this complication is not completely understood. Yet, it is most likely to be a multifactorial condition. Several patient-, as well as surgery-, and implant-specific risk factors have been related to cause capsular contracture. This review aims to provide a clear overview of all risk factors for capsular contracture.
https://ift.tt/2JoZhbo
DONOR SKIN ALLOGRAFT SURVIVAL AFTER BONE MARROW TRANSPLANTATION: CASE REPORT AND SYSTEMATIC REVIEW OF THE LITERATURE
we present a case of skin allograft survival in a patient who previously received a bone marrow transplant from the same HLA-matched donor. DNA fingerprinting of skin biopsies showed mixed cellularity originating from the donor and recipient (68% and 32% donor DNA in the allograft skin and the native recipient's skin, respectively). Histologic sections demonstrated both grade 3/4 rejection and graft-versus-host- disease. We have conducted a systematic review in search for other cases of donor skin allograft survival after a bone marrow or hematopoietic stem cell transplantation.
https://ift.tt/2Hxx24p
Are facial injuries really different?
The article by Rahtz and colleagues concludes that appearance concern after facial injury may not lead either to stigma or to psychosocial burden.1 This is the conclusion that I reached this conclusion in an uncontrolled follow-up study of facial casualties of the First World War treated at the Cambridge Military Hospital, Aldershot and the Queen's Hospital, Sidcup (now Queen Mary's Hospital).
https://ift.tt/2JoZco6
Validation of the revised Food Neophobia Scale (FNS-R) in the Italian context
Source:Appetite, Volume 128
Author(s): Margherita Guidetti, Luciana Carraro, Nicoletta Cavazza, Michele Roccato
Measuring individuals' level of food neophobia, i.e., the reluctance to eat novel food, is a critical task since it negatively affects diet variety and quality. Using structural equations models, the revised Food Neophobia Scale (FNS-R) was validated with a sample of 711 Italian adults. After deleting 4 items characterized by both low face validity and a suboptimal association with the other items, and after correcting statistically for the acquiescent response-set, the resulting 6-item, fully balanced FNS-R showed a good construct validity. Moreover, it showed the expected positive correlations with General Neophobia and with Disgust Sensitivity. Finally, it resulted invariant across participants' genders, age classes, and levels of education, and across methods of administration (paper-and-pencil and on-line). Strong points and possible developments of the study are discussed.
https://ift.tt/2l12lMc
Pain and modifiable risk factors among weight loss seeking Veterans with overweight
Source:Appetite, Volume 128
Author(s): Kathryn M. Godfrey, Anastasia J. Bullock, Lindsey M. Dorflinger, Kathryn M. Min, Christopher B. Ruser, Robin M. Masheb
ObjectiveOverweight/obesity and chronic pain frequently co-occur and demonstrate a bidirectional relationship. Modifiable risk factors, such as eating behaviors and mental health symptoms, may be important to understand this relationship and improve interventions in Veterans.DesignCross-sectional.SettingVeterans Health Administration Medical Center outpatient clinic.SubjectsThe sample of Veterans (N = 126) was mostly male (89.7%), White (76%), and non-Hispanic (94%) with average age of 61.9 years (SD = 8.5) and average body mass index (BMI) of 38.5 (SD = 7.5).MethodsVeterans referred for weight loss treatment (MOVE!) at VA Connecticut completed self-report questionnaires, and electronic medical records were reviewed.ResultsMean self-reported pain rating was 4.5 out of 10 (SD = 2.3). Moderate to severe pain was endorsed by 60% of the sample. Veterans with higher pain intensity and interference reported higher global eating disorder symptoms, emotional overeating, night eating, insomnia severity, and mental health symptoms (all p's < 0.01). However, pain intensity and interference were not associated with BMI.ConclusionsFor Veterans seeking behavioral weight loss treatment, higher pain intensity and interference were associated with more severe eating disorder, sleep, and mental health symptoms. A better description of the clinical characteristics of Veterans with pain who participate in MOVE! highlights their unique needs and may improve treatments to address pain in the context of weight loss treatment.
https://ift.tt/2xXXV1O
Experimental scarcity increases the relative reinforcing value of food in food insecure adults
Source:Appetite, Volume 128
Author(s): Amanda K. Crandall, Jennifer L. Temple
People with fewer financial resources are at greater risk for obesity, but the mechanisms of this relationship are not fully understood. One factor that is related, both cross-sectionally and prospectively, to obesity is the relative reinforcing value of food. It is possible that the experience of scarcity increases this reinforcing value. To date, no studies have examined this potential relationship experimentally in humans. The purpose of the studies presented here was to test the hypothesis that experimental manipulations of perceived scarcity would impact the relative reinforcing value of food. A secondary hypothesis was that individuals who report experiencing food insecurity would be more sensitive to these experimental manipulations. In order to test these hypotheses, we investigated the effects of experimentally manipulated scarcity on the relative reinforcing value of food in a laboratory setting. Study 1 had a within-subjects design and included 25 adults. Scarcity was manipulated by placing time and resource limits on the relative reinforcing value task and examining responding for a high calorie snack food versus that of an alternative reinforcer. Study 1 showed a tendency for food insecure participants to respond more for all reinforcers across conditions and have a higher proportional response for food when resources were limited. Study 2 also made use of a within-subjects design with 30 adults and primed scarcity by creating financial gains and losses on the Iowa Gambling Task. We observed higher relative reinforcing values of food among food insecure participants in the control condition, which decreased in the financial gain condition. When taken together, these two studies suggest that individuals who report experiencing food insecurity respond to acute manipulations of scarcity by increasing their reinforcing value of snack food.
https://ift.tt/2kX7kNE
Usefulness of EEG-EMG coherence analysis to confirm epileptic nature of spells mimicking hemifacial spasms
Source:Clinical Neurophysiology
Author(s): Edoardo Ferlazzo, Sara Gasparini, Chiara Sueri, Vittoria Cianci, Damiano Branca, Silvana Franceschetti, Ferruccio Panzica, Laura Canafoglia, Umberto Aguglia
https://ift.tt/2xWZrBl
Atypical Auditory Language Processing in Adolescents with Autism Spectrum Disorders
Source:Clinical Neurophysiology
Author(s): Junpei Tanigawa, Kuriko Kagitani-Shimono, Junko Matsuzaki, Rei Ogawa, Ryuzo Hanaie, Tomoka Yamamoto, Koji Tominaga, Shin Nabatame, Ikuko Mohri, Masako Taniike, Keiichi Ozono
ObjectiveIndividuals with autism spectrum disorder (ASD) often show characteristic differences in auditory processing. To clarify the mechanisms underlying communication impairment in ASD, we examined auditory language processing with both anatomical and functional methods.MethodsWe assessed the language abilities of adolescents with ASD and typically developing (TD) adolescents, and analyzed the surface-based morphometric structure between the groups using magnetic resonance imaging. Furthermore, we measured cortical responses to an auditory word comprehension task with magnetoencephalography and performed network-based statistics using the phase locking values.ResultsWe observed no structural differences between the groups. However, the volume of the left ventral central sulcus (vCS) showed a significant correlation with linguistic scores in ASD. Moreover, adolescents with ASD showed weaker cortical activation in the left vCS and superior temporal sulcus. Furthermore, these regions showed differential correlations with linguistic scores between the groups. Moreover, the ASD group had an atypical gamma band (25–40 Hz) network centered on the left vCS.ConclusionsAdolescents with ASD showed atypical responses on the auditory word comprehension task and functional brain differences.SignificanceOur results suggest that phonological processing and gamma band cortical activity play a critical role in auditory language processing-related pathophysiology in adolescents with ASD.
https://ift.tt/2kX7eWi
Small fibre neuropathy in mitochondrial diseases explored with sudoscan
Source:Clinical Neurophysiology, Volume 129, Issue 8
Author(s): Marco Luigetti, Guido Primiano, Cristina Cuccagna, Daniela Bernardo, Donato Sauchelli, Catello Vollono, Serenella Servidei
ObjectivePolyneuropathy in mitochondrial diseases (MDs) is relatively common and widely investigated, but few data are instead reported about small fibres involvement.MethodsIn order to investigate the involvement of small fibres in MDs we performed extensive neurophysiological test (nerve conduction studies; sympathetic skin response; sudoscan) in 27 patients with genetic diagnosis of MD (7 m.3243A > G; 4 m.8344A > G; 9 single mtDNA deletion; 7 multiple mtDNA deletions).ResultsNCS showed a polyneuropathy in 11/27 cases (41%). The incidence was very high in POLG1 (100%), m.8344A > G (75%) and m.3243A > G (43%), while only 11% of patients with single deletion had evidence of large fibres involvement. Sympathetic skin response was abnormal only in three patients (one progressive external ophthalmoplegia with single mtDNA deletion; one patient with m.3243A > G mutation; one patient with POLG1 mutation). Sudoscan revealed the presence of an autonomic small fibres dysfunction in 9/27 cases (33%), most of them (7/9) carrying a single mtDNA deletion. Sudoscan data were also confirmed in a sub-group of patients by laser evoked potentials study. Considering only patients with single mtDNA deletion 7/9 (78%) showed abnormal results at sudoscan.ConclusionsSmall fibre neuropathy is another feature to investigate in mitochondrial diseases and seems specifically associated with the presence of single mtDNA deletion.SignificanceThe correct identification through specific neurophysiological tests of small fibres involvement in MDs represents another tile in this challenging diagnosis.
https://ift.tt/2sReRkQ
Incidence of epileptiform discharges in children during induction of anaesthesia using Propofol versus Sevoflurane
Source:Clinical Neurophysiology
Author(s): Susanne Koch, Leopold Rupp, Christine Prager, Rudolf Mörgeli, Sylvia Kramer, Klaus Dieter Wernecke, Astrid Fahlenkamp, Claudia Spies
ObjectiveIn pediatric patients, anaesthesia induction is often performed with intravenous Propofol or Sevoflurane inhalation. Although epileptiform discharges have been observed during inductions with Sevoflurane, their occurrence has not been investigated for i.v. Propofol inductions. The aim of this study is to compare the incidence of epileptiform discharges in children during anaesthesia induction using Propofol versus Sevoflurane.MethodsProspective, observational cohort study in children aged 0.5 to 8 years undergoing elective surgery. Children were anaesthetized with either Propofol or Sevoflurane. Bi-frontal electroencephalograms electrodes were placed before start of anaesthesia. Visual electroencephalogram analysis was performed from start of anesthetic agent administration until Intubation with regard to identify epileptiform patterns, i.e. delta with spikes; rhythmic polyspikes; periodic, epileptiform discharges; or suppression with spikes.Results39 children were anaesthetized with Propofol, and 18 children with Sevoflurane. Epileptiform discharges were seen in 36% of the children in the Propofol group, versus 67% in the Sevoflurane group (p=0.03). Incidence of the distinct types of epileptiform discharge differed for periodic, epileptiform discharges (Sevoflurane group 39% vs. Propofol group 3%; p<0.001). Higher concentration of Remifentanil (≥ 0.15µg/kg/min) was associated with less frequent epileptiform discharges (Exp 5.8; CI 95% 1.6 / 21.2; p=0.008).ConclusionsPropofol i.v. induction of anaesthesia in children triggers epileptiform discharges, whereas to a lesser extent than Sevoflurane does.SignificancePresuming that epileptiform discharges have an impact on postoperative brain function, it is advisable to use Propofol rather than Sevoflurane and higher level of Remifentanil for anaesthesia induction in children.
https://ift.tt/2kXT87b
Survival benefit of adjuvant brachytherapy after hysterectomy with positive surgical margins in cervical cancer
Publication date: Available online 8 June 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Richard Li, Ashwin Shinde, Yi-Jen Chen, Arya Amini, Stephen Lee, Thanh Dellinger, Ernest Han, Mark Wakabayashi, Rebecca Nelson, Sushil Beriwal, Scott Glaser
PurposeWe evaluated the utilization of brachytherapy (BT) in addition to external beam radiation therapy (EBRT) and the resulting impact on survival in patients with cervical cancer after hysterectomy with positive surgical margins.Methods and MaterialsPatients with cervical cancer diagnosed from 2004 to 2015 who underwent hysterectomy followed by adjuvant EBRT were identified using the National Cancer Data Base. Only patients with positive surgical margins were included for analysis. Logistic regression was used to evaluate predictors of BT utilization and for propensity score matching. Survival was compared between patients receiving EBRT alone and EBRT combined with BT for adjuvant treatment. Survival analysis using log-rank test and Cox proportional hazards modeling was performed in the overall and propensity score-matched cohorts.ResultsWe identified 1,719 patients who received hysterectomy with positive surgical margins followed by adjuvant radiation therapy, of which 778 patients (45.3%) received additional BT. Predictors of increased receipt of BT included age > 55 years, private rather than government insurance, radiation treatment duration ≥7 weeks, external beam radiation dose ≥4500 cGy, and time between radiation and surgery ≤9 weeks. With a median follow-up of 3.8 years, 3-year overall survival was 79.4% in patients receiving BT compared to 71.9% in patients receiving EBRT alone (log-rank p<0.001). On multivariate analysis, EBRT and BT was associated with significantly improved survival (hazard ratio 0.77; 95% confidence interval 0.64-0.92; p=0.003) compared to EBRT alone. The survival benefit of combining EBRT and BT persisted on propensity score-matched analysis (log-rank p=0.005).ConclusionsIn women with positive margins after hysterectomy for cervical cancer, the combination of EBRT and BT showed significantly improved overall survival compared to EBRT alone. However, only 45.3% of patients in our cohort received BT.
Teaser
We analyzed a cohort of patients from the National Cancer Database who underwent hysterectomy for cervical cancer with positive surgical margins followed by adjuvant radiation therapy. We found that the addition of brachytherapy to external beam radiation therapy was associated with improved overall survival compared to external beam radiation therapy alone. However, only 45% of patients in this cohort received brachytherapy.https://ift.tt/2kXS7vO
Analyzing Circulating Tumor Cells One at a Time
Publication date: Available online 8 June 2018
Source:Trends in Cell Biology
Author(s): Veronica Ortiz, Min Yu
Whole-genome sequencing has made a significant impact on cancer research, but traditional bulk methods fail to detect information from rare cells. Recently developed single-cell sequencing methods have provided new insights and unprecedented details about cancer progression and diversity. These advancements also enable the investigation of rare cells, such as circulating tumor cells (CTCs) derived from cancer patients. In this review, we outline various single-cell sequencing techniques that can elucidate the molecular properties of CTCs. In addition, we explain the drawbacks that need to be overcome for each method.
https://ift.tt/2HAEEmA
A novel punch biopsy technique without scissors or forceps
Publication date: Available online 9 June 2018
Source:Journal of the American Academy of Dermatology
Author(s): Ali Moiin, Brett C. Neill
https://ift.tt/2LBCgP7
Feasibility of a play-based intervention set for toddlers with autism
Source:Research in Developmental Disabilities, Volume 80
Author(s): Cooper R. Woodard, Jin Chung
The Meta-play Method is a play-based, naturalistic set of interventions designed to decrease the symptoms associated with autism in toddlers. The purpose of the present study was to explore the feasibility of using this intervention set with a small group of toddlers and their parents. We selected seven toddlers diagnosed with autism and tested these children for autism severity and severity of repetitive behaviors. Parents were trained on the basic concepts of DBTA and the Meta-play activities. Researchers reviewed the integrity of interventions at once- or twice-monthly home visits for a six-month period, and recorded progress as rated by the parent. Activities were adapted at each visit to the interests and progress of the participating toddler. At the end of six months, autism symptoms and repetitive behavior decreased and parents reported high levels of social validity. Additional aspects of data collection and outcome measures, and suitability of interventions and procedures are discussed. While some outcomes were encouraging, a number of changes are recommended for future research.
https://ift.tt/2kZcith
Evolutionary Perspective on Sex Differences in the Expression of Neurological Diseases
Source:Progress in Neurobiology
Author(s): David C. Geary
Sex-specific brain and cognitive deficits emerge with malnutrition, some infectious and neurodegenerative diseases, and often with prenatal or postnatal toxin exposure. These deficits are described in disparate literatures and are generally not linked to one another. Sexual selection may provide a unifying framework that integrates our understanding of these deficits and provides direction for future studies of sex-specific vulnerabilities. Sexually selected traits are those that have evolved to facilitate competition for reproductive resources or that influence mate choices, and are often larger and more complex than other traits. Critically, malnutrition, disease, chronic social stress, and exposure to man-made toxins compromise the development and expression of sexually selected traits more strongly than that of other traits. The fundamental mechanism underlying vulnerability might be the efficiency of mitochondrial energy capture and control of oxidative stress that in turn links these traits to current advances in neuroenergetics, stress endocrinology, and toxicology. The key idea is that the elaboration of these cognitive abilities, with more underlying gray matter or more extensive inter-modular white matter connections, makes them particularly sensitive to disruptions in mitochondrial functioning and oxidative stress. A framework of human sexually selected cognitive abilities and underlying brain systems is proposed and used to organize what is currently known about sex-specific vulnerabilities.
https://ift.tt/2sNTm4m
Pathologic role of nitrergic neurotransmission in mood disorders
Source:Progress in Neurobiology
Author(s): Mehdi Ghasemi, Joshua Claunch, Kathy Niu
Mood disorders are chronic, recurrent mental diseases that affect millions of individuals worldwide. Although over the past 40 years the biogenic amine models have provided meaningful links with the clinical phenomena of, and the pharmacological treatments currently employed in, mood disorders, there is still a need to examine the contribution of other systems to the neurobiology and treatment of mood disorders. This article reviews the current literature describing the potential role of nitric oxide (NO) signaling in the pathophysiology and thereby the treatment of mood disorders. The hypothesis has arisen from several observations including (i) altered NO levels in patients with mood disorders; (ii) antidepressant effects of NO signaling blockers in both clinical and pre-clinical studies; (iii) interaction between conventional antidepressants/mood stabilizers and NO signaling modulators in several biochemical and behavioral studies; (iv) biochemical and physiological evidence of interaction between monoaminergic (serotonin, noradrenaline, and dopamine) system and NO signaling; (v) interaction between neurotrophic factors and NO signaling in mood regulation and neuroprotection; and finally (vi) a crucial role for NO signaling in the inflammatory processes involved in pathophysiology of mood disorders. These accumulating lines of evidence have provided a new insight into novel approaches for the treatment of mood disorders.
https://ift.tt/2kVRp2e
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Publication date: September 2017 Source: Free Radical Biology and Medicine, Volume 110 Author(s): Lucía Fernández-del-Río, Anish Nag, Elen...
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Abstract Noise pollution is a major factor of environmental complaints in many cities, which has significant impacts on human health. As a...
