bluuebunny/crossref_metadata_2025 huggingface dataset:
Obsessive-Compulsive Symptoms in Schizophrenia
Authors: Poyurovsky Michael
Published: October 2017

This chapter evidence for a relationship between obsessive-compulsive disorder and psychosis, in some patients. Obsessive-compulsive symptoms are common in individuals with schizophrenia; this ‘schizo-obsessional’ population has been relatively little studied and presents marked clinical challenges. Longitudinal studies suggest that OC symptoms precede psychosis in some patients but develop later in illness in others; they can be induced by some second-generation antipsychotics. Neurobiological and cognitive psychological studies suggest that schizo-obsessional patients have greater impairment in several domains than those with schizophrenia or OC symptoms alone. The literature on pharmacological treatment of this patient population, which is limited, is review.
Evolutionary Perspectives on OCD
Authors: van Schalkwyk Gerrit I , Leckman James F
Published: October 2017

This chapter explores a number of ideas related to an evolutionary perspective on OCD, including ways in which dimensions of OCD symptomology might be adaptive in a variety of contexts; a discussion of nonadaptationist perspectives; and some ideas about how OCD symptoms may represent behavior that is conserved across generations, including the still-controversial idea of group selection in human evolution. Some beliefs that occur in the context of OCD overlap with beliefs that facilitate potentially adaptive ritualistic behavior. Evolutionary perspectives are largely untestable, and in this regard a source of controversy. Despite these limitations, evolutionary perspectives have significant heuristic value, may mutually inform and be informed by advances in neuroscience, and may have clinical value because they may facilitate empathy with patients whose behaviors may be thought of as adaptive in different developmental and social contexts.
Research Domain Criteria and OCD
Authors: Kalanthroff Eyal , Anholt Gideon E. , Simpson Helen Blair
Published: October 2017

This chapter discusses the Research Domain Criteria (RDoC) project, an initiative of the National Institutes of Mental Health (NIMH) of the United States to develop for research purposes new ways of classifying mental disorders based on dimensions of observable behavior and neurobiological measures, and explores how the hallmark symptoms of OCD (obsessions, compulsions, and anxiety) can be mapped onto RDoC domains. Unlike current categorical diagnostic systems (e.g., DSM), RDoC seeks to integrate many levels of information (from genomics to self-report) to validate dimensions defined by neurobiology and behavioral measures that cut across current disorder categories. The chapter explores, for heuristic reasons, how the RDoC matrix might be used to elucidate the neurobehavioral domains of dysfunction that lead to the characteristic symptoms of OCD. It then selectively reviews the OCD literature from the perspective of the RDoC domains, aiming to guide future transdiagnostic studies to examine specific neurobehavioral domains across disorders.
OCD in Ethnoracial Minorities
Authors: Williams Monnica T. , Ching Terence
Published: October 2017

Obsessive-compulsive disorder (OCD) is a multifaceted and functionally disabling condition involving distressing obsessions and repetitive compulsions. Although OCD rates are generally invariant across US ethnoracial minority groups, there remains a paucity of knowledge about the disorder in minorities. This could be due to underrepresentation of these groups in OCD treatment centers, a major source of symptom data for OCD research. Poor minority participation also suggests stigmatic cultural attitudes toward mental illness and related services, among other barriers to treatment, in these groups. Therefore, this chapter reviews symptom presentation, various barriers to treatment, and possible cultural considerations for treatment of OCD in three ethnoracial minority groups in the United States (African Americans, Latino/Hispanic Americans, and Asian Americans). It is hoped that this chapter can help readers better understand how cultural norms can shape the experience of OCD, as well as influence help seeking and treatment success in ethnic and racial minorities.
Cranial Nerves
Authors: Hawkes Christopher H. , Sethi Kapil D. , Swift Thomas R.
Published: October 2017

This chapter describes each cranial nerve and their associated Handles and Red Flags. In relation to the olfactory nerve various features accompanying anosmia are discussed. Visual acuity, field defects, congruity, transient painless monocular visual loss, disorders affecting the pupil and iris, fundoscopy, papilledema, and swollen optic disk are the main categories addressed concerning the optic nerve and visible parts of the eye. Disorders involving the oculomotor, trochlear, and abducens nerves include diplopia, supranuclear gaze paly, nystagmus, and proptosis. Diagnosis of conditions concerning the trigeminal and facial nerves are described. Those affecting the vestibulo-cochlear nerve include tinnitus, Fabry’s disease, deafness, and vestibular disorders. Palatal tremor/myoclonus and Trotter’s triad, disorders affecting the glossopharyngeal and vagus nerves, are included. Finally, Handles and Flags are provided for complaints involving the accessory nerve and hypoglossal nerves.
Limbs and Trunk
Authors: Hawkes Christopher H. , Sethi Kapil D. , Swift Thomas R.
Published: October 2017

This chapter emphasizes various clues apparent from the patient’s history and physical examination. Observation of how a patient walks, talks, and undresses is discussed as a means of discerning clues to a diagnosis. Miscellaneous aspects of the history, particularly sensory symptoms, such as tingling in the hands, feet, and face, shooting leg pains, and neuropathy are described, and clues to psychogenic disorder are elaborated. Also emphasized is the value of inspecting the limbs, skin, and joints. Shortcuts are listed for the traditional physical motor examination, which involves tone, power, coordination, muscle stretch reflexes, and Babinski response. Shortcuts are also described for the sensory examination, using joint position sense, vibration sense, and sensory loss. The chapter concludes with an outline of how to analyze coma.
Demyelination
Authors: Hawkes Christopher H. , Sethi Kapil D. , Swift Thomas R.
Published: October 2017

This chapter describes various clues to the diagnosis of multiple sclerosis based on the history, physical examination and investigation. Some of these clues include Uhtoff’s phenomenon, Lhermitte’s sign, McArdles sign, useless hand syndrome, paroxysmal attacks, sphincter disturbances, optic neuritis, nystagmus, family history, and isolated dysgeusia. Physical examination includes assessment of eye movements, color desaturation, Babinski sign, and Kestenbaum’s sign. Disorders that may be confused with multiple sclerosis, such as CLIPPERS syndrome, hemophagocytic lymphohistiocytosis, primary central nervous system lymphoma; tumefactive multiple sclerosis, and progressive multifocal leukoencephalopathy are also discussed.
Headache
Authors: Hawkes Christopher H. , Sethi Kapil D. , Swift Thomas R.
Published: October 2017

This chapter enumerates features that are reassuring and do not point to serious disease, such as carotid artery tenderness, slow evolution of symptoms as in hemisensory or hemiparetic migraine, sensory or motor symptoms on the same side as the headache, and age of symptom onset. Several Red Flags are given that indicate the need for investigation, such as first or worst headache, cough headache, morning headache, coital headache, thunderclap headache, continuous headache in an elderly person, medication overuse headache, and CADASIL syndrome. Clues for cluster headache, orthostatic headache, idiopathic intracranial hypertension, and several other headache syndromes are mentioned. Also listed are a few specific headaches that respond to indomethacin.
Epilepsy and Sleep Disorders
Authors: Hawkes Christopher H. , Sethi Kapil D. , Swift Thomas R.
Published: October 2017

This chapter lists diagnostic clues that allow identification of various syndromes by inspection alone, such as tuberous sclerosis, Sturge Weber syndrome, lipoid proteinosis, Angelman’s syndrome, and Rett syndrome. Guides to localization and lateralization are provided, as well as the main causes of refractory seizures. Characteristic EEG patterns found in epilepsy and sleep disorders are illustrated. Diagnostic clues associated with non-epileptic attack disorders are described. Handles are exemplified for the major sleep-related disorders, such as sleep–wake transition disorder, frontal lobe seizures, night terror, catathrenia, Klein-Levine syndrome, fatal familial insomnia, and sleep paralysis.
Stroke
Authors: Hawkes Christopher H. , Sethi Kapil D. , Swift Thomas R.
Published: October 2017

This chapter outlines diagnostic clues of importance in the history in stroke patients and how a stroke or transient ischemic attack may be distinguished from migraine, seizure, syncope, and amyloid spells. Disorders that mimic a stroke are described, as well as focal cortical and brainstem syndromes and the one-and-a-half syndrome. Features permitting the identification of internal carotid artery stenosis are delineated. Posterior circulation ischemia is also addressed. Unusual cortical syndromes are identified, such as the cortical borderzone infarct, man in a barrel syndrome, Fabry’s syndrome, Susac’s syndrome, cerebral hyperperfusion syndrome, CADASIL, crossed monoparesis, top of the basilar syndrome, and one and a half syndrome. Specific lacunar stroke and cortical sinus thrombosis disorders are also detailed.
Dementia
Authors: Hawkes Christopher H. , Sethi Kapil D. , Swift Thomas R.
Published: October 2017

This chapter emphasizes the value of preliminary observations in making a provisional diagnosis of dementia. Significant aspects of the history are detailed, such as head injury or brain hemorrhage that could lead to hydrocephalus or superficial siderosis. Diagnostic clues are given that facilitate identification of the posterior cortical variant of Alzheimer’s disease, characterized by progressive decline in visuospatial, visuoperceptual, literacy, and praxic skills. Emphasized is the importance of temporal pattern of disease, manifesting as episodic confusion and dementia progressing over a period of months. Further clues are outlined to facilitate identification of frontotemporal dementia variants, including semantic dementia, the behavioral variant, progressive nonfluent aphasia, and logopenic aphasia. The value of physical examination is stressed as it may disclose an underlying structural lesion.
Risk Factors for Community-Associated Clostridium difficile Infection in Adults: A Case-Control Study
Authors: Guh Alice Y , Adkins Susan Hocevar , Li Qunna , Bulens Sandra N , Farley Monica M , Smith Zirka , Holzbauer Stacy M , Whitten Tory , Phipps Erin C , Hancock Emily B , Dumyati Ghinwa , Concannon Cathleen , Kainer Marion A , Rue Brenda , Lyons Carol , Olson Danyel M , Wilson Lucy , Perlmutter Rebecca , Winston Lisa G , Parker Erin , Bamberg Wendy , Beldavs Zintars G , Ocampo Valerie , Karlsson Maria , Gerding Dale N , McDonald L Clifford
Published: October 2017

Background

An increasing proportion of Clostridium difficile infections (CDI) in the United States are community-associated (CA). We conducted a case-control study to identify CA-CDI risk factors.

Methods

We enrolled participants from 10 US sites during October 2014–March 2015. Case patients were defined as persons age ≥18 years with a positive C. difficile specimen collected as an outpatient or within 3 days of hospitalization who had no admission to a health care facility in the prior 12 weeks and no prior CDI diagnosis. Each case patient was matched to one control (persons without CDI). Participants were interviewed about relevant exposures; multivariate conditional logistic regression was performed.

Results

Of 226 pairs, 70.4% were female and 52.2% were ≥60 years old. More case patients than controls had prior outpatient health care (82.1% vs 57.9%; P < .0001) and antibiotic (62.2% vs 10.3%; P < .0001) exposures. In multivariate analysis, antibiotic exposure—that is, cephalosporin (adjusted matched odds ratio [AmOR], 19.02; 95% CI, 1.13–321.39), clindamycin (AmOR, 35.31; 95% CI, 4.01–311.14), fluoroquinolone (AmOR, 30.71; 95% CI, 2.77–340.05) and beta-lactam and/or beta-lactamase inhibitor combination (AmOR, 9.87; 95% CI, 2.76–340.05),—emergency department visit (AmOR, 17.37; 95% CI, 1.99–151.22), white race (AmOR 7.67; 95% CI, 2.34–25.20), cardiac disease (AmOR, 4.87; 95% CI, 1.20–19.80), chronic kidney disease (AmOR, 12.12; 95% CI, 1.24–118.89), and inflammatory bowel disease (AmOR, 5.13; 95% CI, 1.27–20.79) were associated with CA-CDI.

Conclusions

Antibiotics remain an important risk factor for CA-CDI, underscoring the importance of appropriate outpatient prescribing. Emergency departments might be an environmental source of CDI; further investigation of their contribution to CDI transmission is needed.
Rapid Influenza Testing in an Austere Setting, Mongolia
Authors: Maisetseg Chuluunbaatar , Ulziimaa Daramragchaa , Sack Alexandra , Battsetseg Gonchigoo , Bekh-Ochir Baigalmaa , Yondon Myagmarsukh , Gray Gregory C
Published: October 2017

In 2015–2017, we helped rural Mongolian clinicians with poor infrastructure adopt rapid influenza diagnostic tests (RIDTs). In their hands, the Quidel Sofia Influenza A Test was both sensitive (75%) and specific (100%). If made widely available, such RIDTs would have the potential to markedly reduce influenza morbidity and mortality in Mongolia.
Multiwavelength study of X-ray luminous clusters in the Hyper Suprime-Cam Subaru Strategic Program S16A field
Authors: Miyaoka Keita , Okabe Nobuhiro , Kitaguchi Takao , Oguri Masamune , Fukazawa Yasushi , Mandelbaum Rachel , Medezinski Elinor , Babazaki Yasunori , Nishizawa Atsushi J , Hamana Takashi , Lin Yen-Ting , Akamatsu Hiroki , Chiu I-Non , Fujita Yutaka , Ichinohe Yuto , Komiyama Yutaka , Sasaki Toru , Takizawa Motokazu , Ueda Shutaro , Umetsu Keiichi , Coupon Jean , Hikage Chiaki , Hoshino Akio , Leauthaud Alexie , Matsushita Kyoko , Mitsuishi Ikuyuki , Miyatake Hironao , Miyazaki Satoshi , More Surhud , Nakazawa Kazuhiro , Ota Naomi , Sato Kousuke , Spergel David , Tamura Takayuki , Tanaka Masayuki , Tanaka Manobu M , Utsumi Yousuke
Published: October 2017

We present a joint X-ray, optical, and weak-lensing analysis for X-ray luminous galaxy clusters selected from the MCXC (Meta-Catalog of X-Ray Detected Clusters of Galaxies) cluster catalog in the Hyper Suprime-Cam Subaru Strategic Program (HSC-SSP) survey field with S16A data. As a pilot study for a series of papers, we measure hydrostatic equilibrium (HE) masses using XMM-Newton data for four clusters in the current coverage area out of a sample of 22 MCXC clusters. We additionally analyze a non-MCXC cluster associated with one MCXC cluster. We show that HE masses for the MCXC clusters are correlated with cluster richness from the CAMIRA catalog, while that for the non-MCXC cluster deviates from the scaling relation. The mass normalization of the relationship between cluster richness and HE mass is compatible with one inferred by matching CAMIRA cluster abundance with a theoretical halo mass function. The mean gas mass fraction based on HE masses for the MCXC clusters is 〈fgas〉 = 0.125 ± 0.012 at spherical overdensity Δ = 500, which is ∼80%–90% of the cosmic mean baryon fraction, Ωb/Ωm, measured by cosmic microwave background experiments. We find that the mean baryon fraction estimated from X-ray and HSC-SSP optical data is comparable to Ωb/Ωm. A weak-lensing shear catalog of background galaxies, combined with photometric redshifts, is currently available only for three clusters in our sample. Hydrostatic equilibrium masses roughly agree with weak-lensing masses, albeit with large uncertainty. This study demonstrates that further multiwavelength study for a large sample of clusters using X-ray, HSC-SSP optical, and weak-lensing data will enable us to understand cluster physics and utilize cluster-based cosmology.
Using a Modified A3 Lean Framework to Identify Ways to Increase Students’ Reporting of Mistreatment Behaviors
Authors: Ross Paula T. , Abdoler Emily , Flygt LeeAnne , Mangrulkar Rajesh S. , Santen Sally A.
Published: October 2017

Problem

The proportion of students who experience mistreatment is significantly higher than the proportion of students who report mistreatment. Identifying ways to improve students’ reporting of these incidents is one strategy for increasing opportunities to achieve resolution and prevent future occurrences.

Approach

The authors applied a modified A3 Lean framework to examine medical student reporting of mistreatment behaviors at the University of Michigan Medical School (UMMS) in 2013–2016. The A3 Lean framework is a stepwise approach that involves outlining the background to establish the context of the problem, describing the current condition, identifying the goal or desired outcome, analyzing causes of the problem, providing proposed countermeasures for improvement, and creating follow-up plans. The authors identified three reasons for the difference between students’ experiences and reporting of mistreatment and developed five countermeasures/action plan items to address this difference.

Outcomes

The proportion of students reporting mistreatment at UMMS increased 21.4% between 2013 and 2016. Compared with 2013, more students in 2016 indicated not reporting because the incident did not seem important enough or because they resolved the issue on their own.

Next Steps

The authors have enlisted the support of the health system’s human resources department and presented the inaugural grand rounds on improving the learning environment in 2016. Among other things, they are also partnering with this team to add questions about student mistreatment and civility to the annual employee engagement survey distributed to all 20,000 employees.
Effects of Transcutaneous Electrical Acupoint Stimulation on the Stress Response During Extubation After General Anesthesia in Elderly Patients Undergoing Elective Supratentorial Craniotomy: A Prospective Randomized Controlled Trial
Authors: Bai Wen-Ya , Yang Yan-Chao , Teng Xiu-Fei , Wan Yu-Xiao , Wei Wei , Zhu Jun-Chao
Published: October 2017

Background:

Elderly patients have an increased risk of a stress response during extubation after general anesthesia. In this study, we aimed to investigate whether transcutaneous electrical acupoint stimulation (TEAS) might decrease the stress response and improve the quality of recovery in elderly patients after elective supratentorial craniotomy.

Materials and Methods:

In this prospective randomized controlled study, patients were randomly assigned to either a TEAS group (n=37) or a control group (n=38). The primary outcomes were the hemodynamic parameters and plasma concentrations of epinephrine, norepinephrine, and cortisol. The secondary outcome included the consumption of remifentanil and propofol, time to extubation and reorientation, extubation quality score, postoperative quality of recovery, and postoperative complications.

Results:

Compared with the control group, hemodynamic parameters and plasma concentrations of epinephrine, norepinephrine, and cortisol during extubation were decreased in the TEAS group. TEAS reduced the consumption of remifentanil (P<0.01), as well as incidence of postoperative complications. The extubation quality score was lower (P<0.01) and the quality of recovery score was higher (P<0.01) in the TEAS group than in the control group. However, the time to extubation and reorientation, and the consumption of propofol were not significantly different between the 2 groups.

Conclusions:

TEAS may decrease the stress response during extubation, improve quality of postoperative recovery, and decrease incidence of postoperative complications in elderly patients undergoing elective supratentorial craniotomy.
Radiographic Predictors of Difficult Laryngoscopy in Acromegaly Patients
Authors: Lee Hyung-Chul , Kim Min-Kyung , Kim Yong Hwy , Park Hee-Pyoung
Published: October 2017

Background:

Patients with acromegaly have a high risk of difficult laryngoscopy. However, clinical predictors, such as upper lip bite test or modified Mallampati class, show limited predictive performance for difficult laryngoscopy in such patients. In this retrospective study, we evaluated radiographic indices obtained from skull lateral x-ray and ostiomeatal unit computed tomography images to predict difficult laryngoscopy in acromegaly patients.

Materials and Methods:

Data on demographics, preoperative serum levels of pituitary hormones, and radiographic indices were collected from 90 acromegaly patients that underwent transsphenoidal removal for pituitary tumor from January 2010 to December 2016. Difficult laryngoscopy was defined as Cormack-Lehane grade ≥III.

Results:

Difficult laryngoscopy occurred in 21 (23%) patients. In univariate analysis, age and radiographic indices indicating tongue size, such as tongue area (TA) on ostiomeatal unit computed tomography, linear distance from the alveolar line of the mandible to the hyoid bone, and linear distance from the interior border of the mandible to the hyoid bone on skull lateral x-ray, were associated with difficult laryngoscopy. In multivariate analysis, age (odds ratio [95% confidence interval], 1.084 [1.037-1.190]; P=0.002) and TA (1.002 [1.000-1.003], P=0.014) were independent risk factors for difficult laryngoscopy. The area under the curve of the combined model of age and TA was 0.80.

Conclusions:

Old age and radiographic predictors indicating large tongue size (large TA, long alveolar line of the mandible to the hyoid bone and mandible to the hyoid bone) were associated with an increased rate of difficult laryngoscopy in acromegaly patients. Preoperative radiographic measurements of tongue size can be helpful for safe airway management in such patients.
Association of High-Volume Surgeons Working in High-Volume Hospitals with Cost of Free Flap Surgeries
Authors: Mahmoudi Elham , Lu Yiwen , Chang Shu-Chen , Lin Chia-Yu , Wang Yi-Chun , Chang Chee Jen , Cheng Ming-Huei , Chung Kevin C.
Published: October 2017

Background:

We examined the associations of surgeon and hospital volume with total cost, length of stay (LOS), and cost per day for free tissue transfer (FTT) surgeries. Evidence demonstrates a higher likelihood of success for FTT in higher volume hospitals. Little, however, is known about volume-outcome associations for surgical costs and LOS. We hypothesized that higher provider volume is associated with lower cost and shorter LOS.

Methods:

Using Taiwan’s national data (2001–2012), we conducted a retrospective cohort study of all adults 18–64 years of age who underwent FTT during the study period. We used hierarchical regression modeling for our analyses. Our 3 outcome variables were total cost of FTT surgery, LOS in hospital, and cost per day.

Results:

Except for functional muscle flap, in which LOS was 12 days shorter in high-volume compared with low-volume hospitals (P = 0.017), no association between hospital volume and LOS was found. Contrary to our hypothesis, our results for all FTT cases demonstrate positive associations of medium-volume hospitals (OR = 1.31; CI, 1.11–1.55) and high-volume surgeons (OR = 1.16; CI,1.03–1.32) with total cost and cost per day, respectively. The interactions of hospital volume and surgeon volume show that in medium- and high-volume hospitals, surgeons with the highest volume had the lowest predicted cost per day among hospitals in that category; but all differences in cost were small.

Conclusions:

There were no substantial variations based on different hospital or surgeon volume in LOS, total cost, or cost per day for FTT operations performed in Taiwan.
Strategies for Reducing Fatal Complications in Liposuction
Authors: Cárdenas-Camarena Lázaro , Andrés Gerardo Lozano-Peña , Durán Héctor , Bayter-Marin Jorge Enrique
Published: October 2017

Background:

Liposuction has become one of the most common cosmetic surgical procedures, and severe complications secondary to this procedure have also increased significantly. That is why we carry out a research work to know the most frequent severe complications reported in the scientific literature to indicate criteria for prevention.

Methods:

English-language scientific publications about liposuction and its complications were analyzed using the PubMed.gov, from the beginning of PubMed's history through June 10, 2017. Five terms were used to define liposuction and its complications: "liposuction," "liposuction AND complications," liposuction AND major complications," "liposuction AND complications AND death," and "liposuction AND death." The quantities of results for the 5 phrases were analyzed, along with their contents.

Results:

One thousand sixty-three results were obtained from 1973 through June 10, 2017 for the phrase "Liposuction and Complications" in humans; for "Liposuction and Major Complications," 153 articles were found; for "Liposuction and Deaths," 89 articles were found; and 42 articles were obtained with the terms "Liposuction and Major Complications and Deaths." After final depuration, all those that were not specific to severe liposuction complications were eliminated, leaving a total of 39 articles that were included in our study. Five problems proved to be the most serious complications when performing liposuction: Thromboembolic disease, fat embolism, pulmonary edema, lidocaine intoxication, and intraabdominal visceral lesion.

Conclusions:

The 5 most important complications that can cause death in liposuction are easily preventable using simple measures and proper safety protocols that are described in this work.
Intravenous Access in Infants Undergoing Bilateral Sural Nerve Grafts for Primary Brachial Plexus Exploration
Authors: Al-Qattan Mohammad M. , El-Sayed Amel A. F.
Published: October 2017

Background:

Intravenous access (IVA) in infants undergoing primary brachial plexus exploration may be difficult. Both lower limbs are prepared and draped for sural nerve graft harvesting. The injured upper limb is also prepared and draped and is not available for IVA. In difficult IVA from the remaining upper limb, we have been using one of the feet for IVA. The infection rate and problems of intravenous infusions in this setting have never been studied in the literature. This study documents the infection rate and problems of intravenous infusions in these infants when a foot (within the sterile field) is used for IVA.

Methods:

This is a retrospective study of 63 consecutive infants undergoing primary brachial plexus exploration, and in whom IVA was obtained from one of the feet. Infection rate and problems of intravenous infusions were recorded.

Results:

No surgical wound infection and no infection of the IVA site were noted. There were no instances of accidental dislodgement of the intravenous cannula and no instances of extravasation.

Conclusion:

The use of one of the feet (within the sterile filed) for IVA is safe and acceptable in infants undergoing primary brachial plexus exploration and bilateral sural nerve grafting.
Phenotypic Characterization of Corneal Endothelial Dystrophy in German Shorthaired and Wirehaired Pointers Using In Vivo Advanced Corneal Imaging and Histopathology
Authors: Shull Olivia R. , Reilly Christopher M. , Davis Lola B. , Murphy Christopher J. , Thomasy Sara M.
Published: October 2017

Purpose:

To evaluate corneal morphology using ultrasonic pachymetry (USP), Fourier-domain optical coherence tomography (FD-OCT), and in vivo confocal microscopy (IVCM) in 2 related canine breeds—German shorthaired pointers (GSHPs) and German wirehaired pointers (GWHPs)—with and without corneal endothelial dystrophy (CED). This condition is characterized by premature endothelial cell degeneration leading to concomitant corneal edema and is similar to Fuchs endothelial corneal dystrophy.

Methods:

Corneas of 10 CED-affected (4 GSHP and 6 GWHP) and 19 unaffected, age-matched (15 GSHP and 4 GWHP) dogs were examined using USP, FD-OCT, and IVCM. A 2-sample t test or Mann–Whitney rank-sum test was used to statistically compare parameters between both groups. Data are presented as mean ± SD or median (range).

Results:

Central corneal thickness determined using USP was significantly greater in CED-affected than in unaffected dogs at 1179 (953–1959) and 646 (497–737) μm, respectively (P < 0.001). Central epithelial thickness was found to be significantly decreased in CED-affected versus unaffected dogs at 47 ± 7.1 and 55 ± 7.1 μm, respectively (P = 0.011), using FD-OCT. With IVCM, corneal endothelial density was significantly less (P < 0.001) in 5 dogs with CED versus 19 unaffected controls at 499 ± 315 versus 1805 ± 298 cells/mm2, respectively. CED-affected dogs exhibited endothelial pleomorphism and polymegethism, whereas CED-unaffected dogs had regular hexagonal arrangement of cells.

Conclusions:

GSHPs and GWHPs with CED exhibit marked differences in corneal morphology when compared with age-matched control dogs. These 2 CED-affected breeds represent spontaneous, large animal models for human Fuchs endothelial corneal dystrophy.
Brain-derived neurotrophic factor–mediated projection-specific regulation of depressive-like and nociceptive behaviors in the mesolimbic reward circuitry
Authors: Liu Di , Tang Qian-Qian , Yin Cui , Song Yu , Liu Yan , Yang Jun-Xia , Liu He , Zhang Yue-Man , Wu Si-Yin , Song Ying , Juarez Barbara , Ding Hai-Lei , Han Ming-Hu , Zhang Hongxing , Cao Jun-Li
Published: October 2017

Increasing evidence suggests that the mesolimbic reward system plays critical roles in the regulation of depression and nociception; however, its circuitry and cellular mechanisms remain unclear. In this study, we investigated the output-specific regulatory roles of dopaminergic (DA) neurons within the ventral tegmental area (VTA) in depressive-like and nociceptive behaviors in mice subjected to unpredictable chronic mild stress (CMS), using the projection-specific electrophysiological recording, pharmacological manipulation, behavioral test, and molecular biology technologies. We demonstrated that CMS decreased the firing activity in VTA projecting to medial prefrontal cortex (VTA → mPFC), but not in VTA to nucleus accumbens (VTA → NAc), DA neurons. However, both VTA → mPFC and VTA → NAc DA neurons showed increased firing activity in response to morphine perfusion in CMS mice. Behavioral results showed that intra-VTA microinjection of morphine (25.5 ng/0.15 μL) relieved depressive-like behaviors, intriguingly, accompanied by a thermal hyperalgesia. Furthermore, the relief of depressive-like behaviors induced by intra-VTA injection of morphine in CMS mice could be prevented by blocking brain-derived neurotrophic factor (BDNF) signaling and mimicked by the administration of exogenous BDNF in mPFC rather than in NAc shell. Nociceptive responses induced by the activation of VTA DA neurons with morphine in CMS mice could be prevented by blocking BDNF signaling or mimicked by administration of exogenous BDNF in NAc shell, but not in mPFC. These results reveal projection-specific regulatory mechanisms of depression and nociception in the mesolimbic reward circuitry and provide new insights into the neural circuits involved in the processing of depressive and nociceptive information.
Vigilance-related attention systems subserve the discrimination of relative intensity differences between painful stimuli
Authors: Yang Sung-Ling , Wu Ting-Wei , Tseng Ming-Tsung
Published: October 2017

Humans require the ability to discriminate intensities of noxious stimuli to avoid future harm. This discrimination process seems to be biased by an individual's attention to pain and involves modulation of the relative intensity differences between stimuli (ie, Weber fraction). Here, we ask whether attention networks in the brain modulate the discrimination process and investigate the neural correlates reflecting the Weber fraction for pain intensity. In a delayed discrimination task, participants differentiated the intensity of 2 sequentially applied stimuli after a delay interval. Compared with nonpain discrimination, pain discrimination performance was modulated by participants' vigilance to pain, which was reflected by the functional connectivity between the left inferior parietal lobule and the right thalamus. Of note, this vigilance-related functional coupling specifically predicted participants' behavioral ability to differentiate pain intensities. Moreover, unique to pain discrimination tasks, the response in the right superior frontal gyrus linearly represented the Weber fraction for pain intensity, which significantly biased participants' pain discriminability. These findings suggest that pain intensity discrimination in humans relies on vigilance-related enhancement in the parieto-thalamic attention network, thereby allowing the prefrontal cortex to estimate the relative intensity differences between noxious stimuli.
The Effects of Traumatic and Multiple Loss on Psychopathology, Disability, and Quality of Life in Iraqi Asylum Seekers in the Netherlands
Authors: Hengst Sophie M.C. , Smid Geert E. , Laban Cornelis J.
Published: October 2017

Emerging evidence suggests that the loss of loved ones under traumatic circumstances is highly prevalent among refugees and asylum seekers. We evaluated the effects of traumatic and multiple losses of family members and friends on psychopathology, disability, and quality of life in Iraqi asylum seekers in the Netherlands, and investigated mediation of these effects through psychopathology. Respondents (N = 294) completed structured Arabic interviews. Data were analyzed using structural equation modeling. The loss of a loved one was reported by 87.6% of the sample. Traumatic and multiple losses of family members independently predicted psychopathology, taking the effects of other traumatic events, postmigration stressors, and sociodemographic characteristics into account. Effects of traumatic and multiple losses on quality of life and disability were either partially or fully mediated by psychopathology. These findings highlight the need to evaluate and treat the effects of the loss of loved ones when working with asylum seekers and refugees as well as to incorporate grief-related psychopathology in diagnostic classifications.
Knowledge and Preferences Regarding Antidepressant Medication Among Depressed Latino Patients in Primary Care
Authors: Green Bonnie L. , Watson Maria Rosa , Kaltman Stacey I. , Serrano Adriana , Talisman Nicholas , Kirkpatrick Laura , Campoli Marcela
Published: October 2017

US Latinos are less likely to utilize mental health services than non-Latino whites and to take antidepressant medications. This mixed-method study followed a subset (N = 28) of a research sample of depressed Latino immigrant primary care patients, who took depression medication, with a telephone interview to study their knowledge about and experiences with antidepressant medications. Most (82%) reported taking medication for 2 months or more, and 75% reported feeling better, whereas more than half reported side effects. Most (61%) agreed that antidepressants are generally safe and helpful in treating depression (68%); however, many believed they could be addictive (39%). Fifty percent of patients who discontinued their medication did not inform their providers. Twelve of the 28 patients also participated in focus groups about interactions with providers and made suggestions for conveying information about antidepressants. Patients suggested videos as a format to disseminate medication information because they do not require written comprehension. Other patient recommendations are presented.
Nerve Transfer versus Interpositional Nerve Graft Reconstruction for Posttraumatic, Isolated Axillary Nerve Injuries: A Systematic Review
Authors: Koshy John C. , Agrawal Nikhil A. , Seruya Mitchel
Published: October 2017

Background:

The purpose of this study was to compare functional outcomes between nerve grafting and nerve transfer procedures in the setting of isolated, posttraumatic axillary nerve injuries.

Methods:

A systematic review was performed using the PubMed, Scopus, and Cochrane databases to identify all cases of isolated, posttraumatic axillary nerve injuries in patients aged 18 years or older. Patients who underwent axillary nerve reconstruction were included and categorized by technique: graft or transfer. Demographics were recorded, including age, time to operation, and presence of concomitant injuries. Functional outcomes were evaluated, including British Medical Research Council strength and range of motion for shoulder abduction.

Results:

Ten retrospective studies met criteria, for a total of 66 patients (20 nerve grafts and 46 nerve transfers). Median time from injury to operation was equivalent across the nerve graft and nerve transfer groups (8.0 months versus 7.0 months; p = 0.41). Postoperative follow-up was 24.0 months for nerve grafting versus 18.5 months for nerve transfer (p = 0.13). Clinically useful shoulder abduction, defined as British Medical Research Council grade M3 or greater, was obtained in 100 percent of nerve graft patients versus 87 percent of nerve transfer patients (p = 0.09). Grade M4 or better strength was obtained in 85 percent of nerve graft patients and 73.9 percent of nerve transfer patients (p = 0.32).

Conclusions:

Significant differences in functional outcomes between nerve graft and transfer procedures for posttraumatic axillary nerve injuries are not apparent at this time. Prospective outcomes studies are needed to better elucidate whether functional differences do exist.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
A Systematic Review of Outcomes after Arthroscopic Débridement for Triangular Fibrocartilage Complex Tear
Authors: Saito Taichi , Malay Sunitha , Chung Kevin C.
Published: October 2017

Background:

Evidence regarding the effectiveness of arthroscopic débridement for a triangular fibrocartilage complex tear is uncertain. The purpose of this study was to conduct a systematic review of outcomes to evaluate the effectiveness of débridement for triangular fibrocartilage complex tears.

Methods:

The authors searched all available literature in the PubMed, Embase, and MEDLINE (Ovid) databases for articles reporting on triangular fibrocartilage complex tear débridement. Data collection included arc of motion, grip strength, patient-reported outcomes, and complications.

Results:

A total of 1723 unique studies were identified, of which 18 studies met the authors’ criteria. The mean before and after arc of wrist extension/flexion motion values were 120 and 146 degrees (six studies). The mean before and after grip strength values were 65 percent and 91 percent of the contralateral side (10 studies). Disabilities of the Arm, Shoulder, and Hand scores (six studies) and pain visual analogue scale scores (seven studies) improved from 39 to 18, and from 7 to 3, respectively. The mean pain visual analogue scale score after débridement was 1.9 in the ulnar-positive group and 2.4 in the ulnar-neutral and ulnar-negative groups. Eighty-seven percent of patients returned to their original work.

Conclusions:

Patients reported reduced pain and improved functional and patient-reported outcomes after débridement of triangular fibrocartilage complex tears. Most patients after débridement returned to previous work, with few complications. Although some of these cases may require secondary procedures, simple débridement can be performed with suitable satisfactory outcomes for cases with any type of ulnar variance.
Watch Out for Wild Animals: A Systematic Review of Upper Extremity Injuries Caused by Uncommon Species
Authors: Israel Jacqueline S. , McCarthy James E. , Rose Katherine R. , Rao Venkat K.
Published: October 2017

Background:

Across the world, many species of nondomesticated animals dwell among humans in metropolitan areas. Rare animal bites pose a dilemma for hand surgeons, as they often result in operative injuries and recalcitrant infections. The authors treated an 85-year-old man who experienced severe cellulitis of the index finger following an opossum bite. This case prompted a systematic review of upper extremity injuries caused by species other than dogs, cats, snakes, and insects.

Methods:

The authors conducted a systematic review of PubMed and Scopus databases to identify relevant articles published between 1980 and 2016. Two reviewers critically appraised the studies that met inclusion and exclusion criteria.

Results:

The hand infection in the man who sustained an opossum bite at the authors’ institution was successfully treated with targeted antibiotic therapy, hand elevation, and splinting. Seventy-one articles met inclusion criteria for and were included in this systematic review. The vast majority of existing articles represent level IV and level V evidence. The relevant literature suggests that the majority of hand infections attributable to animal bites and stings are polymicrobial.

Conclusions:

Injuries secondary to aquatic animals appear to be the most frequently described in the literature, and hot water immersion should be used for the majority of envenomation attributable to aquatic species. Infections can often be treated with an aminopenicillin antibiotic combined with a beta-lactamase inhibitor. Given the variability in presentation and potential for sequelae such as soft-tissue necrosis and systemic reactions, hand surgeons should approach such upper extremity injuries with a high degree of caution.
Craniosynostosis Surgery: Does Hospital Case Volume Impact Outcomes or Cost?
Authors: Wes Ari M. , Mazzaferro Daniel , Naran Sanjay , Hopkins Edward , Bartlett Scott P. , Taylor Jesse A.
Published: October 2017

Background:

The relationships between hospital/surgeon characteristics and operative outcomes and cost are being scrutinized increasingly. In patients with craniosynostosis specifically, the relationship between hospital volume and outcomes has yet to be characterized.

Methods:

Subjects undergoing craniosynostosis surgery between 2004 and 2015 were identified in the Pediatric Health Information System. Outcomes were compared between two exposure groups, those undergoing treatment at a high-volume institution (>40 cases per year), and those undergoing treatment at a low-volume institution (40 cases per year). Primary outcomes were any complication, prolonged length of stay, and increased total cost.

Results:

Over 13,000 patients (n = 13,112) from 49 institutions met inclusion criteria. In multivariate regression analyses, subjects treated in high-volume centers were less likely to experience any complication (OR, 0.764; p < 0.001), were less likely to have an extended length of stay (OR, 0.624; p < 0.001), and were less likely to have increased total cost (OR, 0.596; p < 0.001). Subjects undergoing strip craniectomy in high-volume centers were also less likely to have any complication (OR, 0.708; p = 0.018) or increased total cost (OR, 0.51; p < 0.001). Subjects undergoing midvault reconstruction in high-volume centers were less likely to experience any complications (OR, 0.696; p = 0.002), have an extended length of stay (OR, 0.542; p < 0.001), or have increased total cost (OR, 0.495; p < 0.001).

Conclusion:

In hospitals performing a high volume of craniosynostosis surgery, subjects had significantly decreased odds of experiencing a complication, prolonged length of stay, or increased total cost compared with those undergoing treatment in low-volume institutions.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Social Media and the Plastic Surgery Patient
Authors: Sorice Sarah C. , Li Alexander Y. , Gilstrap Jarom , Canales Francisco L. , Furnas Heather J.
Published: October 2017

Background:

Many plastic surgeons use social media as a marketing tool to attract and retain patients, but information about how patients use social media and their preferred types of plastic surgery posts have been lacking.

Methods:

To investigate patients’ preferred social media networks and the type of posts they wished to see, a cross-sectional study was conducted in a single aesthetic practice of two plastic surgeons by surveying 100 consecutive patients.

Results:

The age of the patients averaged 44.4 years (range, 17 to 78 years). Facebook had the greatest patient use and engagement, with YouTube second in use, and Instagram second in number of engaged users. Over half used Pinterest, but with little daily engagement. Only one-fourth used Snapchat, but the percentage of users who were highly engaged was second only to Facebook. The least popular network was Twitter, with the fewest patient users and least engagement. Social media played a minor role compared with the practice’s Web site in both influencing patients to choose the practice and providing information on the day of the appointment. Patients most wanted to see posts on a plastic surgeon’s social media platform related to practice information, before-and-after photographs, and contests. Articles about plastic surgery held the least interest. Among five types of Web site content, patients expressed most interest in before-and-after photographs.

Conclusions:

This study is the first to articulate the plastic surgery patient perspective regarding social media. The findings aim to help plastic surgeons maximize their influence on their target audience.
Five Steps to Internal Mammary Vessel Preparation in Less than 15 Minutes
Authors: Haddock Nicholas T. , Teotia Sumeet S.
Published: October 2017

Background:

Modern breast reconstruction often involves microvascular reconstruction. The most common recipient vessels are the internal mammary artery and vein. Recently, there has been great focus on efficiency, but much of this emphasis has been directed to faster flap harvest or recovery protocols for expeditious discharge. An equally important aspect is internal mammary vessel preparation.

Methods:

Breast reconstruction was performed in 415 patients (715 breasts) using autologous tissue (850 flaps) from 2012 to 2016. In 97.6 percent of these breast reconstructions, the internal mammary vessels were used. The preparation of these vessels was routinely performed using the five-step technique described here.

Results:

Internal mammary preparation time ranged from 7 to 45 minutes (median, 15 minutes). The procedure involves five simplified steps, as follows: step 1, the rib is exposed by splitting the pectoralis major muscle; step 2, the perichondrium anterior to the cartilage is incised and dissected away from the cartilage; step 3, the cartilage is removed with a rongeur; step 4, laterally the perichondrium is elevated and incised (under direct vision, this perichondrium is then split directly over the vessels and the cranial and caudal flaps are resected); and step 5, careful dissection is performed on the artery and vein.

Conclusions:

Safe preparation of recipient vessels in microvascular reconstruction is essential for success. In modern breast reconstruction, the internal mammary artery and vein are typically used. Exposure of these vessels should be predictable and efficient. The authors have found that a systematic approach using the above five steps accomplishes these goals.
The Evolution of Chemical Peeling and Modern-Day Applications
Authors: Weissler Jason M. , Carney Martin J. , Carreras Tartak Jossie A. , Bensimon Richard H. , Percec Ivona
Published: October 2017

Despite the growth of technically more sophisticated skin resurfacing modalities, such as those based on light, radiofrequency, and ultrasound, chemical peel procedures have risen 5 to 25 percent over the past year alone. Chemexfoliation carries historical significance and has markedly evolved since its inception in ancient times. As a result of plastic surgery and dermatologic advancements, modern-day chemexfoliation offers plastic surgeons additional safe and effective options for patients with rhytides, dyschromias, and other signs of light- and environment-induced skin damage. This review discusses the historical evolution of chemexfoliation procedures, highlights modern-day practice habits, and touches on the clinically relevant applications of chemical peels.