bluuebunny/crossref_metadata_2025 huggingface dataset:
The Neurobiology of Psychopathy: A Neurodevelopmental Perspective
Authors: Gao Yu , Glenn Andrea L , Schug Robert A , Yang Yaling , Raine Adrian
Published: January 2017

We provide an overview of the neurobiological underpinnings of psychopathy. Cognitive and affective-emotional processing deficits are associated with abnormal brain structure and function, particularly the amygdala and orbitofrontal cortex. There is limited evidence of lower cortisol levels being associated with psychopathic personality. Initial developmental research is beginning to suggest that these neurobiological processes may have their origins early in life. Findings suggest that psychopathic personality may, in part, have a neurodevelopmental basis. Future longitudinal studies delineating neurobiological correlates of the analogues of interpersonal-affective and antisocial features of psychopathy in children are needed to further substantiate a neurodevelopmental hypothesis of psychopathy.
Comparing Mental Health of Francophone Populations in Canada, France, and Belgium: 12-Month Prevalence Rates of Common Mental Disorders (Part 1)
Authors: Tempier Raymond , Vasiliadis Helen-Maria , Gilbert Fabien , Demyttenaere Koen , Bruffaerts Ronny , Bonnewyn Anke , Lépine Jean-Pierre , Gasquet Isabelle , Mosier Karen , Lesage Alain , Puchala Chassidy , Lepnurm Marje , Kovess-Masféty Viviane
Published: January 2017

Objective:

To compare the 12-month prevalence of common mental disorders among francophones in Canada, France, and Belgium. This is the first article in a 2-part series comparing mental disorders and service use prevalence of French-speaking populations.

Methods:

This is a secondary analysis of data from the Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2) in 2002 and the European Study of Epidemiology of Mental Disorders-Mental Health Disability (ESEMeD) from 2001 to 2003, where comparable questionnaires were administered to representative samples of adults in Canada, France, and Belgium. In Canada, francophone respondents living in Quebec ( n = 7571) and outside Quebec ( n = 500) completed the French version of the CCHS 1.2 questionnaire. Francophone respondents in Belgium ( n = 389) and in France ( n = 1436) completed the French version of the ESEMeD population survey questionnaire. Major depressive episodes (MDEs), specific anxiety disorders (ADs), and alcohol abuse and (or) dependence disorders' rates were assessed.

Results:

The overall prevalence rate for the presence of any MDE, AD, or alcohol abuse and (or) dependence was similar in all francophone populations studied in Canada and Europe and averaged 8.5%.

Conclusions:

Mental disorders were equally distributed in all francophone populations studied. Cross-national comparisons continue to be instrumental in providing information useful for the creation of appropriate policies and programs for specific subsets of populations.
The Early Natural History of Bipolar Disorder: What We Have Learned from Longitudinal High-Risk Research
Authors: Duffy Anne
Published: January 2017

Longitudinal high-risk research has provided convergent evidence that major mood and psychotic disorders often develop from nonspecific antecedents in predisposed people over time and development. For example, bipolar disorder (BD) appears to evolve from nonspecific childhood antecedents, including anxiety and sleep problems, followed by adjustment and minor mood disturbances through early adolescence, culminating in major mood episodes in later adolescence and early adulthood. Therefore, the current cross-sectional symptom-based diagnostic approach requires rethinking: it considers neither the familial risk nor the longitudinal clinical course, with the consequence that the early stages of illness are not recognized as belonging to the end-stage disorder. Emerging evidence of identifiable clinical stages in the development of BD has tremendous potential for early identification, development of stage-specific treatments, and advancing our understanding of the pathophysiology associated with illness onset and progression. The clinical staging model also has direct implications for the optimal organization of clinical services for high-risk youth. Specifically, specialty psychiatric programs are needed that break down traditional institutional barriers to provide surveillance and timely comprehensive psychiatric assessment during the entire risk period, from childhood through to early adulthood. In this regard, the development of specialty psychiatric programs aiming to identify youth in the early stages of evolving psychosis are substantially ahead of services for youth in the early stages of evolving major mood disorders.
Mortality Hazard Associated with Anxiolytic and Hypnotic Drug Use in the National Population Health Survey
Authors: Belleville Geneviève
Published: January 2017

Objective:

Although widely used in the general population, sleeping pills and minor tranquilizers, also known as antianxiety agents, have been associated with undesirable outcomes. Reports about the association of these drugs with an elevated mortality rate are inconsistent and controversial. This study was designed to assess the mortality hazard associated with anxiolytic and hypnotic drug use in the National Population Health Survey in Canada. It was hypothesized that anxiolytic and hypnotic drug use would be associated with an elevated mortality hazard.

Method:

A population-based sample of 14 117 people aged 18 to 102 years participated in a longitudinal panel survey, with data collected every second year from 1994 to 2007. The primary outcome measures reported in this study are self-report use of anxiolytic and hypnotic drugs, and death.

Results:

For respondents who reported anxiolytic or hypnotic drug use in the past month the odds of mortality were 3.22 times more (95% CI 2.70 to 3.84) than for those who did not use anxiolytic or hypnotic drugs in the past month. After controlling for confounding sociodemographic, lifestyle, and health factors (including depression), the odds ratio was reduced to 1.36 (95% CI 1.09 to 1.70) but remained significant.

Conclusion:

Sedative drug use is associated with a small but significant increase in mortality risk. Further research is required to confirm the mechanisms by which sedative drug use increases mortality risk. Where possible, physicians should systematically consider possibilities for nonpharmacological treatment of sleep disturbances and anxiety.
Anxiety Disorders among Offenders with Antisocial Personality Disorders: A Distinct Subtype?
Authors: Hodgins Sheilagh , De Brito Stephane A , Chhabra Preeti , Côté Gilles
Published: January 2017

Objectives:

About 50% of men with antisocial personality disorder (APD) present a comorbid anxiety disorder. Historically, it was thought that anxiety limited criminal activity and the development of APD, but recent evidence suggests that heightened responsiveness to threat may lead to persistent violent behaviour. Our study aimed to determine the prevalence of APD comorbid with anxiety disorders among offenders and the association of these comorbid disorders with violent offending.

Method:

A random sample of 495 male penitentiary inmates completed an interview using the Diagnostic Interview Schedule. After excluding men with psychotic disorders, 279 with APD were retained. All authorized access to their criminal records.

Results:

Two-thirds of the prisoners with APD presented a lifetime anxiety disorder. Among them, one-half had the onset of their anxiety disorder before they were aged 16 years. Among the offenders with APD, those with, compared with those without, anxiety disorders presented significantly more symptoms of APD, were more likely to have begun their criminal careers before they were aged 15 years, to have diagnoses of alcohol and (or) drug abuse and (or) dependence, and to have experienced suicidal ideas and attempts. While there were no differences in the mean number of convictions for violent offences between APD prisoners with and without anxiety disorders, more of those with anxiety disorders had been convicted of serious crimes involving interpersonal violence.

Conclusions:

Among men with APD, a substantial subgroup present life-long anxiety disorders. This pattern of comorbidity may reflect a distinct mechanism underlying violent behaviour and signalling the need for specific treatments.
Placebos in Clinical Practice: Comparing Attitudes, Beliefs, and Patterns of Use between Academic Psychiatrists and Nonpsychiatrists
Authors: Raz Amir , Campbell Natasha , Guindi Daniella , Holcroft Christina , Déry Catherine , Cukier Olivia
Published: January 2017

Controversial and ethically tenuous, the use of placebos is central to medicine but even more pivotal to psychosocial therapies. Scholars, researchers, and practitioners largely disagree about the conceptualization of placebos. While different professionals often confound the meanings of placebo effects with placebo responses, physicians continue to prescribe placebos as part of clinical practice. Our study aims to review attitudes and beliefs concerning placebos outside of clinical research. Herein we compare patterns of placebo use reported by academic psychiatrists with those reported by physicians from different specialties across Canadian medical schools. Using a web-based tool, we circulated an online survey to all 17 Canadian medical schools, with a special emphasis on psychiatry departments therein and in university-affiliated teaching hospitals. A variation on earlier efforts, our 5-minute, 21-question survey was anonymous. Among the 606 respondents who completed our online survey, 257 were psychiatrists. Our analysis revealed that psychiatrists prescribed significantly more subtherapeutic doses of medication than physicians in other specialties, although about 20% of both psychiatrists and nonpsychiatrists prescribed placebos regularly as part of routine clinical practice. However, compared with 6% of nonpsychiatrists, only 2% of psychiatrists deemed placebos of no clinical benefit. In addition, more than 60% of psychiatrists either agreed or strongly agreed that placebos had therapeutic effects relative to fewer than 45% of other practitioners. Findings from this pan-Canadian survey suggest that, compared with other physicians, psychiatrists seem to better value the influence placebos wield on the mind and body and maintain more favourable beliefs and attitudes toward placebo phenomena.
Risk Factors for Depression in Older Adults in Beijing
Authors: Li Ning , Pang Lihua , Chen Gong , Song Xinming , Zhang Jun , Zheng Xiaoying
Published: January 2017

Objective:

Depression is a common mental disorder in older adults. We examined the prevalence and risk factors for depression in older adults in the Beijing area.

Method:

We used data from a cross-sectional survey conducted in July 2006 in Beijing. As part of the national survey for older Chinese adults, 2002 older adults were interviewed. The 15-item Geriatric Depression Scale was used to assess depression. Demographics as well as other personal information were also collected.

Results:

Among Beijing older adults, 13.01% were categorized as depressed. Prevalence rates of depression in rural and urban older adults were 26.63% and 10.79%, respectively. Poor economic status, high activities of daily living (ADL) score, poor physical health, impious offspring, and feeling old were important predictors of depression in older adults in Beijing. For the urban sample, poor economic status, poor physical health, high ADL score, and impious offspring were risk factors for depression. For the rural sample, depression was significantly associated with poor economic status and poor physical health.

Conclusions:

Depression is a common mood disorder among older adults in the Beijing area. Filial piety is a unique predictor for depression in older Chinese adults, compared with findings in Western cultures.
Which Students Will Choose a Career in Psychiatry?
Authors: Gowans Margot C , Epi Grad Dip Clin , Wright Bruce J , Brenneis Fraser R , Scott Ian M
Published: January 2017

Objective:

In Canada, availability of and access to mental health professionals is limited. Only 6.6% of practising physicians are psychiatrists, a situation unlikely to improve in the foreseeable future. Identifying student characteristics present at medical school entry that predict a subsequent psychiatry residency choice could allow targeted recruiting or support to students early on in their careers, in turn creating a supply of psychiatry-oriented residency applicants.

Method:

Between 2002 and 2004, data were collected from students in 15 Canadian medical school classes within 2 weeks of commencement of their medical studies. Surveys included questions on career preferences, attitudes, and demographics. Students were followed through to graduation and entry data linked anonymously with residency choice data. Logistic regression was used to identify early predictors of a psychiatry residency choice.

Results:

Students ( n = 1502) (77.4% of those eligible) contributed to the final analysis, with 5.3% naming psychiatry as their preferred residency career. When stated career interest in psychiatry at medical school entry was not included in a regression model, an exit career choice in psychiatry was predicted by a student's desire for prestige, lesser interest in medical compared with social problems, low hospital orientation, and not volunteering in sports. When an entry career interest in psychiatry was included in the model, this variable became the only predictor of an exit career choice in psychiatry.

Conclusion:

While experience and attitudes at medical school entry can predict whether students will chose a psychiatry career, the strongest predictor is an early career interest in psychiatry.
Trends in Psychotropic Use in Saskatchewan from 1983 to 2007
Authors: Meng Xiangfei , D'Arcy Carl , Tempier Raymond
Published: January 2017

Objective:

There has been little research reported on trends in the use of a full spectrum of psychotropics in a general population. We provide an overview of trends in psychotropic use over a 24-year period for Saskatchewan.

Methods:

Data were drawn from the Saskatchewan Ministry of Health administrative data files. It covers antidepressants (ADs), antipsychotics, mood stabilizers, anxiolytics, stimulants, and cholinesterase inhibitors in outpatient settings. We analyzed data from 9 triennial years from 1983 to 2007. Descriptive statistics were used.

Results:

Among the Saskatchewan population in our study, 8.38% were prescribed at least 1 psychotropic in 1983. The prevalence decreased to 7.44% in 1989, then gradually increased to 12.90% in 2007. We found a continuous increase in the number of psychotropic prescriptions for both males and females. The trend became more marked during the 1990s. Females used more psychotropics. Family physicians were the major prescribers, and their prescriptions dramatically increased over the period. There was an increase in the prescribing of all psychotropics except for anxiolytics. AD prescriptions dramatically increased, especially from 1995 onward. The proportion of patients with 8 to 11 and 12 or more prescriptions per year also gradually increased, whereas the proportion of patients with less than 3 prescriptions per year decreased.

Conclusions:

AD prescriptions are the major reason for the increasing trend of psychotropic use. Given the major role of family physicians in the use of psychotropics, the need for appropriate training and continuing education is reinforced.
Avoiding False Positives: Zones of Rarity, the Threshold Problem, and the DSM Clinical Significance Criterion
Authors: Cooper Rachel V
Published: January 2017

False positives arise when people without disorders are diagnosed as having disorders. Various approaches for avoiding false positives have been suggested. This review critically assesses the roles of zones of rarity, the threshold problem (the problem of determining the boundary of disorder in cases that shade into normality), and the Diagnostic and Statistical Manual of Mental Disorders (DSM) criterion that requires that a disorder cause clinically significant impairment or distress (the harm criterion). The lack of zones of rarity in much of psychiatry gives rise to the threshold problem. The DSM harm criterion is frequently presented as offering a solution to the threshold problem. However, I argue that the harm criterion cannot offer a general solution to the threshold problem, as harm is not always correlated with the intensity and frequency of symptoms. Still, the harm criterion is essential to ensure that people who are merely different are not diagnosed as having a disorder. The threshold problem can be addressed by selecting symptom-based cut-off points to distinguish between disorder and normality. These cut-off points are frequently arbitrary in the sense that they often reflect no natural division between disorder and normal, but they may be more or less wisely chosen. Where possible, the thresholds should be set so that the advantages of diagnosis can be expected to outweigh the disadvantages.
A Surveillance System to Monitor Excess Mortality of People with Mental Illness in Canada
Authors: Lesage Alain , Rochette Louis , Émond Valérie , Pelletier Éric , St-Laurent Danielle , Diallo Fatoumata Binta , Kisely Stephen
Published: January 2017

Objective:

Outcome measures are rarely available for surveillance and system performance monitoring for mental disorders and addictions. Our study aims to demonstrate the feasibility and face validity of routinely measuring the mortality gap in the Canadian context at the provincial and regional levels using the methods and data available to the Canadian Chronic Disease Surveillance System (CCDSS) of the Public Health Agency of Canada.

Methods:

We used longitudinal data from the Quebec Integrated Chronic Disease Surveillance System, which also provides aggregated data to the CCDSS. This includes data from the health insurance registry physician claims and the hospital discharge abstract for all mental disorder diagnoses (International Classification of Diseases [ICD]-9 290–319 or ICD-10 F00–F99). Patients were defined as having had received a mental disorder diagnosis at least once during the year. Life expectancy was measured using Chiang's method for abridged life tables, complemented by the Hsieh method for adjustment of the last age interval.

Results:

We found a lower life expectancy among psychiatric patients of 8 years for men and 5 years for women. For patients with schizophrenia, life expectancy was lowered by 12 years for men and 8 years for women. Cardiovascular disease and cancer were the most common causes of premature death. Findings were consistent across time and regions of the province. Lower estimates of the mortality gap, compared with literature, could be explained by the inclusion of primary care patients and methods.

Conclusions:

Our study demonstrates the feasibility of using administrative data to measure the impact of current and future mental health plans in Canada provided the techniques can be replicated in other Canadian provinces.
A Clinical and Academic Outcome Study of Children Attending a Day Treatment Program
Authors: Kotsopoulos Sotiris , Walker Selena , Beggs Karyn , Jones Barbara
Published: January 2017

Objective:

To assess the behavioural and academic improvement of children who attended a day treatment program during a defined period of time.

Method:

Forty-six children admitted consecutively to the project were assessed on admission and discharge using behavioural and academic measures. They also had intelligence and language assessments. The subjects attended the program for one academic year, on the average. The large majority presented with disruptive behaviour disorders and low academic achievement levels.

Results:

There was a significant improvement reported by the parents in externalizing (P < 0.001) and internalizing (P < 0.05) behaviour. The subjects also gained one academic year, but their levels continued to be low in terms of percentiles. Measures of academic improvement showed significant associations with cognitive measures only (subscales of Wechsler Intelligence Scale for Children-Revised [WISC-R] and Clinical Evaluation of Language Fundamentals-Revised [CELF-R]).

Conclusion:

A day treatment and school program is an effective modality for treatment and remediation of children with severe psychiatric disorders. The academic underachievement may be resistant to remediation within the limited period of attendance in such a program.
Let Me Count the Ways: Measuring Incidence, Prevalence, and Impact in Epidemiological Studies
Authors: Streiner David L
Published: January 2017

This article introduces some of the terms used in psychiatric epidemiology when measuring the number of people in a community who have a disorder and the possible effects of prevention programs. Incidence is a count of the number of new cases of a disorder that occur within a defined time period. It can be expressed as either the proportion of people who can be expected to develop the disorder within that period (the cumulative incidence) or as the rate per person years (the incidence density). Various indices of prevalence refer to the total number of people who have the disorder at any one time, whereas indices of risk are used to define the probability of developing the disorder. The etiologic fraction is the proportion of cases due to a specific cause, and thus it reflects the maximum degree to which primary prevention programs can be effective.
Fitness to Stand Trial: Characteristics of Remands since the 1992 Criminal Code Amendments
Authors: Zapf Patricia A , Roesch Ronald
Published: January 2017

Objective:

To examine the characteristics of a sample of remands after the introduction of the 1992 Criminal Code amendments, to compare those deemed fit with those deemed unfit as the result of an institution-based evaluation of fitness, and to determine the impact of the Code changes on one's detention period by investigating the length of time that individuals were held on remand.

Method:

File information was collected and analyzed for 180 males who were remanded for inpatient evaluations of their fitness to stand trial between October 1994 and July 1995.

Results:

The results indicated that remanded defendants are more likely to be single, unemployed, and living alone and that unfit defendants are significantly more likely to have never been married. As well, individuals who were found to be unfit to stand trial were significantly less likely to have been diagnosed with a drug- or alcohol-use disorder and were 4 times more likely to have been diagnosed with a psychotic disorder. The results also indicated that while the 1992 Criminal Code revisions called for a 5-day evaluation period, it appears that this is rarely accomplished, and, in fact, the average length of time for an assessment of fitness is 23 days. Finally, the majority of remanded individuals are certified and treated with psychotropic medications while on remand.

Conclusion:

The results of this study suggest that the fitness remand period is being used for purposes other than assessing fitness.
Improvement in skin–core adhesion of multiwalled carbon nanotubes modified carbon fiber prepreg/Nomex honeycomb sandwich composites
Authors: Chen Chao , Li Yanxia , Gu Yizhuo , Li Min , Zhang Zuoguang
Published: January 2017

An experimental investigation on the sandwich composites composed of the carbon fiber face sheets and Nomex honeycomb core has been carried out in this study. Multiwalled carbon nanotubes were added into the matrix of prepreg for converting the traditional pure resin adhesive fillet to composites. Resin viscosity was measured to evaluate the effect of the additive amount of multiwalled carbon nanotubes on the rheological properties. The size of adhesive fillet was obtained from the optical microscopy to assess the forming quality. Climbing drum peel test and edgewise compression test were employed for the mechanical assessment. The results showed that the addition of multiwalled carbon nanotubes reinforcement to epoxy resin in the prepreg was very effective in improving the skin–core adhesion. The peel load and peel energy release rate as well as the edgewise compressive strength and edgewise compressive modulus of the sandwich composites varied with different magnitudes due to the additive amount of multiwalled carbon nanotubes. Reinforcing mechanism of the adhesive fillet with multiwalled carbon nanotubes reinforcement was discussed on the basis of the fractographic observations by scanning electron microscopy.
Local papers use community way of life frames more often in coal mining stories
Authors: Hedding Kylah J. , Riffe Daniel
Published: January 2017

This study examines how the competing concerns of environmental effects and economic development were used to frame the news coverage of mountaintop coal mining in community and metro papers in Kentucky and West Virginia, regions heavily dependent on the coal-mining industry.
Educators and professionals agree on outcomes for entrepreneurship courses
Authors: Ferrier Michelle Barrett , Batts Battinto
Published: January 2017

Educators and professionals agree on the top skills and knowledge and the course objectives that should be emphasized within media entrepreneurship courses. All groups of respondents assess team building, revenue streams and content development as the most important skills taught.
Anti-West frames dominate Afghan war news coverage
Authors: Erzikova Elina , Haigh Michel M. , Sampiev Adam
Published: January 2017

A content analysis of war-specific frames used by Soviet mainstream newspapers Izvestia and Komsomolskaya Pravda during the Soviet intervention in Afghanistan revealed that the national political system and foreign policy heavily influenced war reporting in the pre-Gorbachev era. In a censored environment, a highly polarized approach framed the West as the enemy and the USSR as the supporter of the Afghan people.
The Treatment of Acne Scarring Using a Wire Scalpel
Authors: Ant Jeffrey G. , Branman Rhys L.
Published: January 2017

Introduction:

Treatment of acne scarring is a staged and time-consuming procedure. Needle subcision is used to raise rolling scars that are attached below the level of the dermis. This article describes a modification of that technique to treat a “field” of acne scars with a commercially available wire scalpel. This technique treats rolling scars and has some benefit to clusters of deep boxcar scars. A patient example is demonstrated.

Materials and Methods:

After local infiltration with 1% lidocaine with 1:100 000 epinephrine in a volume sufficient to blanch the operative sites, the areas are divided into narrow triangular or oval sections approximately 5 mm at the widest point. A straight needle swedged on a wire scalpel is used to guide the wire from the apex through the 3 sides of the triangle and back out the apex. The desired level is just subdermal. The needle should exit and re-enter through the same hole at the 3 corners. The wire is then grasped firmly and pulled beneath the dermis with a sawlike motion, allowing the wire to severe the dermal attachments. This process is repeated in slightly overlapping sections to avoid depressions from untreated areas until every identified scar is treated.

Patient Presentation:

In the case presented, some acne scarring remained visible; however, the authors noted an overall improvement, and the patient stated he was pleased with the results. Bleeding is usually minimal, and pressure dressings are normally not necessary.

Discussion:

The technique of wire subcision is an extension of a proven technique of needle subcision in the treatment of acne scarring. Although it is not useful in the treatment of all types of acne scarring, it is very effective when treating rolling scars that have dermal attachments. Each pass of the wire treats a wider area than the needle technique and is therefore better designed to completely undermine an area with fewer dermal attachments left untreated. Lacerations can be avoided by carefully exiting and entering through the same needle holes.

Conclusions:

The wire subcision technique treats rolling scars and may benefit clusters of deep boxcar scars. It may also be used to treat wider areas than needle subcision. The technique is simple and the complication rates are low. The authors believe this is a useful addition to the pantheon of acne scarring treatment techniques.
The Cosmetic Umbilicus: A Review of Aesthetic Features and Surgical Methods
Authors: Nelson Kristin , Borsand Marvin
Published: January 2017

Introduction:

The umbilicus (commonly called the belly button or navel) is an important part of the appearance of the abdomen. It must be carefully reconstructed during abdominoplasty to achieve the best cosmetic result. Features important to aesthetic appearance of the umbilicus include size, shape, depth, and position on the anterior abdomen. A variety of techniques, from simple to complicated, are available to attempt to achieve umbilical beauty. The objective of this review is to describe the characteristics of the ideal umbilicus and several available techniques surgeons can use to obtain ideal results when resetting or reconstructing the umbilicus.

Methods:

The literature was reviewed for umbilical reconstruction and umbilicoplasty procedures in abdominoplasty with additional emphasis on what features are important to the aesthetic appearance of the umbilicus. The surgical procedures and aesthetic preferences are summarized in this article.

Results:

Eight surgical procedures are illustrated here. The best surgical techniques allow a procedure to be performed in a timely fashion as well as to produce the best short-term and long-term results. Three of the procedures illustrated are unusual, complex, and time consuming, and are recommended only for cases when the umbilicus must be completely reconstructed because the original umbilicus is too malformed to be of use in reconstruction.

Discussion:

Suggestions taken from the various surgical techniques are emphasized, including striving for proper umbilical depth; defatting the new periumbilical region of the abdominal fat; tacking the stalk to the abdominal aponeurosis or attaching the superficial abdominal fascia to the edges of the abdominal flap incision; recognizing the importance of shape, size, and positioning of the final result; and avoiding large incisions.

Conclusion:

There are many acceptable methods for resetting the umbilicus available to cosmetic surgeons, and each surgeon must determine his or her favorite procedure. The best technique for a particular case may include ideas from several of the surgical approaches. The final result should strive for a moderately small, vertically shaped umbilicus with superior hooding. The new umbilicus should not have any protrusion or distortion.
Autologous Fat Transfer: Eliminating the Centrifuge, Decreasing Lipocyte Trauma and Establishing Standardization for Scientific Study
Authors: Shippert Ron D.
Published: January 2017

Introduction:

The autologous fat transfer procedure has undergone a renewal of interest because of the need for larger quantities of economical filler (face, buttocks, hands, and breasts). Commercial fillers are cost prohibitive when large quantities are needed. Present instruments on the market are not specialized enough to perform well during the autologous fat transfer procedure. As a result, multiple techniques have evolved that produce extremely varied results that are not scientifically verifiable. The objectives of this paper are to (1) review the events that are traumatic for the lipocyte and review how those events can be improved through new instrumentation; (2) review the use of the centrifuge and consider replacement of the centrifuge with an effective filter system; (3) establish instrument standards that will encourage scientific technique verification; and (4) introduce a standardized autologous fat transfer instrument that will save time, reduce significant trauma, and have standardized features to promote accurate scientific study.

Methods:

Information was obtained via a questionnaire, internet investigation, trade show information, personal discussions with surgeons, and the author's experience. Information from the questionnaire was used in the design of a new, improved standardized instrument.

Results:

During this study, an instrument was designed that would reduce operating room time considerably. Most of the time reduction was secondary to keeping the fat in the harvest syringe without transferring or centrifuging. This change in procedure would also considerably reduce lipocyte trauma in all 12 of the commonly accepted lipocyte trauma categories. In addition, the instrument could be standardized with multiple features that would give the surgeon confidence that the surgical results would not change because of the instruments.

Conclusions:

The Tissu-Trans™ device that was designed during this study significantly saves time, simplifies the procedure, and has standardized features that allow for scientific studies that are more accurate. The equipment offers simplicity and “feature latitude,” allowing the surgeon to perform all of the major steps (harvest, filter, irrigate, treatment, and reinjection) from a single harvest syringe. Although all 12 of the traumatic events for lipocytes were reduced in intensity, one should not leap to the conclusion that this correlates with increased lipocyte survival. To date, this has not been proven. Further clinical testing will be necessary to obtain this information.
Monitored Anesthesia Care vs. General Anesthesia: A Comparison of 100 Aesthetic Surgeries Performed in an Office-Based Surgical Center
Authors: Constantine Steven T. , Kennedy Brent D. , Jones Trenton C. , Pifer Matthew A.
Published: January 2017

Introduction:

The demand for and growth of elective aesthetic procedures have exploded over the past decade. This growth in an era of cost containment has led many physicians to seek a more judicious use of medical resources. Outpatient and office-based surgical centers have risen dramatically throughout the country, in part as a means to achieve such a goal. However, there has been significant debate over the most appropriate, cost-effective, and safe anesthetic techniques for such procedures. The objective of this study was to provide supporting evidence for the safety and efficacy of office-based surgical procedures as well as to evaluate and compare various anesthetic techniques in an era of cost containment.

Materials and Methods:

We retrospectively analyzed data from 100 consecutive aesthetic surgical cases performed by 2 surgeons who utilized markedly different anesthetic techniques, namely monitored anesthesia care or general anesthesia, in an office-based surgical center. Retrospective data included patient demographics, medical history, type of procedure, vital signs, duration of procedure, duration of recovery, medication dosages, incidence of intraoperative and immediate postoperative complications, and incidence of immediate postoperative nausea, vomiting, and pain. In addition, an operating cost analysis of both anesthetic techniques was performed.

Results:

There were no deaths or major complications in either group of patients. The average recovery time for the monitored anesthesia care group was 1.0 hour as compared to 1.8 hours in the general anesthesia group. There was a slightly higher incidence of immediate postoperative nausea and/or vomiting as well as immediate postoperative discomfort in the general anesthesia group. In addition, at our facility it was much more cost-effective to provide monitored anesthesia care, at $210.03 per patient as compared to $527.68 per patient undergoing a general anesthetic.

Discussion:

It is reasonable to conclude from our retrospective data that both monitored anesthesia care and general anesthesia are relatively safe methods for providing anesthesia for elective aesthetic procedures. From a cost perspective, it is clear that monitored anesthesia care offers a more cost-effective means for providing anesthesia; however, the decision to utilize one technique versus the other should be based upon surgeon comfort level, the type of procedure performed, and the patient's desires, if reasonable.
Surgical Training and Education: An Unusual Comparison of 2 Departments in a Community Hospital Setting
Authors: Williams Troy C. , Welch Robert
Published: January 2017

Introduction:

General Surgery programs are highly regarded for providing operative procedures to trainees. Obstetrics and Gynecologic Surgery programs also offer a multitude of surgical procedures. We would like to compare and contrast these two types of programs in the hopes of further advancing the art of surgical education and broadening the career options of those considering a career as a cosmetic surgeon.

Materials and Methods:

Operating room and labor and delivery records from Providence Hospital were collected for the calendar year of 2004. The records were reviewed for total number of cases by service. The procedures were then substratified by recognized surgical difficulty and risk (minor vs. major).

Results:

Trainees in the General Surgery department participated in 4708 cases; in the Obstetrics and Gynecologic Surgery department, trainees participated in 4474 cases. The 3 most frequent categories for General Surgery trainees were laparoscopic cholecystectomy (515, major procedure), breast biopsy (427, minor procedure), and resection of lipoma (359, minor procedure). In comparison, for the Obstetrics and Gynecologic Surgery trainees, the 3 most frequent categories included cesarean section (1099, major procedure), hysteroscopy with dilation and curettage (632, minor procedure), and total abdominal hysterectomy (475, major procedure).

Conclusions:

Trainees in both programs enjoy exposure to a large number of major and minor operative procedures. It appears that more major procedures are available to trainees in Obstetrics and Gynecologic Surgery. Applicants should consider either type of training to prepare for a future cosmetic surgery practice.
Deciding the Position of Neoumbilicus in Abdominoplasty: A Novel Idea
Authors: Thomas Mohan , D'Silva James Allen , Menon Hari , Padubidri Ramesh
Published: January 2017

Introduction:

Determining the position of the neoumbilicus in cases of abdominoplasty has always been tricky.

Objective:

To present a simple method of determining the position of the neoumbilicus in cases of abdominoplasty.

Methods:

Presentation of a technique used in 50 cases of abdominoplasty.

Results:

This method has been found to be foolproof in more than 50 patients.

Conclusion:

The main advantage of this method is that patients get a neoumbilicus that is in its original position every single time.
Nonsurgical Methods for Treatment of Capsule Contracture
Authors: Shiffman Melvin A.
Published: January 2017

Background:

The breast implant is a foreign body that stimulates a “walling-off” response associated with scar formation (fibroblast proliferation). It has been presumed that inflammatory cells, extracellular matrix, and fibroblast proliferation are responsible for capsule contracture following breast augmentation. The possible causes of capsule contracture are described, and nonsurgical methods for relief of the capsule contracture are discussed.

Methods:

The literature was reviewed for medications and other nonsurgical methods that may possibly be used for relief of capsule contracture or reduction of the incidence of capsule contracture.

Conclusion:

Additional studies are needed that address the effects of drugs and electrostimulation on capsule contracture following breast augmentation.
Circumareolar Mastopexy with Subpectoral Augmentation—A Practical Guide for Success—Creating Balance between Breast Volume, Nipple Position, and Skin Elasticity
Authors: Bafitis Harold
Published: January 2017

Mastopexy represents a procedure of elegance and aesthetic balance between breast volume, nipple position, and skin elasticity. Surgeons have tried to minimize or completely abandon the classic inverted “T” incision in the majority of breast uplifting procedures. Recently, the periareolar, concentric, or circumareolar mastopexy has been revisited and scrutinized. Circumareolar mastopexy has unfortunately been fraught with complications with dysesthetic results for decades. By adding prosthesis, this further compounds an already difficult problem. In this 78-case study derived over 4 years of practice experience, a reproducible approach to successful circumareolar mastopexy, simultaneously incorporating a subpectoral augmentation is detailed and illustrated. This also includes our postoperative protocol, which we believe is essential to ensure reproducible results.
BAMBI: Bilateral Augmentation Mammoplasty by Injection; Breast Augmentation Using Autologous Fat Transplantation: The Controversy and Personal Experience
Authors: Roomi Riad
Published: January 2017

Introduction:

Breast augmentation is one of the most sought after cosmetic surgical procedures in developed countries. It is accepted that augmentation by silicone implants is the gold standard. However, it is also acknowledged that this method is not without problems and complications in the best hands. Historical review shows that many materials were used to augment the breast. Needless to say, the majority of those have failed, and some with catastrophic consequences. Autologous fat, the subject of this article, was introduced in 1987. In most practices, no other alternative to implants is being offered to prospective patients. It is undeniably true that there is a group of patients who are not candidates for augmentation by implants. Among this group are patients who categorically refuse implants for one reason or another.

Objective:

In our expanding and rapidly advancing specialty, the ability to offer an alternative treatment for any presenting problem is an indispensable tool of our profession. However, when it comes to the small breast problem, the majority of surgeons are unable or unwilling to offer women who seek breast augmentation any alternative to implants. The objective of this article is to prompt an interest for a forum to look at this method more objectively to establish whether it can be approved as an alternative to implants.

Materials and Methods:

Review of the literature.
Long-term Follow-up Study of Intravascular 1320-nm Laser Closure of the Great Saphenous Vein
Authors: Woodhall Katrina E. , Nootheti Pavan K. , Palm Melanie , Goldman Mitchel P.
Published: January 2017

Objective:

To determine the long-term efficacy and safety of a 1320-nm intravascular laser to close the great saphenous vein (GSV).

Methods:

Sixty-four patients with incompetent GSV (0.5–1.44 cm in diameter) associated with distal varicose veins were treated using a 1320-nm intravascular laser at 5–6 W with an automatic pullback mechanism at 1 mm/s. Duplex ultrasound examinations were performed at baseline and patients were followed 1 to 5 years posttreatment.

Participants:

Of the 64 patients, 84% were women and the average age of the participants was 49 years.

Results:

The average baseline GSV measured 0.78 cm (range, 0.37–1.95 cm). The average length of follow-up was 25.3 months. A total of 12.5% (8/64) of patients received follow-up sclerotherapy for residual reticular and telangiectatic veins. Seventy-five percent (52/64) of patients had absent GSV after treatment. Twenty-five percent (12/64) of patients had open, patent GSV with no reflux. The failure rate for treatment was 7.8% (5/64). Treatment failures included open GSV with reflux, 2 patients who underwent repeat cool touch endovenous laser treatment, and 1 patient who had ultrasound-guided foam sclerotherapy treatment.

Conclusions:

The 1320-nm intravascular laser is safe and effective in treating an incompetent GSV up to 1.44 cm in diameter.
Plastic Surgery and Body Building
Authors: Nadler Bruce J.
Published: January 2017

The pursuit of maximizing the appearance of the body strongly links plastic surgery with body building. Surgery can provide the finishing touch to what the body builder has achieved through diet and exercise. Facial deficiencies, traumatic defects, areas not influenced by exercise, and drug side effects can bring the body builder to the surgeon's office. Knowledge of anabolic steroids and their side effects are important to those dealing with body builders.
Deep Temporal Facelift: Its Indications in Surgery for Aging of the Upper Third of the Face
Authors: Faivre Jacques
Published: January 2017

This article describes a new technique that is completely different from superficial temporal facelift (also referred to as the mannequin facelift), which is associated with well-known failures and sequelae. The principle of the deep temporal facelift is to approach the deep surface of the musculo-aponeurotic plane by remaining in contact with the bone and to attach the ascension of this plane by means of sutures anchored to the temporalis muscle and fibrin sealant. Essential indications for this technique are:

drooping of the tail of the eyebrow dropping of the external canthus of the eye crow's-feet.
The Extended Subperiosteal Coronal Lift
Authors: Tobin Howard A.
Published: January 2017

The extended subperiosteal coronal lift is a new technique of facial rejuvenation. It appears to offer improved correction of sagging of the mid and upper face. Combined with traditional lower lifting, it affords a more balanced rejuvenation. The author describes his technique and discusses results, advantages, and complications based on an experience of over 100 patients who underwent extended coronal lifts, either alone or in combination with traditional lower facelift surgery.
Preliminary Results of the Effects of Various Suture Material on the Rat Ear
Authors: Bogner Robin M. , Dedo Douglas D. , Cove Harvey
Published: January 2017

The re-approximation of septal flaps after septoplasty or septorhinoplasty may be complicated by a septal perforation. In the usual operative sequence the mucoperichondrial flaps are elevated on either side of the septum and after morselization the cartilage is placed back into the septal pocket for support and preservation of the integrity of the septum itself. Re-approximation of the septal flaps, septal suturing, septal splints, and packing have all been used alone or in combination to close the septal pocket and prevent hematoma. In order to determine the effects of suturing the septum on the formation of septal perforations, the rat ear was chosen as the experimental model. Like the nasal septum it is made up of a cartilaginous framework covered on both sides by skin. Unlike the nose, the lining is epithelium and not pseudostratified columnar ciliated respiratory epithelium. However, the healing and absorbing qualities of the two types of epithelium are very similar in nature.

Three different types of suture material were placed in the rat ear. Chromic and polyglycolic acid absorbable sutures were placed in the ear and followed grossly and histologically until completely absorbed. A stainless steel staple was used as a control to determine if the epithelium would “pierce” the ear similar to the technique of piercing the ears for earrings. The results of this study show that as the absorbable suture is dissolved the diameter of the tract through the ear gradually decreases and healing occurs without a permanent perforation. However, the stainless steel staple allowed the epithelium to migrate along the shaft, producing a perforation. From these results, the conclusion can be made that suturing the septum with an absorbable suture probably does not contribute significantly to permanent septal perforations.