Facilitating triple rhomboid flaps for meningomyelocele defect closure using a honeycomb structure as a template

Purpose

Various reconstruction options are available for the soft-tissue coverage of meningomyelocele defects. For small defects, primary closure or local single flaps may be sufficient, while large defects require more complex reconstructive techniques. This study suggests an easy way for surgeons to close large meningomyelocele defects using triple rhomboid flaps.

Methods

The hexagonal structure of a honeycomb was considered when planning for the coverage of large meningomyelocele defects. The intact skin around the defect was imagined as multiple hexagons, which allowed us to plan triple rhomboid flaps correctly and more easily. This technique was used in seven patients with defects ranging from 7?×?5 to 12?×?8 cm in size.

Results

No major postoperative complications were seen. Minimal dehiscence was observed in two patients and healed secondarily.

Conclusions

The honeycomb modification for planning triple rhomboid flaps is an easy, practical, and memorable approach for surgeons reconstructing large meningomyelocele defects.

     

Acceleration of osteogenesis by platelet-rich plasma with acellular dermal matrix in a calvarial defect model

Purpose

The effects of platelet-rich plasma (PRP) on improvement of bone regeneration have been widely investigated. However, use of a proper scaffold is also important to the delivery of bioactive materials. The aim of this study was to analyze the effects of PRP with acellular dermal matrix (ADM) as a bone substitute in a cranial defect model.

Methods

Twenty-nine New Zealand white rabbits were randomly divided into four groups including control, PRP, ADM, and PRP with ADM. A 15 × 15-mm² bony defect was carefully created in the cranium. The experimental materials were applied in each group. After 16 weeks, the volume and surface area of new bone were measured using three-dimensional computed tomography and digital photography, and the new bone was analyzed histologically.

Results

The PRP with ADM group exhibited a statistically significant increase in volume and surface area of newly formed bone compared with the other groups (p < 0.05). Histological findings revealed compact lamellar bone in the PRP with ADM group. In contrast, scattered bone islands were detected within the fibrous connective tissue in the other groups.

Conclusions

The regeneration of mature and augmented bone was achieved following the application of PRP mixed with ADM. The results indicated that the PRP combined with ADM could be a potentially useful substitute for bone and may aid in the elimination of additional donor-site harvest procedures.

     

A thoracic spinal bone giant cell tumor in a skeletally immature girl. A case report and literature review

Purpose

Giant cell tumors (GCT) are benign primary bone tumors, locally aggressive, affecting in long bones in young adults during the third decade. It is rare to experience this lesion in skeletally immature patients. GCT are related to a risk of local recurrence and malignant transformation.

Method

We report a rare case of a giant cell tumor of the thoracic spine in a skeletally immature girl presenting with a painful right scoliosis.

Results

MRI, CT scan, and bone scintigraphy were discordant and the percutaneous biopsy non-contributive.

Conclusion

A marginal “en bloc” resection was performed and revealed the GCT. Based on a literature review, the diagnosis and the surgical management of this case are discussed.

     

Devastating Delayed Leukoencephalopathy Associated with Bath Salt Inhalation

Background

“Bath salts” or synthetic cathinone toxicity remains a potentially deadly clinical condition. We report a delayed leukoencephalopathy with persistent minimally conscious state.

Methods

Case report.

Results

A 36-year-old man presents with delayed encephalopathy, dysautonomia, fulminant hepatic failure, and renal failure from severe rhabdomyolysis after consuming bath salts. MRI showed diffusion restriction in the splenium of the corpus callosum and subcortical white matter.

Conclusions

The combination of acute leukoencephalopathy, rhabdomyolysis and fulminant hepatic failure may point to bath salt inhalation and should be known to neurointensivists.

     

Perceptions of Neighborhood Park Quality: Associations with Physical Activity and Body Mass Index

Background

Parks are important resources for physical activity (PA), yet few studies have examined how perceptions of park characteristics relate to PA and health.

Purpose

This study investigated associations between perceptions of neighborhood park quality and overall moderate-to-vigorous PA (MVPA), park-based PA, and body mass index (BMI).

Methods

Data were collected via questionnaire from 893 households in Kansas City, Missouri.

Results

The newly developed neighborhood park quality scale demonstrated good test–retest and internal reliability. Residents’ perceptions of neighborhood park quality were related to PA and health outcomes. Perceiving parks as a benefit was positively related to overall MVPA and park-based PA and negatively related to BMI. Perceptions of well-used parks were positively related to BMI, while perceived cleanliness was negatively related to park-based PA.

Conclusions

Better measuring and understanding how perceptions of local parks are associated with PA and health can improve appreciation of how parks facilitate active living.

     

Gender difference in QTc prolongation of people with mental disorders

Background

We examined gender difference in QTc interval distribution and its related factors in people with mental disorders.

Methods

We retrospectively reviewed medical charts of patients discharged from a university psychiatric unit between November 1997 and December 2000. Subjects were 328 patients (145 males and 183 females) taking psychotropics at their admission. We examined patient characteristics, medical history, diagnosis, and medication before admission.

Results

Mean QTc interval was 0.408 (SD = 0.036). QTc intervals in females were significantly longer than those in males. QTc of females without comorbidity was significantly longer than that of males.

Conclusion

The influence of gender difference on QTc prolongation in people with mental disorders merits further research.

     

Girls get by with a little help from their friends: gender differences in protective effects of social support for psychotic phenomena amongst poly-victimised adolescents

Purpose

To investigate whether social support is protective for psychotic experiences similarly among poly-victimised adolescent girls and boys.

Methods

We utilised data from the Environmental Risk (E-Risk) Longitudinal Twin Study, a nationally-representative sample of 2232 UK-born twins. Participants were privately interviewed at age 18 about victimisation, psychotic experiences, and social support during adolescence.

Results

Perceived social support (overall and from friends) was found to be protective against psychotic experiences amongst poly-victimised adolescent girls, but not boys. Though boys were similarly protected by family support.

Conclusions

Social support-focused interventions targeting psychotic phenomena amongst poly-victimised adolescents may be more effective for girls.

     

Appetite is a Heritable Phenotype Associated with Adiposity

Background

The high heritability of adiposity combined with its shifting distribution over time suggests that genetic and environmental influences interact in the etiology of adiposity.

Purpose

The purpose of this study is to examine evidence that genetically determined differences in appetite underlie variation in susceptibility to obesogenic environments.

Methods

Summary of a program of published research.

Results

Recent behavioral and psychometric studies demonstrate that appetitive characteristics such as responsiveness to internal satiety signals and external food cues not only differentiate obese and normal-weight groups, but are quantitatively associated with weight. Twin analyses show that variation in these appetitive traits is highly heritable. Sensitivity to internal satiety cues is linked with the FTO gene and mediates the association between FTO and weight.

Conclusions

These results indicate that sensitivity to internal and external appetitive signals are heritable phenotypes that increase the risk of overeating in “obesogenic” environments. A behavioral susceptibility model helps to explain how weight is both highly heritable and highly responsive to environmental characteristics.

     

Transsphenoidal meningoencephalocele associated with cleft lip and palate: challenges for diagnosis and surgical treatment

Purpose

The aim of this study was to highlight the challenges for early diagnosis and the difficulties observed in surgical treatment of patients with transsphenoidal meningoencephalocele associated with cleft lip and/or palate.

Method

We evaluated six male patients treated over the course of 4 years. Five patients presented encephalic herniation with nonfunctional brain tissue; one of these presented herniation of the pituitary gland and cerebral ventricles.

Results

All the patients received surgical treatment for the cleft lip and/or palate. Only one patient underwent repair of the meningoencephalocele, via nasal endoscopy. There were no postprocedural clinical or surgical complications.

Conclusion

The tendency is to avoid neurosurgery, opting for periodic follow-up with magnetic resonance imaging. In the presence of cleft palate, palatoplasty is essential to protect the meningoencephalocele.

     

Subjective and objective measures of function and return to work: an observational study with a clinical psychiatric cohort

Purpose

To evaluate the association between two measurement tools (Social and Occupational Functioning Assessment Scale, SOFAS and Sheehan Disability Scale, SDS), returning to work (RTW) and their inter-correlation.

Methods

132 psychiatric patients referred to assessment of work ability participated. The association between SOFAS and SDS Work to RTW were assessed by logistic regression. Inter-correlations between SOFAS and SDS were assessed with the Spearman’s rho correlation coefficient.

Results

SOFAS and SDS Work scores were associated with a 1-year RTW and SOFAS and SDS were inter-correlated.

Conclusions

When assigning the ability to work, both subjective and objective measures of function predict RTW.

     

Mindfulness Meditation for Chronic Pain: Systematic Review and Meta-analysis

Background

Chronic pain patients increasingly seek treatment through mindfulness meditation.

Purpose

This study aims to synthesize evidence on efficacy and safety of mindfulness meditation interventions for the treatment of chronic pain in adults.

Method

We conducted a systematic review on randomized controlled trials (RCTs) with meta-analyses using the Hartung-Knapp-Sidik-Jonkman method for random-effects models. Quality of evidence was assessed using the GRADE approach. Outcomes included pain, depression, quality of life, and analgesic use.

Results

Thirty-eight RCTs met inclusion criteria; seven reported on safety. We found low-quality evidence that mindfulness meditation is associated with a small decrease in pain compared with all types of controls in 30 RCTs. Statistically significant effects were also found for depression symptoms and quality of life.

Conclusions

While mindfulness meditation improves pain and depression symptoms and quality of life, additional well-designed, rigorous, and large-scale RCTs are needed to decisively provide estimates of the efficacy of mindfulness meditation for chronic pain.

     

A Self-Regulatory Intervention for Patients with Head and Neck Cancer: Pilot Randomized Trial

Background

Research is yet to investigate whether psychological interventions delivered early after diagnosis can benefit patients with head and neck cancer (HNC).

Purpose

The aim of this study was to investigate the effectiveness of a brief self-regulatory intervention (targeting illness perceptions and coping) at improving HNC patient health-related quality of life (HRQL).

Methods

A pilot randomized controlled trial was conducted, in which 64 patients were assigned to receive three sessions with a health psychologist in addition to standard care or standard care alone. Participants completed questionnaires assessing HRQL, general distress, and illness perceptions at baseline and again 3 and 6 months later.

Results

Compared to the control group, patients who received the intervention had increased treatment control perceptions at 3 months (p = .01), and increased social quality of life at 6 months (p = .01). The intervention was particularly helpful for patients exhibiting distress at baseline.

Conclusion

A brief psychological intervention following HNC diagnosis can improve patient perceptions of treatment and social quality of life over time. Such interventions could be targeted to patients who are distressed in order to confer the greatest benefit.

Trial Registration Number

12614000813684.

     

Aesthetic Amenities and Safety Hazards Associated with Walking and Bicycling for Transportation in New York City

Background

One strategy to address health problems related to insufficient physical activity is to examine modifiable neighborhood characteristics associated with active transportation.

Purpose

The aim of this study is to evaluate whether neighborhoods with more aesthetic amenities (sidewalk cafés, street trees, and clean sidewalks) and fewer safety hazards (pedestrian-auto fatalities and homicides) are associated with active transportation.

Methods

The 2003 Community Health Survey in New York City, which asked about active transportation (walking or bicycling >10 blocks) in the past 30 days, was linked to ZIP-code population census and built environment characteristics. Adjusted associations were estimated for dichotomous (any active transportation versus none) and continuous (trip frequency) active transportation outcomes.

Results

Among 8,034 adults, those living near sidewalk cafés were 10 % more likely to report active transportation (p?=?0.01). Homicide rate was associated with less frequent active transportation among those reporting any active transportation (p?=?0.002).

Conclusions

Investments in aesthetic amenities or homicide prevention may help to promote active transportation.

     

Resilience Resources Moderate the Association of Adverse Childhood Experiences with Adulthood Inflammation

Background

Exposure to adverse childhood experiences (ACE) has been associated with elevated circulating inflammatory markers in adulthood. Despite the robust effect of ACE on later health outcomes, not all individuals exposed to ACE suffer from poor health.

Purpose

The goal of this study was to evaluate whether current resilience resources may attenuate the impact of ACE on inflammatory markers among individuals with elevated C-reactive protein (CRP) levels.

Methods

Participants (N = 174) completed one-time self-report questionnaires assessing ACE exposure within the first 18 years of life and current resilience resources, and provided blood samples for interleukin-6 (IL-6) and CRP.

Results

Individuals who were exposed to multiple ACE had greater IL-6 than participants with lesser ACE exposure. However, current resilience resources significantly moderated this effect. Among individuals who reported multiple ACE, higher resilience resources were associated with lower IL-6 levels.

Conclusion

These data suggest that resilience resources might attenuate the association between ACE and later health outcomes.

     

Helping Yourself by Offering Help: Mediators of Expressive Helping in Survivors of Hematopoietic Stem Cell Transplant

Background

A randomized experiment by Rini et al. (Health Psychol. 33(12):1541–1551, 2014) demonstrated that expressive helping, which involves three expressive writing sessions regarding hematopoietic stem cell transplant, followed by one writing session directed toward helping other stem cell transplant recipients, reduced psychological distress and bothersome physical symptoms among stem cell transplant recipients with elevated survivorship problems, relative to a neutral writing control condition.

Purpose

The current study evaluated whether word use reflective of emotional expression, cognitive processing, and change in perspective mediates the effects of expressive helping.

Method

The essays of 67 stem cell transplant recipients with high survivorship problems were analyzed with Linguistic Inquiry and Word Count. Multiple mediation modeling was used to test the hypothesized mechanisms of expressive helping on distress and bothersome physical symptoms.

Results

Relative to the control condition, expressive helping produced significant reductions in psychological distress and marginal reductions in physical symptom bother in the analyzed subset of participants from the parent study. Results indicated that positive emotion word use significantly mediated effects of expressive helping on reduced distress, but only for participants who used average (compared to above or below average) rates of negative emotion words. Cognitive processing and change in perspective did not significantly mediate benefits of expressive helping.

Conclusions

Expressive helping carried its positive effects on distress through participants’ higher expression of positive emotions when coupled with moderate rates of negative emotions. Findings highlight the benefit of expressing both positive and negative emotions in stressful situations.

     

Bone mineral density in pediatric patients with meningomyelocele

Purpose

The aim of this study was to determine the bone mineral density (BMD) and the factors leading to reduction in BMD in children diagnosed with meningomyelocele.

Methods

A total of 31 patients with meningomyelocele (mean (SD) age, 8.5 (3.9) years; 51.6 % were females) and 22 healthy children were included. BMD of femoral neck and spinal L1–L4 levels and markers for bone metabolism were recorded.

Results

BMD of femoral neck (p?=?0.001) and spinal L1–L4 (p?=?0.01), serum calcium (p?=?0.031), and urinary deoxypyridinoline (p?=?0.015) levels were significantly lower in patients than in controls. Mobilization was significantly reduced in lumbar (p?=?0.001) and thoracic (p?=?0.002) level meningomyelocele compared to controls, while a significant positive correlation was noted between BMD of spinal L1–L4 and mobility (r?=?0.58, p?=?0.015).

Conclusions

Our findings suggest a decrease in BMD in meningomyelocele patients being associated with osteoporosis rather than nutritional and hormonal factors and the negative impact of higher levels of lesion on the mobility.

     

A Review of Environmental Influences on Food Choices

Background

Diet-related environmental and policy interventions are being advocated at a population level because individual change is more likely to be facilitated and sustained if the environment within which choices are made supports healthful food options.

Purpose

This study aims to review research that examines factors having an influence on food choices in social environments, physical environments, and macroenvironments.

Methods

A snowball strategy was used to identify relevant peer-reviewed studies and reviews, with a focus on research completed in the US and published within the past 10 years.

Results

Research has identified a number of environmental factors associated with dietary intake; however, the majority of completed studies have methodological limitations which limit their credibility to guide interventions and policy changes.

Conclusions

Future research will need to emphasize multilevel investigations, examine how associations vary across population subgroups, develop a standard set of measures for assessing food environments and policies, and improve dietary assessment methodology.

     

Spatial Disparities in the Distribution of Parks and Green Spaces in the USA

Background

Little national evidence is available on spatial disparities in distributions of parks and green spaces in the USA.

Purpose

This study examines ecological associations of spatial access to parks and green spaces with percentages of black, Hispanic, and low-income residents across the urban–rural continuum in the conterminous USA.

Methods

Census tract-level park and green space data were linked with data from the 2010 U.S. Census and 2006–2010 American Community Surveys. Linear mixed regression models were performed to examine these associations.

Results

Poverty levels were negatively associated with distances to parks and percentages of green spaces in urban/suburban areas while positively associated in rural areas. Percentages of blacks and Hispanics were in general negatively linked to distances to parks and green space coverage along the urban–rural spectrum.

Conclusions

Place-based race–ethnicity and poverty are important correlates of spatial access to parks and green spaces, but the associations vary across the urbanization levels.

     

Aspiration of parafalcine empyemas with flexible scope

Purpose

Subdural empyemas are considered neurosurgical emergencies, and the parafalcine location is particularly insidious. We revised the experience of general surgeons who are used to manage chronic pleural purulent collections with video-assisted thoracoscopy.

Methods

With a similar technique, we successfully aspirated a parafalcine empyema using a flexible scope avoiding a more invasive craniotomy. A review of the treatment options of empyematous collections is also provided, focusing particularly on the hazardous parafalcine location.

Results

The management of subdural empyemas poses different decision-making problems compared to common brain abscesses, urging a more rapid and holistic surgical treatment with minimally invasive approach. Endoscopic aspiration of parafalcine empyema was followed by complete recovery in our patient.

Conclusions

Flexible endoscopy is a promising method to obtain complete pus removal even from loculated collections through a bur hole, avoiding large craniotomies and consequent potential complications.

     

The Impact of 3-D Models versus Animations on Perceptions of Osteoporosis and Treatment Motivation: A Randomised Trial

Background

Osteoporosis is a degenerative bone disorder that disproportionately affects older women worldwide. Raising awareness regarding osteoporosis within this demographic is significant for health promotion. Initial evidence suggests that visualisations of illness and treatment can improve illness perceptions, increase treatment motivations and even promote health behaviours. We are yet to understand whether different visualisation mediums vary in their impact on perceptions and motivations.

Purpose

We investigated whether physical models or virtual animations had a greater impact on changing perceptions of osteoporosis and treatment motivation in an at-risk population of older women.

Methods

A total of 128 women aged 50 and over were randomly assigned to view a brief presentation about osteoporosis using either 3-D printed bone models or electronic tablet animations. Illness perceptions, medication beliefs and motivations were measured at baseline and post-presentation. Mixed ANOVAs were used to identify significant changes over time between groups.

Results

There were no significant interaction effects, revealing that neither medium had a greater impact on beliefs over time. Significant main effects of time revealed that from baseline to post-presentation, both mediums increased consequence beliefs, personal and treatment control, understanding of osteoporosis, motivations to take treatment if needed and medication necessity beliefs. Timeline beliefs and medication concerns decreased over time for both groups.

Conclusions

Both 3-D models and animations of osteoporosis are equally effective in changing beliefs and treatment motivation in an at-risk population. Visualisation devices are brief, cost-effective, have high acceptability and have considerable clinical applicability to promote awareness and prevention.