Caput succedaneum mimicking a cephalocele

Caput succedaneum is relatively common at birth but infrequently diagnosed in utero. It has a benign prognosis, but it is very important not to misdiagnose it as a cephalocele, which carries a guarded prognosis. We present the case of a patient who experienced preterm labor and premature rupture of the membranes at 28 weeks' menstrual age. Our initial diagnosis was cephalocele, but after the male infant was delivered by cesarean section, examination revealed no bone defect, and our final diagnosis was caput succedaneum. We also discuss the sonographic findings and diagnostic differences between caput succedaneum, cephalocele, and other fetal head masses.     

The Abbe flap in secondary cleft lip repair

The Abble flap is a full-thickness composite flap, involving the transfer of the skin, muscle, and mucosa of the central part of the lover lip to the upper lip. This vermilionpedicled flap, based on the inferior labial vessels, has been used for secondary corrections in cleft deformities, more often in bilateral cases. Indications for its use include deficiency of scarring of the central part of the upper lip. thinness of the vermilion with a nonexistent lip tuberculum, or the absence of a Cupid's bow. The procedure may be combined with other reconstructive procedures.     

Mental Health Over Time in a Military Sample: The Impact of Alcohol Use Disorder on Trajectories of Psychopathology After Deployment

To identify trajectories of depression and posttraumatic stress (PTS) symptom groups after deployment and determine the effect of alcohol use disorder on these trajectories, depression symptoms were modeled using the 9‐item Patient Health Questionnaire in 727 Ohio National Guard members, and PTS symptoms were modeled using the PTSD Checklist in 472 Ohio National Guard members. There were 55.8% who were resistant to depression symptoms across the 4 years of study, and 41.5% who were resistant to PTS symptoms. There were 18.7% and 42.2% of participants who showed resilience (experiencing slightly elevated symptoms followed by a decline, according to Bonanno et al., 2002) to depression and PTS symptoms, respectively. Mild and chronic dysfunction constituted the smallest trajectory groups across disorders. Marital status, deployment to an area of conflict, and number of lifetime stressors were associated with membership into different latent groups for depression (unstandardized β estimates range = 0.69 to 1.37). Deployment to an area of conflict, number of lifetime traumatic events and education predicted membership into different latent groups for PTS (significant unstandardized β estimate range = 0.83 to 3.17). AUD was associated with an increase in both symptom outcomes (significant unstandardized β estimate range = 0.20 to 9.45). These results suggested that alcohol use disorder may have contributed substantially to trajectories of psychopathology in this population.     

Onset of Alcohol Use Disorders and Comorbid Psychiatric Disorders in a Military Cohort: Are there Critical Periods for Prevention of Alcohol Use Disorders?

Alcohol use disorders (AUD) are commonly comorbid with anxiety and mood disorders; however, a strategy for AUD prevention remains unclear in the presence of three competing etiological models that each recommends different high-risk groups. Therefore, the investigation of the three hypotheses in a characteristically unique cohort is critical to identifying pervasive characteristics of AUD that can inform a universal prevention strategy. The current study evaluated the temporality and onset of comorbid AUD and psychiatric disorders in a representative sample of 528 Ohio Army National Guard soldiers using structured clinical interviews from 2009 to 2012. We examined temporality both statistically and graphically to identify patterns that could inform prevention. General estimating equations with dichotomous predictor variables were used to estimate odds ratios between comorbid psychiatric disorders and AUDs. An annualized rate of 13.5 % persons per year was diagnosed with any AUD between 2010 and 2012. About an equal proportion of participants with comorbid psychiatric disorders and AUD initiated the psychiatric disorder prior to the AUD and half initiated the psychiatric disorder after the AUD. Regardless of onset, however, the majority (80 %) AUD initiated during a short interval between the ages of 16 and 23. Focused primary prevention during this narrow age range (16–23 years) may have the greatest potential to reduce population mental health burden of AUD, irrespective of the sequencing of comorbid psychiatric disorder.     

A multiple-plane approach to measure the structural properties of functionally active regions in the human cortex

Advanced magnetic resonance imaging (MRI) techniques provide the means of studying both the structural and the functional properties of various brain regions, allowing us to address the relationship between the structural changes in human brain regions and the activity of these regions. However, analytical approaches combining functional (fMRI) and structural (sMRI) information are still far from optimal. In order to improve the accuracy of measurement of structural properties in active regions, the current study tested a new analytical approach that repeated a surface-based analysis at multiple planes crossing different depths of cortex. Twelve subjects underwent a fear conditioning study. During these tasks, fMRI and sMRI scans were acquired. The fMRI images were carefully registered to the sMRI images with an additional correction for cortical borders. The fMRI images were then analyzed with the new multiple-plane surface-based approach as compared to the volume-based approach, and the cortical thickness and volume of an active region were measured. The results suggested (1) using an additional correction for cortical borders and an intermediate template image produced an acceptable registration of fMRI and sMRI images; (2) surface-based analysis at multiple depths of cortex revealed more activity than the same analysis at any single depth; (3) projection of active surface vertices in a ribbon fashion improved active volume estimates; and (4) correction with gray matter segmentation removed non-cortical regions from the volumetric measurement of active regions. In conclusion, the new multiple-plane surface-based analysis approaches produce improved measurement of cortical thickness and volume of active brain regions. These results support the use of novel approaches for combined analysis of functional and structural neuroimaging.     

Using the Roy Adaptation Model to explore the dynamics of quality of life and the relationship between lung transplant candidates and their caregivers

Using theory to support nursing research may be considered superfluous by some authors, yet a theoretical framework provides structure and consistency to a research study. This article presents the use of the Roy Adaptation Model within the theoretical framework underpinning an investigation of quality of life as perceived by lung transplant candidates and their caregivers. Each step of the research process is identified in this article and the link to the theoretical framework is demonstrated. The use of nursing frameworks to guide research strengthens the theoretical framework itself and also adds another dimension to the body of nursing knowledge.     

Sonographic duplication artifact of the spinal cord in infants and children.

OBJECTIVE: To describe the features of sonographic duplication artifacts that we have occasionally seen when imaging the spinal cord of infants and children, mostly with postrepair myelomeningocele. METHODS: Sonography of the spine was performed for the evaluation of neonates with suspected spinal cord abnormalities and of older children in the follow-up of postrepair open-spine defects. RESULTS: Each of our patients had a single spinal cord, but the duplication artifact was seen with 2 brands of scanners and with both linear array and vector array transducers. CONCLUSIONS: The finding of duplication artifacts when imaging the spinal cord of infants and children should be recognized as such and should not be misinterpreted as representing diastematomyelia or diplomyelia.