Epigenetic advances in clinical neuroscience

Epigenetics, broadly defined as the regulation of gene expression without alteration of the genome, has become a field of tremendous interest in neuroscience, neurology, and psychiatry. This research has rapidly changed the way researchers think about brain function. Exciting epigenetic discoveries have been found in addiction, early life stress, neurodegeneration, post-traumatic stress disorder, and depression. As researchers more precisely define the epigenetic landscape that regulates disease progression in each of these cases, therapeutics can be designed to specifically target the molecules that mediate these epigenetic processes. Further, epigenetics may lead, to the identification of novel biomarkers for diagnosis and for the monitoring of treatment. Epigenetic profiling is likely to become a routine tool for the diagnosis of neurological and psychiatric disorders in the near future.     

An Interaction Model of Environmental and Psychological Factors Influencing Refugee Mental Health

In this paper, we draw on empirical research and theoretical models of refugee and posttrauma mental health to propose the “Psychological Interaction with Environment (PIE) Matrix Model” of refugee mental health. This model focuses on the mental health of adult refugees and proposes that psychological factors and the external environment interact to influence mental health outcomes and functioning for individuals with refugee backgrounds. Environmental factors include adversity faced before, during, and after the migration journey, including adversity faced in a resettlement or postdisplacement environment. Psychological factors refer to psychological (i.e., cognitive and emotional) mechanisms that individuals may use to cope with adversity. We posit that individuals from refugee backgrounds are likely to show individual differences in psychological processes that may protect against or underpin the development and maintenance of psychopathology following exposure to trauma and displacement. The PIE Matrix Model proposes a framework to guide intervention by identifying key pathways by which psychological and environmental factors impact one another. We suggest that psychological interventions can be targeted according to the kind and level of support different individuals may require, based on individualized and context‐driven assessments of the interaction between environmental and psychological factors at any given point in time. This model draws on existing models of refugee adaptation and highlights the need for longitudinal and experimental research to explain the interaction between these factors and their causal impact on refugee mental health.     

Cost,profile, and postoperative resource use for surgically managed acute hand and wrist injuries with emergency department presentation

Study DesignRetrospective cost-of-illness study.IntroductionInjuries to the hand and wrist are common. Most uncomplicated and stable upper extremity injuries recover with conservative management; however, some require surgical intervention. The economic burden on the health care system from such injuries can be considerable.Purpose of the StudyTo estimate the economic implications of surgically managed acute hand and wrist injuries at one urban health care network.MethodsUsing 33 primary diagnosis ICD-10 codes involving the hand and wrist, 453 consecutive patients from 2014 to 2015 electronic billing records who attended the study setting emergency department and received consequent surgical intervention and outpatient follow-up were identified. Electronic medical records were reviewed to extract demographic data. Costs were calculated from resource use in the emergency department, inpatient, and outpatient settings. Results are presented by demographics, injury type, mechanism of injury, and patient pathway.ResultsTwo hundred and twenty-six individuals (n 1?4 264 surgeries) were included. The total cost of all injuries was $1,204,606. The median cost per injury for non-compensable cases (n = 191) was $4508 [IQR $3993-$6172] and $5057 [IQR $3957-$6730] for compensable cases (n = 35). The median number of postoperative appointments with a surgeon was 2.00 (IQR 1.00-3.00) for both compensable and non-compensable cases. The number of hand therapy appointments for non-compensable cases and compensable cases was 4 [IQR 2-6] and 2 [IQR 1-3], respectively.DiscussionFindings of this investigation highlight opportunities for health promotion strategies for reducing avoidable injuries and present considerations for reducing cost burden by addressing high fail to attend (FTA) appointment rates.ConclusionSurgically managed hand and wrist injuries contribute to a significant financial burden on the health care system. Further research using stringent data collection methods are required to establish epidemiological data and national estimates of cost burden.     

Postoperative hand therapy management of zones V and VI extensor tendon repairs of the fingers: An international inquiry of current practice

Study DesignElectronic Web-based survey.IntroductionEvidence supports early motion over immobilization for postoperative extensor tendon repair management. Various early motion programs and orthoses are used, with no single approach recognized as superior. It remains unknown if and how early motion is used by hand therapists worldwide.Purpose of the StudyThe purpose of this study was to determine if there is a preferred approach and identify practice patterns for constituents of International Federation of Societies for Hand Therapy full-member countries.MethodsParticipation in this English-language survey required respondents to have postoperatively managed at least one extensor tendon repair within the previous year. Approaches surveyed included programs of immobilization, early passive (EPM), and early active (EAM) with motion delivered by resting hand, dynamic, palmar/interphalangeal joints (IPJs) free, or relative motion extension (RME) orthoses. Survey flow depended on the respondent's answer to their “most used” approach in the previous year.ResultsThere were 992 individual responses from 28 International Federation of Societies for Hand Therapy member countries including 887 eligible responses with an 81% completion rate. The order of most used program was EAM (83%), EPM (8%), and immobilization (7%). The two most used orthoses for delivery of EAM were RME (43%) and palmar/IPJs free (25%). The RME orthosis was preferred for earlier recovery of hand function and motion. Barriers to therapists wanting to use the RME/EAM approach related to preference of surgeon (70%) and clinic (24%).DiscussionIn practice, many therapists select from multiple approaches to manage zone V and VI extensor tendon repairs. Therapists believed TAM achieved with the RME/EAM approach was superior to the other approaches. Contrary to the literature, in practice, many therapists modify forearm-based palmar/IPJs free orthosis to exclude the wrist to manage this diagnosis.ConclusionsThe RME/EAM approach was identified as the favored approach. Practice patterns and evidence did not always align.     

Neurobiobehavioral responses to virtual social rejection in females—exploring the influence of oxytocin

In recent years, especially adolescents and young adults interact frequently via social media and digital communication. Mimicking an online communication platform where participants could initiate short conversations with two computerized interlocutors, the Verbal Interaction Social Threat Task (VISTTA) was used to induce feelings of social rejection. Motivational and physiological reactions were investigated in 43 healthy young women undergoing functional magnetic resonance imaging (fMRI), of which 22 received 24 international units (IU) intranasal oxytocin and 21 received placebo. Replicating previous findings, social rejection entailed a lower willingness to cooperate with the two peers. Increased activation in the anterior cingulate cortex and bilateral insula/inferior frontal gyrus was observed when receiving negative feedback from others, and in the precuneus when subsequently rating one’s willingness to cooperate with them in the future. Oxytocin did not seem to alter responses to social rejection. The current findings provide validation of the VISTTA for examining consequences of rejection in a virtual social interaction that bears a strong resemblance to online communication platforms.     

Exposure to ambient air pollution and autoantibody status in rheumatoid arthritis

Clinical Rheumatology - To evaluate the relationship between air pollutant (AP) exposure and rheumatoid arthritis (RA) autoantibody status We performed a cross sectional study utilizing enrollment...     

Monosynaptic inputs to specific cell types of the intermediate and deep layers of the superior colliculus

The intermediate and deep layers of the midbrain superior colliculus (SC) are a key locus for several critical functions, including spatial attention, multisensory integration, and behavioral responses. While the SC is known to integrate input from a variety of brain regions, progress in understanding how these inputs contribute to SC-dependent functions has been hindered by the paucity of data on innervation patterns to specific types of SC neurons. Here, we use G-deleted rabies virus-mediated monosynaptic tracing to identify inputs to excitatory and inhibitory neurons of the intermediate and deep SC. We observed stronger and more numerous projections to excitatory than inhibitory SC neurons. However, a subpopulation of excitatory neurons thought to mediate behavioral output received weaker inputs, from far fewer brain regions, than the overall population of excitatory neurons. Additionally, extrinsic inputs tended to target rostral excitatory and inhibitory SC neurons more strongly than their caudal counterparts, and commissural SC neurons tended to project to similar rostrocaudal positions in the other SC. Our findings support the view that active intrinsic processes are critical to SC-dependent functions, and will enable the examination of how specific inputs contribute to these functions.     

Subcapsular relocation for sacral neuromodulation pulse generator implant revision

Objectives: We describe our technique and experience with subcapsular placement of the Interstim (Medtronic, Minneapolis, MN, USA) pulse generator in cases of revision for implant site pain. Methods: The pulse generator and electrode are carefully exteriorized and the floor of the capsule is incised. The system is placed beneath the floor of the original capsule, which then becomes the roof of the new pocket. A layered closure is performed. Results: Five patients have undergone the technique described with successful resolution of their pain. Conclusions Utilizing the capsule presumably improves defects in skin microcirculation, but also creates additional cushion superior to the pulse generator, helping to counteract the vertical mechanical forces of the pulse generator.