Reliability of Reverse Sural Flap in the Reconstruction of Midfoot and Forefoot Defects

Reconstruction of mid- and forefoot defects involves few options as versatile as free flaps; however, free flaps are not universally available and require long operative time and can be difficult to successfully heal. Although the reverse sural flap is commonly used for lower limb reconstructions, it has been used mainly for reconstruction of defects around the distal leg, ankle, and hindfoot. Few studies have demonstrated the use of this flap in the reconstruction of mid- and forefoot defects. Herein we describe our experience with patients that underwent reconstruction using reverse sural flaps for mid- and hindfoot defects. A total of 16 patient, ranging in age 6 to 54 years, were treated with reverse sural flaps between January 2010 and December 2018. The defects were mainly incurred as a result of trauma. All reconstructions were performed in 2 stages, and success was achieved in 15 (93%) of the 16 cases. No cases of donor site morbidity were observed. Our findings suggest that the reverse sural flap can be used for reconstruction of mid- and forefoot defects as a 2 staged procedure. The flap is easy to raise and can be considered in selected patients with such defects.     

Understanding the Chronic Impacts of Oil Refinery Wastewater Requires Consideration of Sediment Contributions to Toxicity

Previous studies at an oil refinery in Saint John, New Brunswick, Canada, found a diminished fish community downstream of the effluent outfall that appeared to be associated with periodic low dissolved oxygen concentrations due to episodic discharges of contaminated transport vessel ballast water. This study was initiated after the ballast water was removed from the effluent to further investigate the potential causes of residual effects in the study stream, Little River. We used field caging of fish, laboratory bioassays, and chemical analysis of effluents and sediments from the field site to determine if the effluent or contaminated sediments were affecting the recovery of the fish community in Little River. The field studies suggested that exposed, caged fish were affected, displaying >40 % increases in liver sizes and increased liver detoxification enzyme activity (cytochrome P450 1A, CYP1A); however, similar responses were absent in laboratory exposures that used effluent only. Adding sediments collected from the vicinity of the refinery’s outfall to the laboratory bioassays reproduced some of the field responses. Chemical analyses showed high concentrations of PAHs in sediments but low concentrations in the effluent, suggesting that the PAHs in the sediment were contributing more to the impacts than the effluent. Application of effects-based monitoring is suggested as beneficial to identify impacts to fisheries where refinery effluents of this type are involved.     

Effect of childhood maltreatment on brain structure in adult patients with major depressive disorder and healthy participants

Background

Childhood maltreatment has been found to play a crucial role in the development of psychiatric disorders. However, whether childhood maltreatment is associated with structural brain changes described for major depressive disorder (MDD) is still a matter of debate. The aim of this study was to investigate whether patients with MDD and a history of childhood maltreatment display more structural changes than patients without childhood maltreatment or healthy controls.

Methods

Patients with MDD and healthy controls with and without childhood maltreatment experience were investigated using high-resolution magnetic resonance imaging (MRI), and data were analyzed using voxel-based morphometry.

Results

We studied 37 patients with MDD and 46 controls. Grey matter volume was significantly decreased in the hippocampus and significantly increased in the dorsomedial prefrontal cortex (DMPFC) and the orbitofrontal cortex (OFC) in participants who had experienced childhood maltreatment compared with those who had not. Patients displayed smaller left OFC and left DMPFC volumes than controls. No significant difference in hippocampal volume was evident between patients with MDD and healthy controls. In regression analyses, despite effects from depression, age and sex on the DMPFC, OFC and hippocampus, childhood maltreatment was found to independently affect these regions.

Limitations

The retrospective assessment of childhood maltreatment; the natural problem that patients experienced more childhood maltreatment than controls; and the restrictions, owing to sample size, to investigating higher order interactions among factors are discussed as limitations.

Conclusion

These results suggest that early childhood maltreatment is associated with brain structural changes irrespective of sex, age and a history of depression. Thus, the study highlights the importance of childhood maltreatment when investigating brain structures.     

清麴酱激酶的溶栓活性可减轻栓塞性脑梗死后脑损伤

Cheonggukjang is a soybean paste made by fermenting whole cooked soybean with Bacillus subtilis. Cheonggukjang contains a fibrinolytic enzyme that may have clinical applications in removing blood clots. In this study, we use the term “cheonggukjang kinase” (CGK) to refer to this fibrinolytic enzyme. We used fibrin clot lysis and platelet-rich clot lysis assays to clarify the mechanisms by which CGK exerts thrombolytic effects, and, specifically, whether it acts more like a plasminogen activator or like plasmin. Additionally, we examined the thrombolytic effects of CGK in a rat model of cerebral embolic stroke produced by middle cerebral artery occlusion (MCAO) with respect to infarct volume and behavioral performance. In both the fibrin clot lysis and platelet-rich clot lysis assays, the thrombolytic activity was highest in CGK that had been cultured for 40 h. Furthermore, T50%, the time needed to decompose half the clot, did not differ in the presence or absence of plasminogen, indicating that CGK is a plasmin-like protein, not a plasminogen activator. In the rat model of cerebral embolic stroke, clots were no longer visible in rats that received an intravenous infusion of CGK (1 U plasmin-like activity/100 μg CGK/kg) 1 h after MCAO. CGK-treated groups showed a significant dose-dependent reduction in infarct volume. Treatment with CGK also improved functional recovery, as assessed by neurological deficit scores. Reduction of infarct volume and improvement in functional recovery after CGK treatment (1 U plasmin-like activity/100 μg CGK/kg) was greater than after treatment with recombinant tissue plasminogen activator (r-tPA; 10 mg/kg). These data suggest that CGK is an effective agent for reducing infarct volume and improving functional recovery following ischemic brain injury. Moreover, CGK may be a more efficacious clot-dissolving agent than r-tPA. CGK has a number of potential clinical applications in the treatment of stroke.     

Acute hydrocortisone administration does not affect subjective responses to d-amphetamine in humans

RATIONALE: Stress and glucocorticoids facilitate and reinstate psychostimulant self-administration in rodents. However, the effects of stress and glucocorticoids on the subjective and behavioral effects of psychostimulants have not been well studied in humans. OBJECTIVES: To examine the effects of acute hydrocortisone pretreatment on the subjective and behavioral effects of d-amphetamine. METHODS: Hydrocortisone (100 mg) and d-amphetamine (20 mg) were administered orally to 16 healthy male and female volunteers in a four-session, placebo-controlled, within-subject, crossover design. To prevent stomach irritation, subjects received rantidine hydrochloride before each experimental session. Dependent measures included self-reported mood and subjective effects (Addiction Research Center inventory, the profile of mood states, and a series of visual analogue scales), vital signs, salivary cortisol, and psychomotor performance. RESULTS: Hydrocortisone elevated salivary cortisol levels, produced modest dysphoria, and reduced subjects' reports of wanting more drug. However, hydrocortisone pretreatment did not affect any of the physiological, behavioral, or subjective effects of d-amphetamine. CONCLUSIONS: In contrast to the effects of glucocorticoids in rodent studies, these results indicate that an acute increase in cortisol does not enhance the psychostimulant effects of d-amphetamine in humans.     

Longitudinal functional connectivity changes correlate with mood improvement after regular exercise in a dose‐dependent fashion

Exercise increases wellbeing and improves mood. It is however unclear how these mood changes relate to brain function. We conducted a randomized controlled trial investigating resting‐state modifications in healthy adults after an extended period of aerobic physical exercise and their relationship with mood improvements. We aimed to identify novel functional networks whose activity could provide a physiological counterpart to the mood‐related benefits of exercise. Thirty‐eight healthy sedentary volunteers were randomised to either the aerobic exercise group of the study or a control group. Participants in the exercise group attended aerobic sessions with a physiotherapist twice a week for 16 weeks. Resting‐state modifications using magnetic resonance imaging were assessed before and after the programme and related to mood changes. An unbiased approach using graph metrics and network‐based statistics was adopted. Exercise reduced mood disturbance and improved emotional wellbeing. It also induced a decrease in local efficiency in the parahippocampal lobe through strengthening of the functional connections from this structure to the supramarginal gyrus, precentral area, superior temporal gyrus and temporal pole. Changes in mood disturbance following exercise were correlated with those in connectivity between parahippocampal gyrus and superior temporal gyrus as well as with the amount of training. No changes were detected in the control group. In conclusion, connectivity from the parahippocampal gyrus to motor, sensory integration and mood regulation areas was strengthened through exercise. These functional changes might be related to the benefits of regular physical activity on mood.