Medial amygdala ERα expression influences monogamous behaviour of male prairie voles in the field.

Formation of long-term pair-bonds is a complex process, involving multiple neural circuits and is context- and experience-dependent. While laboratory studies using prairie voles have identified the involvement of several neural mechanisms, efforts to translate these findings into predictable field outcomes have been inconsistent at best. Here we test the hypothesis that inhibition of oestrogen receptor alpha (ERα) in the medial amygdala of male prairie voles would significantly increase the expression of social monogamy in the field. Prairie vole populations of equal sex ratio were established in outdoor enclosures with males bred for high levels of ERα expression and low levels of prosocial behaviour associated with social monogamy. Medial amygdala ERα expression was knocked down in half the males per population. Knockdown males displayed a greater degree of social monogamy in five of the eight behavioural indices assessed. This study demonstrates the robust nature of ERα in playing a critical role in the expression of male social monogamy in a field setting.

Postoperative Upper Extremity Function in Implant and Autologous Breast Reconstruction.

BACKGROUND: After mastectomy and breast reconstruction, many patients experience upper extremity complications, such as pain, restriction in motion, and lymphedema. Despite an aesthetically satisfactory outcome, these occurrences can diminish a patient's postoperative quality of life. Several studies have investigated the causes and incidence of these complications. However, there is currently a paucity of data comparing postoperative upper extremity function according to reconstruction technique. METHODS: A review was performed of patients enrolled in a physical therapy (PT) program after mastectomy and immediate breast reconstruction. PT initial encounter evaluations were used to gather data on patients' postoperative upper extremity function. Hospital records were used to gather surgical and demographic data. For each patient, data were collected for each upper extremity that was ipsilateral to a reconstructed breast. Data were then compared between patients who underwent implant-based versus autologous deep inferior epigastric perforator flap reconstruction. RESULTS: A total of 72 patients were identified, including 39 autologous and 33 implant-based reconstruction cases. Proportions of patients who underwent sentinel lymph node biopsies and axillary lymph node dissections were similar between the two groups. The autologous-based reconstruction patients had significantly higher arm pain at rest (p = 0.004) and with activity (p = 0.031) compared with implant patients. Shoulder range of motion and manual muscle test results were similar between groups, with the exception of elbow flexion, which was weaker in implant patients (p = 0.030). Implant patients were also more likely to report "severe difficulty" or "inability" to perform activities of daily living (p = 0.022). Edema/swelling, axillary cording, and lymphedema girth measurements were similar between the two groups. CONCLUSION: Different techniques of breast reconstruction can result in different postoperative upper extremity complications. These data show specific areas where postoperative care and PT can be customized according to reconstruction type. Investigation is currently underway to determine the effect of PT on upper extremity function in these patients.

Emergency Nurses' Perception of Geriatric Readiness in the ED Setting: A Mixed-Methods Study.

INTRODUCTION: The Centers for Disease Control and Prevention (CDC) reports 136.9 million ED visits in 2015, of which 21.4 million (15.6%) were by patients who were 65 or older. This US population demographic is expected to grow by 112% over the next 40 years, becoming just below 25% of the total US population. Emergency nurses will play an increasingly important part in the development of nursing care for geriatric patients. The purpose of this study was to explore emergency nurses' perception of their ability to care for geriatric patients in the emergency setting. METHODS: This was a mixed-methods sequential design using quantitative survey data and qualitative focus group data, which were analyzed separately and then given equal priority during the data-interpretation phase. RESULTS: Less than 50% of survey respondents (N = 1,610) reported geriatric-specific screenings, accommodations, and communication with outside agencies as "always available" in their care settings. Qualitative analysis (N = 23) yielded the categories of Triage/Assessment, Care in the Emergency Environment, Discharge Planning, and Facilitators and Barriers, which generally reflected the trajectory of care for the older patient. The overarching concern was keeping patients safe in both the community and in the emergency department. DISCUSSION: Emergency departments should develop integrated systems to facilitate appropriate care of older patients. Identified barriers to improved care include a lack of integration between emergency care and community care, deficits in geriatric-specific education, inconsistent use of early screening for frailty, and lack of resources in the emergency care environment to intervene appropriately.

Improving cavity-enhanced spectroscopy of molecular ions in the mid-infrared with up-conversion detection and Brewster-plate spoilers.

The performance of sensitive spectroscopic methods in the mid-IR is often limited by fringing due to parasitic etalons and the background noise in mid-infrared detectors. In particular, the technique Noise Immune Cavity Enhanced Optical Heterodyne Velocity Modulation Spectroscopy (NICE-OHVMS), which is capable of determining the frequencies of strong rovibrational transitions of molecular ions with sub-MHz uncertainty, needs improved sensitivity in order to probe weaker transitions. In this work, we have implemented up-conversion detection with NICE-OHVMS in the 3.2 - 3.9 µm region to enable the use of faster and more sensitive detectors which cover visible wavelengths. The higher bandwidth enabled detection at optimized heterodyne frequencies, which increased the overall signal from the H3+ cation by a factor of three and was able to resolve sub-Doppler features which had previously overlapped. Also, we demonstrate the effectiveness of Brewster-plate spoilers to remove fringes due to parasitic etalons in a cavity enhanced technique. Together, these improvements reduced the instrument's noise equivalent absorption to 5.9×10-11 cm-1 Hz-1/2, which represents a factor of 34 improvement in sensitivity compared to previous implementations of NICE-OHVMS. This work will enable extended high-precision spectroscopic surveys of H3+ and other important molecular ions.

Effects of postnatal estrogen manipulations on juvenile alloparental behavior.

Sex- and species-specific patterns of estrogen receptor (ER)-α expression are established early in development, which may contribute to sexual differentiation of behavior and determine male social organization. The current study investigated the effects of ERα and ERß activation during the second postnatal week on subsequent alloparental behavior and ERα expression in juvenile prairie voles. Male and female pups were treated daily with 17ß-estradiol (E2, ERα/ERß agonist), PPT (selective ERα agonist), DPN (selective ERß agonist), or the oil vehicle on postnatal days (PD) 8-14. Alloparental behavior and ERα expression were examined at PD21. PPT treatment inhibited prosocial motivation in males and increased pup-directed aggression in both sexes. E2 and DPN had no apparent effect on behavior in either sex. PPT-treated males had increased ERα expression in the medial preoptic area (MPN), medial amygdala (MEApd) and bed nucleus of the stria terminalis (BSTpr). DPN treatment also increased ERα expression in males, but only in the BSTpr. Female ERα expression was unaffected by treatment. These results support the hypothesis that ERα activation in early life is associated with less prosocial patterns of central ERα expression and alloparental behavior in males. The lack of an effect of E2 on behavior suggests that ERß may antagonize the effects of ERα on alloparental behavior. The results in DPN-treated males suggest that ERα in the MEApd, and not the BSTpr, may be a primary determinant of alloparental behavior in males.

Communication: High precision sub-Doppler infrared spectroscopy of the HeH⁺ ion.

The hydrohelium cation, HeH(+), serves as an important benchmark for ab initio calculations that take into account non-adiabatic, relativistic, and quantum electrodynamic effects. Such calculations are capable of predicting molecular transitions to an accuracy of ~300 MHz or less. However, in order to continue to push the boundaries on these calculations, new measurements of these transitions are required. Here we measure seven rovibrational transitions in the fundamental vibrational band to a precision of ~1 MHz using the technique of Noise Immune Cavity Enhanced Optical Heterodyne Velocity Modulation Spectroscopy. These newly measured transitions are included in a fit to the rotation-vibration term values to derive refined spectroscopic constants in the v = 0 and v = 1 vibrational states, as well as to calculate rotation-vibration energy levels with high precision.

Lupus miliaris disseminatus faciei treated with 1,565 nm nonablative fractionated laser resurfacing: a case report.

BACKGROUND: Lupus miliaris disseminatus faciei (LMDF) is a rare granulomatous disease. It presents as red-brown papules on the face that can resolve with scarring. LMDF is often resistant to treatment. OBJECTIVE: Nonablative fractionated lasers have been used effectively to treat granulomatous disorders; however, there is little data on the treatment of LMDF with lasers. Our objective was to test a novel non-ablative fractionated laser for the treatment of recalcitrant LMDF. RESULTS: A 24-year-old man had a one-year history of LMDF. He had been treated with various topical therapies, oral medications, and laser devices with no improvement and continued progression. We utilized a non-sequential scanning 1,565 nm nonablative fractionated laser to treat this patient. After only one treatment he had significant improvement. He has been subsequently treated five times in the past 6 months and has continued to improve. CONCLUSION: The novel 1,565 nm nonablative fractionated laser may be a useful tool in the treatment of granulomatous conditions such as LMDF.

Cutaneous metastasis of a transitional cell carcinoma.

Cutaneous metastases are infrequently encountered in dermatology. We describe a rare case of a urolethial carcinoma metastatic to the skin in an elderly female. The metastasis expanded rapidly and was thought to possibly be infectious on her initial evaluation by her primary team. We were called in as consultants and biopsied this mass to confirm our concern for metastatic disease. In this case there was an unknown primary tumor. Histologic staining patterns were used to suggest that the tumor may have originated from her urinary bladder.

Multiple clustered and focally atrophic dermatofibromas (DF).

Multiple clustered dermatofibromas describes a confluence of dermatofibromas in one anatomic location. We describe a 32-year-old man who presented for evaluation owing to skin papules and plaques and concerns about malignancy. Repeat histopathological evaluation found no evidence for dermatofibrosarcoma protuberans. Our case presents this relatively rare condition and discusses observation along with potential treatment options.

Impact of pubertal and adult estradiol treatments on cocaine self-administration.

Estradiol is thought to play a critical role in the increased vulnerability to psychostimulant abuse in women. Sex differences in the ability of estradiol to influence cocaine self-administration in adult rats have been hypothesized to depend upon pubertal estradiol exposure. The current study investigated whether the presence of gonadal hormones during puberty affected cocaine self-administration behavior and its sensitivity to adult estradiol treatment in male and female Sprague-Dawley rats. Subjects were gonadectomized or SHAM-operated at postnatal day (PD) 22, and received either OIL or estradiol benzoate (EB) during the approximate time of puberty (PD27 to PD37). Adult rats were subsequently treated with either EB or OIL 30 min before cocaine self-administration (0.3 mg/kg/inf) in order to examine the effects of pubertal manipulations on the estradiol sensitivity of acquisition on a fixed ratio (FR) 1 schedule, total intake on a FR5 schedule and motivation on a progressive ratio schedule. Adult EB treatment only affected cocaine self-administration in females, which is consistent with previous research. Adult EB treatment enhanced acquisition in all females irrespective of puberty manipulations. All females, except those treated with EB during puberty, displayed increased cocaine intake following adult EB treatment. Adult EB treatment only enhanced motivation in females that were intact during puberty, whereas those treated with EB during puberty showed reduced motivation. Therefore, the sensitivities of different self-administration behaviors to adult estradiol treatment are organized independently in females, with pubertal estradiol exerting a greater influence over motivational processes, and negligible effects on learning/acquisition.

Indirect rotational spectroscopy of HCO+.

Spectroscopy of the ν1 band of the astrophysically relevant ion HCO(+) is performed with an optical parametric oscillator calibrated with an optical frequency comb. The sub-MHz accuracy of this technique was confirmed by performing a combination differences analysis with the acquired rovibrational data and comparing the results to known ground-state rotational transitions. A similar combination differences analysis was performed from the same data set to calculate the previously unobserved rotational spectrum of the ν1 vibrationally excited state with precision sufficient for astronomical detection. Initial results of cavity-enhanced sub-Doppler spectroscopy are also presented and hold promise for further improving the accuracy and precision in the near future.

High-precision and high-accuracy rovibrational spectroscopy of molecular ions.

We present a versatile new instrument capable of measuring rovibrational transition frequencies of molecular ions with sub-MHz accuracy and precision. A liquid-nitrogen cooled positive column discharge cell, which can produce large column densities of a wide variety of molecular ions, is probed with sub-Doppler spectroscopy enabled by a high-power optical parametric oscillator locked to a moderate finesse external cavity. Frequency modulation (heterodyne) spectroscopy is employed to reduce intensity fluctuations due to the cavity lock, and velocity modulation spectroscopy permits ion-neutral discrimination. The relatively narrow Lamb dips are precisely and accurately calibrated using an optical frequency comb. This method is completely general as it relies on the direct measurement of absorption or dispersion of rovibrational transitions. We expect that this new approach will open up many new possibilities: from providing new benchmarks for state-of-the-art ab initio calculations to supporting astronomical observations to helping assign congested spectra by combination differences. Herein, we describe the instrument in detail and demonstrate its performance by measuring ten R-branch transitions in the ν2 band of H3(+), two transitions in the ν1 band of HCO(+), and the first sub-Doppler transition of CH5(+).

Paramedian mandibular cleft: revisiting the Tessier classification.

Mandibular clefts are extremely rare, with less than 100 cases reported in the literature. Almost universally, these isolated cases of lower facial clefting have been noted to occur through the midline of the lip and/or mandible. The defect can vary, ranging from mild notching of the lower lip or mandibular alveolus to complete mandibular cleavage. The authors present a rare case of a paramedian mandibular cleft in a patient who also had Goldenhar syndrome and Tessier number 2/12 cleft. With its presentation, the authors revisit the Tessier classification of craniofacial clefts and the embryogenesis of lower facial clefts.

Measuring What Counts to Advance Indigenous Self-Determination: A Case Study of the Nisg̱a'a Lisims Government's Quality of Life Framework and Survey.

Modern Treaties are presented as a means for improving the lives of First Nations, Inuit, and Métis peoples in Canada by providing specific rights, and negotiated benefits. However, the positive impacts of Modern Treaties on Indigenous well-being are contested (Borrows and Coyle 2017; Coulthard 2014; Guimond et al. 2013; Miller 2009; Poelzer and Coates 2015). Developing a more transparent, consistent, collaborative and contextual way of measuring well-being relevant to the cultural realities of Modern Treaty beneficiaries is an important step for generating comparative methods that could systematically demonstrate whether, and under what conditions, such agreements can effectively reduce socio-economic disparities and improve the quality of life of Indigenous communities. The authors first examine previous attempts at measuring Indigenous well-being, then reflect on well-being in relation to the Modern Treaty context. Subsequently, the authors provide an example from one Self-Governing Indigenous Government, the Nisga'a Lisims Government, to collect well-being data through the Nisga'a Nation Household Survey using a mixed quantitative-qualitative method developed through a culturally grounded and participatory approach.

Not All Breast Explants Are Equal: Contemporary Strategies in Breast Explantation Surgery.

SUMMARY: Breast implant removal and replacement has been a common secondary breast procedure in the long-term maintenance of breast augmentation, but more recently growing concerns about silicone-related systemic illness, breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), and changing perceptions of aesthetic beauty have seen breast implant removal without replacement become increasingly requested by patients. Explantation can be challenging, especially when performed with a total capsulectomy. Currently, there is no evidence regarding whether a partial or total capsulectomy has any effect on BIA-ALCL risk mitigation in patients that have textured implants without disease. Total capsulectomy with incomplete resection of a mass can contribute to hyperprogression of BIA-ALCL and death. There have also been cases of BIA-ALCL diagnosed years after removal of the textured device and "total capsulectomy." Therefore, the common practice of simple prophylactic capsulectomy in a textured implant to mitigate future disease has not been established and at the current time should be discouraged. In addition, aesthetic outcomes can be quite variable, and patients should have appropriate preoperative counseling regarding the indications and contraindications for explantation, associated risks, financial implications, and postoperative appearance. The authors review salient aspects related to the planning and management of breast implant removal.

Analysis of surgical options for patients with bilateral carpal tunnel syndrome.

BACKGROUND: Bilateral endoscopic carpal tunnel release is a modality offered for the treatment of the median nerve compression neuropathy. This retrospective study compares outcomes for patients undergoing open carpal tunnel release versus bilateral endoscopic carpal tunnel release. We hypothesized that there is no significant difference in postoperative complication rates between unilateral open and bilateral endoscopic carpal tunnel release surgery. METHODS: The authors identified all patients who underwent open carpal tunnel release, unilateral endoscopic carpal tunnel release and bilateral endoscopic carpal tunnel release at a university hospital from 2012 to 2014. Cases were identified using CPT billing codes and the data was assessed using an analysis of variance (ANOVA). All endoscopic carpal tunnel releases were done by the same surgeon (AP), and greater than 90% of open procedures were done by a different same surgeon (DF). RESULTS: The total combined complication rate was 24.7% with no significant difference (p > .05) between techniques. There were no major complications necessitating a return to the operating room. Variables that had a statistically significant difference between groups (p < .05) included mean tourniquet time, mean total procedure time, and return to work as determined from the number of follow-up appointments. CONCLUSIONS: The study demonstrates equivocal complication profiles and decreased cost associated with bilateral endoscopic tunnel release as compared to sequential open carpal tunnel release. Endoscopic bilateral carpal tunnel release for patients with bilateral carpal tunnel syndrome offers a safe and effective alternative to open carpal tunnel release.

Estrogen receptors in the medial amygdala inhibit the expression of male prosocial behavior.

Studies using estrogen receptor alpha (ERalpha) knock-out mice indicate that ERalpha masculinizes male behavior. Recent studies of ERalpha and male prosocial behavior have shown an inverse relationship between ERalpha expression in regions of the brain that regulate social behavior, including the medial amygdala (MeA), and the expression of male prosocial behavior. These studies have lead to the hypothesis that low levels of ERalpha are necessary to "permit" the expression of high levels of male prosocial behavior. To test this, viral vectors were used to enhance ERalpha in male prairie voles (Microtus ochrogaster), which display high levels of prosocial behavior and low levels of MeA ERalpha. Adult male prairie voles were transfected with ERalpha in the MeA (MeA-ERalpha) or the caudate-putamen (ERalpha control) or luciferase (MeA-site-specific control), and 3 weeks later tested for spontaneous alloparental behavior and partner preference. Enhancing ERalpha in the MeA altered/reduced male prosocial behavior. Only one-third of MeA-ERalpha males, compared with all control males, were alloparental. MeA-ERalpha males also displayed a significant preference for a novel female. This is a critical finding because the manipulations of neuropeptides, oxytocin and vasopressin, can inhibit the formation of a partner preference, but do not lead to the formation of a preference for a novel female. The results support the hypothesis that low levels of ERalpha are necessary for high levels of male prosocial behavior, and provide the first direct evidence that site-specific ERalpha expression plays a critical role in the expression of male prosocial behavior.