Corpus Callosum Microstructural Tract Integrity Relates to Longer Emotion Recognition Reaction Time in People with Schizophrenia.

Objective: Schizophrenia is a complex functionally debilitating neurodevelopmental disorder, with associated social cognitive impairment. Corpus Callosum (CC) white matter tracts deficits are reported for people with schizophrenia; however, few studies focus on interhemispheric processing relative to social cognition tasks. This study aimed to determine if a relationship between the CC and social cognition exists. Method: In this cross-section study, a sample of n = 178 typical controls and n = 58 people with schizophrenia completed measures of mentalising (Reading the Mind in the Eyes), emotion recognition outcome and reaction time (Emotion Recognition Test), and clinical symptoms (Positive and Negative Symptom Scale), alongside diffusion-based tract imaging. The CC and its subregions, i.e., the genu, body, and splenium were the regions of interest (ROI). Results: Reduced white matter tract integrity was observed in the CC for patients when compared to controls. Patients performed slower, and less accurately on emotion recognition tasks, which significantly and negatively correlated to the structural integrity of the CC genu. Tract integrity further significantly and negatively related to clinical symptomatology. Conclusions: People with schizophrenia have altered white matter integrity in the genu of the CC, compared to controls, which relates to cognitive deficits associated with recognising emotional stimuli accurately and quickly, and severity of clinical symptoms.

The impact of delaying colonoscopies during the COVID-19 pandemic on colorectal cancer detection and prevention.

PURPOSE: The COVID-19 pandemic resulted in a partial to total shutdown of endoscopy in many healthcare centers. This study aims to quantify the impact of the reduction in colonoscopies on colorectal cancer (CRC) detection and screening. METHODS: After institutional ethics board approval, the endoscopy database at an academic tertiary-care center in Montreal, Canada, was searched for all colonoscopies performed from during the first wave locally (March-June 2020), and during the ramp up period where endoscopy service resumed (July to August 2020). We compared these periods to the same periods in 2019, the pre-pandemic periods. The indications, CRC and adenoma detection rates, as well as the prioritization of urgent procedures were compared. RESULTS: In the first wave, only 462 colonoscopies were performed, compared to 2515 in the same period in 2019, an 82% reduction. The ramp up period saw 843 colonoscopies performed compared to 1328 in 2019, a 35% reduction. Urgent and inpatient colonoscopies numbers increased (324 (24.8%) vs. 220 (5.7%)) while surveillance and high-risk screening colonoscopies fell (376 (28.8%) vs 1869 (48.6%)). Emergency access to colonoscopy was preserved with a median time to endoscopy of < 1 day (IQR 0,1) in both pandemic periods. During the pandemic periods, there was an absolute reduction in CRC diagnosis of 28, despite the CRC detection per colonoscopy rate increasing slightly in the first wave from 1.7% (44) to 3.9% (18), and in the ramp up period from 2.5% (33) to 3.6% (31). The rate of adenoma detection per colonoscopy did not increase significantly between the pre- and pandemic periods, resulting in reduction in adenoma removal in 723 patients. DISCUSSION: The restriction of access to colonoscopy resulted in a significant reduction in screening and surveillance of high-risk patients, adenomas removed, and CRCs diagnosed. Clinicians and patients will face the oncologic ramifications this the coming years.

Surgical Principles of Rectal Cancer.

This article reviews the oncological principles of rectal cancer surgery, beginning with an overview of the pertinent rectal and pelvic anatomy, followed by a discussion of the historical evolution in surgical management. Evidence supporting current practices with respect to proximal, distal, and circumferential margins are reviewed. Finally, operative approaches to restorative proctectomies and abdominoperineal resections are highlighted.

Childhood trauma, parental bonding, and social cognition in patients with schizophrenia and healthy adults.

OBJECTIVE: This study investigated associations between childhood trauma, parental bonding, and social cognition (i.e., Theory of Mind and emotion recognition) in patients with schizophrenia and healthy adults. METHODS: Using cross-sectional data, we examined the recollections of childhood trauma experiences and social cognitive abilities in 74 patients with schizophrenia and 116 healthy adults. RESULTS: Patients had significantly higher scores compared with healthy participants on childhood trauma, and lower scores on parental bonding and social cognitive measures. Physical neglect was found to be the strongest predictor of emotion recognition impairments in both groups. Optimal parental bonding attenuated the impact of childhood trauma on emotion recognition. CONCLUSION: The present study provides evidence of an association between physical neglect and emotion recognition in patients with schizophrenia and healthy individuals and shows that both childhood trauma and parental bonding may influence social cognitive development. Psychosocial interventions should be developed to prevent and mitigate the long-term effects of childhood adversities.

Childhood trauma, brain structure and emotion recognition in patients with schizophrenia and healthy participants.

Childhood trauma, and in particular physical neglect, has been repeatedly associated with lower performance on measures of social cognition (e.g. emotion recognition tasks) in both psychiatric and non-clinical populations. The neural mechanisms underpinning this association have remained unclear. Here, we investigated whether volumetric changes in three stress-sensitive regions-the amygdala, hippocampus and anterior cingulate cortex (ACC)-mediate the association between childhood trauma and emotion recognition in a healthy participant sample (N = 112) and a clinical sample of patients with schizophrenia (N = 46). Direct effects of childhood trauma, specifically physical neglect, on Emotion Recognition Task were observed in the whole sample. In healthy participants, reduced total and left ACC volumes were observed to fully mediate the association between both physical neglect and total childhood trauma score, and emotion recognition. No mediating effects of the hippocampus and amygdala volumes were observed for either group. These results suggest that reduced ACC volume may represent part of the mechanism by which early life adversity results in poorer social cognitive function. Confirmation of the causal basis of this association would highlight the importance of resilience-building interventions to mitigate the detrimental effects of childhood trauma on brain structure and function.

Effects of complement gene-set polygenic risk score on brain volume and cortical measures in patients with psychotic disorders and healthy controls.

Multiple genome-wide association studies of schizophrenia have reported associations between genetic variants within the MHC region and disease risk, an association that has been partially accounted for by alleles of the complement component 4 (C4) gene. Following on previous findings of association between both C4 and other complement-related variants and memory function, we tested the hypothesis that polygenic scores calculated based on identified schizophrenia risk alleles within the "complement" system would be broadly associated with memory function and associated brain structure. We tested this using a polygenic risk score (PRS) calculated for complement genes, but excluding C4 variants. Higher complement-based PRS scores were observed to be associated with lower memory scores for the sample as a whole (N = 620, F change = 8.25; p = .004). A significant association between higher PRS and lower hippocampal volume was also observed (N = 216, R2 change = 0.016, p = .015). However, after correcting for further testing of association with the more general indices of cortical thickness, surface area or total brain volume, none of which were associated with complement, the association with hippocampal volume became non-significant. A post-hoc analysis of hippocampal subfields suggested an association between complement PRS and several hippocampal subfields, findings that appeared to be particularly driven by the patient sample. In conclusion, our study yielded suggestive evidence of association between complement-based schizophrenia PRS and variation in memory function and hippocampal volume.

Effects of early life adversity on immune function and cognitive performance: results from the ALSPAC cohort.

BACKGROUND: Early life adversity (ELA) is a significant risk factor for mental health disorders. One hypothesised mechanism by which this occurs is via an effect on immune response. In this analysis of epidemiological data, we tested whether ELA was associated with cognitive performance, and if so, whether these effects were influenced by immune function. METHODS: We investigated the longitudinal relationship between ELA, inflammatory markers, and cognition in data from Avon Longitudinal Study of Parents And Children (ALSPAC; n ~ 5000). ELA was defined in terms of physical/emotional abuse, harsh parenting, or domestic violence before 5 years. Social cognition was measured in terms of theory of mind, and general cognitive ability was measured using IQ. Inflammatory markers included serum C-reactive protein and interleukin-6 levels. RESULTS: A significant association was observed between IQ and harsh parenting, whereby children who were physically disciplined had lower IQ scores (accounting for relevant social factors). Both immune markers were associated with variation in cognition, however, neither accounted for the effects of ELA on cognition. DISCUSSION: This study highlights the impact of ELA on cognition. In the absence of evidence that these effects are explained by inflammation, other mechanisms by which the effects of ELA are mediated are discussed.

Do North American colorectal surgeons use mesh to prevent parastomal hernia? A survey of current attitudes and practice

Background: The use of prophylactic mesh in end colostomy procedures has been shown to reduce the rate of parastomal hernia. However, the degree to which the practice has been adopted clinically remains unknown. We conducted a study to evaluate the current opinions and practice patterns of Canadian and US colorectal surgeons with regard to the use of prophylactic mesh in end colostomy. Methods: Between May and July 2017, we conducted an internet-based survey of colorectal surgeons in Canada and the United States (selected at random). Using a questionnaire designed and tested for this study, we assessed the rate of mesh use, types of mesh and placement techniques, and perceived barriers and facilitators associated with the practice. Results: Forty-eight (51.6%) of 93 invited Canadian surgeons and 253 (16.6%) of 1521 invited US surgeons responded (overall response rate 18.6%). Of the 301 respondents, 32 (10.6%) were currently using mesh, 32 (10.6%) had previously used mesh, and 237 (78.7%) had never used mesh. Of 29 respondents currently using mesh, 12 (41.4%) used it only in selected patients; the majority used a sublay technique (20 [69.0%]) and biologic mesh (17 [58.6%]). Most respondents agreed that parastomal hernias are common and negatively affect quality of life; however, there remained concerns about evidence quality and the perceived risk associated with mesh among those who had never or had previously used mesh. Conclusion: Prophylactic mesh placement remains relatively uncommon; when used, biologic mesh was the most common type. Many surgeons were not convinced of the safety or efficacy of prophylactic mesh placement.

Contexte: Il a été démontré que la pose d'un treillis prophylactique durant une colostomie terminale réduit le risque de hernie parastomale. On ignore toutefois à quel point cette pratique a été adoptée en contexte clinique. Nous avons mené une étude pour connaître l'opinion et les habitudes des chirurgiens colorectaux canadiens et américains quant à cette intervention. Méthodes: De mai à juillet 2017, nous avons mené un sondage en ligne auprès de chirurgiens colorectaux canadiens et américains sélectionnés aléatoirement. À l'aide d'un questionnaire conçu et validé pour cette étude, nous avons évalué le taux de pose de treillis, le type de treillis et la technique utilisé, ainsi que les facteurs facilitant ou limitant l'intervention. Résultats: Au total, 48 des 93 chirurgiens canadiens (51,6 %) et 253 des 1521 chirurgiens américains (16,6 %) approchés ont répondu au sondage (taux de réponse global : 18,6 %). Sur les 301 répondants, 32 (10,6 %) ont dit qu'ils installent actuellement des treillis, 32 (10,6 %) ont dit en avoir installé, et 237 (78,7 %) ont dit n'en avoir jamais installé. Parmi 29 répondants posant actuellement des treillis, 12 (41,4 %) ont déclaré y avoir recours pour certains patients seulement; la majorité pose les treillis dans l'espace prépéritonéal (20 [69,0 %]) et se sert de treillis biologiques (17 [58,6 %]). La plupart des répondants s'entendaient pour dire que les hernies parastomales sont courantes et ont des répercussions négatives sur la qualité de vie des patients; cependant, les chirurgiens n'ayant jamais installé de treillis ou en ayant seulement installé par le passé se sont dits préoccupés par la qualité des données et les risques perçus associés aux treillis. Conclusion: La pose d'un treillis à des fins prophylactiques demeure relativement rare. Les treillis biologiques étaient les plus fréquemment utilisés par les répondants. Bon nombre des chirurgiens questionnés n'étaient pas convaincus de l'innocuité ou de l'efficacité de l'intervention.

Beyond C4: Analysis of the complement gene pathway shows enrichment for IQ in patients with psychotic disorders and healthy controls.

Variation in cognitive performance, which strongly predicts functional outcome in schizophrenia (SZ), has been associated with multiple immune-relevant genetic loci. These loci include complement component 4 (C4A), structural variation at which was recently associated with SZ risk and synaptic pruning during neurodevelopment and cognitive function. Here, we test whether this genetic association with cognition and SZ risk is specific to C4A, or extends more broadly to genes related to the complement system. Using a gene-set with an identified role in "complement" function (excluding C4A), we used MAGMA to test if this gene-set was enriched for genes associated with human intelligence and SZ risk, using genome-wide association summary statistics (IQ; N = 269 867, SZ; N = 105 318). We followed up this gene-set analysis with a complement gene-set polygenic score (PGS) regression analysis in an independent data set of patients with psychotic disorders and healthy participants with cognitive and genomic data (N = 1000). Enrichment analysis suggested that genes within the complement pathway were significantly enriched for genes associated with IQ, but not SZ. In a gene-based analysis of 90 genes, SERPING1 was the most enriched gene for the phenotype of IQ. In a PGS regression analysis, we found that a complement pathway PGS associated with IQ genome-wide association studies statistics also predicted variation in IQ in our independent sample. This association (observed across both patients and controls) remained significant after controlling for the relationship between C4A and cognition. These results suggest a robust association between the complement system and cognitive function, extending beyond structural variation at C4A.

Effects of MiR-137 genetic risk score on brain volume and cortical measures in patients with schizophrenia and controls.

Multiple genome-wide association studies of schizophrenia have implicated genetic variants within the gene encoding microRNA-137. As risk variants within or regulated by MIR137 have been implicated in memory performance, we investigated the additive effects of schizophrenia-associated risk variants in genes empirically regulated by MIR137 on brain regions associated with memory function. A polygenic risk score (PRS) was calculated (at a p = 0.05 threshold), using this empirically regulated MIR137 gene set, to investigate associations between this PRS and structural brain measures. These measures included total brain volume, cortical thickness, cortical surface area, and hippocampal volume, in a sample of 216 individuals consisting of healthy participants (n = 171) and patients with psychosis (n = 45). We did not observe a significant association between MIR137 PRS and these cortical thickness, surface area or hippocampal volume measures linked to memory function; a significant association between increasing PRS and decreasing total brain volume, independent of diagnosis status (R2 = 0.008, Beta = -0.09, p = 0.029), was observed. This did not survive correction for multiple testing. In conclusion, our study yielded only suggestive evidence that risk variants interacting with MIR137 impacts on cortical structure.

The anatomy of abdominal flap phalloplasty for transgender surgery.

Abdominal flap phalloplasty is surgical construction of a neophallus using a pedicled abdominal flap for patients transitioning female to male, for males whose penis is congenitally absent, or lost from trauma. It is an option for trans men whose goals do not require urethroplasty or vaginectomy but would like a phallus suitable for male gender appearance. A prosthesis can be placed for penetrative sexual capability. Surgical text descriptions were enhanced by creation of new anatomic illustrations. Anatomy of donor site and surgical technique leading to creation of the neophallus are demonstrated in detail with new relevant illustrations. Significant structures of the donor site of the abdominal flap include the superficial external pudendal artery and ilioinguinal nerve that provide the blood supply and sensory innervation to the base of the flap, respectively. As a pedicled phalloplasty procedure, microsurgical anastomosis is not needed. Patients can expect to have tactile sensation but not innate rigidity. The dorsal nerve of clitoris (and sometimes the clitoris itself) is preserved to provide erogenous sensation. Abdominal flap phalloplasty makes it possible to maintain the natural blood supply and innervation to the neophallus. The neophallus created by abdominal flap phalloplasty has the advantage of homogeneous skin color and texture from contiguous skin. Grafting leaves a less stigmatizing horizontal scar running from one side of the pelvis to the other along the lower abdomen. The anatomy of the abdominal flap phalloplasty supports creation of a neophallus for transsexual anatomy revision. Clin. Anat. 31:181-186, 2018. © 2017 Wiley Periodicals, Inc.

Static and Dynamic Factors Promoting Resilience following Traumatic Brain Injury: A Brief Review.

Traumatic brain injury (TBI) is the greatest contributing cause of death and disability among children and young adults in the United States. The current paper briefly summarizes contemporary literature on factors that can improve outcomes (i.e., promote resilience) for children and adults following TBI. For the purpose of this paper, the authors divided these factors into static or unmodifiable factors (i.e., age, sex, intellectual abilities/education, and preinjury psychiatric history) and dynamic or modifiable factors (i.e., socioeconomic status, family functioning/social support, nutrition, and exercise). Drawing on human and animal studies, the research reviewed indicated that these various factors can improve outcomes in multiple domains of functioning (e.g., cognition, emotion regulation, health and wellness, behavior, etc.) following a TBI. However, many of these factors have not been studied across populations, have been limited to preclinical investigations, have been limited in their scope or follow-up, or have not involved a thorough evaluation of outcomes. Thus, although promising, continued research is vital in the area of factors promoting resilience following TBI in children and adults.

The clinical anatomy of the musculotendinous part of the diaphragm.

The thoracoabdominal diaphragm is a composite musculotendinous structure, separating the thoracic and abdominal cavities. Reemphasis of the already well-delineated variations of the muscular and tendinous portions, and blood and nerve supply of the diaphragm is becoming apparent. Scientific reports concerning reconstruction of the pericardium, activation of the muscle and the phrenic nerves by use of laparoscopically placed intramuscular electrodes, and repair of congenital and traumatic hernias reemphasize the importance of the muscular to tendinous relationships. The objective of this study, therefore, was to measure the ratio of the surface area of the tendinous central region to the muscular region of the diaphragm and provide a clear description across various specimens. We classified diaphragmatic measurements from 104 adult human diaphragms into six classes (I-VI) based on the ratio of surface area between its tendinous and muscular components. The majority of specimens, 56.7%, was attributed to class II and indicated a tendon-to-muscle ratio of between 10 and 15%; however, a small number of specimens indicated a very large tendon area at the expense of muscle bulk. Future research should be geared toward assessing the relationship between surface area of the musculature and its motor points with focus on interventions for herniation repair and recovery. Our results have shown that surgical interventions should be tailored to the individual, as diaphragm size may not necessarily predict tendon-to-muscle ratio.

The cutaneous bacterium Janthinobacterium lividum inhibits the growth of Trichophyton rubrum in vitro.

BACKGROUND: Tinea pedis (athlete's foot) is a fungal infection that is both widespread and challenging to treat. Standard treatments consist of topical and systemic therapies of antifungal agents, such as miconazole, itraconazole, and terbinafine. The extended nature of topical therapy and the toxicity of long-term systemic therapy limit the utility of current treatments. An alternate approach relies on an understanding of bacterial-fungal interactions. Specifically, a probiotic antifungal bacterium such as Janthinobacterium lividum can counter infection; Janthinobacterium is a major constituent of the human skin microbiota. Janthinobacterium lividum has been shown to ameliorate the effects of the cutaneous fungal disease chytridiomycosis in a vertebrate species (Rana muscosa). METHODS: Dual-culture plate challenge assays were performed using J. lividum and Trichophyton rubrum, the leading cause of athlete's foot. RESULTS: In all cases, T. rubrum colonies grew significantly smaller when co-cultured with J. lividum. CONCLUSION: These in vitro results suggest that J. lividum merits further investigation as a human cutaneous probiotic.

Interactions between amphibians' symbiotic bacteria cause the production of emergent anti-fungal metabolites.

Amphibians possess beneficial skin bacteria that protect against the disease chytridiomycosis by producing secondary metabolites that inhibit the pathogen Batrachochytrium dendrobatidis (Bd). Metabolite production may be a mechanism of competition between bacterial species that results in host protection as a by-product. We expect that some co-cultures of bacterial species or strains will result in greater Bd inhibition than mono-cultures. To test this, we cultured four bacterial isolates (Bacillus sp., Janthinobacterium sp., Pseudomonas sp. and Chitinophaga arvensicola) from red-backed salamanders (Plethodon cinereus) and cultured isolates both alone and together to collect their cell-free supernatants (CFS). We challenged Bd with CFSs from four bacterial species in varying combinations. This resulted in three experimental treatments: (1) CFSs of single isolates; (2) combined CFSs of two isolates; and (3) CFSs from co-cultures. Pair-wise combinations of four bacterial isolates CFSs were assayed against Bd and revealed additive Bd inhibition in 42.2% of trials, synergistic inhibition in 42.2% and no effect in 16.6% of trials. When bacteria isolates were grown in co-cultures, complete Bd inhibition was generally observed, and synergistic inhibition occurred in four out of six trials. A metabolite profile of the most potent co-culture, Bacillus sp. and Chitinophaga arvensicola, was determined with LC-MS and compared with the profiles of each isolate in mono-culture. Emergent metabolites appearing in the co-culture were inhibitory to Bd, and the most potent inhibitor was identified as tryptophol. Thus mono-cultures of bacteria cultured from red-backed salamanders interacted synergistically and additively to inhibit Bd, and such bacteria produced emergent metabolites when cultured together, with even greater pathogen inhibition. Knowledge of how bacterial species interact to inhibit Bd can be used to select probiotics to provide amphibians with protection against Bd.

Dysfunctional beliefs and attitudes about sleep in children.

The objective of the study was to determine whether associations between dysfunctional beliefs and attitudes about sleep and sleep disturbance are evident in children. Cross-sectional data were collected from 123 children aged 8-10 years (49% boys). The participants came from ethnically diverse backgrounds from two inner-city schools in London, UK. Children completed the Sleep Self-Report (SSR) and the Dysfunctional Beliefs and Attitudes about Sleep (DBAS) questionnaire (which was adapted for use with children). Parents completed the Child Sleep Habits Questionnaire (CSHQ). The total DBAS score was associated with sleep disturbances defined as total SSR score (beta = 0.40, P < 0.001, r(2) = 0.15), the SSR insomnia items (beta = 0.29, P < 0.01, r(2) = 0.08) and the total CSHQ score (beta = 0.22, P < 0.05, r(2) = 0.04). Some dysfunctional beliefs about sleep predicted sleep disturbance to a greater extent than others. For example, when controlling for the other DBAS subscales, the 'control and predictability of sleep' subscale, but not the 'sleep requirements expectations' subscale, predicted total SSR score and SSR insomnia items. Given this preliminary evidence that dysfunctional beliefs and attitudes about sleep appear to be associated with sleep difficulties in children, future work is needed to further developmentally adapt a version of the DBAS appropriate for use with children.

Detection of feline herpesvirus 1 DNA in skin biopsy specimens from cats with or without dermatitis.

OBJECTIVE: To compare detection rates of feline herpesvirus 1 (FHV-1) DNA in skin biopsy specimens from cats with herpetic dermatitis, cats with nonherpetic dermatitis, and cats without dermatitis. DESIGN: Prevalence survey. Animals-5 cats (9 biopsy specimens) with herpetic ulcerative dermatitis, 14 cats (17 biopsy specimens) with nonherpetic ulcerative dermatitis, and 8 cats (21 biopsy specimens) without clinically apparent skin lesions. PROCEDURES: A single-phase PCR assay was used to detect FHV-1 DNA in biopsy specimens. Assay results were compared with results of histologic examination. RESULTS: FHV-1 DNA was detected in all 9 biopsy specimens from the 5 cats with herpetic dermatitis and in 1 of 17 biopsy specimens from the 14 cats with nonherpetic dermatitis, but was not detected in any of the 21 biopsy specimens from the 8 cats without dermatitis. When results of histologic examination were used as the gold standard, sensitivity and specificity of the PCR assay were 100% and 95%, respectively. CONCLUSIONS AND CLINICAL RELEVANCE: Results confirmed that FHV-1 DNA can be detected in the skin of cats with herpetic dermatitis and suggest that the virus may play a causative role in the disease. In addition, the PCR assay may be useful in confirming a diagnosis of herpetic dermatitis.

The ketogenic diet: a review of the experience at Connecticut Children's Medical Center.

We undertook a retrospective analysis of epilepsy patients referred and treated for more than 6 months with the ketogenic diet during 1994-1999 at Connecticut Children's Medical Center. Outcome measures included antiepileptic drug number, seizure frequency, electroencephalogram background/paroxysmal activity, and adverse effects at 6 months and 1 year on the ketogenic diet. The final cohort included 24 of 48 referred patients (mean age, 6.5 years; range = 1-15 years of age). The etiology of epilepsy was equally divided between idiopathic and cryptogenic epilepsy and symptomatic epilepsy. Intention to treat analysis revealed that 35% (17 of 48) achieved more than 50% reduction in seizure frequency, and 8.5% (four of 48) were seizure-free by 6 months. A sustained 50% or greater reduction at 1 year was observed in 23% (11 of 48), and the same 8.5% (four of 48) remained seizure-free. None of these improvements were statistically related to age (P = 0.97), sex (P = 0.78), or epilepsy etiology (P = 0.80). The number of antiepileptic drugs used per patient decreased. Electroencephalogram at 1 year demonstrated an improvement in background in 31% (five of 16 patients) and a reduction in paroxysmal features in 37.5% (6 of 16 patients). Most adverse effects were mild, self-limited, and occurred early. Hyperuricemia (more than 6 mg/dL) was more persistent in three patients.