Anatomic and histomorphometric study of the nerve to the vastus lateralis in cadaver for its clinical application in facial reanimation.

BACKGROUND: The innervated vastus lateralis flap (IVLF) is a barely used possibility for facial palsy reconstruction because of its thickness compared to the gracilis, latissimus dorsi, and pectoralis minor flaps. The aim of this study is to perform a precise description of the intramuscular distribution of the nerve motor branches and its relationship with the vascular pedicle in order to harvest a segmental muscle flap with the best contractile strength to restore facial reanimation. METHODS: The study was performed on 16 adult cadaver thighs identifying the vastus lateralis muscle and the distribution and relationships of its neurovascular pedicle and branches. We evaluated where the nerve pierced the muscle and the course of the nerve within it. Transverse segments of the nerve were obtained from the proximal and distal ends of the nerve and stained using anti-ChAT (Choline acetyltransferase) antibodies which are specific of motor neurons. RESULTS: A nerve for the vastus lateralis from the posterior division of the femoral nerve divided into 2 branches in 56% of cases; the principal branch coursed along the vascular pedicle and pierced the muscle more proximally than the respective vessels, and a minor branch that pierced the muscle 25-60 mm proximally. There were 3 main intramuscular branches. The nerve length (mean 132.65 ± 22.89 mm) allowed to reach the contralateral side of the face in almost all cases (95%). The mean ChAT positive fibers was 351.0 ± 92.4/mm2 at the proximal end, and 270.3 ± 87.9/mm2 at the distal end (p = 0.49). The number of ChAT negative fibers was higher than ChAT positive in both proximal and distal ends of the nerve. CONCLUSION: We propose the IVLF as a one-step surgical flap for facial paralysis reanimation due to the constant neurovascular pattern and lengthy pedicle. The amount of motor fibers in several segments of the nerve is appropriate to produce a powerful contraction for dynamic reconstruction.

Ocular findings in a Spanish cohort of myotonic dystrophy type 1.

PURPOSE: Myotonic dystrophy type 1 is the most common muscular dystrophy in adulthood, caused by a triplet repeat in chromosome 19q13.3. The present study investigates the frequency of the different ocular alterations in Spanish patients with DM1 and its relationship with the severity of the genetic alteration. METHODS: Cross-sectional and multicenter study was conducted on patients with genetically confirmed DM1. Ophthalmologic examinations included visual acuity assessment, manifest refraction, slit-lamp biomicroscopy, tonometry, ocular motility, corneal tomography, and macular and optic nerve optical coherence tomography. RESULTS: A total of 42 patients (84 eyes) were included. Mean age was 46.9 ± 13.4 (SD) years, and 57.1% were women. Fifteen patients had undergone cataract surgery in at least one eye (35.7%), and 13 (30.9%) had significant cataract. Mean intraocular pressure (IOP) was 10.5 ± 2.9 mmHg, and mean central corneal thickness (CCT) was 580.04 ± 48.61 µm. Half of the patients had significant ptosis, and 8 patients (9.75%) had undergone eyelid surgery. Macular abnormalities included retinal pigment epithelium alterations in 8 eyes of 6 patients, epiretinal membrane in 3 eyes, and lamellar hole in 2 eyes. A moderate correlation was found between IOP and ptosis with the number of triplet repeats. CONCLUSION: Early cataract onset, low IOP, thicker CCT, and ptosis were the most significant manifestations of DM in our sample. Correlation found between IOP and ptosis with CTG repeat could be interesting in order to improve diagnosis and medical care of these patients but should be confirmed in further studies.

Trends in cardiovascular care in the National Health System in Spain. Data from the RECALCAR project 2011-2020.

INTRODUCTION AND OBJECTIVES: The RECALCAR project (Resources and Quality in Cardiology), an initiative of the Spanish Society of Cardiology, aims to standardize information to generate evidence on cardiovascular health outcomes. The objective of this study was to analyze trends in the resources and activity of cardiology units and/or services and to identify the results of cardiovascular care during the last decade in Spain. METHODS: The study was based on the 2 annual data sources of the RECALCAR project: a survey on resources and activity of cardiology units and/or services (2011-2020) and the minimum data set of the National Health System (2011-2019), referring to heart failure (HF), STEMI, and non-STEMI. RESULTS: The survey included 70% of cardiology units and/or services in Spain. The number of hospital beds and length of stay decreased, while there was a notable increase in the number of cardiac imaging studies and percutaneous therapeutic procedures performed. Age- and sex-adjusted admissions for HF tended to decrease, despite an increase in mortality and the percentage of readmissions. In contrast, the trend in mortality and readmissions was highly favorable in STEMI; in non-STEMI, although positive, the trend was less marked. CONCLUSIONS: The information provided by the RECALCAR project shows a favorable trend in the last decade in resources, activity and results of certain cardiovascular processes and constitutes an essential source for future improvements and decision-making in health policy.

Climate change and environmental health in undergraduate health degrees in Latin America.

OBJECTIVE: Analyze the incorporation of climate change and environmental health courses in the curriculum grids of Medicine, Nursing, Nutrition and Clinical Psychology undergraduate courses in Latin American universities. METHODS: Descriptive and cross-sectional document review. Curriculum grids of the top ten Latin American universities were analyzed according to the rankings of QS Latin American University 2020, Times Higher Education World University 2020 and Academic Ranking of World Universities 2019. The presence of courses related to climate change and environmental health was sought in each curriculum grid. RESULTS: 104 of the 161 universities included in the study offered Medicine courses, 93 Nursing courses, 77 Nutrition courses and 118 Clinical Psychology courses. Most of the curriculum grids incorporated courses in public health and/or epidemiology (more than 70%); however, between 22% and 41% included courses on environmental health, and only one curriculum grid had a course on climate change in Medicine and Nursing (1%). CONCLUSIONS: Courses on climate change and environmental health have been scarcely introduced in the curriculum grids of the health field in Latin American universities. This could weaken the important role that health professionals play in providing health care to the population.

The addition of a conjunctival flap to a posterior lamella auricular cartilage graft: A technique to avoid corneal complications.

PURPOSE: To present the benefits of the addition of a conjunctival flap when correcting lower eyelid retraction using an auricular cartilage graft. METHODS: An auricular cartilage graft was obtained either from the concha o the scaphoid fossa. When preparing the receiving bed, the conjunctival incision was made 2 mm below the inferior margin of the lower eyelid tarsus, therefore, a conjunctival flap arising from the inferior border of the tarsus was obtained. The cartilage graft was placed in the lower eyelid. The inferior border of the graft was sutured to the retractors and conjunctiva using absorbable sutures. The superior border was sutured to the inferior tarsus, so that de conjunctival flap covered the superior portion of the graft. RESULTS: Fourteen patients underwent the surgical technique. No corneal complications were observed in the early or late postoperative period. Donor site complications were not encountered. CONCLUSIONS: The confection of a conjunctival flap that lines the superior portion of an auricular cartilage graft in the lower eyelid provides protection against corneal postoperative complications until the graft is epithelized.

Comparing "Individual Health" Message Framing to "Organizational Efficiency" Message Framing to Encourage Adoption of Wearable Health Technologies at Work.

PURPOSE: To determine the relative impact of framing on employee intention to adopt wearable technology (eg, Fitbits) at work. SETTING AND DESIGN: Posttest only online experiment utilizing a 2 (framing: organizational efficiency vs individual health) × 2 (financial incentive: absent vs present) between-subjects design. PARTICIPANTS: Participants (N = 310) were 18 years or older, currently employed, and residing in the United States. MEASURES: Unified Theory of Acceptance and Use of Technology (UTAUT) subscale on behavioral intent (modified for wearable technology). ANALYSIS: Chi-square and between-subjects analysis of variance. RESULTS: Participants receiving the organizational efficiency frame (M = 3.97) expressed significantly lower intention to adopt a wearable compared to the individual health frame (M = 4.37), F2,308 = 3.99, P = .047. Financial incentives had a positive effect on adoption intention (M = 4.39 with incentive, M = 3.95 no incentive), F2,308 = 4.46, P = .036. The main effects of frame and incentive were additive, with participants in the individual health with incentive condition (n = 78, M = 4.60) expressing the highest intention to adopt and organizational efficiency without incentive expressing the lowest adoption intention (n = 77, M = 3.80; P = .03). CONCLUSIONS: Messaging emphasizing individual health benefits plus financial incentives might prove most successful when encouraging adoption of wearables at work.

Frontalis Suspension Using Autologous Fascia Lata in Children Under 3 Years Old.

PURPOSE: To analyze functional results and complications of the use of autologous fascia lata in frontalis suspension in children under 3 years old and to confirm its technical viability. METHODS: A retrospective review of 8 patients (12 eyes) who underwent frontalis suspension using autologous fascia lata sling. RESULTS: Twelve eyes of 8 patients were analyzed, with an average age of 1.8 ± 0.6 years. Preoperatively, the mean margin-to-reflex distance 1 was -0.17 ± 0.577 mm. Postoperatively the mean margin-to-reflex distance 1 was 2.66 ± 0.492 mm without any graft donor site or corneal complications. No recurrence was recorded in the follow-up period (mean follow-up period 28.5 ± 32.33 months). CONCLUSIONS: Autologous fascia lata is an eligible material in frontalis suspension in children under 3 years old, despite the traditional oculoplastic dogma that advises against.

Climate change and environmental health in undergraduate health degrees in Latin America / Cambio climático y salud ambiental en carreras de salud de grado en Latinoamérica

ABSTRACT OBJECTIVE: Analyze the incorporation of climate change and environmental health courses in the curriculum grids of Medicine, Nursing, Nutrition and Clinical Psychology undergraduate courses in Latin American universities. METHODS: Descriptive and cross-sectional document review. Curriculum grids of the top ten Latin American universities were analyzed according to the rankings of QS Latin American University 2020, Times Higher Education World University 2020 and Academic Ranking of World Universities 2019. The presence of courses related to climate change and environmental health was sought in each curriculum grid. RESULTS: 104 of the 161 universities included in the study offered Medicine courses, 93 Nursing courses, 77 Nutrition courses and 118 Clinical Psychology courses. Most of the curriculum grids incorporated courses in public health and/or epidemiology (more than 70%); however, between 22% and 41% included courses on environmental health, and only one curriculum grid had a course on climate change in Medicine and Nursing (1%). CONCLUSIONS: Courses on climate change and environmental health have been scarcely introduced in the curriculum grids of the health field in Latin American universities. This could weaken the important role that health professionals play in providing health care to the population.

RESUMEN OBJETIVO: Analizar la incorporación de cursos de cambio climático y salud ambiental en las mallas curriculares del grado en Medicina, Enfermería, Nutrición y Psicología clínica en universidades latinoamericanas. MÉTODOS: Revisión documental de tipo descriptiva y transversal. Se analizaron las mallas curriculares de las diez primeras universidades latinoamericanas según los rankings QS Latin American University 2020, Times Higher Education World University 2020 y Academic Ranking of World Universities 2019. En cada malla curricular se buscó la presencia de cursos relacionados al cambio climático y la salud ambiental. RESULTADOS: De las 161 universidades que se incluyeron en el estudio, 104 ofrecían la carrera de Medicina, 93 de Enfermería, 77 de Nutrición y 118 de Psicología clínica. La mayor parte de las mallas curriculares incorporaron cursos de salud pública y/o epidemiología (más del 70%), sin embargo, entre el 22% y el 41% incluyeron cursos de salud ambiental, y solo una malla curricular tuvo un curso en cambio climático en Medicina y Enfermería (1%). CONCLUSIONES: Los cursos de cambio climático y salud ambiental han sido introducidos, de forma escasa, en las mallas curriculares del campo de la salud en universidades latinoamericanas. Esto podría debilitar el importante rol que cumplen los profesionales de la salud en la asistencia sanitaria a la población.

What are the barriers, facilitators and interventions targeting help-seeking behaviours for common mental health problems in adolescents? A systematic review.

BACKGROUND: Increasing rates of mental health problems among adolescents are of concern. Teens who are most in need of mental health attention are reluctant to seek help. A better understanding of the help-seeking in this population is needed to overcome this gap. METHODS: Five databases were searched to identify the principal barriers, facilitators and interventions targeting help-seeking for common mental health problems in adolescents aged 10-19 years. The search was performed in June 2018 and updated in April 2019. Two independent screening processes were made using the eligibility criteria. Quality assessment of each study was performed, and findings summarised using a narrative synthesis. RESULTS: Ninety studies meet the inclusion criteria for this review for barrier and facilitators (n = 54) and interventions (n = 36). Stigma and negative beliefs towards mental health services and professionals were the most cited barriers. Facilitators included previous positive experience with health services and mental health literacy. Most interventions were based on psychoeducation, which focused on general mental health knowledge, suicide and self-harm, stigma and depression. Other types of interventions included the use of multimedia and online tools, peer training and outreach initiatives. Overall, the quality of studies was low to medium and there was no general agreement regarding help-seeking definition and measurements. CONCLUSION: Most of the interventions took place in an educational setting however, it is important to consider adolescents outside the educational system. Encouraging help-seeking should come with the increased availability of mental health support for all adolescents in need, but this is still a major challenge for Child and Adolescent Mental Health Services. There is also a need to develop shared definitions, theoretical frameworks and higher methodological standards in research regarding help-seeking behaviours in adolescents. This will allow more consistency and generalisability of findings, improving the development of help-seeking interventions and ensuring timely access to mental health treatments.

Puncture Versus Surgical Cutdown Complications of Transfemoral Aortic Valve Implantation (from the Spanish TAVI Registry).

Vascular complications in transcatheter aortic valve implantation using transfemoral approach are related to higher mortality. Complete percutaneous approach is currently the preferred technique for vascular access. However, some centers still perform surgical cutdown. Our purpose was to determine complications related to vascular access technique in the population of the Spanish TAVI National Registry. From January 2010 to July 2015, 3,046 patients were included in this Registry. Of them, 2,465 underwent transfemoral approach and were treated with either surgical cutdown and closure (cutdown group, n = 632) or percutaneous approach (puncture group, n = 1,833). Valve Academic Research Consortium-2 definitions were used to assess vascular and bleeding complications. Propensity matching resulted in 615 matched pairs. Overall, 30-day vascular complications were significantly higher in the puncture group (109 [18%] vs 42 [6.9%]; relative risk [RR] 2.60; 95% confidence interval [CI] 1.85 to 3.64, p <0.001) due mostly by minor vascular events (89 [15%] vs 25 [4.1%], RR 3.56, 95% CI 2.32 to 5.47, p <0.001). Bleeding rates were lower in the puncture group (18 [3%] vs 40 [6.6%], RR 0.45, 95% CI 0.26 to 0.78, p = 0.003) mainly driven by major bleeding (9 [1.5%] vs 21 [3.4%], RR 0.43, 95% CI 0.20 to 0.93, p = 0.03). At a mean follow-up of 323 days, complication rates remained significantly different between groups (minor vascular complications 90 [15%] vs 31 [5.1%], hazard ratio 2.99, 95% CI 1.99 to 4.50, p <0.001 and major bleeding 10 [1.6%] vs 21 [3.4%], hazard ratio 0.47, 95% CI 0.22 to 1.0, p = 0.04, puncture versus cutdown group, respectively). In conclusion, percutaneous approach yielded higher rates of minor vascular complications but lower rates of major bleeding compared with the surgical cutdown, both at 30-day and at mid-term follow-up in our population.

Outcomes of Estrogen Receptor Negative and Progesterone Receptor Positive Breast Cancer.

PURPOSE: To describe the clinical features and outcomes of estrogen receptor negative (ER-) and progesterone receptor positive (PgR+) breast cancer. METHODS: We retrospectively reviewed a well-characterized database of sequential patients diagnosed with early stage invasive breast carcinoma. Outcomes of interest were time to relapse (TTR) and overall survival (OS). Multivariable Cox proportional hazards analysis was conducted to assess the association of ER-/PgR+ with TTR and OS in comparison to ER+ and to ER- and PgR negative (ER-/PgR-) tumors irrespective of HER2 status. ER and PgR expression was conservatively defined as 10% or greater staining of cancer cells. RESULTS: 815 patients were followed for a median of 40.5 months; 56 patients (7%) had ER-/PgR+, 624 (77%) had ER+ and 136 (17%) had ER-/PgR- phenotypes. Compared with ER+ tumors, ER-/PgR+ tumors were associated with younger age (50 versus 59 years, p=0.03), high grade (50% versus 24%, p<0.001) and more frequent HER2 overexpression/amplification (43% versus 14%, p<0.001). TTR for ER-/PgR+ was intermediate between ER+ and ER-/PgR- tumors, but was not significantly different from ER+ tumors. Recurrences in the ER-/PgR+ and ER-/PgR- groups occurred early in follow-up while in ER+ tumors recurrences continued to occur over the duration of follow-up. OS of ER-/PgR+ was similar to ER+ tumors and better than that of ER-/PgR- tumors. CONCLUSIONS: The ER-/PgR+ phenotype is associated with higher grade with HER2 overexpression/amplification and occurs more commonly in younger women. Risk of relapse and death more closely resembles ER+ than ER-/PgR- tumors suggesting this phenotype represents a group of more aggressive hormone receptor positive tumors.

The Caenorhabditis elegans iodotyrosine deiodinase ortholog SUP-18 functions through a conserved channel SC-box to regulate the muscle two-pore domain potassium channel SUP-9.

Loss-of-function mutations in the Caenorhabditis elegans gene sup-18 suppress the defects in muscle contraction conferred by a gain-of-function mutation in SUP-10, a presumptive regulatory subunit of the SUP-9 two-pore domain K(+) channel associated with muscle membranes. We cloned sup-18 and found that it encodes the C. elegans ortholog of mammalian iodotyrosine deiodinase (IYD), an NADH oxidase/flavin reductase that functions in iodine recycling and is important for the biosynthesis of thyroid hormones that regulate metabolism. The FMN-binding site of mammalian IYD is conserved in SUP-18, which appears to require catalytic activity to function. Genetic analyses suggest that SUP-10 can function with SUP-18 to activate SUP-9 through a pathway that is independent of the presumptive SUP-9 regulatory subunit UNC-93. We identified a novel evolutionarily conserved serine-cysteine-rich region in the C-terminal cytoplasmic domain of SUP-9 required for its specific activation by SUP-10 and SUP-18 but not by UNC-93. Since two-pore domain K(+) channels regulate the resting membrane potentials of numerous cell types, we suggest that the SUP-18 IYD regulates the activity of the SUP-9 channel using NADH as a coenzyme and thus couples the metabolic state of muscle cells to muscle membrane excitability.

Impact of depression on the intensity of patient navigation for women with abnormal cancer screenings.

Patient navigation is increasingly being used to support vulnerable patients to receive timely and quality medical care. We sought to understand whether patients with depression utilize additional patient navigation services after abnormal cancer screening. We compared depressed and non-depressed women using three different measures of intensity of patient navigation: number of patient-navigator encounters, encounter time, and number of unique barriers to care. The study population consisted of 1,455 women who received navigation after abnormal screening for breast or cervical cancer at one of six community health centers in Boston. Navigators spent a median of 60-75 minutes over one or two encounters per participant, with 49% of participants having one or more documented barrier to care. Depressed women did not differ in total numbers of encounters, encounter time, or unique barriers compared with non-depressed women. Our findings suggest that pre-existing depression does not predict which women will utilize additional navigation services.

Evaluation of a constant rate infusion of lidocaine for balanced anesthesia in dogs undergoing surgery.

This study assessed the intraoperative analgesic effects of intravenous lidocaine administered by a constant rate infusion (CRI) in surgical canine patients. A prospective, blinded, randomized study was designed with 2 treatment groups: A (lidocaine) and B (placebo), involving 41 dogs. All patients were premedicated with acepromazine and buprenorphine, induced with propofol and midazolam; anesthesia was maintained with isoflurane in oxygen. Group A received 2 mg/kg IV lidocaine immediately after induction, followed within 5 min by a CRI at 50 µg/kg/min. Group B received an equivalent volume of saline instead of lidocaine. Changes in heart rate and blood pressure during maintenance were treated by increasing CRI. Fentanyl was used as a supplemental analgesic when intraoperative nociceptive response was not controlled with the maximum dose of lidocaine infusion. There was a significantly lower use of supplemental intraoperative analgesia in the lidocaine than in the placebo group. Group B dogs had almost twice as high a risk of intraoperative nociceptive response as group A dogs.

Left atrial appendage-occluding devices for stroke prevention in patients with nonvalvular atrial fibrillation.

Atrial fibrillation is associated with a fivefold increased risk for stroke, mostly secondary to thromboembolic events. Anticoagulation with a vitamin K antagonist is the standard medical therapy for these patients but is difficult to maintain within the therapeutic range and requires frequent monitoring and dose adjustments. Approximately 90% of thromboembolism occurs in the left atrial appendage (LAA) in patients with nonvalvular atrial fibrillation. Occlusion of flow into the LAA may prevent thrombus formation in the appendage and, hence, reduction of stroke. Recently, several percutaneous transcatheter techniques of LAA exclusion using the Percutaneous Left Atrial Appendage Transcatheter Occlusion device, the WATCHMAN device, and AMPLATZER septal occluder and cardiac plug have been employed, with encouraging results. Occlusion of the LAA may be an alternative to vitamin K antagonist therapy for selected patients.

Research and development of a new RF-assisted device for bloodless rapid transection of the liver: computational modeling and in vivo experiments.

BACKGROUND: Efficient and safe transection of biological tissue in liver surgery is strongly dependent on the ability to address both parenchymal division and hemostasis simultaneously. In addition to the conventional clamp crushing or finger fracture methods other techniques based on radiofrequency (RF) currents have been extensively employed to reduce intraoperative blood loss. In this paper we present our broad research plan for a new RF-assisted device for bloodless, rapid resection of the liver. METHODS: Our research plan includes computer modeling and in vivo studies. Computer modeling was based on the Finite Element Method (FEM) and allowed us to estimate the distribution of electrical power deposited in the tissue, along with assessing the effect of the characteristics of the device on the temperature profiles. Studies based on in vivo pig liver models provided a comparison of the performance of the new device with other techniques (saline-linked technology) currently employed in clinical practice. Finally, the plan includes a pilot clinical trial, in which both the new device and the accessory equipment are seen to comply with all safety requirements. RESULTS: The FEM results showed a high electrical gradient around the tip of the blade, responsible for the maximal increase of temperature at that point, where temperature reached 100 degrees C in only 3.85 s. Other hot points with lower temperatures were located at the proximal edge of the device. Additional simulations with an electrically insulated blade produced more uniform and larger lesions (assessed as the 55 degrees C isotherm) than the electrically conducting blade. The in vivo study, in turn, showed greater transection speed (3 +/- 0 and 3 +/- 1 cm2/min for the new device in the open and laparoscopic approaches respectively) and also lower blood loss (70 +/- 74 and 26 +/- 34 mL) during transection of the liver, as compared to saline-linked technology (2 +/- 1 cm2/min with P = 0.002, and 527 +/- 273 mL with P = 0.001). CONCLUSION: A new RF-assisted device for bloodless, rapid liver resection was designed, built and tested. The results demonstrate the potential advantages of this device over others currently employed.