Dissociation and emotion regulation in borderline personality disorder.

BACKGROUND: Although some evidence suggests that borderline personality disorder (BPD) is primarily a disorder of the emotion regulation system, findings remain inconsistent. One potential explanation for this is the moderating role of dissociation. METHOD: In this study, 33 female subjects with BPD and 26 healthy controls (HC; matched by education level and nicotine intake) were presented idiographic aversive, standard unpleasant and neutral scripts. Modulation of startle reflex and electrodermal responses (skin conductance level; SCL) were measured during imagery of emotional and neutral scripts. Additionally, self-reports of emotional experience (valence and arousal) and present-state dissociation were assessed. RESULTS: Patients with BPD showed elevated levels of dissociative experiences during testing. Present-state dissociation mediated group differences in SCL and startle response between the HC and BPD groups. CONCLUSIONS: These results suggest that careful attention must be paid to the moderating effect of dissociative symptoms on the psychophysiological responses of BPD patients. Furthermore, the findings have important implications for the assessment and treatment of BPD, including the need to carefully assess BPD patients for dissociative symptoms and to incorporate the treatment of dissociation.

Targeted bisulfite sequencing: A novel tool for the assessment of DNA methylation with high sensitivity and increased coverage.

DNA methylation analysis is increasingly used in stress research. Available methods are expensive, laborious and often limited by either the analysis of short CpG stretches or low assay sensitivity. Here, we present a cost-efficient next generation sequencing-based strategy for the simultaneous investigation of multiple candidate genes in large cohorts. To illustrate the method, we present analysis of four candidate genes commonly assessed in psychoneuroendocrine research: Glucocorticoid receptor (NR3C1), Serotonin transporter (SLC6A4), FKBP Prolyl isomerase 5 (FKBP5), and the Oxytocin receptor (OXTR). DNA methylation standards (100 %; 75 %; 50 %; 25 % and 0 %) and DNA of a female and male donor were bisulfite treated in three independent trials and were used to generate sequencing libraries for 42 CpGs from the NR3C1 1 F promoter region, 84 CpGs of the SLC6A4 5' regulatory region, 5 CpGs located in FKBP5 intron 7, and additional 12 CpGs located in a potential enhancer element in intron 3 of the OXTR. In addition, DNA of 45 patients with borderline personality disorder (BPD) and 45 healthy controls was assayed. Multiplex libraries of all samples were sequenced on a MiSeq system and analyzed for mean methylation values of all CpG sites using amplikyzer2 software. Results indicated excellent accuracy of the assays when investigating replicates generated from the same bisulfite converted DNA, and very high linearity (R2 > 0.9) of the assays shown by the analysis of differentially methylated DNA standards. Comparing DNA methylation between BPD and healthy controls revealed no biologically relevant differences. The technical approach as described here facilitates targeted DNA methylation analysis and represents a highly sensitive, cost-efficient and high throughput tool to close the gap between coverage and precision in epigenetic research of stress-associated phenotypes.

Total knee arthroplasty after distal femoral osteotomy long-term survivorship and clinical outcomes.

AIMS: There is little literature about total knee arthroplasty (TKA) after distal femoral osteotomy (DFO). Consequently, the purpose of this study was to analyze the outcomes of TKA after DFO, with particular emphasis on: survivorship free from aseptic loosening, revision, or any re-operation; complications; radiological results; and clinical outcome. PATIENTS AND METHODS: We retrospectively reviewed 29 patients (17 women, 12 men) from our total joint registry who had undergone 31 cemented TKAs after a DFO between 2000 and 2012. Their mean age at TKA was 51 years (22 to 76) and their mean body mass index 32 kg/m2 (20 to 45). The mean time between DFO and TKA was ten years (2 to 20). The mean follow-up from TKA was ten years (2 to 16). The prostheses were posterior-stabilized in 77%, varus-valgus constraint (VVC) in 13%, and cruciate-retaining in 10%. While no patient had metaphyseal fixation (e.g. cones or sleeves), 16% needed a femoral stem. RESULTS: The ten-year survivorship was 95% with aseptic loosening as the endpoint, 88% with revision for any reason as the endpoint, and 81% with re-operation for any reason as the endpoint. Three TKAs were revised for instability (n = 2) and aseptic tibial loosening (n = 1). No femoral component was revised for aseptic loosening. Patients under the age of 50 years were at greater risk of revision for any reason (hazard ratio 7; p = 0.03). There were two additional re-operations (6%) and four complications (13%), including three manipulations under anaesthetic (MUA; 10%). The Knee Society scores improved from a mean of 50 preoperatively (32 to 68) to a mean of 93 postoperatively (76 to 100; p < 0.001). CONCLUSION: A cemented posterior-stabilized TKA has an 88% ten-year survivorship with revision for any reason as the endpoint. No femoral component was revised for aseptic loosening. Patients under the age of 50 years have a greater risk of revision. The clinical outcome was significantly improved but balancing the knee was challenging in 13% of TKAs requiring VVC. Overall, 10% of TKAs needed an MUA, and 6% of TKAs were revised for instability. Cite this article: Bone Joint J 2019;101-B:660-666.

[Free graft of a portion of the pinna with additional skin flap for filling-in defects of the nose]. / Svobodnaia peresadka chasti ushnoi rakoviny s dopolnitel'nym kozhnym loskutom pri zameshchenii iz"ianov nosa.

The authors are convinced that for a successful use of part of the auricle floor for the replacement of penetrating nose defects a complete dissection of scarry tissue around the defect is necessary. The authors propose to use part of the auricle floor with an additional skin flap dissected from its internal surface and mastoid area. The proposed method gave good results in the treatment of 4 patients with defects of the nose. The operations were successful due to its exact plan, care of the tissues and correct performing of all steps of the operation.

[Principles of treating congenital cleft lip and palate]. / Printsipy lecheniia bol'nykh s vrozhdennymi rasshchelinami guby i neba.

Six months is believed to be optimal age for primary chiloplasty; the most effective method is a combined chiloplasty after Mirault---Limberg---Obukhova---Anamenski resulting in primary union in 99% of cases. In cleft palate the operation is possible at the age of 6--7 years. The article describes specific features of the surgical treatment of clefts involving part of the hard palate, complete uni- and bilateral cleft palate and alveolar processes of maxilla.

[Fractures of the apex of the orbit in injuries of facial bones]. / Perelomy vershiny glaznitsy pri povrezhdeniiakh kostei litsa.

Thirty patients with fractures of the apex of the orbit were examined by clinical and x-ray methods. The types of fractures of facial skull bones were specified, which were aggravated by the patients state, as was the type of injuries to osseous structures participating in the formation of the orbital apex. A purposeful x-ray examination of the orbital apex in patients with injuries to facial bones helps to rule out undervaluation of the severity of injury which can be assessed only on the basis of clinical signs. Use of a modified panoramic sonography for examination of the apex of the orbit in accordance with the standard program of Sonark device for the examination of orbital nerve canals helps assess the nature of injuries to bone structures in this area.