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OBJECTIVE: Because of the small numbers of thoracic outlet syndrome (TOS) patients treated with bilateral first rib resection and scalenectomy (FRRS), this patient subset has not been well studied. We examined a large cohort of TOS patients who underwent bilateral FRRS to evaluate patient characteristics and outcomes. METHODS: Patients treated with bilateral FRRS at Johns Hopkins Medical Institutions from 2003 to 2012 were identified by review of a prospectively maintained database. Statistical analysis compared patients with unilateral and bilateral FRRS and bilateral patients with different TOS indications. RESULTS: Fifty-three patients underwent bilateral FRRS with a mean follow-up of 11.4 months. Average time between operations was 17.0 months (range, 5.1-59.8 months). Compared with 408 unilateral FRRS patients, bilateral patients were younger (30 vs 35 years; P = .012), with no significant difference in gender. Among patients with dual-sided FRRS, 25 (47%) had bilateral neurogenic symptoms, 2 (4%) had bilateral arterial symptoms, and 26 (49%) had venous symptoms with the first side due to intermittent compression in 5 (second side: four, intermittent compression; one, neurogenic) and effort thrombosis in 21 (second side: 9, effort thrombosis; 8, intermittent compression; 4, neurogenic). Ten patients had prophylactic FRRS to prevent contralateral venous or arterial thrombosis, and eight had cervical ribs. Compared with neurogenic patients, venous patients were younger (25 vs 35 years; P < .001), with a trend toward more competitive athletes (seven venous vs two neurogenic). Symptomatic restenosis requiring dilation occurred after four FRRS for venous symptoms at a mean of 32.4 months, and rethrombosis occurred after four FRRS at a mean of 4 weeks (one treated with warfarin, three with tissue plasminogen activator), all on the primary side. Overall, 88% of FRRS for symptomatic TOS led to resolved symptoms at last follow-up. CONCLUSIONS: Bilateral FRRS is an effective method for treatment of TOS. Venous bilateral patients more often are younger, are competitive athletes, and require close postoperative monitoring for recurrent stenosis and thrombosis.
Assuntos
Angioplastia com Balão , Músculos do Pescoço/cirurgia , Costelas/cirurgia , Síndrome do Desfiladeiro Torácico/cirurgia , Trombose/tratamento farmacológico , Adolescente , Adulto , Fatores Etários , Idoso , Anticoagulantes/uso terapêutico , Criança , Constrição Patológica/etiologia , Constrição Patológica/terapia , Feminino , Fibrinolíticos/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Artéria Subclávia , Veia Subclávia , Síndrome do Desfiladeiro Torácico/complicações , Trombose/etiologia , Ativador de Plasminogênio Tecidual/uso terapêutico , Resultado do Tratamento , Varfarina/uso terapêutico , Adulto JovemRESUMO
Research suggests that people can accurately predict the political affiliations of others using only information extracted from the face. It is less clear from this research, however, what particular facial physiological processes or features communicate such information. Using a model of emotion developed in psychology that treats emotional expressivity as an individual-level trait, this article provides a theoretical account of why emotional expressivity may provide reliable signals of political orientation, and it tests the theory in four empirical studies. We find statistically significant liberal/conservative differences in self-reported emotional expressivity, in facial emotional expressivity measured physiologically, in the perceived emotional expressivity and ideology of political elites, and in an experiment that finds that more emotionally expressive faces are perceived as more liberal.
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BACKGROUND: Three-dimensional printing technology has been advancing in surgical applications. This systematic review examines its patient-specific applications in craniomaxillofacial surgery. METHODS: Terms related to "three-dimensional printing" and "surgery" were searched on PubMed on May 4, 2015; 313 unique articles were returned. Inclusion and exclusion criteria concentrated on patient-specific surgical applications, yielding 141 full-text articles, of which 33 craniomaxillofacial articles were analyzed. RESULTS: Thirty-three articles included 315 patients who underwent three-dimensional printing-assisted operations. The most common modeling software was Mimics, the most common printing software was 3D Systems, the average time to create a printed object was 18.9 hours (range, 1.5 to 96 hours), and the average cost of a printed object was $1353.31 (range, $69.75 to $5500). Surgical procedures were divided among 203 craniofacial patients (205 three-dimensional printing objects) and 112 maxillofacial patients (137 objects). Printing technologies could be classified as contour models, guides, splints, and implants. For craniofacial patients, 173 contour models (84 percent), 13 guides (6 percent), two splints (1 percent), and 17 implants (8 percent) were made. For maxillofacial patients, 41 contour models (30 percent), 48 guides (35 percent), 40 splints (29 percent), and eight implants (6 percent) were made. These distributions were significantly different (p < 0.0001). Four studies compared three-dimensional printing techniques to conventional techniques; two of them found that three-dimensional printing produced improved outcomes. CONCLUSIONS: Three-dimensional printing technology in craniomaxillofacial surgery can be classified into contour models (type I), guides (type II), splints (type III), and implants (type IV). These four methods vary in their use between craniofacial and maxillofacial surgery, reflecting their different goals. This understanding may help advance and predict three-dimensional printing applications for other types of plastic surgery and beyond.
Assuntos
Procedimentos Cirúrgicos Bucais/classificação , Procedimentos Cirúrgicos Bucais/métodos , Planejamento de Assistência ao Paciente , Impressão Tridimensional , Cirurgia Assistida por Computador , Humanos , Próteses e ImplantesRESUMO
We report evidence that individual-level variation in people's physiological and attentional responses to aversive and appetitive stimuli are correlated with broad political orientations. Specifically, we find that greater orientation to aversive stimuli tends to be associated with right-of-centre and greater orientation to appetitive (pleasing) stimuli with left-of-centre political inclinations. These findings are consistent with recent evidence that political views are connected to physiological predispositions but are unique in incorporating findings on variation in directed attention that make it possible to understand additional aspects of the link between the physiological and the political.