Selective filtering of excitatory inputs to nucleus accumbens by dopamine and serotonin.

The detailed mechanisms by which dopamine (DA) and serotonin (5-HT) act in the nucleus accumbens (NAc) to influence motivated behaviors in distinct ways remain largely unknown. Here, we examined whether DA and 5-HT selectively modulate excitatory synaptic transmission in NAc medium spiny neurons in an input-specific manner. DA reduced excitatory postsynaptic currents (EPSCs) generated by paraventricular thalamus (PVT) inputs but not by ventral hippocampus (vHip), basolateral amygdala (BLA), or medial prefrontal cortex (mPFC) inputs. In contrast, 5-HT reduced EPSCs generated by inputs from all areas except the mPFC. Release of endogenous DA and 5-HT by methamphetamine (METH) and (±)3,4-methylenedioxymethamphetamine (MDMA), respectively, recapitulated these input-specific synaptic effects. Optogenetic inhibition of PVT inputs enhanced cocaine-conditioned place preference, whereas mPFC input inhibition reduced the enhancement of sociability elicited by MDMA. These findings suggest that the distinct, input-specific filtering of excitatory inputs in the NAc by DA and 5-HT contribute to their discrete behavioral effects.

Comparison of Nasal Analysis by Photographs (2D) against Low-cost Surface Laser Imaging (3D) and against Computed Axial Tomography Imaging.

Introduction In aesthetic surgery, we have a few evaluation tools that numerically and objectively measure the changes we make in patients. This article aimed to evaluate the nasal systematic analysis and compare findings between the three systems of nasal evaluation: photographs 2D, 3D surface imaging with the Kinect system, and 3D CT scan imaging. Methods We designed a longitudinal and descriptive prospective study with simple non-blind randomization. To compare the systematic nasal analysis between the three methods. If the findings are similar, all three methods would be useful in independent clinical scenarios. Results A total of 42 observations were included finding a minimum age of 21 with a mean of 28 years old. Also, 64% were female, 93% had adequate facial proportions, and 50% were Fitzpatrick III. For outcome statistics, we found differential nasal deviation between 3D images with a mean of 6.53 mm. While when comparing the nasal dorsum length, we found a statistical significance of p = 0.051. When comparing the nasal dorsum length index, we found no significant difference p = 0.32. Also, we did not find statistical significance when comparing the nasofrontal angle and tip rotation angle p = 1 for both. Conclusion We found that the population we serve has characteristics of Hispanic mestizo nose. The three methods seem to evaluate systematic nasal analysis in a very similar way, and any of them can be used depending on the scenario and the needs of plastic surgeons.

The influence of vector-borne disease on human history: socio-ecological mechanisms.

Vector-borne diseases (VBDs) are embedded within complex socio-ecological systems. While research has traditionally focused on the direct effects of VBDs on human morbidity and mortality, it is increasingly clear that their impacts are much more pervasive. VBDs are dynamically linked to feedbacks between environmental conditions, vector ecology, disease burden, and societal responses that drive transmission. As a result, VBDs have had profound influence on human history. Mechanisms include: (1) killing or debilitating large numbers of people, with demographic and population-level impacts; (2) differentially affecting populations based on prior history of disease exposure, immunity, and resistance; (3) being weaponised to promote or justify hierarchies of power, colonialism, racism, classism and sexism; (4) catalysing changes in ideas, institutions, infrastructure, technologies and social practices in efforts to control disease outbreaks; and (5) changing human relationships with the land and environment. We use historical and archaeological evidence interpreted through an ecological lens to illustrate how VBDs have shaped society and culture, focusing on case studies from four pertinent VBDs: plague, malaria, yellow fever and trypanosomiasis. By comparing across diseases, time periods and geographies, we highlight the enormous scope and variety of mechanisms by which VBDs have influenced human history.

Cognitive impairment in multiple sclerosis: diagnosis and monitoring.

INTRODUCTION: Cognitive impairment (CI) has a prevalence of 45-70% in people with multiple sclerosis (MS), producing a negative impact on their quality of life, personal life, and work. Early detection of CI has become an important aspect to be considered for an adequate follow-up, to optimize social adaptation and to implement specific cognitive rehabilitation strategies. The aim of this work is to propose a suitable cognitive evaluation of patients with MS based on available and efficient tools for diagnosis and monitoring purposes well supported by literature review and clinical experience. METHODS: A multidisciplinary panel of professionals from the field of neurology, neuropsychology, and neuroimaging performed a literature review of the topic of cognitive impairment assessment. This was combined and completed with their clinical experience to produce a set of recommendations. RESULTS: Some limitations to cognitive evaluation are described: shortage of time and resources during the neurology consultation, scarceness or absence of specialized professionals' availability, importance of tests adaptation, and doubts about its use to define therapeutic efficiency. We recommend a baseline and annual screening evaluation, and we suggest a baseline and periodic neuropsychological assessment. The latter ought to change to a recommendation with the presence of either positive screening test, or subjective to cognitive complaints, screening-test results and patient or family report mismatch, or in specific social/work situations. CONCLUSIONS: Cognitive evaluation should be performed on all patients diagnosed with MS and throughout follow-up. It is necessary to support the creation of multidisciplinary MS teams to optimize the evaluation and follow-up of MS patients.

Auricular Total Reconstruction with Radial Forearm Prelaminated Flap Assisted by 3D Surface Imaging and 3D Printing.

The anatomic position of the auricle leaves it vulnerable to traumatic lesions. In most cases, the best reconstructive outcome is accomplished using a temporoparietal flap with a costal cartilage frame and a partial thickness skin graft. Exceptional cases may require different approaches because the reconstructive goals could be more structural than aesthetic. An important factor in this regard is the mechanical properties of the skin that will provide coverage. This study aimed to share a particular case of total auricular reconstruction assisted by 3D surface imaging and 3D printing in a radial forearm free flap. We present a 58-year-old man with a history of having tympanic barotrauma causing hearing loss, burdening him with the use of auricular devices for hearing assistance. Seven days before presenting for the initial treatment, he sustained ear trauma while performing mechanical reparations in a car. The wheel was activated, causing a total amputation of the right ear. He first went to another hospital' where they performed primary closure and then referred him to our unit. The team performed a prelaminated radial forearm free flap assisted by 3D scanning and planning. A detailed comparison between the left ear and the result of the reconstruction was measured and described. The radial forearm prelaminated free flap is a viable structural alternative with the disadvantage of poor auricular definition in some cases.

Comparison of wire versus Nylon in Bonny-Mallet Finger treated with pull-out surgery.

INTRODUCTION: Zone I extensor tendon lesion accompanies an avulsion fracture of the bone insertion. A common complication of traditional pull-out is the necrosis of the site of the button in the finger pad. Zhang described an alternative way of anchoring the cerclage to the Kirschner Wire (K-wire) to relieve the pressure in the finger pad. He describes the use of wire cerclage, for fracture reduction. The objective of this paper is to perform a comparison between wire and nylon using Zhang pull-out technique. MATERIAL AND METHODS: We performed a cohort study comparing Nylon versus Wire in Zhang technique. Comparing cosmetic satisfaction, stiffness, residual pain, and Crawford scale. RESULTS: When comparing the outcomes between both groups, we found no statistical difference in cosmetic satisfaction (p = 0.285), stiffness (p = 0.460), and residual pain (p =1.000), overall complications (p = 1.000), or Crawford scale (p = 1.000). We only found a significant statistical difference in pain when removing the cerclage, being greater in Group B (p = 0.008). CONCLUSIONS: We found no significant outcome difference between nylon and wire cerclage. However, at the time of removing it, patients experience less pain.

INTRODUCCIÓN: Una complicación común del pull-put tradicional es la necrosis del sitio del botón en la yema del dedo. Zhang describió una forma alternativa de anclar el cerclaje al clavo de Kirschner para aliviar la presión en la yema del dedo. Describe el uso de cerclaje de alambre para la reducción de fracturas. El objetivo de este trabajo es realizar una comparación entre el alambre y el nailon utilizando la técnica de extracción de Zhang. MATERIAL Y MÉTODOS: Realizamos un estudio de cohorte comparando la técnica de nailon versus alambre en Zhang. Comparación de satisfacción cosmética, rigidez, dolor residual y escala de Crawford. RESULTADOS: Al comparar los resultados entre ambos grupos, no encontramos diferencias estadísticas en la satisfacción cosmética (p = 0.285), rigidez (p = 0.460) y dolor residual (p = 1.000), complicaciones generales (p = 1.000) o escala de Crawford (p = 1.000). Solo encontramos una diferencia estadística significativa en el dolor al retirar el cerclaje, siendo mayor en el Grupo B (p = 0.008). CONCLUSIONES: No encontramos diferencias significativas en los resultados entre el cerclaje de nailon y el cerclaje con alambre. Pero, al momento de retirarlo, los pacientes experimentan menos dolor. Tipo de estudio: terapéutico Nivel de evidencia III.

Influence of BMI, Age, and Gender on the Thickness of Most Common Thinned Flaps.

BACKGROUND: Since the description of superficial fascia flap harvesting, a new window of opportunity has been open in obese patients, where a higher subcutaneous thickness of tissue is present. To our knowledge, the impact of body mass index on superficial fascial flaps has not been reported. METHODS: We recruited 122 patients from April 2019 to January 2020. From these patients, the 3 most common thinned flaps were selected: the superficial circumflex iliac perforator flap; the anterolateral thigh flap at the perforator A, B, and C; and the thoracodorsal flap. Two vertical measures were registered: the distance from the skin to the superficial fascia, and from this point to the deep fascia. RESULTS: The average flap measurement presented here was within the range, as previous clinical studies. The superficial fatty layer thickness in the superficial circumflex iliac perforator and anterolateral thigh flap was somewhat similar in thickness between overweight and obese patients, showing a minimal increase with higher body mass index. The anterolateral thigh flap was found thicker among women, and no statistical difference was shown between age groups in any of the flaps. CONCLUSIONS: A better understanding of the fat layers' thickness will result in better planning, minimizing secondary debulking procedures, decreasing operative time, and reducing general complications among obese patients. Thus, a better understanding of flap structure and physiology in obese patients will lower complications and give more predictable results.