Identifying the nature of episodic memory deficits in Major Depressive Disorder using a Real-World What-Where-When task.

ABSTRACTDeficits in episodic memory have been reported in various psychiatric conditions, including Major Depressive Disorder (MDD). Many widely used episodic memory tests do not have the ability to distinguish between impaired memory of separate components of a real-life event (e.g., what happened, where it happened and when), and impaired binding of such real-life features. To address this issue, a naturalistic, real-world What-Where-When memory task was employed to assess the nature of episodic memory impairments in MDD. A validation study established that the task is sensitive to age-related episodic memory changes, and that intentional encoding does not invalidate the task. The main study then compared the performance of patients with depression and control participants on the intentionally encoded WWW task. Patients with MDD presented an overall episodic memory impairment arising from deficits in object memory and the ability to bind objects to temporal context. Taken together, our study confirms the episodic memory impairment in MDD, by providing evidence of deficient object memory and reduced ability to bind temporal context to objects in patients. Our naturalistic WWW task presents a promising approach for thorough identification of the nature of episodic memory impairments, under a real-world environment, in various conditions, including MDD.

En bloc resection of lacrimal sac tumors and simultaneous orbital reconstruction: surgical and functional outcomes.

PURPOSE: To describe a surgical technique of en bloc resection of lacrimal sac tumors by the shared expertise of 2 specialists to achieve optimal tumor margin clearance and the simultaneous reconstruction of the bony defect to preserve ocular functions and cosmesis. METHODS: All patients who had resection of malignant nasolacrimal drainage system tumors using the combined technique and posttreatment protocol between 1997 and 2011 were studied in this retrospective, noncomparative, interventional case series. A combined medial maxillectomy and medial orbitotomy for en bloc resection of the lacrimal sac tumor was followed by reconstruction with a tailored contoured titanium mesh to support the globe and eyelid. Disease relapse, disease survival, ocular functions (vision loss, motility, globe dystopia, and diplopia), and cosmesis (medial canthal tendon dystopia and eyelid retraction) were documented. RESULTS: Fourteen patients with malignant lacrimal sac tumors underwent en bloc resection. Postoperative radiation was ultimately administered to 9 patients. All patients but one were alive at last follow up. Tumor recurred locally in 2 patients with a regional recurrence in a third patient. Complications from radiation therapy included skin breakdown over the mesh (9/14 patients) with nasocutaneous fistula, medial canthal tendon dystopia (2/14 patients), and corneal perforation in a patient with recurrent disease. Despite removal of the tear drainage system, only 7 of 14 patients reported epiphora. None of the patients developed diplopia after resection and radiation therapy. CONCLUSIONS: The combined sinus-orbit approach is an effective method of managing lacrimal sac tumors to achieve optimal tumor clearance from the orbit and nasal cavity. Simultaneous reconstruction of the bony defect with a contoured titanium mesh provides a fixation anchor for the medial canthal tendon and globe support and serves as a supporting platform for the lower eyelid and cheek to minimize midface collapse. Postoperative radiation is associated with skin flap breakdown and nasocutaneous fistula formation.

Analysis of Facial Implants for Bacterial Biofilm Formation Using Scanning Electron Microscopy.

IMPORTANCE: Alloplastic implants are widely used in facial plastic surgery, both in rhinoplasty and nonrhinoplasty procedures. Implant infection and extrusion are significant concerns of such implants after placement. Bacterial biofilms have been previously implicated in chronic wound infections, particularly in the presence of foreign bodies, such as alloplastic facial implants. Owing to their structural composition, biofilms are resistant to treatment with conventional antibiotics, and implant removal is frequently the only option. OBJECTIVE: To evaluate explanted alloplastic facial implants for the presence or absence of bacterial biofilm using scanning electron microscopy. DESIGN, SETTING, AND PARTICIPANTS: Facial implants explanted by a single surgeon were analyzed for biofilm formation between July 1, 2012, and June 30, 2013. Of 7 facial implants, 4 consisted of silicone, and 3 were porous polyethylene. Six of the 7 were nasal dorsal implants, and 1 silicone implant was removed from the midface. Nonexplanted fresh silicone and porous polyethylene implants were each used as a control. MAIN OUTCOMES AND MEASURES: Scanning electron microscopy images were analyzed by an electron microscopist masked to the clinical history and implant type. The presence of biofilm formation was graded as none, mild, moderate, or severe. RESULTS: A total of 7 patients with previously placed alloplastic facial implants at an outside institution underwent revision rhinoplasty and removal of facial implants. All porous polyethylene implants showed biofilm formation to various degrees. Furthermore, all porous polyethylene implants had at least some areas of severe biofilm formation. One of the 3 porous polyethylene implants demonstrated severe biofilm formation on the entire implant, and the other 2 porous polyethylene implants showed areas of mild and severe biofilm formation. The only 2 implants without any evidence of biofilm were silicone implants. Of the other 2 silicone implants, 1 demonstrated no biofilm formation in 1 area and severe biofilm formation in another area, whereas the other had areas of moderate and severe biofilm formation. CONCLUSIONS AND RELEVANCE: Five of 7 explanted facial implants showed at least some degree of biofilm formation. All implants with rougher surfaces, namely, porous polyethylene implants, demonstrated biofilm formation to a severe degree. Those with smoother surfaces, namely, silicone implants, were the only ones on which biofilm formation was either absent or less severe. Therefore, the suspicion that biofilms can form on facial implants is established through this investigation. LEVEL OF EVIDENCE: NA.

Mixed oviposition in individual females of Gryllus firmus: Graded proportions of fast-developing and diapause eggs.

Eggs of field crickets (Gryllus spp.) held at 25±1°C hatch in 2-4 weeks ("fast-developing" eggs) or 5-28 weeks (diapause eggs). Most species lay but one type: at least 10 species lay only fast-developing eggs, and pennsylvanicus and ovisopis lay only diapause eggs. Gryllus firmus from Gainesville, Florida, lays both types, and individual females do so for as long as 8 weeks. The proportion of diapause eggs laid weekly by captive females exposed to outdoor photoperiods and temperatures varies seasonally from <5% (March-June) to ca. 50% (November-December). At outdoor temperatures in late fall some eggs that are presumptively fast-developing (at 25° C) enter diapause.Some firmus from Carolina Beach, North Carolina, lay both diapause and fast-developing eggs. Outdoor rearing experiments established that spring adults could result from fast-developing eggs of fall adults, refuting the hypothesis that spring and fall adults at that locality represent temporally isolated demes.High variance in hatching times for eggs laid by one female is appropriate to the unpredictable extremes of moisture and temperature that occur in the open, sandy habitats of G. firmus. Physiological mechanisms of the mixed oviposition and specific environmental determinants of the varying proportions are unknown.

Comparison and overview of currently available neurotoxins.

BACKGROUND: Botulinum toxin has been in use since the 1970s. Over the last few years, the indications for botulinum toxin use have extended for cosmetic and noncosmetic applications. Three preparations of botulinum toxin type A and one preparation of botulinum toxin type B are commercially available and approved for use in the United States by the United States Food and Drug Administration. OBJECTIVE: To review the most recent literature on all commercially available botulinum toxins in the United States, their indications, Food and Drug Administration approvals, and handling (reconstitution, storage, and dilution). METHODS: A literature review (not Cochrane type analysis) using several databases (PubMed, MEDLINE, textbooks, Food and Drug Administration homepage, and manufacturer information) was performed. CONCLUSION: Several different preparations of botulinum toxins exist worldwide, none of which are identical or interchangeable. Manufacturer recommendations on all available botulinum neurotoxins advise the use of unpreserved saline for reconstitution. Side effects are mostly mild and always self-limited. More serious complications are associated with higher doses, improper injection techniques, and occur in patients with underlying comorbidities.

Effect of coblation polypectomy on estimated blood loss in endoscopic sinus surgery.

BACKGROUND: We conducted a pilot study comparing estimated blood loss (EBL) using coblation-assisted endoscopic sinus surgery (CAESS) where coblation is used to debulk nasal polyps before microdebridement with a traditional microdebrider technique in chronic rhinosinusitis (CRS) patients with sinonasal polyps undergoing endoscopic sinus surgery (ESS). METHODS: A retrospective analysis was performed at a tertiary care center on patients with nasal polyposis undergoing ESS between January 2008 and July 2008. The University of Miami CT staging system was used preoperatively to evaluate the extent of sinonasal disease. The duration of surgery, blood loss per minute, total EBL, and demographic data were collected. RESULTS: Twenty-one patients underwent nasal polypectomy/ESS using CAESS and 16 patients underwent nasal polypectomy/ESS using microdebridement. The two groups had comparable University of Miami CT staging scores (p>0.05). The average EBL was 307.1+/-169.8 mL using coblation compared with 627.8+/-424.2 mL using microdebridement (p<0.05). The average duration of surgery using coblation was 116.2+/-41.7 minutes, compared with 125.3+/-48.4 minutes using microdebridement (p>0.05). The average blood loss per minute was 2.8+/-1.7 mL in the coblation group compared with 4.8+/-2.1 mL in the microdebridement group (p<0.05). Subgroup analyses showed a significant decrease in average EBL and EBL/minute to be only significant for revision cases (p<0.05) and not for primary cases (p>0.05). CONCLUSION: Coblation-assisted nasal polypectomy/ESS is associated with a statistically significant lower EBL and blood loss per minute when compared with traditional microdebridement technique. Coblation represents a new device that can reduce blood loss in patients with nasal polyposis undergoing traditional revision ESS. Further prospective randomized trials are needed to validate these findings.