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To evaluate the effectiveness and safety of a Hasner's valve incision performed under endoscopic intranasal surgery for the management of congenital nasolacrimal duct obstruction.
This retrospective study comprised 484 patients with congenital nasolacrimal duct obstruction who underwent incision of Hasner's valve under endoscopic intranasal surgery between April 2000 and October 2016. The primary endpoint was the procedure's functional success rate. The secondary endpoints were Hasner's valve and inferior turbinate anatomical findings, demographic data, complication rate and surgical duration.
In patients with no medical history of nasolacrimal duct probing, 91 per cent had a successful result, 5 per cent had a partially successful result, 3.9 per cent showed no change and 0.1 per cent had a worse result following the procedure. Concerning the secondary endpoints, outcomes were more frequently successful in children younger than three years. Only one patient had a post-operative infection. All patients underwent general anaesthesia; no complications related to general anaesthesia were observed. Mean surgical duration was 13.1 ± 5.7 minutes.
Incising Hasner's valve after medially displacing the inferior turbinate under nasal endoscopy seems to be an adequate primary surgical treatment for congenital nasolacrimal duct obstruction.
Iraq and Afghanistan Veterans with posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) history have high rates of performance validity test (PVT) failure. The study aimed to determine whether those with scores in the invalid versus valid range on PVTs show similar benefit from psychotherapy and if psychotherapy improves PVT performance.
Veterans (N = 100) with PTSD, mild-to-moderate TBI history, and cognitive complaints underwent neuropsychological testing at baseline, post-treatment, and 3-month post-treatment. Veterans were randomly assigned to cognitive processing therapy (CPT) or a novel hybrid intervention integrating CPT with TBI psychoeducation and cognitive rehabilitation strategies from Cognitive Symptom Management and Rehabilitation Therapy (CogSMART). Performance below standard cutoffs on any PVT trial across three different PVT measures was considered invalid (PVT-Fail), whereas performance above cutoffs on all measures was considered valid (PVT-Pass).
Although both PVT groups exhibited clinically significant improvement in PTSD symptoms, the PVT-Pass group demonstrated greater symptom reduction than the PVT-Fail group. Measures of post-concussive and depressive symptoms improved to a similar degree across groups. Treatment condition did not moderate these results. Rate of valid test performance increased from baseline to follow-up across conditions, with a stronger effect in the SMART-CPT compared to CPT condition.
Both PVT groups experienced improved psychological symptoms following treatment. Veterans who failed PVTs at baseline demonstrated better test engagement following treatment, resulting in higher rates of valid PVTs at follow-up. Veterans with invalid PVTs should be enrolled in trauma-focused treatment and may benefit from neuropsychological assessment after, rather than before, treatment.
Environmental factors such as sunshine hours, temperature and UV radiation (UVR) are known to influence seasonal fluctuations in vitamin D concentrations. However, currently there is poor understanding regarding the environmental factors or individual characteristics that best predict neonatal 25-hydroxyvitamin D (25(OH)D) concentrations. The aims of this study were to (1) identify environmental and individual determinants of 25(OH)D concentrations in newborns and (2) investigate whether environmental factors and individual characteristics could be used as proxy measures for neonatal 25(OH)D concentrations. 25-Hydroxyvitamin D3 (25(OH)D3) was measured from neonatal dried blood spots (DBS) of 1182 individuals born between 1993 and 2002. Monthly aggregated data on daily number of sunshine hours, temperature and UVR, available from 1993, were retrieved from the Danish Meteorological Institute. The individual predictors were obtained from the Danish National Birth register, and Statistics Denmark. The optimal model to predict 25(OH)D3 concentrations from neonatal DBS was the one including the following variables: UVR, temperature, maternal education, maternal smoking during pregnancy, gestational age at birth and parity. This model explained 30 % of the variation of 25(OH)D3 in the neonatal DBS. Ambient UVR in the month before the birth month was the best single-item predictor of neonatal 25(OH)D3, accounting for 24 % of its variance. Although this prediction model cannot substitute for actual blood measurements, it might prove useful in cohort studies ranking individuals in groups according to 25(OH)D3 status.
The exposure of adult, female, Mediterranean goats during anoestrus to males with induced sexual activity via photostimulation, induces a very high percentage of ovulations. The present work examines the ability of photostimulated bucks to improve the male effect-induced reproductive response of young does over that induced by non-stimulated bucks. A 2×2 factorial experiment was designed, consisting of doe age and buck photoperiod treatments. During seasonal anoestrus, 41 does aged 7 (n=19) or 10 (n=22) months were subjected to the male effect on 10 April; half of each group was exposed to males rendered sexually active by prior exposure to 3 months of long days (16 h of light/day) from 31 October (PHOTO bucks), and half to males maintained under the natural photoperiod (CONTROL bucks). Oestrous activity was recorded daily by direct visual observation of the marks left by male-worn marking harnesses over the 32 days following the bringing of the sexes together (introduction). Doe body weight and body condition were determined weekly. Ovulation was detected by measuring plasma progesterone concentrations twice per week over the 3 weeks after introduction. The ovulation rate was assessed by transrectal ultrasonography. Fecundity, fertility, prolificacy and productivity were also determined. The interaction doe age × buck photoperiod treatment had no effect on any outcome. The percentage of females showing ovulation or oestrus was higher in the does exposed to PHOTO bucks (85% v. 43% for those exposed to CONTROL bucks) they also showed higher fertility (75% v. 43%) and productivity (1.05±0.17 v. 0.57±0.16 kids born per doe serviced) (all P values at least P<0.05). The 10-month-old group showed higher percentage of females showing ovulation, oestrus, fertility and productivity than the 7-month-old does after the male effect (females showing ovulation: 82% v. 42%; showing oestrus: 73% v. 42%; fertility: 73% v. 42% and productivity: 1.09±0.17 v. 0.47±0.14 goat kids born per doe serviced; respectively, all P values at least P<0.05). The present results show that the use of photostimulated males improves the reproductive performance of 7- and 10-month-old does, and may contribute towards increasing their productivity and lifetime reproductive performance.
Objectives: Suicidal ideation (SI) is highly prevalent in Iraq/Afghanistan-era veterans with a history of mild traumatic brain injury (mTBI), and multiple mTBIs impart even greater risk for poorer neuropsychological functioning and suicidality. However, little is known about the cognitive mechanisms that may confer increased risk of suicidality in this population. Thus, we examined relationships between neuropsychological functioning and suicidality and specifically whether lifetime mTBI burden would moderate relationships between cognitive functioning and suicidal ideation. Methods: Iraq/Afghanistan-era Veterans with a history of mTBI seeking outpatient services (N = 282) completed a clinical neuropsychological assessment and psychiatric and postconcussive symptom questionnaires. Results: Individuals who endorsed SI reported more severe post-traumatic stress disorder (PTSD), depression, and postconcussive symptoms and exhibited significantly worse memory performance compared to those who denied SI. Furthermore, mTBI burden interacted with both attention/processing speed and memory, such that poorer performance in these domains was associated with greater likelihood of SI in individuals with a history of three or more mTBIs. The pattern of results remained consistent when controlling for PTSD, depression, and postconcussive symptoms. Conclusions: Slowed processing speed and/or memory difficulties may make it challenging to access and use past experiences to solve current problems and imagine future outcomes, leading to increases in hopelessness and SI in veterans with three or more mTBIs. Results have the potential to better inform treatment decisions for veterans with history of multiple mTBIs. (JINS, 2019, 25, 79–89)
This anthology surveys the ecological impacts of the First World War. Editors Richard P. Tucker, Tait Keller, J. R. McNeill, and Martin Schmidt bring together a list of experienced authors who explore the global interactions of states, armies, civilians, and the environment during the war. They show how the First World War ushered in enormous environmental changes, including the devastation of rural and urban environments, the consumption of strategic natural resources such as metals and petroleum, the impact of war on urban industry, and the disruption of agricultural landscapes leading to widespread famine. Taking a global perspective, Environmental Histories of the First World War presents the ecological consequences of the vast destructive power of the new weaponry and the close collaboration between militaries and civilian governments taking place during this time, showing how this war set trends for the rest of the century.