A novel Fontan Y-graft for interrupted inferior vena cava and azygos continuation

OBJECTIVES To evaluate the hemodynamicdynamic advantage of a new Fontan surgical template that is intended for complex single-ventricle patients with interrupted inferior vena cava-azygos and hemi-azygos continuation. The new technique has emerged from a comprehensive pre-surgical simulation campaign conducted to facilitate a balanced hepatic flow and somatic Fontan pathway growth after Kawashima procedure. METHODS For 9 patients, aged 2 to18 years, majority having poor preoperative oxygen saturation, a pre-surgical computational fluid dynamics customization is conducted. Both the traditional Fontan pathways and the proposed novel Y-graft templates are considered. Numerical model was validated against in vivo phase-contrast magnetic resonance imaging data and in vitro experiments. RESULTS The proposed template is selected and executed for 6 out of the 9 patients based on its predicted superior hemodynamic performance. Pre-surgical simulations performed for this cohort indicated that flow from the hepatic veins (HEP) do not reach to the desired lung. The novel Y-graft template, customized via a right- or left-sided displacement of the total cavopulmonary connection anastomosis location resulted a drastic increase in HEP flow to the desired lung. Orientation of HEP to azygos direct shunt is found to be important as it can alter the flow pattern from 38% in the caudally located direct shunt to 3% in the cranial configuration with significantly reversed flow. The postoperative measurements prove that oxygen saturation increased significantly (P-value = 0.00009) to normal levels in 1 year follow-up. CONCLUSIONS The new Y-graft template, if customized for the individual patient, is a viable alternative to the traditional surgical pathways. This template addresses the competing hemodynamic design factors of low physiological venous pressure, high postoperative oxygen saturation, low energy loss and balanced hepatic growth factor distribution possibly assuring adequate lung development. Date and number of IRB approval 25 October 2019, 280011928-604.01.01

Serum brain-derived neurotrophic factor: Determinants and relationship with depressive symptoms in a community population of middle-aged and elderly people

OBJECTIVES: Brain-derived neurotrophic factor (BDNF) is involved in major depressive disorder and neurodegenerative diseases. Clinical studies, showing decreased serum BDNF levels, are difficult to interpret due to limited knowledge of potential confounders and mixed results for age and sex effects. We explored potential determinants of serum BDNF levels in a community sample of 1230 subjects. METHODS: Multiple linear regression analyses with serum BDNF level as the dependent variable were conducted to explore the effect of four categories of potential BDNF determinants (sampling characteristics, sociodemographic variables, lifestyle factors and somatic diseases) and of self-reported depressive symptoms (Beck's Depression Inventory (BDI). RESULTS: Our results show that BDNF levels decline with age in women, whereas in men levels remain stable. Moreover, after controlling for age and gender, the assays still showed lower serum BDNF levels with higher BDI sum scores. Effects remained significant after correction for two main confounders (time of sampling and smoking), suggesting that they serve as molecular trait factors independent of lifestyle factors. CONCLUSIONS: Given the age-sex interaction on serum BDNF levels and the known association between BDNF and gonadal hormones, research is warranted to delineate the effects of the latter interaction on the risk of psychiatric and neurodegenerative diseases

Placebo-controlled evaluation of direct electrical current administration for palmoplantar hyperhidrosis

Background Direct electrical current (d.c.) administration based on tap water iontophoresis has been used as a therapeutic option for palmoplantar hyperhidrosis. The placebo effect of this technique has not been investigated adequately

the last 10-year period

Background Scientific productivity is closely related to gross income, population, and cultures of the countries. Every country, more or less, has a responsibility of contributing to science. Materials and methods The publications, citations received, and the h-index under the category of dermatology in 43 journals between the years of 19992003 and 20042008 according to the ISI JCR data of 2008 were examined individually for each OECD country. Results In the journals under the category of dermatology between the years of 1999 and 2008, there were 89,319 publications, 76,899 of which were published by OECD countries. USA ranks first with 27,109 publications and 196,002 citations; Germany, Japan, England, and France are the other countries among the top five, respectively. Regarding the number of publications, Turkey and Korea are among the top 10 by surpassing many Northern European countries. With regard to h-index and citations, Northern European countries and Canada rank among the top 10, while Japan, Spain, Turkey, and Korea rank behind. The number of publications showed a significant correlation with the number of citations, population, gross domestic product, and h-index. Conclusions Nearly half of all publications were performed by the European origin OECD countries, and one-third of all publications were performed by USA. Journals from Germany and France, which are published in their own language, receive fewer citations, but they contribute a lot to these countries with respect to the number of publications

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Dissociative identity disorder presenting as dermatitis artefacta

Dermatitis artefacta is a rare psychiatric condition characterized by rubbing of skin blisters and denial of self-infliction. Dissociation may be comorbid with self-injurious behavior. A background of emotional disturbances during formative years and in later life often results in feelings of isolation and insecurity, which can lead to dissociation as a primary defense mechanism used to overcome traumatic events. In this case report, we describe a female patient with dermatitis artefacta associated with dissociative identity disorder. The patient was a 14-year-old girl. Multiple large, deep ulcerations with unnatural shapes were seen on her left forearm. The ulcerations were thought to be self-inflicted. Psychiatric examination revealed that she had a different identity, and inflicted the lesions when this was assumed. This case leads us to suggest that patients with dermatitis artefacta might have comorbid dissociative experiences, which cannot be identified easily