Internal cantholysis for full thickness eyelid defects

AbstractEyelid reconstruction requires an understanding of normal eyelid anatomy and function. A thorough understanding of the basic anatomy, contour, and mobility of the eyelids is essential in restoring the tissue to its presurgical level. There are many different surgical options to assist in the repair of full thickness eyelid defects involving the margin. Direct wound closure depends on eyelid laxity and is often possible with smaller defects. Moderate to larger sized defects are often under undue wound tension if direct closure is attempted. We have developed a new technique for closure of eyelid defects using a transconjunctival cantholysis to release the lateral canthal tendon cruces, thereby avoiding the external incision while still allowing for eyelid mobility. Using this technique for defects 15mm in horizontal eyelid margin length or greater, we have found positive results. Direct closure of eyelid defects represents the most straightforward technique to repair any full-thickness eyelid defect and provides maximal functional and cosmetic results. Internal cantholysis represents an excellent option for repairing smaller and even larger full thickness eyelid defects. Eyelid mobility increases by 4–10mm, sometimes more, and allows for closure of defects larger than even 20mm

Dysthyroid optic neuropathy: update on pathogenesis, diagnosis, and management

INTRODUCTION: Dysthyroid optic neuropathy (DON) is a severe manifestation of thyroid eye disease (TED) that can result in permanent vision loss. Management is complex, multidisciplinary, and involves medical and/or surgical therapies. This review describes current concepts in the epidemiology, pathophysiology, diagnosis, and treatment of DON. AREAS COVERED: An extensive review of the literature was performed to detail current concepts on the diagnosis and management of DON. This includes utilization of various medical and surgical modalities for disease management. EXPERT COMMENTARY: DON can result in permanent blindness and often requires the use of corticosteroids and surgical decompression. We favor the use of intravenous corticosteroids and a transcaruncular approach when surgical decompression is indicated. The use of orbital radiation for DON is often reserved for patients that are poor surgical candidates and/or patients with refractory disease

Suppression of field-induced spin density wave order in Sr_{3}Ru_{2}O_{7} with pressure

Measuring the resistivity of high-purity single crystals of Sr_{3}Ru_{2}O_{7} under pressure, we find strong evidence that the field-induced spin density wave phase at the H ∥ c metamagnetic transition is suppressed at a surprisingly low pressure of ∼ 3 ± 1 kbar. This offers the possibility of studying a bare quasi-two-dimensional spin density wave quantum critical point, testing the T → 0 K limit of theories of Planckian dissipation and quantum criticality. Preliminary attempts to fit ρ(T) with a quantum critical spin fluctuation model, while encouraging, reveal a need for further, complementary measurements

Attachment disorders diagnosed by community practitioners:a replication and extension

Background: While considered a rare diagnosis, reactive attachment disorder (RAD) is simultaneously the subject of considerable debate. A recent report suggested that RAD is overdiagnosed in community settings and that conduct problems may be used to make a diagnosis of RAD (Woolgar & Baldock, Child and Adolescent Mental Health, 20, 2015, 34–40). This study seeks to replicate and extend these findings. Method: Clinical assessment data from 100 consecutive admissions of maltreated foster and adopted children (ages 3–17) to a specialty treatment clinic in the United States were reviewed. Measures included semi-structured interviews of RAD and disinhibited social engagement disorder (DSED) symptoms and caregiver-report questionnaires of emotional problems, conduct problems, and the quality of the parent–child relationship. Results: Of the 100 cases reviewed, 39 presented with a diagnostic history of RAD, DSED, or ‘attachment disorder’. Of these cases, three were diagnosed in-clinic with DSED; no cases met diagnostic criteria for RAD according to DSM-5 criteria. However, analyses found that those diagnosed with RAD by community-based clinicians were significantly more likely to display conduct problems and to be adopted (as opposed to in foster care). Conclusions: These findings confirm those of Woolgar and Baldock (Child and Adolescent Mental Health, 20, 2015, 34–40). It appears that the diagnostic criteria of RAD are commonly being inaccurately applied in general community-based practice. Clarification of diagnostic criteria for RAD in recent revisions of diagnostic taxonomies, the accumulation of empirical data on RAD, and improved instrumentation are either poorly disseminated or inadequately implemented in community-based practice settings

Metamagnetic Quantum Criticality

A renormalization group treatment of metamagnetic quantum criticality in metals is presented. In clean systems the universality class is found to be of the overdamped, conserving (dynamical exponent z=3) Ising type. Detailed results are obtained for the field and temperature dependence of physical quantities including the differential susceptibility, resistivity and specific heat near the transition. An application of the theory is made to Sr3Ru2O7, which appears to exhibit a metamagnetic critical end-point at a very low temperature and a field of order 5-7T.Comment: 4 pages latex (Revtex 4) and 3 eps figure

Ultraviolet-Optical observations of the Seyfert 2 Galaxies NGC 7130, NGC 5135 and IC 3639: Implications for the Starburst-AGN Connection

We present and discuss HST (WFPC2 and FOC) images and UV GHRS spectra plus ground-based near UV through to near IR spectra of three Seyfert 2 nuclei (NGC 7130, NGC 5135 and IC 3639). These galaxies, together to Mrk 477, were selected from a bigger sample that comprises the 20 brightest Seyfert 2 nuclei, with the goal to study the origin of the UV-optical-near IR featureless continuum in Seyfert 2 nuclei. These four galaxies have bolometric luminosities, as computed with the four IRAS bands, of 10^11 Lsol. They are close enough to be resolved with HST the nuclear zone. This makes these Seyfert 2 galaxies benchmarks to study the Starburst-AGN connection in more distant galaxies. The data provide direct evidence of the existence of a central nuclear starburst that dominates the UV light, and that seem to be responsible for the origin of the so called featureless continuum. These starbursts are dusty and compact. They have sizes (from less than 100 pc to a few hundred pc) much smaller and closer to the nucleus than that seen in the prototype Seyfert 2 galaxy NGC 1068. The bolometric luminosity of these starbursts is similar to the estimated bolometric luminosities of their obscured Seyfert 1 nuclei, and thus they contribute in the same amount to the overall energetics of these galaxies.Comment: to be published in ApJ 505, September issue. The figures are in a tar files at: http://www.iaa.es/~rosa/Seyfert

Metamagnetic Quantum Criticality in Sr3Ru2O7

We consider the metamagnetic transition in the bilayer ruthenate, ${\rm Sr_3Ru_2O_7}$, and use this to motivate a renormalization group treatment of a zero-temperature quantum-critical end-point. We summarize the results of mean field theory and give a pedagogical derivation of the renormalization-group equations. These are then solved to yield numerical results for the susceptibility, the specific heat and the resistivity exponent which can be compared with measured data on ${\rm Sr_3Ru_2O_7}$ to provide a powerful test for the standard framework of metallic quantum criticality. The observed approach to the critical point is well-described by our theory explaining a number of unusual features of experimental data. The puzzling behaviour very near to the critical point itself, though, is not accounted for by this, or any other theory with a Fermi surface

The Microbiome of Temporal Arteries

Objective: A role for microorganisms in giant cell arteritis (GCA) has long been suspected. We describe the microbiomes of temporal arteries from patients with GCA and controls. Methods: Temporal artery biopsies from patients suspected to have GCA were collected under aseptic conditions and snap-frozen. Fluorescence in situ hybridization (FISH) and long-read 16S rRNA-gene sequencing was used to examine microbiomes of temporal arteries. Taxonomic classification of bacterial sequences was performed to the genus level and relative abundances were calculated. Microbiome differential abundances were analyzed by principal coordinate analysis (PCoA) with comparative Unifrac distances and predicted functional profiling using PICRUSt. Results : Forty-seven patients, including 9 with biopsy-positive GCA, 15 with biopsy-negative GCA and 23 controls without GCA, were enrolled. FISH for bacterial DNA revealed signal in the arterial media. Beta, but not alpha, diversity differed between GCA and control temporal arteries (P = 0.042). Importantly, there were no significant differences between biopsy-positive and biopsy-negative GCA (P > 0.99). The largest differential abundances seen between GCA and non-GCA temporal arteries included Proteobacteria (P), Bifidobacterium (g), Parasutterella (g) and Granulicatella (g) [Log 2-fold change > 4]. Conclusion: Temporal arteries are not sterile, but rather are inhabited by a community of bacteria. We have demonstrated that there are microbiomic differences between GCA and non-GCA temporal arteries, but not between biopsy-positive and biopsy-negative GCA

Parent-of-origin-specific allelic associations among 106 genomic loci for age at menarche.

Age at menarche is a marker of timing of puberty in females. It varies widely between individuals, is a heritable trait and is associated with risks for obesity, type 2 diabetes, cardiovascular disease, breast cancer and all-cause mortality. Studies of rare human disorders of puberty and animal models point to a complex hypothalamic-pituitary-hormonal regulation, but the mechanisms that determine pubertal timing and underlie its links to disease risk remain unclear. Here, using genome-wide and custom-genotyping arrays in up to 182,416 women of European descent from 57 studies, we found robust evidence (P < 5 × 10(-8)) for 123 signals at 106 genomic loci associated with age at menarche. Many loci were associated with other pubertal traits in both sexes, and there was substantial overlap with genes implicated in body mass index and various diseases, including rare disorders of puberty. Menarche signals were enriched in imprinted regions, with three loci (DLK1-WDR25, MKRN3-MAGEL2 and KCNK9) demonstrating parent-of-origin-specific associations concordant with known parental expression patterns. Pathway analyses implicated nuclear hormone receptors, particularly retinoic acid and γ-aminobutyric acid-B2 receptor signalling, among novel mechanisms that regulate pubertal timing in humans. Our findings suggest a genetic architecture involving at least hundreds of common variants in the coordinated timing of the pubertal transition