Anticoagulation: a practical guide for strabismus surgeons.

An increasing number of surgical strabismus patients are taking oral anticoagulant and antiplatelet agents, with more diverse mechanisms of action than those used in the past. The decision as to whether to continue these drugs throughout the perioperative period is difficult and must be based on the balance between hemorrhagic and thrombotic risk. To help guide strabismus surgeons with clinical management in these cases, we review potential hemorrhagic complications of strabismus surgery and examine the use of anticoagulant and antiplatelet drugs during the perioperative period. Surgical strategies that might help minimize intraoperative hemorrhage in patients on anticoagulant therapy are also discussed

Đe se završava južnoslovenski areal? Napomene o panonskom narječju poznoga praslovenskog

U izlaganju se prikazuju refleksi praslovenskih akcenatskih opreka i osobita pažnja se dijeli praslovenskome starom akutu u kontekstu panonske prelazne zone pozne praslovenskoga jezika. U pitanju je relativno dugi opstanak uzlaznosti akuta u zahodnom arealu južnoslovenskih kao i dijela zapadnoslovenskih dijalekata te mogućih razloga za taj opstanak

Investigating the Potential Causal Relationship Between Parental Knowledge and Youth Risky Behavior: a Propensity Score Analysis

This longitudinal study aims to explore the potential causal relationship between parental knowledge and youth risky behavior among a sample of rural, early adolescents (84% White, 47% male). Using Inverse Propensity Weighting, the sample was adjusted by controlling for 33 potential confounding variables. Confounding variables include other aspects of the parent-child relationship, parental monitoring, demographic variables and earlier levels of problem behavior. The effect of parental knowledge was significant for youth substance and polysubstance use initiation, alcohol and cigarette use, attitudes towards substance use, and delinquency. Our results suggest that parental knowledge may be causally related to substance use during middle school, as the relationship between knowledge and youth outcomes remained after controlling for 33 different confounding variables. The discussion focuses on understanding issues of causality in parenting and intervention implications

Modeling multiple risks during infancy to predict quality of the caregiving environment: Contributions of a person-centered approach

The primary goal of this study was to compare several variable-centered and person-centered methods for modeling multiple risk factors during infancy to predict the quality of caregiving environments at six months of age. Nine risk factors related to family demographics and maternal psychosocial risk, assessed when children were two months old, were explored in the understudied population of children born in low-income, non-urban communities in Pennsylvania and North Carolina (N = 1047). These risk factors were 1) single (unpartnered) parent status, 2) marital status, 3) mother’s age at first child birth, 4) maternal education, 5) maternal reading ability, 6) poverty status, 7) residential crowding, 8) prenatal smoking exposure, and 9) maternal depression. We compared conclusions drawn using a bivariate approach, multiple regression analysis, the cumulative risk index, and latent class analysis (LCA). The risk classes derived using LCA provided a more intuitive summary of how multiple risks were organized within individuals as compared to the other methods. The five risk classes were: married low-risk; married low-income; cohabiting multiproblem; single low-income; and single low-income/education. The LCA findings illustrated how the association between particular family configurations and the infants’ caregiving environment quality varied across race and site. Discussion focuses on the value of person-centered models of analysis to understand complexities of prediction of multiple risk factors

doi:10.1016/j.ecresq.2010.07.003

a b s t r a c t Recently, research has begun to identify cognitive and social-emotional predictors of early academic success. Yet few studies have examined the mechanisms by which children's social-emotional skills are associated with later academic success. The present study examines the associations between preschool emotion knowledge, kindergarten attention skills, and first grade academic competence in a sample of mostly disadvantaged children. Results indicate that attention during kindergarten is a significant mediator of this association, even after accounting for the effects of maternal education, family income, and children's age, sex, and receptive vocabulary skills. The findings provide further support for the implementation of preventive curricula that focus on both social and emotional development as well as attentional development as one strategy for improving future academic success in young children

Dissociable Genetic Contributions to Error Processing: A Multimodal Neuroimaging Study

Background: Neuroimaging studies reliably identify two markers of error commission: the error-related negativity (ERN), an event-related potential, and functional MRI activation of the dorsal anterior cingulate cortex (dACC). While theorized to reflect the same neural process, recent evidence suggests that the ERN arises from the posterior cingulate cortex not the dACC. Here, we tested the hypothesis that these two error markers also have different genetic mediation. Methods: We measured both error markers in a sample of 92 comprised of healthy individuals and those with diagnoses of schizophrenia, obsessive-compulsive disorder or autism spectrum disorder. Participants performed the same task during functional MRI and simultaneously acquired magnetoencephalography and electroencephalography. We examined the mediation of the error markers by two single nucleotide polymorphisms: dopamine D4 receptor (DRD4) C-521T (rs1800955), which has been associated with the ERN and methylenetetrahydrofolate reductase (MTHFR) C677T (rs1801133), which has been associated with error-related dACC activation. We then compared the effects of each polymorphism on the two error markers modeled as a bivariate response. Results: We replicated our previous report of a posterior cingulate source of the ERN in healthy participants in the schizophrenia and obsessive-compulsive disorder groups. The effect of genotype on error markers did not differ significantly by diagnostic group. DRD4 C-521T allele load had a significant linear effect on ERN amplitude, but not on dACC activation, and this difference was significant. MTHFR C677T allele load had a significant linear effect on dACC activation but not ERN amplitude, but the difference in effects on the two error markers was not significant. Conclusions: DRD4 C-521T, but not MTHFR C677T, had a significant differential effect on two canonical error markers. Together with the anatomical dissociation between the ERN and error-related dACC activation, these findings suggest that these error markers have different neural and genetic mediation

Understanding How Mindful Parenting May Be Linked to Mother–Adolescent Communication

Researchers have sought to understand the processes that may promote effective parent-adolescent communication because of the strong links to adolescent adjustment. Mindfulness, a relatively new construct in Western psychology that derives from ancient Eastern traditions, has been shown to facilitate communication and to be beneficial when applied in the parenting context. In this article, we tested if and how mindful parenting was linked to routine adolescent disclosure and parental solicitation within a longitudinal sample of rural and suburban, early adolescents and their mothers (n = 432; mean adolescent age = 12.14, 46% male, 72% Caucasian). We found that three factors -- negative parental reactions to disclosure, adolescent feelings of parental over-control, and the affective quality of the parent-adolescent relationship -- mediated the association between mindful parenting and adolescent disclosure and parental solicitation. Results suggest that mindful parenting may improve mother-adolescent communication by reducing parental negative reactions to information, adolescent perceptions of over-control, and by improving the affective quality of the parent-adolescent relationship. The discussion highlights intervention implications and future directions for research

β-cell metabolic alterations under chronic nutrient overload in rat and human islets

The aim of this study was to assess multifactorial β-cell responses to metabolic perturbations in primary rat and human islets. Treatment of dispersed rat islet cells with elevated glucose and free fatty acids (FFAs, oleate:palmitate = 1:1 v/v) resulted in increases in the size and the number of lipid droplets in β-cells in a time- and concentration-dependent manner. Glucose and FFAs synergistically stimulated the nutrient sensor mammalian target of rapamycin complex 1 (mTORC1). A potent mTORC1 inhibitor, rapamycin (25 nM), significantly reduced triglyceride accumulation in rat islets. Importantly, lipid droplets accumulated only in β-cells but not in α-cells in an mTORC1-dependent manner. Nutrient activation of mTORC1 upregulated the expression of adipose differentiation related protein (ADRP), known to stabilize lipid droplets. Rat islet size and new DNA synthesis also increased under nutrient overload. Insulin secretion into the culture medium increased steadily over a 4-day period without any significant difference between glucose (10 mM) alone and the combination of glucose (10 mM) and FFAs (240 μM). Insulin content and insulin biosynthesis, however, were significantly reduced under the combination of nutrients compared with glucose alone. Elevated nutrients also stimulated lipid droplet formation in human islets in an mTORC1-dependent manner. Unlike rat islets, however, human islets did not increase in size under nutrient overload despite a normal response to nutrients in releasing insulin. The different responses of islet cell growth under nutrient overload appear to impact insulin biosynthesis and storage differently in rat and human islets

Occult purulent pericarditis detected by indium-111 leukocyte imaging.

Leukocyte imaging with indium-111 is a relatively new technique which, to this point in time, has been discussed almost exclusively in the radiologic literature. Although this procedure has been used mainly to detect intra-abdominal infection, the thorax is routinely imaged along with the abdomen, and therefore detection of cardiac disease may be feasible. This case report is of a young woman after liver transplantation who developed occult purulent pericarditis initially detected by a leukocyte scan with indium-111. This case demonstrates that striking pericardial uptake on a whole-body indium-111 leukocyte scan can occur with purulent pericarditis, and it reemphasizes how insidiously purulent pericarditis may present in an immunosuppressed patient

Upper limb nerve transfer surgery in patients with tetraplegia

IMPORTANCE: Cervical spinal cord injury (SCI) causes devastating loss of upper extremity function and independence. Nerve transfers are a promising approach to reanimate upper limbs; however, there remains a paucity of high-quality evidence supporting a clinical benefit for patients with tetraplegia. OBJECTIVE: To evaluate the clinical utility of nerve transfers for reanimation of upper limb function in tetraplegia. DESIGN, SETTING, AND PARTICIPANTS: In this prospective case series, adults with cervical SCI and upper extremity paralysis whose recovery plateaued were enrolled between September 1, 2015, and January 31, 2019. Data analysis was performed from August 2021 to February 2022. INTERVENTIONS: Nerve transfers to reanimate upper extremity motor function with target reinnervation of elbow extension and hand grasp, pinch, and/or release. MAIN OUTCOMES AND MEASURES: The primary outcome was motor strength measured by Medical Research Council (MRC) grades 0 to 5. Secondary outcomes included Sollerman Hand Function Test (SHFT); Michigan Hand Outcome Questionnaire (MHQ); Disabilities of Arm, Shoulder, and Hand (DASH); and 36-Item Short Form Health Survey (SF-36) physical component summary (PCS) and mental component summary (MCS) scores. Outcomes were assessed up to 48 months postoperatively. RESULTS: Twenty-two patients with tetraplegia (median age, 36 years [range, 18-76 years]; 21 male [95%]) underwent 60 nerve transfers on 35 upper limbs at a median time of 21 months (range, 6-142 months) after SCI. At final follow-up, upper limb motor strength improved significantly: median MRC grades were 3 (IQR, 2.5-4; P = .01) for triceps, with 70% of upper limbs gaining an MRC grade of 3 or higher for elbow extension; 4 (IQR, 2-4; P \u3c .001) for finger extensors, with 79% of hands gaining an MRC grade of 3 or higher for finger extension; and 2 (IQR, 1-3; P \u3c .001) for finger flexors, with 52% of hands gaining an MRC grade of 3 or higher for finger flexion. The secondary outcomes of SHFT, MHQ, DASH, and SF36-PCS scores improved beyond the established minimal clinically important difference. Both early (\u3c12 months) and delayed (≥12 months) nerve transfers after SCI achieved comparable motor outcomes. Continual improvement in motor strength was observed in the finger flexors and extensors across the entire duration of follow-up. CONCLUSIONS AND RELEVANCE: In this prospective case series, nerve transfer surgery was associated with improvement of upper limb motor strength and functional independence in patients with tetraplegia. Nerve transfer is a promising intervention feasible in both subacute and chronic SCI