Examining the relationship between obesity and mental health outcomes among individuals admitted to a level I trauma centre.

The increased incidence of obesity in the general population translates into clinicians caring for an increased number of trauma patients with obesity. Previous research has documented the unique anatomical and physiological challenges that clinicians face when caring for trauma patients with obesity; however, little is known about psychological challenges that trauma patients with obesity may also experience in the months following injury. The aim of this study is to determine the relationship between obesity and (i) mental health, (ii) demographic and injury-related variables and (iii) quality-of-life outcomes among trauma patients between hospitalization and 3-months post-injury. This is a prospective, longitudinal study conducted between March 2012 and May 2014 at a single, level I trauma centre in the southwest United States. Inclusion criteria for this convenience sample consisted of patients who were admitted to the trauma or orthopaedic trauma service ≥24 h, medically stable, spoke English or Spanish and ≥18 years of age. In total, 455 eligible patients were consented and enrolled; 343 (70.87%) completed 3-month follow-up. The objective of this study is to investigate the relationship between obesity and mental health among trauma patients in the months following injury. Demographic and injury-related data were also collected; patients' height and weight were used to determine body mass index. Health outcomes were assessed during initial hospitalization and at 3-month follow-up and included depression, post-traumatic stress symptoms, pain and return to work. Prior to data collection, it was hypothesized that obesity would have a negative effect on mental health outcomes among patients 3 months post-injury. The final sample consisted of 343 participants; average age was 46.4 ± 17.3 years; majority male (n = 213, 63%) and Caucasian (n = 231, 69%). Patients with obesity had higher odds of screening positive for depression (odds ratio [OR] = 2.36, P = 0.02) and overweight patients had lower odds of returning to work (OR = 0.31, P = 0.01) 3 months post-injury compared to patients of normal weight (65% vs. 40%). No other significant differences were found. Results of the current study are novel in that they identify psychological challenges that overweight and trauma patients with obesity may experience. These results demonstrate the need for mental health professionals to be involved in follow-up care to extending in the months following injury.

First live birth after uterus transplantation in the United States.

Uterus transplantation has proven to be a successful treatment for women with absolute uterine infertility, caused either by the absence of a uterus or the presence of a nonfunctioning uterus. We report the first birth of a healthy child following uterus transplantation in the United States, from a recipient of a uterus allograft procured from an altruistic living donor. Two major modifications from the previously reported live births characterized this uterus transplant. First, the transplanted uterus relied upon and sustained the pregnancy while having only the utero-ovarian vein as venous outflow. The implication is a significantly simplified living donor surgery that paves the way for minimally invasive laparoscopic or robot-assisted techniques for the donor hysterectomy. Second, the time from transplantation to embryo transfer was significantly shortened from prior protocols, allowing for an overall shorter exposure to immunosuppression by the recipient and lowering the risk for potential adverse effects from these medications.

Live nondirected uterus donors: Psychological characteristics and motivation for donation.

Emerging research suggests that uterus transplantation is a viable option for women without a uterus who want to become pregnant and carry a child to term. Currently, no knowledge exists regarding nondirected uterus donors. This study (NCT 02656550) explored the baseline psychological characteristics of nondirected uterus donors at a single study site. Of the 62 potential donors who underwent initial screening, 6 nondirected donors were chosen and participated in uterus donation. Participants received a comprehensive evaluation, which included clinical history and psychological assessments. The mean age of the donors was 42 years; most (83%) were white/not Hispanic, and all had a college degree. Current depression was reported by 2 participants, past depression was reported in 2 participants, and past anxiety was reported in 3 participants. Based on several different psychological measures, donors had a higher general well-being than the normative sample, and none of the participants' scores indicated psychological distress. All 6 women indicated that giving another woman an opportunity to carry her own child was a motivation for pursuing uterus donation. Further research on potential psychological motives and gains for the donor as well as long-term effects on donors is crucial for ethical practice.

Living Donor Uterus Transplantation: A Single Center's Observations and Lessons Learned From Early Setbacks to Technical Success.

Uterus transplantation is a vascularized composite allograft transplantation. It allows women who do not have a uterus to become pregnant and deliver a baby. In this paper, we analyze the first five cases of living donor uterus transplantation performed in the United States. The first three recipients lost their uterus grafts at days 14, 12, and 6, respectively, after transplant. Vascular complications, related to both inflow and outflow problems, were identified as the primary reason for the graft losses. Two recipients, at 6 and 3 mo, respectively, after transplant, have functioning grafts with regular menstrual cycles. Ultimate success will be claimed only after a live birth. This paper is an in-depth analysis of evaluation, surgical technique, and follow-up of these five living donor uterus transplants. The lessons learned were instrumental in allowing us to evolve from failure to technical and functional success. We aim to share our conclusions and build on knowledge in the evolving field of uterus transplantation.

Resilience following spinal cord injury: a phenomenological view.

STUDY DESIGN: Qualitative research design involving semi-structured focus groups. OBJECTIVES: To increase current understanding of how persons with spinal cord injuries (SCI) define resilience and what factors contribute to their resilience or the resilience of others. SETTING: Inpatient rehabilitation program in a large urban city in the Southwestern United States. METHODS: A convenience sample of 28 participants (14 current patients; 14 former patients) participated in semi-structured focus groups led by the research investigators. RESULTS: Through a constant comparative analysis of the data, six themes emerged in participants' responses regarding what they believed contributed to their own resilience in adapting to SCI. The six themes included psychological strength, social support, perspective, adaptive coping, spirituality or faith, and serving as a role model or inspiring others. CONCLUSION: Consistent with previous research findings, individuals with SCI identified positive thinking (for example, optimism, hope and positive attitude), perseverance and determination, and social support from friends and family as important contributors to their ability to adapt in spite of experiencing traumatic events that resulted in SCI. Findings provide richness and depth to current empirical conceptualizations of resilience.

Zebedee: a novel copia-Ty1 family of transposable elements in the genome of the medically important mosquito Aedes aegypti.

We have utilised PCR to directly identify a novel family of copia-Ty1 retrotransposable elements (RTPs) in the genome of the mosquito Aedes aegypti. Two members of the family have been sequenced in their entirety and their structural characteristics determined. ZebedeeI is 3505 bp long and appears to be flanked by 21bp direct repeat sequences. A single open reading frame (ORF) of 972 amino acids has the coding potential for a polyprotein with homology corresponding to the conserved amino acid motifs of Long Terminal Repeat (LTR) retrotransposon protease, integrase and reverse transcriptase. ZebedeeII likewise shares significant homology with these regions and also appears to be flanked by short direct terminal repeat sequences of 22 bp. Fifty copies of the 22 bp repeat sequence are present abutting the 5' end of ZebedeeII, with two (partial) representatives of this repeat sequence being present at the 3' end. The Zebedee family appears to have a low middle repetitive copy number in different strains of Ae. aegypti; and transcripts of the elements have been detected in cultured mosquito cells by RT-PCR. Despite the lack of a gag homologue or the LTR hallmarks of previously characterised copia-Ty1 RTPs, phylogenetic analyses place Zebedee within this group, showing considerable homology to copia from Drosophila melanogaster.

Altered family processes related to an ill family member: a validation study.

The purpose of this retrospective descriptive survey was to validate the defining characteristics for altered family processes related to an ill family nursing diagnosis. Using Ferhing's (1987) Diagnostic Cantent Validation Model, data were collected from 58 registered nurses. Clinical nurses submitted 14 defining characteristics not identified by NANDA nor found in the literature. Many of these characteristics expressed the same concepts in different terms from those used by NANDA. The results of this study give credibility to NANDA's conceptually stated defining characteristics and suggest further clinical research.

Current therapy for subungual melanoma.

Malignant subungual melanoma is an infrequently encountered but often misdiagnosed clinical entity. The podiatric surgeon plays a major role in the early diagnosis and surgical management. An illustrative case report of its clinical presentation and a thorough review of current therapeutic modalities are presented.

Adolescents and colposcopy: the use of different procedures to reduce anxiety.

OBJECTIVE: Two consecutively occurring studies examined whether using a video colposcope to view this procedure or allowing the female adolescent to watch music videos would reduce anxiety and related body movements. STUDY DESIGN: Female adolescents who underwent colposcopy were randomly assigned to one of two groups, experimental and control. In study 1, 27 female adolescents were randomly assigned either to view the procedure on a television monitor or to be part of a control group (no visual distraction). In study 2, 30 female adolescents were randomly assigned either to a music video group or to a control group. Studies were completed in a consecutive manner and used the same measures, colposcopic equipment, and professional staff, including physician. Multiple measures of anxiety were used (heart rate, behavior observation, and paper and pencil) before, during, and after the procedure. During each colposcopy the subject's behavior across 10 dimensions was observed and coded. Data were analyzed by chi 2, analysis of variance, and Student t tests. RESULTS: Study 1 found no significant differences in body movements and anxiety ratings between the video colposcope group and controls. In study 2, subjects who were allowed to watch the music videos demonstrated significantly fewer body movements indicative of pain, required less physician reassurance, and received fewer procedural explanations (p < 0.05). CONCLUSION: Results suggest that allowing a female adolescent to watch music videos during a colposcopic examination appears to decrease body movements associated with discomfort.

Fibrolipomatous hamartoma of nerve.

Fibrolipomatous hamartomas of nerve are rare, benign, fibrofatty malformations of peripheral nerves, most commonly affecting the median nerve. Lower extremity cases are extremely rare. The authors present a very rare case of a fibrolipomatous hamartoma involving the superficial peroneal nerve, and review the literature regarding its clinical presentation and surgical management.

Mariner: its prospects as a DNA vector for the genetic manipulation of medically important insects.

Originally described in Drosophila mauritiana, the mariner transposable element has very recently been identified in 63 other insect species, representing ten insect orders, and including the malaria-vector mosquito, Anopheles gambiae. Ann Warren and Julian Crampton here discuss how transposable elements can be exploited as valuable research tools for the molecular characterization of genomes and as DNA vectors for genome manipulation and the 'creation' of transgenic organisms.

The Aedes aegypti genome: complexity and organization.

We describe the use of DNA reassociation kinetics to determine the total genome size and complexity together with the individual complexity and copy number of the single copy, middle repetitive and highly repeated DNA fractions of cell line and larval DNA from the mosquito, Aedes aegypti. The genome of Ae. aegypti is both large and complex, being one third the size of the human genome, and exhibits a short period interspersed repeat pattern. The implications of patterns of sequence arrangement and genome complexities for experiments aimed at isolating specific classes of DNA sequences, such as mobile genetic elements, are discussed.

Pinch grafts--applications in podiatric wound closure.

Pinch grafts were initially described in the late nineteenth century as a technique that could be utilized, under selected conditions, to promote wound healing. This procedure remains a viable component of the podiatric surgical armamentarium. There has been relatively little information on this subject in the literature: podiatric, orthopedic, or general medical, during the past several decades. A review of the historic development of the procedure, and case presentations, for examples of current applications, are presented.

Verrucous squamous cell carcinoma.

Verrucous squamous cell carcinoma involving the plantar aspect of the foot is a relatively rare and generally slow growing tumor that is capable of great local destruction. Diagnosis is based on history, clinical appearance and, most importantly, deep biopsy. A case report is presented, along with a literature review of the history, treatment and prognosis of this rare entity.