Multiple schedules of conjugate reinforcement and extinction: A translational model for assessing automatically reinforced behavior.

This study evaluated the extent to which a conjugate reinforcement schedule (CONJ) involving a contingency between pedaling a stationary bike and viewing a preferred movie could serve as a translational preparation for the analysis of automatically reinforced behavior. In part, researchers examined whether providing participants with either an accurate or an inaccurate rule about the extinction (EXT) component of a multiple schedule (MULT) contributed to the development of control by the MULT (CONJ EXT) schedule. Results show schedule control emerged for four of five participants who received the accurate rule and none of the five participants who received the inaccurate rule. In addition, participants who received accurate rules typically increased pedaling during CONJ components that followed two consecutive EXT components, suggesting that they experienced deprivation for audio and visual stimulation generated by pedaling. These preliminary findings suggest that researchers could use this translational preparation to identify matched interventions for some automatically reinforced behavior.

Rotational flap closure of first and fifth metatarsal head plantar ulcers: adjunctive procedure when performing first or fifth ray amputation.

Partial ray amputation is a common treatment of diabetes-related neuropathic ulcers located beneath the metatarsal heads. The standard incision for partial first or fifth ray amputation involves a tennis racket incision, with the proximal arm made mid-line along the respective medial or lateral side of the metatarsal head and neck, creating equal dorsal and plantar flaps. This incision works well when the ulcer is located within the excised soft tissue distal to the incision or when the plantar ulcer is superficial and will heal secondarily once the underlying bone has been removed. This standard first or fifth ray amputation incision does not, however, allow excision and closure of plantar ulcers located beneath the first or fifth metatarsal head. Two cases are presented to demonstrate our surgical protocol for partial first or fifth ray amputation using a local rotational flap to cover plantar metatarsal head ulcers. These cases highlight our patient selection criteria, staging protocol when cellulitis or abscess is present, rotational flap design, surgical technique pearls, and the typical postoperative healing progress.

Topical ketamine cream in the treatment of painful diabetic neuropathy: a randomized, placebo-controlled, double-blind initial study.

BACKGROUND: Painful diabetic neuropathy remains a difficult pathologic condition to manage effectively despite numerous pharmacologic interventions. A randomized, placebo-controlled, double-blind study was undertaken to determine whether topical 5% ketamine cream is effective in reducing the pain of diabetic neuropathy. METHODS: Seventeen diabetic patients completed the study. The Michigan Neuropathy Screening Instrument was used to determine whether the neuropathy was likely caused by the diabetic condition. Hemoglobin A(1c) levels were measured before treatment. Patients applied 1 mL of either ketamine cream or placebo cream for 1 month. The intensity of seven different pain characteristics was evaluated before and after treatment. A two-way repeated analysis of variance design was used to test for differences between treatments and within patients (time). RESULTS: We found no significant treatment main effect, but pain improved significantly over time in both groups. There was no statistical interaction effect (treatment × time) in any of the pain characteristics, indicating that pain improved in the two treatment groups similarly with time. CONCLUSIONS: The 5% topical ketamine cream was no more effective than was placebo in relieving pain caused by diabetic neuropathy.

The Keck and Kelly wedge calcaneal osteotomy for Haglund's deformity: a technique for reproducible results.

Surgical treatment of Haglund's deformity typically involves either bump removal or a closing wedge calcaneal osteotomy. Although bump removal may initially seem easier to perform and quicker to heal, there are advantages to avoiding bone resection adjacent to the Achilles tendon. Healing of the wedge osteotomy can be faster and more predicable than tendon healing at the Achilles insertion, which is beneficial to the young and active population that tends to have this condition. This article describes a reproducible Keck and Kelly closing wedge osteotomy technique that effectively decompresses the posterior/superior aspect of the calcaneus without need for dissection around the Achilles insertion. Our technique allows for consistent correction of Haglund's deformity, reliable symptom relief, and minimal opportunity for intraoperative or postoperative complications. Technique pearls include patient selection criteria for bump removal versus wedge osteotomy and a preoperative template protocol.

Gastrocnemius recession as an alternative to tendoAchillis lengthening for relief of forefoot pressure in a patient with peripheral neuropathy: a case report and description of a technical modification.

The gastrocnemius recession is a popular surgical procedure for the treatment of equinus contracture. Lengthening the gastrocnemius tendon has been show to be an effective means of reducing pressure to the plantar forefoot by weakening the triceps surae complex. The more traditional method of weakening the triceps surae is a modification of Hoke's triple hemisection through the tendoAchillis. This technique unfortunately carries a serious risk of the development of a calcaneal gait. The purpose of this case report is to demonstrate that the gastrocnemius recession is an effective and safe alternative to the traditional tendoAchillis lengthening. The authors also describe a minimally invasive technique that uses a pediatric speculum for a self-retrained retractor and portal for instrumentation and visualization.

Effect of sperm preparation techniques by density gradient on intra-individual variation of sperm motility.

The purpose of this study was to examine the effect of sperm preparation by density gradient on the intra-individual variation in sperm motility. Patients presenting for density gradient (DG) sperm preparation were analyzed retrospectively. Patients who had more than one preparation were included. The variation within each patient was studied using the coefficient of variation (CV = standard deviation/mean x 100). Density gradient preparation resulted in a reduction in the CV of sperm motility (CV motility before DG: 19.8 +/- 15.82% vs. CV motility after DG: 15.9 +/- 17.97%, p < 0.001). However, CV of sperm concentration (44.2 +/- 26.51%) and CV progressively motile sperm (49.2 +/- 28.48%) remained very high after DG. This variability should be reflected in counseling patients undergoing intrauterine insemination.