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Handbook of Clinical Neurology 2024In neurology practice, it is common to encounter a variety of visual complaints. Historically, in the absence of known ocular pathology, epilepsy, or insult to the... (Review)
Review
In neurology practice, it is common to encounter a variety of visual complaints. Historically, in the absence of known ocular pathology, epilepsy, or insult to the central nervous system, positive symptoms were assumed to be migrainous in origin. This assumption was sometimes made even in the absence of a history of migraine. In the past decade, there has been considerable effort to better delineate and study nonmigrainous visual phenomena, with the most extensive focus on a newly defined syndrome, visual snow syndrome (VSS). The heightened awareness of visual snow as a symptom and syndrome has greatly enhanced the understanding of this visual phenomenon; however, in the last few years, there has been an almost pendulous swing in clinic, with patients now being given the diagnosis of VSS for any dots or flickering they may have in their vision. To avoid clinical misdiagnosis, it is critical that we expand our understanding not just of VSS but also of underlying pathologies that may present similarly. This chapter will review classical migraine aura, persistent migraine aura, visual snow and a number of positive and negative visual complaints that are on the differential when seeing patients with suspected aura or visual snow. This is followed by an in-depth discussion on the current understanding of the presenting symptoms, pathophysiology, evaluation and management of VSS. We also outline secondary causes of visual snow.
Topics: Humans; Vision Disorders; Migraine Disorders; Migraine with Aura; Perceptual Disorders; Epilepsy; Syndrome
PubMed: 38307662
DOI: 10.1016/B978-0-12-823357-3.00018-5 -
Clinical and Experimental Dermatology Jul 2020
Topics: Abdomen; Dermatitis; Diagnosis, Differential; Humans; Lymphedema; Male; Middle Aged; Obesity, Morbid; Scleroderma, Localized
PubMed: 32141633
DOI: 10.1111/ced.14210 -
Poultry Science Feb 2022Pendulous crop (PC) in the turkey occurs when the crop distends from its normal position, thereby preventing the movement of feed and water from the crop down into the...
Pendulous crop (PC) in the turkey occurs when the crop distends from its normal position, thereby preventing the movement of feed and water from the crop down into the digestive system. This condition negatively impacts the turkey industry at both production and welfare levels. In this study, we estimated the genetic parameters for PC incidence and its genetic correlation with 5 production traits. Additionally, we evaluated the prediction accuracy and bias of breeding values for the selection candidates using pedigree (BLUP) or pedigree-genomic (ssGBLUP) relationships among the animals. A total of 245,783 turkey records were made available by Hybrid Turkeys, Kitchener, Canada. Of these, 6,545 were affected with PC. In addition, the data included 9,634 records for breast meat yield (BMY); 5,592 records for feed conversion ratio (FCR) and residual feed intake (RFI) in males; 170,844 records for body weight (BW) and walking score (WS) between 18 and 20 wk of age for males (71,012) and females (99,832), respectively. Among this population, 36,830 were genotyped using a 65K SNP Illumina Inc. chip. While all animals passed the quality control criteria, only 53,455 SNP markers were retained for subsequent analysis. Heritability for PC was estimated at 0.16 ± 0.00 and 0.17 ± 0.00 using BLUP and ssGBLUP, respectively. The incidence of PC was not genetically correlated with WS or FCR. Low unfavourable genetic correlations with BW (0.12 and 0.14), BMY (0.24 and 0.24) and RFI (-0.33 and -0.28) were obtained using BLUP and ssGBLUP, respectively. Using ssGBLUP showed higher prediction accuracy (0.51) for the breeding values for the selection candidates than the pedigree-based model (0.35). Whereas the bias of the prediction was slightly reduced with ssGBLUP (0.33 ± 0.05) than BLUP (0.30 ± 0.08), both models showed a regression coefficient lower than one, indicating inflation in the predictions. The results of this study suggest that PC is a heritable trait and selection for lower PC incidence rates is feasible. Although further investigation is necessary, selection for BW, BMY, and RFI may increase PC incidence. Incorporating genomic information would lead to higher accuracy in predicting the genetic merit for selection candidates.
Topics: Animals; Body Weight; Chickens; Female; Genomics; Genotype; Male; Models, Genetic; Pedigree; Phenotype; Turkeys
PubMed: 34954445
DOI: 10.1016/j.psj.2021.101601 -
A lever action hypothesis for pendulous hummingbird flowers: experimental evidence from a columbine.Annals of Botany Jan 2020Pendulous flowers (due to a flexible pedicel) are a common, convergent trait of hummingbird-pollinated flowers. However, the role of flexible pedicels remains uncertain...
BACKGROUND AND AIMS
Pendulous flowers (due to a flexible pedicel) are a common, convergent trait of hummingbird-pollinated flowers. However, the role of flexible pedicels remains uncertain despite several functional hypotheses. Here we present and test the 'lever action hypothesis': flexible pedicels allow pendulous flowers to move upwards from all sides, pushing the stigma and anthers against the underside of the feeding hummingbird regardless of which nectary is being visited.
METHODS
To test whether this lever action increased pollination success, we wired emasculated flowers of serpentine columbine, Aquilegia eximia, to prevent levering and compared pollination success of immobilized flowers with emasculated unwired and wire controls.
KEY RESULTS
Seed set was significantly lower in wire-immobilized flowers than unwired control and wire control flowers. Video analysis of visits to wire-immobilized and unwired flowers demonstrated that birds contacted the stigmas and anthers of immobilized flowers less often than those of flowers with flexible pedicels.
CONCLUSIONS
We conclude that flexible pedicels permit the levering of reproductive structures onto a hovering bird. Hummingbirds, as uniquely large, hovering pollinators, differ from flies or bees which are too small to cause levering of flowers while hovering. Thus, flexible pedicels may be an adaptation to hummingbird pollination, in particular due to hummingbird size. We further speculate that this mechanism is effective only in radially symmetric flowers; in contrast, zygomorphic hummingbird-pollinated flowers are usually more or less horizontally oriented rather than having pendulous flowers and flexible pedicels.
Topics: Animals; Aquilegia; Bees; Birds; Flowers; Pollination; Reproduction
PubMed: 31402377
DOI: 10.1093/aob/mcz134 -
Urology Jun 2022Post-phalloplasty, patients may present with urologic complications, including strictures, urethrocutaneous fistulas and vaginal cavity remnants. OBJECTIVE: To...
BACKGROUND
Post-phalloplasty, patients may present with urologic complications, including strictures, urethrocutaneous fistulas and vaginal cavity remnants. OBJECTIVE: To demonstrate the feasibility of staged repairs for long complex neophallus strictures.
METHODS
All post-phalloplasty patients who underwent pendulous (pars pendulans) or panurethral urethroplasty for strictures >7 cm were identified. In preparation for surgery patients were co-managed with their local providers, whenever possible, in treating symptomatic infections with culture-specific antibiotics, draining abscess and managing suprapubic catheters. During Stage-1, a ventral incision through the perineum and neophallus was created to expose remnants of the neo-urethral plate. Additional findings (fistula/remnant cavity) were treated at this stage if found, along with re-mobilization of a previously placed gracilis flap. The neourethral plate was augmented with buccal mucosal graft (BMG) with a goal of achieving an approximately 3-cm-wide plate. The lateral neourethral edges were sutured to the edges of the skin incision creating a temporary perineal urethrostomy. Stage-2 was performed in a delayed fashion and included mobilization and tubularization of the neourethra, with additional oral mucosa inlay (BMG or lingual), if needed, followed by a multi-layer closure. Postoperatively, patients were assessed in clinic when possible, or via telemedicine appointments for urethral patency, and queried using patient-reported outcome measures. Failures were defined as need for additional revisions or urethral instrumentation.
RESULTS
Twenty-one patients presented between December 2013 and July 2021 with urinary obstruction due to long penile strictures. Seventeen patients, mean age 33 (22-58), elected to undergo staged reconstruction. Prior phalloplasty techniques included radial forearm flap phalloplasty in 15/17 and anterolateral thigh flap in 2/17. In 11/17 patients BMG was previously used during phalloplasty for urethral prelamination. Mean stricture length was 12 cm (7-17). Concurrent procedures during Stage-1 included re-harvesting BMG (11/17), gracilis flap re-mobilization (7/17) and redo-vaginectomy (5/17). During Stage-2, 14 patients (82%) required additional oral graft inlays: lingual 6/14 (including 2 bilateral), BMG 5/14 (including 1 bilateral) and lingual+BMG in 3/14. At a mean follow-up of 24 months (4-77), there were 2 failures (12%). Thirteen patients completed follow-up questionnaires and all reported upright voiding and at least a moderate improvement in their condition on Global Response Assessment: +3 (markedly improved) in 11/13 (85%), and +2 (moderately improved) in 2/13 (15%).
CONCLUSION
A staged urethroplasty is a feasible option for transgender men with long complex penile strictures of the neophallus. This technique demonstrates promising early functional outcomes and high patient satisfaction.
Topics: Adult; Constriction, Pathologic; Female; Humans; Male; Mouth Mucosa; Penile Diseases; Retrospective Studies; Treatment Outcome; Urethra; Urethral Stricture; Urologic Surgical Procedures, Male
PubMed: 35101545
DOI: 10.1016/j.urology.2021.12.029 -
The Journal of Sexual Medicine Feb 2022Several treatment options for urethral complications following metoidioplasty in transmen are described in the literature, yet little is known with regard to the...
BACKGROUND
Several treatment options for urethral complications following metoidioplasty in transmen are described in the literature, yet little is known with regard to the surgical outcomes.
AIM
The aim of this study was to analyze the surgical outcomes after treatment of urethral strictures and urethral fistulas following metoidioplasty.
METHODS
A multicenter retrospective cohort study was conducted with transmen treated for strictures and fistulas after metoidioplasty in 3 tertiary referral centers.
OUTCOMES
The primary outcome was the recurrence-free rate after surgical treatment of urethral strictures and urethral fistulas over a time period of 3 years postoperatively.
RESULTS
Of 96 transmen included in this study with a urethral complication, 44 (46%) experienced a urethral fistula, 31 (32%) a urethral stricture, and 21 (22%) both complications simultaneously. The recurrence-free rate for urethral strictures following endoscopic management (ie, urethral dilation or direct visual internal urethrotomy) was 61% after 1, 50% after 2, and 43% after 3 years, compared to 82% following open treatment options after 1, 2, and 3 years (P = .002). Open treatment options were Heineke-Mikulicz procedure (7/9, 78% success), excision and primary anastomosis (3/3, 100%), 2-stage without graft (9/9, 100%), pedicled flap urethroplasty (1/1, 100%), and buccal mucosa graft urethroplasty (2/4 [50%] single-stage, 1/1 [100%] 2-stage). The recurrence-free rate for small urethral fistulas located at the pendulous urethra was 79% after 1, and 72% after 2 and 3 years, compared to 45% after 1, and 41% after 2 and 3 years for large fistulas, generally located at the urethral anastomoses of the fixed urethra. Treatment options for urethral fistulas were fistulectomy (26/48, 54%), fistulectomy & (redo) colpectomy (7/11, 64%), buccal mucosa graft urethroplasty (1/1, 100%), and retubularization of the urethral plate (3/4, 75%). A colpectomy before or during reoperation of a urethral fistula at the proximal urethral anastomosis showed higher success rates compared to without a colpectomy (7/11 [64%] vs 2/13 [15%] respectively, P = .03).
CLINICAL IMPLICATIONS
This study provides insight in the treatment possibilities and corresponding outcomes of urethral complications following metoidioplasty in transmen.
STRENGTHS & LIMITATIONS
Strengths were the relatively large sample size and the overview of multiple treatment options available. Limitations were the heterogeneity of the cohort, underexposure of some surgical modalities, and absence of patient-reported outcomes.
CONCLUSION
Open surgical techniques show better long-term outcomes in the management of urethral strictures compared to endoscopic options, and a colpectomy is beneficial before or during urethral fistula repair at the proximal urethral anastomosis. de Rooij FPW, Falcone M, Waterschoot M, et al. Surgical Outcomes After Treatment of Urethral Complications Following Metoidioplasty in Transgender Men. J Sex Med 2022;19:377-384.
Topics: Humans; Male; Mouth Mucosa; Retrospective Studies; Transgender Persons; Treatment Outcome; Urethra; Urethral Stricture; Urologic Surgical Procedures, Male
PubMed: 34974989
DOI: 10.1016/j.jsxm.2021.12.006 -
PhytoKeys 2022A new species from Gangwon-do, South Korea, is described and illustrated, based on its morphology and distribution. is different from , another similar species in...
A new species from Gangwon-do, South Korea, is described and illustrated, based on its morphology and distribution. is different from , another similar species in South Korea, in some ways: possesses a serrate leaf margin with flat tooth tip, while possesses a crenate leaf margin with erect tooth tip; it has an erect inflorescence, while has a pendulous inflorescence; it has a smaller flower which is 2-2.6 cm long, while has a flower of 2.3-3.2 cm; the flower is white or pinkish-white with yellowish and purplish spots, while has a white lower sepal and pinkish-white lateral united petals with yellowish spots; the distal part of the lower sepal is mostly not coiled or rarely 1-coiled, while that of is never coiled; the spur tip is expanded, round and slightly biparted, while that of is expanded, ellipsoidal and clearly biparted. A taxonomic description, a holotype and photos of morphological characteristics of the new species are provided. A table which includes the morphological comparison and a geographical distribution map are presented as well.
PubMed: 36760723
DOI: 10.3897/phytokeys.211.90236 -
The Surgeon : Journal of the Royal... Oct 2022Primary urethral carcinoma is a rare clinical entity with an incidence of 1 case per million in the United Kingdom. Cancers of the distal urethra are most commonly of...
INTRODUCTION
Primary urethral carcinoma is a rare clinical entity with an incidence of 1 case per million in the United Kingdom. Cancers of the distal urethra are most commonly of squamous subtype and often associated with Human Papilloma Virus infection. Penile preserving techniques are recommended in tumours of the pendulous urethra with a number of surgical approaches described. Herein, we describe the surgical management of 7 patients presenting with primary urethral carcinoma.
METHODS
Seven patients diagnosed with primary urethral carcinoma of the distal urethra were identified using a prospectively maintained penile cancer database at our institution from May 2017 to November 2020.
RESULTS
The mean age at presentation was 56.5 (33-80) years. Presenting symptoms included visible lesion, LUTS and a groin mass. Three patients had lesions located within the glanular urethra and had a distal urethrectomy and primary closure. Two patients with lesions extending proximal to the glanular urethra and into or beyond the fossa navicularis had a distal urethrectomy with a hypospadic neomeatus formation. One patient with tumour extending into the glans penis underwent distal urethrectomy and partial glansectomy with split thickness skin graft. A partial penectomy was performed for one patient with urethral tumour invading the corporal heads. Mean follow-up was 23.4 (±17.0) months. There have been no disease recurrences to date.
CONCLUSION
Penile preserving techniques are feasible in patients with tumours of the pendulous urethra and do not appear to compromise local control.
Topics: Carcinoma; Humans; Male; Neoplasm Recurrence, Local; Penile Neoplasms; Urethra; Urethral Neoplasms
PubMed: 35012866
DOI: 10.1016/j.surge.2021.08.011 -
PloS One 2023Growing concerns over health and welfare impacts from extreme phenotypes in dogs have created an urgent need for reliable demographic information on the national breed...
INTRODUCTION
Growing concerns over health and welfare impacts from extreme phenotypes in dogs have created an urgent need for reliable demographic information on the national breed structures of dogs.
METHODS
This study included all dogs under primary veterinary care in the UK during 2019 at practices participating in VetCompass. Demographic data on these dogs were analysed to report on the frequency of common breeds and also to report on conformation, bodyweight, sex and neuter associations with these breeds.
RESULTS
The study included 2,237,105 dogs under UK veterinary care in 2019. Overall, 69.4% (n = 1,551,462) were classified as purebred, 6.7% (149,308) as designer-crossbred and 24.0% (536,335) as nondesigner-crossbred. Across 800 unique breed names, the most frequent breeds at any age were nondesigner-crossbred (n = 536,335, 24.0%), Labrador Retriever (154,222, 6.9%) and Jack Russell Terrier (101,294, 4.5%). Among 229,624 (10.3%) dogs aged under one year, the most frequent breeds were nondesigner-crossbred (n = 45,995, 20.0%), French Bulldog (16,036, 7.0%) and Cockapoo (14,321, 6.2%). Overall, based on breed characteristics, 17.6% (395,739) were classified as brachycephalic, 43.1% (969,403) as mesaticephalic and 8.3% (186,320) as dolichocephalic. Of 1,551,336 dogs that were classifiable based on breed, 52.6% (815,673) were chondrodystrophic. Of 1,462,925 dogs that were classifiable, there were 54.6% (n = 798,426) short haired, 32.6% (476,883) medium haired and 12.8% (186,934) long haired. Of 1,547,653 dogs that were classifiable for ear carriage, 24.5% (n = 379,581) were erect, 28.1% (434,273) were semi-erect, 19.7% (305,475) were v-shaped drop and 27.7% (428,324) were pendulous. Overall, there was a 1.09:1.00 ratio of male (n = 1,163,512; 52.2%) to female dogs (n = 1,067,552; 47.8%).
CONCLUSIONS
Health and welfare issues linked to popular breeds with extreme phenotypes suggest that there is much work to do to help owners to make more welfare-friendly decisions when choosing which type of dog to own.
Topics: Dogs; Male; Animals; Female; Dog Diseases; Craniosynostoses; Phenotype; United Kingdom; Demography
PubMed: 37494312
DOI: 10.1371/journal.pone.0288081 -
The Science of the Total Environment Dec 2023Unstable agricultural systems, such as unreliable fruit production, threaten global food security and could negatively impact human nutrition. However, methods of...
Unstable agricultural systems, such as unreliable fruit production, threaten global food security and could negatively impact human nutrition. However, methods of maintaining a stable fruit supply have received little attention. Therefore, this study explored the impact of a systematic service model on the establishment of an integrated soil-fruit-climate management (ISM) approach and stabilization of apple yield based on a fixed-effects model using sample data from Fuji apple farmers in China for six consecutive years (2016-2021). The results showed that the systematic service model dramatically improved the adoption of ISM-based technology. By 2021, the rate of ISM technology adoption among farmers reached 84.4 %, especially pendulous branch-fruiting technology and Osmia pollination, which increased by 82.2 % and 37.8 %, respectively, compared to that in 2016. With the adoption of the ISM approach, apple yields and tree loadings stabilized over time. For example, the yield change rate and tree loading change rate were 14.8 % and 7.3 % lower, respectively, in 2021 than in 2016. We demonstrated through a fixed-effects analysis that the ISM approach exerts a fully mediated effect on the mechanism of action of service measure quantity disclosure, which positively impacted the rate of change in yield and tree loadings. This finding indicated that the six-in-one systematic service model of soil testing, pest and disease diagnosis, course training, meteorological monitoring, on-site guidance, and experimental demonstration established by the Science and Technology Backyard model resolved the information, goal, and hardware gaps that limited the adoption of this technology by farmers and promoted the construction of an integrated soil-fruit-climate management approach, which in turn has stabilized the apple production system.
Topics: Humans; Animals; Malus; Fruit; Soil; Agriculture; Climate
PubMed: 37844636
DOI: 10.1016/j.scitotenv.2023.167840