Craniofacial Surgery

Controversy on the Age of Hypertelorism Correction Introduction: Orbital hypertelorism (HTO) is a challenging craniofacial problem seen in association with some congenital deformities. The age of HTO correction is a matter of debate. The Aim of the work: to evaluate the outcome of HTO correction and determine the optimal timing for intervention, striving for the earliest possible intervention with the lowest relapse. Patients and methods: A standard craniofacial approach with medial bone resection, 4 walls orbital box osteotomy and orbital medialization were done for all patients. Skeletal and soft tissue procedures were done as indicated. Results: there were 10 patients aging 6 to 19 years. Seven were associated with craniofacial clefts, and 3 with craniosynostosis syndromes. HTO was severe in 8 cases and moderate in 2 cases. It was asymmetric in 2 cases. Frontoorbital remodeling was done in 3 cases with craniosynostosis. Failed surgery was reported in 2 cases. A redo surgery was done for one of them with an excellent outcome, while refused by the other. Nine patients had an excellent outcome. The mean level of satisfaction was 93.37%. Three patients had ugly facial scars. No major complications were recorded. Conclusion: The time for surgical treatment of HTO is determined by the severity of the associated deformity. If there is an urgent factor indicating intervention, early correction can be performed exceptionally; otherwise, HTO correction should be performed after the age of 6 years. Address correspondence and reprint requests to Ahmed Gaber Hassanein, MD, Address: Maxillofacial Surgery Unit, General Surgery Department, Sohag Faculty of Medicine, Sohag, Egypt; E-mail: ahmedgaber_74@yahoo.com Received 2 August, 2018 Accepted 10 April, 2019 The authors report no conflicts of interest. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jcraniofacialsurgery.com). © 2019 by Mutaz B. Habal, MD.

Applications of Bone Morphogenetic Protein-2: Alternative Therapies in Craniofacial Reconstruction Large defects of the craniofacial skeleton can be exceedingly difficult to reconstruct since autologous bone grafts are limited by donor site morbidity and alloplastic implants have low biocompatibility. Bone morphogenetic proteins (BMPs) in craniofacial reconstruction have been used with mixed outcomes and complication concerns; however, results for specific indications have been promising. In alveolar clefts, cranial vault defects, mandibular defects, and rare Tessier craniofacial clefts, BMP-2 impregnated in collagen matrix was looked at as an alternative therapy for challenging cases. In cases where structural support was required, BMP-2 was used as part of a construct with bio-resorbable plates. Demineralized bone was added in certain cases. The authors described specific indications, detailed surgical techniques, and a review of the current literature regarding the use of BMP-2 in craniofacial reconstruction. BMP-2 is a viable option for craniofacial reconstruction to decrease donor-site morbidity or when alternatives are contraindicated. It is not recommended for routine use or in the oncologic setting but should currently be reserved as an alternative therapy for complex cases with limited options. Bone morphogenetic proteins are a promising, emerging option for complex craniofacial reconstruction. Future directions of BMP-2 therapies will become apparent as data from prospective randomized trials emerges. Address correspondence and reprint requests to James P. Bradley, MD, 1991 Marcus Avenue, #102, Lake Success, NY, 11042; E-mail: JPBradley4@mac.com Received 9 October, 2018 Accepted 20 March, 2019 The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

Correlation Between Speech Outcomes and the Amount of Maxillary Advancement After Orthognathic Surgery (Le Fort I Conventional Osteotomy and Distraction Osteogenesis) in Patients With Cleft Lip and Palate Background: The purpose of this study is to evaluate the factors affecting the speech outcome following Le fort I conventional osteotomy(CO) or Le Fort I distraction osteogenesis(DO) in patients with cleft lip and palate at a single institution. Method: Records of cleft lip and palate patients who underwent orthognathic surgery between 2010 and 2015 were reviewed. Data included age at orthognathic surgery, sex, cleft lip and palate type, type of orthognathic surgery, the amount of maxillary advancement, and speech assessment. Speech outcomes were classified into 2 categories. Compared with the pre and post-operative Pittsburgh Weighted speech scale scores, in case that the post-operative total score is increased the authors define it as "Speech deterioration" and if not, the authors define it as "Speech preservation." Result: The 44 patients were identified, 33 patients underwent CO and 11 patients underwent DO. The mean age was 19.4 ± 1.4. The mean period time of speech evaluation after orthognathic surgery was 1.0 ± 0.46 year. The mean amount of maxillary advancement was 7.2 ± 3.2 mm and show significant correlation with speech outcomes. (P = 0.012) . In CO group, the patients who had the maxilla 1∼5 mm advancement maintained their speech completely and 44% of patients with 6∼8 mm deteriorated their speech. In DO group, patients with 9∼10 mm maintained their speech completely, 50% of patients with 11∼12 mm deteriorated their speech and 100% of patients with 13∼16 mm deteriorated their speech. According to the relationship between the amount of maxillary advancement and speech outcomes, there was a statistically significant correlation in both CO and DO groups. (P = 0.04, 0.029). Conclusion: It was found that speech of the patients with more amount of maxillary advancement tended to get worse. Also, it was observed that there exist some stable ranges of maxillary advancement for speech safety which does not effect on speech. (1∼5 mm in CO group and 9∼10 mm in DO group). Address correspondence and reprint requests to Yountaek Koo, MD, Wonjin Plastic Surgery, Seoul, Korea, 419, Gangnam-daero, Seocho-gu, Seoul, Korea; E-mail: kooyountaek@gmail.com; Sukwha Kim, MD, Department of Plastic Surgery, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul 110–744, Korea; E-mail: kimsw@snu.ac.kr Received 20 October, 2018 Accepted 1 April, 2019 The authors report no conflicts of interest. Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jcraniofacialsurgery.com). © 2019 by Mutaz B. Habal, MD.

Three-Dimension–Printed Surgical Guide for Accurate and Safe Mandibuloplasty in Patients With Prominent Mandibular Angles Performance of mandibuloplasty is highly dependent on each surgeon's experience, and reproducing the results of simulation surgery is often difficult. In order to obtain successful clinical outcomes, a fast and efficient surgery technique that minimizes operation time and risk to patients is needed. The authors designed a 3D-printed mandible fit surgical guide for use as a bridge between simulation and actual surgery. The authors enrolled 7 patients with prominent mandibular angle who visited the outpatient clinic of the Department of Plastic and Reconstructive Surgery at Asan Medical Center in Seoul, Korea between December 2013 and May 2017. The surgical guides were made with a 3D printer and simulated based on individual facial bone CT scans. The surgical guides were designed to fit the lower border of the mandible and to cover the portion planned for removal. The resulting personalized 3D-printed surgical guides were applied on both mandibular angles to the body and along the lower border of the mandible. Osteotomy of the mandibular angle and body were performed along the surgical guide. All patients recovered without any immediate postoperative complications. The use of 3D-printed surgical guide was effective in simplifying the process of mandibuloplasty. Our results demonstrate the value of 3D printing technology in mandibuloplasty. Address correspondence and reprint requests to Jong-Woo Choi, MD, PhD, Department of Plastic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea; E-mail: pschoi@amc.seoul.kr Received 30 October, 2018 Accepted 10 April, 2019 The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

A Novel Use of Buccal Fat Pad Flap for Immediate Reconstruction of Palatal Tumor Resection Defect Integrity of the palatal mucosa may be disrupted due to various pathological and congenital factors. In maxillofacial defects, the buccal fat pad has been used frequently to repair the palatal region and close oro-nasal communications. In this case report, the use of buccal fat pad for the closure of a surgical palatal defect is presented with a 3-year follow-up. A 75-year-old female patient visited our clinic with a complaint of a non-adaptive maxillary denture. During clinical and radiographic examination, a well-demarcated mass on the palatal mucosa extending to the soft palate of the left side was observed. Subsequent to resection of the tumor, a defect occurred on the palatal region extending toward the soft palate. The pedicled buccal fat pad was chosen for closure of the defect. The patient was followed-up at 3, 7, 14, and 30 days after surgery. Epithelization and healing of the surgical wound were uneventful. At the 3-year follow-up, functional closure of the left palatal region was observed with no recurrence. Buccal fat pad is an easily manipulated flap with predictable results for the reconstruction of medium-sized defects of the oral and maxillofacial region with minimal postoperative discomfort for the patient. Address correspondence and reprint requests to Onur Koç, DDS, PhD, Hacettepe University Faculty of Dentistry Oral and Maxillofacial Surgery Department Sihhiye, Ankara, Turkey; E-mail: onurkoc101@gmail.com Received 4 November, 2018 Accepted 20 March, 2019 The authors declare no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

Lateral Osteotomy Fixation Technique in Rhinoplasty Rhinoplasty is the most challenging facial aesthetic surgical procedure according to many plastic surgeons. Nasal bone osteotomies, especially lateral osteotomies, have a complicated history. If lateral osteotomy is not stable after osteotomy during intraoperative period, stabilization is attempted with internal and external nasal splints but it is not possible to be confident about the stabilization since it is not fully fixed and cannot be observed directly. The authors presented the technique stabilization of the lateral osteotomy inferior tip with cerclage wire, if there is a stabilization problem or step-off deformity after lateral osteotomy. Address correspondence and reprint requests to Muhammet Uraloğlu, MD, Karadeniz Teknik Üniversitesi Tip Fakültesi, Farabi Hastanesi Plastik Cerrahi Anabilim Dali, Trabzon, Turkey; E-mail: uraloglu@hotmail.com Received 11 May, 2018 Accepted 29 March, 2019 The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

The Trends of Pediatric Facial Fractures Due to Violence in a Level One Trauma Population Introduction: Pediatric facial fractures due to intentionally violent mechanisms represent a unique subset of facial fractures. The objective of our research is to identify how violence affects patterns of facial fractures and their management in pediatric patients. Methods: An IRB approved, retrospective study of our institution's pediatric patients ≤18 years of age who presented with ≥1 facial fracture due to violence from January 2006 to December 2015 was performed. Violence was defined as trauma intended to hurt another or self. Demographics, fractures, mechanism, concomitant injuries, and management were analyzed. Results: The 1274 patients were diagnosed with facial fractures, with 235 of these due to violence (18%). These patients of violence (POV) had 332 fractures, with an average fracture per patient of 1.4 ± .0.8. The majority (86%) were male, Non-Hispanic African American (35%), and the average age was 15.9 ± 2.8 years. The most common fracture was the mandible (50% of patients) and most common mechanism was assault (76%). The POV were older, male, and of minority race/ethnic groups when compared to patients of non-violence (PONV) (P <0.01). The POV presented with fewer concomitant injuries, were less likely to be admitted to the intensive care unit, and more often surgically managed when compared to the PONV (P <0.01). Conclusion: This study represents the largest US, single institution, Level 1 trauma center study of pediatric facial fractures. Pediatric patients with facial fractures due to a violent mechanism represent a distinct category of trauma patients with a unique profile of injuries. Address correspondence and reprint requests to Matthew R. Greives, MD, FACS, Division of Pediatric Plastic Surgery, Department of Pediatric Surgery, McGovern School of Medicine, University of Texas Health Science Center, 6431 Fannin Street, MSB 5.281, Houston, TX 77030; E-mail: Matthew.R.Greives@uth.tmc.edu Received 15 February, 2019 Accepted 8 April, 2019 The manuscript has not previously been submitted. Abstract has been presented at the American College of Surgeons South Texas Annual Meeting in Houston, TX on February 24, 2018. The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

Temporal Hollowing Augmentation With Polyetheretherketone Patient-Specific Implant Temporal hollowing is a common complication of surgical dissection in the temporal region. As it is a serious cosmetic problem, the need for reconstruction is increasing. Advances in medical imaging, computer software, 3-dimensional printing technology, and biochemistry have enabled surgeons to use patient-specific implants for correction of craniofacial deformities. Titanium, polymethylmethacrylate, and polyetheretherketone are representative materials of the alloplastic implant. In this article, the authors report the first case of temporal hollowing augmentation using a polyetheretherketone patient-specific implant. Address correspondence and reprint requests to Ki Yong Hong, MD, PhD, Department of Plastic and Reconstructive Surgery, Ilsan Hospital, Dongguk University Medical Center, Dongguk-ro 27, IlSanDong-gu, GoYang-si, GyeongGi-do, 10326, South Korea; E-mail: pskyhong@gmail.com Received 26 February, 2019 Accepted 15 April, 2019 The authors report no conflicts of interest. © 2019 by Mutaz B. Habal, MD.

Mammalian Skull Dimensions and the Golden Ratio (Φ) The Golden Ratio (Phi, or Φ = 1.618…) is a potentially unifying quantity of structure and function in nature, as best observed in phyllotactic patterns in plants. For centuries, Φ has been identified in human anatomy, and in recent decades, Φ has been identified in human physiology as well. The anatomy and evolution of the human skull have been the focus of intense study. Evolving over millenia, the human skull embodies an elegant harmonization of structure and function. The authors explored the dimensions of the neurocranium by focusing on the midline calvarial perimeter between the nasion and inion (nasioiniac arc) and its partition by bregma into 2 sub-arcs. The authors studied 100 human skulls and 70 skulls of 6 other mammalian species and calculated 2 ratios: 1) the nasioiniac arc divided by the parieto-occipital arc (between bregma and inion), and 2) the parieto-occipital arc divided by the frontal arc (between nasion and bregma). The authors report that in humans these 2 ratios coincide (1.64 ± 0.04 and 1.57 ± 0.10) and approximate Φ. In the other 6 mammalian species, these 2 ratios were not only different, but also unique to each species. The difference between the ratios showed a trend toward convergence on Φ correlating with species complexity. The partition of the nasioiniac arc by bregma into 2 unequal arcs is a situation analogous to that of the geometrical division of a line into Φ. The authors hypothesize that the Golden Ratio (Φ) principle, documented in other biological systems, may be present in the architecture and evolution of the human skull. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0 Address correspondence and reprint requests to Rafael J. Tamargo, MD, Department of Neurosurgery, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Zayed Tower, Suite 6115, 1800 Orleans Street, Baltimore, MD, 21287; E-mail: rtamarg@jhmi.edu Received 7 March, 2019 Accepted 8 April, 2019 The authors have no conflict of interest to declare. © 2019 by Mutaz B. Habal, MD.

Extension of the Question Mark Temporal Craniectomy Trauma Incision to Bicoronal Incision for Delayed Cranioplasty No abstract available

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Microbiology

Effects of pH value on the expression of key iron/sulfur oxidation genes during bioleaching of chalcopyrite on thermophilic condition Abstract Physicochemical factors such pH value would affect the microbial metabolism during chalcopyrite bioleaching. To this end, the effects of pH on the expression of critical functional genes during bioleaching were evaluated. A mixed culture of moderate thermophiles was used for chalcopyrite bioleaching at initial pH values of 1.0, 2.0, and 3.0, and bioleaching processes were monitored via measuring the physicochemical parameters. Quantitative real-time PCR assay was used to monitor the dynamics of microbial community structures and the expression of critical iron/sulfur oxidation genes (4Fe-4S ferredoxin and sulfate adenylyltransferase genes, respectively). Redundancy analysis and calculation of correlation coefficients were used to reveal linkages between gene expression and various physicochemical factors. The leaching processes at initial pH of 1.0 and 3.0 were prolonged compared with that at initial pH of 2.0. It was shown that Sulfobacillus thermosulfidooxidans and Acidithiobacillus caldus were the dominant species during the early stage in free and attached cells, respectively, while Ferroplasma thermophilum became predominant in the later phase. The gene expression in Sulfobacillus thermosulfidooxidans and Ferroplasma thermophilum was greatly affected by pH values. On the other hand, the relationship between pH and gene expression in Acidithiobacillus caldus was not significant. The study unraveled the importance of pH value on chalcopyrite bioleaching, and pH selectively influenced the expression of key functional genes of some specific species.

Probiotic lactobacilli mediated changes in global epigenetic signatures of human intestinal epithelial cells during Escherichia coli challenge Abstract Host genome environment association is critical for proper development and functioning of an individual. Microbiota and probiotics within the cellular vicinity may serve such critical stimuli that can bring out different epigenetic mediated host responses. The aim of present study was to explore the changes in epigenetic signatures of Caco-2 cells by probiotic strains (Lactobacillus rhamnosus MTCC 5897: LR, Lactobacillus fermentumMTCC 5898: LF and their mixture: RF), respectively, or during challenge with Escherichia coli (ATCC 14948) using exclusion, competition and displacement assays. Adenocarcinoma intestinal epithelial Caco-2 cells were treated with LR, LF, RF and E. coli for 6 h, respectively. Caco-2 cells were also challenged with E. coli and probiotic lactobacilli during exclusion, competition and displacement assays. Finally, global epigenetic modifications by acetylation of H4 and H3 histone proteins and DNA methylation patterns were determined. Probiotic-treated Caco-2 cells displayed significant (p < 0.01) reduction in percent global H4 and H3 acetylation, respectively, in contrast to their elevated (p < 0.05) levels after E. coli infection. On the other hand, a remarkable (p < 0.01) decrease in percent H4 and H3 acetylation were observed when E. coli were excluded, competed or displaced by lactobacilli strains. No changes in the global DNA methylation patterns were observed in Caco-2 cells after exposure to probiotic strains or E. coli, respectively, but surprisingly, their levels increased significantly (p < 0.05) when lactobacilli-treated cells were challenged with E. coli during exclusion or competition than displacement assays. Probiotic L. rhamnosus and L. fermentum modulated the host epigenetic signatures via global histone acetylation individually or during E. coli challenge by exclusion, competition and displacement assays. Whilst on the other hand changes in global DNA methylation patterns were obtained significantly during probiotic treatment with E. coli in exclusion and competition protocols.

Antibacterial activity of endophytic fungi isolated from Sceletium tortuosum L. (Kougoed) Abstract Endophytic fungi have the ability to co-exist with their host plants without causing any harm and are beneficial to both the plant and the fungi. The current study determined the antimicrobial properties and identify the chemical compounds of secondary metabolites produced by endophytic fungi isolated from Sceletium tortuosum L. A total of 60 endophytic fungi produced secondary metabolites that were detected after fermentation and extraction. Antibacterial properties of the secondary metabolites were determined using the disc diffusion assay against pathogenic environmental Gram-positive and Gram-negative bacteria as well as control stains. The chemical compounds were characterized by GC-MS. Overall, 15% of fungal extracts displayed narrow spectrum of activity against the bacteria strains. Despite this, none of the fungal extracts inhibited growth of Enterococcus faecalis (ATCC S1299) and Enterococcus gallinarum (ATCC 700425) while Bacillus cereus (ATCC 10876) was the most susceptible against the fungal extracts. Fusarium oxysporum (GG 008) with accession no. KJ774041.1 displayed significant antibacterial activity that was linked to high levels of 5-hydroxymethylfurfural (HMF) and octadecanoic acid as revealed by GC-MS. This study revealed the presence of bioactive secondary metabolites with antibacterial activities from fungi isolated from Sceletium tortuosum L.

Biochemical analysis of elephant foot yam ( Amorphophallus paeoniifolius ) lacto-pickle with probiotic Lactobacillus plantarum Abstract Lacto-pickles are tangy, crisp, and definitely not intimidating to eat. We previously standardized fermentations of elephant foot yam (EFY) into lacto-pickle using different fermentation specifications. The aims of this work were to perform the effect of starter culture strain Lactobacillus plantarum (MTCC-1325) on chemical and biochemical properties of EFY lacto-pickle. In this study, we conducted the preprocessing of blanched EFY blocks/cubes in brine (NaCl, 8%, w/v) and inoculated with the starter culture (L. plantarum MTCC-1325). The impact of L. plantarum (MTCC-1325) during lacto-pickle fermentation and its effect on the antioxidant property, structural characterization (scanning electron microscopy (SEM) and infrared spectroscopy (FTIR)), sensory analysis, and volatilome profile (gas chromatography and mass spectrometry (GC-MS)) of EFY lacto-pickle were determined. Inoculated samples showed significantly higher acidification of the brine, reaching a pH of 2.67 and titratable acidity (TA) of 2.8 g/L within 42 days of fermentation, suggesting potential antioxidant activity. The FTIR technique revealed the changes/deformation of functional groups and SEM study suggested the interaction/adhesion between starter culture L. plantarum (MTCC 1325) on EFY lacto-pickle. The starter culture used clearly influenced volatile organic compounds (VOCs) profiles of EFY lacto-pickle. Moreover, EFY lacto-pickle produced with the starter culture significantly perceived a positive response in the overall acceptance. Overall results indicated the successful and accelerated EFY lacto-pickle was achieved when using L. plantarum (MTCC-1325) as starter culture and thus the possible use of this fortified product by the consumers in their diet.

Dynamics of bacterial communities in a river water treatment wetland Abstract Bacteria play important roles in the removal of inorganic and organic pollutants in constructed wetlands (CWs) used for surface water treatment, however, the environmental variables driving the change of bacterial community remain poorly understood. The present work explored seasonal and spatial dynamics of bacterial communities in a large CW used for river water treatment and the associated environmental variables. Quantitative PCR assay and high-throughput sequencing analysis were used to determine the abundance, richness, diversity, and structure of wetland bacterial community. Bacterial abundance was correlated to nitrite and temperature, while bacterial diversity could be influenced by pH as well as carbon, nitrogen, and phosphorus. Bacterial community structure might be shaped by nitrogen and phosphorus. A considerable difference in bacterial community composition existed between wetland soils and sediments. Proteobacteria (accounting for 33–60%) was the largest bacterial phylum, and Chloroflexi (5–24%) was also abundant. The abundance, richness, diversity, and composition of the bacterial community were influenced by wetland plant type and wetland trophic status.

MALDI-TOF/TOF mass spectrometry for determination of yeast diversity in traditional cornelian cherry tarhana produced with different cereal/pseudocereal flours Abstract Purpose This study is to determine the dynamics in the microflora of cornelian cherry tarhana (CCT), a traditional food of Turkey, by MALDI-TOF/TOF MS. Methods Non-fermented and fermented CCT productions were performed by using flours of bread wheat, wholegrain hull-less barley, buckwheat, and clear flour. Identification of the isolates obtained from raw materials and various production steps of the CCT was performed by MALDI-TOF/TOF MS. Dendograms were prepared by cluster analysis and the distances between the strains isolated during production stages and from cornelian cherry puree were determined. Results Totally, 231 isolates were obtained and 45.5% of them were identified at species level, 30.3% at genus level while 24.2% of the isolates could not be identified. It was found that microflora of cornelian cherry tarhana is mainly composed of yeasts. Thirty-two percent of the identified yeast isolates were Hanseniaspora uvarum and the others were Saccharomycescerevisiae (19.6%), Torulaspora delbrueckii (18.6%), Candida krusei (11.3%), Candida lusitaniae (9.3%), Metschnikowia pulcherrima (3.1%), Wickerhamomyces anomalus (2.1%), Candida kefyr (2.1%), Cyberlindnera fabianii (1%), and Candida parapsilosis (1%). Only two lactic acid bacteria could be isolated, which were Lactobacillus reuteri and Enterococcus spp., originating from buckwheat flour and clear flour, respectively. Dendograms revealed that some of the yeast strains isolated during production were originating from cornelian cherry. Conclusions Microflora of CCT was investigated for the first time. This is one of the few studies using MALDI-TOF/TOF MS for identification of food originated yeasts. Novel species–identified, endogenic yeasts which could have potential technological characteristics were introduced.

Inulinase hyperproduction by Kluyveromyces marxianus through codon optimization, selection of the promoter, and high-cell-density fermentation for efficient inulin hydrolysis Abstract This study aimed to overexpress an inulinase gene in Kluyveromyces marxianus to achieve the inulinase overproduction and preparation of ultra-high-fructose syrup. First, the inulinase gene (INU1 gene) was overexpressed through codon optimization and selection of a suitable promoter. Then, the inulinase was overproduced by high-cell-density fermentation. Finally, ultra-high-fructose syrup was prepared. It was found that optimization of the codons of the native INU1 gene encoding inulinase from Kluyveromyces marxianus KM-0 made a recombinant strain KM-N70 carrying the optimized INU1N gene produce 251.4 U/mL of the inulinase activity. Furthermore, inulinase activity produced by a recombinant KM-KN16 strain carrying the optimized INU1N gene directed by the native TPS1 promoter from K. marxianus KM-0 reached 338.5 U/mL and expression level of the optimized INU1N gene in the recombinant KM-KN16 strain was also greatly enhanced. During a 10-L fermentation, the recombinant KM-KN16 strain could produce 374.3 U/mL of inulinase activity within 24 h, while during a high-cell-density fed-batch fermentation, the recombinant KM-KN16 strain could produce 896.1 U/mL of inulinase activity and OD600nm value of its culture reached 108. The crude inulinase preparation obtained in this study had an inulinase activity of 18,699.8 ± 736.4 U/g of the crude preparation. It was found that 90.3% of 332.4 g/L of inulin was hydrolyzed to produce 41.0 g/L of glucose and 256.0 g/L of fructose and 91.1% of 328.2 g/L of inulin in the extract of the tubers of Jerusalem artichoke was hydrolyzed to produce 48.3 g/L of glucose and 250.5 g/L of fructose by the crude inulinase preparation (75 U/g of the substrate) within 8 h. The hydrolysates contained major monosaccharides and a trace amount of trisaccharides and the monosaccharides were composed of around 85% fructose and 15% glucose. So far, any other yeasts available have produced only up to 120 U/mL of inulinase activity. Together, this made the recombinant KM-KN16 strain be the best inulinase producer at this moment. The inulinase activity of 18,699.8 ± 736.4 U/g of the crude preparation and the ultra-high-fructose syrup with 41.0 g/L of glucose and 256.0 g/L of fructose were obtained. The inulinase activity obtained in this study was the highest among all the inulinase activities produced by yeast, fungal, and bacterial strains obtained so far.

Diversity of β-lactam resistance genes in gram-negative rods isolated from a municipal wastewater treatment plant Abstract Urban wastewater treatment plants (UWTPs) are considered hot spots for the accumulation and transfer of antibiotic resistant bacteria and their genes. We investigated the prevalence, diversity, and genomic localization of β-lactamase resistance genes in wastewater from different parts of an UWTP, such as raw wastewater, wastewater from biological reactor, and treated wastewater, collected from the UWTP of Warsaw, Poland. In this study, we focused on gram-negative rods, mainly Enterobacteriaceae, and used Multiplex PCR to identify various β-lactamase resistance genes (bla). Susceptibility to a number of antibiotics and genomic localization of β-lactamase resistance genes were then determined using disc-diffusion and Southern hybridization methods, respectively. No differences in the frequency of different types of bla genes between the sampling points were discerned. Three new variants of β-lactamase genes (blaCMY-157, blaMOX-13, and blaFOX-15) were identified. Four bla genes (blaTEM-12, blaTEM-30, blaTEM-47/68, blaACT) that had never been found in UWTPs were identified in this study. Nine of the identified bla genes had been found in the same environment previously. The blaFOX-15 variant on a Kluyvera sp. plasmid and blaGES type on Raoultella spp. plasmids were observed for the first time in these genera. There was a decrease in the number of multidrug resistant strains in the effluent compared to the influent. Finally, a significantly higher number of cefotaxime and carbapenem unsusceptible strains were detected in the influent than in the effluent. The results strongly support the hypothesis of UWTPs as a hot spot for antibiotic resistant genes (ARGs) and antibiotic resistant bacteria (ARB) accumulation and indicate that β-lactamase genes are widely disseminated among gram-negative rods isolated from this environment.

Capability of plant growth-promoting bacteria in chromium-contaminated soil after application of composted tannery sludge Abstract The aim of this study was to select bacterial strains with biochemical capability to tolerate high concentration of chromium (Cr) in soils. Plant growth-promoting bacteria (PGPB) were isolated from the root nodules of Phaseolus lunatus and grown in Cr-contaminated soil with the application of composted tannery sludge. Soils were collected from the experimental field with the application of composted tannery sludge (CTS) in five rates: 0, 2.5, 5, 10, and 20 t ha−1 CTS. Bacterial strains were isolated and evaluated for their biochemical capabilities for production of urease, protease, amylase, lipase, catalase, gelatinase, and indole-3-acetic acid, P solubilization, and Cr tolerance. A total of 54 PGPB were isolated from the nodules, being 40%, 37%, 13%, and 10% found in the treatments with 2.5, 5, 10, and 20 t ha−1, respectively. The majority of these isolates presented positive responses for the tests of urease, catalase, and phosphate solubilization, while some isolates were positive for the test of protease, lipase, carboxymethyl cellulose, gelatinase, and amylase. We also observed a decrease in the number of isolates able to tolerate high concentration of Cr. Three strains (UFPI-LCC61, UFPI-LCC64, and UFPI-LCC87) presented high biochemical capability and tolerance to Cr. However, the isolate UFPI-LCC87 showed high biochemical capability and tolerance to the highest concentration of Cr. Our results indicated bacterial strains that present potential to be used in soils contaminated with Cr and also for promoting plant growth.

Lichens and other lithobionts on the carbonate rock surfaces of the heritage site of the tomb of Lazarus (Palestinian territories): diversity, biodeterioration, and control issues in a semi-arid environment Abstract Purpose Investigations on the lithobiontic colonization of the stone cultural heritage in (semi-)arid regions are needed to address conservation strategies. In this work, lithobiontic communities were examined on the carbonate rock surfaces of the heritage site of the Tomb of Lazarus. We aimed to evaluate their distribution and interaction with the lithic substrate, together with the efficacy of biocidal treatments for their control. Methods Diversity and abundance of lithobionts were surveyed on the Jerusalem stone blocks of three architectural elements. Observations at the lichen-rock interface were carried out by reflected light and scanning electron microscopy. The efficacy against lichens of the widely used biocide benzalkonium chloride (BZC) was compared for different concentrations and application methods, and evaluated by epifluorescence microscopy. Results Chlorolichens were the dominant component of lithobiontic communities, more thoroughly adapted to the semi-arid conditions of the site than mosses and black biofilms of cyanobacteria and dematiaceous fungi. A different structural organization, in terms of thallus thickness and depth of the hyphal penetration component, characterized epilithic and endolithic lichen species, responsible for different deteriogenic activities. Biocidal assays showed that even the methodologies that are usually effective in temperate conditions (as the application of BZC 1.5% by poultice) may not completely devitalize lichens adapted to the stress conditions of semi-arid climates, unless a pervasive biocide diffusion through metabolically active thalli is carefully guaranteed. Conclusion Lithobionts act as biodeteriogens on the semi-arid surfaces of the investigated heritage site. Their removal is thus recommendable, but it needs to be adequately supported with a careful calibration of devitalization strategies.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Autism and Developmental Disorders

Fundamental Motor Skill Interventions for Children and Adolescents on the Autism Spectrum: a Literature Review Abstract In addition to the core characteristics of ASD, recent research has demonstrated that children on the autism spectrum develop motor skills differently, often delayed, compared with peers. Motor skill interventions can help improve motor skills, which in turn can increase the likelihood of participating in physical activity (PA) and potential to build social skills. However, research in this area is limited. A search of several prominent databases revealed a total of five empirical studies focused on building gross motor skills for children on the autism spectrum. Although the reviewed studies varied in the delivery and focus of intervention, overall, the reviewed studies suggest a positive effect from any intervention for children on the autism spectrum. Further research in this area is necessary to better understand the most effective means of delivering a motor skill intervention.

The Perceptions of School Involvement of Parents of Students with Autism Spectrum Disorders: a Systematic Literature Review Abstract Several different types of parent involvement with schools have been identified in the special education and general education literature, including (a) advocacy, (b) collaborative partnership, (c) home-school communication, and (d) school-based participation. However, it is unclear which types of involvement are addressed in the literature and how parents of children with autism spectrum disorders perceive these types of school involvement. In this systematic literature review, we synthesized this body of literature, which consisted of 37 studies published from 2001 to 2017. Authors addressed all four types of parent involvement using a range of measures, most frequently addressing home-school communication. Limitations and implications for research and practice are discussed, including the importance of collecting and reporting on the characteristics of survey respondents and identifying and validating common measures across studies.

Considering Methodological Accommodation to the Diversity of ASD: A Realist Synthesis Review of Data Collection Methods for Examining First-Person Experiences Abstract Drawing on a realist synthesis approach, this review identified qualitative data collection approaches that inform "first-person" lived experience in autism spectrum disorder (ASD) across phenotypic expression. It further drew upon methodologic approaches used in other conditions that similarly represent individuals with impaired verbal expression. The aim of this realist synthesis approach was to identify methods with relevance to participants across the autism spectrum. Methods that emerged for eliciting first-hand perspectives consisted of photovoice, Talking Mats, "deep assessment," SenseCam, and TimeSlips. Applying these methodologies in ASD has the potential to advance knowledge about the quality of life, priorities and needs of people with ASD, and advanced qualitative approaches beyond methods that are not inclusive of cognitive and expressive diversity.

A Systematic Review of Generalization and Maintenance Outcomes of Social Skills Intervention for Preschool Children with Autism Spectrum Disorder Abstract Generalization and maintenance of intervention outcomes are of paramount importance in achieving socially significant outcomes within applied behavior analysis. Social skills interventions for young children with autism spectrum disorders (ASD) are widely represented within the empirical literature; however, generalization and maintenance outcomes are often under reported. While recognition of the importance of generalization and maintenance is increasing, there is a lack of research systematically evaluating these outcomes and the factors that support successful generalization and maintenance. The current review aimed to investigate the status of generalization and maintenance within the social skills intervention literature for preschool age children with ASD. A total of 57 studies which measured generalization and/or maintenance of social skills intervention outcomes were included in the current review and evaluated regarding generalization and maintenance data collection and assessment, generalization-promotion strategies employed, generalization and maintenance outcomes, and factors posited to influence these outcomes.

Applications of Supervised Machine Learning in Autism Spectrum Disorder Research: a Review Abstract Autism spectrum disorder (ASD) research has yet to leverage "big data" on the same scale as other fields; however, advancements in easy, affordable data collection and analysis may soon make this a reality. Indeed, there has been a notable increase in research literature evaluating the effectiveness of machine learning for diagnosing ASD, exploring its genetic underpinnings, and designing effective interventions. This paper provides a comprehensive review of 45 papers utilizing supervised machine learning in ASD, including algorithms for classification and text analysis. The goal of the paper is to identify and describe supervised machine learning trends in ASD literature as well as inform and guide researchers interested in expanding the body of clinically, computationally, and statistically sound approaches for mining ASD data.

Addressing the Mathematics Gap for Students with ASD: an Evidence-Based Systematic Review of Video-Based Mathematics Interventions Abstract This systematic review of literature synthesizes research on video-based instruction (VBI) to teach mathematics to students with autism spectrum disorder (ASD). Eleven studies, including gray literature, were included in the synthesis resulting in data analysis of performance from 29 participants. To better align with transparent reporting guidelines of PRISMA (Moher et al., PLoS Medicine 6(7), 2009), we synthesize information regarding participants, intervention outcomes, and study design. Effects of student and study-level outcomes are presented in non-overlapping data (PND) and improvement rate difference (IRD). Findings show VBI has considerable support for positive effects across types of VBI, student characteristics, and mathematical concepts. Effective interventions incorporated academic and behavioral components with evidence base. With six studies demonstrating strong evidence, 16 individual cases of effect, and research spanning at least three research teams and research locations, results indicate that VBI meets minimum evidence set forth by Reichow et al., (Journal of Autism and Developmental Disorders 38:1311–1319, 2008) to be an established evidence-based practice to teach mathematics to students with ASD.

Measuring the Academic Outcomes of iPads for Students with Autism: a Meta-Analysis Abstract The ability for individualization and the wide array of available apps have made portable electronic devices popular for use with students with autism, particularly in the classroom. The current study examined the effectiveness of using iPads to deliver academic interventions to students with autism. Seven studies using iPads with single-case deigns and small samples were analyzed through both Tau-U and hierarchical linear modeling (HLM) techniques. Analysis of potential moderating variables indicated no significant differences across academic subject, grade of participants, or number of sessions. However, the HLM analyses revealed a significant difference for the introduction of the intervention. Discussion focuses on the use of iPads for academic interventions for students with autism and recommendations for practitioners.

Effective Interventions in Teaching Employment Skills to Individuals with Developmental Disabilities: A Single-Case Meta-analysis Abstract This meta-analysis analyzed 39 studies that met the inclusion criteria for employment-related interventions for individuals with developmental disabilities. Each experiment included in this analysis either met or met with reservations all of the basic design standards (Kratochwill et al. 2010, 2013). Tau-U effect sizes were calculated for each A–B contrast extracted from the included experiments, and moderator analyses were conducted for dependent variables, participant characteristics, setting characteristics, and implementer characteristics for all video modeling interventions. Moderate to strong effects were seen across almost all moderator levels, and few significant differences were determined between the levels. According to overall effect sizes, all interventions were effective, but video modeling interventions were considered not only to be effective but also evidence-based interventions in teaching employment skills to individuals with developmental disabilities.

Modelling Me, Modelling You: the Autistic Self Abstract The stereotype of autism spectrum conditions (ASC or 'autism') focuses on the social and communicative elements of the diagnostic criteria. In this review, we step back from autism as a social and communicative disorder and focus on the autistic self. The autistic self is a key component of the condition which has nevertheless received comparatively little attention. We provide a taxonomy for experimental paradigms in the cognitive sciences that aim to address questions related to the self. We articulate reasons based on domain-general cognitive mechanisms, autobiography and historical conceptions for why the self might differ in ASC. We conclude with elucidating the implications of a predictive processing account of autism on conceptualising the autistic self and how this fits with existing literature, with a focus on context sensitivity, model complexity, learning, integration, active inference and precision. This opens up large scope for future research on unique differences in the autistic self, which could be extended as a framework for understanding the condition as a whole in a new and unified way.

Abnormal Structural and Functional Connectivity of the Corpus Callosum in Autism Spectrum Disorders: a Review Abstract Autism spectrum disorder (ASD) is characterised by difficulties with social communication, interaction, and repetitive and stereotypical patterns of behaviour. Recent studies suggest that abnormalities in the corpus callosum (CC) can produce autistic symptoms, so this cerebral structure is a target for autism research. It is the largest area of white matter fibre that connects the cerebral hemispheres and has been considered an index of interhemispheric connectivity. The poor connectivity that is a characteristic of autism could be due to CC abnormalities. In this review, we describe empirical studies that have used functional magnetic resonance imaging (fMRI) and diffusion tensor imaging (DTI) to investigate the role of the CC in functional and structural brain connectivity in individuals with ASD. Establishing the anatomical correlates of abnormal connectivity in ASD is a major objective of structural and functional connectivity studies. Reduced CC volume is one of the most consistent findings in studies of autistic brains. Structural connectivity studies have shown that the CC is generally altered in ASD. In addition, functional connectivity studies show atypical activity in individuals with ASD during social cognition tasks, working memory tasks, and tests of executive function. Research on functional and structural connectivity has contributed to understanding the role of the CC in the clinical symptoms and social and cognitive deficits associated with ASD.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Applied Physiology

Correction to: Inert gas narcosis in scuba diving, different gases different reactions The original version of this article unfortunately contained a mistake.

Correction to: Suspension syndrome: a potentially fatal vagally mediated circulatory collapse—an experimental randomized crossover trial The original version of this article unfortunately contained a mistake. Information was missing in the acknowledgements section. The correct information is given below.

Hoffman MD, Snipe RM, Costa RJ (2018) Ad libitum drinking adequately supports hydration during 2 h of running in different ambient temperatures. Eur J Appl Physiol 118:2687–2697

Response to Armstrong and Bergeron

Reply to the Letter to the Editor: Utility of lacrimal caruncle infrared thermography when monitoring alterations in autonomic activity in healthy humans

Utility of infrared thermography when monitoring autonomic activity

Physiological comparison between non-athletes, endurance, power and team athletes Abstract We hypothesized that endurance athletes have lower muscle power than power athletes due to a combination of weaker and slower muscles, while their higher endurance is attributable to better oxygen extraction, reflecting a higher muscle oxidative capacity and larger stroke volume. Endurance (n = 87; distance runners, road cyclists, paddlers, skiers), power (n = 77; sprinters, throwers, combat sport athletes, body builders), team (n = 64; basketball, soccer, volleyball) and non-athletes (n = 223) performed a countermovement jump and an incremental running test to estimate their maximal anaerobic and aerobic power (VO2max), respectively. Dynamometry and M-mode echocardiography were used to measure muscle strength and stroke volume. The VO2max (L min−1) was larger in endurance and team athletes than in power athletes and non-athletes (p < 0.05). Athletes had a larger stroke volume, left ventricular mass and left ventricular wall thickness than non-athletes (p < 0.02), but there were no significant differences between athlete groups. The higher anaerobic power in power and team athletes than in endurance athletes and non-athletes (p < 0.001) was associated with a larger force (p < 0.001), but not faster contractile properties. Endurance athletes (20.6%) had a higher (p < 0.05) aerobic:anaerobic power ratio than controls and power and team athletes (14.0–15.3%). The larger oxygen pulse, without significant differences in stroke volume, in endurance than power athletes indicates a larger oxygen extraction during exercise. Power athletes had stronger, but not faster, muscles than endurance athletes. The similar VO2max in endurance and team athletes and similar jump power in team and power athletes suggest that concurrent training does not necessarily impair power or endurance performance.

Cross-education: effects of age on rapid and maximal voluntary contractile characteristics in males Abstract Purpose The purpose of this study was to determine the effect of age on the cross-education of rapid and maximal contractile properties for the knee extensors. Methods Young (n = 10; age = 21.1 ± 1.7 years) and older (n = 10; age = 65.3 ± 8.3 years) males performed unilateral isokinetic resistance training (RT) of the knee extensors for 4 weeks. Maximal voluntary isokinetic (45° s−1 and 300° s−1) and isometric testing was conducted for the trained and untrained leg before and after RT. Peak torque (PT) and acceleration were obtained from isokinetic testing as well as torque at 30 ms (TQ30) and 100 ms (TQ100) from the 45° s−1 contraction. PT and rate of torque development were recorded from the isometric contractions. Results Independent of age, isometric PT (10.1%; p = 0.006) as well as PT and acceleration at 300° s−1 (6.7%; p = 0.008 and 4.0%; p = 0.016, respectively) increased in the untrained leg. At 45° s−1, acceleration was increased (3.6%; p = 0.021), but PT remained unchanged (p = 0.227). TQ100 increased similarly between groups (4.5%; p = 0.014), but TQ30 increased only in the older group (9.5%; p = 0.022). Conclusions Cross-education of rapid and maximal contractile parameters can be achieved early during unilateral RT independent of age. These findings indicate the potential for particular unilateral RT protocols to be used for older adults in rehabilitative settings to offset disuse-related reductions in contractile function, which are most dramatic in this population.

The time course of cross-education during short-term isometric strength training Abstract Purpose This study examined the time course of contralateral adaptations in maximal isometric strength (MVC), rate of force development (RFD), and rate of electromyographic (EMG) rise (RER) during 4 weeks of unilateral isometric strength training with the non-dominant elbow flexors. Methods Twenty participants were allocated to strength training (n = 10, three female, two left hand dominant) or control (n = 10, three female, two left hand dominant) groups. Both groups completed testing at baseline and following each week of training to evaluate MVC strength, EMG amplitude, RFD and RER at early (RFD50, RER50) and late (RFD200, RER200) contraction phases for the dominant 'untrained' elbow flexors. The training group completed 11 unilateral isometric training sessions across 4 weeks. Results The contralateral improvements for MVC strength (P < 0.01) and RFD200 (P = 0.017) were evidenced after 2 weeks, whereas RFD50 (P < 0.01) and RER50 (P = 0.02) showed significant improvements after 3 weeks. Each of the dependent variables was significantly (P < 0.05) greater than baseline values at the end of the training intervention for the trained arm. No changes in any of the variables were observed for the control group (P > 0.10). Conclusions Unilateral isometric strength training for 2–3 weeks can produce substantial increases in isometric muscle strength and RFD for both the trained and untrained arms. These data have implications for rehabilitative exercise design and prescription.

Suspension syndrome: a potentially fatal vagally mediated circulatory collapse—an experimental randomized crossover trial Abstract Purpose Suspension syndrome describes a potentially life-threatening event during passive suspension on a rope. The pathophysiological mechanism is not fully understood and optimal treatment unknown. We aimed to elucidate the pathophysiology and to give treatment recommendations. Methods In this experimental, randomized crossover trial, 20 healthy volunteers were suspended in a sit harness for a maximum of 60 min, with and without prior climbing. Venous pooling was assessed by measuring the diameter of the superficial femoral vein (SFV), lower leg tissue oxygenation (StO2) and by determining localized bioelectrical impedance. Hemodynamic response was assessed by measuring heart rate, blood pressure, stroke volume, and left ventricular diameters. Signs and symptoms of pre-syncope were recorded. Results Twelve (30%) out of 40 tests were prematurely terminated due to pre-syncopal symptoms (mean 44.7 min, minimum 13.4, maximum 59.7). SFV diameter increased, StO2 and the capacitive resistance of the cells decreased indicating venous pooling. Heart rate and blood pressure did not change in participants without pre-syncope. In contrast, in participants experiencing pre-syncope, heart rate and blood pressure dropped immediately before the event. All symptoms dissolved and values returned to normal within 5 min with participants in a supine position. Conclusions Sudden pre-syncope during passive suspension in a harness was observed in 30% of the tests. Blood pools in the veins of the lower legs; however, a vagal mechanism finally leads to loss of consciousness. Time to pre-syncope is unpredictable and persons suspended on a rope should be rescued and put into a supine position as soon as possible.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

Culture, Medicine, Psychiatry

Distinguishing Core from Peripheral Psychiatric Symptoms: Addictive and Problematic Internet Gaming in North America, Europe, and China Abstract We explore the problem of distinguishing the relatively constant versus culturally variable dimensions of mental suffering and disorder in the context of a cross-cultural study of Internet gaming-related distress. We extend the conceptual contrast of "core" and "peripheral" symptoms drawn from game studies and use a framework that synthesizes cultural and neurobiological understandings of emotional distress. In our framework, "core" symptoms are relatively constant across cultures and therefore presumed to be more closely tied to a neurobiological base. By contrast, we treat as "peripheral" symptoms those that are more culturally variable, and thus less directly tied to the neurobiology of addiction. We develop and illustrate this approach with a factor analysis of cross-cultural survey data, resting on previous ethnographic work, through which we compare online gaming distress experienced in North America (n = 2025), Europe (n = 1198), and China (n = 841). We identify the same four-factor structure across the three regions, with Addiction always the first and most important factor, though with variability in regional factors' exact item composition. The study aims to advance an integrative biocultural approach to distinguishing universal as opposed to culturally contingent dimensions of human suffering, and to help resolve debates about whether problem gaming represents a form of addiction.

Finding Common Ground in the Context of Difference: A South African Case Study Abstract In a rapidly transforming world, cultural assimilation and the hybridity of clients and therapists are increasingly acknowledged. Juxtaposed against universalist and relativist discourses in Cultural Psychiatry, the elucidation of perceived "difference" from cultural norms, constructed as being observed in the lives of either the client, or therapist, or both, requires critical reflection on how such norms are derived and by whom. This cultural case study describes a clinical encounter between a Muslim South African woman, and a South African man of Afrikaner descent. A shared experience of marginalization led to surprising similarities and common ground against obvious cultural differences, which have contributed to the strengthening of the therapeutic relationship and consolidation of trust. Beside the more parsimonious focus on "shared marginalization" as a potential bridge to move towards transcending overt cultural differences, the case study's emphasis on a shared humanity within the interwoven texture of perceived difference go beyond dichotomous discourses that sharply dissect "sameness" from "otherness". This may well have relevance to any clinical encounter in which identity is dynamically presented and re-presented in complex ways.

Differences on Quality of Life of Patients with Schizophrenia: A Multicentric Study from Three Latin-America Countries Abstract The aim of the study is to explore the variation on patient's Quality of Life (QoL) across three Latin-Americans countries. The study included 253 stabilized outpatients with schizophrenia from three Mental Health Services in Bolivia (N = 83), Chile (N = 85) and Peru (N = 85). Patients' were assessed using Schizophrenia Quality of Life Questionnaire (SQoL18). We collected socio-demographic information and clinical data, while recognizing the cultural complexity/dynamics of each country, and the influence of cultural contexts on how people experience the health systems. There are differences in QoL according to each country. Peru reports better levels of QoL at the Total Score Index and in most of the dimensions of the SQoL18. Bolivia shows the lowest indicators of QoL, except, interestingly, for the Resilience dimension where it reaches the highest scores. Even when the studied regions in the three Latin American countries share several cultural characteristics, there are also some important differences between them on patients' QoL. Possible disparities at investment in mental health by the Governments of each country are discussed while possible influences of (inter)cultural contexts are taken into account.

Enacting Homebirth Bodies: Midwifery Techniques in Germany Abstract Building on insights from science and technology studies-inspired anthropological research on reproduction, this paper uses a praxiographic approach to analyze homebirth midwifery practices in Germany. I show that such practices are syncretic, and that techniques of routinizing and multiplying obstetrical interventions are combined in more or less coherent ways to configure pregnancies and births as physical, emotional, and social becomings. In the process of attending, homebirth bodies learn to co-respond to each other, to the midwifery techniques, and to the homebirth environment. Understanding how and with which aims midwives and women invest in those longterm engagements specific to homebirth surroundings may inform clinical practices.

What is 'Alzheimer's Disease'? The 'Auguste D' Case Re-opened Abstract What is Alzheimer's: an organic, neuropathological psychiatric disease, caused by plaques and tangles in aging brains or/and an existential condition affecting the minds of aging persons experiencing disconnection from meaning-bearing networks of social relations? Reviewing current research and revisiting Alzheimer's original case of 'Auguste D' this paper offers an historical–sociological genealogy that raises fundamental questions of causality, and even of the ontological status of Alzheimer's and the dementia reputed to it as a disease entity. Drawing on Kuhn's notion of 'science as usual' and Foucault's notion of the discursive formation of 'regimes of truth', our analysis seeks to understand how a sole medical focus on either bio-markers of neurological disease or genetic association was accomplished in the absence of sufficient and robust evidence. To counter the exclusion of psychosocial considerations, this paper offers two original hypotheses on the iconic case of 'Auguste D', taking into account the social milieu in which she lived and the specific circumstances of her life. It goes on to suggest the way in which the contemporary socio-cultural context may have dementiagenic tendencies. This research supports Gaines and Whitehouse's argument that research into the phenomenon and symptoms of Alzheimer's should focus on extracorporal and psychosocial factors.

Refracting Affects: Affect, Psychotherapy, and Spirit Dis-Possession Abstract The notion of affect has generated much confusion in anthropology given its focus on that which seems to escape our language. The evanescent features of affects have irritated many anthropologists who consider affect theory as an empirically weak or esoteric hermeneutics. In this article, I respond to these critiques by developing an anthropology of therapy that foregrounds the role of affects. My intent is to explore the possible contribution of affect theory to medical and psychological anthropology. I draw from my ethnography on couple's therapy in Argentina to suggest that we cannot understand therapeutic efficacy if we focus only on language and discourse. I ask what it means to regard affects as late modern spirits and take psychotherapy as a modern ritual of "affect dispossession." I propose to ask how affects, like spirits, can haunt our present rendering our lives barely livable. Focusing on a session of therapy in Buenos Aires, I describe how a therapist channels the spirit of impasse that colonizes the lives of her patients. Developing an enchanted hermeneutics, I engage with Eve Sedgwick's call for an other-than-paranoid social theory by engaging the imagination as an important organ of perception in the medical anthropology of affects.

Blood, Sweat, and/or Tears: Comparing Nervios Symptom Descriptions in Honduras Abstract With the aim of advancing the cross-cultural investigation of the folk illness nervios, I conducted a dual-sited comparative study of symptom descriptions among two diverse research settings in Honduras. Baer et al. (Cult Med Psychiatry 27(3):315–337, 2003) used cultural consensus modeling (CCM) to confirm a core description of nervios among four Latino groups in the US, Mexico, and Guatemala, but observed that overall agreement and average competence in a shared illness model decreased along a gradient from presumably more-to-less economically developed sites. This has left unresolved whether such variation extends to other Latin American regions. This paper is an exploratory analysis of inter- and intracultural variation in nervios symptom descriptions by 50 Hondurans from the market town of Copán Ruinas (n = 25) and city of San Pedro Sula (n = 25). I performed CCM using a combination of free-listing, pile-sorting, and rating activities to establish if respondents across sites share a single model of nervios. I found consensus for the San Pedro Sula subsample, but not for Copán Ruinas or for the overall sample. Results suggest nervios is constitutive of differing forms of distress ranging from chronic illness to acute suffering, as well as anger- and panic-based manifestations that overlap with biomedical ideas about depression, anxiety, and panic disorder. This variation derives in part from demographic factors such as age, gender, and residence, but may also result from ethnic and regional diversity among subsamples. However, consensus only being present among San Pedro Sula respondents suggests their greater awareness of cultural distinctions between biomedical and folk medical knowledge, which is likely due to their exposure to manifold health frameworks in those settings.

How to Fail a Scale: Reflections on a Failed Attempt to Assess Resilience Abstract How we interpret concepts from suffering to survival has been historically debated in the field of anthropology, transcultural psychiatry, and global mental health. These debates have centered on the notion that such concepts are cross-culturally reproducible, although scholars who work the boundaries of culture, medicine, and psychiatry often triangulate methods from internationally standardized scales to various interpretive methods from participant observation to narrative. This article considers resilience, as opposed to suffering, as the subject of a reproducible entity by discussing the failure of an attempt to capture resilience via an internationally reputed scale called the "Resilience Scale for Adults" among cancer patients in urban South Africa. Our effort to utilize the internationally validated scale, and our attempt to draw on ethnographic and interview work to translate this scale to a locally relevant entity failed due to linguistic, cultural, and practical issues. In brief, the attempt failed because our resilience scale was too long, syntactically ambiguous, and culturally inappropriate. We write this article to spur a larger conversation about evaluating resilience from scale to ethnography, and how the concept and measurement of resilience might figure into fields of anthropology and medicine.

Global Mental Health and Idioms of Distress: The Paradox of Culture-Sensitive Pathologization of Distress in Cambodia Abstract Efforts to provide culturally appropriate global mental health interventions have included attention to local idioms of distress. This article critically examines the potential gap between lay ethnopsychological understandings of the Cambodian idiom of baksbat (broken courage) on the one hand and clinical conceptualizations of the idiom as a potential indicator of posttraumatic stress disorder. Ethnographic semi-structured interviews with trauma survivors reveal resistance to current clinical translations and hybrid Euro-Western and Khmer treatment interventions. While the notion of idioms of distress is intended to draw attention to everyday non-pathologizing forms of discourse, the creation of hybrid assessment and treatment constructs linking idioms to trauma-related pathology may obscure the pragmatic communicative functions of the idiom, making them subordinate to an existing model of psychiatric disorder and pathologizing everyday modes of coping. Participants' narratives highlight self-perceived connections between stressors that determine the trajectory and outcome of distress and shared cultural worldviews that together uniquely shape their meaning. These observations point to the dilemmas of linking idioms of distress with co-morbid illness constructs in ways that may pathologize normal emotional responses. Results have implications for efforts to develop effective models of post-conflict trauma care in global mental health.

"How Can We Help You": Mental Health Practitioners' Experiences of Service Provision in Northern Namibia Abstract Although 12–13% of Namibians are reported to struggle with psychological distress, very few practitioners are available to provide mental health services in Namibia. Those practitioners who are available are often trained from Western counseling and psychiatric perspectives that may not readily align to beliefs about illness held constructed in Namibian cultures. Institutional effort is invested in the education and use of mental health practitioners, including counselors, social workers, nurses, psychologists, and psychiatrists. However, little is known about the experiences of these providers. Therefore, this study, a grounded theory ethnography, was undertaken as part of broader ethnographic work to understand how mental health practitioners (N = 7) in Northern Namibia view their work with Aawambo Namibians given that Namibian mental health practitioners are few but embedded in the country's health care system. Four categories were identified in analyses: Provision of Mental Health Services in the North, Practitioners' Conceptualizations of Psychological Distress: Western and Aawambo Influences, Beliefs about Mental Health Services in the North, and Integration of Traditional Treatment and Counseling. Results are discussed with respect to cultural competence in Namibian mental health practice and potential for integrating traditional practices and mental health services.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com