As the understanding of the intrinsic reliance of the anterior cruciate ligament on the medial collateral ligament (MCL) has grown, we have delved further into trying to understand what specific ...function needs to be restored in their combined injury. At the same time, we have expanded our knowledge of the relation between the MCL and the medial meniscus. It is a great step forward for our knowledge to begin to infer medial stability from the status of the medial meniscus in these complex cases. In my practice, this manifests as understanding that a floating meniscus indicates deep MCL injury, which makes me more likely to treat a moderate MCL injury operatively. I look forward to the continued understanding of the dynamic positioning of the medial meniscus and its treatment in combined anterior cruciate ligament–MCL injuries.
Attachment theory is a comprehensive, empirically supported theory of emotional, relational, and neurophysiological development. Modern psychoanalysis is a theory of technique that addresses early ...psychological deficits and conflicts considered beyond the reach of traditional psychoanalysis. Both orientations have influenced the theory and practice of group psychotherapy and emphasize personality maturation as a treatment goal. This paper explores their potential synergies when treating preoedipal, insecurely attached emotional states, disrupted emotional self-regulation, and impaired mentalization. Theoretical and technical applications are suggested that may enhance the treatment of disordered attachment in group psychotherapy. By addressing insecure attachment as resistance, modern psychoanalytic techniques may engage the emotional substrates of the attachment process to facilitate the expansion of relational capacities, mentalization, self-regulation, the differentiation of self/other representations, and epistemic trust.
Choroideremia (CHM) is an X- linked retinal degeneration that is symptomatic in the 1(st) or 2(nd) decade of life causing nyctalopia and loss of peripheral vision. The disease progresses through ...mid-life, when most patients become blind. CHM is a favorable target for gene augmentation therapy, as the disease is due to loss of function of a protein necessary for retinal cell health, Rab Escort Protein 1 (REP1).The CHM cDNA can be packaged in recombinant adeno-associated virus (rAAV), which has an established track record in human gene therapy studies, and, in addition, there are sensitive and quantitative assays to document REP1 activity. An animal model that accurately reflects the human condition is not available. In this study, we tested the ability to restore REP1 function in personalized in vitro models of CHM: lymphoblasts and induced pluripotent stems cells (iPSCs) from human patients. The initial step of evaluating safety of the treatment was carried out by evaluating for acute retinal histopathologic effects in normal-sighted mice and no obvious toxicity was identified. Delivery of the CHM cDNA to affected cells restores REP1 enzymatic activity and also restores proper protein trafficking. The gene transfer is efficient and the preliminary safety data are encouraging. These studies pave the way for a human clinical trial of gene therapy for CHM.
Nonsyndromic recessive retinal dystrophies cause severe visual impairment due to the death of photoreceptor and retinal pigment epithelium cells. These diseases until recently have been considered to ...be incurable. Molecular genetic studies in the last two decades have revealed the underlying molecular causes in approximately two-thirds of patients. The mammalian eye has been at the forefront of therapeutic trials based on gene augmentation in humans with an early-onset nonsyndromic recessive retinal dystrophy due to mutations in the retinal pigment epithelium-specific protein 65kDa (RPE65) gene. Tremendous challenges still lie ahead to extrapolate these studies to other retinal disease-causing genes, as human gene augmentation studies require testing in animal models for each individual gene and sufficiently large patient cohorts for clinical trials remain to be identified through cost-effective mutation screening protocols.
This prospective study applied self-determination theory to investigate the effects of students' course-specific self-regulation and their perceptions of their instructors' autonomy support on ...adjustment and academic performance in a college-level organic chemistry course. The study revealed that: (1) students' reports of entering the course for relatively autonomous (vs. controlled) reasons predicted higher perceived competence and interest/enjoyment and lower anxiety and grade-focused performance goals during the course, and were related to whether or not the students drooped the course; and (2) students' perceptions of their instructors' autonomy support predicted increases in autonomous self-regulation, perceived competence, and interest/enjoyment, and decreases in anxiety over the semester. The change in autonomous self-regulation in turn predicted students' performance in the course. Further, instructor autonomy support also predicted course performance directly, although differences in the initial level of students' autonomous self-regulation moderated that effect, with autonomy support relating strongly to academic performance for students initially low in autonomous self-regulation but not for students initially high in autonomous self-regulation.
Abstract Deep medial collateral ligament (MCL) injury leads to meniscal lift-off and extrusion of the medial meniscus, resulting in instability and increased medial compartment pressures with ...subsequent cartilage damage. Repair of the deep MCL meniscotibial ligament in concert with superficial MCL repair or reconstruction is intended to restore the native anatomy , stability, and function of the medial meniscus. We present an arthroscopically assisted technique using standard arthroscopy portals and a medial open approach.
Verbal attacks are unavoidable within long-term psychotherapy groups. This article examines the inherent therapeutic value of potentially destructive exchanges. Group leader attempts to objectively ...define and regulate "attacks" are critiqued. A case example illustrates how leader interventions using induced feelings can enhance the therapeutic process and subsequent relational repair. Leader difficulties in identifying with the relational positions involved (attacker, victim, bystander) are explored, and a framework is offered for illuminating unconscious, dissociated, or unformulated emotional communications. It is argued that leader resistances may inadvertently promote and maintain group members' damaging tendency to direct aggression toward rather than away from the self. Instead of being avoided or controlled, verbal attacking can be considered meaningful developmental progress and leveraged clinically to promote emotional maturation within the group.
PurposeImmunodeficiency screening has been added to many state-directed newborn screening programs. The current methodology is limited to screening for severe T-cell lymphopenia disorders. We ...evaluated the potential of genomic sequencing to augment current newborn screening for immunodeficiency, including identification of non-T cell disorders.MethodsWe analyzed whole-genome sequencing (WGS) and clinical data from a cohort of 1,349 newborn-parent trios by genotype-first and phenotype-first approaches. For the genotype-first approach, we analyzed predicted protein-impacting variants in 329 immunodeficiency-related genes in the WGS data. As a phenotype-first approach, electronic health records were used to identify children with clinical features suggestive of immunodeficiency. Genomes of these children and their parents were analyzed using a separate pipeline for identification of candidate pathogenic variants for rare Mendelian disorders.ResultsWGS provides adequate coverage for most known immunodeficiency-related genes. 13,476 distinct variants and 8,502 distinct predicted protein-impacting variants were identified in this cohort; five individuals carried potentially pathogenic variants requiring expert clinical correlation. One clinically asymptomatic individual was found genomically to have complement component 9 deficiency. Of the symptomatic children, one was molecularly identified as having an immunodeficiency condition and two were found to have other molecular diagnoses.ConclusionNeonatal genomic sequencing can potentially augment newborn screening for immunodeficiency.
Nursing assistants provide the majority of direct resident care in nursing homes and are centrally involved in implementing quality improvement (QI), yet little is known about their experiences in ...QI. Interviews with nursing assistants found that respondents perceive themselves as having a unique and important role in QI. They described key outcomes of QI as positive gains in the daily lives of residents, improved work processes, and increased time between staff and residents.
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