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Retrospective cross-sectional case series.Lesions of the triangular fibrocartilage complex (TFCC) can result in pain during axial load and unstable distal radioulnar joint (DRUJ). Conventional wrist orthoses decrease initial pain sufficiently but also prevent any movement during recovery and do not contribute to the stabilization of the DRUJ.In this retrospective analysis, we tested if the weight-bearing capacity of patients with lesions of the triangular fibrocartilage complex was increased by wearing a brace that stabilizes the distal radioulnar joint.Twenty-three patients had an arthroscopically confirmed TFCC lesion. We compared preoperative dynamic weight-bearing capacity of both hands with and without a commercially available wrist brace (WristWidget). Subgroup analysis was performed for stability of the distal radioulnar joint and etiology of the TFCC lesion. The dynamic ulnar variance was measured in a modified weight bearing test. We used parametric tests for normally distributed values.The weight-bearing capacity of the hand with TFCC lesion was significantly lower than of the control hand (16 verus 36 kg; p0.001). The relative load of the affected hand compared to the unaffected hand increased from 48 % (CI 37-60, SD 27) to 59 % (CI 47-72, SD 29 with a brace. The device had no effect on the control hand. Twelve patients with unstable DRUJ had a lower weight-bearing capacity compared to the eleven with stable joint. The percentage improvement with bracing was higher for those with unstable joints (versus stable) and traumatic lesions (versus degenrative).The use of a wrist brace significantly increases the weight-bearing capacity and therefore the maximum tolerated axial load of patients with a lesion of the TFCC. Patients with traumatic lesion or unstable DRUJ tend to show lower values than with degenerative lesions or stable joints.

Alterations in host phenotype induced by metazoan parasites are widespread in nature, yet the underlying mechanisms and the sources of intraspecific variation in the extent of those alterations remain poorly understood. In light of the microbiome revolution sweeping through ecology and evolutionary biology, we hypothesise that the composition of symbiotic microbial communities living within individual parasites influences the nature and extent of their effect on host phenotype. The interests of both the parasite and its symbionts are aligned through the latter's vertical transmission, favouring joint contributions to the manipulation of host phenotype. Our hypothesis can explain the variation in the extent to which parasites alter host phenotype, as microbiome composition varies among individual parasites. We propose two non-exclusive approaches to test the hypothesis, furthering the integration of microbiomes into studies of host-parasite interactions.

Genetic adaptation to future environmental conditions is crucial to help species persist as the climate changes. Genome scans are powerful tools to understand adaptive landscapes, enabling us to correlate genetic diversity with environmental gradients while disentangling neutral from adaptive variation. However, low gene flow can lead to both local adaptation and highly structured populations, and is a major confounding factor for genome scans, resulting in an inflated number of candidate loci. Here, we compared candidate locus detection in a marine mollusc (Onithochiton neglectus), taking advantage of a natural geographical contrast in the levels of genetic structure between its populations. O. neglectus is endemic to New Zealand and distributed throughout an environmental gradient from the subtropical north to the subantarctic south. Due to a brooding developmental mode, populations tend to be locally isolated. However, adult hitchhiking on rafting kelp increases connectivity among southern populations. We applied two genome scans for outliers (Bayescan and PCAdapt) and two genotype-environment association (GEA) tests (BayeScEnv and RDA). To limit issues with false positives, we combined results using the geometric mean of q-values and performed association tests with random environmental variables. This novel approach is a compromise between stringent and relaxed approaches widely used before, and allowed us to classify candidate loci as low confidence or high confidence. Genome scans for outliers detected a large number of significant outliers in strong and moderately structured populations. No high-confidence GEA loci were detected in the context of strong population structure. However, 86 high-confidence loci were associated predominantly with latitudinally varying abiotic factors in the less structured southern populations. This suggests that the degree of connectivity driven by kelp rafting over the southern scale may be insufficient to counteract local adaptation in this species. Our study supports the expectation that genome scans may be prone to errors in highly structured populations. Nonetheless, it also empirically demonstrates that careful statistical controls enable the identification of candidate loci that invite more detailed investigations. Ultimately, genome scans are valuable tools to help guide further research aiming to determine the potential of non-model species to adapt to future environments.

Onithochiton neglectus is a morphologically variable, brooding chiton inhabiting coastal reefs throughout New Zealand and its Sub-Antarctic Islands. Southern O. neglectus populations are typically associated with buoyant kelp (Durvillaea spp.) and are potentially connected via kelp-rafting. Northern O. neglectus populations are less likely to raft, due to lower numbers of Durvillaea in northern New Zealand. To test for the impact of kelp-rafting on the spatial distribution of variation in O. neglectus, we undertook a combined analysis of morphological and genetic variation across the range of the species. Geometric morphometrics were used to assess shell shape. We detected a northern vs. southern split in shell shape, corresponding to the frequency of the O. neglectus/Durvillaea spp. association. To assess O. neglectus genetic patterns across New Zealand, we estimated phylogenetic trees with nuclear (ITS) and mitochondrial (COI and 16S) markers, which revealed distinct northern and southern lineages, and an additional lineage in central New Zealand. Neither the morphological nor genetic groups match existing O. neglectus subspecies, but are concordant with the patterns of association of O. neglectus with Durvillaea. We suggest that shell shape may be linked to O. neglectus’ regionally variable ecological association with kelp holdfasts.

Introduction Aggressive benign mandibular tumors are uncommon in the pediatric population, and there is few publishing in the literature specifically dealing with them. Aggressive tumors can be defined based on known biologic behavior and/or histologic type and/or clinical characteristics.Aim of the Study: To review the clinical features and management of lower jaw pediatric aggressive benign tumor. Patients and methods Medical records review of pediatric patients presented with aggressive benign mandibular tumors to the Maxillofacial and Plastic Surgery Department, University of Alexandria, Egypt between 2011 and 2019. Results Fifty-eight patients were included in this study, aged between 2 and 16 years (average = 11.8). Ameloblastoma was the commonest pathological diagnosis (n = 18) followed by central giant cell granuloma (n = 11) and juvenile ossifying fibroma (n = 10). Patients with central giant cell granuloma were treated by en-block resection (n = 4) or curettage after interferon alfa injection (n = 7). All other benign tumors were treated by en-block resection. The length of follow-up ranged from 1 to 8 years. Successful reconstruction was accomplished in 45 patients (88.2%). Conclusions Aggressive lesion should be treated in an aggressive manner and immediate reconstruction is advocated. However, pharmacotherapy combined with enucleation is a more conservative approach for management of aggressive central giant cell tumors.

Comparing divergence in quantitative traits and neutral molecular markers, such as QST–FST comparisons, provides a means to distinguish between natural selection and genetic drift as causes of population differentiation in complex polygenic traits. Onithochiton neglectus (Rochebrune, 1881) is a morphologically variable chiton endemic to New Zealand, with populations distributed over a broad latitudinal environmental gradient. In this species, the morphological variants cluster into 2 geographically separated shell shape groups, and the phenotypic variation in shell shape has been hypothesized to be adaptive. Here, we assessed this hypothesis by comparing neutral genomic differentiation between populations (FST) with an index of phenotypic differentiation (PST). We used 7,562 putatively neutral single-nucleotide polymorphisms (SNPs) across 15 populations and 3 clades of O. neglectus throughout New Zealand to infer FST. PST was calculated from 18 shell shape traits and gave highly variable estimates across populations, clades, and shape groups. By systematically comparing PST with FST, we identified evidence of local adaptation in a number of the O. neglectus shell shape traits. This supports the hypothesis that shell shape could be an adaptive trait, potentially correlated with the ability to live and raft in kelp holdfasts.

The aim was to characterize the incidence and short-term prognostic value of an acute kidney injury (AKI) during the admission where an ileostomy is formed.Adults with a baseline serum creatinine measurement discharged alive after ileostomy formation from 2014 to 2016 were included. All patients had daily basic metabolic panels and the Kidney Diseases Improving Global Outcomes criteria were used to determine the presence and severity of any AKI. Dehydration was defined by a single urine abnormality or clinical criteria combined with an objective abnormality in vitals or basic metabolic panels.Of 262 patients, 19.4% sustained an AKI (74.5% Stage I, 15.7% Stage II, 9.8% Stage III) during the index admission. Predictors of incident AKI were increasing age, male sex, higher baseline creatinine and open surgery. Patients with AKI had significantly longer length of stay and 45% had creatinine1.0 mg/dl at discharge. Of the total cohort, 11% were readmitted with dehydration and the independent predictors were AKI during the index admission, high ileostomy output, age65 years, male sex and prior ileostomy. Of those readmitted with dehydration, 79% had AKI at readmission.Nearly 20% of patients with ileostomies develop an AKI during the index admission with almost half resolving by discharge. Patients with AKIs are at high risk for 30-day dehydration-related readmission and AKI is present in nearly 80% of those readmitted with dehydration. Since AKI is objective, based on routine laboratory measures, and has known prognostic value it is probably a more robust outcome than dehydration for researchers, surgeons and patients.

Kuwait is a small Arabian Gulf country with a high rate of consanguinity and where a national newborn screening program was expanded in October 2014 to include a wide range of endocrine and metabolic disorders. A retrospective study conducted between January 2015 and December 2020 revealed a total of 304,086 newborns have been screened in Kuwait. Six newborns were diagnosed with classic homocystinuria with an incidence of 1:50,000, which is not as high as in Qatar but higher than the global incidence. Molecular testing for five of them has revealed three previously reported pathogenic variants in the CBS gene, c.969G&gt, A, p.(Trp323Ter), c.982G&gt, A, p.(Asp328Asn), and the Qatari founder variant c.1006C&gt, T, p.(Arg336Cys). This is the first study to review the screening of newborns in Kuwait for classic homocystinuria, starting with the detection of elevated blood methionine and providing a follow-up strategy for positive results, including plasma total homocysteine and amino acid analyses. Further, we have demonstrated an increase in the specificity of the current newborn screening test for classic homocystinuria by including the methionine to phenylalanine ratio along with the elevated methionine blood levels in first-tier testing. Here, we provide evidence that the newborn screening in Kuwait has led to the early detection of classic homocystinuria cases and enabled the affected individuals to lead active and productive lives.

Twenty-nine percent of postileostomy discharges are readmitted, most commonly because of dehydration. However, there is a lack of detailed data specifically evaluating factors associated with readmission with dehydration. In addition, patients with a history of an ileostomy have often been excluded from previous studies and therefore represent a group of understudied ileostomates.This study aimed to evaluate factors available at discharge associated with 30-day readmission for dehydration, rather than all-cause readmissions.This was a retrospective cohort study.Study patients received ileostomies at a tertiary academic medical center from 2014 to 2016.Patients with a preexisting ileostomy that was not recreated per the operative note were excluded, whereas those who received a new ileostomy were included.The primary outcome measured was 30-day readmission for dehydration as defined by objective clinical criteria.A total of 262 patients underwent ileostomy creation and were discharged alive. Twenty-five percent were ≥65 years of age, 53% were men, 14% had a history of ileostomy, 18% had a creatinine1.0 on discharge, and 26% had high ileostomy output at any time during the index admission. Among all ileostomates, the all-cause readmission rate was 30%. Mean days to readmission for any cause was 8.5, whereas for dehydration it was 11.6 days. Of the readmissions, 37% were readmitted with a diagnosis of dehydration, and dehydration was the sole reason in 26%. Among those with dehydration, the most common length of stay was 2 days. In multivariable logistic regression, 30-day readmission with dehydration was associated with older age, male sex, history of an ileostomy, high ileostomy output during index admission, and a discharge creatinine1.0.This study was limited by its retrospective design.Ileostomy dehydration efforts have focused on new ileostomy patients; however, our data suggest that patients with a history of an ileostomy are actually at risk for readmission with dehydration. Further studies aimed at the reduction of readmission with dehydration after ileostomy are warranted and should include patients with a history of an ileostomy. See Video Abstract at http://links.lww.com/DCR/A643.

In the current study, two equipment were used to control wheat Aphid, Rhopalosiphum padi. The first equipment, Knapsack sprayer (3WDB) with battery charge and flat fan nozzle. The second equipment, Knapsack motor sprayer (IE34F) with hydraulic pump and spray gun at New Salhyia city, Sharqia Governorate. The present study aimed to determine the effects of application method on initial and late biological efficacy of imidacloprid and dinotefuran (belong to neonicotinoid) against wheat aphid. Results in two seasons (2016 & 2017) indicated that, IE34F Motor sprayer (as high volume sprayer) showed less initial efficacy compared with 3WDB Power sprayer (as medium sprayer volume). Although the imidacloprid pesticide gives high efficacy compared with dinotefuran pesticide. The main obtained difference was Imidacloprid with 3WDB Power sprayer gave the highest efficacy with a significant difference compared with dinotefuran with IE34F Motor sprayer.

Medicine is at the heart of healthcare. Healthcare systems have contributed to increasing the life expectancy and the wellbeing of millions of people worldwide during the 20 th century [1] and they represent an asset of utmost importance in achieving fairness in accessing health-related prevention, promotion and recovery from illness [2]. Thus one of the driving purposes of medical education must be to enhance the performance of health systems for meeting the needs of patients and populations in an equitable and efficient way. A crucial factor in this endeavor will be the successful adaptation of professional education for local and national leadership in workforce teams that are capable of extending reach to all people. The purpose of this paper is to explore a deeper understanding that a person centered approach is essential as to how this can be achieved. Health is about people. The goal of physicians and all health professionals, irrespective of nationality and specialty is to share a common global vision for the future. [3] In this, all health professionals in all countries should be educated to gather knowledge, and to engage in critical reasoning and practice to high ethical standards so that they are competent to participate in person-centered and people-centered health systems as members of locally responsive and globally connected teams. The ultimate vision must be to assure universal coverage of high-quality comprehensive services that are essential to advancing opportunity for health equity within and between countries [4]. The aspiration for better health commonly shared will resonate with aspiring young professionals who seek value and meaning in their work.

Ibero-American Perspectives on Person-centered Medical Education

Background: The development of person-centered medical education is inscribed within an international programmatic movement toward a medicine focused on the totality of the person. This movement, with broad historical bases, has been maturing since 2008 through conferences with global health institutions, research projects, and academic publications. A key challenge in the application of person-centered medicine (PCM) to the practice of medicine has been the elucidation of its core principles and the development of operationalized measures that allows for assessment of the degree of person-centeredness in clinical care and medical education.

Developments in person-centered coordinated care are essential given the challenges of the growing epidemic of physical comorbidity in the mentally ill population. Excessive deaths due to comorbidity, especially cardiovascular disease, continue to contribute to the significant reduction in life expectancy in people with mental health problems. Contemporary and proposed models are now available to provide evidence for a way forward in this field. Practical guidance on implementation using person-centered care planning has now been developed to promote a more collaborative and integrated approach as a solution to the current single disease focused model of care, which is failing this patient group. The WHO perspective supports this strategy with the recent global objectives outlining proactive and preventative strategies and interventions to tackle comorbidity. The emphasis is on a transformation of current systems using evidence-based approaches for more integration to support the delivery of more effective and efficient care for those with mental disorders and other comorbid chronic diseases. Coordinated, collaborative, system-wide strategies encompass transparent shared decision making in prevention, early intervention, treatment options, lifestyle management and pharmacological rationalization. Hence urgent action is required to help create the conditions to enable the delivery of person-centered coordinated care in health care systems by involving commissioning bodies, clinicians, patient groups along with voluntary and other community providers. Contemporary models of care for comorbidity emphasize the importance of coordination in the management of physical well-being from the onset of treatment of people with mental health problems in order to ensure better outcomes, improved overall well-being, and a longer life expectancy. Illustratively, no further funds are available to implement this shift in the model of care in the United Kingdom, so redesign and redistribution of current resources will be key to promote this more seamless coordinated system of care to improve the quality of life and life expectancy for this population.

The person-centered integrative diagnosis (PID) is a model that aims at putting into practice the vision of person-centered medicine affirming the whole person of the patient in context as the center of clinical care and health promotion at the individual and community levels. The PID is a novel model of conceptualizing the process and formulation of clinical diagnosis. The PID presents a paradigm shift with a broader and deeper notion of diagnosis, beyond the restricted concept of nosological diagnoses. It involves a multilevel formulation of health status (both ill and positive aspects of health) through interactive participation and engagement of clinicians, patients, and families using all relevant descriptive tools (categorization, dimensions, and narratives). The current organizational schema of the PID comprises a multilevel standardized component model integrating three main domains. Each level or major domain addresses both ill health and positive aspects of health. The first level is the assessment of health status (ill health and positive aspects of health or well-being). The second level includes contributors to health, both risk factors and protective factors. The third major level includes health experience and values. Experience with the PID through a practical guide in Latin America supported the usefulness and adequacy of the PID model.

Surgical education requires more than time and commitment; it is a period of a professional development that relies on one's resilience and fortitude. While training programs makes substantial efforts to onboard learners and prepare them for the experiences to come, most are likely underutilizing one of the greatest resources available to learners: their personal communities. Every intern who enters residency brings with them the emotional bonds and benefits of family, friends, and/or other community members who may or may not understand the nature of surgical training and the professional journey ahead. In an effort to support our own learners and increase the awareness of resources available to them, we hosted an orientation for interns' friends and families. The programming allowed for residents and their personal supports to better understand residency culture, meet educational leadership, and discuss the experiences of more senior residents, faculty and their families over time. Additionally, some education was provided regarding the signs and symptoms of burnout and depression; our aim was to help residents' communities feel better able to recognize and respond to such symptoms. The preliminary feedback regarding the program is strong, encouraging its continued implementation.

The Role of Culture and Experience in Person Centered Medicine

Objectives To examine the differential impact of depressive and manic mood states on alcohol craving in patients with bipolar disorder and comorbid alcoholism. Methods Forty-four men and women, ages 18-65, with DSM-IV-TR comorbid diagnoses of bipolar I disorder and alcohol dependence were assessed over a three-month period to examine the extent to which their depressive and manic symptoms were associated with alcohol cravings (i.e., desire to use and not to use alcohol) at each assessment point, controlling for age, ethnicity, socio-economic status, baseline alcohol use, and number of assessments. Results Both manic and depressive symptoms were associated with greater desire to use alcohol. Only depressive symptomatology was associated with reduced desire not to use alcohol, and desire not to use alcohol declined over the course of the three-month treatment period. Conclusion Whereas enhanced desire to drink alcohol may be a conditioned reaction to both manic and depressed mood states, desire not to drink alcohol may be more of an indicator of treatment motivation, which is negatively affected by depressed mood. Depressive symptoms may warrant prioritization and aggressive targeting early in treatment given that desire to refrain from alcohol use was only influenced by depressive symptoms and declined over the course of treatment.

OBJECTIVE: In Mexico specialized treatment services for people with co-occurring disorders are limited within public health services, while private options are deemed too costly. Over 2,000 community-based residential care facilities have risen as an alternative and are the main source of treatment for individuals with substance use disorders; however suboptimal practices within such facilities are common. Information on the clinical characteristics of patients receiving care in these facilities is scarce and capacity to provide high quality care for co-occurring disorders is unknown. The aims of this study were to examine the prevalence of co-occurring disorders in patients receiving treatment for substance use in these community-based residential centers and to assess whether the presence of co-occurring disorders is associated with higher severity of substance use, psychiatric symptomatology and other health risks. METHODS: This study was conducted with 601 patients receiving treatment for substance use disorders at 30 facilities located in five Mexican states, recruited in 2013 and 2014. Patients were assessed with self-report measures on substance use, service utilization, suicidality, HIV risk behaviors, psychiatric symptomatology and psychiatric disorder diagnostic criteria. RESULTS: The prevalence of any co-occurring disorder in this sample was 62.6%. Antisocial personality disorder was the most prevalent (43.8%) followed by major depressive disorder (30.9%). The presence of a co-occurring disorder was associated with higher severity of psychiatric symptoms (aB = .496, SE = .050, p < .05); more days of substance use (aB = .219, SE = .019, p < .05); current suicidal ideation (aOR = 5.07, 95% CI [2.58, 11.17]; p < .05), plans (aOR = 5.17 95% CI [2.44, 12.73];p < .05), and attempts (aOR = 6.43 95% CI [1.83, 40.78];p < .05); more sexual risk behaviors; and more contact with professional services (aOR = 1.77, 95% CI [1.26, 2.49], p < .05). CONCLUSIONS: Co-occurring disorders are highly prevalent in community-based residential centers in Mexico and are associated with significantly increased probability of other health risks. This highlights the need to develop care standards for this population and the importance of clinical research in these settings.

This was a first double-blind, placebo-controlled pilot study to evaluate the efficacy of the novel antidepressant medication mirtazapine for treating both the depressive symptoms and the level of alcohol consumption of subjects with comorbid major depressive disorder and an alcohol use disorder (MDD/AUD). The results of two previous studies of mirtazapine in MDD/AUD subjects had suggested efficacy for mirtazapine for decreasing their level of depressive symptoms, but level of alcohol consumption had not been assessed in those studies. All subjects in this 12-week pilot study were randomized to either mirtazapine or placebo, and also received motivational enhancement therapy. Between-group analyses involving the outcome measures of depressive symptoms, level of alcohol consumption, and level of alcohol craving indicated no significant differences between groups, possibly because of limited sample size. However, within-group t tests in the mirtazapine group showed a significant decrease in depressive symptoms by week 2, also noted at all subsequent assessments (weeks 3, 4, 6, 8, 10, and 12) during the 12-week study. In contrast, no significant decrease in depressive symptoms was noted in the placebo group until week 8. No evidence of efficacy was found for mirtazapine for decreasing level of alcohol consumption in MDD /AUD subjects.

Wholeness and Life Course in Person Centered Medicine

BACKGROUND: Several single-site alcohol treatment clinical trials have demonstrated efficacy for immediate-release (IR) gabapentin in reducing drinking outcomes among individuals with alcohol dependence. The purpose of this study was to conduct a large, multisite clinical trial of gabapentin enacarbil extended-release (GE-XR) (HORIZANT(®)), a gabapentin prodrug formulation, to determine its safety and efficacy in treating alcohol use disorder (AUD). METHODS: Men and women (n= 346) who met DSM–5 criteria for at least moderate AUD were recruited across 10 US clinical sites. Participants received double-blind GE-XR (600 mg twice a day [BID]) or placebo and a computerized behavioral intervention (Take Control) for 6 months. Efficacy analyses were pre-specified for the last 4 weeks of the treatment period. RESULTS: The GE-XR and placebo groups did not differ significantly on the primary outcome measure, percentage of subjects with no heavy drinking days (28.3 vs 21.5, respectively, p=0.157). Similarly, no clinical benefit was found for other drinking measures (percent subjects abstinent, percent days abstinent, percent heavy drinking days, drinks per week, drinks per drinking day), alcohol craving, alcohol-related consequences, sleep problems, smoking, and depression/anxiety symptoms. Common side-effects were fatigue, dizziness, and somnolence. A population pharmacokinetics analysis revealed that patients had lower gabapentin exposure levels compared with those in other studies using a similar dose but for other indications. CONCLUSION: Overall, GE-XR at 600 mg BID did not reduce alcohol consumption or craving in individuals with AUD. It is possible that, unlike the IR formulation of gabapentin, which showed efficacy in smaller Phase 2 trials at a higher dose, GE-XR is not effective in treating AUD, at least not at doses approved by the FDA for treating other medical conditions.

Psychosomatics involves an important approach to medical care that is connected to a holistic theoretical perspective as well as a practical guide to clinical work. To this effect, this paper briefly reviews psychosomatics within the framework of holistic theory and care, which happens to be one of the key concepts of person-centered medicine (PCM). Next, the paper considers the basic notions of person-centered medicine and the way this has evolved historically from ancient civilizations through modern medicine. The conceptualization of PCM is further approached from a systematic study organized by the International College of Person Centered Medicine. After that, the paper focuses on person-centered psychiatry in general and then more specifically on person-centered diagnosis both as a theoretical model and as a practical guide.

Co-morbidity represents one of the greatest challenges for twenty-first-century medicine. A high prevalence of co-morbidity in the severely mentally ill (SMI) has been well established leading to a significant impact on quality of life, life expectancy and premature death by 15–20 years. The major recognised contributor to excess death is cardiovascular disease.

Bipolar disorder (BD) medical comorbidity presents significant clinical and public health concerns with serious impact on health. The aim of this article is to present an updated narrative review of original research articles (case control, longitudinal cohort, and cross-sectional studies) and meta-analyses published in English language journals from January 2013 to May 2017 focusing on general medical comorbidity in BD, including the added risks of iatrogenic factors relevant to the treatment of BD. We found numerous patterns of association between BD and various medical disorders involving multiple organ systems. One pattern indicated reciprocal increase in the rate of each comorbid condition, such as an increased rate of BD in asthma or migraine, and likewise an increase in the rate of asthma or migraine in patients with BD. A second pattern was a predominantly unidirectional increase in the rate of BD in patients with certain medical disorders, such as multiple sclerosis or cerebellar diseases. A third pattern was a predominantly unidirectional increased rate of medical disorders in patients with BD. One study suggested the potential involvement of genetic mechanisms for the association between BD and migraine. Most of the studies had cross-sectional or retrospective designs, and many relied on analysis of large administrative databases inviting multiple potential biases. Our review highlights the association between BD and a variety of medical disorders. Further research is needed to elucidate the potential underlying etiopathological mechanisms that contribute to observed comorbidities. The results of this review also emphasize the need for comprehensive screening for medical disorders in BD and for adoption of an integrated model of care to address these complex comorbidities.

Solitary fibrous tumor is a rare, benign spindle cell neoplasm that was first described in the thoracic pleura. This tumor is now known to occur at many extrapleural sites. There are established criteria for the diagnosis of malignant solitary fibrous tumor including ≥4 mitotic figures per 10 high-power fields, increased cellularity, cytologic atypia, infiltrative margins, and/or necrosis. Although all solitary fibrous tumors have the potential to recur or metastasize, those with malignant histologic features tend to behave more aggressively. We report a case of solitary fibrous tumor, with malignant histologic features, in a 21-year-old woman which arose from the serosal surface of the sigmoid colon.

In the conceptualization of Person Centered Medicine (PCM) one can recognize core concepts as well as diversity at multiple levels. The core concepts convey vision and depth. Diversity displays plurality, richness and scope. And both are intertwined and articulated through the unfolding process and journey that the construction of PCM represents. This paper briefly elaborates on these complementary perspectives of PCM. And ends introducing a set of papers that illustrate its core and diversity.

Background: ADHD affects 2.5% to 5% of the adult population, is often under-diagnosed and poorly managed with few treatment options. Limited pharmacotherapeutic options are available, and many patients and clinicians are reluctant to use them for fear of side effects or concerns about substance abuse liability. Very limited psychotherapeutic options are available for ADHD. Cognitive behavioral group therapy (CBTg) is the only approach with some preliminary promising results, however there is no individual CBT option for this population.Objectives: There is a growing popularity of yoga as a therapeutic technique in psychiatric disorders and it may offer distinct advantages for adult ADHD. The objectives of this paper is to discuss the benefit of yoga as a person-centered individualized intervention for adults with ADHD. Methods: We discuss the therapeutic utility of a more encompassing and systematic application of yoga practices, including their physical and philosophical, meditative and spiritual aspects to address the symptoms of ADHD and to enhance wellness through lifelong growth and skill building yoga for adults with ADHD. We also present a systematic comparison between yoga practices and the standard CBTg therapy to demonstrate that the proposed yoga intervention is able to address ADHD symptoms areas targeted by CBTg. Results: Intervention based on a systematic application of yoga practices may offer targeted interventions to match ADHD patients’ symptoms and needs and compares positively with CBTg. Furthermore, yoga therapy may be superior to CBTg in terms of convenience, person-centeredness and individualized care. Conclusions: Yoga may offer a valuable option to meet patients’ needs by integrating both physical and philosophical aspects to dynamically targeting specific areas of emotional, behavioral and cognitive dysfunctions as well as the hyperactivity symptoms.