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Ernst Siemerling (September 9, 1857 – January 6, 1931) was a German neurologist and psychiatrist born in Müssow near Greifswald .
In 1882 he obtained his medical doctorate from the University of Marburg . In 1883-84 he was an assistant at the psychiatric clinic at Halle , and afterwards an assistant to Karl Westphal (1833-1890) at the Berlin psychiatric clinic.
In 1888 he became habilitated for neurology and psychiatry, later being appointed professor and director of the psychiatric clinic at the University of Tübingen (1893). In 1900 he accepted a similar position at the University of Kiel , where he remained until his retirement in 1926.
In 1923, with Hans Gerhard Creutzfeldt (1885-1964), he described adrenoleukodystrophy (ALD), a rare disorder that is sometimes referred to as " Siemerling-Creutzfeldt Disease ". With Oswald Bumke (1877-1950), he was editor of the Archiv für Psychiatrie und Nervenkrankheiten , and with Otto Binswanger (1852-1929), was co-author of Lehrbuch der Psychiatrie , a textbook on psychiatry that was published in several editions.
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https://en.wikipedia.org/wiki/Ernst_Siemerling
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Eryptosis ( Erythrocyte apoptosis or Red blood cell programmed death ) is a type of apoptosis that occurs in injured erythrocytes (RBCs) because of various factors including hyperosmolarity , oxidative stress , energy depletion, heavy metals exposure or xenobiotics . Like apoptosis, eryptosis is characterized by cell shrinkage, membrane blebbing, activation of proteases , and phosphatidylserine exposure at the outer membrane leaflet. [ 1 ] [ 2 ]
Conditions with excessive eryptosis include: [ 3 ]
This article related to pathology is a stub . You can help Wikipedia by expanding it .
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Erythema gyratum repens is a skin condition that has a strong association with internal cancers . [ 1 ] It characteristically presents with red wavy lines , generally in older adults. [ 1 ] These regular whirly rings rapidly and repetitively appear within existing ones, giving the impression that the rash is moving. [ 3 ] The resulting pattern is similar to wood grain . [ 1 ] There is often an intense itch and scale over the leading edge, which may be slightly raised. [ 2 ]
The cause is believed to have an immunological base. [ 4 ] 80% of cases have an underlying cancer , of which almost half have lung cancer . [ 1 ] Sometimes no cause is found. [ 3 ]
Diagnosis is generally by its appearance, although tests may be required to exclude other conditions. [ 3 ] These tests may include blood tests. [ 1 ] A cancer may be located using medical imaging . [ 1 ] Necrolytic migratory erythema and erythema migrans are some of many other skin conditions that may appear similar. [ 1 ]
Treatment and outlook depend on the underlying cause. [ 1 ] Antihistamines may help to reduce the itch. [ 2 ] [ 5 ] The rash typically resolves with successful cancer treatment. [ 3 ]
The condition is rare. [ 1 ] Males are affected twice as frequently as females. [ 1 ] J. A. Gammel first described the condition in 1952. [ 6 ] [ 7 ]
Erythema gyratum repens characteristically presents as wavy red lines on the skin . [ 1 ] These regular whirly rings rapidly and repetitively appear within existing ones, expanding outward at a rate of up to 1cm a day, giving the impression that the rash is moving. [ 3 ] The resulting pattern is similar to wood grain . [ 1 ] There is typically an intense itch and scale over the leading edge, which may be slightly raised. [ 2 ] The trunk and limbs are most frequently affected. [ 5 ] Thickening of the skin of the palms co-exists in around 10% of affected individuals, whatever the underlying cause. [ 1 ] The skin may become extremely dry . [ 3 ] Onset is generally in older adults; after the age of 60-years. [ 1 ]
The cause of erythema gyratum repens is believed to have an immunological base. [ 4 ] 80% of cases have an underlying cancer, of which almost half have lung cancer . [ 1 ] Other cancers reported to be associated include cancers of the oesophagus and breast , and less frequently gastric cancer , uterine cancer , throat cancer , pancreas cancer and lymphoma . [ 1 ] The rash generally precedes the cancer diagnosis by around 9-months. [ 2 ] Less frequently, the cause may be tuberculosis of the lung, or no cause is found. [ 3 ] Other rare reported associations have included cryptogenic organizing pneumonia and rheumatoid arthritis . [ 2 ]
Diagnosis is generally by its appearance. [ 3 ] Tests include blood tests such as a complete blood count which may reveal raised eosinophils . [ 2 ] Other blood tests include PSA , antinuclear antibodies and biochemistry. [ 1 ] Medical imaging may locate a cancer; chest X-ray , mammogram , CT scan of pelvis and abdomen. [ 1 ] If indicated then an endoscopy may be required; colonoscopy , gastroscopy . [ 1 ]
Necrolytic migratory erythema , erythema migrans , tinea corporis , erythrokeratodermia variabilis , and subacute cutaneous lupus erythematosus are some of many other skin conditions that may appear similar. [ 1 ]
Treatment and outlook depend on the underlying cause. [ 1 ] Antihistamines may help to reduce the itch, although the role of applying a steroid cream is unclear. [ 2 ] [ 5 ] The rash typically resolves with successful cancer treatment. [ 3 ]
The condition is rare. [ 1 ] Males are affected twice as frequently as females. [ 1 ]
J. A. Gammel first described the condition in 1952, in an individual who was later found to have breast cancer. [ 6 ] [ 7 ]
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https://en.wikipedia.org/wiki/Erythema_gyratum_repens
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Erythrodontia is the red discoloration of teeth . [ 1 ] It can be seen in congenital erythropoietic porphyria .
This dentistry article is a stub . You can help Wikipedia by expanding it .
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Erythroid dysplasia is a condition in which immature red blood cells ( erythroid cells ) in the bone marrow are abnormal [ 1 ] in size and/or number. Erythroid dysplasia may be caused by vitamin deficiency or chemotherapy , or it may be a sign of refractory anemia , which is a myelodysplastic syndrome . Also called erythrodysplasia . [ citation needed ]
This article incorporates public domain material from Dictionary of Cancer Terms . U.S. National Cancer Institute .
This oncology article is a stub . You can help Wikipedia by expanding it .
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Erythropoietin in neuroprotection is the use of the glycoprotein erythropoietin (Epo) for neuroprotection . Epo controls erythropoiesis , or red blood cell production.
Erythropoietin and its receptor were thought to be present in the central nervous system according to experiments with antibodies that were subsequently shown to be nonspecific. While erythropoietin alpha is capable of crossing the blood brain barrier via active transport , [ 1 ] concentrations in the central nervous system are very low. The possibility that Epo might have effects on neural tissues resulted in experiments to explore whether Epo might be tissue protective. The reported presence of Epo within the spinal fluid of infants and the expression of Epo-R in the spinal cord, suggested a potential role by Epo within the CNS therefore Epo represented a potential therapy to protect photoreceptors damaged from hypoxic pretreatment. [ 2 ]
In some animal studies, Epo has been shown to protect nerve cells from hypoxia-induced glutamate toxicity . [ 2 ] [ 3 ] Epo has also been reported to enhance nerve recovery after spinal trauma. Celik and associates investigated motor neuron apoptosis in rabbits with a transient global spinal ischemia model. [ 4 ] The functional neurological status of animals given RhEpo was better after recovery from anesthesia, and kept improving over a two-day period. The animals given saline demonstrated a poor functional neurological status and showed no significant improvements. These results suggested that RhEpo has both an acute and delayed beneficial action in ischemic spinal cord injury.
In contrast to these results, numerous studies have suggested that Epo had no neuroprotective benefit in animal models and EpoR was not detected in brain tissues using anti-EpoR antibodies that were shown to be sensitive and specific. [ citation needed ]
While EpoR was reportedly detected in the embryonic brain, its role in brain development is unclear. In one study Epo stimulated neural progenitor cells and prevented apoptosis in the embryonic brain in mice. [ 5 ] Mice without EpoR demonstrated severe anemia, defective heart development, and eventually death around embryonic day 13.5 from apoptosis in the liver , endocardium , myocardium , and fetal brain. As early as embryonic day 10.5 the lack of EpoR can affect brain development by increasing fetal brain apoptosis and decreasing the number of neural progenitor cells. By exposing cultures of EpoR positive embryonic cortical neurons to stimulation by Epo administration, the cells decreased apoptosis, as opposed to the decrease in neuron generation in EpoR negative cells.
However it has been questioned whether EpoR may or may not be a determining factor for the nervous system function. [ 6 ] The contribution of Epo and EpoR to neuroprotection and development are not as clearly understood as its role in erythropoiesis in hematopoietic tissue. In a line of mice that expressed EpoR exclusively in hematopoietic cells, the mice developed normally had normal brains and brain function and were fertile, despite the lack of EpoR in nonhematopoietic tissue. Differential expression of EpoR between erythroid cells. Most notably, plasma Epo concentration is regulated by nonhematopoietic EpoR expression when the peak of plasma concentrations for induced anemia in mutant and wild-type mice. The expression of EpoR in nonhematopoietic tissue is dispensable in normal mouse development, but that the sensitivity of erythroid progenitors to Epo is regulated by the expression of EpoR.
Erythropoietin mutants R103-E and S100-E (though S100 in Epo doesn't exist) has been reported to be non-erythropoietin but retain the neuroprotective function. Epo with R103 mutation is a potent inhibitor of wild type Epo from binding to its receptor. Though, the viral vector expressed R103-E Epo mutant was shown to be inhibitory to the progression / development of nervous tissue damage in many models, it is not shown to recover the nervous tissue post damage. Given the associated risks, it would be foolish to administer / express Mutant as a preventive measure from neuronal injury. Hence, from a medical or commercial point of view, safe and feasible neuro-protective Epo mutants are not possible.
Quite a bit of research emphasis is on non erythropoietic but, neuroprotective Peptides of Erythropoietin. Peptide of Epo with amino acids 92-111 is neuroprotective while its erythropoietic potency is 10 fold less than the wild type.
A short peptide sequence from the erythropoietin molecule called JM4, has been found to be non-erythropoietic yet theoretically neuroprotective and is being readied for Stage 1 and 2 clinical studies. [ 7 ] [ 8 ]
Erythropoietin and its receptor are also reported in the peripheral nervous system , specifically in the bodies and axons of ganglions in the dorsal root, and at increased levels in Schwann cells after peripheral nerve injury. [ 9 ] The distribution of EpoR was different from Epo, specifically in some neuronal cell bodies in the dorsal root ganglion , endothelial cells , and Schwann cells of normal nerves. Most importantly, experiments with immunostaining revealed that the distribution and concentration of EpoR on Schwann cells doesn’t change after peripheral nerve injury. However those studies are of questionable significance since the antibodies were nonspecific to EpoR. Other research that suggested Epo is up-regulated according to mRNA expression in astrocytes and hypoxia-induced neurons, while EpoR is not. [ 10 ] A correlation between the expression of Epo-R in ganglion cells and binding to sensory receptors in the periphery like Pacini bodies and neuromuscular spindles suggests that Epo-R is related to touch regulation. [ 11 ]
After nerve injury, the increased production of Epo may induce activation of certain cellular pathways, while the concentration of EpoR doesn’t change. In Schwann cells, increased erythropoietin levels may stimulate Schwann cell proliferation via JAK2 and ERK/MAP kinase activation to be explained later. Similar to stimulation of red blood cell precursor cells (erythrogenesis), erythropoietin stimulates non-differentiated Schwann cells to proliferate. [ 11 ]
Although the mechanism is unclear, it is apparent that erythropoietin has anti-apoptotic action after central and peripheral nerve injury. Cross-talk between JAK2 and NF-κB signaling cascades has been demonstrated to be a possible factor in central nerve injury. Erythropoietin has also been shown to prevent axonal degeneration when produced by neighboring Schwann cells with nitrous oxide as the axonal injury signal. [ 12 ]
Erythropoietin exerts its neuroprotective role directly by activating transmitter molecules that play a role in erythrogenesis and indirectly by restoring blood flow. [ 13 ] Subcutaneous administration of RhEpo on cerebral blood flow autoregulation after experimental subarachnoid hemorrhage was studied. In different groups of male Sprague-Dawley Rats, the injection of Epo after induction of hemorrhage normalized the autoregulation of cerebral blood flow, while those treated with a vehicle showed no autoregulation.
The pathway for erythropoietin in both the central and peripheral nervous systems begins with the binding of Epo to EpoR. This leads to the enzymatic phosphorylation of PI3-K and NF-κB and results in the activation of proteins that regulate nerve cell apoptosis. [ 14 ] Recent research shows that Epo activates JAK2 cascades which activate NF-κB, leading to the expression of CIAP and c-IAP2, two apoptosis-inhibiting genes. Research conducted in rat hippocampal neurons demonstrates that the protective role of Epo in hypoxia-induced cell death acts through extracellular signal-regulated kinases ERK1, ERK2 and protein kinase Akt-1/PKB. [ 15 ] The action of Epo is not limited to just promoting cell survival and that the inhibition of neural apoptosis underlies short latency protective effects of Epo after brain injury. Accordingly, the neurotrophic actions may demonstrate longer-latency effects, but more research needs to be conducted on its clinical safety and effectiveness.
Additionally to the anti-apoptotic effect, Epo reduces inflammatory response during different types of cerebral injury via the NF-κB pathway. [ 16 ] The NF-κB pathway activated by Epo/EpoR phosphorylation plays a role in regulating inflammatory and immune response, in addition to preventing apoptosis due to cellular stress. [ 17 ] NF-κB proteins regulate immune response through B-lymphocyte control and T-lymphocyte proliferation. These proteins are all important for the expression of genes specific to immune and inflammatory response regulation.
As a neuroprotective agent erythropoietin has many functions: antagonizing glutamate cytotoxic action, enhancing antioxidant enzyme expression, reducing free radical production rate, and affecting neurotransmitter release. It exerts its neuroprotective effect indirectly through restoration of blood flow or directly by activating transmitter molecules in neurons that also play a role in erythrogenesis. Although apoptosis is not reversible, early intervention with neuroprotective therapeutic procedures such as erythropoietin administration may reduce the number of neurons that undergo apoptosis. [ 11 ]
The systemic administration of RhEpo has been shown to reduce dorsal root ganglion cell apoptosis. [ 18 ] While animals treated with RhEpo weren’t initially protected from mechanical allodynia after spinal nerve crush, a significantly improved recovery rate compared to animals not treated with RhEpo was demonstrated. This RhEpo therapy increased JAK2 phosphorylation, which has been found to be a key signaling step in Epo-induced neuroprotection by an anti-apoptotic mechanism. These findings demonstrate Epo therapy as a feasible treatment of neuropathic pain by reducing the protraction of pain after nerve injury. However, more studies need to be conducted to determine the optimal time and dosage for RhEpo treatment.
In infants with poor neurodevelopment, prematurity and asphyxia are typical problems. These conditions can lead to cerebral palsy , mental retardation , and sensory impairment. Hypothermia therapy for neonatal encephalopathy is a proven therapy for neonatal brain injury. However, recent research has demonstrated that high doses of recombinant erythropoietin can reduce or prevent this type of neonatal brain injury if administered early. [ 19 ] A high rate of neuronal apoptosis is evident in the developing brain due to initial overproduction. Neurons that are electrically active and make synaptic connections survive, while those that do not undergo apoptosis. While this is a normal phenomenon, it is also known that neurons in the developing brain are at an increased risk to undergo apoptosis in response to injury. A small amount of the RhEpo can cross the blood–brain barrier and protect against hypoxic-ischemia injury. Epo treatment has also shown to preserve hemispheric brain volume 6 weeks after neonatal stroke . [ 20 ] It demonstrated both neuroprotective effects and a direction towards neurogenesis in neonatal stroke without associated long-term difficulties.
Systemic administration of RhEpo has also been shown to reduce lesion-associated behavioral impairment in hippocampally injured rats. [ 21 ] The study confirmed that Epo administration improved posttraumatic behavioral and cognitive abilities versus a saline control that experienced no improvement, although it had no detectable effect on task acquisition in non-lesioned animals. Epo is able to reduce or eliminate the consequences of mechanical injury to the hippocampus but also demonstrates possible therapeutic effects in other cognitive domains.
Epo was shown to specifically protect dopaminergic neurons, which are closely tied into attention deficit hyperactivity disorder . [ 19 ] Specifically in mice, Epo demonstrated protective effects on nigral dopaminergic neurons in a mouse model of Parkinson's disease . [ 22 ] This recent experiment tested the hypothesis that RhEpo could protect dopaminergic neurons and improve the neurobehavioral outcome in a rat model of Parkinson's Disease. The intrastriatal administration of RhEpo significantly reduced the degree of rotational asymmetry, and the RhEpo-treated rats demonstrated improvement in skilled forearm use. These experiments demonstrated that intrastriatal administration of RhEpo can protect nigral dopaminergic neurons from 6-OHDA induced cell death and improve neurobehavioral outcome in a rat model of Parkinson's Disease.
Currently methylprednisolone (Medrol) is only pharmaceutical agent used to treat spinal cord trauma. [ 11 ] It is a corticosteroid that reduces damage to nerve cells and decreases inflammation near injury sites. It is typically administered within the first 8 hours after injury, but demonstrates poor results both in patients and experimental models. Some controversy has come about concerning the use of methylprednisolone because of its associated risks and poor clinical results, but it is the only medication available.
If administered within a specific timeframe in experiments with erythropoietin in central nervous system, Epo has a favorable response in brain and spinal cord injuries like mechanical trauma or subarachnoid hemorrhages. [ 23 ] Research also demonstrates a therapeutic role in modulating neuronal excitability and acting as a trophic factor both in vivo and in vitro. [ 23 ] This administration of erythropoietin functions by inhibiting the apoptosis of sensor and motor neurons via stimulation of intracellular anti-apoptotic metabolic paths. The action of erythropoietin on Schwann cells and inflammatory response after neurological trauma also points to initial stimulation of nerve regeneration after peripheral nerve injury. [ 11 ]
Erythropoietin and its receptor have an essential role in neurogenesis , specifically in post-stroke neurogenesis and in the migration of neuroblasts to areas of neural injury. [ 24 ] Severe embryonic neurogenesis defects in animals that were null for Epo or EpoR genes are found. In EpoR knock-down animals, deletion of EpoR genes specific to the brain lead to a reduction in cell growth in the subventricular zone and impaired neurogenesis after stroke. This post-stroke neurogenesis was characterized by an impaired migration of neuroblasts in the peri-infarct cortex. This results is in agreement with the classical approach to Epo/EpoR contributions in development in that it demonstrated an Epo/EpoR requirement for embryonic neural development, adult neurogenesis, and neuron regeneration after injury. High doses of exogenous erythropoietin could demonstrate a neuroprotective role by binding to a receptor that contains the common beta receptor but lacks EpoR. These types of studies into Epo and EpoR null animals have seen and are further elucidating the neuroprotective role of Epo/EpoR in genetics and development.
While the neuroprotective effects of Epo administration in models of brain injury and disease have been well described, the effects of Epo on Neuroregeneration are currently being investigated. Epo administration during optic nerve transaction was used to assess the neuroprotective properties in vivo as well as demonstrate the neuroregenerative capabilities. [ 25 ] The intravitreal injection of Epo increased retinal ganglion cell somata and axon survival after transaction. A small amount of axons penetrated the transaction site and regenerated up to 1 mm into the distal nerve. In a second experiment, Epo doubled the number of retinal ganglion cell axons regenerating along a length of nerve grafted onto the retrobulbar optic nerve. This evidence of Epo as a neuroprotective and neuroregenerative agent is extremely promising for Epo as therapy in central nerve injury and repair.
Erythropoietin has shown to have a neuroprotective role in both the central and peripheral nervous system through pathways that inhibit apoptosis. It has been successful in demonstrating neuroprotective effects in many models of brain injury and in some experiments. It is also capable of influencing neuron stimulation and promoting peripheral nerve regeneration. Epo has a lot of potential uses and could provide a therapeutic answer for nervous system injury. However, more studies need to be conducted to determine the optimal time and dosage for Epo treatment.
Neuroprotection is also a concept used in ophthalmology regarding glaucoma . The only neuroprotection currently proven in glaucoma is intraocular pressure reduction. However, there are theories that there are other possible areas of neuroprotection, such as protecting from the toxicity induced by degenerating nerve fibres from glaucoma. Cell culture models show that retinal ganglion cells can be prevented from dying by certain pharmacological treatments. Intraperitoneal injection of Epo in DBA/2J mice protected / slowed down the degeneration of Retinal ganglion cell (RGC). [ 26 ] Overexpression of Epo and Epo mutants in the eye via, viral vectors is toxic to the retina.
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Esafoxolaner/eprinomectin/praziquantel , sold under the brand name Nexgard Combo , is a fixed-dose combination medication used for the treatment and control of flea infestations, ticks, ear mites, and infections caused by tapeworms and Toxocara cati in cats. [ 3 ] [ 4 ] It is also used for the prevention of heartworm disease Dirofilaria immitis . It contains esafoxolaner , an aryl isoxazoline ; eprinomectin , an avermectin anthelmintic ; and praziquantel , a pyrazinoisoquinoline anthelmintic. [ 3 ]
In the United States, esafoxolaner/eprinomectin/praziquantel is indicated for the prevention of heartworm disease caused by Dirofilaria immitis and for the treatment and control of roundworm (fourth stage larval and adult Toxocara cati ), hookworm (fourth stage larval and adult Ancylostoma tubaeforme ; adult Ancylostoma braziliense ), and tapeworm ( Dipylidium caninum ) infections. [ 5 ] [ 6 ] It kills adult fleas ( Ctenocephalides felis ) and is indicated for the treatment and prevention of flea infestations and the treatment and control of Ixodes scapularis (black-legged tick) and Amblyomma americanum (lone star tick) infestations for one month in cats and kittens eight weeks of age and older, and weighing 1.8 pounds (0.82 kg) or greater. [ 5 ] [ 6 ]
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An esophageal stent is a stent (tube) placed in the esophagus to keep a blocked area open so the patient can swallow soft food and liquids. They are effective in the treatment of conditions causing intrinsic esophageal obstruction or external esophageal compression. For the palliative treatment of esophageal cancer most esophageal stents are self-expandable metallic stents . For benign esophageal disease such as refractory esophageal strictures, plastic stents are available. Common complications include chest pain, overgrowth of tissue around the stent and stent migration. [ citation needed ] Esophageal stents may also be used to staunch the bleeding of esophageal varices . [ 1 ]
Esophageal stents are placed using endoscopy when after the tip of the endoscope is positioned above the area to be stented, then guidewire is passed through the obstruction into the stomach. The endoscope is withdrawn and using the guidewire with either fluoroscopic or endoscopic guidance the stent is passed down the guidewire to the affected area of the esophagus and deployed. [ 2 ] Finally, the guidewire is removed and the stent is left to fully expand over the next 2–3 days.
In one study of 997 patients who had self-expanding metal stents for malignant esophageal obstruction it was found that esophageal stents were 95% effective. [ 3 ]
Pros of Esophageal Stent
There are several potential benefits of an esophageal stent procedure:
Cons of Esophageal Stent
There are also several potential drawbacks to an esophageal stent procedure:
This article incorporates public domain material from Dictionary of Cancer Terms . U.S. National Cancer Institute .
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https://en.wikipedia.org/wiki/Esophageal_stent
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Esther Bernabela is a doctor and politician from Bonaire . She is an independent member of the Island Council of Bonaire . [ 1 ] [ 2 ] In the 2017 election, Bernabela joined a coalition of elected members of the Bonaire Patriotic Union (UPB) and the Bonaire Democratic Party . [ 3 ] This replaced the previous 2016 coalition that she was a member of. [ 4 ] A former leader of the UPB, she declared herself an independent candidate in March 2016, [ 5 ] and withdrew her support from the party in April. [ 6 ] However by 2021 she had re-joined the party. [ 2 ]
In 2020 she spoke out against the rise in prostitution in Bonaire. [ 7 ] She has previously worked for the International University School of Medicine . [ 8 ]
This article about a politician of the Caribbean Netherlands is a stub . You can help Wikipedia by expanding it .
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Esther Mae Wilkins (December 9, 1916 – December 12, 2016) was an American dental hygienist , dentist and author of the first comprehensive book on dental hygiene , Clinical Practice of the Dental Hygienist (first edition published in 1959). [ 1 ] The dental instrument known as the Wilkins/Tufts Explorer was named after her. [ 1 ] [ 2 ] [ 3 ]
Born in Chelmsford, Massachusetts to Ernest Wilkins and Edith Packard, [ 4 ] Esther Wilkins grew up in the nearby town of Tyngsborough . [ 2 ] Her father was a handyman, and her mother was a secretary. [ 4 ] She graduated from Lowell High School [ 5 ] in 1934. [ 6 ]
In 1938, she graduated from Simmons College in Boston. She first enrolled in the nursing program, but then switched to a general science major. Her interest in dental hygiene began her senior year, when one of her professors lectured on public health careers. Inspired, Wilkins walked over to the children's dental clinic at the Forsyth School and soon decided to become a hygienist. She earned a certificate from the Forsyth School of Dental Hygiene in 1939. [ 1 ]
After receiving her certificate in dental hygiene, Wilkins took a position with dentist Frank Willis, D13, in Manchester-by-the-Sea, Massachusetts . After several years as a hygienist, she applied for a degree in dentistry at Tufts University and was accepted for the class of 1948. The dean convinced her to defer to avoid being the only female student in the class. Following his advice, Wilkins entered the program the next year, where she was one of three women. At the time, less than 2 percent of U.S. dentists were women. [ 2 ]
After graduating from Tufts, Wilkins completed an internship in children's dentistry at Eastman Dental Dispensary in Rochester, New York in 1950. [ 7 ] Sponsored by Kodak founder George Eastman , the dispensary offered free dental services to low-income children.
In 1950, she founded the dental hygiene program at the University of Washington, Seattle 's School of Dentistry. She developed the curriculum and taught most of the courses offered. [ 8 ]
Realizing a need for up-to-date textbooks on dental hygiene, Wilkins began writing and mimeographing handouts for her students. Over the years, the stack of papers accumulated, and soon Wilkins was approached by a textbook seller about turning her writing into a book. [ 1 ] The first edition of Clinical Practice of the Dental Hygienist was published in 1959. The book has since become a cornerstone of text in dental hygiene programs. Wilkins released updated editions of the textbook through its 12th edition in 2016. The book has been translated into many languages, including Japanese, Italian, Korean, Portuguese, and Canadian French, [ 9 ] and is used in dental hygiene schools around the world. [ 2 ] [ 8 ]
After 12 years at the University of Washington, Wilkins returned to the Tufts University School of Dental Medicine to earn an Advanced Periodontal Certification in 1966. [ 7 ] She became a clinical professor at the university's School of Dentistry in 1966 and taught there for 45 years. In 2011, she became a professor emeritus. [ 4 ] [ 10 ]
She launched the Esther Wilkins Education Program to provide dental hygiene professionals with tools and lessons to educate children about oral health. [ 11 ]
Two awards have been established in her name: the Esther Wilkins Lifetime Achievement Award, by Dimensions of Dental Hygiene The Journal of Professional Excellence, and the Dr. Esther M. Wilkins Distinguished Alumni Award, by the Forsyth School for Dental Hygienists. [ 15 ]
In 2004, Wilkins received an honorary degree from the Massachusetts College of Pharmacy and Health Sciences for her achievements in the practice and advancement of dental hygiene. [ 16 ]
She established the Esther M. Wilkins Endowed Scholarship in 2011. [ 17 ]
In 1966, Wilkins married a former dentistry classmate, James B. Gallagher. [ 4 ] They were married for 22 years until Gallagher's death in 1988. [ 2 ]
Wilkins died of a stroke on December 12, 2016, at a nursing home [ 6 ] in Hudson , New Hampshire. [ 3 ] [ 4 ] Her death came three days after her 100th birthday. [ 18 ]
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Estrogen deprivation therapy , also known as endocrine therapy , is a form of hormone therapy that is used in the treatment of breast cancer . Modalities include antiestrogens or estrogen blockers such as selective estrogen receptor modulators (SERMs) such as tamoxifen , selective estrogen receptor degraders such as fulvestrant , and aromatase inhibitors such as anastrozole and ovariectomy . [ citation needed ]
A breast biopsy is tested for whether the cancer cells contain estrogen or progesterone receptors. A breast cancer that is positive for estrogen receptors is usually also progesterone receptor positive. This type of cancer is called ER/PR positive, which constitutes approximately 80% of all breast cancers. [ 1 ] ER positive cancers use estrogen to grow, so administering endocrine therapy to a patient diagnosed with ER/PR positive cancer will depress tumor growth.
Endocrine therapy should not be confused with menopausal hormone therapy or hormone replacement therapy, which is using estrogen and/or progesterone supplements to relieve symptoms of menopause. [ 2 ] Estrogen feeds breast cancer cells, so when a woman on hormone replacement therapy (HRT) is diagnosed with ER/PR positive breast cancer, her doctor will ask her to stop the HRT. [ 2 ]
Patients that have tumors small enough to take out with surgery will receive endocrine therapy after their surgery, which is part of adjuvant therapy. Large tumors may receive neo-adjuvant therapy via chemotherapy or radiation to shrink the tumor small enough to operate on.
Selective estrogen receptor modulators (SERMs) act by mimicking estrogen and replacing estrogen on estrogen receptors, blocking estrogen from binding and preventing tumors from using estrogen to grow. [ 2 ] They do not interfere with estrogen production. Tamoxifen (Nolvadex) is a commonly used drug for pre-menopausal women diagnosed with ER/PR positive breast cancer. Tamoxifen selectively blocks the effect of estrogen in breast tissue but acts as an estrogen agonist in the uterus and in bone. [ 2 ] Research shows that women on tamoxifen for at least 5 years out of surgery are less likely to have recurrent breast cancer, including new breast cancer in the other breast, and death at 15 years. [ 3 ]
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Estrogen dominance (ED) is a theory about a metabolic state where the level of estrogen outweighs the level of progesterone in the body. This is said to be caused by a decrease in progesterone without a subsequent decrease in estrogen.
The theory was proposed first by Dr Raymond Peat. [ 1 ] John R. Lee learned about progesterone and estrogen dominance when he attended a lecture by Dr. Raymond Peat. [ 2 ] John R. Lee and Virginia Hopkins wrote about estrogen dominance in their 1996 book, What Your Doctor May Not Tell You About Menopause: The Breakthrough Book on Natural Progesterone . In their book Lee and Hopkins assert that ED causes fatigue, depression, anxiety, low libido, weight gain specifically in the midsection, water retention, headaches, mood swings, white spots on fingernails, and fibrocystic breasts . [ 3 ] The book criticizes estrogen replacement therapy and proposes the use of "natural progesterone" for menopausal women to alleviate a variety of complaints. Lee's theories have been criticized for being inadequately supported through science, being primarily based on anecdotal evidence with no rigorous research supporting them. [ 4 ] Estrogen dominance can affect both men and women.
Estrogen dominance is widely discussed by many proponents and on many alternative medicine websites, including:
Christiane Northrup , former obstetrics and gynecology physician, believes that estrogen dominance is linked to "allergies, autoimmune disorders, breast cancer, uterine cancer, infertility, ovarian cysts, and increased blood clotting, and is also associated with acceleration of the aging process." She believes that ED can be reduced by several methods, including taking multi-vitamins, using progesterone cream, decreasing stress, and detoxifying the liver. [ 5 ]
Nisha Chellam, an internal medicine and holistic and integrative health physician, admits that "estrogen dominance isn't an official medical diagnosis" but believes that it is "an under-diagnosed condition." The list of symptoms Chellam attributes to ED include "unexplained weight gain, difficulty losing weight, breast tenderness, subcutaneous fat , heavy periods, missing periods, prolonged cycles, painful periods, premenstrual dysmorphic disorder [ sic ? ], infertility, mood swings, insomnia, headaches and migraines." [ 6 ]
Bob Wood, R.Ph. , lists the symptoms of estrogen dominance as "fibrocystic and tender breasts, heavy menstrual bleeding, irregular menstrual cycles, mood swings, vasomotor symptoms, weight gain and uterine fibroids " and believes that testing and "balancing hormones is of benefit to women of all ages". [ 7 ]
Extensive research has been conducted on all aspects of estrogen including its mechanism of action, contraindications to estrogen supplementation and estrogen toxicity. [ 8 ] Research on hormone replacement therapies have indicated that hormone replacement did not help prevent heart disease and it increased risk for some medical conditions. [ 9 ] [ 10 ] Research conducted by Alfred Plechner points to cortisol as a possible cause of naturally elevated estrogen. "The cortisol abnormality creates a domino effect on feedback loops involving the hypothalamus–pituitary–adrenal axis. In this scenario, estrogen becomes elevated..."
[ 11 ]
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The Estrogen in Venous Thromboembolism Trial ( EVTET ) was a randomized controlled trial (RCT) of menopausal hormone therapy in 140 postmenopausal women with previous history of venous thromboembolism (VTE). [ 1 ] [ 2 ] It was a double-blind RCT of the estrogen , oral estradiol 2 mg/day, plus the progestogen , norethisterone acetate (NETA) (n=71) 1 mg/day (brand name Kliogest ) versus placebo (n=69). [ 1 ] The results of the trial were published in 2000 and 2001. [ 1 ] [ 2 ] The incidence of VTE was 10.7% (8 women) in the hormone therapy group and 2.3% (1 woman) in the placebo group, with all events occurring within 261 days after study inclusion. [ 1 ] The difference did not reach statistical significance in the sequential analysis , but was statistically significant if the sequential design was ignored (p = 0.04). [ 1 ] Markers of coagulation were likewise increased by hormone therapy. [ 2 ] As a result of the high incidence of VTE in the treatment group, the trial was terminated prematurely. [ 1 ] The researchers concluded on the basis of their findings that menopausal hormone therapy should not be used in women with a previous history of VTE. [ 1 ]
Although the findings of the EVTET and other studies warrant caution concerning the use of oral estrogens in women with past VTE, research has found that transdermal estradiol, in contrast to oral estradiol and other oral estrogens, minimally influences coagulation, [ 3 ] and in systematic reviews and meta-analyses of observational studies , has not been associated with increased risk of VTE at doses of up to 100 μg/day. [ 4 ] [ 5 ] [ 6 ] [ 7 ] Similarly, a small study found that transdermal estradiol did not influence coagulation in women with prior VTE, [ 8 ] and the observational Menopause, Estrogen and Venous Events (MEVE) study found that transdermal estradiol was not associated with increased risk of VTE in postmenopausal women with past VTE ( HR Tooltip hazard ratio = 1.0 (95% CI Tooltip confidence interval 0.4–2.4) for transdermal estradiol vs. HR = 6.4 (95% CI 1.5–27.3) for oral estrogens). [ 9 ] [ 10 ] [ 11 ] [ 12 ] [ 13 ] Accordingly, menopausal hormone therapy guidelines state that transdermal estradiol is likely to have less risk of VTE and recommend use of transdermal estradiol in women with past VTE or at high risk for VTE. [ 14 ] [ 15 ] [ 16 ] [ 17 ] However, RCTs are still needed to confirm the findings. [ 15 ] [ 16 ] [ 17 ]
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https://en.wikipedia.org/wiki/Estrogen_in_Venous_Thromboembolism_Trial
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The estrogen receptor test (ERT) is a laboratory test to determine whether cancer cells have estrogen receptors . This information can guide treatment of the cancer. [ 1 ]
The test uses immunohistochemical techniques on the estrogen receptor (ER). Immunohistochemistry (IHC) methods involve selective identification of antigen proteins by exploiting antigen–antibody relationships.
Historically, the ligand binding assay was used to determine ER activity. This method was limited because large quantities of fresh tissue were needed for each assay. IHC can be performed on fixed tissue and needle biopsies , [ 2 ] and is more accurate in assessing ER status of a tumor. [ 3 ]
Today, ER analysis is one of many routinely performed immunohistochemical assays performed to classify hormone receptor status of breast cancers to provide insight into cancer prognosis and management.
There are two main types of estrogen receptor (ER): estrogen receptor alpha (ERα), and estrogen receptor beta (ER-β), also known as NR3A2. Both are nuclear receptors activated by the sex hormone estrogen . Estrogen signaling can be selectively stimulated or inhibited, dependent on the equilibrium of these two receptor types in target organs. [ 4 ] These two ER types are encoded by different genes located on separate chromosomes and have different functions. ERα is encoded by the ESR1 (Estrogen Receptor 1) gene, is mostly active in the mammary gland and uterus , and aids in the regulation of skeletal homeostasis and metabolism. [ 5 ] ER-β plays a prominent role in the central nervous and immune systems. [ 5 ]
The ERT immunohistochemical assessment is a semi-quantitative method used to predict the likelihood of successful treatment of breast cancer with anti-estrogen therapy. ER-positive breast carcinomas are likely to respond to endocrine treatments. Therefore, monitoring ER activity can be essential in understanding disease progression and guiding treatment.
Various target antibodies may be used in the IHC assessment of the ER. Typically, the antibody used is the anti-Estrogen Receptor (ER) (SP1) Rabbit Monoclonal Antibody . Employing SP1 allows detection of estrogen receptor (ER) antigens in sections of the fixed tissue samples. In conjunction with light microscopy, approximate ER activity can be estimated using the level of staining of the cell's components. The anti-ER (SP1) antibody targets the ER alpha protein (ERα) located in the nucleus of ER-positive cells. [ 6 ] The anti-ER (SP1) antibody's response is a useful indication of the progression, management, and prediction of therapy outcome of breast cancer. These antibodies are commercially available from three commonly used auto strain vendors: Dako, Leica, and Ventana. In a study by Kornaga et al. , all behaved similarly in the semi-quantitative analysis of breast cancer biopsy samples. [ 6 ]
In a study in 2002, six breast carcinoma cases were received, characterized, and analyzed through the ERT IHC assessment. The level of known ER activity was classified (negative, low, medium, and high) and selected for observation. After embedment in a paraffin block, the samples were stained using a hematoxylin and eosin staining (H & E staining) system. The IHC analysis was performed on the same day using anti-ER monoclonal antibodies . There was a consistently strong correlation between the IHC results and the known ER activity. [ 7 ]
Observation of estrogen receptor activity provides insight into growth and proliferation of breast cancer. The complex biochemical reactions of estrogen receptors are necessary for the mediation of cellular interactions in response to various cell-altering factors, including ligands , cofactors , and other simulative complexes. [ 8 ]
The estrogen receptor is a regulator of cellular functions, including cell growth and proliferation, and can serve as a means of inter-cellular differentiation. [ 8 ] Monitoring the activity of the ER via the ERT is necessary as it plays an essential role in normal breast development and function, as well as in cancerous situations. Accurate measurements of the ER activities are critical in the initial classification and monitoring of progression in breast cancers. The ER can serve as an indicative biomarker as it is a potential predictor for the clinical responses of a patient to certain treatments. Patients with breast cancer that is ER-positive at presentation are most likely to respond to cancer treatments through endocrine therapy. [ 9 ]
Estrogen receptors are over-expressed in approximately 70% of diagnosed breast cancers . Growing exposure of the mammary epithelium to estrogen is related to the risk of breast cancer as the binding of estrogen to the HER2 receptor in mammary cells causes a rise in the division and cell synthesis. This ultimately leads to a higher risk of replication errors, and the disruption of the normal cellular processes results in mistakes in apoptosis , cellular proliferation , or DNA repair . [ 10 ]
The ERT has been suggested as a predictor for the level of success of the use of endocrine therapy in cancer treatment. Many of the endocrine therapies for breast cancer treatments involve the use of selective estrogen receptor modulators (SERMs). SERMs, such as tamoxifen , are ER antagonists in breast tissue. Estrogen receptor tests are used in determining the sensitivity of breast cancer lesions to tamoxifen. Patients with ER-positive tumors are likely to respond well to these endocrine therapies.
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https://en.wikipedia.org/wiki/Estrogen_receptor_test
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Estrogenic fat likely refers to adipose tissue that develops under the direct influence of estrogens , particularly estradiol . The term, albeit not very common, specifically pertains to subcutaneous adipose tissue (also known as subcutaneous fat)
Estrogenic fat mainly refers to the feminine secondary sex characteristic that develops at puberty and is maintained by estradiol throughout the premenopausal years, while estradiol production levels are maintained. It results from estrogenic contributions to the accumulation of fatty acids in the hips, thighs, and buttocks rather than the abdomen promoting a gynoid body shape. [ 1 ] [ 2 ] Estrogenic fat refers to subcutaneous adipose deposits as they are more sensitive to estrogen signaling than visceral adipose deposits due to higher concentrations of estrogen receptors than the latter. [ 3 ] Studies have shown that not only does body fat distribution vary by sex, [ 4 ] but is also modulated by sex hormones. [ 3 ] [ 5 ] Post menopausal women typically show a more android fat distribution following declines in estrogen and regain gynoid-like fat distribution with estrogen replacement. [ 6 ]
Studies on sexual dimorphisms of obesity show that estradiol plays a part in the regulation of fat storage; specifically the balance between subcutaneous and visceral fat storage, [ 1 ] and show an inverse relationship between visceral fat storage and estrogen levels [ 7 ] [ 8 ]
Both estrogen receptors (ERα and ERβ) have been identified in adipose tissue and direct action of estrogen signaling in adipose tissue has been shown in humans, mice, and rats. [ 9 ] [ 10 ] Direct effects of estrogen in adipose cells( adipocytes ) includes modulation of cellular differentiation and proliferation, lipolysis , adipose tissue hyperplasia , cellular protein profile. [ 11 ] [ 12 ]
Many sex hormone receptors have been found in adipose tissue; with subcutaneous adipose tissue(SAT) possessing higher concentrations of estrogen receptors than androgen receptors. [ 3 ] In addition, estrogen receptor activity is known to down regulate androgen receptor expression in SAT. [ 4 ] Estrogen signaling promotes fat deposition in SAT depots which shifts fat storage dynamics away from visceral storage , [ 1 ] which is linked to higher incidence of coronary artery disease. [ 13 ] Clinical studies show the risk of NAFLD in post menopausal women is significantly reduced with estrogen replacement therapy [ 14 ]
Pre-menopausal women have higher levels of hormones, including estrogen. After menopause , subcutaneous fat depots in the breasts diminish due to lower levels adipocytes estrogen signaling, with a more pronounced decrease in estradiol levels. [ 15 ]
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Etelcalcetide , sold under the brand name Parsabiv , is a calcimimetic medication for the treatment of secondary hyperparathyroidism in people undergoing hemodialysis . It is administered intravenously at the end of each dialysis session. [ 3 ] [ 4 ] Etelcalcetide functions by binding to and activating the calcium-sensing receptor in the parathyroid gland . [ 3 ] Parsabiv is currently owned by Amgen and Ono Pharmaceuticals in Japan. [ 5 ] [ 6 ]
Etelcalcetide is used for the treatment of secondary hyperparathyroidism in people with chronic kidney disease (CKD) on hemodialysis. [ 7 ] Hyperparathyroidism is the condition of elevated parathyroid hormone (PTH) levels and is often observed in people with CKD. [ 8 ]
Etelcalcetide functions by binding to and activating the calcium-sensing receptor (CaSR) in the parathyroid gland as an allosteric activator , resulting in PTH reduction and suppression. [ 3 ]
Etelcalcetide functions in a first order elimination, with a half life of 19 hours. [ 6 ]
No interaction studies in humans were conducted. Studies in vitro showed no affinity of etelcalcetide to cytochrome P450 enzymes or common transport proteins . Therefore, no relevant pharmacokinetic interactions are expected. [ 7 ] [ 9 ]
Common side effects (in more than 10% of people) are nausea , vomiting, diarrhoea, muscle spasms, and hypocalcaemia (too low blood calcium levels). In clinical studies, the latter side effect was usually mild to moderate and without symptoms. An increase of the QT interval of more than 60 ms was detected in 1.2% of people receiving etelcalcetide. [ 7 ] [ 9 ]
Due to the lower iPTH levels achieved by the use of this drug, it is possible that adynamic bone disease could occur at levels "below 100 pg/mL" [ 6 ]
The drug is contraindicated in people with blood serum calcium levels below the norm . [ 7 ] [ 9 ]
The substance is a peptide consisting mostly of D - amino acids instead of the common L -amino acids. More specifically, it is the disulfide of N -acetyl- D - cysteinyl - D - alanyl - D - arginyl - D -arginyl- D -arginyl- D -alanyl- D -argininamide with L -cysteine. [ 10 ]
Originally, Etelcalcetide was being developed by KAI Pharmaceuticals. After positive phase II trials, Amgen acquired KAI for $315 million. [ 11 ]
In 2011, KAI entered into agreement with Ono Pharmaceutical for production of Etelcalcetide in Japan, the deal being worth ¥1 billion. [ 6 ]
In August 2015 Amgen Inc. announced its submission of a new drug application to the Food and Drug Administration for etelcalcetide. [ 3 ] The European Medicines Agency approved the medication in November 2016. [ 7 ]
In February 2017, the FDA approved Parsabiv for the treatment of secondary hyperparathyroidism. [ 12 ]
Phase II trials found that Etelcalcetide was able to lower PTH levels in one cohort by -49% vs a 29% increase in the placebo group. [ 6 ] In another phase II study "89% of patients experienced a C30% reduction in PTH and 56% achieved a PTH level of B300 pg/mL." [ 6 ]
In 2017, two phase III trials found that using etelcalcetide showed greater symptom reduction compared to placebo. [ 13 ] Etelcalcetide was also able to lower PTH levels below 300pg/mL more often. [ 13 ]
Phase I pediatric studies are planned for the US and UK for etelcalcetide. [ 6 ]
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https://en.wikipedia.org/wiki/Etelcalcetide
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Ethel Florence Annie Godfrey (1871 Melbourne, Australia – 17 September 1956) was one of the first female dentists in Victoria, Australia . [ 1 ] [ 2 ]
Godfrey is a graduate of Presbyterian Ladies' College, Melbourne , [ 3 ] where she is remembered as a notable graduate. [ 4 ] She was one of four female students at Mr. E. Lenthal Oldfield's Dental College and Oral Hospital where she was a student between 1895 and 1898. [ 5 ] She passed the Dental Board exam in November 1898 and registered as a dentist on 8 February 1899. [ 6 ] [ 7 ] [ 8 ] The Victoria Hospital for Women and Children appointed her appointed honorary dentist in August 1899, the first dental appointment at a hospital in Victoria. [ 9 ]
Godfrey practiced dentistry at 34 Collins Street in Melbourne alongside her business partner and future sister-in-law Alys Berry. When she married Dr. Samuel Arthur Ewing in 1903, she stopped her dentistry practice and had three children. [ 1 ]
Godfrey died on 17 September 1956. [ 10 ]
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Ethel May Vaughan-Sawyer (6 July 1868 – 9 March 1949) was a British gynaecological surgeon. [ 1 ] She was described by pioneering physician and feminist Louisa Garrett Anderson as "100 times better at her work than I am". [ 1 ] A champion of women's rights to work and take part in political life, Vaughan-Sawyer described herself as an example of "healthy normal womanhood usefully and happily employed". [ 1 ] [ 2 ]
Ethel May Vaughan was born on 6 July 1868 in Derby , the oldest of eight children born to Cedric Vaughan and Jane Ellen Ridley. [ 1 ] Her father was a locomotive engineer, who from 1872 was manager of the Hodbarrow Mining Company in Cumberland , where the family moved. [ 1 ]
With her two younger sisters, Ethel was educated at a private school in Bottesford, Leicestershire, and later in Lausanne . [ 1 ] From 1889, she studied at University College London , and in 1891 entered the London School of Medicine for Women , where she excelled. [ 1 ] She graduated BS and MB in 1896, and MD in 1898. [ 1 ]
In 1907, Vaughan married George Henry Vaughan-Sawyer, a captain and author. [ 1 ] The marriage was happy and their daughter, Petronella Grace, was born on 31 August 1908. [ 1 ] [ 3 ] George Henry Vaughan-Sawyer was killed in action in 1914. [ 1 ] [ 4 ] Petronella Grace, a designer and illustrator, died in 1931 at the age of 22. [ 1 ] [ 5 ]
In 1897, Vaughan became assistant medical officer to Camberwell Infirmary. [ 1 ] She subsequently became curator of the Royal Free Hospital 's museum, and in 1899 clinical assistant to physician Raymond Crawfurd . [ 1 ] In 1901, she spent time in Paris with fellow physician Louisa Garrett Anderson, visiting French hospitals. [ 1 ]
By that year, Vaughan had established a private practice from her home in Brompton Square, South Kensington, alongside her friend Dr. Kate Marion Hunter . [ 1 ] When, a year later, Mary Scharlieb was appointed physician for the diseases of women at the Royal Free Hospital, Vaughan was made her assistant. [ 1 ] Scharlieb described Vaughan as both "a great pleasure to work with" and "one of the best and most skilful surgeons of the next generation". [ 1 ]
On Scharlieb's retirement in 1908, Vaughan took over, assisted by Florence Willey . [ 1 ] Vaughan also lectured at her alma mater , the London School of Medicine for Women. [ 1 ] Following the birth of her daughter in August 1908, Vaughan (now Vaughan-Sawyer) returned to the operating table in November proving, as Claire Brock has written, "that medical women were more than capable of combining the roles of surgeon, wife, and mother." [ 1 ] At the Royal Free Hospital, Vaughan's surgical skill was evident, as was her interest in new and developing surgeries, detailed in her case notes. [ 1 ] [ 6 ] Vaughan-Sawyer also retained a private practice in Harley Street , and was actively involved in both the Royal Society of Medicine 's obstetric and gynaecological division, and the Association of Registered Medical Women. [ 1 ] She lectured widely, and was a member of the Fabian Women's Group . [ 1 ]
In 1920, Vaughan-Sawyer was part of a committee seeking to establish scholarships for Serbian women to train in medicine at the Royal Free Hospital. [ 7 ]
Vaughan-Sawyer remained at the Royal Free Hospital until 1926, when her eyesight began to fail and she retired from her post. [ 1 ] Two years later, she became the Royal Free Hospital's consulting gynaecologist. [ 1 ]
Vaughan-Sawyer died on 9 March 1949 in hospital in Northwood, Middlesex , having lived for two years in St John's Guest House for the Blind in Worthing . [ 1 ] On her death, a correspondent to The Times described her as having spoken of all the "calamities" of her life - and everything else - "with robust humour and a philosophy that had its roots in her deep and living faith." [ 8 ] Her obituary in the same paper remembered her as "for many years a noted gynaecologist and obstetrician". [ 9 ] An obituary was also published the British Medical Journal. [ 3 ]
Ethel Vaughan-Sawyer's case notes are held by the London Metropolitan Archives . [ 10 ]
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https://en.wikipedia.org/wiki/Ethel_Vaughan-Sawyer
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Ethical guidelines for treating trauma survivors can provide professionals direction to enhance their efforts. Trauma survivors have unique needs and vary in their resilience , post-traumatic growth , and negative and positive outcomes from their experiences. Numerous ethical guidelines can inform a trauma-informed care (TIC) approach. [ 1 ]
Trauma can result from a wide range of experiences which expose humans to one or more physical, emotional, and/or relational dangers. Treatment can be provided by a wide range of practices, ranging from yoga, education, law, mental health, justice, to medical. It can be provided by organizations .
Within the field of psychology, ethics define the standards of professional conduct. The American Psychological Association (APA [ 2 ] ) describes their Ethics Code as a “common set of principles and standards upon which psychologists build their professional and scientific work” (p. 8). Ethics help clinicians to think through and critically analyze situations, while also serving as aspirations and virtues that clinicians should strive towards. [ 3 ] When working with trauma survivors, oftentimes a client's traumatic experiences can be so overwhelming for both the patient and the clinician that professional and ethical boundaries may become endangered. [ 3 ]
The following ethical guidelines should be considered when working with clients who have survived a traumatic experience:
The APA ethics code [ 4 ] outlines many professional guidelines for clinicians including the maintenance of confidentiality , minimizing intrusions to privacy, and obtaining informed consent. Informed consent ensures the client has an adequate understanding of the techniques and procedures that will be used during therapy, expected timeline for treatment, and possible consequences for engaging in specific tasks and goals. [ 4 ]
When clinicians work with trauma survivors their informed consent should emphasize diagnosis and treatment of trauma and include clear guidelines for maintaining secure and firm boundaries. Some research suggests that clients who have experienced complex trauma may deliberately or unconsciously test clinician's boundaries by missing or arriving late for appointments, bringing the clinician gifts, attempting to photograph the therapist, calling during non-office hours, or trying to extend the session either in person or with a follow-up phone call. [ 5 ]
Research suggests that trauma survivors are more likely than those without a history of trauma to report suicidal ideation and to engage in self-harming behaviors . [ 6 ] Furthermore, research also indicates that suicide attempts are correlated with both childhood maltreatment and PTSD symptom severity. [ 7 ] Clinicians who treat trauma survivors should continuously monitor their client's suicidal ideation, means, and plans especially surrounding anniversary dates and triggering experiences. [ 3 ] Client safety should be prioritized when working with trauma survivors, and should include immediately assessing client safety following intense sessions and frequent follow-ups with clients between sessions. [ 5 ]
The APA outlines General Principles that clinicians should use in order to aspire towards the very highest ethical ideals. [ 2 ] Among these General Principles are Principle A: Beneficence and Nonmaleficence and Principle C: Integrity. Beneficence and Nonmaleficence describes that clinicians strive to benefit those with whom they work, and make efforts to do no harm. [ 2 ] Fidelity and Responsibility includes establishing relationships of trust and being aware of one's professional responsibilities. [ 2 ] Both of these principles should be considered when a clinician attempts to establish and maintain a strong therapeutic alliance with trauma survivors.
For clients with a history of trauma, particularly those who have experienced betrayal trauma , forging close and trusting relationships with others may be difficult. [ 6 ] In addition, during the course of therapy clients may discuss terrifying, horrific, or disturbing experiences, which may elicit strong reactions from the therapist. Some of the possible negative reactions could include distancing and emotional detachment, [ 3 ] which may reinforce clients’ often negative schemas and self-image. Clinicians may also contribute to the challenges of establishing a strong therapeutic alliance by becoming overly inquisitive about the client's traumatic experience, which, in turn, may lead to a lack of accurate empathy . For these reasons, clinicians treating those with a history of trauma may encounter unique challenges when attempting to develop a strong therapeutic alliance.
Within the course of traditional therapy it is possible for transference and counter transference to interfere with treatment. For clinicians treating those with a history of trauma it is possible to experience “a priori counter-transference”. [ 8 ] A priori counter-transference includes the thoughts, feelings, and prejudices that may arise before meeting with a potential client as a result of knowing that the client has gone through a certain traumatic event. [ 8 ] These initial reactions may create ethical dilemmas as the clinician's personal attitudes, beliefs, and values may become compromised, thereby increasing the amount of counter-transference the clinician may have towards the client. The APA ethics code 2.06(b) describes a clinician's ethical responsibility should personal situations interfere with a clinician's ability to perform their duties adequately. [ 2 ] Clinicians experiencing a priori counter-transference should consider utilizing more frequent consultations, receive increased levels of personal therapy, or consider limiting, suspending, or terminating their work-related duties. [ 2 ]
Dutton and Painter [ 9 ] originally coined the term “ traumatic bonding ” to describe the relationship bond that occurs between the perpetrator and victim of abusive relationships. As a result of ongoing cycles of positive and traumatic experiences powerful emotional bonds are created that are resistant to change. [ 9 ] The term can also be borrowed to describe the relationship between a trauma clinician and the client. As the client describes their traumatic memories and re-experiences the accompanying powerful emotions and sensations they are prone to form a remarkably intense bond with their clinician. These emotionally driven experiences present ethical challenges and pitfalls for the clinician including behaving in extremes such as acting in an overprotective manner or distancing themselves from the client. The clinician may also feel triggered by their own similar trauma history, causing unnecessary discloses or the need to share the client's story in order to seek revenge or justice. The APA ethics code 2.06(a) describes that clinicians should refrain from practicing if they know there is a substantial likelihood that their personal problems will prevent them from being objective or competent. [ 2 ] Clinicians who recognize that traumatic bonding might be occurring should increase consultations or consider limiting, suspending, or terminating their work-related duties. [ 2 ]
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Ethilon is a synthetic nonabsorbable nylon suture manufactured by Ethicon in Cornelia, Georgia. Black in color, it is a monofilament suture that is used frequently for soft-tissue approximation and ligation. Even though it is nonabsorbable, the knot security decreases over time (in vivo) and should not be used where permanent retention is required. [ 1 ] Practitioners should exercise caution using such material in urinary and biliary tracts, as this can lead to calculi formation.
One of its most frequent uses is for percutaneous closures. Ethilon has good knot security and low tissue reactivity. [ citation needed ]
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Ethmoidectomy is the medical name for a procedure that involves removing the partitions between the ethmoid sinuses in order to create larger sinus cavities . This procedure treats sinus infections and sinus obstructions that have been the cause of chronic sinus problems. The procedure may also involve the removal of nasal polyps present in the ethmoids. [ 1 ]
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Etiology ( / ˌ iː t i ˈ ɒ l ə dʒ i / ; alternatively spelled aetiology or ætiology ) is the study of causation or origination. The word is derived from the Greek word αἰτιολογία ( aitiología ) , meaning "giving a reason for" (from αἰτία ( aitía ) ' cause ' and -λογία ( -logía ) ' study of ' ). [ 1 ] More completely, etiology is the study of the causes, origins, or reasons behind the way that things are, or the way they function, or it can refer to the causes themselves. [ 2 ] The word is commonly used in medicine (pertaining to causes of disease or illness) and in philosophy , but also in physics , biology , psychology , political science , geography , cosmology , spatial analysis and theology in reference to the causes or origins of various phenomena .
In the past, when many physical phenomena were not well understood or when histories were not recorded, myths often arose to provide etiologies. Thus, an etiological myth, or origin myth , is a myth that has arisen, been told over time or written to explain the origins of various social or natural phenomena. For example, Virgil 's Aeneid is a national myth written to explain and glorify the origins of the Roman Empire . In theology , many religions have creation myths explaining the origins of the world or its relationship to believers.
In medicine, the etiology of an illness or condition refers to the frequent studies to determine one or more factors that come together to cause the illness. Relatedly, when disease is widespread, epidemiological studies investigate what associated factors, such as location, sex, exposure to chemicals, and many others, make a population more or less likely to have an illness, condition, or disease, thus helping determine its etiology. Sometimes determining etiology is an imprecise process. In the past, the etiology of a common sailor's disease, scurvy , was long unknown. When large, ocean-going ships were built, sailors began to put to sea for long periods of time, and often lacked fresh fruit and vegetables. Without knowing the precise cause, Captain James Cook suspected scurvy was caused by the lack of vegetables in the diet. Based on his suspicion, he forced his crew to eat sauerkraut , a cabbage preparation, every day, and based upon the positive outcomes, he inferred that it prevented scurvy, even though he did not know precisely why. It took about another two hundred years to discover the precise etiology: the lack of vitamin C in a sailor's diet.
The following are examples of intrinsic factors:
An etiological myth, or origin myth, is a myth intended to explain the origins of cult practices, natural phenomena, proper names and the like. For example, the name Delphi and its associated deity, Apollon Delphinios , are explained in the Homeric Hymn which tells of how Apollo, in the shape of a dolphin ( delphis ), propelled Cretans over the seas to make them his priests. While Delphi is actually related to the word delphus ('womb'), many etiological myths are similarly based on folk etymology (the term Amazon , for example). In the Aeneid (published c. 17 BC ), Virgil claims the descent of Augustus Caesar 's Julian clan from the hero Aeneas through his son Ascanius , also called Iulus. The story of Prometheus ' sacrifice trick at Mecone in Hesiod 's Theogony relates how Prometheus tricked Zeus into choosing the bones and fat of the first sacrificial animal rather than the meat to justify why, after a sacrifice, the Greeks offered the bones wrapped in fat to the gods while keeping the meat for themselves. In Ovid 's Pyramus and Thisbe , the origin of the color of mulberries is explained, as the white berries become stained red from the blood gushing forth from their double suicide.
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Etonogestrel is a medication which is used as a means of birth control for women. [ 4 ] [ 5 ] [ 12 ] [ 13 ] It is available as an implant placed under the skin of the upper arm under the brand names Nexplanon and Implanon. It is a progestin that is also used in combination with ethinylestradiol , an estrogen , as a vaginal ring under the brand names NuvaRing and Circlet . [ 14 ] Etonogestrel is effective as a means of birth control and lasts at least three or four years with some data showing effectiveness for five years. [ 9 ] [ 11 ] Following removal, fertility quickly returns. [ 15 ]
Side effects of etonogestrel include menstrual irregularities , breast tenderness , mood changes, acne , headaches, vaginitis , and others. [ 4 ] Etonogestrel is a progestin , or a synthetic progestogen , and hence is an agonist of the progesterone receptor , the biological target of progestogens like progesterone . [ 16 ] It works by stopping ovulation , thickening the mucus around the opening of the cervix , and altering the lining of the uterus . [ 17 ] It has very weak androgenic and glucocorticoid activity and no other important hormonal activity. [ 16 ]
Etonogestrel was patented in 1972 and introduced for medical use in 1998. [ 18 ] [ 19 ] [ 20 ] It became available in the United States in 2006. [ 18 ] [ 19 ] Etonogestrel implants are approved in more than 90 countries and used by about three million women globally as of 2010. [ 17 ] [ 21 ]
A closely related and more widely known and used progestin, desogestrel , is a prodrug of etonogestrel in the body. [ 16 ]
Etonogestrel is used in hormonal contraception in form of the etonogestrel contraceptive implant [ 4 ] and the contraceptive vaginal ring (brand names NuvaRing, Circlet), the latter in combination with ethinylestradiol . [ 5 ]
Etonogestrel birth control implants are a type of long-acting reversible contraception , which has been shown to be one of the most effective form of birth control. [ 22 ] The failure rate of the implants is 0.05% for both perfect use and typical use because the method requires no user action after placement. [ 23 ] Studies of one type, which include over 2,467 women-years of exposure, found no pregnancies. [ 24 ] [ 25 ] [ 26 ]
Other studies have found some failures with this method, some attributed to failures of the method itself and others to improper placement, drug interactions, or conception prior to method insertion. [ 27 ]
In comparison, tubal sterilization has a failure rate of 0.5% and IUDs have a failure rate of 0.2–0.8%. [ 23 ] A single implant is approved for three years with data showing effectiveness for five years. [ 28 ] [ 11 ]
Women should not use implants if they: [ 29 ]
Women should not use combined hormone contraceptives (CHC) if they have migraines with auras. [ 30 ]
A full list of contraindications can be found in the WHO Medical Eligibility Criteria for Contraceptive Use 2015 and the CDC United States Medical Eligibility Criteria for Contraceptive Use 2016 .
Irregular bleeding and spotting : Many women will experience some type of irregular, unpredictable, prolonged, frequent, or infrequent bleeding. [ 31 ] Some women also experience amenorrhea . For some women, prolonged bleeding will decline after the first three months of use. However, other women may experience this bleeding pattern through all five years of use. While these patterns are not dangerous, they are the most common reason that women give for discontinuing the use of the implant. After removal, bleeding patterns return to previous patterns in most women. [ 24 ] [ 25 ] [ 26 ]
Insertion complications : Some minor side effects such as bruising, skin irritation, or pain around the insertion site are common. [ 24 ] However, there are some rare complications that can occur, such as infection or expulsion. [ 24 ] [ 32 ] In some cases, a serious complication occurs when the provider fails to insert, and the rod is left in the inserter. An Australian study reported 84 pregnancies as a result of such failure. [ 27 ]
Migration : Although very rare, the rod can sometimes move slightly within the arm. This can make removal more difficult. It is possible that insertion in the same site as a previous implant increases the likelihood of migration. [ 32 ] Rods can be located only through high-frequency ultrasound or magnetic resonance imaging (MRI). [ 24 ] It can be located using traditional X-ray or CT-scan because of the inclusion of barium sulphate. There have been rare reports of implants having reached the lung via the pulmonary artery. [ 33 ] Correct subdermal insertion over the triceps muscle reduces the risk of these events.
Possible weight gain : Some women may experience slight weight gain when using the implant. [ 24 ] However, current studies are not conclusive because they do not compare the weight of women using implants with a control group of women not using the implant. The average increase in body weight in studies was less than 5 pounds (2.25 kg) over 2 years. [ 25 ]
Ovarian cysts : A small portion of women using implants and other contraceptive implants develop ovarian cysts . [ 24 ] Usually these cysts will disappear without treatment. [ 34 ]
Pregnancy : It is recommended that implants be removed if a pregnancy does occur. However, there is no evidence to suggest that the implant has a negative effect on pregnancy or a developing fetus. [ 24 ]
Acne : Acne has been self-reported to be a side effect, and is listed as a side effect by the FDA. However, a study of users found that a majority of users with acne before their insertion reported that their acne had decreased, and only 16% of those who did not have acne before insertion developed acne. [ 25 ]
Other possible symptoms : Other symptoms that have been reported in trials of implants include headache, emotional lability , depression, abdominal pain, loss of libido, and vaginal dryness. [ 24 ] However, there have been no studies that conclusively determine that these symptoms are caused by the implant. [ 25 ] [ 26 ]
No serious side effects are expected when overdosing contraceptives in general. [ 35 ]
Efavirenz , an inducer of the liver enzyme CYP3A4 , appears to decrease etonogestrel levels [ 36 ] and increase rates of undesired pregnancy among implant users.
Similar effects are expected for other CYP3A4 inducers, but it is not known whether these are clinically relevant. The opposite is true of CYP3A4 inhibitors such as ketoconazole , itraconazole and clarithromycin : they might increase etonogestrel concentrations in the body. [ 35 ]
Nexplanon/Implanon consists of a single rod made of ethylene vinylacetate copolymer that is 4 cm long and 2 mm in diameter. [ 31 ] It is similar to a matchstick in size. The rod contains 68 mg of etonogestrel (sometimes called 3-keto-destrogestrel), a type of progestin. [ 24 ] Peak serum etonogestrel concentrations have been found to reach 781–894 pg/mL in the first few weeks, gradually decreasing to 192–261 pg/mL after one year, 154–194 pg/mL after two years, and 156–177 pg/mL after three years, maintaining ovulation suppression and contraceptive efficacy. [ 37 ] Serum levels maintain relatively stable through 36 months, which implies that the method may be effective for longer than three years. [ 38 ]
Although not formally approved by the manufacturer for more than three years, studies have shown it remains a highly effective contraceptive for five years. [ 28 ]
It is a type of progestogen-only contraception .
An experienced clinician must perform the insertion of implants to ensure proper insertion and minimize the risk of nerve damage or misplacement, which could result in pregnancy. [ 39 ] Before insertion, the arm is washed with a cleaning solution and a local anesthetic is applied to the upper arm around the insertion area. [ 24 ] A needle-like applicator is used to insert the rod under the skin into the subdermal tissue on the inner side of the arm posterior to the groove between the biceps and triceps muscles. [ 40 ] The average time for insertion is 0.5 to 1 minute. [ 25 ] [ 26 ] A bandage should be kept on the insertion site for 24 hours afterwards. Bruising and mild discomfort are common after insertion. [ 24 ] Serious insertion site complications such as infection can occur very rarely, in less than 1% of patients. If a woman receives an implant outside the first five days of her period, she should wait to have sex or use a backup method of contraception (such as a condom , female condom , diaphragm , sponge, or emergency contraception ) for the following week after insertion to prevent pregnancy. However, if the implant is inserted during the first five days of a woman's period, the drug typically is effective for that cycle and beyond. [ 41 ]
Implants can be removed at any time if pregnancy is desired. The rod must also be removed by an experienced clinician. At removal, a local anesthetic is again used around the implant area at the distal end. [ 24 ] If the provider cannot feel the implant, imaging tests may be necessary to locate the rod before it can be removed. A small incision is made in the skin over the end of the implant site. In some cases, a fibrous sheath may have formed around the implant, in which case the sheath must be incised. [ 24 ] The implant is removed using forceps. The removal procedure lasts, on average, 3 to 3.5 minutes. [ 25 ] [ 26 ]
Within a week of removal, the hormones from the device leave the body and etonogestrel is undetectable in most users. [ 24 ] Most women will begin to ovulate within six weeks of removal. [ 38 ] [ 42 ] Fertility levels will return to what they were before implant insertion. [ 15 ]
Nexplanon and Implanon NXT are essentially identical to Implanon except Nexplanon and Implanon NXT have 15 mg of barium sulphate added to the core, so it is detectable by x-ray. [ 43 ] [ 28 ] Nexplanon and Implanon NXT also has a pre-loaded applicator for easier insertion. [ 44 ]
The mechanism of action of progestin-only contraceptives depends on the progestin activity and dose. [ 45 ] Intermediate dose progestin-only contraceptives like Nexplanon or Implanon allow some follicular development but inhibit ovulation in almost all cycles as the primary mechanism of action. Ovulation was not observed in studies of Implanon in the first two years of use and only rarely in the third year with no pregnancies. A secondary mechanism of action is the progestogenic increase in cervical mucus viscosity which inhibits sperm penetration. [ 46 ] Hormonal contraceptives also have effects on the endometrium that theoretically could affect implantation, however no scientific evidence indicates that prevention of implantation actually results from their use. [ 47 ]
Etonogestrel is a progestogen , or an agonist of the progesterone receptor . [ 16 ] It is less androgenic than levonorgestrel and norethisterone , [ 48 ] [ 49 ] and it does not cause a decrease in sex hormone-binding globulin levels. [ 50 ] However, it is still associated with acne in up to 13.5% of patients when used as an implant, though this side effect only accounts for 1.3% of premature removals of the implant. [ 51 ] In addition to its progestogenic and weak androgenic activity, etonogestrel binds to the glucocorticoid receptor with about 14% of the affinity of dexamethasone (relative to 1% for levonorgestrel) and has very weak glucocorticoid activity. [ 16 ] Etonogestrel has no other hormonal activity (e.g., estrogenic , antimineralocorticoid ). [ 16 ] Some inhibition of 5α-reductase and hepatic cytochrome P450 enzymes has been observed with etonogestrel in vitro , similarly to other 19-nortestosterone progestins. [ 16 ]
The bioavailability of etonogestrel when given as a subcutaneous implant or as a vaginal ring is 100%. [ 4 ] [ 5 ] Steady-state levels of etonogestrel are achieved within one week upon insertion as an implant or vaginal ring. [ 4 ] [ 5 ] The mean volume of distribution of etonogestrel is 201 L. [ 4 ] The plasma protein binding of the medication is at least 98%, with 66% bound to albumin and 32% bound to sex hormone-binding globulin . [ 4 ] [ 5 ] Etonogestrel is metabolized in the liver by CYP3A4 . [ 4 ] [ 5 ] The biological activity of its metabolites is unknown. [ 4 ] [ 5 ] The elimination half-life of etonogestrel is about 25 to 29 hours. [ 4 ] [ 5 ] Following removal of an etonogestrel-containing implant, levels of the medication were below the limits of assay detection by one week. [ 4 ] The major portion of etonogestrel is eliminated in urine and a minor portion is eliminated in feces . [ 4 ] [ 5 ]
Etonogestrel, also known as 11-methylene-17α-ethynyl-18-methyl-19-nortestosterone or as 11-methylene-17α-ethynyl-18-methylestr-4-en-17β-ol-3-one, is a synthetic estrane steroid and a derivative of testosterone . [ 12 ] [ 14 ] It is more specifically a derivative of norethisterone (17α-ethynyl-19-nortestosterone) and is a member of the gonane (18-methylestrane) subgroup of the 19-nortestosterone family of progestins. [ 54 ] [ 55 ] Etonogestrel is the C3 ketone derivative of desogestrel and the C11 methylene derivative of levonorgestrel and is also known as 3-ketodesogestrel and as 11-methylenelevonorgestrel. [ 1 ]
The possibility of the subdermal contraceptive implant began when silicone was discovered in the 1940s and found to be bio-compatible with the human body. [ 56 ] In 1964, Folkman and Long published the first study demonstrating that such a rod could be used to deliver drugs. [ 57 ] In 1966 Dziuk and Cook published a study that looked at release rates and suggested that the rods could be well suited for contraception. [ 58 ] After a study that used implants with progestogens for contraception, the Population Council developed and patented Norplant and Jadelle . [ 59 ] Norplant has six rods and is considered a first-generation implant. Jadelle (Norplant II), a two-rod implant, and other single rod implants that followed, were developed because of complications resulting from Norplant's six-rod system. The Jadelle system contains two silicone rods mixed with levonorgestrel. In 1990 De Nijs patented a co-axial extrusion technique of ethylene vinylacetate copolymers and 3-keto-desogestrel (etonogestrel) for the preparation of long-acting contraceptive devices, such as Implanon, Nexplanon and Nuvaring. [ 60 ] The single rods were less visible under the skin and used etonogestrel as opposed to levonorgestrel in the hopes that it would reduce side effects. [ 56 ]
Desogestrel (3-deketoetonogestrel), a prodrug of etonogestrel, was introduced for medical use in 1981. [ 6 ] [ 61 ]
Norplant was used internationally beginning in 1983 and was marketed in the United States and the United Kingdom in 1993. There were many complications associated with Norplant removal in the United States and it was taken off the market in 2002. Although Jadelle was approved by the FDA, it has never been marketed in the United States, but it is widely used in Africa and Asia. [ 59 ]
Etonogestrel itself was first introduced as Implanon in Indonesia in 1998, [ 18 ] [ 19 ] was marketed in the United Kingdom shortly thereafter, [ 62 ] and approved for use in the United States in 2006. [ 18 ] [ 19 ] Nexplanon was developed to eliminate the problem of non-insertion and localization of Implanon by changing the inserter device and making the rod radiopaque. [ 43 ] As of January 2012, Implanon is no longer being marketed and Nexplanon is the only available single-rod implant.
Etonogestrel is the generic name of the drug and its INN Tooltip International Nonproprietary Name , USAN Tooltip United States Adopted Name , and BAN Tooltip British Approved Name . [ 12 ] [ 14 ] It is also known by its developmental code name ORG-3236 . [ 12 ] [ 14 ]
Etonogestrel is marketed under the brand names Circlet, Implanon, Nexplanon, and NuvaRing. [ 12 ] [ 14 ]
Etonogestrel is available widely throughout the world, including in the United States, Canada, the United Kingdom, Ireland, elsewhere throughout Europe, South Africa, Latin America, South , East , and Southeast Asia, and elsewhere in the world. [ 14 ]
An etonogestrel-releasing intrauterine device was under development for use as a form of birth control for women but development was discontinued in 2015. [ 63 ]
Etonogestrel has been studied for use as a potential male contraceptive . [ 64 ]
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Eubacterium nodatum is a Gram positive member of the oral flora of some patients with chronic periodontitis . [ 1 ] It has been recently added to the red complex bacteria, that are most associated with disease.
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The European Academy of Neurology (EAN) is a non-profit organisation that unites and supports neurologists across Europe . Currently, 47 European national neurological societies as well as 4000 individuals are registered members of EAN. Thus, EAN represents more than 45,000 European neurologists.
The EAN was founded during the Joint Congress of European Neurology in June 2014 by the former European Federation of Neurological Societies (EFNS) and European Neurological Society (ENS). The academy's current president is Professor Paul Boon ( Ghent , Belgium ). [ 1 ]
The EAN organises the annual congress of European neurology, which is held in different European cities and is attended by approximately 6,000 international participants. [ 2 ]
2014: EFNS–ENS Joint Congress of European Neurology in Istanbul , Turkey . Birthplace of the European Academy of Neurology. [ 3 ]
2015: 1st EAN Congress in Berlin , Germany [ 4 ]
2016: 2nd EAN Congress in Copenhagen , Denmark [ 4 ]
2017: 3rd EAN Congress in Amsterdam , Netherlands [ 4 ]
2018: 4th EAN Congress in Lisbon , Portugal [ 4 ]
2019: 5th EAN Congress in Oslo , Norway [ 4 ] [ 2 ]
2020: 6th EAN Congress in Paris , France [ 4 ]
2021: 7th EAN Congress in Vienna , Austria [ 5 ]
2022: 8th EAN Congress in Vienna , Austria [ 5 ]
2023: 9th EAN Congress in Budapest , Hungary [ 6 ]
2024: 10th EAN Congress in Helsinki , Finland [ 6 ]
2025: 11th EAN Congress in Sevilla , Spain [ 6 ]
The European Academy of Neurology consists of an elected/appointed Board, as well as programme, education, liaison and scientific committees. [ 7 ] There are 29 subspecialty scientific panels, [ 8 ] each responsible for a specific neurological topic: [ citation needed ]
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The European Association for Cardio-Thoracic Surgery ( EACTS ) is a membership organisation devoted to the practice of cardiothoracic surgery . The mission statement of the association is to advance education in the field of cardiac, thoracic and vascular interventions; and promote research into cardiovascular and thoracic physiology, pathology and therapy, with the aim to correlate and disseminate the results for the public benefit. Within the EACTS there is a large number of committees working on various issues in order to improve cardio-thoracic surgery. [ 1 ]
EACTS was founded as a European organisation. However, its membership is now spread all over the world in all continents representing some 70 countries. Since its foundation in 1986 more than 3500 members have been admitted, and the interest in applying for membership has grown considerably during the last few years. [ 2 ]
The EACTS Annual Meeting is the largest cardio-thoracic meeting in the world [ citation needed ] focusing on scientific developments and research in the following specialities: Acquired Cardiac Disease, Congenital Heart Disease, Vascular Disease and Thoracic Disease. [ citation needed ]
The EACTS publishes two journals focused on high-quality research and cardio thoracic surgery education and one website featuring video based cardio-thoracic tutorials these are: European Journal of Cardio-Thoracic Surgery (EJCTS) , Interactive Cardiovascular and Thoracic Surgery (ICVTS) , and Multimedia Manual of Cardio-Thoracic Surgery (MMCTS) [ citation needed ]
The Quality Improvement Programme was launched in 2012 to facilitate continuing improvement of clinical outcomes in adult cardiac surgery through improving education, and various research initiatives. [ citation needed ]
The organisation has collaborated with the European Society of Cardiology , the American Heart Association , Oxford University , and other organizations to produce clinical practice guidelines and consensus statements related to the treatment of cardiovascular disease. [ 3 ] [ 4 ] [ 5 ]
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The European Association of Oral Medicine (EAOM) is a dental organization established in 1998 with mainly European representatives, but some non-European. [ 1 ] [ 2 ] It was founded by Miguel Lucas Tomás (Spain), Crispian Scully (United Kingdom), Isaac van der Waal (Netherlands), Sir David Mason, Tony Axéll (Scandinavia), Antonio Azul (Portugal), and Stephen Challacombe (United Kingdom). [ 1 ] [ 3 ] [ 4 ]
The presidents of the EAOM have been: [ 5 ]
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https://en.wikipedia.org/wiki/European_Association_of_Oral_Medicine
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The European Brain Council ( EBC ) is a coordinating international health organization founded in 2002. It comprises major organisations in the field of brain research and brain disorders in Europe, and thus its structure involves a network of patients, scientists and doctors, working in partnership with the pharmaceutical and medical devices industries. The EBC works with decision-making bodies such as the European Commission , [ 2 ] the European Parliament [ 3 ] and the World Health Organization . [ 4 ]
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The European Cancer Prevention Organization ( ECP ) is a scientific organization representing physicians of all oncology sub-specialties with focus on cancer prevention . ECP was founded in 1981 with the support of several European scientists. The elected president of ECP is Professor Giovanni Corso . The Cancer Plan will aim to make at least 80% of the population aware of the Code by 2025.
ECP was created in 1981 to promote European cooperation in cancer prevention studies. At that time, several scientists had become convinced that lifestyle factors could be related to the risk of 60% or more of all human cancers , thus offering hope that many could be actually prevented. Alain Maskens, a Belgian oncologist , circulated a document that proposed to create an organization with three main goals:
Several experts agreed to form a scientific committee responsible for defining the project priorities, methods and structures. The Committee held its first meeting in Brussels on December 11 and 12, 1981. The participants included: Guy Blaudin de Thé ( Lyon ), Franco Conte ( Genova ), Daniela Daniele ( Torino ), Pierre Dellenbach ( Strasbourg ), Lajos Döbrössy ( WHO Europe), Peter Ebbesen ( Aarhus ), Jean Faivre ( Dijon ), Pierre Jeandrain (Brussels), Joseph Joossens ( Leuven ), Cristina Kettlitz ( Milano ), Paul Mainguet ( Louvain ), Franz Oesch ( Mainz ), Marcel Roberfroid (Louvain), Leonardo Santi (Genova), James Scott ( Leeds ), Martine Van Glabbeke ( EORTC ), and Jean-Pierre Wolff ( Villejuif ). After a series of scientific presentations, the participants held discussions about methods and priorities, led by Prof. Scott, who became the first chairman of the ECP Scientific Committee. The main points which came out of this session were:
Alain Maskens received the responsibility of coordinating the project, as first medical coordinator.
In the months that followed, a legal ECP entity was created for managing the administrative aspects of the organization. The working groups started accruing members, and preparing joint research projects. A first symposium was organized in March 1983, soon to be followed by others on an annual basis.
An important event occurred 10 years later, in October 1991: the launch of the European Journal of Cancer Prevention , the official journal of ECP. This major achievement was led by Dr. Michael Hill, who had by then replaced James Scott as Chairman of the ECP Scientific Committee, and by Dr. Attilio Giacosa, who had replaced Dr. Maskens as medical coordinator of ECP.
The aim of ECP has progressively changed, currently it includes epidemiology , nutrition , genetics , molecular biology , targeted therapies , surgery , and innovative research areas. Members come from different European countries, and they organize an annual meeting to discuss about progress in cancer prevention and novel research projects.
ECP offers several educational opportunities for physicians. These activities comprise scientific meetings , educational conferences, professional workshops, and special symposia about issues of particular relevance to oncologists and researchers. [ 1 ] [ 2 ] In 1992, the European Journal of Cancer Prevention was created and affiliated to the ECP organization as official journal. [ 3 ]
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The European Federation of Neurological Societies was an organisation that united and supported neurologists across the whole of Europe. As of 2013, 45 European national neurological societies were registered members of the EFNS, and the federation represented more than 19,000 European neurologists. It was founded in 1991 in Vienna , Austria . [ citation needed ]
In June 2014 the federation, together with the European Neurological Society , founded the European Academy of Neurology . Both parent organisations were dissolved at the same time.
The European Federation of Neurological Societies (EFNS) was a different organization from the European Federation of Neurological Associations (EFNA). "Although EFNA [was] not an official member of the Federation [EFNS], it [did] work closely with the EFNS." [ 1 ]
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The European Federation of Periodontology (EFP) is a global non-profit organisation with a European core, which promotes periodontal science and practice, as well as awareness of gum health and gum disease to oral-health professionals, other medical professionals, policymakers, and the public. The EFP’s vision is “Periodontal health for a better life.”
Founded in 1991, the EFP is a federation of 43 national periodontal societies and represents more than 18,000 oral-health professionals and researchers in six continents. It pursues its mission by organising evidence-based scientific events and campaigns, including: EuroPerio, the world’s leading congress in periodontology and implant dentistry; Perio Master Clinic, a theme-based conference on periodontal practice; Perio Workshop, a high-level meeting that sheds light on emerging issues; and Gum Health Day, a global awareness initiative celebrated on May 12.
The EFP’s Journal of Clinical Periodontology , published monthly, is a leading scientific publication and has among the highest impact factors of journals in dentistry, oral surgery, and medicine. [ 1 ] [ 2 ] The federation also publishes a monthly research summary ( JCP Digest ), as well as the magazines Perio Insigh t and Perio Life .
The EFP defines and promotes high-quality training in periodontology and implant dentistry on all three levels of professional education: undergraduate training, postgraduate vocational education and training, and specialist training at its 24 accredited university programmes.
The federation, along with its member societies, has been working towards the pan-European recognition by the European Union of periodontology as a speciality within dentistry. [ 3 ]
The EFP is supported by industry partners but has no commercial or professional agenda.
The EFP’s strategic vision is “periodontal health for a better life", emphasising the interaction between periodontal health and overall health and the positive role that periodontology can play in public health. The federation seeks to serve both the professional periodontal and dentistry sector as well as patients and the public. Periodontology or periodontics (from Ancient Greek περί , perí – “around”; and ὀδούς , odoús – “tooth”, genitive ὀδόντος , odóntos ) encompasses the art, science, and practice of attaining and maintaining healthy tissues supporting and surrounding teeth (or their substitutes), replacing lost teeth by implantation of natural and/or synthetic devices, and reconstructing lost supporting structures by regeneration or repair with the goal of maintaining health, function, and aesthetics to improve oral and general health and wellbeing. [ 4 ]
In seeking to fulfil its strategic vision, the EFP has four strategic objectives: [ 4 ]
1. Improved health and wellbeing : Improve and promote periodontal health globally as part of oral and general health and wellbeing, ensuring social and economic inclusion, by working in partnership with patients, governments, professional bodies, industry, consumer groups, and other organisations.
2. Education and training : Maintain, refine, harmonise, and further develop the highest standards of education and training in the art, science, and practice of periodontology and implant dentistry to increase knowledge/awareness among other oral-health and other health professionals of the importance of periodontal diseases and their consequences.
3. Policy and influence : In collaboration with national member organisations and through strong leadership, influence policy at national and international levels, including the recognition of periodontal diseases as a public-health problem as well as a source and consequence of social inequality. The recognition of periodontology as a dental speciality in the EU is fundamental prerequisite.
4. Science and research : Promote research and the knowledge base in all aspects of periodontology and implant dentistry, with global dissemination and application of research findings to enhance patient and public awareness and to promote the practice of evidence-based and patient-centred care and, in turn, clinical outcomes.
As set out in the federation’s by-laws: The EFP is a non-profit making organisation whose goal is the promotion of periodontology and, more generally, oral health both in Europe and worldwide. In particular:
In addition, the EFP also has a goal to promote and represent the interests of the discipline of periodontology in Europe and worldwide. [ 5 ]
The origins of the European Federation of Periodontology (EFP) date back to a conversation in 1985 between Dr Jean-Louis Giovannoli (France) and Professor Ubele van der Velden (the Netherlands). The concept of a united and co-operative body of European societies of periodontology emerged from this conversation. Subsequent discussions and meetings, over the following six years, led to the formation of the Federation.
The European Federation of Periodontology was formally created at a meeting on 12–13 December 1991 in Amsterdam at which the federation’s objectives were adopted and its constitution and by-laws were approved. The newly formed EFP comprised the national societies of periodontology of 11 European countries: the Belgian, British, Dutch, French, German, Irish, Italian, Portuguese, Spanish, Swedish, and Swiss societies. [ 6 ]
The EFP’s constitution and by-laws were amended in 1996, 2010, and 2016. [ 7 ]
The EFP’s first scientific congress, called EuroPerio1, was held at EuroDisney in Paris, France, on 12–15 May 1994. Since then, a further nine editions of the EuroPerio congress have been held.
The first European Workshop on Periodontology (later rebranded as Perio Workshop) was held in February 1993 in Ittingen Charterhouse , Thurgau , Switzerland , focused on “the clinical practice of periodontology”. A further 17 such workshops have since been held, some in partnership with other organisations.
In 1998, the EFP gave its first accreditation to a postgraduate programme in periodontology, to the Academic Centre of Dentistry (ACTA) in Amsterdam, the Netherlands, soon followed by the University of Bern in Switzerland. [ 6 ] By 2023 the number of accredited programmes stood at 23 in 15 countries.
The EFP’s flagship publication is the Journal of Clinical Periodontology which has been published since 1974 and which became the official journal of the federation in December 1993. The publisher of the Journal since 2008 has been Wiley Online Library .
The EFP organises, with its national-society members, an annual periodontal-health awareness day held on May 12. Launched in 2014 as the European Day of Periodontology, this awareness day subsequently evolved into Gum Health Day, which aims to be a global event that raises the visibility of periodontology and gum health among the public.
Since 2017, the EFP has run workshops and awareness campaigns in conjunction with its commercial partners. The first of these focused on oral health and pregnancy and subsequent campaigns have covered the links between periodontal disease and caries, diabetes, and cardiovascular disease, and the collaboration between periodontists and family doctors.
In November 2017, the EFP and the American Academy of Periodontology (AAP) joined forces at the World Workshop on Periodontal and Peri-implant Diseases and Conditions in Chicago, USA, to draw up a new classification of periodontal and peri-implant diseases and conditions. Subsequently, the EFP has encouraged clinicians to adopt the new classification and created three S3-level clinical practices guideline on the treatment of periodontitis and peri-implant diseases and conditions in accordance with the new classification. [ 8 ] [ 9 ]
At its general assembly in October 2020, the EFP launched its Sustainability Manifesto , which commits the federation to ensuring that sustainability is at the heart of all its activities. This was followed by the launch in October 2022 of Responsible Periodontology , a logo that expresses the EFP’s commitment that its activities – promoting disease prevention and healthy lifestyles, educational programmes, and campaigns – are carried out with ethics, respect, and ensuring that all voices count. [ 10 ]
In May 2020, in response to the SARS-Cov-2 pandemic, the EFP published a Covid-19 safety protocol for dental practices. [ 11 ]
The prime purpose of the EFP is the promotion of periodontology and, more generally, periodontal and general health both in Europe and worldwide by means of research, education, and the further development of periodontal science. [ 12 ]
The EFP has three categories of membership: full members, associate members, and international associate members. New members are accepted at the federation’s annual general assembly, usually held in March or April. As of March 2024, the EFP had 43 member societies (28 full members, two associate members, and 13 international associate members). [ 13 ]
Full members : Austrian Society of Periodontology, Azerbaijani Society of Periodontology, Belgian Society of Periodontology, British Society of Periodontology and Implant Dentistry, Croatian Society of Periodontology, Czech Society of Periodontology, Danish Society of Periodontology, Dutch Society of Periodontology, Finnish Society of Periodontology, French Society of Periodontology and Oral Implantology, German Society of Periodontology, Georgian Association of Periodontology, Hellenic Society of Periodontology and Implant Dentistry, Hungarian Society of Periodontology, Irish Society of Periodontology, Israeli Society of Periodontology and Osseointegration, Italian Society of Periodontology and Implantology, Lithuanian Association of Periodontology, Norwegian Society of Periodontology, Polish Society of Periodontology, Portuguese Society of Periodontology and Implantology, Romanian Society of Periodontology, Serbian Society of Periodontology, Slovenian Society of Periodontology, Spanish Society of Periodontology and Osseointegration, Swedish Society of Periodontology and Implantology, Swiss Society of Periodontology, Turkish Society of Periodontology.
Associate members :Armenian Periodontists Association, Moroccan Society of Periodontology and Implantology.
International associate members : Argentinian Society of Periodontology, Australian Society of Periodontology, Brazilian Society of Periodontology, Colombian Association of Periodontology and Osseointegration, Lebanese Society of Periodontology, Malaysian Society of Periodontology, Mexican Association of Periodontology, Periodontists' Association of Nigeria, Philippine Society of Periodontology, Society of Periodontology Singapore, Taiwan Academy of Periodontology, Uruguayan Society of Periodontology.
The triennial EuroPerio congress is the most important event organised by the EFP and one of the world’s biggest meetings in the field of periodontology. The most recent edition – EuroPerio10 in Copenhagen (2022) – attracted more than 7,000 attendees from more than 100 countries and featured hundreds of scientific presentations and also included live video transmissions of periodontal surgery. [ 14 ]
Since EuroPerio1 in 1994, a total of 10 editions of the EuroPerio congress have been held. [ 6 ] EuroPerio10 was due to be held in June 2021 but, because of the SARS-CoV-2 pandemic, was postponed until June 2022. Each EuroPerio congress is organised by an organising committee – selected at an EFP general assembly – which comprises a chair, a scientific chair, and a treasurer as well as other members including representatives of the EFP-affiliated society in the country that hosts the congress. Since EuroPerio7 in Vienna in 2012, the EFP has used the services of professional conference organiser Mondial Congress & Events to help organise the EuroPerio congresses.
The full list of EuroPerio congresses, with their chairs and scientific chairs is:
EuroPerio11 is due to take place in Vienna, Austria, 14–17 May 2025. Chair: Anton Sculean. Scientific chair: Lior Shapira. EuroPerio12 will be held in Munich, Germany, in 2028 with an organising committee of Andreas Stavropoulos (Sweden), Virginie Monnet-Corti (France), and Mervi Gürsoy (Finland).
Perio Workshop (originally called the European Workshop on Periodontology) is a scientific meeting in which a group of international experts discuss the latest evidence on topics of relevance to periodontology and implant dentistry and draw up an evidence-based consensus. The findings of each workshop have been published, initially by Quintessence International and, since 2002, as special open-access monographic supplements of the Journal of Clinical Periodontology.
Since the first European Workshop on Periodontology was held in 1993, a total of 19 workshops have taken place. The first six workshops were held in Ittingen Charterhouse , Thurgau , Switzerland and were chaired by Nikaus Lang. Since 2009, the workshops have taken place at La Granja de San Ildefonso, Segovia, Spain, chaired by Mariano Sanz (2009-2019) and David Herrera (2021-).
The workshops of 2012 and 2017 were “world workshops”, jointly organised by the EFP and the American Academy of Periodontology (AAP). Several other workshops were held in collaboration with other dental and medical organisations.
The 19 editions of Perio Workshop/European Workshop on Periodontology have covered a wide range of topics in periodontology and implant dentistry:
The 20th edition of the workshop is due to take place in November 2024, under the title "Periodontal Diagnosis: From advances in technologies to the 2018 classification".
Perio Master Clinic is an EFP-organised meeting focused on periodontal clinicians' training and expertise. It was created to “bridge the gap” between the triennial EuroPerio congresses and offers a more intimate environment, with hands-on training by leading clinical practitioners of periodontology and implant dentistry. Since 2019, there have also been related master clinics held outside Europe (since 2023, under the name International Perio Master Clinic).
Six editions of Perio Master Clinic and International Perio Master Clinic [ 15 ] have so far taken place:
Perio Master Clinic 2026 is due to be held in Baku, Azerbaijan on 6–7 March 2026. Theme: Perio-restorative interface (Chair: Cavid Ahmedbeyli, Scientific chair: Mariano Sanz).
International Perio Master Clinic 2027 is scheduled to be held in Rio de Janeiro, Brazil.
At the World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions, held in Chicago in November 2017, the EFP and the American Academy of Periodontology (AAP) drew up a new classification of periodontal and peri-implant diseases and conditions after reviewing the scientific evidence and creating a consensus knowledge base. This new classification updated the previous classification of 1999. The World Workshop’s research papers and consensus reports were published simultaneously in June 2018 in the EFP’s Journal of Clinical Periodontology and the AAP’s Journal of Periodontology . The new classification was presented formally by the two organisations at the EuroPerio9 congress in Amsterdam on 22 June 2018. [ 8 ]
To assist clinicians in implementing the new classification, the EFP published a toolkit in April 2019, comprising a set of guidance notes, slide presentations, infographics, and videos. [ 16 ] [ 17 ]
At Perio Workshop 2019, the process of drawing up a formal S3-level clinical practice guideline for the treatment of periodontitis stages I-III was started. This guideline was published in July 2020 in a special supplement of the Journal of Clinical Periodontology . [ 9 ]
This guideline approaches the treatment of periodontitis (stages I, II and III) using a pre-established stepwise approach to therapy that, depending on the disease stage, should be incremental, each including different interventions. Consensus was achieved on recommendations covering different interventions, aimed at:
(a) behavioural changes, supragingival biofilm, gingival inflammation, and risk factor control.
(b) supra- and sub-gingival instrumentation, with and without adjunctive therapies.
(c) different types of periodontal surgical interventions.
(d) the necessary supportive periodontal care to extend benefits over time.
This S3-level guideline informs clinical practice, health systems, policymakers and, indirectly, the public on the available and most effective modalities to treat periodontitis and to maintain a healthy dentition for a lifetime, according to the available evidence at the time of publication. [ 18 ]
Perio Workshop 2021 then created another S3-level clinical practice guideline for the treatment of stage IV periodontitis, published in June 2022 in a special supplement of the Journal of Clinical Periodontology . [ 19 ] This was followed by the guideline for the multidisciplinary treatment of peri-implant diseases, published as a Journal of Clinical Periodontology supplement in June 2023. [ 20 ] This was followed by the guideline for the multidisciplinary treatment of peri-implant diseases, published as a Journal of Clinical Periodontology supplement in June 2023.
The EFP organises, together with its affiliated national societies of periodontology, an annual periodontal-health awareness day held on May 12. Launched in 2014 as the European Day of Periodontology, this awareness day subsequently evolved into Gum Health Day, [ 15 ] which aims to be a global event that raises the visibility of periodontology and gum health among the public. Each year a different topic and slogan is chosen, and outreach events and media activities are carried out in many countries. The following awareness days have been organised:
Education has been fundamental to the EFP’s mission since the federation’s inception. At a meeting in May 1990 in Maastricht, the Netherlands, where the constitution and rules of procedure of what would the following year become the EFP were proposed, among the aims of the new organisation were:
“To promote equal and high standards in the countries of the member societies in the areas of […]
In 1998, the EFP gave its first accreditation to a postgraduate programme in periodontology, to the Academic Centre of Dentistry (ACTA) in Amsterdam, the Netherlands, followed later that year by the University of Bern in Switzerland. In July 2024, there were 24 universities in 16 countries teaching EFP-accredited programmes in periodontology: [ 21 ]
The EFP organises a biennial Postgraduate Symposium involving second- and third-year students of the programmes, together with the programme directors and co-ordinators. The symposium provides opportunities for the postgraduate students to present their clinical or research work. It is also intended to encourage networking between students of the various EFP-accredited programmes. Each symposium is organised by a different programme. Nine symposia have been held so far: in Switzerland (2005), the Netherlands (2007), Turkey (2009), the United Kingdom (2011), Belgium (2013), Spain (2015), Ireland (2017), Sweden (2019), Belgium (2022), and the Netherlands (2024). The next one is due to be held in Barcelona in 2026. [ 22 ]
In 2018, the EFP launched EFP Alumni , a community that represents periodontists who have received the EFP certificate after completing their accredited masters’ courses at one of the accredited programmes together with members of the faculties that teach the courses.
In terms of undergraduate education, the EFP issued the booklet “Curricular Guidelines in Undergraduate Education” in 1996, which was distributed to dental schools and periodontal departments in Europe, and to national societies of periodontology, the Association for Dental Education in Europe, and the American Academy of Periodontology. [ 6 ] [ 23 ]
In 2016, the EFP conducted a survey of undergraduate education in periodontology to find out to what extent dental schools were meeting the objectives and learning outcomes as defined in Curricular Guidelines and to evaluate the preclinical and clinical work done by students during their undergraduate training. The survey found a huge diversity in the way periodontology was taught at the undergraduate level.
Also in 2016, the Journal of Clinical Periodontology published the EFP Delphi study on trends in periodontology and periodontics in Europe for the year 2025, which predicted an increase in the need for education in periodontology, especially at university level. [ 24 ]
The EFP’s J ournal of Clinical Periodontology , published monthly, is a leading scientific publication and has the highest impact factor of journals in dentistry, oral surgery, and medicine. Its impact factor for 2023 was 5.8. [ 2 ]
Since April 2020, the Journal of Clinical Periodontology ( JCP ) has been edited by Panos N. Papapanou, who succeeded Maurizio S. Tonetti (2005-2020) and Jan Lindhe (1976-2004). The JCP became the official journal of the EFP in 1993. It was first published in 1974 and its first editor (1974-1976) was Hans Rudolf Mühlemann.The aim of the Journal of Clinical Periodontology is to provide a platform for the exchange of scientific and clinical progress in the field of periodontology and allied disciplines, and to do so at the highest possible level. The JCP also aims to facilitate the application of new scientific knowledge to the daily practice of the concerned disciplines and addresses both practicing clinicians and members of the academic community.
The Journal is the official publication of the European Federation of Periodontology but serves an international audience by publishing contributions of high scientific merit in the fields of periodontology and implant dentistry. The journal accepts a broad spectrum of original work characterised as clinical or preclinical, basic or translational, as well as authoritative reviews, and proceedings of important scientific workshops. The journal’s scope encompasses the physiology and pathology of the periodontal and peri-implant tissues, the biology and the modulation of periodontal and peri-implant tissue healing and regeneration, the diagnosis, aetiology, epidemiology, prevention and therapy of periodontal and peri-implant diseases and conditions, the association of periodontal infection/inflammation and general health, and the clinical aspects of comprehensive rehabilitation of the periodontitis-affected patient.
The EFP also publishes the monthly research summary JCP Digest , which offers concise research in periodontology to enable clinicians to keep their knowledge up to date, summarising studies first published in the Journal of Clinical Periodontology . Edited by Andreas Stavropoulos (chair, EFP scientific affairs committee), with the co-operation of the JCP editor-in-chief, each issue is prepared by a team of students at one of the EFP-accredited postgraduate periodontology courses. [ 25 ]
In addition, since 2016 the EFP has published Perio Insight , a magazine that offers expert views and debates on key topics in periodontology and implant dentistry, and coverage of research carried out at the EFP-accredited postgraduate programmes of periodontology. Perio Insight was relaunched as an online magazine with regularly updated content in March 2023.
Perio Life , the biannual magazine of EFP Alumni, was launched in 2021, and the EFP also publishes Perio Review, an annual report on its activities that was launched in 2019 as a replacement for the twice-yearly bulletin EFP News . The editor of Perio Insight , Perio Life , and Perio Review is Joanna Kamma and Andreas Stavropoulos is the scientific adviser to Perio Insight . [ 6 ]
Other, one-off, publications by the EFP include:
The EFP’s work is supported by its partners, commercial companies involved in the periodontal and dental sector whether as consumer brands or as providers of equipment and materials to dental practitioners. Their support helps the EFP in performing its work of serving the development of periodontal science and clinical practice and the promotion of oral health.
As of July 2024, the EFP’s partners were Colgate, Curasept, Dentaid, Dentsply, Haleon, Kenvue, Oral-B, Philips, and the Straumann Group. The EFP also collaborates actively on specific projects with other sponsors and exhibitors, notably in the framework of the EuroPerio congresses.
The EFP believes that “the transparent collaboration between businesses and an informative non-profit-making scientific entity is a great asset for strengthening the links between science and commercial development, which greatly benefits professionals in periodontology, dentistry, and oral hygiene, as well as the general interest of the public.” [ 15 ]
Since 2017, the EFP has organised workshops and outreach campaigns with its partners focusing on specific areas of concern within periodontology. The materials produced by these campaigns are written by experts and based on the latest scientific evidence. Materials include scientific reports, recommendations, graphics, and videos. In some cases, dedicated workshops on the campaign topic were held first to review the evidence.
In April 2020, the EFP launched its first series of interactive webinars – Perio Sessions – as a way to provide continuing education online. Perio Sessions featured expert presentations on important scientific and clinical issues in periodontology and implant dentistry. Topics covered included the EFP’s S3-level clinical practice guideline, periodontal surgery, and innovative techniques in periodontal and peri-implant therapy. In July 2020, the federation launched Perio Talks on Instagram, conversations between clinicians who also respond to questions from the live audience. These two initiatives were later brought under the umbrella brand of EFP Virtual. In September 2021, within EFP Virtual, the EFP launched the EuroPerio Series of online educational sessions related to the scientific programme of the forthcoming EuroPerio10 congress (Copenhagen, June 2022). In June 2022, Perio Talks podcasts were launched in which experts discuss key topics in periodontology and implant dentistry, ranging from peri-implantitis and periodontal regeneration to the financial and human cost of gum disease and the role of AI in dentistry. [ 35 ] [ 36 ] [ 37 ]
The EFP awards four prizes: the Jaccard/EFP Prize for Periodontal Research (given every three years at the EuroPerio congress), the annual Postgraduate Research Prize in EFP-accredited postgraduate programmes in periodontology, the Undergraduate Essay Prize, and the EFP Innovation Award for Digital Solutions for Gum Health (supported by Haleon).
The EFP makes two annual awards: the EFP Distinguished Scientist Award and the EFP Distinguished Service Award. Other awards, the EFP Eminence in Periodontology Award and the EFP International Eminence in Periodontology Award, are awarded on an occasional basis. The EFP Eminence in Periodontology award has been conferred on Ubele van der Velden (2014), Gianfranco Carnevale (2015), Mariano Sanz (2021), Iain Chapple (2022), Maurizio Tonetti (2023), and Anton Sculean (2024). The International Eminence in Periodontology has been awarded to Bob Genco (2020), William Giannobile (2023), and Mark Bartold (2024). [ 38 ]
In 2005 the European Directive on the Recognition of Professional Qualifications was approved. It was noted that periodontology was recognized as a speciality in 11 European Union member states. Since then, the EFP has been actively seeking recognition of periodontology as a speciality at the European level, starting with the publication in 2006 of the paper “Periodontology as a Recognized Dental Speciality in Europe” [ 3 ] and continuing with the lobbying of European policymakers. The EFP believes that official recognition as a speciality frees periodontists from bureaucratic problems by enabling greater professional mobility and would also boost the exchange of knowledge, increase graduate applications, aid training, and increase access for patients. [ 3 ]
At present, periodontology is recognised as a speciality in 11 of the 27 members of the EU: Belgium, Bulgaria, Croatia, Hungary, Latvia, Lithuania, Poland, Portugal, Slovenia, Sweden, and Romania. It is also recognized as a speciality in the UK, which left the EU in 2020. In several countries, there has been strong resistance to speciality recognition from dental associations, which are worried that the recognition of more dental specialties may limit the scope of practice for general dental practitioners. In September 2019, the question of the EU-wide recognition of periodontology as a speciality was discussed at a meeting of the EU Group of Co-ordinators (GoCs) for professional qualifications and freedom of movement. [ 39 ]
The EFP actively communicates via social media on the platforms Facebook (@efp.org) , Instagram (@perioeurope) , LinkedIn (The European Federation of Periodontology) , X (@perioeurope) , YouTube (EFP European Federation of Periodontology) , and TikTok (@perioeurope).
Articles about the EFP, its work, and its campaigns have appeared in both the specialist and the general media in various countries. Such articles include:
"Why the health of your gums could save your life". The Times , February 16, 2021. [ 40 ]
"Time to take gum disease seriously: the societal and economic impact of periodontitis". The Economist , June 15, 2021. [ 41 ]
"Interview: 'Periodontics was never a static field'". Dental Tribune . May 4, 2021. [ 42 ]
"El israelí Lior Shapira, nuevo presidente de la Federación Europea de Periodoncia" (in Spanish). Gaceta Dental , April 5, 2021. [ 43 ]
On Covid-19: "Un estudio relaciona la salud de las encías con el riesgo de complicaciones por coronavirus" (in Spanish). El País , February 3, 2021. [ 44 ] "EFP devises SARS-CoV-2 safety protocol for dental patients and practices". Dental Tribune . May 11, 2020. [ 45 ] "New EFP president on Covid-19: “Remain positive and safe”. Dental Tribune . April 6, 2020. [ 46 ]
"Coronavirus, senza dentista raddoppia il rischio di problemi alle gengive" (in Italian). La Repubblica . May 5, 2020. [ 47 ]
"Los periodoncistas europeos sugieren un triaje telefónico antes de dar cita" (in Spanish). La Vanguardia . May 7, 2020. [ 48 ]
On Perio Workshop 2019: "Workshop yields new guideline for periodontitis treatment". Dentistry Today . December 12, 2019. [ 49 ]
"Neue evidenzbasierte Leitlinie für die Parodontaltherapie" (in German). Quintessenz , December 5, 2019. [ 50 ]
On Perio & Cardio campaign: "Campaign highlights links between periodontal and cardiovascular diseases". Dental Tribune . September 22, 2020. [ 51 ]
"Parodontitis und Herz-Kreislauf-Erkrankungen" (in German). Dental Magazin . February 21, 2020. [ 52 ] "Cardiologues et parodontistes : dialogue européen pour actualiser les connaissances" (in French). Information Dentaire . March 13, 2020. [ 53 ]
On Perio Master Clinic 2020: "Interview: Prof. Anton Sculean on the Perio Master Clinic 2020". Dental Tribune . February 27, 2020. [ 54 ] Neueste Erkenntnisse zum „Heiligen Gral“ der Zahnmedizin" (in German). Quintessenz . March 16, 2020. [ 55 ]
On Gum Health Day: "Gum Health Day 2020 takes digital approach". Dental Tribune . May 12, 2020. [ 56 ] "Gum Health Day 2021: promouvere la salute parodontale per una vita migliore" (in Italian). Odontoiatria33 . May 11, 2021. [ 57 ]
"Cuidado de los dientes: los minutos que debe durar tu cepillado para que sea efectivo" (in Spanish). ABC . September 9, 2020. [ 58 ]
"Gengive infiammate, sanguinamenti? La nostra dentatura è a rischio" (in Italian). Il Corriere della Sera. April 12, 2021. [ 59 ]
"Von 1991 bis 2021: EFP feiert 30-jähriges Bestehen"(in German). ZWP . March, 2021. [ 60 ]
“Vaping could be as dangerous to oral health as cigarettes”. Univadis . 19 September 2023. [ 61 ]
“EFP publishes guideline on prevention and treatment of peri-implant disease”. Dental Tribune . 13 July 2023. [ 62 ]
“Treating stage IV periodontitis – the latest EFP guideline”. Dentistry . 9 August 2022. [ 62 ]
"Spyros Vassilopoulos: ‘La salud de las encías es clave también para nuestra apariencia física y nuestra autoconfianza’”. Gaceta Dental (in Spanish). 9 May 2023. [ 63 ]
“I piercing lingua e labbra? Troppo pericoloso: ‘Dovrebbero essere rimossi per salvare denti e gengive” (in Italian). Corriere della Sera . 28 July 2022. [ 64 ]
“Every member society of the EFP feels that it is part of a family”. Dental Tribune . 21 June 2022. [ 65 ]
“Phoebus Madianos, presidente de la EuroPerio10” (in Spanish). Dentista y Paciente . 4 August 2022. [ 66 ]
The EFP’s executive committee consists of the president, the president-elect, the two most recent past presidents, the secretary general, the treasurer, and two elected members. The president serves a one-year term, while the other committee members are elected for terms of three years.
The executive committee discusses all actions that should be taken by the EFP and prepares them for discussion and approval at the annual general assembly, which consists of representatives of the EFP-affiliated national societies of periodontology.
Seven committees have been formed to meet the needs of the objectives that EFP has set: the congress committee, European project committee, internal & external affairs committee, nominating committee, undergraduate education committee, postgraduate education committee, scientific affairs committee, workshop committee, and EFP Alumni. There are also committees for each edition of EuroPerio and Perio Master Clinic. [ 67 ]
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The European Federation of Psychiatric Trainees ( EFPT ) is a non-profit organization for European national psychiatric trainees. [ 1 ] [ 2 ] It is a federation of the national trainees associations (NTA) of psychiatric trainees of about 38 European nations.
The EFPT is a non-profit organization registered under Belgian law. The governing body of the EFPT is the General Assembly, which meets annually. [ 3 ] A board of directors (Board members) is annually elected by the General Assembly. Board members work as a team to fulfil the EFPTs goals and projects, with the help of General Managers, who are elected by board members. [ 4 ]
The EFPT produces statements that form the basis of the EFPT's work and are communicated to partner organizations. [ 3 ] [ 5 ] [ 6 ]
The EFPT has a community of active working groups organizing events dedicated to the improvement of trainees' knowledge and skills (e.g., psychopathology, research methods, leadership, neuropsychopharmacology). [ 7 ]
In the past, the EFPT led several research projects about :
The EFPT also conceived materials promoting a positive image of psychiatry, with some videos targeting stigmatization. [ 12 ]
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The European Journal of Cancer (abbreviated as EJC or Eur. J. Cancer ) is a peer-reviewed medical journal devoted to cancer research on experimental oncology , clinical oncology (medical, paediatric, radiation, surgical), and on cancer epidemiology and prevention. It is the official journal of the European Organisation for Research and Treatment of Cancer (EORTC) and the European Society of Breast Cancer Specialists (EUSOMA). The editor-in-chief is Alexander M. M. Eggermont.
In Clarivate's 2021 Journal Citation Reports indexed by Web of Science , the European Journal of Cancer received an impact factor of 10.002, ranking it 21st journal out of 220 journals in the category cancer research and 26th journal out of 369 journals in the category oncology in the Scimago Journal Ranking . [ 1 ] [ 2 ]
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The European Journal of Cancer Care is a bimonthly peer-reviewed medical journal covering research on cancer care. The editor-in-chief is David Weller ( University of Edinburgh ). The journal was established in 1992 and is published by Wiley-Blackwell .
The journal is abstracted and indexed in:
According to the Journal Citation Reports , the journal has a 2017 impact factor of 2.409. [ 1 ]
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The European Journal of Cancer Prevention (print: ISSN 0959-8278 , online: ISSN 1473-5709 ) is the official journal of the European Cancer Prevention Organization . It was established in 1991 and is published bimonthly by Lippincott Williams & Wilkins . The journal focuses on raising awareness of the various forms of cancer prevention as well as stimulating research and innovation. The articles cover a wide scope of field areas, including descriptive and metabolic epidemiology , histopathology , lifestyle issues, environment, genetics , biochemistry , molecular biology , microbiology , clinical medicine , intervention trials and public education, basic laboratory studies, and special group studies. [ 1 ] The current editor in chief is prof. Giovanni Corso . According to the 2021 Journal Citation Reports the journal has an impact factor of 2.4, ranking it 189 of 241 journals in the category Oncology.
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The European Journal of Cardio-Thoracic Surgery , abbreviated Eur J Cardiothorac Surg , is an academic journal, principally covering topics pertaining to cardiac surgery and thoracic surgery .
The journal has an editorial board of 28, with 13 associate editors, 8 assistant editors, a managing editor, an editorial manager, and an editor-in-chief. [ 1 ]
Articles in the journal become open access one year after publication. The journal is abstracted and indexed by:
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The European Network for the Investigation of Gender Incongruence ( ENIGI ) is a collaborative multicenter prospective cohort study on gender incongruence which started in 2010 and is being conducted by several transgender clinics in Europe . [ 1 ] [ 2 ] The clinics that have been involved in the initiative include the Center of Expertise on Gender Dysphoria (CEGD) at Amsterdam University Medical Centers , location VUmc in Amsterdam, Netherlands , the Center for Sexology and Gender at Ghent University Hospital in Ghent, Belgium , the University Medical Center Hamburg-Eppendorf in Hamburg, Germany , the Oslo University Hospital, Rikshospitalet in Oslo, Norway , and the University Hospital of the University of Florence in Florence, Italy . [ 1 ] [ 2 ] The clinics in the ENIGI initiative developed a common study and treatment protocol and maintain a shared database. [ 1 ] [ 2 ] The study includes an endocrine part to evaluate the effects of transgender hormone therapy in transfeminine and transmasculine people. [ 2 ]
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The European Ophthalmic Pathology Society is a learned society for advancing ophthalmic pathology , the study of the pathological basis of the diseases of the eye and its adnexa: the orbit , eyelids , conjunctiva and the lacrimal apparatus . [ 1 ]
Founded in April 1962 at the premises of the Royal College of Surgeons of England in London, [ 2 ] it was inspired by a similar learned society in the United States, the Verhoeff-Zimmerman Society , [ 3 ] founded in 1945 and at that time called "The American Ophthalmic Pathology Club". [ 2 ] In the early 1960s, ophthalmic pathology in Europe was not yet recognized as a distinct discipline and its practitioners had rarely had a formal training in the subject. Invitations to an inaugural meeting to be held in London were sent by Norman Ashton of London, S. Ry Andersen of Copenhagen, and Willem Manschot of Rotterdam to about 30 prospective members in May, 1961, together with details of what would be expected of them:
The society is governed by its council, which is chaired by the society's president, according to a constitution and bye-laws . The members of the council and the president are elected from and by the Ordinary Members, the basic members of the society, who are themselves elected by existing Ordinary Members and are limited to 35 in number. The council is elected for three years and consists of the president, the corresponding secretary and the organizing secretary, the latter being responsible for organizing the next scientific meeting.
The current officers, [ 4 ] elected in June 2017 and June 2019 (Organizing Secretary), are:
According to its constitution, the aim of the society is to promote the advancement of ophthalmic pathology by co-ordination with general ophthalmology , general pathology and allied sciences. In addition, it encourages research, teaching and improvement of technical methods in ophthalmic pathology through scientific meetings. The society organizes an annual meeting typically held in a city where one of its Ordinary Members is located, and branded symposia on ophthalmic pathology in collaboration with general ophthalmological congresses held in Europe and elsewhere.
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The European Prospective Investigation into Cancer and Nutrition (EPIC) study is a Europe -wide prospective cohort study of the relationships between diet and cancer , as well as other chronic diseases, such as cardiovascular disease . With over half a million participants, it is the largest study of diet and disease to be undertaken. [ 1 ]
EPIC is coordinated by the International Agency for Research on Cancer (IARC), part of the World Health Organization , and funded by the "Europe Against Cancer" programme of the European Commission as well as multiple nation-specific grants and charities.
521,457 healthy adults, mostly aged 35–70 years, were enrolled in 23 centres in ten European countries: Denmark (11%), France (14%), Germany (10%), Greece (5%), Italy (9%), The Netherlands (8%), Norway (7%), Spain (8%), Sweden (10%) and the United Kingdom (17%). One UK centre (Oxford) recruited 27,000 vegetarians and vegans ; this subgroup forms the largest study of this dietary group. Recruitment to the study took place between 1993 and 1999, and follow-up is planned for at least ten years, with repeat interview/questionnaires every three to five years. The main prospective data collected are standardised dietary questionnaires (self-administered or interview-based), seven-day food diaries, blood samples and anthropometric measurements, such as body mass index and waist-to-hip ratio . Additionally, the GenAir case-control study is studying the relationship of passive smoking and air pollution with cancers and respiratory diseases .
Up to 2004, there were over 26,000 new cases of cancer recorded among participants, with the most common being cancers of the breast, colorectum, prostate and lung. Current analyses are focusing particularly on stomach , colorectal , breast , prostate and lung cancers. The different dietary patterns in the different countries should enable reliable associations to be made between particular diets and cancers. The analysis of stored blood samples should also allow dissection of genetic factors involved in cancers, as well as the effects of hormones and hormone-like factors.
The study and its analysis is ongoing, but key results of the study retrieved in 2008 are:
Subsequent findings from 2012 and 2013 are:
Subsequent findings from 2021 are:
Review
Primary
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The European Society of CardioVascular Surgery (ESCVS) is a medical society founded in 1951 in Turin, Italy. Its first president was René Leriche , first Congress held in Strasbourg in 1952 and its initial members were made up of 40 physicians representing 11 countries in Europe. It is a chapter of the International Society of Angiology, which later became the International Society for Cardiovascular Surgery. [ 1 ] [ 2 ] [ 3 ]
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The European Society of Cardiology ( ESC ) is an independent non-profit , non-governmental professional association that works to advance the prevention, diagnosis and management of diseases of the heart and blood vessels, and improve scientific understanding of the heart and vascular system. [ 2 ] This is done by:
Most of the approximately 100,000 ESC members are cardiologists, cardiovascular nurses and allied professionals wishing to increase their knowledge and update their skills.
The association adheres to the Alliance for Biomedical Research in Europe Code of Conduct.
The ESC was founded in 1950. Its headquarters is located in the technology park of Sophia Antipolis between Nice and Cannes, in the south of France. The first ESC-organised congress, The European Congress of Cardiology was held in London in September 1952. [ 3 ]
In February 2013, the ESC opened the European Heart Agency in Brussels , close to the European Parliament complex, in order to have a base in the political and legislative capital of Europe. [ 4 ]
The ESC is governed by an elected board of volunteers who are cardiovascular experts. [ 5 ]
Its activities are overseen by dedicated committees made up of more than 2,000 volunteers. [ 6 ]
Employed staff support ESC volunteers in the development and management of its activities. ESC staff report to the chief executive officer, who reports to the president and management group of the ESC Board. [ citation needed ]
The ESC comprises 57 National Cardiac Societies, 7 sub-specialty associations and 22 sub-specialty working groups and councils. [ 7 ] Since 2013, [ 8 ] additional support has been developed within the sub-specialty communities to address the special interests and needs of young physicians. [ 9 ]
The ESC organises numerous cardiology congresses each year, including the largest cardiology congress in the world, ESC Congress .
Annual or biennial sub-specialty congresses address acute cardiac care (Acute CardioVascular Care), cardiac imaging (EuroEcho), prevention, rehabilitation and sports cardiology (ESC Preventive Cardiology), nuclear cardiology and cardiac CT (ICNC-CT), magnetic resonance (EuroCMR congress), interventional cardiology (EuroPCR), heart failure (Heart Failure), heart rhythm and electrophysiology (EHRA), as well as basic science (Frontiers in CardioVascular Biolomedicine). [ 10 ]
The ESC produces clinical practice guidelines for cardiology professionals from evidence-based clinical trials data. The guidelines aim to present all the relevant evidence on a particular clinical issue in order to help physicians weigh the benefits and risks of particular diagnostic or therapeutic procedures. [ 11 ]
A Fellow of the European Society of Cardiology is a cardiologist considered to be a person who has had a significant experience in the field and who has distinguished themself individually in clinical, educational, investigational, organisational or professional aspects of cardiology. Fellows have the right to use the postnominal designation of the FESC. [ 12 ]
The ESC publishes 17 periodicals covering cardiovascular medicine and research: [ 13 ]
The ESC publishes numerous books for those studying cardiology and subspecialties in the field: [ 14 ]
The ESC supports continuing medical training and development by offering a broad portfolio of needs-based education initiatives, including online and in-person courses as well as post-graduate programmes led by experts in cardiology. [ 15 ]
Grants to help offset education costs are offered by the association. [ citation needed ]
Among the educational products produced by the ESC are interactive webinars that include case-based presentations, online assessments, and live discussions with key opinion leaders in cardiology. [ 16 ] The society hosts an online platform for these presentations called ESC 365. [ 17 ]
Despite advances in cardiovascular medicine, cardiovascular disease (CVD) remains the world's biggest killer. The ESC collects cardiovascular data from across its 57 members countries through its 'Atlas of Cardiology' to better understand why and how CVD mortality can be reduced. [ 18 ]
This compendium underlines major healthcare gaps and inequalities and provides robust data for budget owners and decision-makers who can improve population health at a European level. [ citation needed ]
The ESC operates a registry programme supported by pharmaceutical industry sponsors. [ 19 ] [ 20 ]
The ESC leverages the knowledge, network and influence of the cardiology profession to promote policy, regulation and research funding that advances cardiovascular science, supports high quality healthcare, and encourages evidence-based decision making. [ 21 ]
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The European Society of Endocrinology ( ESE ) is a scientific society to promote for the public benefit research , education and clinical practice in endocrinology by the organisation of conferences , training courses and publications , by raising public awareness, liaison with national and international legislators .
Major activities include the organisation of the annual European Congress of Endocrinology. ESE also organises postgraduate courses at least biannually. ESE has three official journals: Endocrine Connections and Endocrinology, Diabetes & Metabolism Case Reports , which are published by Bioscientifica , and the European Journal of Endocrinology , which is published by Oxford University Press . [ 1 ]
The overall governing body of ESE is the General Council, which comprises all ordinary members, affiliated societies and corporate members. The voting members of the General Council are electing the Executive Committee which shall manage the business of the Society and may exercise all the powers of the Society.
Ordinary membership is open to researchers, clinicians and students in the field of endocrinology and hormonal systems . Affiliated societies membership is open to national endocrine societies and sub-specialist endocrine societies in Europe. Corporate membership is open to companies working in the field of endocrinology. Honorary membership is for persons of special distinction in endocrinology or who have performed outstanding service to the Society.
An early predecessor organisation of the ESE was the Committee of the Acta Endocrinologica Countries (CAEC), which founded Acta Endocrinologica (Copenhagen) , later renamed European Journal of Endocrinology , in June 1948. It also organised the Acta Endocrinologica Congresses, the first of which took place in Copenhagen, Denmark, on 22–25 August 1954. This series of congresses gave way to the first European Congress of Endocrinology in 1987, when the European Federation of Endocrine Societies (EFES), an umbrella organisation of national societies for endocrinology in Europe, was founded. [ 2 ] On this basis, the ESE was officially launched on January 1, 2006, following a consultation process with EFES member organisations. [ 3 ]
Affiliated Society membership is open to national endocrine societies and pan-European sub-specialist endocrine societies in Europe.
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Eva Wangechi Mubia Njenga is a Kenyan consultant physician and endocrinologist , who serves as the Chairperson of the Kenya Medical Practitioners and Dentists Board , the professional body that regulates medical doctors and dentists practicing in the country. She was appointed to that position on 10 April 2019, being the first female in the history of Kenya , to serve in that role. [ 1 ]
Njenga holds a Bachelor of Medicine and Bachelor of Surgery degree and a Master of Medicine degree in Internal Medicine , both from the University of Nairobi . She also has a Certificate in Medical Anthropology and a Certificate in Social Medicine , both awarded by Harvard University in the United States. In addition, she holds an Advanced Post Graduate Course in Endocrinology , obtained from Newcastle University Medical School , in the United Kingdom. [ 1 ] [ 2 ]
Njenga has previously worked at Kenyatta National Hospital , the largest public referral hospital in Kenya. She has also worked at Nakuru County Hospital and at Joslin Diabetes Center in Boston , Massachusetts , United States. [ 1 ] [ 2 ] She currently maintains a private endocrinology consultancy medical practice in the central business district of Nairobi , Kenya's capital city. [ 2 ] At her new position, she replaced Professor George Magoha , who was appointed Cabinet Secretary of Education in the Kenya's cabinet . [ 1 ]
She is a member of several professional bodies and associations, including the American Diabetes Association, Kenya , Kenya Medical Association and Kenya Association of Physicians. She serves on the executive board of the Kenya Diabetes Association and is the Chairperson of Kenya Diabetes Study Group and is the former Vice Chairman of the Kenya Medical Women Association. She has also served and the Chairman of the Diabetes Management & Information Centre and a former member of the Pharmacy and Poisons Board of Kenya. [ 2 ]
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Evaluation and management coding (commonly known as E/M coding or E&M coding ) is a medical coding process in support of medical billing . Practicing health care providers in the United States must use E/M coding to be reimbursed by Medicare , Medicaid programs, or private insurance for patient encounters. [ 1 ]
E/M standards and guidelines were established by Congress in 1995 [ 2 ] and revised in 1997. [ 3 ] It has been adopted by private health insurance companies as the standard guidelines for determining type and severity of patient conditions. This allows medical service providers to document and bill for reimbursement for services provided.
E/M codes are based on the Current Procedural Terminology (CPT) codes established by the American Medical Association (AMA).
In 2010, new codes were added to the E/M Coding set, for prolonged services without direct face-to-face contact. [ 4 ]
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Everett Shapiro (December 5, 1917 – January 1, 2002) was an American orthodontist who was a past president of the American Board of Orthodontics and the American Journal of Orthodontics and Dentofacial Orthopedics . [ 1 ]
He was born in Dorchester, Massachusetts on December 5, 1917. [ 2 ] He attended the University of Massachusetts and obtained his bachelor's degree in 1940. He received his dental degree from Harvard School of Dental Medicine in 1944. He then served in the United States Army for two years where he became a captain. He then obtained his certificate in orthodontics from Tufts Dental School in 1949. He became part of the faculty of the Department of Orthodontics after graduation until 1960. In 1960 he became the Chair of the Orthodontic Program until his retirement in 1998. Dr. Shapiro was Professor Emeritus in the Department of Orthodontics at Tufts University School of Dental Medicine .
There is an award dedicated for Dr. Shapiro's contributions to the field of Orthodontics named Everett Shapiro Award in Diagnosis and Treatment Planning . There is also an Everett Shapiro Library dedicated in the Department of Orthodontics at Tufts Dental School. [ 3 ]
He died at the age of 84 due to natural causes in 2002. He is buried at Lindwood Memorial Park, Randolph, Massachusetts.
This dentistry article is a stub . You can help Wikipedia by expanding it .
This biographical article related to medicine in the United States is a stub . You can help Wikipedia by expanding it .
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EveryDoctor is a British grassroots advocacy group made up of doctors. [ 1 ] The group was established in 2019, and grew during the COVID-19 pandemic in the United Kingdom . [ 2 ] In May 2021, EveryDoctor and the Good Law Project brought legal action against the British government in relation to COVID-19 PPE contracts during the first wave of the COVID-19 pandemic, accusing the Department of Health and Social Care of unlawful procurement procedures and providing inadequate PPE supplies. [ 2 ] [ 3 ] [ 4 ] [ 5 ]
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Evidence-based dentistry ( EBD ) is the dental part of the more general movement toward evidence-based medicine and other evidence-based practices. The pervasive access to information on the internet includes different aspects of dentistry for both the dentists and patients. This has created a need to ensure that evidence referenced to are valid, reliable and of good quality. [ 1 ]
Evidence-based dentistry has become more prevalent than ever, as information, derived from high-quality, evidence-based research is made available to clinicians and patients in clinical guidelines. By formulating evidence-based best-practice clinical guidelines that practitioners can refer to with simple chairside and patient-friendly versions, this need can be addressed.
Evidence-based dentistry has been defined by the American Dental Association (ADA) as "an approach to oral healthcare that requires the judicious integration of systematic assessments of clinically relevant scientific evidence, relating to the patient's oral and medical condition and history, with the dentist's clinical expertise and the patient's treatment needs and preferences." [ 2 ]
Three main pillars or principles [ 3 ] exist in evidence-based dentistry. The three pillars are defined as:
The use of high-quality research to establish the guidelines for best practices defines evidence-based practice. In essence, evidence-based dentistry requires clinicians to remain constantly updated on current techniques and procedures so that patients can continuously receive the best treatment possible.
Evidence-based dentistry (EBD) was first introduced by Gordon Guyatt and the Evidence-Based Medicine Working Group at McMaster University in Ontario, Canada , in the 1990s as part of the larger movement toward evidence-based medicine and other evidence-based practices .
Much praise has gone to the dentistry approach of clinical decision making. In an EB case report written by Miller SA, is focused on the "use of evidence-based decision-making in private practice for emergency treatment of dental trauma". The case concludes with high praise for this method, going as far to say that "[the] evidence-based method was efficient, and very helpful in optimizing the management of the emergency dental treatment". [ 4 ] However, it is important to ensure that the collection of data in the evidence during evidence-based clinical decision making isn’t corrupted. Crawford JM writes about publication bias, as well as the possible effects it can have on evidence-based clinical making. He writes that it is important to watch out for publication bias, as it can "hinder advancements in oral health care by decreasing the availability of scientific evidence and threatening the validity of evidence-based practice". [ 5 ]
There are many tools that have been developed for dental-based clinical decision making. Authors Rios Santos JV, Castello Castaneda C, and Bullon P all documented the "development of a computer application to help the decision making process in teaching dentistry." It offers the ability to review information, to help reinforce information that is learned by students. Teaching staff can also "design any theme they wish, increasing the efficiency and support capabilities of the program". [ 6 ]
In summary, there are three main pillars [ 7 ] exist in evidence-based dentistry which serves as its main principles. The three pillars are defined as:
Much less attention is paid to both the other two spheres of EBD, clinical expertise and patient values. [ 8 ]
Clinical expertise plays a part in the successful outcomes of treatment with diagnostic skills preventing over and under-treatments, technical dental skills maximizing the longevity of surgical and restorative procedures and communication skills being core to patient management and perceived success.
Not all patients have the same priorities for their care. Understanding a patient's individual needs, wants and circumstances gives the clinician a place from which to discuss treatment options available with the patient. This might be competing priorities between dentists, therapists, and hygienists who generally aim for longevity and aesthetics and patients who may be more interested in keeping costs down, aesthetics or would prefer less invasive treatments.
Given that "Patient needs and preferences" and "Dentist's clinical expertise" are variable and will differ among numerous clinicians and population, "Relevant scientific evidence" is of critical importance. Therefore, it is imperative that information referenced to are derived from high-quality, evidence-based research, which can be used to establish the guidelines for providing the best practices.
In essence, Evidence-based dentistry can allow clinicians to remain constantly updated on the newest techniques and procedures so that patients can continuously receive the best treatment possible.
The new model set by EBM uses a systematic process to incorporate current research into practice. The evidence-based process requires the practitioner to develop five key skills:
The American Dental Association defined evidence-based dentistry like so:
Evidence-based dentistry (EBD) is an approach to oral health care that requires the judicious integration of systematic assessments of clinically relevant scientific evidence, relating to the patient's oral and medical condition and history, with the dentist's clinical expertise and the patient's treatment needs and preferences.
The American Dental Education Association (ADEA) has incorporated the definition of evidence-based dentistry into core competencies required by dental education programs. These competencies focus on graduates to become lifelong learners and consumers of current research findings and require students to develop skills that are reflective of evidence-based dentistry. [ 11 ]
A dentist's learning curve for using the evidence-based process can be steep, but there are continuing education courses, workbooks and tools available to simplify the integration of current research into practice.
Dental graduates around the globe are possibly up to date at the time they graduate, but usually are fundamentally lacking in the understanding of trials/studies design and relevance/importance. Dental specialty training, however, stresses evidence-based outcomes, results and methodologies. But this becomes out of date as new information and technology appear. Hence it is important, especially with regards to patient safety, for dentists to be able to keep up to date with developments. Having an understanding of how to interpret research results, and some practice in reading the literature in a structured way, can turn the dental literature into a useful and comprehensible practice tool. For this to happen, EBD learning absolutely needs to be at the heart of dental education. Dental students can be taught EBD concept during their time in dental school so that they will develop the ability to evaluate critically new knowledge and determine its relevance to the clinical problems and challenges presented by the individual patient. They also acquire the ability to interpret, assess, integrate, and apply data and information in the process of clinical problem solving, reasoning, and decision making. EBD is a lifelong learning process and help to develop ability to learn independently.
Dentists can prescribe medications upon initial registration. [ 13 ] This is important as evidence has shown that general practitioners prefer to refer to dentists for the management of dental emergencies. [ 14 ] Research has shown that there are potential limitations in the knowledge of dental students for conventional and complementary and alternative medications. [ 15 ] [ 16 ]
Formed in 1993, the Scottish Intercollegiate Guidelines Network (SIGN) goals are to decrease the discrepancy in treatments and results, through the creation and dissemination of nationwide clinical guidelines encompassing recommendations for effective practice established on up-to-date evidence to improve the quality of health care for patients in Scotland. [ 17 ]
SIGN guidelines are established using a clear methodology [ 18 ] constructed on three fundamental principles, which are:
As of 2009, SIGN has also adopted the practise of implementing [ 19 ] the GRADE methodology to all its SIGN guidelines.
Part of NHS Education for Scotland (NES), the Scottish Dental Clinical Effectiveness Programme (SDCEP) [ 20 ] is an initiative of the National Dental Advisory Committee (NDAC) which is an organisation of dental professionals, across all specialities, that functions as consultative wing to the Chief Dental Officer. Its main goal is to appraise the best available and pertinent information with regards to dentistry and convert it into guidelines which are easily comprehensible and executable.
The Scottish Dental Clinical Effectiveness Programme consist of a central group for Programme Development and multiple other groups for guideline development. With
the principal objective of developing guidance that delivers the best quality of patient care through supporting dental teams, the SDCEP uses the most suitable high-quality evidences from a plethora of sources to make guidelines recommendations.
Founded under the intention of NDAC to give a systematized methodology [ 21 ] when providing clinical guidance for the dental profession, the SDCEP has since become a crucial factor between the gold standard practice guidelines and dental education and practice.
Despite the high praise for evidence-based dentistry, there are a number of limitation and criticism that has been given to the process. Chambers DW provides quite a bit of criticism, as well as a number of limitations that evidence-based dentistry provides. In no particular order of importance, a number of mentioned objections towards this format are:
Evidence-based dental journals have been developed as resources for busy clinicians to aid in the integration of current research into practice. These journals publish concise summaries of original studies as well as review articles. These critical summaries, consist of an appraisal of original research, with discussion of the relevant, practical information of the research study.
Systematic reviews are also helpful for the busy practitioner because they combine the results of multiple studies that have investigated the same specific phenomenon or question.
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Evocative/suppression testing refers to a class of tests performed where one substance is measured both before and after the administration of another substance to determine if the levels are stimulated ("evocative") or suppressed. [ 1 ]
They are most commonly performed in the evaluation of possible endocrine disorders. [ citation needed ]
Certain tests are performed in the evaluation of multiple conditions, and not all listed substances may be measured in each test.
Examples include:
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The evolution of mammalian auditory ossicles was an evolutionary process that resulted in the formation of the mammalian middle ear , where the three middle ear bones or ossicles , namely the incus , malleus and stapes (a.k.a. "the anvil, hammer, and stirrup"), are a defining characteristic of mammals. The event is well-documented [ 1 ] and important [ 2 ] [ 3 ] academically as a demonstration of transitional forms and exaptation , the re-purposing of existing structures during evolution. [ 4 ]
The ossicles evolved from skull bones present in most tetrapods , including amphibians , sauropsids (which include extant reptiles and birds ) and early synapsids (which include ancestors of mammals). The reptilian quadrate , articular and columella bones are homologs of the mammalian incus, malleus and stapes, respectively. In reptiles (and early synapsids by association), the eardrum is connected to the inner ear via a single bone, the columella, while the upper and lower jaws contain several bones not found in modern mammals. Over the course of mammalian evolution , one bone from the upper jaw (the quadrate) and one from the lower jaw (the articular) lost their function in the jaw articulation and migrated to form the middle ear. The shortened columella connected to these bones to form a kinematic chain of three ossicles, which serve to amplify air-sourced fine vibrations transmitted from the eardrum and facilitate more acute hearing in terrestrial environments.
Following on the ideas of Étienne Geoffroy Saint-Hilaire (1818), and studies by Johann Friedrich Meckel the Younger (1820), Carl Gustav Carus (1818), Martin Rathke (1825), and Karl Ernst von Baer (1828), [ 5 ] the relationship between the reptilian jaw bones and mammalian middle-ear bones was first established on the basis of embryology and comparative anatomy by Karl Bogislaus Reichert (in 1837, before the publication of On the Origin of Species in 1859). These ideas were advanced by Ernst Gaupp , [ 6 ] and are now known as the Reichert–Gaupp theory . [ 7 ] [ 8 ]
The discovery of the link in homology between the reptilian jaw joint and mammalian malleus and incus is considered an important milestone in the history of comparative anatomy. [ 9 ] Work on extinct theromorphs by Owen (1845), and continued by Seeley , Broom , and Watson, was pivotal in discovering the intermediate steps to this change. [ 10 ] The transition between the "reptilian" jaw and the "mammalian" middle ear was not bridged in the fossil record until the 1950s [ 11 ] with the elaboration of such fossils as the now-famous Morganucodon . [ 12 ]
During embryonic development, the incus and malleus arise from the same first pharyngeal arch as the mandible and maxilla , and are served by mandibular and maxillary division of the trigeminal nerve . [ 13 ] Recent genetic studies are able to relate the development of the ossicles from the embryonic arch [ 14 ] to hypothesized evolutionary history. [ 15 ] Bapx1 , also known as Nkx3.2 (a member of the NK2 class of homeobox genes), [ 16 ] is implicated in the change from the jaw bones of non-mammals to the ossicles of mammals. [ 17 ] [ 18 ] Other implicated genes include the Dlx genes, Prx genes, and Wnt genes. [ 19 ]
Living mammal species can be identified by the presence in females of mammary glands which produce milk. Other features are required when classifying fossils , since mammary glands and other soft-tissue features are not visible in fossils. Paleontologists therefore use the ossicles as distinguishing bony features shared by all living mammals (including monotremes ), but not present in any of the early Triassic therapsids (" mammal-like reptiles ").
Early amniotes had a jaw joint composed of the articular (a small bone at the back of the lower jaw) and the quadrate (a small bone at the back of the upper jaw). All non-mammalian amniotes use this system including lizards , crocodilians , dinosaurs (and their descendants the birds ) and therapsids ; so the only ossicle in their middle ears is the stapes . The mammalian jaw joint is composed of different skull bones, including the dentary (the lower jaw bone which carries the teeth) and the squamosal (another small skull bone). In mammals, the quadrate and articular bones have evolved into the incus and malleus bones in the middle ear. [ 20 ] [ 21 ]
The mammalian middle ear contains three tiny bones known as the ossicles : malleus , incus , and stapes . The ossicles are a complex system of levers whose functions include: reducing the amplitude of the vibrations; increasing the mechanical force of vibrations; and thus improving the efficient transmission of sound energy from the eardrum to the inner ear structures. The ossicles act as the mechanical analog of an electrical transformer , matching the mechanical impedance of vibrations in air to vibrations in the liquid of the cochlea . The net effect of this impedance matching is to greatly increase the overall sensitivity and upper frequency limits of mammalian hearing, as compared to reptilian hearing. The details of these structures and their effects vary noticeably between different mammal species, even when the species are as closely related as humans and chimpanzees . [ 22 ]
The following simplified cladogram displays relationships between tetrapods :
other eupelycosaurs
other therapsids
Mammals
The first fully terrestrial vertebrates were amniotes , which developed in eggs with internal membranes which allowed the developing embryo to breathe but kept water in. The first amniotes arose in the late Carboniferous from the ancestral reptiliomorphs (a group of amphibians whose only living descendants are amniotes). Within a few million years two important amniote lineages became distinct: the synapsid ancestors of mammals, and the sauropsids ancestors of lizards , snakes , crocodilians , dinosaurs and birds . [ 23 ]
The evolution of mammalian jaw joints and ears did not occur simultaneously with the evolution of other mammalian features. In other words, jaw joints and ears do not define any except the most recent groups of mammals.
In modern amniotes (including mammals), the middle ear collects airborne sounds through an eardrum and transmits vibrations to the inner ear via thin cartilaginous and ossified structures. These structures usually include the stapes (a stirrup -shaped auditory ossicle).
Early tetrapods likely did not possess eardrums. Eardrums appear to have evolved independently three to six times. [ 25 ] [ 26 ] In basal members of the 3 major clades of amniotes (synapsids, eureptiles , and parareptiles ) the stapes bones are relatively massive props that support the braincase , and this function prevents them from being used as part of the hearing system. However, there is increasing evidence that synapsids, eureptiles and parareptiles developed eardrums connected to the inner ear by stapes during the Permian . [ 27 ]
The jaws of early synapsids, including the ancestors of mammals, were similar to those of other tetrapods of the time, with a lower jaw consisting of a tooth -bearing dentary bone and several smaller posterior bones. The jaw joint consisted of the articular bone in the lower jaw and the quadrate in the upper jaw. The early pelycosaurs (late Carboniferous and early Permian ) likely did not have tympanic membranes (external eardrums). Additionally, their massive stapes bones supported the braincase, with the lower ends resting on the quadrates. Their descendants, the therapsids (including mammalian ancestors), probably had tympanic membranes in contact with the quadrate bones. The stapes remained in contact with the quadrate bone, but functioned as auditory ossicles rather than supports for the brain case. As a result, the quadrate bones of therapsids likely had a dual function in both the jaw joint and auditory system. [ 28 ] [ 29 ]
During the Permian and early Triassic the dentary of therapsids, including the ancestors of mammals, continually enlarged while other jaw bones were reduced. [ 30 ]
Eventually, the dentary bone evolved to make contact with the squamosal , a bone in the upper jaw located anterior to the quadrate, allowing two simultaneous jaw joints: [ 31 ] an anterior " mammalian " joint between the dentary and squamosal and a posterior "reptilian" joint between the quadrate and articular. This "twin-jointed jaw" can be seen in late cynodonts and early mammaliforms . [ 32 ] Morganucodon is one of the first discovered and most thoroughly studied of the mammaliforms, since an unusually large number of morganucodont fossils have been found. It is an example of a nearly perfect evolutionary intermediate between the mammal-like reptiles and extant mammals. [ 33 ]
The earliest mammals were generally small animals, and were likely nocturnal insectivores . This suggests a plausible source of evolutionary pressure: with these small bones in the middle ear, a mammal has extended its range of hearing for higher-pitched sounds which would improve the detection of insects in the dark. [ 34 ]
The evidence that the malleus and incus are homologous to the reptilian articular and quadrate was originally embryological, and since this discovery an abundance of transitional fossils has both supported the conclusion and given a detailed history of the transition. [ 35 ] The evolution of the stapes (from the columella ) was an earlier and distinct event. [ 36 ] [ 37 ]
The evolution of the mammalian middle ear appears to have occurred in two steps. A partial middle ear formed by the departure of postdentary bones from the dentary, and happened independently in the ancestors of monotremes and therians . The second step was the transition to a definite mammalian middle ear, and evolved independently at least three times in the ancestors of today's monotremes, marsupials and placentals. [ 38 ]
As the dentary bone of the lower jaw continued to enlarge during the Triassic, the older quadrate-articular joint fell out of use. Some of the bones were lost, but the quadrate , the articular , and the angular bones became free-floating and associated with the stapes . This occurred at least twice in the mammaliformes . The multituberculates had jaw joints that consisted of only the dentary and squamosal bones, and the quadrate and articular bones were part of the middle ear. Other features of their teeth, jaws and skulls are significantly different from those of mammals. [ 21 ] [ 39 ]
In the lineage most closely related to mammals, the jaws of Hadrocodium (about 195M years ago in the very early Jurassic) suggest that it may have been the first to have a nearly fully mammalian middle ear: it lacks the trough at the rear of the lower jaw, over which the eardrum stretched in therapsids and earlier mammaliformes. The absence of this trough suggests that Hadrocodium ’s ear was part of the cranium, as it is in mammals, and that the former articular and quadrate had migrated to the middle ear and become the malleus and incus. Hadrocodium ’s dentary has a "bay" at the rear which mammals lack, a hint that the dentary bone retained the same shape as if the articular and quadrate had remained part of the jaw joint. [ 40 ] However, several studies have cast doubt on whether Hadrocodium did indeed possess a definitive mammalian middle ear; Hadrocodium likely had an ossified connection between the middle ear and the jaw, which is not visible in the fossil evidence due to limited preservation. [ 41 ] [ 42 ] Researchers now hypothesize that the definitive mammalian middle ear did not emerge any earlier than the late Jurassic (~163M years ago). [ 42 ]
It has been suggested that a relatively large trough in the jaw bone of the early Cretaceous monotreme Teinolophos provides evidence of a pre-mammalian jaw joint, because therapsids and many mammaliforms had such troughs in which the articular and angular bones "docked". Thus, Teinolophos had a pre-mammalian middle ear, indicating that the mammalian middle ear ossicles evolved independently in monotremes and in other mammals. [ 43 ] A more recent analysis of Teinolophos concluded that the trough was a channel for the large vibration and electrical sensory nerves terminating in the bill (a defining feature of the modern platypus). Thus, the trough is not evidence that Teinolophos had a pre-mammalian jaw joint and a pre-mammalian middle ear. [ 44 ]
A recently discovered intermediate form is the primitive mammal Yanoconodon , which lived approximately 125 million years ago in the Mesozoic era. In Yanoconodon the ossicles have separated from the jaw and serve the hearing function in the middle ear, yet maintain a slender connection to the jaw via the ossified Meckel's cartilage . [ 45 ] [ 42 ] Maintaining a connection via the ossified Meckel's cartilage may have been evolutionary advantageous since the auditory ossicles were not connected to the cranium in Yanoconodon (as they are in extant mammals), and required structural support via Meckel's cartilage. [ 46 ]
The frequency range and sensitivity of the ear is dependent on the shape and arrangement of the middle-ear bones. In the reptilian lineage, hearing depends on the conduction of low-frequency vibrations through the ground or bony structures (such as the columella ). By modifying the articular bone, quadrate bone, and columella into small ossicles, mammals were able to hear a wider range of high-frequency airborne vibrations. [ 47 ] Hearing within mammals is further aided by a tympanum in the outer ear and an elongated lagena ( cochlea ) in the inner ear.
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Cochlea / ˈ k oʊ k l i ə / is Latin for “snail, shell or screw” and originates from the Greek word κοχλίας kokhlias . The modern definition, the auditory portion of the inner ear , originated in the late 17th century. Within the mammalian cochlea exists the organ of Corti , which contains hair cells that are responsible for translating the vibrations it receives from surrounding fluid-filled ducts into electrical impulses that are sent to the brain to process sound. [ 1 ]
This spiral-shaped cochlea is estimated to have originated during the early Cretaceous Period , around 120 million years ago. [ 2 ] Further, the auditory innervation of the spiral-shaped cochlea also traces back to the Cretaceous period. [ 3 ] The evolution of the human cochlea is a major area of scientific interest because of its favourable representation in the fossil record. [ 4 ] During the last century, many scientists such as evolutionary biologists and paleontologists strove to develop new methods and techniques to overcome the many obstacles associated with working with ancient, delicate artifacts. [ 2 ] [ 5 ] [ 6 ]
In the past, scientists were limited in their ability to fully examine specimens without causing damage to them. [ 2 ] In more recent times, technologies such as micro-CT scanning became available. [ 5 ] These technologies allow for the visual differentiation between fossilized animal materials and other sedimentary remains. [ 2 ] With the use of X-ray technologies, it is possible to ascertain some information about the auditory capabilities of extinct creatures, giving insight to human ancestors as well as their contemporary species. [ 6 ]
While the basic structure of the inner ear in lepidosaurs (lizards and snakes), archosaurs (birds and crocodilians) and mammals is similar, and the organs are considered to be homologous, each group has a unique type of auditory organ. [ 2 ] The hearing organ arose within the lagenar duct of stem reptiles , lying between the saccular and lagenar epithelia . In lepidosaurs, the hearing organ, the basilar papilla, is generally small, with at most 2000 hair cells, whereas in archosaurs the basilar papilla can be much longer (>10mm in owls ) and contain many more hair cells that show two typical size extremes, the short and the tall hair cells. In mammals, the structure is known as the organ of Corti and shows a unique arrangement of hair cells and supporting cells. All mammalian organs of Corti contain a supporting tunnel made up of pillar cells, on the inner side of which there are inner hair cells and outer hair cells on the outer side. The definitive mammalian middle ear and the elongated cochlea allows for better sensitivity for higher frequencies. [ 2 ]
As in all lepidosaurs and archosaurs, the single- ossicle (columellar) middle ear transmits sound to the footplate of the columella , which sends a pressure wave through the inner ear. In snakes, the basilar papilla is roughly 1mm long and only responds to frequencies below about 1 kHz. In contrast, lizards tend to have two areas of hair cells , one responding below and the other above 1 kHz. The upper frequency limit in most lizards is roughly 5–8 kHz. The longest lizard papillae are about 2mm long and contain 2000 hair cells and their afferent innervating fibers can be very sharply tuned to frequency. [ 7 ]
In birds and crocodilians , the similarity of the structure of the basilar papilla betrays their close evolutionary relationship. The basilar papilla is up to about 10mm long and contains up to 16,500 hair cells. While most birds have an upper hearing limit of only about 6 kHz, the barn owl can hear up to 12 kHz and thus close to the human upper limit. [ 8 ]
Egg-laying mammals , the monotremes ( echidna and platypus ), do not have a spiral cochlea, but one shaped more like a banana, up to about 7 mm long. Like in lepidosaurs and archosaurs, it contains a lagena, a vestibular sensory epithelium, at its tip. Only in therian mammals ( marsupials and placentals ) is the cochlea truly coiled 1.5 to 3.5 times. Whereas in monotremes there are many rows of both inner and outer hair cells in the organ of Corti, in therian (marsupial and placental) mammals the number of inner hair-cell rows is one, and there are generally only three rows of outer hair cells. [ 7 ]
Amphibians have unique inner ear structures. There are two sensory papillae involved in hearing, the basilar (higher frequency) and amphibian (lower frequency) papillae, but it is uncertain whether either is homologous to the hearing organs of lepidosaurs, archosaurs and mammals and it is uncertain when they arose. [ 9 ]
Fish have no dedicated auditory epithelium, but use various vestibular sensory organs that respond to sound. In most teleost fishes it is the saccular macula that responds to sound. In some, such as goldfishes , there is also a special bony connection to the gas bladder that increases sensitivity allowing hearing up to about 4 kHz. [ 9 ]
The size of cochlea has been measured throughout its evolution based on the fossil record. In one study, the basal turn of the cochlea was measured, and it was hypothesized that cochlear size correlates with body mass. The size of the basal turn of the cochlea was not different in Neanderthals and Holocene humans, however it became larger in early modern humans and Upper Paleolithic humans. Furthermore, the position and orientation of the cochlea is similar between Neanderthals and Holocene humans, relative to plane of the lateral canal, whereas early modern and upper Paleolithic humans have a more superiorly placed cochlea than Holocene humans. When comparing hominins of the Middle Pleistocene , Neanderthals and Holocene humans, the apex of the cochlea faces more inferiorly in the hominins than the latter two groups. Finally, the cochlea of European middle Pleistocene hominins faces more inferiorly than Neanderthals, modern humans, and Homo erectus . [ 10 ]
Human beings, along with apes , are the only mammals that do not have high frequency (>32 kHz) hearing. [ 10 ] Humans have long cochleae, but the space devoted to each frequency range is quite large (2.5mm per octave), resulting in a comparatively reduced upper frequency limit. [ 2 ] The human cochlea has approximately 2.5 turns around the modiolus (the axis). [ 2 ] Humans, like many mammals and birds, are able to perceive auditory signals that displace the eardrum by a mere picometre . [ 11 ]
Because of its prominence and preserved state in the fossil record, until recently, the ear had been used to determine phylogeny . [ 4 ] The ear itself contains different portions, including the outer ear , the middle ear , and the inner ear and all of these show evolutionary changes that are often unique to each lineage. It was the independent evolution of a tympanic middle ear in the Triassic period that produced strong selection pressures towards improved hearing organs in the separate lineages of land vertebrates . [ 4 ]
The cochlea is the tri-chambered auditory detection portion of the ear, consisting of the scala media , the scala tympani , and the scala vestibuli . [ 9 ] Regarding mammals, placental and marsupial cochleae have similar cochlear responses to auditory stimulation as well as DC resting potentials. [ 12 ] This leads to the investigation of the relationship between these therian mammals and researching their ancestral species to trace the origin of the cochlea. [ 2 ]
This spiral-shaped cochlea that is in both marsupial and placental mammals is traced back to approximately 120 million years ago. [ 2 ] The development of the most basic basilar papilla (the auditory organ that later evolved into the Organ of Corti in mammals) happened at the same time as the water-to-land transition of vertebrates, approximately 380 million years ago. [ 7 ] The actual coiling or spiral nature of the cochlea occurred to save space inside the skull . [ 3 ] The longer the cochlea, the higher is the potential resolution of sound frequencies given the same hearing range. [ 3 ] The oldest of the truly coiled mammalian cochleae were approximately 4 mm in length. [ 2 ]
The earliest evidence available for primates depicts a short cochlea with prominent laminae, suggesting that they had good high-frequency sensitivity as opposed to low-frequency sensitivity. [ 13 ] After this, over a period of around 60 million years, evidence suggests that primates developed longer cochleae and less prominent laminae, which means that they had an improvement in low-frequency sensitivity and a decrease in high-frequency sensitivity. [ 13 ] By the early Miocene period , the cycle of the elongation of the cochleae and the deterioration of the laminae was completed. [ 13 ] Evidence shows that primates have had an increasing cochlear volume to body mass ratio over time. [ 3 ] These changes in the cochlear labyrinth volume negatively affect the highest and lowest audible frequencies, causing a downward shift. [ 3 ] Non-primates appear to have smaller cochlear labyrinth volumes overall when compared to primates . [ 3 ] Some evidence also suggests that selective forces for the larger cochlear labyrinth may have started after the basal primate node. [ 3 ]
Mammals are the subject of a substantial amount of research not only because of the potential knowledge to be gained regarding humans, but also because of their rich and abundant representation in the fossil record. [ 14 ] The spiral shape of the cochlea evolved later on in the evolutionary pathway of mammals than previously believed, just before the therians split into the two lineages marsupials and placentals, about 120 million years ago. [ 2 ]
Parallel to the evolution of the cochlea, prestin shows an increased rate of evolution in therian mammals. Prestin is the motor protein of the outer hair cells of the inner ear of the mammalian cochlea. [ 15 ] [ 16 ] It is found in the hair cells of all vertebrates, including fish, but are thought to have initially been membrane transporter molecules. A high concentration of prestin are found only in the lateral membranes of therian outer hair cells (there is uncertainty with regard to concentrations in monotremes). This high concentration is not found in inner hair cells, and is also lacking in all hair cell types of non-mammals. [ 17 ]
Prestin also has a role in motility, which evolved a greater importance in the motor function in land vertebrates, but this developed vastly differently in different lineages. In certain birds and mammals, prestin function as both transporters and motors, but the strongest evolution to robust motor dynamics only evolved in therian mammals. It is hypothesized that this motor system is significant to the therian cochlea at high frequencies because of the distinctive cellular and bony composition of the organ of Corti that allows prestin to intensify the movements of the whole structure. [ 2 ]
Modern ultra-sound echolocating species such as bats and toothed whales show highly evolved prestin, and this prestin shows identical sequence alterations over time. Unusually, the sequences thus apparently evolved independent from each other during different time periods. Furthermore, the evolution of neurotransmitter receptor systems ( acetylcholine ) that regulate the motor feedback of the outer hair cells coincides with prestin evolution in therians. This suggests that there was a parallel evolution of a control system and a motor system in the inner ear of therian mammals. [ 7 ]
Land vertebrates evolved middle ears independently in each major lineage, and are thus the result of parallel evolution. [ 7 ] The configurations of the middle ears of monotreme and therian mammals can thus be interpreted as convergent evolution or homoplasy . [ 14 ] Thus evidence from fossils demonstrate homoplasies for the detachment of the ear from the jaw. [ 14 ] Furthermore, it is apparent that the land-based eardrum, or tympanic membrane, and connecting structures such as the Eustachian tube evolved convergently in multiple different settings as opposed to being a defining morphology . [ 18 ]
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The evolution of the human oral microbiome is the study of microorganisms in the oral cavity and how they have adapted over time. There are recent advancements in ancient dental research that have given insight to the evolution of the human oral microbiome. [ 1 ] Using these techniques it is now known what metabolite classes have been preserved and the difference in genetic diversity that exists from ancient to modern microbiota. [ 2 ] The relationship between oral microbiota and its human host has changed and this transition can directly be linked to common diseases in human evolutionary past. [ 3 ] Evolutionary medicine provides a framework for reevaluating oral health and disease and biological anthropology provides the context to identify the ancestral human microbiome. [ 1 ] These disciplines together give insights into the oral microbiome and can potentially help contribute to restoring and maintaining oral health in the future. [ 1 ]
Since the 1980s, it has been well known that archeological dental calculus preserves cellular structures and oral bacteria, but a new discovery in the last decade has revealed that dental calculus is a long-term reservoir of DNA and proteins. [ 1 ] Human DNA in dental calculus was initially targeted by PCR amplification of mitochondrial DNA (mtDNA), followed by either haplogroup inference or conventional cloning and Sanger sequencing . [ 4 ] Shotgun metagenomics paired with next-generation sequencing (NGS) technology further confirmed dental calculus contains mitochondrial and nuclear DNA. [ 4 ] Dental calculus typically contains 10–1,000-fold more DNA than bone or dentine , making it the richest known source of aDNA , one of the possible double helical structures of DNA, in the archaeological record. [ 1 ] [ 4 ] Archaeological dental calculus is an alternative source of high quality mitochondrial DNA sufficient for full mitogenome reconstruction. [ 4 ] This reconstruction can then be applied to maternal lineage ancestry analysis to determine the haplogroup , thus identifying which geographical regions maternal ancestors settled. [ 4 ] [ 5 ] Protein sequencing has also been applied revealing bacterial functions such as virulence factors and their interactions with the host are viable from ancient dental calculus. [ 5 ] Proteomics has revealed over 60 human proteins with origins in dental calculus such as follicular dendritic cell-secreted protein, alpha amylase I, hemoglobin, etc. [ 4 ] Metabolomics and lipidomic studies are used to determine what metabolic categories (amino acids, carbohydrates, cofactors and vitamins, energy, lipids, nucleic acids, peptides, xenobiotics) and the source of metabolites (host, microbial, diet) are found within dental calculus samples. [ 6 ] Many of these newly developed techniques used to study ancient dental calculus are still in their early stages and need to overcome several limitations to offer a more accurate understanding on the evolution of the oral microbiome. Some examples of these limitations are isolation of contaminant DNA, correct identification of ancient microbial species, identification and isolation of non-bacterial DNA as well as better statistical techniques. [ 7 ]
Microbial profiles differ significantly between dental plaque and dental calculus although calculus forms from plaque. [ 8 ] The protein and metabolic profiles also have distinct taxonomic and metabolic functions between dental plaque and dental calculus. [ 8 ] As the oral biofilm develops, taxonomic shifts take place due to the structural and resource changes in the biofilm through time. [ 8 ] The early colonizers are typically facultative anaerobes that are saccharolytic, however, as the biofilm grows and oxygen is depleted, methanogens and sulfate-reducers increase in abundance and the early colonizers decrease. [ 8 ] This matured biofilm community is the one preserved in dental calculus. [ 8 ] Ancient dental calculus often contain high amounts of proteolytic obligate anaerobes that resemble the mature biofilm including Tannerella, Porphyromonas , Methanobrevibacter , and Desulfobulbus. [ 8 ] [ 3 ] Historic calculus samples have less metabolite profile diversity (amino acids, carbohydrates, cofactors, vitamins, energy, lipids, nucleic acids, peptides) suggesting that individual phenotypes may be lost through metabolite degradation over time. [ 6 ] One problem with sampling ancient dental calculus is that little is known about age-related protein degradation. [ 6 ] Lipids are some of the best preserved metabolites and are stable over time giving them a promising focus for further evolutionary studies of dental calculus. [ 6 ] Phenylalanine , succinate , hydrocinnimate, cadaverine , and putrescine are all metabolite markers of periodontal disease that can be found in calculus. [ 6 ] Bacterial composition of ancient dental calculus is similar to modern but with the exception of higher amounts of Bacillota and Actinomycetota . [ 9 ] Human oral bacteria underwent a distinct shift to a disease-associated configuration with the transition from hunter-gatherer to farming in early Neolithic and then stayed relatively consistent through the Medieval period (~400 years BP). [ 9 ] In contrast the modern oral environment is less diverse and has high levels of cariogenic bacteria like S. mutans. [ 9 ]
Human microbiota plays a central role in health and diseases and disruption of the microbiome leads to dysbiosis (the relationship between microbiota and host is linked to illnesses etc.). [ 10 ] Unlike other human microbiomes, the oral microbiome is in dysbiosis causing disease in a majority of people in their lifetime. [ 3 ] The human oral microbiome has long served as a holding tank for a wide variety of opportunistic pathogens involved in both local and systemic disease. [ 3 ] The oral microbiome also harbors a diverse variety of presumed antibiotic resistant genes. [ 3 ] An abundance of immune system proteins both inflammatory ( myeloperoxidase , azurocidin , lysozyme , calprotectin, elastase ) and anti-inflammatory ( α-1-antitrypsin and α-1-antichymotrypsin) are found in ancient dental calculus. [ 3 ] This conservation of immune system proteins is strongly supportive of their role in periodontal inflammation and disease. [ 3 ] Dental caries (tooth decay) and periodontal disease were both rare in pre- Neolithic hunter-gatherer societies. [ 9 ] Both increased following the transition to an agricultural diet, insinuating there was a major impact on the human oral microbiome. [ 9 ] The farming populations contained more periodontal disease-associated taxa such as P. gingivalis , Tannerella and Treponema . [ 9 ] Tannerella forsythia being the most prevalent human oral pathogen found in ancient dental calculus up to date. [ 2 ]
Tannerella forsythia is an anaerobic bacteria l species and is implicated in periodontal diseases. [ 11 ] The high conservation of the sialic acid catabolism and transport operon in T. forsythia illustrates a human-specific adaptation due to the close relationship with the human host. [ 12 ] T. forsythia is believed to have co-evolved with humans. [ 12 ] Ancient dental calculus samples containing T. forsythia have higher amounts of periodontitis-associated species than samples that do not contain T. forsythia. [ 2 ] These T. forsythia containing samples also have bone loss in tooth areas indicative of advanced periodontitis. [ 2 ] The T. forsythia genomes have high sequence similarity; however, some virulence -associated genes vary significantly between modern and ancient T. forsythia. [ 2 ] The S-layer proteins of T. forsythia are critical for host immune evasion and biofilm co-aggregation. [ 3 ] In ancient dental calculus, the S-layer gene and protein sequences were abundant and well-preserved, making them a target for investigating the evolution of periodontal pathogenesis in humans. [ 3 ]
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Evolutionary psychiatry , also known as Darwinian Psychiatry , [ 1 ] [ 2 ] is a theoretical approach to psychiatry that aims to explain psychiatric disorders in evolutionary terms. [ 3 ] [ 4 ] As a branch of the field of evolutionary medicine , it is distinct from the medical practice of psychiatry in its emphasis on providing scientific explanations rather than treatments for mental disorder. This often concerns questions of ultimate causation . For example, psychiatric genetics may discover genes associated with mental disorders, but evolutionary psychiatry asks why those genes persist in the population. Other core questions in evolutionary psychiatry are why heritable mental disorders are so common [ 5 ] how to distinguish mental function and dysfunction, [ 6 ] and whether certain forms of suffering conveyed an adaptive advantage. [ 7 ] Disorders commonly considered are depression , anxiety , schizophrenia , autism , eating disorders , and others. Key explanatory concepts are of evolutionary mismatch (when modern environments cause mental health conditions) and the fact that evolution is guided by reproductive success rather than health or wellbeing . Rather than providing an alternative account of the cause of mental disorder, evolutionary psychiatry seeks to integrate findings from traditional schools of psychology and psychiatry such as social psychology , behaviourism , biological psychiatry and psychoanalysis into a holistic account related to evolutionary biology. In this sense, it aims to meet the criteria of a Kuhnian paradigm shift .
Though heavily influenced by evolutionary psychology , [ 3 ] as Abed and St John-Smith noted in 2016, "Unlike evolutionary psychology, which is a vibrant and thriving sub-discipline of academic psychology with a strong and well-funded research program, evolutionary psychiatry remains the interest of a small number of psychiatrists who are thinly scattered across the world." It has gained increasing institutional recognition in recent years, including the formation of an evolutionary psychiatry special interest group within the Royal College of Psychiatrists and the Section on Evolutionary Psychiatry within the World Psychiatric Association , [ 8 ] and has gained traction with the publication of texts aimed at the popular audience such as Good Reasons for Bad Feelings: Insight from the Frontier of Evolutionary Psychiatry [ 7 ] by Randolph Nesse.
The pursuit of evolutionary psychiatry in its modern form can be traced to the late 20th century. A landmark text was George Williams and Randolph Nesse 's Why We Get Sick: The New Science of Darwinian Medicine [ 9 ] (which could also be considered as marking the beginning of evolutionary medicine), the publication of Evolutionary Psychiatry: A New Beginning by John Price and Anthony Stevens and others. However, the questions which evolutionary psychiatry concerns itself with have a longer history, for instance being recognised by Julian Huxley and Ernst Mayr in an early paper [ 10 ] considering possible evolutionary explanations for what has become known as the 'schizophrenia paradox'.
Concepts applied by modern evolutionary psychiatry to explain mental disorder are also much older than the field, in many cases. Psychological suffering as an inevitable, and sometimes useful, part of human existence has been long-recognised, and the idea of divine madness pervades ancient societies and religions. Cesare Lombroso , a pioneering psychiatrist, began utilising evolutionary theory to explain mental disorder as early as 1864, proposing that insanity was the price of genius, as human brains had not evolved with the capacity to become hyper-intelligent and creative and yet remain sane. [ 11 ] Darwin applied evolutionary theory to explain psychological traits and emotions, and recognised the usefulness of studying mental disorders in pursuit of understanding natural psychological function. Freud was heavily influenced by Darwinian theory, and towards the end of his life recommended psychoanalysts should study evolutionary theory. [ 12 ] Bowlby 's attachment theory was developed in explicit reference to evolutionary theory. [ 13 ]
In 2016 the Evolutionary Psychiatry Special Interest Group (EPSIG) was set up in the Royal College of Psychiatrists , UK by Riadh Abed and Paul St-John Smith. [ 8 ] It is now the largest global institution for connecting psychiatrists and researchers interested in evolutionary psychiatry [ 14 ] with over 1700 members. [ 15 ] It has run several seminars and meetings dedicated to evolutionary psychiatry, hosting lectures by prominent academics such as Simon Baron-Cohen and Robin Dunbar . All of the meetings are available on the EPSIGUK YouTube channel. [ 16 ] EPSIG also publishes regular newsletters, [ 17 ] organising conferences, conducting interviews and hosting special essays related to evolutionary psychiatry (for which there is not yet a dedicated academic journal). As Riadh Abed, (previous chair) stated in a newsletter "Our aims are both big and radical: they are for evolution to be accepted as the overarching framework for psychiatry and for evolution to take center stage in our understanding of mental health and mental disorder." [ 14 ]
Abed and St-John Smith edited a 2022 volume Evolutionary Psychiatry: Current Perspectives on Evolution and Mental Health , [ 18 ] co-published by the Royal College of Psychiatrists and Cambridge University Press, marking the most extensive publication in the field to date, and forming the basis for the first podcast dedicated to evolutionary psychiatry, the 'Evolving Psychiatry' podcast.
Mental disorders are often defined by 'dysfunction' in psychiatric manuals such as the DSM , without a precise definition of what constitutes dysfunction, allowing any mental state deemed socially unacceptable (such as homosexuality ) to be considered dysfunctional, and thus a mental disorder.
Evolutionary theory is uniquely placed to be able to distinguish biological function from dysfunction by evolutionary processes. [ 19 ] Unlike the objects and processes of physics and chemistry , which cannot strictly be said to be functioning nor dysfunctioning, [ 20 ] biological systems are the products of evolution by natural selection , and so their 'function' and 'dysfunction' can be related to that evolutionary process. The concept of evolutionary function is tied to the reproductive success brought about by phenotypes which caused genes to be propagated. Eyes evolved to see – the function of the eyes is to see – so dysfunctional eyes are those that cannot see. This sense of function is defined by the evolutionary history of eyesight providing reproductive success, not current cultural opinions of normality and abnormality on which common conceptions of health and disorder often depend. [ 21 ] Jerome Wakefield's influential 'Harmful Dysfunction' definition of disorder utilises evolutionarily selected effects to ground the concept of 'dysfunction' in the objective process of evolution. Wakefield proposes that mental disorder must be both harmful, in a value-defined sense, and dysfunctional, in an evolutionary sense.
This grounding of dysfunction in an objective historical process is important in the context of psychiatry's history of labelling socially undesirable mental states and traits as 'disorders', such as female masturbation and homosexuality. Current diagnostic manuals are decided by consensus. For example, in 1973 the APA called a vote to reconsider homosexuality's status as a mental disorder. By a 58% majority, it was struck off. [ 22 ] The category of borderline personality disorder was created upon the basis of a single paper and consensus between about a dozen psychiatrists. [ 23 ] In 2014 psychiatrists voted on the features of a new disorder, internet gaming disorder . [ 24 ] The reliance on votes and expert consensus rather than objective evidence or biomarkers is a longstanding criticism of psychiatry that evolutionary psychiatry can avoid by adopting the evolutionary definition of dysfunction.
The research questions and concerns of evolutionary medicine and psychiatry can be distinguished from normal biomedicine and biological-psychiatry research as asking ultimate instead of proximate questions. This ultimate-proximate distinction was introduced by Ernst Mayr [ 25 ] to identify different levels of causational explanation: proximate explanations refer to mechanistic biological processes (e.g. genes, ontogenetic development, hormones, neurological structure and function) whilst ultimate explanations ask about the evolutionary process of natural selection which led to these biological structures and processes functioning as observed. This could be conceived of as proximate explanations are 'how' questions whilst ultimate explanations are 'why' questions.
Niko Tinbergen further deconstructed this ultimate-proximate distinction into his 'four questions'. [ 26 ] These questions of mechanism, ontogeny, function and phylogeny can be asked of any single trait or disorder (often behavioural, although not necessarily) to identify the different questions of causation which are simultaneously relevant.
Proximate questions can be separated into questions of mechanism , which concerns how the trait works, the structure and process of its biological mechanism, and questions of ontogeny or individual development which concerns how the trait develops in an individual.
Ultimate questions can be either of or evolutionary function or adaptive value, which concerns how the trait influenced fitness throughout evolutionary history; and questions of phylogeny or evolution, which concern the history of a trait down the phylogenetic tree.
To take the example of depression, we can ask about proximate mechanisms (e.g. neurotransmitter properties), ontogenetic development (e.g. neurological development over an individual's lifespan), adaptive function (e.g. low mood system) and phylogeny (e.g. apparent low mood in reaction to social defeat in primates).
Mental disorder results from many different environmental and genetic causes, with various complex neurological correlates – but evolutionary medicine recognises several general principles which allow vulnerability to disorder. Adapted from Nesse (2019), [ 7 ] Stearns (2016) [ 27 ] and Gluckman (2016). [ 28 ]
Natural selection acts on reproductive fitness , not biological states which are what may be considered healthy; healthy states are only selected if they also have positive effects on reproductive success. This is used in evolutionary medicine to explain aging and diseases of senescence: diseases which appear past reproductive age have minimal effect on fecundity. Psychological suffering and various cognitive states which may seem unhealthy or disorderly may equally be products of evolutionary processes if they increased reproductive success. Evidence of this may be seen in disorders associated with substantial apparent dysfunction, yet average levels of fertility.
Evolutionary mismatch occurs when evolved traits become maladaptive due to changes in the environment. This is a common factor causing evolutionary change (e.g. in the peppered moth) and is relevant to medicine when the mismatched traits cause problems affecting health. Psychiatric conditions may in some cases be evolved states which we are misinterpreting as disorders because they no longer fit our social expectations; or they may be mental states or traits which would manifest healthily in ancestral environments, but become pathological due to some feature of modern environments. Evidence of mismatch is most prominent when comparing traditional-living humans to modern-living humans or when new environmental factors arise which clearly cause disease (e.g. the availability of cheap, high calorie foods causing obesity).
Psychological responses such as fear and panic are adaptive in many situations, [ 29 ] especially of imminent danger, and seen in multiple species. Certain mental disorders may result from such responses, either as a maladaptive overactivation of the response, or as an adaptive process which is specifically tuned to over-activate because the fitness cost of the response is outweighed by the fitness benefit – called the smoke detector principle. [ 30 ] The fact that such experiences are highly distressing, debilitating and inappropriate leads to their diagnosis as mental disorders.
Natural selection acts upon genetic mutations , which are present in every generation, removing those which reduce fitness and increasing the prevalence of those which improve fitness. Mutations are also more likely to reduce fitness than improve it. Biological traits with a large mutational target size, such as brains, where over 80% of the genome is expressed, [ 31 ] are especially likely to be suspect to harmful mutations which negatively affect cognitive function, which are then removed by natural selection. Such mutations are often associated with intellectual disability, certain cases of autism , schizophrenia , and many more disorders. The fact that de-novo mutations cause such disorders in a few cases has been used to argue that the other cases are caused by as-yet undiscovered disease processes, although the presence of heterogeneity within disorder categories and the lack of discovered pathology despite significant work in neuroscience and genetics is evidence against that view.
Schizophrenia is primarily characterized by psychosis ( hallucinations and delusions ) and symptoms of cognitive debilitation such as erratic speech, lost interest in normal activities and disordered thinking. It is the most extreme condition of the schizophrenia or psychosis spectrum , which includes schizotypy and other psychotic disorders, arguably extending to unusual experiences such as perceiving ghosts or believing in magic which are common in the population.
Schizophrenia is a heritable condition, prevalent in slightly less than 1% of the population, with negative effects of fecundity, especially in men. [ 32 ] Because of this, it was perhaps the first psychiatric condition explicitly raised as specifically requiring an evolutionary explanation, [ 10 ] in the so-called 'schizophrenia paradox' (now more generally known as the paradox of common, harmful, heritable mental disorders [ 5 ] ). To explain schizophrenia's persistence various evolutionary hypotheses have been made.
Hypotheses of schizophrenia as a true dysfunction are plentiful. It has been hypothesised that schizophrenia is a dysfunctional byproduct of human evolution for language and brain hemisphere lateralization, [ 33 ] or a dysfunction of the social brain, [ 34 ] or related to theory-of-mind . [ 35 ] Other theories have referred to the possibility it is caused by mutation-selection balance . [ 5 ] However, the expected rare and de novo mutations have only been found in a small proportion of cases. [ 36 ] Many alleles predisposing to schizophrenia are common in the population, making adaptive hypotheses plausible, as has been noted since the mid 20th century. [ 10 ]
Hypotheses explaining schizophrenia as resulting from adaptation vary widely. Early theorists proposed it conveyed improvements to the immune system or illness recovery [ 10 ] or facilitates group-splitting. [ 37 ] Inspired by the longstanding cultural ideas of madness as related to genius , Nettle proposed that schizotypy could be related to creative success, [ 38 ] which added to mating success, and that the positive effects of schizotypal traits might be an explanation for why these traits persist. However, the measured fecundity benefit of such traits has been found to not outweigh the cost of schizophrenia via inclusive fitness (although this may be due to selection bias ). [ 39 ]
The shamanism hypothesis of schizophrenia states that in traditional societies the experience of psychosis facilitated the induction of shamans ( magico-religious practitioners such as medicine men, diviners, witch doctors, exorcists and mediums). Shamanism is a common feature of human societies, with certain individuals deemed to have a particular connection to the supernatural world which gives them the ability to perform magic, especially healing. This in particular is used explain the common religious and grandiose content of psychotic experiences and the belief in supernatural powers, which may have been believed rather than disbelieved in traditional societies. The onset of schizophrenia also closely resembles shamanic initiations, which often feature hallucinations, delusions and incoherent speech. Possible links between shamanism and insanity have been recognised for many decades by anthropologists (e.g. "...mentally ill people are often regarded as holy in primitive societies" [ 40 ] and "Feeblemindedness is treated with scorn in Niue today, but insanity still calls forth respect" [ 41 ] ) but the most recent iteration of the theory is by Joseph Polimeni, [ 42 ] who argues that shamans facilitate group functioning, and so psychosis evolved as a result of group selection. Critics have argued that the trance states and self-control exhibited by shamans are unlike the characteristics of schizophrenia.
Attention-Deficit/Hyperactivity Disorder explores the origins of mental disorders by considering how certain traits may have been advantageous in ancestral environments. Attention-Deficit/Hyperactivity Disorder ( ADHD ) is examined within an Evolutionary psychiatry framework understands why behaviors associated with the disorder persist in the human population.
One hypothesis suggests that traits like hyperactivity, impulsivity, and novelty-seeking were beneficial for hunter-gatherer societies. These characteristics could enhance survival by promoting exploration, quick decision-making, and adaptability in changing environments. The “hunter versus farmer” theory posits that while such traits were advantageous for nomadic hunters, they became less suitable with the advent of sedentary agricultural societies, leading to conflicts with modern social structures and expectations. [ 43 ] [ 44 ]
Proponents of this view argue that ADHD behaviors are not inherently pathological but are mismatches between ancient adaptive traits and contemporary environments. This argument fits into larger idea of neurodiversity and encourages a reevaluation of ADHD, promoting understanding and adaptation rather than solely focusing on symptom management. Some psychiatrists have even begun to cater to evolutionary framework of ADHD. [ 45 ]
Critics caution that evolutionary explanations may oversimplify the complex interplay of genetic, environmental, and neurodevelopmental factors that contribute to ADHD. They emphasize the importance of evidence-based approaches in diagnosis and treatment, noting that while evolutionary theories provide interesting insights, they should not replace established scientific methodologies. Though the enticing idea that ADHD was once advantageous is catching up in media.
Autism spectrum disorder is characterized by difficulties with social interaction and communication, and restricted and repetitive behavior. In developed countries, about 1.5% of children are diagnosed with ASD as of 2017 [update] , [ 46 ] up from 0.7% in 2000 in the United States. It is diagnosed four-to-five times more often in males than females. [ 47 ]
Autism differs widely between individuals (it is highly heterogenous ) with different causes for different individuals. Some cases are caused by deleterious mutations [ 48 ] or prenatal and neonatal trauma, [ 49 ] for which no adaptive explanation is required. These cases are often associated with intellectual disability . Estimates range that between 5–20% of the autism spectrum can be explained by these dysfunctional processes, especially of genetics. [ 50 ] [ 48 ] However, other cases of autism are eligible for adaptive explanations. The fact that multiple explanations for autism exist causes conflict within the autism community, especially between proponents of the neurodiversity perspective and family members caring for individuals with ASD that have severe disabilities. [ 51 ]
The idea of autism as conveying cognitive strengths has become steadily more popular since the film Rain Man and the recent growth of the neurodiversity and autism rights movements , although recognition of unusual autistic ability be found even in the early writings of Hans Asperger who called his autistic patients 'little professors'. [ 52 ] It has been suggested by autistics such as Temple Grandin that autistic hunter-gatherer ancestors were important figures in the community, especially for their inventive capacity:
'Who do you think made the first stone spear? (...) That wasn't the yakkity yaks sitting around the campfire. It was some Asperger sitting in the back of a cave figuring out how to chip rocks into spearheads. Without some autistic traits you wouldn't even have a recording device to record this conversation on." [ 53 ]
Leading autism researcher Simon Baron-Cohen has proposed that autism is an extreme systemising cognitive type, [ 54 ] on an empathising-systemising spectrum which all people fall onto, somewhat related to the things-people dimension of interests. He recognised the exceptional talent of many autistic people in some area of non-human knowledge or skill. [ 55 ] In his book, "The Pattern Seekers: how autism drives human invention" , [ 56 ] he proposes a theory of human inventiveness that places autistic individuals as having extreme versions of these inventing (or systemising) traits.
Marco del Giudice has suggested autistic-like traits in their non-pathological form contribute to a male-typical strategy geared toward high parental investment, low-mating effort, and long-term resource allocation. [ 57 ] He has also related this to a slow life history strategy . [ 58 ] This is based on the fact that autistics show lower interest in short-term mating, higher partner-specific investment, and stronger commitment to long-term romantic relations.
Bernard Crespi has suggested that autism is a disorder of high intelligence, [ 59 ] noting that autism commonly involves enhanced, but imbalanced, components of intelligence. This hypothesis is supported by evidence showing that autism and high IQ share a diverse set of convergent correlates, including large brain size, fast brain growth, increased sensory and visual-spatial abilities, enhanced synaptic functions, increased attentional focus, high socioeconomic status, more deliberative decision-making, profession and occupational interests in engineering and physical sciences, and high levels of positive assortative mating. Recent evolutionary selection pressures for high intelligence in humans have therefore conveyed autism risk.
Antisocial personality disorder (sometimes known as sociopathy or psychopathy ), is characterised by deceitfulness, lack of empathy and guilt, impulsiveness, and antisocial behaviour. [ 60 ] The prevalence of psychopathy in the general population is estimated to be around 1%, [ 61 ] [ 62 ] and 20% in prison populations [ 63 ] with higher rates in North America than Europe . [ 64 ] Psychopathy, narcissism and Machiavellianism are considered to be part of the Dark Triad , traits that are generally characterised by selfishness and low agreeableness. [ 65 ]
Various evolutionary hypotheses have been proposed to explain psychopathy and the Dark Triad. Within an ancestral context, high self-interest and low levels of empathy could function as a short-term mating strategy. There is evidence that Dark Triad traits are positively correlated with the number of sexual partners, more unrestrictive sociosexuality and preference for short-term mates. [ 65 ]
Glenn et al. [ 60 ] stated two theories on how selection might allow for psychopathic traits. The first is as a fast life-history strategy, associated with less focusing on the future, high risk taking and short-term mating. The second is mutation-selection balance , with many common alleles of small effect selected against, which, when accumulated, can result in psychopathic behaviour, without any significant disruption of reproductive fitness .
Mealey's influential account [ 66 ] states that psychopaths are designed for social deception and evolved to pursue manipulative life strategies or cheating strategies, (reflected in cheater-cooperation models of game theory ). Cheating strategies are stable at low frequencies in the population, but will be detected and punished at higher frequencies. This frequency-dependent strategy would explain the prevalence of psychopathic traits in the population.
Mealey [ 66 ] makes four statements about psychopathy:
Mealey [ 66 ] also explains the higher male prevalence and predisposing environmental factors (low physical attractiveness, age, health, physical attractiveness, intelligence, socioeconomic status, and social skills) as signals that a cheating strategy is preferable, hence why these factors are associated with psychopathic traits.
Major depressive disorder (MDD) is characterized by at least two weeks of persistent low mood. It is accompanied by a wide variety of negative feelings such as low self-esteem , loss of interest in normally enjoyable activities and low energy. There are multiple possible evolutionary explanations for the occurrence of depression and low mood in humans. Many different hypotheses are not mutually exclusive . It has been suggested that different life events and other disease processes are responsible for different forms of depression [ 67 ] with subtypes related to infection, long-term stress, loneliness, traumatic experience, hierarchy conflict, grief, romantic rejection, postpartum events, the season, chemicals, somatic diseases and starvation. Individualising treatment based on causational subtypes is suggested as lending direction in treatments. Other hypotheses include:
The social competition hypothesis (similarly to the social rank theory ) interprets depression as an emotion of submission, an involuntary strategy to create a subjective sense of incapacity. Feelings of powerlessness or helplessness cause this incapacity, inhibiting aggression towards higher-ranked people and signalling submission. Low mood encourages acceptance of a loss in rank and promotes yielding. [ 68 ] John Price endorsed this theory, noting that chickens who lose a fight withdraw from social engagement and act submissively, reducing further attacks by chickens higher in the hierarchy and avoiding being wounded or even killed. [ 7 ]
Similar to the social competition hypothesis, the 'social risk hypothesis' states that depression prevents people engaging in social interactions which might lead to them being ostracised. This hypothesis is inspired by risk-sensitive foraging . It suggests that people in successful social relationships can tolerate higher levels of social risk-taking, while on the other hand, people with low social standing cannot. The theory suggests that the low mood which accompanies MDD exists in order to reduce potential risk taking and encourages isolation in those individuals. [ 69 ]
Depression is common in people who are pursuing unreachable goals and depression might be a manifestation, similarly to the social competition hypothesis, of a failure to yield. [ 70 ] Low mood increases an organism's ability to cope with the adaptive challenges characteristic of unpropitious situations. Pessimism and lack of motivation may give a fitness advantage by inhibiting certain actions. When current life plans are not working, the distress and lack of motivation that characterize depression may motivate planning and reassessment or escape, even by suicide . Feelings of sadness and discouragement may be a useful stimulus to consider ways of changing the situation, by disengagement of motivation from an unreachable goal. In nature, it would make sense to decrease motivation in situations where taking action would be futile and therefore a waste of resources. Therefore, low mood in those situations would help the individual to preserve energy. This hypothesis is inspired by the marginal value theorem .
The 'analytical rumination' hypothesis is a refinement of the psychic pain hypothesis. It suggests that depressive symptoms are triggered by complex problems and an inability to find the correct course of action. This theory describes how this could lead to a loss of interest in virtually all activities in order to benefit the individual to single-mindedly focus on the problem at hand. [ 71 ]
Depression, deliberate self-harm and suicide may be reactions to life circumstances that encourage others to provide resources and help to the depressed or suicidal individual. Group members, and especially family members, have a vested interest in keeping the depressed individual alive and changing their circumstances in such a way as to make them a functioning member of society again. It may be the case that certain life choices (e.g. marrying somebody who your parents dislike) may become possible only when depressed or suicidal behaviour is observed by the family or social group. [ 72 ] This could explain various precipitating factors for depression. [ 73 ] However, some research has found that signs of depression only lead to a short-term increase of care by family members, after which they tend to withdraw. [ 7 ]
Evolutionary perspectives exist on Anorexia nervosa (henceforth 'anorexia') and Bulimia nervosa (henceforth 'bulimia'). Anorexia is characterized by restriction of food intake, bulimia by cycles of binging (excessive eating) and purging (forced removal of the food). [ 74 ] Both are associated with fear of weight gain, body image disturbance, and physical attractiveness concerns. [ 75 ]
The Sexual Competition Hypothesis [ 76 ] relates eating disorders to body shape and physical appearance as of adaptive function in human females (who are highly over-represented in eating disorders): eating disorders are supposed to increase female attractiveness. Some evidence from non-clinical and clinical populations support this hypothesis. [ 77 ] [ 78 ] They apply the framework of life-history theory , proposing anorexia as a slow life history strategy whilst bulimia is a fast strategy. Both studies had their limitations and it was further mentioned that the deep structures of eating disorders may not be reflected by their current classifications. [ 79 ]
An alternative account comes from Nesse . [ 7 ] Recognising that many anorexia patients are neither actively chasing men nor particularly interested in sex, and that eating disorders became more common in the second half of the 20th century, [ 80 ] he argues eating disorders are new problems with no redeeming features. They are caused by increasingly high concerns about appearance linked with the possibility in modern societies to compare someone's appearance to thousands of others instantly. Glorification of unrealistic body types in media, as well as increased availability of sex, may contribute to this. [ 7 ] He does, however, acknowledge that intra-sexual competition is a driving force of anorexia and bulimia in undergraduate women. [ 81 ]
Obesity is not an eating disorder in any classification system, [ 82 ] though it is established that overweight and obesity in particular is connected with various diseases, [ 83 ] and an evolutionary perspective can explain the tendency towards overeating. The human body has evolved to cope with the environments of scarcity, selecting for beneficial adaptations of hunger and eating. Fat storage allows preparation for future food shortages. [ 84 ] In a case of mismatch , modern environments have cheap, readily available food, and very few times of scarcity. Kardum et al. also elaborated the differences in nutrient composition in modern and ancestral societies to illustrate the challenge modern diet imposes on the not-yet adapted human body and genotype. [ 82 ]
Anxiety is a feeling of worry, unpleasantness and dread towards possible future events and exists to protect us from dangers. [ 85 ] [ 86 ] In the US, anxiety disorders are the most common mental illness, with around 29% of adults expected to have any anxiety disorder in their lifetime. [ 87 ] Women are disproportionately affected.
Evolutionary perspectives on anxiety disorders generally consider the adaptive function of the emotion of normal anxiety, and reasons this adaptive system may manifest in the various types of anxiety disorder. [ 88 ]
A key evolutionary explanation for anxiety disorder is the Smoke Detector Principle. [ 86 ] It is often preferable to overactivate anxiety in dangerous situations, in the same way a smoke detector is designed to overactivate. Randolph Nesse writes:
"You are thirsty on the ancient African savanna and a watering hole is just ahead, but you hear a noise in the grass. It could be a lion, or it might just be a monkey. Should you flee? It depends on the costs. Assume that fleeing in panic costs 100 calories. Not fleeing costs nothing if it is only a monkey, but if the noise was made by a lion, the cost is 100'000 calories – about how much energy a lion would get from having you for lunch!" [ 89 ]
Next to normal anxiety there are multiple types of anxiety disorders which are all characterised by excessive fear and anxiety. [ 90 ] These disorders include: specific phobias (e.g., agoraphobia ), generalized anxiety disorder , social anxiety disorder , separation anxiety disorder , panic disorder , and selective mutism . [ 90 ]
Evolutionary psychiatry has so far primarily concentrated on scientific explanations for mental disorders rather than developing novel treatment approaches. [ 7 ] However, there are various consequences of taking an evolutionary perspective on mental disorder for treatment decisions, at an individual and public health level, which make evolutionary psychiatry an important field of future research and application. [ 19 ]
Evolutionary explanations for disorders which reframe them as mismatched or otherwise costly adaptations may be taken to imply that treatment is unnecessary – but this is not the view of evolutionary psychiatrists – and is the same mistake made by those who believe evolutionary biology means endorsing eugenics , a version of the naturalistic fallacy – that what is natural (in this case, evolved) is good. Many medical interventions are 'unnatural' in this sense (e.g. contraception and anaesthetic ). The explanations of evolutionary psychiatry have no inherent value in directing treatment. Randolph Nesse writes:
"On learning that low mood can be useful, some people conclude that it therefore should not be treated. This mistake is like the one that arose when anethesia was first invented: some doctors refused to use it, even during surgery, because, they said, pain is normal. We must not let new understanding of the utility of low mood interfere with our efforts to relieve mental pain." [ 7 ] : 111
Although evolutionary explanations may not affect the necessity for treatment, they can be directive or supportive of treatment, or make current treatment strategies more effective. Proposed benefits of taking an evolutionary perspective on mental disorders have largely come from integrating evolutionary explanations into psychotherapy. [ 91 ] [ 92 ] [ 93 ] Bailey and Gilbert write:
"The evolutionary approach helps to answer three fundamental questions about humanity that go to the heart of professional helping and clinical practice: First, what and who are we as human beings – that is, what is human nature or species 'normality'?; second, how and why do humans develop and/or behave in less than optimal ways – that is, what can evolution tell us about the causes of suffering and psychopathology?; and, third, what can professional helpers and psychotherapists do to ameliorate or even 'cure' the suffering of heart and mind?" [ 93 ] : 333
It has been suggested that patients are encouraged and destigmatised by hearing evolutionary explanations for their conditions, [ 92 ] with positive effects during cognitive behavioural therapy – integration of knowledge of behavioural genetics, neuroscience and evolutionary psychiatry into psychotherapy has been called 'Informed Cognitive Therapy' [ 92 ] by Mike Abrams . Abrams also proposes that recognising the inherited and somewhat immutable nature of certain traits (such as psychopathy and autism ) implies that therapists should not try and alter the traits characteristics, but instead provide advice on how to best utilise these cognitive types within the context of modern society. This aligns with the aims and claims of the neurodiversity movement.
Evolutionary explanations for mental disorders, especially of mismatch , have connotations for public health measures and organisational psychology . Disorders which are consequences of novel environments may be rectified or prevented by implementing social structures which better replicate ancestral environments. For example, postpartum depression may be more likely in modern environments where single parents are given sole responsibility in raising a child, which is highly unusual in the context of an evolutionary history of alloparenting and communal care. Reversing this mismatch, social services supporting new mothers in parenting may prevent postpartum depression ( see Evolutionary approaches to postpartum depression ). Education and employment environments which are particularly likely to cause mental disorders may also be altered to better suit natural human psychological capacities.
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Ewald Hecker (20 October 1843, Halle – 11 January 1909, Wiesbaden ) was a German psychiatrist who was an important figure in the early days of modern psychiatry . [ 1 ] He is known for research done with his mentor, psychiatrist Karl Ludwig Kahlbaum (1828-1899).
In the early 1870s Kahlbaum and Hecker did a series of studies on young psychotic patients at Kahlbaum's clinic in Görlitz , Prussia. Together they provided clinical analyses of the mentally ill, and arranged their disorders into specific, descriptive categories. It was during this period that Hecker developed the concepts of hebephrenia [ 2 ] and cyclothymia . He described hebephrenia as a disorder that begins in adolescence with erratic behaviour followed by a rapid decline of all mental functions, and cyclothymia as a cyclical mood disorder. [ 3 ]
The pioneering research of Kahlbaum and Hecker proposed the existence of more than one discrete psychiatric disorder, [ 4 ] which contrasted with the concept of " unitary psychosis " that maintained all psychiatric symptoms were manifestations of a single mental disorder. [ 5 ]
Hecker had progressive ideas concerning treatment of the mentally ill, and was an advocate in establishing a humane environment for mental patients. In 1891 he purchased a private psychiatric hospital in Wiesbaden .
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Ex vivo reconstruction , short for ex vivo renal artery reconstruction and autotransplantation, is a technique mainly used for complex disease involving multiple segmental branches in patients with fibromuscular dysplasia . In ex vivo reconstruction, temporary nephrectomy and ex vivo repair with microvascular techniques followed by autotransplantation allows the precise repair of such lesions . [ 1 ]
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In medicine , an exacerbation is the worsening of a disease or an increase in its symptoms . [ 1 ] Examples includes an acute exacerbation of chronic obstructive pulmonary disease and acute exacerbation of congestive heart failure . [ citation needed ]
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In medicine , excavation has two meanings:
Examples of naturally hollow spaces that are considered excavations include:
The tool used to create an excavation (e.g., to remove damaged areas before filling dental caries ) is an excavator. [ 1 ] Excavation is also the technique used to remove granulation tissue when necessary. [ 1 ]
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Excimer laser trabeculostomy (ELT) is a procedure to create holes in the trabecular meshwork to reduce intraocular pressure . It uses a XeCl 308 nm excimer laser . [ 1 ] It is considered a minimally invasive glaucoma surgeries , and was first described in 1987 by Michael Berlin. [ 2 ]
Alternative treatments for glaucoma include mechanical drilling, thermal lasers, thermal cauterisation, and tube implants. However, these approaches typically disrupt the eye tissue enough to cause inflammation which often outweighs the benefit of the procedure. [ 1 ] Excimer laser trabeculostomy uses cold lasers which reduces tissue fibrosis otherwise caused by excimer lasers. A 2020 review of 8 studies found the procedure reduced intraocular pressure by 20-40% and generally had favourable outcomes for reducing glaucoma medication needs. [ 3 ]
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Exercise-induced anaphylaxis ( EIA , EIAn, EIAs) is a rare condition in which anaphylaxis , a serious or life-threatening allergic response, is brought on by physical activity. [ 1 ] Approximately 5–15% of all reported cases of anaphylaxis are thought to be exercise-induced. [ 2 ]
The exact proportion of the population with EIA is unknown, but a 2001 study of 76,229 Japanese junior high students showed that the frequency of EIA was 0.031%. [ 3 ]
Exercise-induced anaphylaxis is not a widely known or understood condition, with the first research on the disorder only having been conducted in the past 40 years. A case report in 1979 on EIA was the first research of its kind, where a patient was described to experience anaphylactic shock related to exercise 5–24 hours following the consumption of shellfish. [ 4 ]
The condition is thought to be more prevalent in women, with two studies of EIA patients reporting a ratio of 2:1 for females:males with the disorder. [ 5 ] [ 6 ] There is, however, thought to be no link to ethnicity. [ 7 ]
Survey results from EIA patients have shown that the average number of attacks per year is 14.5. [ 6 ] However, most sufferers of EIA report that both severity and frequency of attacks decrease over time. [ 8 ]
The anaphylaxis campaign splits symptoms of EIA into two categories: mild and severe. Mild symptoms may include "widespread flushing of the skin", hives or urticaria, swelling of the body ( angioedema ), swelling of the lips, and nausea or vomiting. [ 9 ] More severe symptoms might include the swelling of the tongue, difficulty in swallowing or breathing, constriction of the airways, feeling faint, and unconsciousness. [ 9 ]
Symptoms can start immediately following exercise, but 90% of patients report experiencing an attack 30 minutes following activity. [ 6 ]
A paper by Sheffer and Austen (1980) splits an EIA event into four distinct stages: prodromal, early, fully developed, and late. [ 10 ] Characteristic symptoms of the prodromal stage include redness and itching. In the early stage, generalised urticaria develops. If the reaction does not diminish, it may become fully developed EIA, in which gastrointestinal symptoms and constriction of the airway may occur. The late phase, which follows recovery from the reaction, includes frontal headaches and a feeling of fatigue; these symptoms may manifest themselves up to 72 hours following onset of the reaction. [ 10 ]
Cardiovascular symptoms are reported in 1/3 of patients diagnosed with EIA. [ 6 ]
Food-dependent exercise-induced anaphylaxis (FDEIA) is a subcategory of the disorder where exercise only invokes a reaction when followed by the ingestion of a food allergen. Patients whose EIA is food-dependent are thought to make up from one third to a half of all EIA cases. [ 7 ] In a 2001 study of 76,229 Japanese junior high students, 0.017% of students were found to suffer from the condition. [ 3 ]
In European countries, the most common trigger foods for FDEIA are tomatoes, cereals and peanuts. [ 11 ] In Japan, FDEIA is most commonly triggered by omega-5-gliadins, an allergen found in wheat. [ 12 ] [ 13 ] Other common foods thought to be linked to FDEIA include shellfish, seeds, dairy (in particular cow's milk), fruits and vegetables (such as grapes, onions and oranges), meats, and even mushrooms. [ 2 ] FDEIA has also been linked to the allergy to red meat referred to as the Alpha-gal (or α-Gal) syndrome . [ 14 ] [ 15 ]
Ingestion of the trigger food most often precedes exercise by minutes or hours in cases of an attack; there are, however, reported incidents of attacks occurring when ingestion transpires shortly following activity. [ 7 ] While a lot remains unknown about the pathophysiology of food-dependent exercise-induced anaphylaxis (FDEIA), one theory points to changes in pH; this theory is based on the fact that pH becomes more acidic in the muscles and serum following exercise. Decreasing pH is associated with an increase in mast cell degranulation, a key component to the immune response, and one study found that, when patients with FDEIA are given the antacid sodium bicarbonate prior to exercise, they do not experience FDEIA symptoms. [ 16 ]
Exercise-induced anaphylaxis is most commonly brought on by aerobic exercise. It is most often caused by higher levels of exertion, such as jogging, but can be brought on by milder activities, such as a gentle walk. [ 17 ] In a 1999 study, 78% of sufferers reported that attacks were frequently caused by jogging, whereas 42% reported symptoms following brisk walking. [ 6 ]
There are several factors outside of food and exercise that have been suggested to increase the risk of an EIA attack. These include the consumption of alcohol, exposure to pollen, extreme temperatures, the taking of non-steroidal anti-inflammatory drugs ( NSAIDs ), and even certain phases of the menstrual cycle. [ 18 ]
The pathophysiology surrounding EIA and FDEIA is not yet fully understood, but there are several theories.
Research shows that histamine , a chemical involved in the allergic response, plays a key role in EIA. Increased histamine levels in the blood plasma have been recorded during incidents of both EIA [ 19 ] [ 20 ] and FDEIA. [ 3 ] Morphological changes in mast cells in the skin of EIA patients have been observed following exercise, and are comparable to changes occurring in atopic patients following exposure to an allergen. [ 21 ]
Theories for the pathophysiology of EIA include increased gastrointestinal permeability, increased tissue enzyme activity, and blood flow redistribution.
Exercise is known to increase absorption from the gastrointestinal tract. [ 7 ] It is theorised that increased or altered gastrointestinal permeability enhances contact of allergens with the gut-associated immune system. [ 7 ] In some FDEIA patients, the appearance and/or severity of symptoms depends on the amount of the patient's trigger food ingested. [ 22 ] An increase in gut permeability may also increase the risk of absorption of 'partially digested allergenic proteins'. [ 7 ] Supporting research for this theory includes a study by Matsuo et al. (2005), where wheat-dependent EIA sufferers were found to have omega-5-gliadins in their sera following exercise and consumption of wheat, but not in patients that ingested wheat only. [ 23 ]
Another theory is that exercise and aspirin could activate tissue transglutaminase in intestinal mucus. [ 7 ] Omega-5-gliadins, a compound found in wheat that is commonly associated with FDEIA, is cross-linked by transglutaminase, resulting in large formations of peptide aggregates, and leads to an increase in IgE binding. [ 24 ]
During exercise, blood is redistributed from inactive to active tissues in the body. [ 7 ] It has been suggested that food-sensitised immune cells associated with the gut do not evoke anaphylactic symptoms so long as they remain in a local circulation. [ 25 ] The theory suggests that if these sensitised cells are shifted to the skin and/or skeletal muscles following exercise, FDEIA symptoms are likely to occur. [ 25 ] A 2010 study demonstrated that food allergens were well tolerated by mast cells in the intestinal tract, and thus no symptoms occurred at rest. [ 26 ] Mast cells are structurally different in the gut than those found in the skin or skeletal muscles, [ 27 ] and thus could be induced by food allergens.
If exercise is stopped when symptoms are first detected, improvement in condition normally occurs within minutes, and no further treatment is required. [ 17 ] [ 18 ]
Common treatments for the condition include taking regular anti-histamines , the use of an epinephrine injector (commonly known as an EpiPen ), and through abstinence of exercise. In a 1999 study, 56% of sufferers reported the use of anti-histamines as treatment for their EIA, and 31% reported having treated the condition with epinephrine. [ 6 ] Many patients reported treating the condition with changes in behaviour, with 44% of EIA sufferers reporting having reduced the incidence of attacks by avoiding exercise during "extremely hot or cold weather", 37% by avoiding trigger foods, 36% by refraining from exercise during allergy season, and 33% during high humidity. [ 6 ]
[ 7 ] [ 9 ]
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Exercise capacity is defined as "the maximum amount of physical exertion that a patient can sustain". [ 1 ] [ 2 ]
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Exeresis may refer to the surgical removal of any part or organ, roughly synonymous to excision . [ 1 ] However, it may specifically refer to clearing the uterus of its contents after a miscarriage , such as vacuum aspiration . [ citation needed ]
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Expert Review of Anticancer Therapy is a monthly peer-reviewed medical journal covering all clinical aspects of cancer therapy . It was established in 2001 and is published by Taylor & Francis under the academic publishing division of Informa . The current Editor-in-Chief is Gertjan J L Kaspers who is Head of Pediatric Oncology at VU University Medical Center Amsterdam.
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Exploding head syndrome ( EHS ) is an abnormal sensory perception during sleep in which a person experiences auditory hallucinations that are loud and of short duration when falling asleep or waking up . [ 2 ] [ 4 ] The noise may be frightening, typically occurs only occasionally, and is not a serious health concern. [ 2 ] People may also experience a flash of light. [ 5 ] Pain is typically absent. [ 2 ]
The cause is unknown. [ 3 ] Potential organic explanations that have been investigated but ruled out include ear problems, temporal lobe seizure , nerve dysfunction, or specific genetic changes . [ 2 ] Potential risk factors include psychological stress . [ 2 ] It is classified as a sleep disorder or headache disorder . [ 2 ] [ 5 ] People often go undiagnosed. [ 5 ]
There is no high-quality evidence to support treatment. [ 2 ] Reassurance may be sufficient. [ 2 ] Clomipramine and calcium channel blockers have been tried. [ 2 ] While the frequency of the condition is not well studied, some have estimated that it occurs in about 10% of people. [ 2 ] Women are reportedly more commonly affected. [ 5 ] The condition was initially described at least as early as 1876. [ 2 ] The current name came into use in 1988. [ 5 ]
Individuals with exploding head syndrome hear or experience loud imagined noises as they are falling asleep or are waking up, have a strong, often frightened emotional reaction to the sound, and do not report significant pain; around 10% of people also experience visual disturbances like perceiving visual static, lightning, or flashes of light. Some people may also experience heat, strange feelings in their torso, or a feeling of electrical tingling that ascends to the head before the auditory hallucinations occur. [ 2 ] With the heightened arousal, people experience distress, confusion, myoclonic jerks , tachycardia , sweating, and a feeling that they have stopped breathing and need to make a conscious effort to breathe again. [ 4 ] [ 6 ] [ 7 ] [ 8 ]
The pattern of the auditory hallucinations is variable. Some people report having a total of two or four attacks followed by a prolonged or total remission, having attacks over the course of a few weeks or months before the attacks spontaneously disappear, or the attacks may even recur irregularly every few days, weeks, or months for much of a lifetime. [ 2 ]
The cause of EHS is unknown. [ 3 ] A number of hypotheses have been put forth with the most common being dysfunction of the reticular formation in the brainstem responsible for transition between waking and sleeping. [ 2 ]
Other theories into causes of EHS include:
Exploding head syndrome was first described in the 19th century, [ 2 ] and may have first been mentioned in the 17th century. [ 9 ]
Exploding head syndrome is classified under other parasomnias by the 2014 International Classification of Sleep Disorders (ICSD, 3rd.Ed.) and is an unusual type of auditory hallucination in that it occurs in people who are not fully awake. [ 10 ] [ 11 ]
According to ICD-10 and DSM-5 EHS is classified as either other specified sleep-wake disorder (codes:780.59 or G47.8) or unspecified sleep-wake disorder (codes: 780.59 or G47.9). [ 12 ] [ 13 ]
As of 2018 [update] , no clinical trials had been conducted to determine what treatments are safe and effective; a few case reports had been published describing treatment of small numbers of people (two to twelve per report) with clomipramine , flunarizine , nifedipine , topiramate , carbamazepine . [ 2 ] Studies suggest that education and reassurance can reduce the frequency of EHS episodes. [ 4 ] There is some evidence that individuals with EHS rarely report episodes to medical professionals. [ 8 ]
There have not been sufficient studies to make conclusive statements about how common or who is most often affected. [ 2 ] One study found that 14% of a sample of undergrads reported at least one episode over the course of their lives, with higher rates in those who also have sleep paralysis . [ 14 ]
Case reports of EHS have been published since at least 1876, which Silas Weir Mitchell described as "sensory discharges" in a patient. [ 14 ] However, it has been suggested that the earliest written account of EHS was described in the biography of the French philosopher René Descartes in 1691. [ 9 ] The phrase "snapping of the brain" was coined in 1920 by the British physician and psychiatrist Robert Armstrong-Jones . [ 14 ] A detailed description of the syndrome and the name "exploding head syndrome" was given by British neurologist John M. S. Pearce in 1989. [ 15 ] More recently, Peter Goadsby and Brian Sharpless have proposed renaming EHS "episodic cranial sensory shock" [ 1 ] as it describes the symptoms more accurately and better attributes to Mitchell.
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Exploratory surgery is surgery whose purpose is to look inside the body to help diagnose an ailment. Because surgery is an invasive and often risky intervention, it is typically only used when other methods such as external observation and testing body fluids have failed. Modern imaging techniques, starting with the invention of CT scans in 1972, have made it possible to look inside the body without surgery; these less-invasive techniques have significantly replaced exploratory surgery in humans. [ 1 ] Exploratory surgery is still used for non-human animals, where tools for imaging are more expensive than exploratory surgery and often less available.
As late as the early 1970s, when a patient presented to a hospital and reported severe pain for which there was no cause readily detectable from external observation or tests of body fluids, exploratory surgery was often the only way to make a definitive diagnosis while the patient was alive. [ 2 ] This was highly risky. [ 2 ] The patient could irreversibly decompensate from some undetected acute condition before the surgery could be initiated and completed, or the surgery might reveal no significant abnormalities. [ 2 ] In a high percentage of cases, exploratory surgery was unable to provide a definitive answer, meaning the patient had endured great suffering for no net benefit. [ 2 ]
Since the 1970s, exploratory surgery is used to make a diagnosis when typical imaging techniques fail to find an accurate diagnosis. The use of new technologies such as MRIs have made exploratory surgeries less frequent. For example, GE HealthCare reported in 2009 that in the United States, the number of laparatomies performed annually fell from 85,000 in 1993 to 35,000 in 2006, and the number of thoracotomies performed annually fell from 5,500 to 2,000 in 2006. [ 2 ] Many kinds of exploratory surgeries can now be performed using endoscopy which uses a camera and minimal incisions instead of more invasive techniques. [ 3 ]
The most common use of exploratory surgery in humans is in the abdomen , a laparotomy. If a camera is used, it's called a laparoscopy . A laparotomy can be used to diagnose cancer , endometriosis , gallstones , gastrointestinal perforation , appendicitis , diverticulitis , liver abscess , ectopic pregnancy , and other conditions involving abdominal organs. A biopsy can be performed during the procedure. [ 3 ]
Because animals cannot voice their symptoms as easily as humans, exploratory surgery is more common in animals. Exploratory surgery is done when looking for a foreign body that may be lodged in the animal's body, when looking for cancer, or when looking for various other gastrointestinal problems . It is a fairly routine procedure that is done only after tests and bloodwork reveal nothing abnormal.
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External counterpulsation therapy ( ECP ) is a procedure that may be performed on individuals with angina , heart failure , or cardiomyopathy .
The FDA approved the CardiAssist ECP system for the treatment of angina, acute myocardial infarction and cardiogenic shock under a 510(k) submission in 1980 [ 1 ] [ failed verification ] Since then, additional ECP devices have been cleared by the FDA for use in treating stable or unstable angina pectoris, acute myocardial infarction, cardiogenic shock, and congestive heart failure. [ 2 ]
Studies have found EECP to be beneficial for patients with erectile dysfunction and some COPD patients. Additionally, improvements in exercise endurance in the non-diseased patient has been found in research studies. [ 3 ] [ 4 ]
Some reviews did not find sufficient evidence that it was useful for either angina or heart failure. [ 5 ] [ 6 ] Other reviews found tentative benefit in those with angina that does not improve with medications. [ 7 ] [ 8 ]
For stroke due to lack of blood flow, a 2012 Cochrane review found significant neurological improvement, but insufficient evidence to make reliable conclusions. [ 9 ]
External counterpulsation therapy significantly improved the exercise endurance of normal adults, low endurance adults, and COPD patients. [ 3 ]
While an individual is undergoing ECP, they have pneumatic cuffs on their legs and is connected to telemetry monitors that monitor heart rate and rhythm. The most common type in use involves three cuffs placed on each leg (on the calves, the lower thighs, and the upper thighs (or buttocks)). The cuffs are timed to inflate and deflate based on the individual's electrocardiogram . The cuffs should ideally inflate at the beginning of diastole and deflate at the beginning of systole . During the inflation portion of the cycle, the calf cuffs inflate first, then the lower thigh cuffs, and finally the upper thigh cuffs. Inflation is controlled by a pressure monitor, and the cuffs are inflated to about 200 mmHg . [ citation needed ]
Of note, therapies are tailored on an individual basis but beginning regimens tend to include daily one-hour treatments that occur 5 days of the week and last 6–8 weeks with an average overall of 35 hours. [ 10 ]
One theory is that ECP exposes the coronary circulation to increased shear stress , and that this results in the production of a cascade of growth factors that result in new blood vessel formation in the heart (arteriogenesis and angiogenesis ). [ 11 ] [ 12 ]
To best understand the pathophysiology of the therapy it is easiest to understand what each step does. To begin with, as the cuffs on each leg inflate, starting at the calf and working up to the upper thighs, blood is propelled back to the heart thereby increasing the venous return or preload. This increase in preload occurs simultaneously with diastole which happens to be the time during the cardiac cycle in which coronary perfusion occurs. So, by increasing the coronary perfusion, you allow more oxygen to perfuse the heart and ultimately generate more collateral circulation without actually increasing the work of the heart. Additionally, cardiac output is increased via the Frank-Starling mechanism secondary to the increased venous return. As the cardiac cycle progresses to systole, the cuffs on the extremities deflate, allowing for the increased cardiac output to adequately perfuse all tissues including the extremities. [ 13 ]
“Heal Your Heart with EECP” by Debra Braverman, MD.
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In cardiac surgery and vascular surgery , external support (or external stent ) is a type of scaffold made of metal or plastic material that is inserted over the outside of the vein graft in order to decrease the intermediate and late vein graft failure after bypass surgery (e.g. CABG ).
An external support (external stent) should be differentiated from a stent . An external support is placed on the outside of the vessel whereas a stent is inserted into the lumen of a vessel. [ citation needed ]
Veins are adapted to an environment of low pressure and low flow. In order to bypass the coronary obstruction and restore blood flow, veins are transferred and integrated into the arterial circulation , where they exposed to high pressure and flow. These new hemodynamic conditions cause intimal hyperplasia and atherosclerosis that cause intermediate and late vein graft failure . [ 1 ] [ 2 ] The idea of placing an external support on the vein graft was first suggested in 1963. [ 3 ] The rational being that it will diminish the circumferential strain of the graft wall, therefore inhibiting intimal hyperplasia and later superimposed atherosclerosis, aiding with the adaptation of the vein toward the arterial environment.
The external scaffold provides a mechanical support for the vein graft, absorbs the high arterial pressure, constrict the vein graft dilatation, reduces lumen irregularities and mitigates intimal hyperplasia formation. As shown both in human tissue cultures and experimental models . [ 4 ] [ 5 ] [ 6 ] [ 7 ] [ 8 ] However, until recently there were a limited number of clinical studies that showed less positive results. [ 9 ] [ 10 ] [ 11 ] It was hypothesized that graft patency rates were lower with external support, because of aggressive over constriction of the vein graft, unsuitable material of the devices and the use of fibrin glue that has shown to cause tissue damage, fibrosis and intimal hyperplasia. [ 12 ] [ 13 ] [ 14 ] Lately, more promising results with second generation devices showed that external support can mitigate intimal hyperplasia development, improve vein graft lumen uniformity and improve the flow pattern inside the graft. [ 15 ] [ 16 ] [ 17 ] [ 18 ] These benefits shown to remain for up to five years follow up. [ 19 ] In addition to improving the vein graft failure rates in bypass surgeries, other research studies showed that external support might allow the use of conduits that previously have been considered to be unsuitable for surgery. [ 20 ] [ 21 ]
To date the technique is practiced in several cardiac centers in Europe, Israel and South Africa. Further clinical studies are ongoing in Europe and the US on a larger number of patients. [ 22 ] [ 23 ] [ 24 ]
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Extinction is a neurological disorder that impairs the ability to simultaneously perceive multiple stimuli of the same type. Extinction is usually caused by damage resulting in lesions on one side of the brain .
[ 1 ] [ 2 ]
[ 3 ] [ 4 ]
In addition to revealing the critical lesion sites associated with the various clinical manifestations of visual neglect, a key message of the current investigation is that there is a need to develop more sensitive and nuanced assessment tools to characterize the different facets of this heterogeneous syndrome. It will be important to bring laboratory tests into the clinic in an effort to identify specific cognitive functions by examining each in isolation thus combining more specific descriptions extinction with better clinical measures that isolate specific cognitive functions to yield more consistent lesion mapping results in the future. [ 5 ]
[ 6 ] [ 7 ] [ 8 ] [ 9 ] [ 10 ] [ 11 ]
[ 12 ] [ 13 ] [ 14 ]
Visual or spatial extinction, also known as pseudohemianopia , is the inability to perceive two simultaneous stimuli in each visual field. [ 15 ] [ 16 ] In visual extinction this attentional deficit in perception applies mainly to attention in the relevant dimension. Visual extinction is greatest when objects either have the same color or the same shape.
Studies suggest that brain damage to the parietal lobe causes sensory neglect and that in turn causes extinction. [ 17 ] Any kind of brain damage, such as stroke, brain tissue death, or tumors, can lead to neglect and cause unilateral damage to one side of the parietal lobe . Overall, a person with parietal brain damage still has intact visual fields.
One way to reduce the effects of extinction is to use grouping of items. Brightness- and edge- based grouping both reduce visual extinction, and the effect is additive. [ 15 ] Grouping with similar shapes also reduces the effects of extinction. This suggests that the attentional deficit in extinction can be compensated, at least in part, by the brain's object recognition systems.
While the parietal lobe deals with sensation and perception, the amygdala controls the perception of fear and emotion. This is because the ability of the amygdala to perceive fear is autonomous (without conscious effort and attention). However, perception of fear can become habituated, so efforts to reduce extinction by use of the amygdala can be unreliable. [ citation needed ]
Auditory extinction is the failure to hear simultaneous stimuli on the left and right sides. This extinction is also caused by brain damage on one side of the brain where awareness is lost on the contralesional side. Affected people report the presence of side-specific phonemes , albeit extinguishing them at the same time. This indicates that auditory extinction, like other forms of extinction, is more about acknowledging a stimulus in the contralesional side than it is about the actual sensing of the stimulus. [ 18 ]
When it comes to treating and recognizing the occurrence of auditory extinction, most sound can still be perceived with the other ear. By nature, sound possesses directionality but still fills space, and these qualities make it more amenable to misattribution of source location. [ 19 ] This is called the 'prior entry' effect: when a stimulus occurring at an attended location receives privileged access to awareness relative to one occurring at an unattended location. [ 20 ]
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An extracorporeal procedure is a medical procedure which is performed outside the body. Extracorporeal devices are the artificial organs that remain outside the body while treating a patient. Extracorporeal devices are useful in hemodialysis and cardiac surgery . [ 1 ]
A procedure in which blood is taken from a patient's circulation to have a process applied to it before it is returned to the circulation. All of the apparatuses carrying the blood outside the body are collectively termed the extracorporeal circuit .
Extracorporeal shockwave lithotripsy (ESWL), which is unrelated to other extracorporeal therapies, in that the device used to break up the kidney stones is held completely outside the body, whilst the lithotripsy itself occurs inside the body.
Extracorporeal radiotherapy , where a large bone with a tumour is removed and given a dose far exceeding what would otherwise be safe to give to a patient. [ 2 ] [ 3 ]
Extracorporeal pulsatile circulatory control (EPCC) is a process by which brain function (animal model) is kept intact, keeping the organ alive and functioning independent from the rest of the body for several hours. [ 4 ]
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Extracutaneous mastocytoma presents with benign appearing mast cells occurring in sites other than the skin or bone marrow. [ 1 ] : 617
This oncology article is a stub . You can help Wikipedia by expanding it .
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Extraskeletal myxoid chondrosarcoma (EMC) is a rare low-grade malignant mesenchymal neoplasm of the soft tissues, that differs from other sarcomas by unique histology and characteristic chromosomal translocations. There is an uncertain differentiation (there is no evidence yet showing that EMC exhibits the feature of cartilaginous differentiation) and neuroendocrine differentiation is even possible. [ 1 ]
EMC was firstly described in 1953 by Stout et al. when they discussed the different species of extraskeletal chondrosarcoma, [ 2 ] but EMC concept was firstly proposed in 1972 by Enzinger et al. [ 3 ] Brody thought that this was a unique low-grade malignancy with a low growth rate and both clinically and histopathologically distinct anamnesis beside the typical chondrosarcomas. [ 4 ] However, the parental line of EMC cells remains indeterminate. According to the most recent edition of the World Health Organization Classification of Tumors of Soft Tissue and Bone, EMC has been classified as a type of soft tissue tumor with uncertain differentiation. [ 5 ]
Recent statistics demonstrate that EMC shows a higher incidence of local recurrence, metastasis and patient mortality [ 6 ] and therefore are classified as mean-grade malignancies.
EMC is rare and accounts for less than 3% of soft tissue tumors. It mainly affects adults with an average age of about 54 years (age range 29 to 73 years) and is more common in males, the ratio of male to female is 2:1. [ 5 ]
EMCS appears clinically as a slowly developing mass of soft tissue associated with pain and tenderness. [ 7 ] Two-thirds of EMC tumors are primarily found in sub-fascia soft tissues of the proximal extremities and limb girdles, especially the thigh and popliteal fossa. The average tumor size is about 9.3 cm (3.3–18 cm). [ 5 ] Uncommon locations are the distal extremities, the paraspinal part and the head and neck region. [8] Incidence of the head and neck region is less than 5%. [ 1 ]
The cells in EMC tumors do not express specific tumor marker proteins that would help in diagnosing this disease. For example, less than 20% of EMC tumor cases contain cells that express the S100 protein [ 8 ] whereas many other tumor types contain cells that express S100 protein in most or all cases (see Pathology of S100 protein ).
The cytogenetics of this tumor reside in the reciprocal translocations of the 9q22 locus with chromosomes 3q11, 15q21, 17q11, and 22q12. Other cytogenetic events can be observed but are not characteristic. The most common translocation includes the EWSR1 locus at 22q12 and the NR4A3 (also known as TEC and CHN) locus at 9q22. As often can be seen in chimeric transcripts including EWSR1, the transactivation domain of EWSR1 is fused to the DNA-binding domain of NR4A3. Several types of fusion products can be observed, depending on which exons are involved. NR4A3 is an orphan nuclear receptor that is able to activate the FOS promoter and plays a role in the regulation of hematopoietic growth and differentiation. In EMC the DNA-binding domain is constant and the transactivation domains of several genes are involved. These genes include TAF2N (17q11), also termed TAF15 , [ 9 ] encoding an RNA-binding protein which is a component of transcription factor II D , TCF12 (15q21) encoding a transcription factor in the basic helix–loop–helix family, and TFG (3q11) which encodes a regulator of the nuclear factor-κB (NF-κB) signaling pathway with homology to FUS and EWSR1 in its N-terminal region. TFG is also observed as a fusion transcript with ALK (2p23) in anaplastic large-cell lymphoma and with ANTRK1 (1q21) in some of the thyroid papillary carcinomas . Recent evidence demonstrates that tumors with these various translocations have similar profiles of the gene expression. [ 10 ]
Five fusion partners for NR4A3 have been described including: EWSR1 (22q12.2), TAF15 (17q12), FUS (16p11.2), TCF12 (15q21), and TFG (3q12.2). The EWSR1, TAF15 (i.e. TAF2N), and FUS proteins are members of the FET protein family of RNA binding proteins. They are partners in various fusion proteins that are associated with, and suggested to promote, not only EMC but also a wide range of other tumor types. [ 11 ] The fusion proteins found in the neoplastic cells of EMC consist of NR4A3 in >90% of cases partnered with EWRS1 in >75% of cases or, alternatively, TAF15, TCF12, or TFG in uncommon cases. [ 12 ]
EMC shows the smallest morphological variation between the tumors among all myxoid soft tissue neoplasms. The myxoid matrix has a fibrous structure that is different from the grainy appearance of most other myxoid lesions. It is stained with magenta in the air-dried samples. Among all myxoid tumors, EMC has the least vascular structures. Chondroblast-like lacunas may be formed, but no differentiation of hyaline cartilago has been described.
Smears contain plump spindle-shaped or oval tumor cells arranged in a lacelike pattern of loosely cohesive cords and nests. The malignant cells are uniform and lack nuclear pleomorphism. The nuclei have round or oval shape and are hyperchromatic with finely stippled chromatin. The nucleolus is small and inconspicuous. Nuclear clefts and grooves are common and the cytoplasm is homogeneous, scanty to moderately abundant, and often appears wispy and tapered, with well-defined borders of cells.
EMC patients have a long-term clinical course with a survival rate of 5 years in 90% of patients, 10 years at 70% and 15 years at 60%. Local recurrences occur in up to 48% of patients. [ 13 ] Metastasis occurs in approximately 50% of cases with the most frequent occurrence in the lungs, which is common site of metastasis in all sarcomas. There have been rare cases of spontaneous regression of pulmonary metastases without any treatment. [ 14 ]
As with all these subgroups of sarcomas, standard treatment for primary EMC is complete surgical resection, in high risk cases followed by radiation therapy. Unfortunately, the rates of response to conventional chemotherapeutic and radiation regimens are low. [ 1 ]
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Extravasation is the leakage of a fluid out of its contained space into the surrounding area, especially blood or blood cells from vessels . In the case of inflammation , it refers to the movement of white blood cells through the capillary wall , into the surrounding tissues. This is known as leukocyte extravasation , also called diapedesis. In the case of cancer metastasis , it refers to cancer cells exiting the capillaries and entering other tissues, where secondary tumors may form. The term is commonly used in a medical context.
More specifically, extravasation can refer to:
Extravasation of irrigation fluid is the unintended migration of irrigation fluid (e.g., saline ) introduced into a human body . This may occur in several types of endoscopic surgery, such as minimally invasive orthopedic surgery, i.e., arthroscopy , TURP (trans-urethral resection of the prostate), and TCRE (trans-cervical resection of the endometrium). [ 1 ]
In arthroscopy , fluid under pressure is used to inflate and distend a joint and make a working surgical space. An arthroscopy is typically performed on shoulder and knee joints; however, hip arthroscopy is becoming more popular. An arthroscopy is done by making surgical portals or puncture wounds into the joint. A surgical instrument called an arthroscope is used to introduce irrigation fluid under pressure to distend the joint. The arthroscope includes a small (typically 4 mm in diameter) optic scope rod to view the joint. Other portals or puncture wounds are made to introduce surgical instruments to perform cutting or repair procedures. [ 2 ] [ 3 ]
If the joint is surrounded by soft tissue , as in the shoulder and hip, fluid under pressure may leak out of the joint space through the surgical portals and collect in the patient's soft tissue. A typical arthroscopy can result in 1–3 liters of irrigation fluid being absorbed into the patient's interstitial tissue. This buildup of irrigation fluid in the soft tissue may cause edema . This swelling can interfere with the arthroscopic procedure by collapsing the surgical space, or migrating into the patient's neck and causing airway blockage. [ 4 ] In hip arthroscopy , a feared complication is abdominal flooding where the irrigation fluid leaks from the hip joint capsule and drains into the abdominal cavity. [ 5 ] Risk factors for fluid extravasation include procedure length (>90–120 min), obesity, and age (>45–50) with accompanying lack of muscle tone. [ 6 ]
Shoulder arthroscopy is typically limited to about 90–120 minutes before the swelling from fluid extravasation interferes with the procedure, and presents a potential risk to the patient. Typically, fluid extravasation is managed by controlling fluid pressure, or hastening the procedure. [ 7 ]
Extravasation may also refer to the leakage of infused substances from the vasculature tissue into the subcutaneous tissue . The leakage of high- osmolarity solutions or chemotherapy agents can result in significant tissue destruction and significant complications.
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Extravasation is the leakage of intravenously (IV) infused, and potentially damaging, medications into the extravascular tissue around the site of infusion. The leakage can occur through brittle veins in the elderly, through previous venipuncture access, or through direct leakage from wrongly positioned venous access devices. When the leakage is not of harmful consequence it is known as infiltration . Extravasation of medication during intravenous therapy is an adverse event related to therapy that, depending on the medication, amount of exposure, and location, can potentially cause serious injury and permanent harm, such as tissue necrosis . Milder consequences of extravasation include irritation, characterized by symptoms of pain and inflammation , with the clinical signs of warmth, erythema (redness), or tenderness. [ 1 ]
Complications related to extravasation are possible with any medication. Since vesicants are blistering agents, extravasation may lead to irreversible tissue injury.
Extravasation is particularly serious during chemotherapy , since chemotherapy medications are highly toxic.
The best "treatment" of extravasation is prevention . Depending on the medication that has extravasated, there are potential management options and treatments that aim to minimize damage, although the effectiveness of many of these treatments has not been well studied. [ 2 ] In cases of tissue necrosis, surgical debridement and reconstruction may be necessary. The following steps are typically involved in managing extravasation:
List of vesicant and irritant medications: [ 2 ]
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Eye injuries during general anaesthesia are reasonably common if care is not taken to prevent them.
The incidence of eye injuries during general anaesthesia has been studied, and different methods of eye protection have been compared. [ citation needed ]
When eyes are untaped during general anaesthesia , the incidence of ocular injury has been reported to be as high as 44%. [ 1 ] [ 2 ] If tape is used to hold the eyes closed, ocular injury occurs during 0.1-0.5% of general anaesthetics , and is usually corneal in nature. [ 3 ] [ 4 ]
Intraoperative eye injuries account for 2% of medico-legal claims against anaesthetists in Australia and United Kingdom, [ 3 ] [ 1 ] and 3% in the USA. [ 5 ]
General anaesthesia reduces the tonic contraction of the orbicularis oculi muscle, causing lagophthalmos i.e. the eyelids do not close fully in 59% of patients. [ 3 ]
In addition, general anaesthesia reduces tear production and tear-film stability, resulting in corneal epithelial drying and reduced lysosomal protection. The protection afforded by Bell's phenomenon (in which the eyeball turns upwards during sleep, protecting the cornea) is also lost during general anaesthesia . [ 6 ]
Corneal abrasions are the most common injury; they are caused by direct trauma, exposure keratopathy / keratitis [ 1 ] [ 7 ] [ 8 ] or chemical injury. [ 7 ] [ 9 ]
An open eye increases the vulnerability of the cornea to direct trauma from objects such as face masks, laryngoscopes, identification badges, stethoscopes, surgical instruments, anaesthetic circuits, and drapes. [ 6 ]
Exposure keratopathy/keratitis refers to the drying of the cornea with subsequent epithelial breakdown. [ 10 ] When the cornea dries out it may stick to the eyelid and cause an abrasion when the eye reopens. [ 11 ]
Chemical injury can occur if cleaning solutions such as povidone-iodine (Betadine), chlorhexidine or alcohol are inadvertently spilt into the eye, for example when the face, neck or shoulder is being prepped for surgery. [ 4 ] [ 1 ]
Therefore, the anaesthetist ensures that the eyes are fully closed and remain closed throughout the procedure. Seemingly trivial contact can result in corneal abrasions and the risk of this occurring is markedly increased if exposure keratopathy is already present. [ 1 ] Corneal abrasions can be excruciatingly painful in the postoperative period, may hamper postoperative rehabilitation and may require ongoing ophthalmological review and after care. In extreme cases there may be partial or complete visual loss. [ citation needed ]
Iatrogenic injury of the eyelids is also common. Bruising (frequently) and tearing (rarely) of the eyelid can occur when the adhesive dressing used to hold the eye closed is removed. Removal of eyelashes can also occur.
Methods to prevent intraoperative corneal injuries include [ citation needed ]
However, none of the protective strategies are completely effective; vigilance is always required i.e. the eyes need to be inspected regularly throughout surgery to check they are closed. [ 3 ]
The most commonly employed method is to use tape or a general purpose adhesive dressing. Unfortunately the adhesive used on the tape or dressing will generally be inappropriate for this use. The adhesive strength may change when reaching body temperature, or over time. [ 12 ]
As the operation progresses this can cause the adhesive to stop working and become gooey, allowing the eyelids to move apart, and leaving behind a sticky residue. This leaves the cornea exposed to epithelial drying and/or abrasions, sometimes caused by the tape that was originally applied to protect the cornea. Alternatively, the adhesive strength may increase, which upon removal can result in eyelid bruising, tears, or eyelash removal [ citation needed ] .
Rolls of tapes are often “laying around” the operating theatre or kept in health care workers' pockets.
Therefore, they can be a source of hospital-acquired infections (HAI's) such as Methicillin-resistant Staphylococcus aureus (MRSA) & Vancomycin-resistant Enterococcus (VRE), with a 2010 study showing that 50% of partially used tape rolls tested positive for MRSA , VRE or both. [ 13 ]
Most tapes and dressings are non-transparent and so it is not possible to see if the patient’s eyes are opened or closed throughout the case. It is not uncommon for the eyelids to move open as the case progresses, even with adhesive tapes stuck onto them. In a practical sense, these medical tapes/dressings may be difficult to remove from a patient because their ends can become stuck flush with the skin. The possibility of tape removal causing trauma is also significantly increased in older people, people with sensitive skin, dermatitis, dehydration or side effects of medications. [ 14 ]
As noted above, there have been several studies looking at the efficacy and safety of eye ointments/lubricants as adjuncts with tape or as a stand-alone management for intra-operative eye closure. Unfortunately many in common use have problems. Petroleum gel is flammable and is best avoided when electrocautery and open oxygen are to be used around the face. Preservative-free eye ointment is preferred, as preservative can cause corneal epithelial sloughing and conjunctival hyperemia . [ 9 ] They have been implicated in blurred vision in up to 75% of patients and they do not protect from direct trauma. [ 6 ] [ 15 ]
Specially made eyelid occlusion dressings are available commercially, such as EyeGard (manufactured in the USA by KMI Surgical and marketed by Sharn Anesthesia), EyePro (Innovgas Pty Ltd, Australia) and Anesthesia-Aid (Sperian Protection). These dressings overcome most of the problems associated with tape or general purpose dressings.
Some of the adverse outcomes associated with intra-operative injuries include:
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Eye shaving (Chinese 刀锋洗眼; lit: 'blade wash eyes') is a rare traditional practice primarily observed in Chengdu , China . It involves the use of a metal blade to scrape the eyeball and eyelids , aimed at refreshing the eyes and promoting visual clarity.
Eye shaving typically begins with the practitioner holding the eyelids open using their fingers. A metal blade is then gently scraped back and forth across the eyelid and eyeball. Some practitioners may employ a small rod to manipulate the upper eyelid to further clean the area. The entire process lasts about five minutes. [ 1 ]
According to Qu Chao, an ophthalmologist in Chengdu , the technique seems to clear the moisturizing sebaceous glands located along the edge of the eyelid. [ 2 ] Documented for over sixty years, it was believed to help treat trachoma . The tradition is said to have been "phased out". [ 3 ] Most individuals undergoing eye shaving are of an older generation who have used the method to care for their eyes for decades. [ 4 ]
Anecdotal evidence from individuals who have undergone eye shaving suggests that some patients believe the treatment enhances vision clarity. [ 1 ]
Eye shaving is strongly advised against by ophtalmologists, who note that while unblocking Meibomian glands can alleviate symptoms of conditions such as dry eye syndrome and blepharitis , safer alternatives exist. [ 5 ] Potential dangers of eye shaving include lacerations from the metal blade, increased risk of infections due to a non-sterile environment, and the possibility of long-term damage from improper techniques. [ 1 ]
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Eye surgery , also known as ophthalmic surgery or ocular surgery , is surgery performed on the eye or its adnexa . [ 1 ] Eye surgery is part of ophthalmology and is performed by an ophthalmologist or eye surgeon. The eye is a fragile organ, and requires due care before, during, and after a surgical procedure to minimize or prevent further damage. An eye surgeon is responsible for selecting the appropriate surgical procedure for the patient, and for taking the necessary safety precautions. Mentions of eye surgery can be found in several ancient texts dating back as early as 1800 BC, with cataract treatment starting in the fifth century BC. [ 2 ] It continues to be a widely practiced class of surgery, with various techniques having been developed for treating eye problems.
Since the eye is heavily supplied by nerves, anesthesia is essential. Local anesthesia is most commonly used. Topical anesthesia using lidocaine topical gel is often used for quick procedures. Since topical anesthesia requires cooperation from the patient, general anesthesia is often used for children, traumatic eye injuries, or major orbitotomies, and for apprehensive patients. The physician administering anesthesia , or a nurse anesthetist or anesthetist assistant with expertise in anesthesia of the eye, monitors the patient's cardiovascular status. Sterile precautions are taken to prepare the area for surgery and lower the risk of infection. These precautions include the use of antiseptics , such as povidone-iodine , and sterile drapes, gowns, and gloves.
Although the terms laser eye surgery and refractive surgery are commonly used as if they were interchangeable, this is not the case. Lasers may be used to treat nonrefractive conditions (e.g. to seal a retinal tear). [ 3 ] Laser eye surgery or laser corneal surgery is a medical procedure that uses a laser to reshape the surface of the eye to correct myopia (short-sightedness), hypermetropia (long-sightedness), and astigmatism (uneven curvature of the eye's surface). Importantly, refractive surgery is not compatible with everyone, and people may find on occasion that eyewear is still needed after surgery. [ 4 ]
Recent developments also include procedures that can change eye color from brown to blue. [ 5 ] [ 6 ] Before proceeding with laser surgery, the eye specialist needs to certify that the patient is a suitable candidate for the surgery and there are several factors to be considered before doing laser surgery. [ 7 ]
A cataract is an opacification or cloudiness of the eye's crystalline lens due to aging, disease, or trauma that typically prevents light from forming a clear image on the retina . If visual loss is significant, surgical removal of the lens may be warranted, with lost optical power usually replaced with a plastic intraocular lens . Owing to the high prevalence of cataracts, cataract extraction is the most common eye surgery. Rest after surgery is recommended. [ 8 ]
Glaucoma is a group of diseases affecting the optic nerve that results in vision loss and is frequently characterized by raised intraocular pressure . Many types of glaucoma surgery exist, and variations or combinations of those types can facilitate the escape of excess aqueous humor from the eye to lower intraocular pressure, and a few that lower it by decreasing the production of aqueous humor.
Canaloplasty is an advanced, nonpenetrating procedure designed to enhance drainage through the eye's natural drainage system to provide sustained reduction of intraocular pressure. Canaloplasty uses microcatheter technology in a simple and minimally invasive procedure.
To perform a canaloplasty, an ophthalmologist creates a tiny incision to gain access to a canal in the eye. A microcatheter circumnavigates the canal around the iris, enlarging the main drainage channel and its smaller collector channels through the injection of a sterile, gel-like material called viscoelastic. [ clarification needed ] The catheter is then removed and a suture is placed within the canal and tightened. [ clarification needed ] By opening up the canal, the pressure inside the eye can be reduced. [ clarification needed ] [ 9 ] [ 10 ] [ 11 ] [ 12 ]
Refractive surgery aims to correct errors of refraction in the eye, reducing or eliminating the need for corrective lenses.
Corneal surgery includes most refractive surgery, as well as:
Vitreoretinal surgery includes:
With about 1.2 million procedures each year, extraocular muscle surgery is the third-most common eye surgery in the United States. [1] Archived 2016-08-18 at the Wayback Machine
Oculoplastic surgery, or oculoplastics, is the subspecialty of ophthalmology that deals with the reconstruction of the eye and associated structures. Oculoplastic surgeons perform procedures such as the repair of droopy eyelids ( blepharoplasty ), [ 30 ] repair of tear duct obstructions, orbital fracture repairs, removal of tumors in and around the eyes, and facial rejuvenation procedures including laser skin resurfacing, eye lifts, brow lifts, and even facelifts. Common procedures are:
Many of these described procedures are historical and are not recommended due to a risk of complications. Particularly, these include operations done on ciliary body in an attempt to control glaucoma, since highly safer surgeries for glaucoma, including lasers, nonpenetrating surgery, guarded filtration surgery, and seton valve implants have been invented.
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Eye transplantation is the transplantation of the globe of the human eye from a donor to a recipient.
Research efforts in whole eye transplantation (WET) are focused on its application in living human recipients, still some obstacles need to be addressed. Apart from the surgical and neurological considerations, there are key ethical concerns such as patients' perceptions and desires for both nonvision-restoring WET and vision-restoring WET, risks and benefits compared to prosthetic alternatives, psychosocial considerations for potential recipients regarding personal identity related to the donor's eyes, public perceptions of whole-eye donation, implications for corneal transplantation eligibility of the donor's eyes, consent for whole-eye donation, and establishment of ethical mechanisms for allocation and distribution of WET. With limited studies available on this topic since the first vascularized composite allotransplantation (VCA) [ 1 ] [ 2 ] [ 3 ] took place in 1998, the understanding of WET is informed by a few studies with limitations. For example, amphibian regeneration cannot directly apply to humans. Ocular transplants may offer a viable option for restoring form in patients undergoing facial transplantation with enucleated orbits. [ 4 ]
In 1885, the Revue générale d'ophtalmologie reported that the staphylomatous and buphthalmic eye of a 17-year-old girl had been replaced by the eye of a rabbit by a Dr. Chibret. [ 5 ] [ 6 ] The operation failed after 15 days due to a lack of effective immunosuppression . [ 6 ]
In 1969, Conrad Moore of the Texas Medical Center claimed that he had carried out the transplantation of a whole eye, but he subsequently retracted his claim. [ 7 ]
In November 2023, surgeons at NYU Langone Health announced the first successful eye transplantation, [ 8 ] which was carried out as part of a partial face transplant in an operation that took 21 hours. [ 8 ] The recipient, Aaron James, had lost the left side of his face with his eye, nose and mouth in a high-voltage power line accident. [ 8 ] Reuters reported that the transplanted eye has "well-functioning blood vessels and a promising-looking retina". [ 8 ] The eye is not using the optic nerve to communicate with the brain, and James has not regained sight through the eye. [ 8 ] Adult stem cells have been harvested from his bone marrow and been injected into the optic nerve. [ 8 ] The lead surgeon, Eduardo D. Rodriguez, said that "If some form of vision restoration occurred, it would be wonderful, but ... the goal was for us to perform the technical operation". [ 8 ]
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Hand–eye coordination (also known as eye–hand coordination ) is the coordinated motor control of eye movement with hand movement and the processing of visual input to guide reaching and grasping along with the use of proprioception of the hands to guide the eyes, a modality of multisensory integration . Eye–hand coordination has been studied in activities as diverse as the movement of solid objects such as wooden blocks, archery, sporting performance, music reading , computer gaming, copy-typing, and even tea-making. It is part of the mechanisms of performing everyday tasks; in its absence, most people would not be able to carry out even the simplest of actions such as picking up a book from a table.
Neuroscientists have extensively researched human gaze behaviour, noting that the use of the gaze is very task-specific, [ 1 ] but that humans typically exhibit proactive control to guide their movement. Usually the eyes fixate on a target before the hands are used to engage in a movement, indicating that the eyes provide spatial information for the hands. [ 2 ] The duration that the eyes appear to lock onto a goal for a hand movement varies—sometimes the eyes remain fixated until a task is completed. Other times, the eyes seem to scout ahead toward other objects of interest before the hand even grasps and manipulates the object.
When eyes and hands are used for core exercises, the eyes generally direct the movement of the hands to targets. [ 3 ] Furthermore, the eyes provide initial information of the object, including its size, shape, and possibly grasping sites for judging the force the fingertips need to exert to engage in a task.
For sequential tasks, eye-gaze movement occurs during important kinematic events like changing the direction of a movement or when passing perceived landmarks. [ 4 ] This is related to the task-search-oriented nature of the eyes and their relation to the movement planning of the hands and the errors between motor signal output and consequences perceived by the eyes and other senses that can be used for corrective movement. The eyes have a tendency to "refixate" on a target to refresh the memory of its shape, or to update for changes in its shape or geometry in drawing tasks that involve the relating of visual input and hand movement to produce a copy of what was perceived. [ 5 ] In high accuracy tasks, when acting on greater amounts of visual stimuli, the time it takes to plan and execute movement increases linearly, for example when using a computer mouse , per Fitts's law . [ 6 ]
Humans have the ability to aim eye movement toward the hand without vision, using the sense of proprioception , with only minor errors related to internal knowledge of limb position. [ 7 ] It has been shown the proprioception of limbs, in both active and passive movement, results in saccadic overshoots when the hands are used to guide eye movement. In experiments these overshoots result from the control of eye saccades rather than previous movement of the hands. [ citation needed ] This implies that limb-based proprioception is capable of being transformed into ocular motor coordinates to guide eye saccades, which allows for the guidance of the saccades by hands and feet. [ citation needed ]
Numerous disorders, diseases, and impairments have been found to result in disruption to eye–hand coordination, owing to damage to the brain itself, degeneration of the brain due to disease or aging, or an apparent inability to coordinate senses completely.
Impairments to eye–hand coordination have been shown in older adults, especially during high-velocity and precise movements. This has been attributed to the general degeneration of the cortex, resulting in a loss of the ability to compute visual inputs and relate them to hand movements. [ 8 ] However, while older adults tend to take more time for these sorts of tasks, they are still able to remain just as accurate as younger adults, but only if the additional time is taken. [ citation needed ]
Bálint's syndrome is characterized by a complete lack of eye–hand coordination and has been demonstrated to occur in isolation to optic ataxia. [ 9 ] It is a rare psychological condition resulting most often from damage bilaterally to the superior parieto-occipital cortex. [ 10 ] One of the most common causes is from strokes, but tumours, trauma, and Alzheimer's disease can also cause damage. Balint's syndrome patients can suffer from three major components: optic apraxia, optic ataxia, and simultanagnosia. [ 11 ] Simultanagnosia is when patients have difficulty perceiving more than one object at a time. [ 10 ] There have been three different approaches for rehabilitation. The first approach is the adaptive or functional approach; it involves functional tasks that use a patient's strengths and abilities. The second approach is remedial approach and involves restoration of the damaged central nervous system by training perceptual skills. The last approach is multi-context approach and involves practising a targeted strategy in a multiple environment with varied tasks and movement demands, along with self-awareness tasks. [ 12 ]
Optic apraxia is a condition that results from a total inability of a person to coordinate eye and hand movements. Although similar to optic ataxia, its effects are more severe and do not necessarily come from damage to the brain, but may arise from genetic defects or tissue degeneration. [ citation needed ]
Optic ataxia or visuomotor ataxia is a clinical problem associated with damage to the occipital–parietal cortex in humans, resulting in a lack of coordination between the eyes and hand. It can affect either one or both hands and can be present in part of the visual field or the entire visual field. [ 13 ] Optic ataxia has been often considered to be a high-level impairment of hand–eye coordination resulting from a cascade of failures in the sensory to motor transformations in the posterior parietal cortex. Visual perception, naming, and reading are still possible, but visual information cannot direct hand motor movements. [ 13 ] Optic ataxia has been often confused with Balint's syndrome, but recent research has shown that optic ataxia can occur independently of Balint's syndrome. [ 9 ] Optic ataxia patients usually have troubles reaching toward visual objects on the side of the world opposite to the side of brain damage. Often these problems are relative to current gaze direction, and appear to be remapped along with changes in gaze direction. Some patients with damage to the parietal cortex show "magnetic reaching": a problem in which reaches seem drawn toward the direction of gaze, even when it is deviated from the desired object of grasp. [ citation needed ]
Adults with Parkinson's disease have been observed to show the same impairments as found in normal aging, only to a more extreme degree, in addition to a loss of control of motor functions per normal symptoms of the disease. [ 8 ] It is a movement disorder and occurs when there is degeneration of dopaminergic neurons that connect the substantia nigra with the caudate nucleus. A patient's primary symptoms include muscular rigidity, slowness of movement, a resting tremor, and postural instability. [ 14 ] The ability to plan and learn from experience has been shown to allow adults with Parkinson's to improvement times, but only under conditions where they are using medications to combat the effects of Parkinson's. Some patients are given L-DOPA, a precursor to dopamine. It is able to cross the blood–brain barrier and then is taken up by dopaminergic neurons and then converted to dopamine. [ 14 ]
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The FACE risk profile is a commercial mental health assessment tool that is part of a collection of tools produced by Imosphere.
FACE stands for " Functional Analysis of Care Environments ".
Imosphere produces several toolkits to assess risk and needs in health and social care , mental health , people with learning disabilities , young people, and people with substance misuse problems; to assess peoples' mental capacity , and as an assessment of needs for telecare .
The FACE risk profile is part of the toolkits for calculating risks for people with mental health problems, learning disabilities, substance misuse problems, young and older people, and in perinatal services .
This psychiatry -related article is a stub . You can help Wikipedia by expanding it .
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The FDI World Dental Federation ( French : Fédération dentaire internationale ) is an international organization representing the dental profession to oral health by developing health policies, education programs, and advocating for dentistry internationally. [ 1 ]
FDI was established in Paris in 1900.
In 2005 Michele Aerden became its first female president. [ 2 ]
FDI is now headquartered in Geneva, Switzerland , operating as a non-governmental organization. It is overseen by a General Assembly, which sets policy, and its activities are carried out by five standing committees composed of 60 volunteers from its national member associations.
Each year, around 300 delegates participate in FDI's World Dental Parliament. [ 3 ] [ 4 ]
The FDI Annual World Dental Congress (FDI AWDC) is a global event organized by the FDI World Dental Federation. [ 5 ] It is a platform for dental professionals, researchers, and industry leaders to gather and discuss developments in oral health care and related fields. [ 4 ]
The General Assembly, also known as the FDI World Dental Parliament, is a part of the Congress where member associations and specialist groups of FDI convene to discuss matters related to the dental profession. [ 3 ] The World Oral Health Forum, held during the Congress, allows policymakers, public health experts, and stakeholders to address issues in oral health. [ 6 ]
The FDI World Dental Federation organizes the annual World Oral Health Day since 2013, observed annually internationally on 20 March. [ 7 ] The day is meant to raise global awareness of the issues surrounding oral health and the importance of oral hygiene.
FDI is a member of the World Health Profession Alliance (WHPA), which also includes the International Council of Nurses (ICN), the World Medical Association (WMA), the International Pharmaceutical Federation (FIP), and the World Confederation for Physical Therapy (WCPT).
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FDI World Dental Federation notation (also "FDI notation" or "ISO 3950 notation") is the world's most commonly used dental notation (tooth numbering system). [ 1 ] [ 2 ] It is designated by the International Organization for Standardization as standard ISO 3950 "Dentistry — Designation system for teeth and areas of the oral cavity". [ 3 ]
The system is developed by the FDI World Dental Federation . It is also used by the World Health Organization , and is used in most countries of the world except the United States (which uses the UNS ).
The system uses two numbers to define each tooth. One to specify the quadrant, and one to specify the tooth within that quadrant.
Orientation of the chart is traditionally "dentist's view", i.e. patient's right corresponds to notation chart left. The designations "left" and "right" on the chart below correspond to the patient's left and right.
Codes, names, and usual number of roots: (see chart of teeth at Universal Numbering System )
The syntax is the quadrant code followed by the tooth code. Sometimes a dot is inserted between the quadrant code and tooth code in order to avoid ambiguity with other numbering systems, especially the UNS .
Examples:
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Fellowship in Dental Surgery of the Royal College of Surgeons of England (FDSRCS) [ 1 ] is a Dental postgraduate professional qualification . It is bestowed by the Faculty of Dental Surgery of the Royal College of Surgeons of England .
The Royal College of Surgeons in Ireland , The Royal College of Surgeons of Edinburgh and The Royal College of Physicians and Surgeons of Glasgow each has its equivalent Fellowship degree.
The Faculty can also grant other qualifications as the Membership of the Faculty of Dental Surgery of the Royal College of Surgeons of England ( MFDSRCS ), Diploma in Dental Public Health, Diploma in Special Care Dentistry , Membership in Restorative Dentistry and the Membership in Surgical Dentistry.
The FDSRCS was mostly granted after passing examinations. Currently, it can still be granted by the faculty after consideration of applicants' career and achievements; this is done through an election process by the faculty's council. [ 2 ]
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The FOUR Score is a clinical grading scale designed for use by medical professionals in the assessment of patients with impaired level of consciousness . It was developed by Dr. Eelco F.M. Wijdicks and colleagues in Neurocritical care at the Mayo Clinic in Rochester, Minnesota . "FOUR" in this context is an acronym for "Full Outline of UnResponsiveness".
The FOUR Score is a 17-point scale (with potential scores ranging from 0 - 16). Decreasing FOUR Score is associated with worsening level of consciousness . The FOUR Score assesses four domains of neurological function: eye responses, motor responses, brainstem reflexes, and breathing pattern.
The rationale for the development of the FOUR Score constituted creation of a clinical grading scale for the assessment of patients with impaired level of consciousness that can be used in patients with or without endotracheal intubation . The main clinical grading scale in use for patients with impaired level of consciousness has historically been the Glasgow Coma Scale (GCS), which cannot be administered to patients with an endotracheal tube (one component of the GCS is the assessment of verbal responses, which are not possible in the presence of an endotracheal tube). [ 1 ]
The FOUR score has been validated with reference to the Glasgow Coma Scale in several clinical contexts, including assessment by physicians in the Neurocritical Care Unit, [ 2 ] assessment by intensive care nurses, [ 3 ] assessment of patients in the medical intensive care unit (ICU), [ 4 ] and assessment of patients in the Emergency Department . [ 5 ] Comparison of the inter-observer reliability of the FOUR Score and the GCS suggests that the FOUR Score may have a modest but significant advantage in this particular measure of test function. [ 6 ]
Overall, FOUR score has better biostatistical properties than Glasgow Coma Scale in terms of sensitivity, specificity, accuracy and positive predictive value. [ 7 ]
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FRAX (fracture risk assessment tool) is a diagnostic tool used to evaluate the 10-year probability of bone fracture risk. It was developed by the University of Sheffield . [ 1 ] FRAX integrates clinical risk factors and bone mineral density at the femoral neck to calculate the 10-year probability of hip fracture and the 10-year probability of a major osteoporotic fracture (clinical spine, forearm, hip or shoulder fracture). [ 2 ] The models used to develop the FRAX diagnostic tool were derived from studying patient populations in North America, Europe, Latin America, Asia and Australia. [ 3 ]
The parameters included in a FRAX assessment are: [ 1 ]
FRAX is freely accessible online, and commercially available as a desktop application, in paper-form as a FRAX pad, as an iPhone application, and as an Android application. The tool is compatible with 58 models for 53 countries, and is available in 28 languages. [ 1 ]
FRAX is incorporated into many national guidelines around the world, including those of Belgium, Canada, Japan, Netherlands, Poland, Sweden, Switzerland, UK (NOGG), and US (NOF). FRAX assessments are intended to provide guidance for determining access to treatment in healthcare systems. [ 4 ]
Glucocorticoid use is included FRAX as a dichotomous variable, whereas the increased risk for fractures seen with glucocorticoid use is dependent on glucocorticoid dose and duration of use. Several methods have been proposed how to adjust FRAX accordingly. [ 5 ]
Though known to be a risk factor for fractures, type 2 diabetes is not included as such in FRAX. Some clinicians choose rheumatoid arthritis as an equivalent risk factor instead. [ 5 ]
FRAX was developed and most commonly used to assess fracture risk for previously untreated individuals, though some have suggested it can also be used in those treated in the past or even on current treatment for osteoporosis. [ 6 ]
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Fabrice André is a French medical oncologist specializing in breast cancer . He is the Director of Research at Gustave Roussy in Villejuif , France , and a Professor of Medicine at the University of Paris-Saclay . André also serves as the President of the European Society for Medical Oncology (ESMO) for the 2025-2026 term. [ 1 ] [ 2 ] [ 3 ]
Fabrice André was born on May 10, 1972. [ 4 ] He completed his secondary education in Villard-de-Lans before pursuing higher studies in Grenoble . He earned a medical degree in oncology from the University of Grenoble in 2002 and obtained a PhD in Biotechnology from the University of Paris in 2005, with a dissertation on cancer immunotherapy . André completed his medical oncology residency at Gustave Roussy, where he became a University Professor-Hospital Practitioner in the Department of Medical Oncology in 2012. [ 1 ] [ 3 ]
From 2010 to 2016, Fabrice André led the Inserm 981/Gustave Roussy/Université Paris-XI joint research unit, focusing on predictive biomarkers and molecular strategies in anticancer therapy. [ 3 ] He was the first chair of the ESMO Young Oncologist Committee and served as the coordinator of the ESMO Breast Cancer Faculty from 2012 to 2014, remaining a member since 2015. He was also a member of the ESMO Cancer Research Faculty from 2012 to 2014 and chaired the ESMO Translational Research and Precision Medicine Working Group until 2019, continuing as a member from 2020. Additionally, André is a member of the ESMO Council and served as the Scientific Co-Chair of the ESMO 2022 Congress and the MAP Congress. [ 1 ]
Since 2020, he has been Gustave Roussy's Director of Research. He was a member of the Annals of Oncology editorial Board from 2010 to 2013, became an Associate Editor in 2014, and served as Editor-in-Chief from 2017 to 2023. [ 1 ] [ 3 ]
André was elected President of the European Society for Medical Oncology (ESMO) for the 2025–2026 term, having been selected as President-Elect on June 27, 2022. [ 5 ] [ 6 ]
Additionally, André is the chairman of the biomarker group at UNICANCER, the French cooperative group, and has served on the scientific committees of several international conferences, including SABCS , AACR , ECCO , ESMO , and IMPAKT. [ 3 ]
Professor André’s research focuses on biomarkers and personalized therapies, with an emphasis on biomarker discovery, targeted agent development, and the integration of personalized medicine . He leads Phase I-III clinical trials on targeted therapies for breast cancer and oversees large-scale national studies on the implementation of high-throughput technologies in healthcare systems. [ 1 ] [ 2 ] [ 3 ] [ 4 ]
He has authored or co-authored 350 scientific publications in international journals and is recognized as a Highly Cited Researcher by the Web of Science Group. The think tank BIS Research also ranks him among the 25 most influential figures in precision medicine. [ 2 ] [ 7 ]
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A face-bow is a dental instrument used in the field of prosthodontics . Its purpose is to transfer functional and aesthetic components from patient's mouth to the dental articulator . Specifically, it transfers the relationship of maxillary arch and temporomandibular joint to the casts. It records the upper model's (maxilla) relationship to the External Acoustic Meatus, in the hinge axis. It aids in mounting maxillary cast on the articulator.
U-shaped frame - forms the main part of the frame with remaining components attached to it by clamps. Frame extends from the region of TMJ or external acoustic meatus to a distance of 2-3 inches in front of the face. [ 1 ]
Condylar rods – are positioned 13 mm anterior to the auditory meatus on the Canto-Tragal line. This placement generally locates the rods within 5 mm of the true centre of the opening hinge axis of the jaw. [ 1 ]
Bite fork – consist of stem and prongs. Wax material is usually attached to the bite fork, and the bite fork is held in contact with maxillary jaw or mandibular jaw in kinematic face-bow. [ 1 ]
Locking device – helps to attach the bite fork to the U-shaped frame. [ 1 ]
Orbital pointer with clamp – used as a third reference point. The pointer tip is placed in the contact with infraorbital notch which is 43 mm above the incisal edge of the right incisors. [ 1 ]
George B. Snow is credited as the inventor of face-bow. [ 2 ] In his version of face-bow, he positioned the plaster cast in the articulator in respect to distance of median incisal point from the condyles and all the other points on the occlusal plane. Snow attempted to give the occlusal plane an individual position also in this third dimension : and in order to achieve this he set about as follows. He fixed his bite-fork in the upper occlusion rim in such away that the handle, when the rim was placed in the patient's mouth. was parallel with a plane extending from the bottom of the glenoid fossa and passing through the anterior nasal spine. This plane cannot be determined directly on a living person; but it approximately corresponds with a line drawn from the upper part of the tragus to the lower edge of the nostril. In American literature, this plane is known as the Bromell plane , in Europe as the Camper plane . Snow then placed the bite-fork horizontally when the casts were mounted in the articulator. [ citation needed ]
This dentistry article is a stub . You can help Wikipedia by expanding it .
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FaceBase is an NIH -supported initiative that began in September 2009. Funded by the National Institute of Dental and Craniofacial Research , the FaceBase Consortium is a five-year initiative that systematically compiles the biological instructions to construct the middle region of the human face and precisely define the genetics underlying its common developmental disorders such as cleft lip and palate . [ 1 ] A range of genetic and environmental factors are thought to contribute to facial clefting [ 2 ] and FaceBase is designed to enhance investigations into these causes and their outcomes.
The FaceBase Biorepository is a collection or bank of DNA samples and information from families around the world to be used in research studies. Individuals with birth defects that involve the head, face, and eye can participate along with their family members. DNA is collected through blood or saliva and combined with information about the subject's family history and pregnancy history. The goal of the biorepository is to collect samples and data from 5,000 people to drive research studies on the genetic and environmental factors that contribute to craniofacial birth defects. [ 3 ]
So far, a number of genes have been found to play a role in craniofacial development and the FaceBase project is continuing to research these genes to better understand craniofacial birth defects such as cleft lip and palate. These genes include AXIN2 , BMP4 , FGFR1 , FGFR2 , FOXE1 , IRF6 , MAFB (gene) , MMP3 , MSX1 , MSX2 ( Msh homeobox 2 ), MSX3, PAX7 , PDGFC , PTCH1 , SATB2 , SOX9 , SUMO1 ( Small ubiquitin-related modifier 1 ), TBX22 , TCOF ( Treacle protein ), TFAP2A , VAX1 , TP63 , ARHGAP29 , NOG, NTN1 , WNT genes, and locus 8q24. [ 4 ]
A key part of the initiative is the Hub, which intends to provide easily accessible craniofacial research data. [ 5 ] The FaceBase Hub aims to allow scientists to more rapidly and effectively generate hypotheses and accelerate the pace of their research. [ 6 ]
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A face transplant is a medical procedure to replace all or part of a person's face using tissue from a donor. Part
of a field called "Vascularized Composite Tissue Allotransplantation" (VCA) it involves the transplantation of facial skin , the nasal structure, the nose , the lips , the muscles of facial movement used for expression, the nerves that provide sensation, and, potentially, the bones that support the face. The recipient of a face transplant will take life-long medications to suppress the immune system and fight off rejection . [ 1 ]
The world's first partial face transplant on a living human was carried out on Isabelle Dinoire, in Amiens (France), in 2005. [ 2 ] The world's first full face transplant was completed in Spain in 2010. [ 3 ] Turkey, [ 4 ] France, the United States, and Spain (in order of total number of successful face transplants performed) are considered the leading countries in the research into the procedure. [ 2 ] As of 2025, there have been around 50 face transplants.
The ethics and benefits of face transplants are still being debated, and in 2019 a major UKRI grant was awarded to the historian Fay Bound Alberti to work with surgeons and patients and determine whether they are successful. Funded by the UKRI the Interface project brought together surgeons from all around the world to determine what needed to be done to improve the procedure, and that work supported a more recent NASEM study to improve patient care and expectations. Their report is now available online.
People with faces disfigured by trauma , burns , disease, or birth defects might aesthetically benefit from the procedure. [ 5 ] Professor Peter Butler at the Royal Free Hospital first suggested this approach in treating people with facial disfigurement in a Lancet article in 2002, though it had been discussed for a decade in the USA. This suggestion caused considerable debate at the time concerning the ethics of this procedure. [ 5 ]
An alternative to a face transplant is facial reconstruction, which typically involves moving the patient's own skin from their back, buttocks, thighs, or chest to their face in a series of as many as 50 operations to regain even limited functionality, and a face that is often likened to a mask or a living quilt .
The world's first full-face replant operation was on 9-year-old Sandeep Kaur, whose face was ripped off when her hair was caught in a thresher . Sandeep's mother witnessed the accident. Sandeep arrived at the hospital unconscious with her face in two pieces in a plastic bag. An article in The Guardian recounts: "In 1994, a nine-year-old child in northern India lost her face and scalp in a threshing machine accident. Her parents raced to the hospital with her face in a plastic bag and a surgeon managed to reconnect the arteries and replant the skin." [ 11 ] The operation was successful, although the child was left with some muscle damage as well as scarring around the perimeter where the facial skin was sutured back on. Sandeep's doctor was Abraham Thomas , one of India's top microsurgeons . In 2004, Sandeep was training to be a nurse. [ 12 ]
In 1996, a similar operation was performed in the Australian state of Victoria , when a woman's face and scalp, torn off in a similar accident, was packed in ice and successfully reattached. [ 13 ]
The world's first partial face transplant on a living human was carried out on 27 November 2005 [ 14 ] [ 15 ] by Bernard Devauchelle , an oral and maxillofacial surgeon , Benoit Lengelé, a Belgian plastic surgeon, and Jean-Michel Dubernard in Amiens , France. [ 16 ] Isabelle Dinoire [ 14 ] underwent surgery to replace her original face, which had been mauled by her dog. A triangle of face tissue from a brain-dead woman's nose and mouth was grafted onto the patient. On 13 December 2007, the first detailed report of the progress of this transplant after 18 months was released in the New England Journal of Medicine and documents that the patient was happy with the results but also that the journey has been very difficult, especially with respect to her immune system's response. [ 17 ] [ 18 ] Dinoire died on 22 April 2016
at the age of 49 following cancer from medications. [ 19 ]
A 29-year-old French man underwent surgery in 2007. He had a facial tumor called a neurofibroma caused by a genetic disorder. The tumor was so massive that the man could not eat or speak properly. [ citation needed ]
In March 2008, the treatment of 30-year-old Pascal Coler of France, who has neurofibromatosis, ended after he received what his doctors call the world's first successful almost full face transplant. [ 20 ] [ 21 ] The operation, which lasted approximately 20 hours, was designed and performed by Laurent Lantieri and his team (Jean-Paul Meningaud, Antonios Paraskevas and Fabio Ingallina).
In April 2006, Guo Shuzhong at the Xijing military hospital in Xi'an , transplanted the cheek, upper lip, and nose of Li Guoxing, who was mauled by an Asiatic black bear while protecting his sheep. [ 22 ] [ 23 ] On 21 December 2008, it was reported that Li had died in July in his home village in Yunnan . Prior to his death, a documentary on the Discovery Channel showed he had stopped taking immuno-suppressant drugs in favour of herbal medication; a decision that was likely a contributing factor to his death, according to his surgeon. [ 24 ]
Selahattin Özmen performed a partial face transplant on 17 March 2012 on Hatice Nergis, a twenty-year-old woman at Gazi University 's hospital in Ankara . It was Turkey's third, the first woman-to-woman and the first three-dimensional with bone tissue. The patient from Kahramanmaraş had lost her upper jaw six years prior in a firearm accident, including her mouth, lips, palate, teeth and nasal cavity, and was since then unable to eat. She had undergone around 35 reconstructive plastic surgery operations. The donor was a 28-year-old Turkish woman of Moldavian origin in Istanbul , who had died by suicide. [ 25 ] [ 26 ] [ 27 ] Nergis died in Ankara on 15 November 2016 after she was hospitalized two days prior complaining about acute pain. [ 28 ]
In December 2011, a 54-year-old man underwent a partial face transplant to the lower two-thirds of the face (including bone) after a ballistic accident. The operation was performed by a multidisciplinary team led by plastic surgeon Phillip Blondeel; Hubert Vermeersch, Nathalie Roche and Filip Stillaert were other members of the surgical team. For the first time 3D CT planning was used to plan the operation that lasted 20 hours. As of 2014 the patient is alive, with "good recovery of motor and sensory function and social reintegration". [ 29 ]
In September 2018, a 49-year-old woman affected by Neurofibromatosis type I received a partial face transplant from a 21-year-old girl at Sant'Andrea Hospital of Sapienza University in Rome. The procedure took 27 hours and was carried out by two teams led by Fabio Santanelli di Pompeo and Benedetto Longo. [ 30 ] The patient had a complication and after two days the surgeons had to replace the facial graft with autologous tissue. The patient is still alive and waiting for a second face transplantation. [ 31 ]
In May 2018, the first Canadian complete face transplant was performed under the leadership of plastic surgeon Daniel Borsuk at the Hopital Maisonneuve Rosemont, in Montreal , Quebec . [ 32 ] [ 33 ] The transplant took over 30 hours and replaced the upper and lower jaws, nose, lips and teeth on Maurice Desjardins , a 64-year-old man that shot himself in a hunting accident. At that time, Mr. Desjardins was the oldest person to benefit from a face transplant. [ 34 ] [ 35 ]
On 20 March 2010, a team of 30 Spanish doctors led by plastic surgeon Joan Pere Barret at the Vall d'Hebron University Hospital in Barcelona carried out the world's first full face transplant, on a man injured in a shooting accident. [ 36 ]
On 8 July 2010, the French media reported that a full face transplant, including tear ducts and eyelids, was carried out at the Henri-Mondor hospital in Créteil . [ 37 ]
In March 2011, a surgical team, led by Bohdan Pomahač at Brigham and Women's Hospital in Boston, Massachusetts , performed a full face transplant on Dallas Wiens , who was badly disfigured in a power line accident that left him blind and without lips, nose or eyebrows. The patient's sight couldn't be recovered but he was able to talk on the phone and smell. [ 38 ]
In April 2011, less than one month after the hospital performed the first full face transplant in the country, the Brigham and Women's Hospital face transplant team, led by Bohdan Pomahač, performed the nation's second full face transplant on patient Mitch Hunter of Speedway, Indiana. It was the third face transplant procedure to be performed at BWH and the fourth face transplant in the country. The team of more than 30 physicians, nurses, anesthesiologists and residents worked for more than 14 hours to replace the full facial area of the patient, including the nose, muscles of facial animation and the nerves that power them and provide sensation. Hunter had a severe shock from a high voltage electrical wire following a car accident in 2001. [ 39 ]
On 15 May 2013, at the Maria Skłodowska-Curie Institute of Oncology branch in Gliwice , Poland, an entire face was transplanted onto a male patient, Grzegorz (aged 33) after he lost the front of his head in a machine accident at work. The surgery took 27 hours and was directed by Professor Adam Maciejewski. There had not been much planning or prep time before the surgery, which was performed about one month after the accident, because the transplantation was done as an urgent life-saving surgery due to the patient's difficulty in eating and breathing. Shortly after the donor's death, the decision to perform the surgery was made and his body was transported hundreds of kilometers to Gliwice once his relatives gave their consent. The doctors believe that their patient has an excellent chance to live a normal, active life after surgery, and that his face should operate more or less normally (his eyes survived the accident untouched). [ 40 ]
Seven months later, on 4 December, the same Polish medical team in Gliwice transplanted a face onto a 26-year-old female patient with neurofibromatosis . Two months after the operation, she left the hospital. [ 41 ] [ 42 ]
On 21 January 2012, Turkish surgeon Ömer Özkan and his team successfully performed a full face transplant at Akdeniz University 's hospital in Antalya . The 19-year-old patient, Uğur Acar, was badly burnt in a house fire when he was a baby. The donor was 39-year-old Ahmet Kaya, who died on 20 January. [ 43 ] The Turkish doctors declared that his body had accepted the new tissue. [ 44 ]
Almost one month later on 24 February 2012, a surgical team led by Serdar Nasır conducted the country's second successful full face transplant at Hacettepe University 's hospital in Ankara on 25-year-old Cengiz Gül. The patient's face was badly burned in a television tube implosion accident when he was two years old. The donor was a undisclosed 40-year-old (the donor's family did not permit the identity of the donor to be revealed), who experienced brain death two days before the surgery following a motorcycle accident that occurred on 17 February. [ 45 ]
On 16 May 2012, surgeon Ömer Özkan and his team at the Akdeniz University Hospital performed the country's fourth and their second full face transplant. The face and ears of 27-year-old patient Turan Çolak from İzmir were burnt when he fell into an oven when he was three and half years old. The donor was Tevfik Yılmaz, a 19-year-old man from Uşak who had attempted suicide on 8 May. He was declared brain dead in the evening hours of 15 May after having been in intensive care for seven days. His parents donated all his organs. [ 46 ]
On 18 July 2013, the face of a Polish man was successfully given to a Turkish man in a transplant performed by Özkan, at Akdeniz University hospital following a 6.5-hour operation, making it the fifth such operation to take place in the country. It was the 25th face transplant operation in the world. The donor was Andrzej Kucza, a 42-year-old Polish tourist who was declared brain dead following a heart attack on 14 July while swimming in Turkey's sea resort Muğla . The receiver was 27-year-old patient Recep Sert from Bursa . [ 47 ]
On 23 August 2013, surgeon Ömer Özkan and his team at Akdeniz University performed the sixth face transplant surgery in Turkey. Salih Üstün (54) received the scalp, eyelids, jaw and maxilla, nose and the half tongue of 31-year-old Muhittin Turan, who was declared brain dead after a motorcycle accident that took place two days before. [ 48 ]
On 30 December 2013, Özkan and his team conducted their fifth and Turkey's seventh face transplant surgery at the hospital of Akdeniz University. The nose, upper lip, upper jaw and maxilla of brain dead Ali Emre Küçük, aged 34, were successfully transplanted to 22-year-old Recep Kaya, whose face was badly deformed in a shotgun accident. While Kaya was flown from Kırklareli to Antalya via Istanbul in four hours, the donor's organs were transported from Edirne by an ambulance airplane. The surgery took 4 hours and 10 minutes. [ 49 ]
In October 2006, surgeon Peter Butler at London's Royal Free Hospital in the UK was given permission by the NHS ethics board to carry out face transplants. His team will select four adult patients (children cannot be selected due to concerns over consent), with operations being carried out at six-month intervals. [ 50 ] As of 2022, neither Butler nor any other UK surgeon has performed a face transplant. [ 51 ]
In 2004, the Cleveland Clinic became the first institution to approve this surgery and test it on cadavers.
In 2005, the Cleveland Clinic became the first US hospital to approve the procedure. In December 2008, a team at the Cleveland Clinic, led by Maria Siemionow and including a group of supporting doctors and six plastic surgeons (Steven Bernard, Dr Mark Hendrickson, Robert Lohman, Dan Alam and Francis Papay) performed the first face transplant in the US on a woman named Connie Culp . [ 52 ] [ 53 ] [ 54 ] It was the world's first near-total facial transplant and the fourth known facial transplant to have been successfully performed to date. This operation was the first facial transplant known to have included bones, along with muscle, skin, blood vessels, and nerves. The woman received a nose, most of the sinuses around the nose, the upper jaw, and even some teeth from a brain-dead donor. As doctors recovered the donor's facial tissue, they paid special attention to maintaining arteries, veins, and nerves, as well as soft tissue and bony structures. The surgeons then connected facial graft vessels to the patient's blood vessels in order to restore blood circulation in the reconstructed face before connecting arteries, veins and nerves in the 22-hour procedure. She had been disfigured to the point where she could not eat or breathe on her own as a result of a traumatic injury several years ago, which had left her without a nose, right eye and upper jaw. Doctors hoped the operation would allow her to regain her sense of smell and ability to smile, and said she had a "clear understanding" of the risks involved. Connie died 29 July 2020.
The second partial face transplant in the US took place at Brigham and Women's Hospital in Boston on 9 April 2009. During a 17-hour operation, a surgical team led by Bohdan Pomahač , replaced the nose, upper lip, cheeks, and roof of the mouth – along with corresponding muscles, bones and nerves – of James Maki, age 59. Maki's face was severely injured after falling onto the electrified third rail at a Boston subway station in 2005. In May 2009, he made a public media appearance and declared he was happy with the result. [ 55 ] This procedure was also shown in the eighth episode of the ABC documentary series Boston Med .
The first full face transplant performed in the US was done on a construction worker named Dallas Wiens in March 2011. He was burned in an electrical accident in 2008. This operation, performed by Bohdan Pomahač and BWH plastic surgery team, [ 56 ] was paid for with the help of the US defense department. They hope to learn from this procedure and use what they learn to help soldiers with facial injuries. [ 57 ] One of the top benefits of the surgery was that Dallas has regained his sense of smell. [ 58 ]
The Brigham and Women's Hospital transplant team led by Bohdan Pomahač, performed the nation's second full face transplant on patient Mitch Hunter of Speedway, Indiana. Hunter, who is a US war veteran, was left disfigured in a car accident, burning about 94% of his face. It was the third face transplant procedure to be performed at BWH and the fourth face transplant in the country. The team of more than 30 physicians, nurses, anesthesiologists and residents worked for more than 14 hours to replace the full facial area of patient Mitch Hunter including the nose, eyelids, muscles of facial animation and the nerves that power them and provide sensation. Mitch Hunter was a passenger in a single cab pick-up truck, upon exiting the vehicle and pulling another passenger off a downed line, Hunter was then struck by a 10,000-volt 7-amp power line for a little under five minutes. The electricity entered his lower left leg, with the majority exiting his face, leaving him severely disfigured. He also lost part of his lower left leg, below the knee, and lost two digits on his right hand (pinkie and ring finger). Hunter has regained almost 100% of his normal sensation back in his face and his only complaint is that he looks too much like his older brother. [ 39 ]
57-year-old Charla Nash , who was mauled by a chimpanzee named Travis in 2009, after the owner gave the chimp Xanax and wine. She underwent a 20-hour full face transplant in May 2011 at Brigham and Women's Hospital in Boston . Nash's full face transplant was the third surgery of its kind performed in the United States, all at the same hospital. [ 3 ]
In March 2012, a face transplant was completed at the University of Maryland Medical Center and R Adams Cowley Shock Trauma Center under the leadership of plastic surgeon Eduardo Rodriguez and his team (Amir Dorafshar, Michael Christy, Branko Bojovic and Daniel Borsuk [ 59 ] ). [ 60 ] The recipient was 37-year-old Richard Norris, who had sustained a facial gunshot injury in 1997. This transplant included all facial and anterior neck skin, both jaws, and the tongue. [ 61 ]
In September 2014, another face transplant was performed by the Cleveland Clinic group. The patient had had complex trauma that masked the development of a rare type of autoimmune disease (granulomatosis with polyangiitis and pyoderma gengrenosum) affecting the face. It was the first face transplant in a patient with an autoimmune disease involving the craniofacial region. Prior to surgery, an analysis of renal transplant outcomes in granulomatosis with polyangiitis was conducted to evaluate allograft outcomes in these cohorts. That literature established feasibility and encouraged the Cleveland Clinic team to proceed with the surgery. The intervention was reported successful up to three years post-transplantation. [ 62 ] [ 63 ] [ 64 ] [ 65 ]
In August 2015, a face transplant was completed at the NYU Langone Medical Center under the leadership of the chair of plastic surgery Eduardo D. Rodriguez and his team. A 41-year-old retired fireman named Patrick Hardison received the face of cyclist David Rodebaugh. [ 66 ]
In June 2016, a multidisciplinary team of surgeons, physicians and other health professionals completed a near-total face transplant at Mayo Clinic 's Rochester campus. Patient Andrew Sandness, a 32-year-old from eastern Wyoming, had devastating facial injuries from a self-inflicted gunshot wound in 2006. The surgery, which spanned more than 50 hours, restored Sandness' nose, upper and lower jaw, palate, teeth, cheeks, facial muscles, oral mucosa, some of the salivary glands and the skin of his face (from below the eyelids to the neck and from ear to ear). The care team led by Samir Mardini, and Hatem Amer, the surgical director and medical director, respectively, for the Mayo Clinic Essam and Dalal Obaid Center for Reconstructive Transplant Surgery, devoted more than 50 Saturdays over 3 + 1 ⁄ 2 years to rehearsing the surgery, using sets of cadaver heads to transplant the face of one to the other. They used 3-D imaging and virtual surgery to plot out the bony cuts so the donor's face would fit perfectly on the transplant recipient. Today, in addition to his physical transformation, Sandness can smell again, breathe normally and eat foods that were off-limits for a decade. [ 67 ]
In a 31-hour operation starting on 4 May 2017, surgeons at the Cleveland Clinic transplanted a face donated from Adrea Schneider, who had died of a drug overdose, to Katie Stubblefield, whose face had been disfigured in a suicide attempt by rifle on 25 March 2014. As of 2018 [update] , Katie is the youngest person in the United States to have had a face transplant, age 21 at the time. Surgeons originally planned to leave her cheeks, eyebrows, eyelids, most of her forehead, and the sides of her face alone. However, because the donor face was larger and darker than Katie's, they made the decision to transplant the donor's full face. This holds the risk that in case of acute rejection in which the face must be removed, she would not have enough tissue for reconstructive surgery. Katie was featured on the cover of National Geographic in September 2018 for an article entitled "The Story of a Face." [ 68 ] [ 69 ]
In July 2019, 68-year-old Robert Chelsea became the oldest person, as well as the first black person in the world, to receive a full face transplant. On 6 August 2013, Robert was involved in an horrific car accident, leaving burns over 75% of his body. The severe damage meant that Robert was missing significant facial elements such as a part of his nose, which limited his ability to eat and drink. Functionality was important to Robert and was a key reason behind his pursuit of the surgery. In 2016, a face transplant was first discussed. Yet, health care disparities have led to a lack of black organ donations. This meant that Robert waited two years to find a face that matched something close to his own complexion. [ 70 ] The surgery was performed on 27 July 2019 at Brigham and Women's Hospital. [ 71 ]
In February 2024, 30-year-old Derek Pfaff received a full-face transplant from an anonymous donor. Pfaff had previously shot himself in the face during a suicide attempt in March 2014, 10 years prior to the surgery. The results of the surgery were later revealed in November 2024. [ 72 ] [ 73 ]
A number of combined VCA procedures, such as bilateral hand transplants , have been described in the literature and media sources. These combined procedures also include attempts at triple-limb [ 74 ] [ 75 ] and quadruple-limb [ 76 ] transplants, however, only three face transplants have been attempted in combination with other allografts.
In 2009, Laurent Lantieri and his team attempted a face and bilateral hand transplant on a 37-year-old man who sustained extensive injuries during a self-immolation attempt one year prior. The patient ultimately died of anoxic brain injury two months after his initial transplant during surgical management of infectious and vascular complications. Autopsy revealed no signs of rejection in any of the allografts. [ 77 ]
On 12 August 2020, at NYU Langone Health in New York, New York, Eduardo D. Rodriguez led a team of over 140 personnel in successfully transplanting the face and bilateral hands of a brain dead donor onto 22-year-old Joe DiMeo, who sustained disfiguring burns after a car accident in 2018. [ 78 ] [ 79 ] The procedure lasted approximately 23 hours, and involved the entire facial soft tissue (extending from the anterior hairline to the neck, including the eyelids, nose, lips, and ears, along with strategic skeletal components), as well as both hands at the distal forearm level. [ 80 ]
Charla Nash's face transplant, described above, also initially included bilateral hands from the same donor. Circulation to Nash's transplanted hands was compromised after she was started on vasopressors as part of treatment for sepsis. [ 77 ] The hands were ultimately amputated, however the patient survived, as did her facial allograft.
In May 2023, a team of 140 doctors at NYU Langone Health successfully conducted the first combination eye transplant and partial face transplant. The patient, a 46-year-old linesman, was electrocuted by high voltage wires in 2021 causing the loss of the lower portion of his face and his left eye. The eye, while not restoring vision to the patient, has successfully received blood flow to the retina. [ 81 ]
The procedure consists of a series of operations requiring rotating teams of specialists. With issues of tissue type, age, sex, and skin color taken into consideration, the patient's face is removed and replaced (sometimes including the underlying fat, nerves, blood vessels, bones, and/or musculature). The surgery may last anywhere from 8 to 36 hours, followed by a 10- to 14-day hospital stay.
There has been a substantial amount of ethical debate surrounding the operation and its performance. [ 82 ] The main issue is that, as noted below, the procedure entails submitting otherwise physically healthy people to potentially fatal, lifelong immunosuppressant therapy. So far, four people have died of complications related to the procedure. Citing the comments of various plastic surgeons and medical professionals from France and Mexico, anthropologist Samuel Taylor-Alexander suggests that the operation has been infused with nationalist import, which is ultimately influencing the decision-making and ethical judgements of the involved parties. [ 83 ] His most recent research suggests the face transplant community needs to do more in order to ensure that the experiential knowledge of face transplant recipients is included in the ongoing evaluation of the field. [ 84 ] As of October 2019, the AboutFace Project Archived 1 February 2021 at the Wayback Machine , funded by a UKRI Future Leaders Fellowship awarded to Dr Fay Bound Alberti , is exploring these debates as part of its wider research into the emotional and cultural history of face transplants. [ 85 ] The AboutFace project has entered its second phase as Interface , a research project which explores the relationship between identity, emotion, and communication, as revealed through the human face.
After the procedure, a lifelong regimen of immunosuppressive drugs is necessary to suppress the patient's own immune systems and prevent rejection. [ 86 ] Long-term immunosuppression increases the risk of developing life-threatening infections, kidney damage, and cancer. The surgery may result in complications such as infections that could damage the transplanted face and require a second transplant or reconstruction with skin grafts.
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A facemask (also referred to as a protraction facemask , orthopedic facemask , or reverse-pull headgear ) is a type of an orthodontic headgear used to treat underbite and other malocclusions where the upper jaw is too far backwards. [ 1 ] A metal bar sits in front of the patients face with support from the forehead and chin. Elastics are connected to the metal bar and the teeth - directly through the lips / mouth of the patient. The elastics apply forward and downward pressure on the upper jaw. Thus the force direction is the opposite from a standard headgear which is why this appliance is also known as a reverse-pull-headgear. [ 1 ]
This facemask appliance needs to worn by the patient for between 14 and 16 hours daily. [ 2 ]
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Facet joint injections are used to alleviate symptoms of Facet syndrome . [ 1 ] The procedure is an outpatient surgery, so that the patient can go home on the same day. It usually takes 10–20 minutes, but may take up to 30 minutes if the patient needs an IV for relaxation. [ 2 ] Facet joint injections came into use from 1963, when Hirsch injected a hypertonic solution of saline into facet joints. [ 3 ] He found that this solution relieved lower back pain in the sacroiliac and gluteal regions of the spine. In 1979 fluoroscopy was used for guidance of the needle into the facet joints with steroids and local anesthetics. [ 3 ]
Facet joint injections can be used to diagnose the facet joints as the source of pain. [ 4 ] When the facet joint is numbed, there should be pain relief. If the pain is not relieved, there could be another underlying issue that is causing the pain. Facet joint injections are mainly used as a therapeutic to relieve back pain caused by the facet joints. The numbing injection provides temporary relief and the anti-inflammatory mixture provides long term relief. [ 4 ]
The patient lies face down on the table. The area of the spine that will be treated (lower back, mid back, upper back) is sterilely cleansed with an antibacterial solution using aseptic techniques. The antibacterial solution usually contains iodine and alcohol. A local anesthetic, like Bupivacaine, is injected into the area to numb the joint. [ 5 ] The patient might feel a slight sting. Imaging guidance is used to direct the needle into the facet joint. The type of imaging system used depends on the preference of the doctor. It is usually fluoroscopy using CT or x-ray guidance. [ 4 ] [ 3 ] CT fluoroscopy increases the precision of the needle placement. Others may use ultrasound or magnetic resonance guidance. Contrast dye is injected into the facet joint to assure that the needle is in the correct place. Once confirmed, a mixture of an anesthetic and anti-inflammatory medication, is slowly injected into the joint. The needle is then released. The injection can be used to treat any facet joint that is causing pain, so this procedure may need to be repeated for the adjacent facet joints.
IV sedation can be used for anxious patients to help them sit still. Doctors try to avoid this because it interferes with a patient’s pain response, which is needed to determine which facet joint is the source of the pain. [ 3 ] If the patient chooses to have the sedation, they can’t eat or drink 4–6 hours prior to the procedure. [ 3 ]
Examination of the evidence on the effectiveness of facet joint injection has suggested that it has little effect. In 2018 the Lancet published a series of papers by a group of many international experts on the extent of back pain and evidence for treatments. The authors were scathing about the widespread use of “inappropriate tests” and “unnecessary, ineffective and harmful treatments”. [ 6 ] On facet joint injection it was stated that "Injecting facet joints with local anaesthetic can cause temporary relief of pain; however, the Framingham Heart Study (3529 participants) did not find an association between radiological osteoarthritis of facet joints and presence of low back pain." [ 7 ] [ 8 ] One of the authors, Prof. Martin Underwood at Warwick Medical School , said that facet joint injections "are very widely used in the public and private sectors. There is no evidence to support their use, but nevertheless the numbers done in the NHS go up year on year".
The UK National Institute for Health and Care Excellence (NICE) gives the official recommendation "1.3.1 Do not offer spinal injections for managing low back pain". [ 9 ]
The most common side effects from this procedure include itching, rash, nausea, facial flushing/sweating. [ 10 ] Some patients experience temporary weight gain due to the steroid. Diabetics may experience an increase in blood sugar. [ 10 ] [ 4 ] This is a quick and simple procedure, so complications are very rare, but should not be ignored. The risk of complications is decreased when proper aseptic technique is followed, and by the use of the imaging guidance. These complications include an epidural abscess due to infection, temporary increased pain, puncture of the sack containing spinal fluid, excess bleeding, nerve damage, leakage of local anesthetic into the spinal canal, and spondylodiscitis (disc inflammation). [ 5 ] [ 3 ] Most of the symptoms last 24–48 hours and are usually relieved by a cold compress and NSAIDS. The numbness should wear off in a few hours.
Individuals taking Coumadin or any blood-thinning medications must come off this medication 4–7 days before the injection. [ 5 ] The doctor should be aware of any allergies to steroids or anesthetics. Any ongoing active infections should be discussed with the doctor as well. Antiplatelet drugs must be stopped 5–10 days before this procedure. [ 5 ] History of anxiety or the inability to sit still should be mentioned to the doctor to prevent any movement during the procedure.
After the procedure, the patient waits in the room for 20–30 minutes to look for any immediate side effects. [ 4 ] The patient is then evaluated to see if the injection worked. The patient is asked to perform certain movements that would normally aggravate their pain. If pain is still present, the wrong facet joint may have been targeted, or the facet joints were not the source of pain. Normally it takes 3–5 days for the pain to be completely relieved. [ 10 ] Patients’ can return to their normal activities the day after the procedure. Physical therapy is not normally needed. The injection is usually performed up to 3 times a year. [ 3 ]
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Facetectomy is a surgical procedure which involves decompression of a spinal nerve root . For example, it can be performed in severely resistant cases of cervical rhizalgia , where the cervical nerve roots within the intervertebral foramina are decompressed. [ 1 ]
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Facial feminization surgery ( FFS ) is a set of reconstructive [ 1 ] surgical procedures that alter typically male facial features to bring them closer in shape and size to typical female facial features. FFS can include various bony and soft tissue procedures such as brow lift , rhinoplasty , cheek implantation , and lip augmentation . [ 2 ]
Faces contain secondary sex characteristics that make male and female faces readily distinguishable, including the shape of the forehead, nose, lips, cheeks, chin, and jawline; the features in the upper third of the face seem to be the most important, and subtle changes in the lips can have a strong effect.
For some transgender women and non binary people, FFS is medically necessary to treat gender dysphoria . [ 3 ] [ 4 ] It can be just as important or even more important than genital forms of sex reassignment surgery (SRS) in reducing gender dysphoria and helping trans women integrate socially as women; data on these sorts of outcomes are limited by small study size and confounding variables like other feminization procedures. [ 5 ] [ 6 ] While most FFS patients are transgender women , some cisgender women who feel that their faces are too masculine will also undergo FFS. [ 7 ]
FFS candidates should wait until the bones of their skull have stopped growing before undergoing FFS. The way to determine if the bones of the skull have stopped growing is to take successive radiographs of the mandible and wrist bones to make sure that bone growth has stopped. [ 8 ]
The surgical procedures most frequently performed during FFS include the following. [ 5 ] [ 9 ]
Some studies have shown that the shape of the forehead is one of the key differences between cisgender males and cisgender females. [ 5 ] [ 10 ] Hairline correction, forehead recontouring, eye socket recontouring, and brow lift are procedures often performed at the same time, with rhinoplasty in mind. [ 5 ] They are detailed below.
In males, the hairline is often higher than in females and usually has receded corners above the temples that give it an "M" shape. The hairline can be moved forward and given a more rounded shape, either with a procedure called a " scalp advance " wherein the scalp is lifted and repositioned, or with hair transplantation . [ 5 ]
Cisgender males tend to have a horizontal ridge of bone running across the forehead just above eyebrow level called the brow ridge (or "brow bossing"), which includes the "supraorbital rims" (the lower edge, on which the eyebrows sit). Cisgender males also tend to have indented temples and a flatter forehead than females. [ 5 ]
The brow ridge is usually solid bone and can simply be ground down. The section of bossing between the eyebrows (the glabella ) sits over a hollow area called the frontal sinus . The frontal sinus is hollow, and thus it can be more difficult to remove bossing there. If the bone over the frontal sinus is thick enough the bossing can be removed by simply grinding down the bone. However, in some people, the wall of bone is so thin that it is not possible to grind the bossing away completely without breaking through the wall into the frontal sinus. [ 5 ]
FFS surgeons have taken two main approaches to resolving this problem. The most conservative approach is to grind down the wall of bone as far as possible without breaking through, and then build up the area around any remaining bossing with hydroxyapatite bone cement which can smooth out any visible step between remaining bossing and the rest of the forehead. In these cases, some additional reduction in the bossing can sometimes be achieved by thinning the soft tissues that sit over it. Alternatively, FFS surgeons can perform a procedure called a forehead reconstruction or cranioplasty where the glabella bone is taken apart, thinned and re-shaped, and reassembled in the new feminine position with small titanium wires or titanium orthopedic plate and screws. [ 5 ] The data on which approach is better is limited and does not provide guidance. [ 5 ] The risks of cranioplasty include the skull not healing properly, movement of the bone fragments, and the formation of cysts; these can usually be corrected by another procedure. [ 5 ]
Cisgender men tend to have lower eyebrows relative to the position of their brow ridges when compared to cisgender women. Cis men's eyebrows tend to be below their brow ridges while cis women's eyebrows tend to be above their brow ridges. Accordingly, FFS to raise the eyebrows results in a face with a more womanly appearance. [ 8 ]
In some studies, the eye shape has been shown to be the key differentiating feature between cis males and females. [ 5 ] [ 10 ] Cis female eye sockets tend to be smaller, located higher on the face, to have more sharply angled outer edges, and to be closer together at their inner edges (the intercanthal distance ). [ 5 ] Some FFS alter the orbit shape; data on outcomes is limited. [ 5 ]
Cis males tend to have larger, longer, and wider noses than cis females; also, the tip of the female nose will more often visibly point slightly upwards than that of a male. Hence, the procedure involves removing bone and cartilage and remodelling what remains. [ 5 ] [ 10 ] In most cases this is performed in an open procedure, but endonasal procedures have been used; in all cases when reducing the nose there is a risk of interfering with nasal valve function. [ 5 ] Standard rhinoplasty procedures are generally used. [ 11 ] There is limited data on outcomes. [ 5 ]
Cis females often have more forward projection in their cheekbones as well as fuller cheeks overall, with a triangle formed by the cheekbones and the point of the chin. Planning of cheek contouring is done while planning reshaping of the chin. [ 5 ] The cheeks are reshaped by cutting away bone and repositioning the facial bones. [ 5 ] Augmenting the cheeks with implants or with fat harvested from other parts of the body is common. Risks of implants include infection, and the implant moving and becoming asymmetrical; fat can eventually be absorbed. [ 5 ]
Subtle changes to the shape and structure of lips can have a strong influence on feminization. [ 5 ] The distance between the base of the nose and the top of the upper lip tends to be longer in males than in females and the upper lip is longer; when a female mouth is open and relaxed, the upper incisors are often exposed by a few millimeters. [ 5 ]
An incision is usually made just under the base of the nose and a section of skin is removed. When the gap is closed it has the effect of lifting the top lip, placing it in a more feminine position and often exposing a little of the upper incisors. The surgeon can also use a lip lift to roll the top lip out a little, making it appear fuller. [ 5 ]
Cis females often have fuller lips than cis males, so lip filling is often used in feminization. Injectable fillers are low-risk but tend to be absorbed after six months or so, and many implants have higher complication rates like infection or rejection. [ 5 ] Use of fat harvested from the person can result in lumps and does not last long. [ 5 ] The longest lasting and least risky results appear to arise from use of acellular dermis products. [ 5 ]
The chins of cis males tend to be longer and wider than those of cis females, with a more square base, and to project outward more than female chins. [ 10 ] Cis male jawlines tend to extend outward from the chin at a wider angle than those of cis females, and to have a sharp corner at the back. [ 5 ]
The chin can be reduced in length either by bone shaving or with a procedure called a " sliding genioplasty ", where a section of bone is removed. The jaw can be reshaped through jaw reduction surgery; sometimes this is done through the mouth. The chewing muscles can also be reduced to make the jaw appear narrower. [ 5 ]
The biggest risk in these procedures is damage to the mental nerve that runs through the chin and jaw; other risks include damage to tooth roots, infection, nonunion, and damage to the mentalis muscle that controls the lower lip and is at the edges of the chin. [ 5 ]
Males tend to have a much more prominent Adam's apple than females following puberty. [ 5 ] [ 10 ] The Adam's apple can be reduced with a procedure called a chondrolaryngoplasty ; the goal of the procedure is to reduce the size without leaving a scar. [ 5 ] There are risks of damage to the vocal cords and destabilization of the epiglottis . [ 5 ]
Beautification and rejuvenation procedures are often performed at the same time as facial feminisation. For example, it is common for eye bags and sagging eyelids to be corrected with a procedure called " blepharoplasty " and many feminization patients undergo a face and neck lift . [ 5 ]
FFS techniques are derived from maxillofacial , otolaryngology , and plastic aesthetic and reconstructive surgery . [ 5 ] [ 8 ]
FFS began in 1982 when Darrell Pratt, a plastic surgeon who performed sex reassignment surgeries , approached Douglas Ousterhout with a request from a transgender woman patient of Pratt's; the patient wanted plastic surgery to make her face appear more feminine, since people still reacted to her as though she were a man. [ 12 ] Ousterhout's prior practice had involved reconstructing faces and skulls of people who had had birth defects, accidents, or other trauma. [ 12 ] Ousterhout was interested in helping but knew that he did not know what a "female face" was, so he investigated by first reading the physical anthropology from the early 20th century to identify what features were "female", then deriving measurements defining those features from a series of cephalograms taken in the 1970s, and then working with a set of several hundred skulls to see if he could reliably differentiate which were females and which were males using those measurements. [ 6 ] [ 12 ] Ousterhout then began working out what surgical techniques and materials he already used could be applied in order to transform a male face into a female face. He pioneered most of the procedures involved in FFS and was involved in their subsequent improvements as well. [ 6 ]
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Facial implants are used to enhance certain features of the face. The surgery may be elective , or needed as the result of prior surgery on the face. Each involves placing synthetic materials deep under the subcutaneous tissue and onto the underlying bone . A maxillofacial or plastic surgeon uses them to aesthetically improve facial contours, proportion and correct imbalances caused by injury or hereditary traits . However, in cases that require orthognathic osteotomies , those should be done before any implants are considered.
In most cases, facial implant surgery is completed on an outpatient basis in a hospital, a surgeon's office or a surgical center. A local anesthesia or oral sedative may be used, or the patient may be put to sleep during the procedure using general anesthesia .
The most commonly used implants are:
Less commonly used implants are:
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Facial masculinization surgery ( FMS ) is a set of plastic surgery procedures that can transform the patient's face to exhibit typical masculine morphology . Cisgender men may elect to undergo these procedures, and in the context of transgender people, FMS is a type of facial gender confirmation surgery (FGCS), which also includes facial feminization surgery (FFS) for transgender women . [ 1 ]
FMS can include various bony procedures such as chin augmentation , cheek augmentation , as well as augmentation of the forehead , jaw , and Adam's apple . In FMS, most procedures involve "having structures added to give more angles to the face." [ 2 ]
Trans men have requested FMS procedures since the 20th century. [ 3 ] FMS is currently less common than FFS. [ 4 ] Urologist Miriam Hadj-Moussa notes that "transgender men rarely undergo facial masculinization surgery since testosterone therapy leads to growth of facial hair and makes it easier for them to present." [ 5 ]
In 2011, Douglas Ousterhout outlined the available FMS procedures, drawing on the work of Paul Tessier . [ 6 ] In 2015 Shane Morrison published an overview of all gender affirming surgeries for trans men, including FMS. [ 7 ] In 2017, Ousterhout's successor Jordan Deschamps-Braly published a case report on the first female-to-male facial confirmation surgery that included masculinization of the Adam's apple. [ 8 ]
According to the World Professional Association for Transgender Health (WPATH), for many transgender men, FMS is considered medically necessary to treat gender dysphoria . [ 9 ] [ 10 ] Following the WPATH recommendations, several literature reviews and summaries of the state of the art were published in 2017 and 2018. [ 11 ] [ 12 ] [ 13 ] [ 14 ]
The surgical procedures most frequently performed during FMS often include facial implants and include the following, as outlined in the literature. [ 6 ] [ 15 ] [ 16 ]
The purpose of forehead augmentation is to create a less rounded forehead with a more prominent supraorbital ridge typical of cisgender men. It can be done with a customized implant, a calvarial bone graft , fat grafting , or materials such as bone cement that are molded into shape before they harden. Injectable fillers may also be used as an outpatient procedure. [ 6 ] [ 16 ] [ 17 ]
Orthognathic surgery was first performed for functional reasons in the late 19th century, with cosmetic procedures being improved and refined throughout the 20th century. [ 18 ] In facial masculinization surgery, the goal is to create a more robust and square jaw with a sharper mandibular angle . This can be achieved through hydroxyapatite ( bone mineral ) grafts, which promote new bone growth, or through customized implants. [ 16 ]
To change the appearance of the jaw, chin augmentation may also be performed. This can consist of chin implants or an osteotomy to make the chin tip appear wider and more prominent. [ 16 ]
This newer procedure uses an implant made from cartilage taken from the patient's rib cage to augment the tip of the thyroid cartilage known as the "Adam's apple." It was first performed in 2017. [ 8 ]
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The facial nerve , also known as the seventh cranial nerve , cranial nerve VII , or simply CN VII , is a cranial nerve that emerges from the pons of the brainstem , controls the muscles of facial expression , and functions in the conveyance of taste sensations from the anterior two-thirds of the tongue . [ 1 ] [ 2 ] The nerve typically travels from the pons through the facial canal in the temporal bone and exits the skull at the stylomastoid foramen . [ 3 ] It arises from the brainstem from an area posterior to the cranial nerve VI (abducens nerve) and anterior to cranial nerve VIII (vestibulocochlear nerve).
The facial nerve also supplies preganglionic parasympathetic fibers to several head and neck ganglia .
The facial and intermediate nerves can be collectively referred to as the nervus intermediofacialis. [ citation needed ]
The path of the facial nerve can be divided into six segments:
The motor part of the facial nerve arises from the facial nerve nucleus in the pons , while the sensory and parasympathetic parts of the facial nerve arise from the intermediate nerve .
From the brain stem, the motor and sensory parts of the facial nerve join and traverse the posterior cranial fossa before entering the petrous temporal bone via the internal auditory meatus . Upon exiting the internal auditory meatus, the nerve then runs a tortuous course through the facial canal , which is divided into the labyrinthine, tympanic, and mastoid segments.
The labyrinthine segment is the shortest and narrowest segment of the facial nerve and ends where the facial nerve forms a bend known as the geniculum of the facial nerve ( genu meaning knee), which contains the geniculate ganglion for sensory nerve bodies. The first branch of the facial nerve, the greater petrosal nerve , arises here from the geniculate ganglion. The greater petrosal nerve runs through the pterygoid canal and synapses at the pterygopalatine ganglion . Postsynaptic fibers of the greater petrosal nerve innervate the lacrimal gland .
In the tympanic segment, the facial nerve runs through the tympanic cavity , medial to the incus .
The pyramidal eminence is the second bend in the facial nerve, where the nerve runs downward as the mastoid segment, the longest segment of the facial nerve. In the temporal part of the facial canal, the nerve gives branch to the stapedius muscle and chorda tympani . The chorda tympani supplies taste fibers to the anterior two thirds of the tongue, and also synapses with the submandibular ganglion . Postsynaptic fibers from the submandibular ganglion supply the sublingual and submandibular glands .
Upon emerging from the stylomastoid foramen , the facial nerve gives rise to the posterior auricular branch . It then gives rise to the branch to the posterior belly of the digastric, and then the branch to the stylohyoid. The facial nerve then passes through the parotid gland , which it does not innervate, to form the parotid plexus . The nerve then bifurcates at the pes anserinus to become the upper and lower divisions of the facial nerve. [ 4 ] It then splits into five branches (temporal, zygomatic, buccal, marginal mandibular and cervical), innervating the muscles of facial expression . [ 5 ] [ 6 ]
The greater petrosal nerve arises at the superior salivatory nucleus of the pons and provides parasympathetic innervation to several glands, including the nasal glands , the palatine glands , the lacrimal gland , and the pharyngeal gland . It also provides parasympathetic innervation to the sphenoid sinus , frontal sinus , maxillary sinus , ethmoid sinus , and nasal cavity . This nerve also includes taste fibers for the palate via the lesser palatine nerve and greater palatine nerve .
The communicating branch to the otic ganglion arises at the geniculate ganglion and joins the lesser petrosal nerve to reach the otic ganglion. [ 7 ]
The nerve to stapedius provides motor innervation for the stapedius muscle in middle ear
The chorda tympani provides parasympathetic innervation to the sublingual and submandibular glands, as well as special sensory taste fibers for the anterior two thirds of the tongue. [ 1 ]
Distal to stylomastoid foramen , the following nerves branch off the facial nerve:
Intra operatively the facial nerve is recognized at 3 constant landmarks: [ citation needed ]
The cell bodies for the facial nerve are grouped in anatomical areas called nuclei or ganglia . The cell bodies for the afferent nerves are found in the geniculate ganglion for taste sensation. The cell bodies for muscular efferent nerves are found in the facial motor nucleus whereas the cell bodies for the parasympathetic efferent nerves are found in the superior salivatory nucleus .
The facial nerve is developmentally derived from the second pharyngeal arch , or branchial arch. The second arch is called the hyoid arch because it contributes to the formation of the lesser horn and upper body of the hyoid bone (the rest of the hyoid is formed by the third arch). The facial nerve supplies motor and sensory innervation to the muscles formed by the second pharyngeal arch, including the muscles of facial expression, the posterior belly of the digastric, stylohyoid, and stapedius. The motor division of the facial nerve is derived from the basal plate of the embryonic pons, while the sensory division originates from the cranial neural crest . [ 9 ]
Although the anterior two thirds of the tongue are derived from the first pharyngeal arch, which gives rise to the trigeminal nerve, not all innervation of the tongue is supplied by it. The lingual branch of the mandibular division (V3) of the trigeminal nerve supplies non-taste sensation (pressure, heat, texture) to the anterior part of the tongue via general somatic afferent fibers . Nerve fibers for taste are supplied by the chorda tympani branch of the facial nerve via special visceral afferent fibers. [ 10 ]
The main function of the facial nerve is motor control of all the muscles of facial expression . It also innervates the posterior belly of the digastric muscle , the stylohyoid muscle , and the stapedius muscle of the middle ear . These skeletal muscles are developed from the second pharyngeal arch .
In addition, the facial nerve receives taste sensations from the anterior two-thirds of the tongue via the chorda tympani . Taste sensation is sent to the gustatory portion (superior part) of the solitary nucleus . General sensation from the anterior two-thirds of tongue are supplied by afferent fibers of the third division of the fifth cranial nerve ( CN V -3). These sensory ( CN V3 ) and taste (VII) fibers travel together as the lingual nerve briefly before the chorda tympani leaves the lingual nerve to enter the tympanic cavity (middle ear) via the petrotympanic fissure. It joins the rest of the facial nerve via the canaliculus for chorda tympani. The facial nerve then forms the geniculate ganglion , which contains the cell bodies of the taste fibers of chorda tympani and other taste and sensory pathways. From the geniculate ganglion, the taste fibers continue as the intermediate nerve which goes to the upper anterior quadrant of the fundus of the internal acoustic meatus along with the motor root of the facial nerve. The intermediate nerve reaches the posterior cranial fossa via the internal acoustic meatus before synapsing in the solitary nucleus .
The facial nerve also supplies a small amount of afferent innervation to the oropharynx below the palatine tonsil . There is also a small amount of cutaneous sensation carried by the nervus intermedius from the skin in and around the auricle (outer ear).
The facial nerve also supplies parasympathetic fibers to the submandibular gland and sublingual glands via chorda tympani . Parasympathetic innervation serves to increase the flow of saliva from these glands. It also supplies parasympathetic innervation to the nasal mucosa and the lacrimal gland via the pterygopalatine ganglion . The parasympathetic fibers that travel in the facial nerve originate in the superior salivatory nucleus .
The facial nerve also functions as the efferent limb of the corneal reflex .
The facial nerve carries axons of type GSA, general somatic afferent , to skin of the posterior ear.
The facial nerve also carries axons of type GVE, general visceral efferent , which innervate the sublingual, submandibular, and lacrimal glands, also mucosa of nasal cavity.
Axons of type SVE, special visceral efferent , innervate muscles of facial expression, stapedius, the posterior belly of digastric, and the stylohyoid.
The axons of type SVA, special visceral afferent , provide taste to the anterior two-thirds of tongue via chorda tympani .
People may suffer from acute facial nerve paralysis , which is usually manifested by facial paralysis. [ 11 ] Bell's palsy is one type of idiopathic acute facial nerve paralysis, which is more accurately described as a multiple cranial nerve ganglionitis that involves the facial nerve, and most likely results from viral infection and also sometimes as a result of Lyme disease . Iatrogenic Bell's palsy may also be as a result of an incorrectly placed dental local-anesthetic ( inferior alveolar nerve block ). Although giving the appearance of a hemiplegic stroke, effects dissipate with the drug. When the facial nerve is permanently damaged due to a birth defect, trauma, or other disorder, surgery including a cross facial nerve graft or masseteric facial nerve transfer may be performed to help regain facial movement. [ citation needed ] Facial nerve decompression surgery is also sometimes carried out in certain cases of facial nerve compression.
Voluntary facial movements, such as wrinkling the brow, showing teeth, frowning, closing the eyes tightly (inability to do so is called lagophthalmos ), [ 12 ] pursing the lips and puffing out the cheeks, all test the facial nerve. There should be no noticeable asymmetry.
In an upper motor neuron lesion, called central seven , only the lower part of the face on the contralateral side will be affected, due to the bilateral control to the upper facial muscles ( frontalis and orbicularis oculi ).
Lower motor neuron lesions can result in a CN VII palsy (Bell's palsy is the idiopathic form of facial nerve palsy), manifested as both upper and lower facial weakness on the same side of the lesion.
Taste can be tested on the anterior two-thirds of the tongue. This can be tested with a swab dipped in a flavored solution, or with electronic stimulation (similar to putting your tongue on a battery).
Corneal reflex . The afferent arc is mediated by the general sensory afferents of the trigeminal nerve. The efferent arc occurs via the facial nerve. The reflex involves consensual blinking of both eyes in response to stimulation of one eye. This is due to the facial nerves' innervation of the muscles of facial expression, namely orbicularis oculi, responsible for blinking. Thus, the corneal reflex effectively tests the proper functioning of both cranial nerves V and VII.
This article incorporates text in the public domain from page 901 of the 20th edition of Gray's Anatomy (1918)
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Facial nerve decompression is a type of nerve decompression surgery where abnormal compression on the facial nerve is relieved.
Pressure and compression of any cause on a peripheral nerve can cause nerve impulse block. That is, the nerve is no longer able to send electrochemical impulses, and hence does not send signals to the brain or from the brain to muscles. There may also be demyelination (loss of the nerve's myelin sheath ) and degeneration of the nerve in the affected area but it does not effect axons beyond this site. [ citation needed ]
The facial nerve is a mixed nerve (i.e. containing both sensory and motor nerve fibres) and therefore compression can create sensory (e.g. anesthesia - numbness, or paresthesia - tingling) and motor deficits. Early surgical intervention tends to be carried out because after three to four months, fibrosis (replacement with fibrous tissue ) occurs in a significant portion of nerve fibers, and after that decompression is not of much value.
There are three main patterns of facial nerve compression. The type of injury also gives an idea about the prognosis .
There are several specific causes of facial nerve compression, discussed below.
This is a partial weakness or complete paralysis of the muscles of facial expression . Facial nerve compression is often due to edema (swelling) of the nerve and marked vascular congestion. Reason for the facial nerve compression is not known that's why also known as idiopathic Bell's palsy. [ citation needed ]
Caused by a viral infection and often associated with herpetic eruption of the meatus and cavum conchae. Deafness and vertigo is also seen. This is also known as a Ramsay Hunt Syndrome.
Often occurs before the age of 18 and associated with recurring facial palsy and edema of the face.
More commonly longitudinal fracture of petrous bone and fracture of temporal bone can cause facial nerve compression.
Use of forceps during the delivery can cause trauma to facial nerve. Compression of the diploic bone of the infant’s rudimentary mastoid process can compress facial nerve.
Edema and inflammation caused by this condition affect the facial (fallopian) canal and causes compression of facial nerve
Abscess and tumours of parotid gland can cause compression of motor part of the facial nerve resulting in facial palsy.
Tumour of facial nerve like schwannomas and perineuromas. Other tumours that can compress facial nerve along its course like congenital cholesteatomas, hemangiomas , acoustic neuromas , parotid gland neoplasms, or metastases of other tumors.
There are several medical tests to know that if the decompression surgery is needed or not and tests also shows the degree of injury.
In this test there is direct current applied to the stylomastoid foramen and assess with visual response. No longer used and do not predict prognosis .
In this test electrodes are situated over the main trunk and nerve is stimulated until the visual response is seen from the normal side and same is done for the diseased side. Then difference between the current required to produce response is measured. If it is more than 3.5mA then it suggests the axonal degeneration. If it is more than 20 mA then it suggests immediate decompression surgery.
In this test increasing electric stimulation to nerve is given until the facial twitch is seen then it is repeated to affected side. Difference between both sides are measured as equal, lesser or no response. It is very painful exam.
In this test electrodes are placed over the main trunk then suprathreshold stimulus is given and muscle action potential is measured over the both side.
In this test electrodes are directly placed in muscles and compound action potential of muscles is measured.
Useful in identifying a false positive Electroneurography. Presence of compound muscle action potential on voluntary EMG is a sign of good prognosis.
Indications include:
Contraindications include:
Individuals with Bell's palsy or Ramsey hunt syndrome may benefit from facial nerve decompression, but this is controversial. [ 1 ]
The aim of decompression surgery is to open the affected area and nerve sheath, and to release pressure. This reduces compression on the nerve fibers, improves blood circulation and minimizes damage to distal nerve fibers.
Several surgicala approaches are described to achieve decompression:
"Total decompression" can also be carried out via combination of all the above. [ 2 ]
Internal auditory canal (I.A.C.) porous to tympanic segment.
This middle cranial fossae exposure is used to expose I.A.C. and labyrinthine segment of the facial nerve when hearing preservation is goal. The geniculate ganglion and tympanic portion of the nerve can also be decompressed from this approach.
The middle cranial fossa route is the only method that can be used to expose the entire I.A.C. and labyrinthine segment with preservation of hearing. This is combination with the retrolabyrinthine and transmastoid approaches, enables visualization of the entire course of the facial nerve and still preserves function of the inner ear. The middle cranial foassa technique is most commonly used for the decompression of the facial nerve in Bell's palsy and longitudinal temporal bone fracture. This approach may be useful in the management of patient with schwannomas of cranial nerve 7 and 8, as well as with patient with melkersson-rosenthal syndrome.
For patient with total hearing loss, translabyrinthine approach was made with a skin incision from mastoid apex to the scalp going posterior for 5–6 cm;then it was turned anterior again, toward the top of auricle parallel to lower incision. Temporalis muscles incision followed the skin incision and standard translabyrinthine approach was completed by decompressing the facial nerve totally from stylomastoid foramen to the I.A.C.
(Vestibular Scwannnoma), Vestibular Nerve Section, Vascular Compression, Meningioma, Skull Base Fracture, Facial Nerve Decompression, Superior Semicircular Canal Dehiscence, Skull Base Tumors, Aneurysms, Cholesterol Granulomma
CSF leakage and meningitis, headache, intracranial vascular complication, facial nerve injury, injury to the other cranial nerve, disordered vestibular compensation. [ 4 ]
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Facial onset sensory and motor neuronopathy , often abbreviated FOSMN , is a rare disorder of the nervous system in which sensory and motor nerves of the face and limbs progressively degenerate over a period of months to years. This degenerative process, the cause of which is unknown, eventually results in sensory and motor symptoms — the former consisting mainly of paresthesia followed by numbness, and the latter in muscle weakness, atrophy, and eventual paralysis. FOSM is characterized by sensory and motor loss beginning in the face and spreading to involve an increasingly larger area including the scalp, upper arms and trunk. The muscles or respiration and swallowing are commonly affected. [ 1 ] [ 2 ] In many ways, it is reminiscent of the much better known condition amyotrophic lateral sclerosis , with which it is closely related. There is no cure; treatment is supportive. Life expectancy may be shortened by respiratory complications arising from weakness of the muscles that aid breathing and swallowing. It was first described in four patients by Vucic and colleagues [ 3 ] working at the Massachusetts General Hospital in the United States ; subsequent reports from the United Kingdom, [ 4 ] Europe and Asia [ 5 ] point to a global incidence of the disease. It is thought to be exceptionally rare, with only approximately 100 individuals described to date in the medical literature. [ 6 ]
The sensory symptoms in FOSM start in the distribution of the trigeminal nerve with paresthesias and numbness and characteristically spread from the head to lower parts of the body; involving the scalp, neck, shoulders and upper extremities. The lower extremities are sometimes also affected. [ 6 ] The trigeminal involvement may be unilateral or bilateral at onset. [ 6 ] Lower motor neuron involvement may start at the same time as sensory involvement or soon afterwards and also spreads in a head to lower body sequence. [ 6 ] Bulbar symptoms due to involvement of the cranial nerves are very common; which often leads to difficulties with swallowing or respirations. This may necessitate placement of a feeding tube or non-invasive ventilation . [ 6 ] Lower motor neuron symptoms commonly seen in FOSMN commonly include weakness, fasciculations , difficulties with speech and trouble swallowing . [ 6 ] Whereas lower motor neuron signs is observed in all cases of FOSMN, upper motor neuron associated weakness, which presents as brisk reflexes sometimes with clonus and a positive Babinski Sign , is also seen but is less common. [ 6 ] In approximately 50% of cases symptoms are initially asymmetric; affecting one side of the body, with eventual progression to the other side. In cases of asymmetric spread; the initially affected side may have more severe symptoms. [ 6 ] Although most features of FOSMN reflect lower motor neuron impairment some findings have suggested upper motor neuron impairment in FOSMN. [ 6 ]
Frontotemporal dementia , including the behavioral variant, is a co-morbid condition associated with FOSMN. [ 6 ]
The etiology of FOSMN is unknown but it is thought to involve a neurodegenerative or autoimmune process. [ 6 ] Some people with FOSMN were positive for various auto-antibodies and others had partial symptom improvement in response to various immunotherapies suggesting a possible autoimmune pathophysiology. [ 6 ] Abnormal TAR DNA-binding protein 43 (TDP-43) deposits were found on autopsy in the nerves of some with FOSMN. Abnormal TDP-43 deposits are seen in 98% of cases of ALS and are also commonly found in frontotemporal dementia. The pathological TDP-43 deposits suggest a neurodegenerative cause of FOSMN with pathophysiology closely linked to that of ALS and frontotemporal dementia. [ 6 ]
As with many neurological diseases, there is no test that is diagnostic of FOSMN. The diagnosis can be notoriously difficult, mainly on account of its rarity. Diagnosis is based on clinical signs and symptoms with exclusion of similar conditions. There are no validated diagnostic criteria. [ 6 ] The principal differential diagnosis to consider is amyotrophic lateral sclerosis or a related motor neuron disorder: the chief distinction between the two is the presence of sensory abnormalities in FOSMN, and their absence in the motor neuron disorders. Diagnostic tests such as nerve conduction studies , electromyography , cerebrospinal fluid analyses, and blood tests can help narrow the diagnostic possibilities and support a clinical diagnosis. [ 6 ] Neurophysiology studies show a generalized sensory and motor neuronopathy which is most severe cranially. [ 3 ]
There is currently no cure for FOSMN. Those with severe disease often require a feeding tube as swallowing is impaired. [ 6 ] Those with weakness affecting the muscles of respiration may require non-invasive ventilation. There have been case reports of symptom improvement after immunotherapy, suggesting a possible immune mediated etiology. [ 7 ]
The rate of disease progression is extremely variable with survival ranging from 14 months to 46 years. Of those who died from FOSMN, the mean duration of disease was 7.5 years. [ 6 ] Cranial nerve (bulbar) weakness is a common causes of death in those with FOSM, with aspiration pneumonia or respiratory failure commonly leading to death. [ 6 ]
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Reconstructive surgery is surgery performed to restore normal appearance and function to body parts malformed by a disease or medical condition.
Reconstructive surgery is a term with training, clinical, and reimbursement implications. It has historically been referred to as synonymous with plastic surgery . [ 1 ] In regard to training, plastic surgery is a recognized medical specialty and a surgeon can be a "board-certified" plastic surgeon by the American Board of Plastic Surgery . [ 2 ] However, reconstructive surgery is not a specialty and there are no board-certified reconstructive surgeons.
More accurately, reconstructive surgery should be contrasted with cosmetic surgery . Reconstructive surgery is performed to
Separately, the patient must be healthy enough so that the benefits of the procedure outweigh the risks of complications or death. A procedure could be considered reconstructive but not medically necessary due to the risk to the patient.
In addition, Section 1862(a) (1) (A) of the Social Security Act directs the following:
"No payment may be made under Part A or Part B for any expenses incurred for items or services not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member." [ 4 ] Therefore, outside clinical interpretation and carrier guidelines, there is a federal statute that "improving functionality and restoring appearance" are covered as reconstructive and medically necessary. [ 5 ]
This definition is contrasted with cosmetic surgery performed to improve aesthetics or the appearance of a body part. [ 6 ] A plastic surgeon can perform both reconstructive and cosmetic procedures. Some procedures, such as a panniculectomy (aka tummy tuck) can be considered as cosmetic by one insurance company and reconstructive by another. The surgeon may not be using the Medicare or reimbursement criteria when referring to a procedure as reconstructive or cosmetic. Plastic surgeons, maxillo-facial surgeons and otolaryngologists do reconstructive surgery on faces to correct congenital defects, after trauma and to reconstruct the head and neck after cancer. [ 7 ]
Another good example is repair of a cleft palate, or cheiloplasty, which surgically corrects abnormal development, restores function to the lips and mouth and produces a more normal appearance. [ 8 ] This meets the definition of reconstructive surgery and is mandated by state laws in at least 31 states, but could be denied as cosmetic by individual insurance companies in the remaining states. [ 9 ]
Other branches of surgery ( e.g. , general surgery , gynecological surgery , pediatric surgery , plastic surgery , podiatric surgery ) also perform some reconstructive procedures.
Reconstructive surgery represents a small but critical component of the comprehensive care of cancer patients. Its primary role in the treatment of cancer patients is to extend the ability of other surgeons and specialists to more radically treat cancer, offering patients the best opportunity for cure. [ 10 ]
Reconstructive surgeons use the concept of a reconstructive ladder to manage increasingly complex wounds. This ranges from very simple techniques such as primary closure and dressings to more complex skin grafts, tissue expansion, and free flaps. [ citation needed ]
Reconstructive surgery procedures include breast implant removal, reduction mammoplasty, breast reconstruction, surgical correction of birth anomalies, congenital nevi surgery, and liposuction for lipedema . [ 11 ] [ 12 ] Cosmetic surgery procedures include breast enhancement , reduction and lift, face lift , forehead lift , upper and lower eyelid surgery ( blepharoplasty ), laser skin resurfacing ( laser resurfacing ), chemical peel , nose reshaping ( rhinoplasty ), reconstruction liposuction , Nasal reconstruction using a paramedian forehead flap , as well as tummy tuck ( abdominoplasty ). [ 13 ]
Facial plastic and reconstructive surgery ( FPRS ) is a surgical subspecialty focused on improving both the functional and aesthetic aspects of the face, head, and neck. [ 14 ]
Recent literature in medline also has noted implementation of barbed suture in these procedures. [ 15 ]
Biomaterials are, in their simplest form, plastic implants used to correct or replace damaged body parts. Biomaterials were not used for reconstructive purposes until after World War II due to the new and improved technology and the tremendous need for the correction of damaged body parts that could replace transplantation . The process involves scientific and medical research to ensure that the biomaterials are biocompatible and that they can assume the mechanical and functioning roles of the components they are replacing. [ citation needed ]
A successful implantation can best be achieved by a team that understands not only the anatomical , physiological , biochemical , and pathological aspects of the problem, but also comprehends bioengineering . Cellular and tissue engineering is crucial to know for reconstructive procedures. [ 16 ]
An overview of the standardization and control of biomedical devices has recently been gathered by D. G. Singleton. Papers have covered in depth the U.S. Food and Drug Administration (FDA) Premarket Approval Process (J. L. Ely) and FDA regulations governing Class III devices. Two papers have described how the National Institute of Standards and Technology , American Dental Association , National Institute of Dental and Craniofacial Research , and private dental companies have collaborated in a number of important advances in dental materials, devices, and analytical systems. [ citation needed ]
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The Fairweather Lodge Program is a psychosocial rehabilitation model in which residents live together and run or participate in a business that provides them with employment. As of 2006, there were over 90 Fairweather Lodges in 16 US states.
The Fairweather Lodge Program was developed by psychologist George Fairweather in California in 1963. [ 1 ] Fairweather found that patients with serious and persistent mental illness were less likely to require rehospitalization (i.e., "community tenure" is longer)when they lived and worked together in the community as a group, rather than individually.
A “Fairweather Lodge” is a home that offers support for adults with mental illness. The Lodge setting is shared, independent housing and can be offered either short-term or long-term, depending on the needs and desires of the individual. Lodge members are active, productive men and women who share the responsibilities of household management and support each other in recovery. This interdependence relies on the skills and competencies of each individual and utilizes them to create a family style of living. By residing together, each member's potential standard of living can be greatly improved through companionship, shared expenses and mutual peer support. A Lodge managed by its members through group decision-making. While staff, provided by a sponsoring agency, may serve as advisors and be available in emergencies, on-site staffing is very limited.
The Fairweather Lodge model also includes an employment component, with the understanding that participation in gainful employment supports mental health recovery. To provide employment, a Lodge may run a small business chosen by member consensus and jointly planned. Alternatively, the sponsoring agency may provide employment to Lodge residents through its own business initiatives.
1. The lodge must provide the residents a safe, healthy and caring environment that reinforces the recovery process.
2. The lodge must be a part of the overall plan for managing the residents' mental health symptoms and promoting good mental health.
3. The sponsor must provide services to the residents as long as they want and need them. The lodge must allow open entry and exit for the residents.
4. Residents with psychiatric disabilities can increase their community success and raise their social status through employment, through accumulating wealth and through direct consumerism .
5. Aside from their roles in the lodge business, residents need to have meaningful roles in the larger community.
6. A successful lodge resembles a family.
7. In order to progress, residents with psychiatric disabilities need autonomy that is commensurate with their abilities with the ultimate goal is full autonomy. The lodge must provide its residents with as much autonomy as possible.
8. The lodge must not depend on resources from any single entity, or on the philanthropy of its host community.
The Coalition for Community Living (CCL) is a national organization that promotes the Fairweather Lodge model and monitors the lodge programs.
Each quarter, the CCL collects outcome data on each lodge to determine if it can be certified as a Fairweather Lodge. The outcome measures gauge adherence to the Faiweather principles and are designed to track meaningful quality of life indicators, such as safety and desirability of housing, access to quality mental health services, employment and earnings, healthy lifestyle and community belonging and personal autonomy.
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Fairy riding ( Scottish Gaelic : marcachd shìth / a' mharcachd-shìth / na marcachd-shìth ) was a term used for a kind of paralysis found in livestock in Scotland . It occurred in the spine of sheep , cows and horses , and was attributed to fairies riding on them.
It was also attributed in some places where perspiration , due to weakness , was discovered in cattle .
It can be compared to elf-shot , where fairies were thought to have shot animals.
This medical article is a stub . You can help Wikipedia by expanding it .
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Faith healing is the practice of prayer and gestures (such as laying on of hands ) that are believed by some to elicit divine intervention in spiritual and physical healing, especially the Christian practice. [ 1 ] Believers assert that the healing of disease and disability can be brought about by religious faith through prayer or other rituals that, according to adherents, can stimulate a divine presence and power. Religious belief in divine intervention does not depend on empirical evidence of an evidence-based outcome achieved via faith healing. [ 2 ] Virtually all [ a ] scientists and philosophers dismiss faith healing as pseudoscience . [ 3 ] [ 4 ] [ 5 ] [ 6 ]
Claims that "a myriad of techniques" such as prayer , divine intervention , or the ministrations of an individual healer can cure illness have been popular throughout history. [ 7 ] There have been claims that faith can cure blindness , deafness , cancer , HIV/AIDS , developmental disorders , anemia , arthritis , corns , defective speech , multiple sclerosis , skin rashes , total body paralysis , and various injuries. [ 8 ] Recoveries have been attributed to many techniques commonly classified as faith healing. It can involve prayer, a visit to a religious shrine , or simply a strong belief in a supreme being. [ 8 ]
Many people interpret the Bible , especially the New Testament , as teaching belief in, and the practice of, faith healing. According to a 2004 Newsweek poll, 72 percent of Americans said they believe that praying to God can cure someone, even if science says the person has an incurable disease. [ 9 ] Unlike faith healing, advocates of spiritual healing make no attempt to seek divine intervention, instead believing in divine energy. The increased interest in alternative medicine at the end of the 20th century has given rise to a parallel interest among sociologists in the relationship of religion to health. [ 2 ]
Faith healing can be classified as a spiritual , supernatural , [ 10 ] or paranormal topic, [ 11 ] and, in some cases, belief in faith healing can be classified as magical thinking . [ 12 ] The American Cancer Society states "available scientific evidence does not support claims that faith healing can actually cure physical ailments". [ 8 ] "Death, disability, and other unwanted outcomes have occurred when faith healing was elected instead of medical care for serious injuries or illnesses." [ 8 ] When parents have practiced faith healing but not medical care, many children have died that otherwise would have been expected to live. [ 13 ] Similar results are found in adults. [ 14 ]
Regarded as a Christian belief that God heals people through the power of the Holy Spirit , faith healing often involves the laying on of hands . It is also called supernatural healing, divine healing, and miracle healing, among other things. Healing in the Bible is often associated with the ministry of specific individuals including Elijah , Jesus and Paul . [ 2 ]
Christian physician Reginald B. Cherry views faith healing as a pathway of healing in which God uses both the natural and the supernatural to heal. [ 15 ] Being healed has been described as a privilege of accepting Christ's redemption on the cross. [ 16 ] Pentecostal writer Wilfred Graves Jr. views the healing of the body as a physical expression of salvation . [ 17 ] Matthew 8:17 , after describing Jesus exorcising at sunset and healing all of the sick who were brought to him, quotes these miracles as a fulfillment of the prophecy in Isaiah 53:5 : "He took up our infirmities and carried our diseases".
Even those Christian writers who believe in faith healing do not all believe that one's faith presently brings about the desired healing. "[Y]our faith does not effect your healing now. When you are healed rests entirely on what the sovereign purposes of the Healer are." [ 18 ] Larry Keefauver cautions against allowing enthusiasm for faith healing to stir up false hopes. "Just believing hard enough, long enough or strong enough will not strengthen you or prompt your healing. Doing mental gymnastics to 'hold on to your miracle' will not cause your healing to manifest now." [ 18 ] Those who actively lay hands on others and pray with them to be healed are usually aware that healing may not always follow immediately. Proponents of faith healing say it may come later, and it may not come in this life. "The truth is that your healing may manifest in eternity, not in time". [ 18 ]
Parts of the four canonical gospels in the New Testament say that Jesus cured physical ailments well outside the capacity of first-century medicine. Jesus' healing acts are considered miraculous and spectacular due to the results being impossible or statistically improbable. [ 19 ] One example is the case of "a woman who had had a discharge of blood for twelve years, and who had suffered much under many physicians, and had spent all that she had, and was not better but rather grew worse". [ 20 ] After healing her, Jesus tells her "Daughter, your faith has made you well. Go in peace! Be cured from your illness". [ 21 ] At least two other times Jesus credited the sufferer's faith as the means of being healed: Mark 10:52 and Luke 19:10 .
Jesus endorsed the use of the medical assistance of the time (medicines of oil and wine) when he told the parable of the Good Samaritan (Luke 10:25–37), who "bound up [an injured man's] wounds, pouring on oil and wine" (verse 34) as a physician would. Jesus then told the doubting teacher of the law (who had elicited this parable by his self-justifying question, "And who is my neighbor?" in verse 29) to "go, and do likewise" in loving others with whom he would never ordinarily associate (verse 37). [ 22 ]
The healing in the gospels is referred to as a "sign" [ 23 ] to prove Jesus' divinity and to foster belief in him as the Christ. [ 24 ] However, when asked for other types of miracles, Jesus refused some [ 25 ] but granted others [ 26 ] in consideration of the motive of the request. Some theologians' understanding is that Jesus healed all who were present every single time. [ 27 ] Sometimes he determines whether they had faith that he would heal them. [ 28 ] Four of the seven miraculous signs performed in the Fourth Gospel that indicated he was sent from God were acts of healing or resurrection. He heals the Capernaum official's son, heals a paralytic by the pool in Bethsaida , healing a man born blind, and resurrecting Lazarus of Bethany . [ 29 ]
Jesus told his followers to heal the sick [ 30 ] and stated that signs such as healing are evidence of faith. Jesus also told his followers to "cure sick people, raise up dead persons, make lepers clean, expel demons. You received free, give free". [ 31 ]
Jesus sternly ordered many who received healing from him: "Do not tell anyone!" [ 32 ] Jesus did not approve of anyone asking for a sign just for the spectacle of it, describing such as coming from a "wicked and adulterous generation". [ 33 ]
The apostle Paul believed healing is one of the special gifts of the Holy Spirit , [ 34 ] [ 35 ] and that the possibility exists that certain persons may possess this gift to an extraordinarily high degree. [ 36 ]
In the New Testament Epistle of James , [ 37 ] the faithful are told that to be healed, those who are sick should call upon the elders of the church to pray over [them] and anoint [them] with oil in the name of the Lord.
The New Testament says that during Jesus' ministry and after his Resurrection , the apostles healed the sick and cast out demons, made lame men walk, raised the dead and performed other miracles. Apostles were holy men who had direct access to God and could channel his power to help and heal people. [ 38 ] For example, Saint Peter healed a disabled man. [ 39 ] [ 40 ]
Jesus used miracles to convince people that he was inaugurating the Messianic Age , as in Mt 12.28. Scholars have described Jesus' miracles as establishing the kingdom during his lifetime. [ 41 ]
Accounts or references to healing appear in the writings of many Ante Nicene Fathers , although many of these mentions are very general and do not include specifics. [ 42 ]
The Roman Catholic Church recognizes two "not mutually exclusive" kinds of healing, [ 43 ] : I,3 [ 44 ] : nn2–3 one justified by science and one justified by faith:
The Catechism of the Catholic Church states that "the Holy spirit gives to some a special charism of healing" but also that "the most intense prayers do not always obtain the healing of all illnesses" by which it cites St. Paul as a biblical example of someone who found meaning in their own suffering. [ 45 ]
In 2000, the Congregation for the Doctrine of the Faith issued "Instruction on prayers for healing" with specific norms about prayer meetings for obtaining healing, [ 43 ] which presents the Catholic Church's doctrines of sickness and healing. [ 46 ] : 230 [ further explanation needed ]
It accepts "that there may be means of natural healing that have not yet been understood or recognized by science", [ 44 ] : n6 [ b ] but it rejects superstitious practices which are neither compatible with Christian teaching nor compatible with scientific evidence. [ 44 ] : nn11–12
Faith healing is reported by Catholics as the result of intercessory prayer to a saint or to a person with the gift of healing . According to U.S. Catholic magazine, "Even in this skeptical, postmodern, scientific age – miracles really are possible." According to a Newsweek poll, three-fourths of American Catholics say they pray for "miracles" of some sort. [ 48 ]
According to John Cavadini, when healing is granted, "The miracle is not primarily for the person healed, but for all people, as a sign of God's work in the ultimate healing called 'salvation', or a sign of the kingdom that is coming." Some might view their own healing as a sign they are particularly worthy or holy, while others do not deserve it. [ 48 ]
The Catholic Church has a special Congregation dedicated to the careful investigation of the validity of alleged miracles attributed to prospective saints. Pope Francis tightened the rules on money and miracles in the canonization process. [ 49 ] Since Catholic Christians believe the lives of canonized saints in the Church will reflect Christ's, many have come to expect healing miracles. While the popular conception of a miracle can be wide-ranging, the Catholic Church has a specific definition for the kind of miracle formally recognized in a canonization process. [ 50 ]
According to Catholic Encyclopedia , it is often said that cures at shrines and during Christian pilgrimages are mainly due to psychotherapy – partly to confident trust in Divine providence , and partly to the strong expectancy of cure that comes over suggestible persons at these times and places. [ 47 ] [ c ]
Among the best-known accounts by Catholics of faith healings are those attributed to the miraculous intercession of the apparition of the Blessed Virgin Mary known as Our Lady of Lourdes at the Sanctuary of Our Lady of Lourdes in France and the remissions of life-threatening disease claimed by those who have applied for aid to Saint Jude , who is known as the " patron saint of lost causes". [ failed verification – see discussion ] [ 51 ]
As of 2004 [update] , Catholic medics have asserted that there have been 67 miracles and 7,000 unexplainable medical cures at Lourdes since 1858. [ 52 ] In a 1908 book, it says these cures were subjected to intense medical scrutiny and were only recognized as authentic spiritual cures after a commission of doctors and scientists, called the Lourdes Medical Bureau , had ruled out any physical mechanism for the patient's recovery. [ 53 ]
In some Pentecostal and Charismatic Evangelical churches, a special place is thus reserved for faith healings with laying on of hands during worship services or for campaigns evangelization. [ 54 ] [ 55 ] Faith healing or divine healing is considered to be an inheritance of Jesus acquired by his death and resurrection. [ 56 ] Biblical inerrancy ensures that the miracles and healings described in the Bible are still relevant and may be present in the life of the believer. [ 57 ]
At the beginning of the 20th century, the new Pentecostal movement drew participants from the Holiness movement and other movements in America that already believed in divine healing. By the 1930s, several faith healers drew large crowds and established worldwide followings.
The first Pentecostals in the modern sense appeared in Topeka, Kansas , in a Bible school conducted by Charles Fox Parham , a holiness teacher and former Methodist pastor. Pentecostalism achieved worldwide attention in 1906 through the Azusa Street Revival in Los Angeles led by William Joseph Seymour . [ 58 ]
Smith Wigglesworth was also a well-known figure in the early part of the 20th century. A former English plumber turned evangelist who lived simply and read nothing but the Bible from the time his wife taught him to read, Wigglesworth traveled around the world preaching about Jesus and performing faith healings. Wigglesworth claimed to raise several people from the dead in Jesus' name in his meetings. [ 59 ]
During the 1920s and 1930s, Aimee Semple McPherson was a controversial faith healer of growing popularity during the Great Depression . Subsequently, William M. Branham has been credited as the initiator of the post-World War II healing revivals . [ 60 ] : 58 [ 61 ] : 25 The healing revival he began led many to emulate his style and spawned a generation of faith healers. Because of this, Branham has been recognized as the "father of modern faith healers". [ 62 ] According to writer and researcher Patsy Sims, "the power of a Branham service and his stage presence remains a legend unparalleled in the history of the Charismatic movement". [ 63 ] By the late 1940s, Oral Roberts , who was associated with and promoted by Branham's Voice of Healing magazine also became well known, and he continued with faith healing until the 1980s. [ 64 ] Roberts discounted faith healing in the late 1950s, stating, "I never was a faith healer and I was never raised that way. My parents believed very strongly in medical science and we have a doctor who takes care of our children when they get sick. I cannot heal anyone – God does that." [ 65 ] A friend of Roberts was Kathryn Kuhlman , another popular faith healer, who gained fame in the 1950s and had a television program on CBS . Also in this era, Jack Coe [ 66 ] [ 67 ] and A. A. Allen [ 68 ] were faith healers who traveled with large tents for large open-air crusades.
Oral Roberts's successful use of television as a medium to gain a wider audience led others to follow suit. His former pilot, Kenneth Copeland , started a healing ministry. Pat Robertson , Benny Hinn , and Peter Popoff became well-known televangelists who claimed to heal the sick. [ 69 ] Richard Rossi is known for advertising his healing clinics through secular television and radio. Kuhlman influenced Benny Hinn, who adopted some of her techniques and wrote a book about her. [ 70 ]
Christian Science claims that healing is possible through prayer based on an understanding of God and the underlying spiritual perfection of God's creation. [ 7 ] [ 71 ] The material world as humanly perceived is believed to not be the spiritual reality. Christian Scientists believe that healing through prayer is possible insofar as it succeeds in bringing the spiritual reality of health into human experience. [ 72 ] Prayer does not change the spiritual creation but gives a clearer view of it, and the result appears in the human scene as healing: the human picture adjusts to coincide more nearly with the divine reality. [ 73 ] Therefore, Christian Scientists do not consider themselves to be faith healers since faith or belief in Christian Science is not required on the part of the patient, and because they consider healings reliable and provable rather than random. [ 74 ] [ 75 ]
Although there is no hierarchy in Christian Science, practitioners devote full time to prayer for others on a professional basis, and advertise in an online directory published by the church. [ 76 ] [ 77 ] Christian Scientists sometimes tell their stories of healing at weekly testimony meetings at local Christian Science churches, or publish them in the church's magazines including The Christian Science Journal printed monthly since 1883, the Christian Science Sentinel printed weekly since 1898, and The Herald of Christian Science a foreign language magazine beginning with a German edition in 1903 and later expanding to Spanish, French, and Portuguese editions. Christian Science Reading Rooms often have archives of such healing accounts. [ 78 ] [ 77 ]
The Church of Jesus Christ of Latter-day Saints (LDS) has had a long history of faith healings. Many members of the LDS Church have told their stories of healing within the LDS publication, the Ensign . [ 79 ] [ 80 ] [ 81 ] [ 82 ] The church believes healings come most often as a result of priesthood blessings given by the laying on of hands; however, prayer often accompanied with fasting is also thought to cause healings. Healing is always attributed to be God's power. Latter-day Saints believe that the Priesthood of God, held by prophets (such as Moses) and worthy disciples of the Savior, was restored via heavenly messengers to the first prophet of this dispensation, Joseph Smith . [ 83 ] [ 84 ]
According to LDS doctrine, even though members may have the restored priesthood authority to heal in the name of Jesus Christ, all efforts should be made to seek the appropriate medical help. Brigham Young stated this effectively, while also noting that the ultimate outcome is still dependent on the will of God. [ 85 ]
If we are sick, and ask the Lord to heal us, and to do all for us that is necessary to be done, according to my understanding of the Gospel of salvation, I might as well ask the Lord to cause my wheat and corn to grow, without my plowing the ground and casting in the seed. It appears consistent to me to apply every remedy that comes within the range of my knowledge, and to ask my Father in Heaven, in the name of Jesus Christ, to sanctify that application to the healing of my body. [ 86 ]
But suppose we were traveling in the mountains, ... and one or two were taken sick, without anything in the world in the shape of healing medicine within our reach, what should we do? According to my faith, ask the Lord Almighty to ... heal the sick. This is our privilege, when so situated that we cannot get anything to help ourselves. Then the Lord and his servants can do all. But it is my duty to do, when I have it in my power. [ 86 ]
We lay hands on the sick and wish them to be healed, and pray the Lord to heal them, but we cannot always say that he will. [ 87 ]
A number of healing traditions exist among Muslims. Some healers are particularly focused on diagnosing cases of possession by jinn or demons. [ 88 ]
Chinese-born Australian businessman Jun Hong Lu was a prominent proponent of the " Guan Yin Citta Dharma Door", claiming that practicing the three "golden practices" of reciting texts and mantras, liberation of beings, and making vows, laid a solid foundation for improved physical, mental, and psychological well-being, with many followers publicly attesting to have been healed through practice. [ 89 ]
Some critics of Scientology have referred to some of its practices as being similar to faith healing, based on claims made by L. Ron Hubbard in Dianetics: The Modern Science of Mental Health and other writings. [ 90 ]
Nearly all [ a ] scientists dismiss faith healing as pseudoscience. [ 3 ] [ 4 ] [ 5 ] [ 6 ] Believers assert that faith healing makes no scientific claims and thus should be treated as a matter of faith that is not testable by science. [ 91 ] Critics reply that claims of medical cures should be tested scientifically because, although faith in the supernatural is not in itself usually considered to be the purview of science, [ 92 ] [ 93 ] [ d ] claims of reproducible effects are nevertheless subject to scientific investigation. [ 4 ] [ 91 ]
Scientists and doctors generally find that faith healing lacks biological plausibility or epistemic warrant, [ 3 ] : 30–31 which is one of the criteria used to judge whether clinical research is ethical and financially justified. [ 95 ] A Cochrane review of intercessory prayer found "although some of the results of individual studies suggest a positive effect of intercessory prayer, the majority do not". [ 96 ] The authors concluded: "We are not convinced that further trials of this intervention should be undertaken and would prefer to see any resources available for such a trial used to investigate other questions in health care". [ 96 ]
A review in 1954 investigated spiritual healing , therapeutic touch and faith healing. Of the hundred cases reviewed, none revealed that the healer's intervention alone resulted in any improvement or cure of a measurable organic disability. [ 97 ]
In addition, at least one study has suggested that adult Christian Scientists, who generally use prayer rather than medical care, have a higher death rate than other people of the same age. [ 8 ]
The Global Medical Research Institute (GMRI) was created in 2012 to start collecting medical records of patients who claim to have received a supernatural healing miracle as a result of Christian Spiritual Healing practices. The organization has a panel of medical doctors who review the patient's records looking at entries prior to the claimed miracles and entries after the miracle was claimed to have taken place. "The overall goal of GMRI is to promote an empirically grounded understanding of the physiological, emotional, and sociological effects of Christian Spiritual Healing practices". [ 98 ] This is accomplished by applying the same rigorous standards used in other forms of medical and scientific research.
A 2011 article in the New Scientist magazine cited positive physical results from meditation, positive thinking and spiritual faith [ 99 ]
I have visited Lourdes in France and Fatima in Portugal, healing shrines of the Christian Virgin Mary. I have also visited Epidaurus in Greece and Pergamum in Turkey, healing shrines of the pagan god Asklepios. The miraculous healings recorded in both places were remarkably the same. There are, for example, many crutches hanging in the grotto of Lourdes, mute witness to those who arrived lame and left whole. There are, however, no prosthetic limbs among them, no witnesses to paraplegics whose lost limbs were restored.
Skeptics of faith healing offer primarily two explanations for anecdotes of cures or improvements, relieving any need to appeal to the supernatural. [ e ] [ 102 ] The first is post hoc ergo propter hoc , meaning that a genuine improvement or spontaneous remission may have been experienced coincidental with but independent from anything the faith healer or patient did or said. These patients would have improved just as well even had they done nothing. The second is the placebo effect, through which a person may experience genuine pain relief and other symptomatic alleviation. In this case, the patient genuinely has been helped by the faith healer or faith-based remedy, not through any mysterious or numinous function, but by the power of their own belief that they would be healed. [ 103 ] [ f ] [ 104 ] In both cases the patient may experience a real reduction in symptoms, though in neither case has anything miraculous or inexplicable occurred. Both cases, however, are strictly limited to the body's natural abilities.
According to the American Cancer Society : [ 8 ]
... available scientific evidence does not support claims that faith healing can actually cure physical ailments... One review published in 1998 looked at 172 cases of deaths among children treated by faith healing instead of conventional methods. These researchers estimated that if conventional treatment had been given, the survival rate for most of these children would have been more than 90 percent, with the remainder of the children also having a good chance of survival. A more recent study found that more than 200 children had died of treatable illnesses in the United States over the past thirty years because their parents relied on spiritual healing rather than conventional medical treatment.
The American Medical Association considers that prayer as therapy should not be a medically reimbursable or deductible expense. [ 105 ]
Belgian philosopher and skeptic Etienne Vermeersch coined the term Lourdes effect as a criticism of the magical thinking and placebo effect possibilities for the claimed miraculous cures as there are no documented events where a severed arm has been reattached through faith healing at Lourdes. Vermeersch identifies ambiguity and equivocal nature of the miraculous cures as a key feature of miraculous events. [ 106 ] [ 107 ] [ 108 ]
Reliance on faith healing to the exclusion of other forms of treatment can have a public health impact when it reduces or eliminates access to modern medical techniques. [ g ] [ h ] [ i ] This is evident in both higher mortality rates for children [ 13 ] and in reduced life expectancy for adults. [ 14 ] Critics have also made note of serious injury that has resulted from falsely labelled "healings", where patients erroneously consider themselves cured and cease or withdraw from treatment. [ 7 ] [ j ] For example, at least six people have died after faith healing by their church and being told they had been healed of HIV and could stop taking their medications. [ 111 ] It is the stated position of the AMA that "prayer as therapy should not delay access to traditional medical care". [ 105 ] Choosing faith healing while rejecting modern medicine can and does cause people to die needlessly. [ 112 ]
Christian theological criticism of faith healing broadly falls into two distinct levels of disagreement.
The first is widely termed the "open-but-cautious" view of the miraculous in the church today. This term is deliberately used by Robert L. Saucy in the book Are Miraculous Gifts for Today? . [ 113 ] Don Carson is another example of a Christian teacher who has put forward what has been described as an "open-but-cautious" view. [ 114 ] In dealing with the claims of Warfield , particularly "Warfield's insistence that miracles ceased", [ 115 ] Carson asserts, "But this argument stands up only if such miraculous gifts are theologically tied exclusively to a role of attestation; and that is demonstrably not so." [ 115 ] However, while affirming that he does not expect healing to happen today, Carson is critical of aspects of the faith healing movement, "Another issue is that of immense abuses in healing practises.... The most common form of abuse is the view that since all illness is directly or indirectly attributable to the devil and his works, and since Christ by his cross has defeated the devil, and by his Spirit has given us the power to overcome him, healing is the inheritance right of all true Christians who call upon the Lord with genuine faith." [ 116 ]
The second level of theological disagreement with Christian faith healing goes further. Commonly referred to as cessationism , its adherents either claim that faith healing will not happen today at all, or may happen today, but it would be unusual. Richard Gaffin argues for a form of cessationism in an essay alongside Saucy's in the book Are Miraculous Gifts for Today ? In his book Perspectives on Pentecost [ 117 ] Gaffin states of healing and related gifts that "the conclusion to be drawn is that as listed in 1 Corinthians 12(vv. 9f., 29f.) and encountered throughout the narrative in Acts, these gifts, particularly when exercised regularly by a given individual, are part of the foundational structure of the church... and so have passed out of the life of the church." [ 118 ] Gaffin qualifies this, however, by saying "At the same time, however, the sovereign will and power of God today to heal the sick, particularly in response to prayer (see e.g. James 5:14, 15), ought to be acknowledged and insisted on." [ 119 ]
According to the Catholic apologist Trent Horn, while the Bible teaches believers to pray when they are sick, this is not to be viewed as an exclusion of medical care, citing Sirach 38:9,12-14:
"when you are sick do not be negligent, but pray to the Lord, and he will heal you...And give the physician his place, for the Lord created him; let him not leave you, for there is need of him. There is a time when success lies in the hands of physicians, for they too will pray to the Lord, that he should grant them success in diagnosis and in healing, for the sake of preserving life." [ 120 ]
Skeptics of faith healers point to fraudulent practices either in the healings themselves (such as plants in the audience with fake illnesses), or concurrent with the healing work supposedly taking place and claim that faith healing is a quack practice in which the "healers" use well known non-supernatural illusions to exploit credulous people in order to obtain their gratitude, confidence and money. [ 69 ] James Randi 's The Faith Healers investigates Christian evangelists such as Peter Popoff , who claimed to heal sick people on stage in front of an audience. Popoff pretended to know private details about participants' lives by receiving radio transmissions from his wife who was off-stage and had gathered information from audience members prior to the show. [ 69 ] According to this book, many of the leading modern evangelistic healers have engaged in deception and fraud. [ 121 ] The book also questioned how faith healers use funds that were sent to them for specific purposes. [ k ] Physicist Robert L. Park [ 103 ] and doctor and consumer advocate Stephen Barrett [ 7 ] have called into question the ethics of some exorbitant fees.
There have also been legal controversies. For example, in 1955 at a Jack Coe revival service in Miami , Florida, Coe told the parents of a three-year-old boy that he healed their son who had polio. [ 122 ] [ 123 ] Coe then told the parents to remove the boy's leg braces . [ 122 ] [ 123 ] However, their son was not cured of polio and removing the braces left the boy in constant pain. [ 122 ] [ 123 ] [ 124 ] As a result, through the efforts of Joseph L. Lewis , Coe was arrested and charged on February 6, 1956, with practicing medicine without a license, a felony in the state of Florida. [ 125 ] A Florida Justice of the Peace dismissed the case on grounds that Florida exempts divine healing from the law. [ 67 ] [ 126 ] [ 127 ] Later that year Coe was diagnosed with bulbar polio , and died a few weeks later at Dallas' Parkland Hospital on December 17, 1956. [ 122 ] [ 128 ] [ 129 ] [ 130 ]
TV personality Derren Brown produced a show on faith healing entitled Miracles for Sale which arguably exposed the art of faith healing as a scam. In this show, Derren trained a scuba diver trainer picked from the general public to be a faith healer and took him to Texas to successfully deliver a faith healing session to a congregation. [ 131 ]
The 1974 Child Abuse Prevention and Treatment Act (CAPTA) required states to grant religious exemptions to child neglect and child abuse laws in order to receive federal money. [ 132 ] The CAPTA amendments of 1996 42 U.S.C. § 5106i state:
(a) In General. – Nothing in this Act shall be construed –
"(1) as establishing a Federal requirement that a parent or legal guardian provide a child any medical service or treatment against the religious beliefs of the parent or legal guardian; and "(2) to require that a State find, or to prohibit a State from finding, abuse or neglect in cases in which a parent or legal guardian relies solely or partially upon spiritual means rather than medical treatment, in accordance with the religious beliefs of the parent or legal guardian.
"(b) State Requirement. – Notwithstanding subsection (a), a State shall, at a minimum, have in place authority under State law to permit the child protective services system of the State to pursue any legal remedies, including the authority to initiate legal proceedings in a court of competent jurisdiction, to provide medical care or treatment for a child when such care or treatment is necessary to prevent or remedy serious harm to the child, or to prevent the withholding of medically indicated treatment from children with life threatening conditions. Except with respect to the withholding of medically indicated treatments from disabled infants with life threatening conditions, case by case determinations concerning the exercise of the authority of this subsection shall be within the sole discretion of the State.
Thirty-one states have child-abuse religious exemptions. These are Alabama, Alaska, California, Colorado, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Minnesota, Mississippi, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, Ohio, Oklahoma, Oregon, Pennsylvania, Vermont, Virginia, and Wyoming. [ 133 ] In six of these states, Arkansas, Idaho, Iowa, Louisiana, Ohio and Virginia, the exemptions extend to murder and manslaughter. Of these, Idaho is the only state accused of having a large number of deaths due to the legislation in recent times. [ 134 ] [ 135 ] In February 2015, controversy was sparked in Idaho over a bill believed to further reinforce parental rights to deny their children medical care. [ 136 ]
Parents of an 11-year-old girl were convicted of child abuse and felony reckless negligent homicide and found responsible for killing their children when they withheld lifesaving medical care and chose only prayers. [ 137 ]
Parents of an 8-year-old girl in Australia and 12 members of their religious sect were found guilty of manslaughter for withholding lifesaving medication. Members of the sect sang and prayed rather than seeking medical help. [ 138 ]
Pitt, Joseph C.; Pera, Marcello (2012). Rational Changes in Science: Essays on Scientific Reasoning . Springer Science & Business Media. ISBN 978-9400937796 . Retrieved 18 April 2018 . Such examples of pseudoscience as the theory of biorhythms, astrology, dianetics, creationism, faith healing may seem too obvious examples of pseudoscience for academic readers.
Zerbe, Michael J. (2007). Composition and the Rhetoric of Science: Engaging the Dominant Discourse . SIU Press. p. 86. ISBN 978-0809327409 . [T]he authors of the 2002 National Science Foundation Science and Engineering Indicators devoted and entire section of their report to the concern that the public is increasingly trusting in pseudoscience such as astrology, UFOs and alien abduction, extrasensory perception, channeling the dead, faith healing, and psychic hotlines.
Robert Cogan (1998). Critical Thinking: Step by Step . University Press of America. p. 217 . ISBN 978-0761810674 . Faith healing is probably the most dangerous pseudoscience.
Leonard, Bill J. ; Crainshaw, Jill Y. (2013). Encyclopedia of Religious Controversies in the United States: A–L . ABC-CLIO. ISBN 978-1598848670 . Retrieved 18 April 2018 . Certain approaches to faith healing are also widely considered to be pseudoscientific, including those of Christian Science, voodoo, and Spiritualism.
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https://en.wikipedia.org/wiki/Faith_healing
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The familial amyloid neuropathies (or familial amyloidotic neuropathies , neuropathic heredofamilial amyloidosis , familial amyloid polyneuropathy ) are a rare group of autosomal dominant diseases wherein the autonomic nervous system and/or other nerves are compromised by protein aggregation and/or amyloid fibril formation. [ 1 ] [ 2 ] [ 3 ]
The aggregation of one precursor protein leads to peripheral neuropathy and/or autonomic nervous system dysfunction. These proteins include: transthyretin (ATTR, the most commonly implicated protein), apolipoprotein A1 , and gelsolin . [ 4 ]
Due to the rareness of the other types of familial neuropathies, transthyretin amyloidogenesis-associated polyneuropathy should probably be considered first. [ 5 ]
"FAP-I" and "FAP-II" are associated with transthyretin . [ 1 ] [ 6 ] ( Senile systemic amyloidosis [abbreviated "SSA"] is also associated with transthyretin aggregation.)
"FAP-III" is also known as "Iowa-type", and involves apolipoprotein A1 . [ 7 ]
"FAP-IV" is also known as " Finnish-type ", and involves gelsolin . [ 8 ]
Fibrinogen , apolipoprotein A1 , and lysozyme are associated with a closely related condition, familial visceral amyloidosis .
Diagnosis is confirmed by blood tests, organ biopsies, and tissue biopsies. Genetic testing can also be used to confirm a mutation in the TTR gene. Although some people with a hATTR gene mutation may not experience symptoms.
Liver transplantation has proven to be effective for ATTR familial amyloidosis due to Val30Met mutation. [ 9 ]
In 2011 the European Medicines Agency approved tafamidis for this condition. [ 10 ] The FDA rejected the application for marketing approval in the US in 2012 on the basis that the clinical trial data did not show efficacy based on a functional endpoint, and the FDA requested further clinical trials. [ 11 ]
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https://en.wikipedia.org/wiki/Familial_amyloid_neuropathy
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