Mean Sensation Research Articles

Reconstruction of Multiple Lip and Facial Defects With Bipaddle and Sensate Radial Forearm Free Flap.

Free flaps and their modifications are used to reconstruct multiple large defects in the lip and face. In this study, we present our results on the reconstruction of these defects using bipaddle and sensate free radial forearm-palmaris longus flaps and subsequent revision surgeries. Patient medical records of 11 patients with a mean age of 63.9 ± 12.8 years were retrospectively reviewed. Functional oral competence, lip cosmetics, lip sensation, and donor forearm scars were evaluated using the drooling rating scale, visual analog scale, Semmes Weinstein Monofilament test, and patient and observer scar assessment scale, respectively. The mean dimensions of distal and proximal skin paddles of bipaddle free radial forearm-palmaris longus flaps were 12.7 ± 9.9 and 20.5 ± 3.8 cm2. Mean lengths of the bridge and proximal pedicles were 4.7 ± 1.6 and 5.5 ± 0.7 cm. All the flaps survived. No drooling was observed in the 2 patients without lower lip defects. The mean drooling scores of the 9 patients with lower lip defects were statistically different (Analysis of Variance, pANOVA < 0.00001) at 3, 6, 9, and 12 months postoperatively. The differences between 3 and 12 months were the most significant (pANOVA < 0.00001, pTUKEY < 0.000001). The lip sensation and drooling scores showed a strong positive correlation (r = 0.8504). All patients were able to speak fluently, drink fluid without leakage, and blow a balloon easily. All patients and observers were satisfied with the lip cosmetics, with no significant difference between satisfaction scores (P = 0.087615).There was a statistically significant difference (P < 0.00001) between mean sensation scores of surrounding healthy lip (2.94 ± 0.27) and free flaps (4.15 ± 0.4). All the donor scars healed uneventfully.

Psychoacoustic Characteristics of Tinnitus in Relation to Audiometric Profile

The aim of the study was to examine the relationship between tinnitus pitch and maximum hearing loss, frequency range of hearing loss, and the edge frequency of the audiogram, as well as, to analyze tinnitus loudness at tinnitus frequency and normal hearing frequency. The study included 212 patients, aged between 21 to 75 years (mean age of 54.4 ±13.5 years) with chronic subjective tinnitus and sensorineural hearing loss. For the statistical data analysis we used Chi-square test and Fisher’s exact test with level of significance p < 0.05. Tinnitus pitch corresponding to the frequency range of hearing loss, maximum hearing loss and the edge frequency was found in 70.8%, 37.3%, and 16.5% of the patients, respectively. The majority of patients had tinnitus pitch from 3000 to 8000 Hz corresponding to the range of hearing loss (p < 0.001). The mean tinnitus pitch was 3545 Hz ±2482. The majority (66%) of patients had tinnitus loudness 4–7 dB SL. The mean sensation level at tinnitus frequency was 4.9 dB SL ±1.9, and 13 dB SL ±2.9 at normal hearing frequency. Tinnitus pitch corresponded to the frequency range of hearing loss in majority of patients. There was no relationship between tinnitus pitch and the edge frequency of the audiogram. Loudness matching outside the tinnitus frequency showed higher sensation level than loudness matching at tinnitus frequency.

Physiological and perceptual responses of exposure to different thermal environments at low pressure (61.6 kPa)

In aerospace and military activities, people tend to encounter hypobaric and hypoxic extreme environments caused by the high-altitude, which can lead to physiological and perceptual changes of the human body, thus affecting work efficiency and health. In this study, ambient temperature is set at 21 °C, 26 °C, 30 °C, and altitude is set at 4000 m, with humidity of 40% and air velocity of less than 0.3 m/s. Besides, 13 healthy subjects were recruited to continuously measure their physiological parameters, including axillary temperature, local skin temperature, blood oxygen saturation, heart rate, and blood pressure, and the subjective parameters of overall and local thermal sensation. The main results are as follows: At 21 °C, the axillary temperature declined slightly over time. Also, there was a linear correlation between local skin temperature and thermal sensation. The heart rate and sweating rate under 30 °C were higher than under other conditions(P < 0.05). However, there was no significant difference in sweating rate between 21 °C and 26 °C(P = 0.99). Meanwhile, the sweat volume increased linearly with time under the three conditions(P < 0.001). The blood oxygen saturation was 82.2–83.6% at low pressure(61.6 kPa). Regarding thermal sensations, more than 84% of people felt neutral at 26 °C. This study found that the feet and calves were most sensitive to environmental temperature at 61.6 kPa. The human body's mean sensation thermal vote(MSTV) was kept in the range of −0.5∼+0.5, and the mean skin temperature in the thermal comfort zone was about 32.3–33.9 °C. Also, the recommended environmental temperature should be in the range of 23.3–28.6 °C.

P-065 PROSPECTIVE STUDY OF QUALITY OF LIFE OUTCOMES OF TOTALLY TRANSFASCIAL SUTURE FIXATION OF MESH WITH CLOSURE OF DEFECT IN LAPAROSCOPIC VENTRAL HERNIA REPAIR

Abstract Aim To study the Quality of life Outcome in totally transfacial suture fixation of mesh with primary closure of defect in laparoscopic ventral hernia repair with regards to: Materials &amp; Methods Patients who visited the OPD of General Surgery, KGMU, Lucknow, UP and was diagnosed as a case of symptomatic ventral and incisional hernia fulfilling the inclusion and exclusion criteria were enrolled. Results A total of 40 patients from OPD department of General Surgery were enrolled. Maximum numbers of patients in the study i.e. 14(35%) belong to M4. Mean BMI is 28.6. Mean defect size was 3.25 cm (Range- 2cm to 5 cm). Mean duration of hospital stay was 2.85 days. With this procedure the patients were able to resume his/her daily routines very early and a mean of 4.65 days was recorded among the 40 patients involved in the study. Also a mean of 11.6 days was recorded as the time taken to return to office works which was all within two weeks after the operation. Carolina's comfort scale measure quality of life score in pre-op and post-op period on sensation of mesh,pain sensation and limitation of movement . where the scores were added and the mean sensation of mesh at post-operative period was 0.30. Conclusion There was significant improvement in dimensions of body pain, physical function, vitality, emotional role, mental health and sensation of mesh in small and medium size hernia, with totally transfascial suture fixation of mesh.

Transcutaneous Electric Nerve Stimulation Reduces Pathological Sensation of Mesh One Week after Open Inguinal Hernia Surgery: Follow-Up Results from a Randomized, Double Blind and Placebo-Controlled Trial.

Background and Objectives: Quality of life (QoL) and chronic pain are important outcomes following hernia surgery. The long-term effects of Transcutaneous Electric Nerve Stimulation (TENS) on postoperative recovery are not well known. In this trial we investigated the role of TENS on QoL and on the incidence of chronic pain following inguinal hernia repair with mesh. Materials and Methods: A total of 80 male patients with elective primary unilateral hernia Lichtenstein repair were randomly allocated to receive TENS or a placebo-TENS procedure. The TENS group received conventional TENS twice a day on the first and second postoperative days. The intensity was set at 0–0.5 mA in the placebo-TENS group. General and hernia-specific QoL, as well as the incidence of chronic pain were assessed using SF-36v2 and the Carolinas comfort scale. Results: Less sensation of mesh was reported by the TENS group patients one week after surgery. At this time point, the mean sensation score was 6.07 ± 8.88 in the TENS group and 14.08 ± 16.67 in the placebo-TENS group (p = 0.029). Although at two days and one week postoperatively, TENS group patients tended to have less pain, less movement restrictions and better overall hernia-specific QoL, the differences were not statistically significant. At 6 months postoperatively, no incidence of chronic pain was found in either the placebo-TENS or TENS group. Conclusions: Conventional TENS applied in the early postoperative period following inguinal hernia repair with mesh was found to reduce mesh-related foreign body sensation one week after surgery. Promising results were also found for other QoL domains.

Probability mass functions forecasting of occupants’ sensation votes under the effects of temperature, illuminance, and sound level based on ANN

Occupants' individual sensation has been usually quantified under the stimulation of single environmental factor and presented by a mean sensation vote in previous literatures. However, individual factor sensation was affected by multiple environmental factors and personal sensation vote will probably deviate considerably from a mean vote. Hence, there is an attempt to adopt Probability Mass Function (PMF) as an evaluation method for presenting the distributions of occupants' sensation vote under the simultaneous stimulation of multiple environmental parameters and predict such distributions. Our investigation firstly conducted a controlled laboratory test and collected occupants' sensation votes on thermal, acoustic, and visual environments. Subsequently, we developed, optimized, and trained three artificial neural networks (ANNs) using the collected data for predicting PMFs of occupants' 7-point sensation votes i.e., thermal sensation vote, acoustic sensation vote, and visual sensation vote, under the simultaneously stimulus of temperature, illuminance , and sound level. Finally, the ANN models were generalized to predict the PMFs of thermal, visual, and acoustic sensation vote under different environments within typical ranges of environmental factors. Results indicated that the PMFs predicted by the trained ANN models show a good agreement with the collected vote proportion distributions. Thereafter, by comparing the expected values of sensation votes under different defined conditions, it confirmed the existence of crossed and interaction effects of multiple environmental factors on human comfort. The combinations of environmental parameters that lead to a neutral sensation were illustrated as a space with small thicknesses under three-dimensional coordinate system. The neutral air temperature, illumination, and sound level are between 23 °C–24.7 °C, 580 Lux~650 Lux, and 41.5 dB–43.5 dB, respectively. Moreover, the effect directions and effect sizes of temperature, illuminance, and sound level on occupants’ sensation were numerically expressed and discussed by variable control. Suggestions on environment control strategy and further research were also provided. • Probability Mass Function (PMF) was adopted as a description method for occupants' sensation votes. • Three Three-Input Seven-Output ANN models were developed for predicting PMFs of occupants' 7-point sensation votes. • Effect directions and effect sizes of temperature, illuminance, and sound level on sensation were numerically expressed.

Patient evaluations after local anesthesia with a computer-assisted method and a conventional syringe before and after reflection time: A prospective randomized controlled trial

ObjectivesThis prospective randomized controlled trial aimed to evaluate and compare patient response to a conventional syringe and a computer-controlled local anesthetic delivery system (CCLAD) both immediately and after reflection time, including the impact of anesthesia duration. MethodsTwenty adult patients (10 men and 10 women) with at least two tooth-neck defects each in different quadrants were treated with local buccal infiltration anesthesia. Using split-mouth design, one quadrant was anesthetized using a conventional syringe, the other with CCLAD. The time elapsed between time of injection and time of disappearance of numbness was recorded. Patients were asked to mark on a Visual Analog Scale their visual impression of the device regarding anxiety-inducement, their sensation of mucosal puncture, pain during administration, and pain perception during treatment for the two different methods as well as future preference immediately after treatment and after reflection time. ResultsThe level of anxiety-inducement and pain during administration were ranked three times higher with the conventional syringe (35.95%–11.85%, p < 0.001 and 21.3%–7.7%, p = 0.005, respectively). There was no difference in mean sensation of mucosal puncture, nor a statistically significant correlation between duration of administration and time until disappearance of numbness. Once anesthesia was administered, no pain during treatment was detected using either method. Patients’ preference of methods changed significantly with time in favor of CCLAD (p = 0.01). ConclusionsThe use of CCLAD increased patients' comfort visually and in terms of administration; patients’ preference in favor of CCLAD increased with time. Clinical significancePatients' preference of CCLAD over against the conventional syringe, even more so after reflection time, can imply the preference of CCLAD for clinicians, too, in order to enhance patients' and clinicians’ comfort.

Short-term isothermic heat acclimation elicits beneficial adaptations but medium-term elicits a more complete adaptation

PurposeTo investigate the effects of 60 min daily, short-term (STHA) and medium-term (MTHA) isothermic heat acclimation (HA) on the physiological and perceptual responses to exercise heat stress.MethodsSixteen, ultra-endurance runners (female = 3) visited the laboratory on 13 occasions. A 45 min sub-maximal (40% Wmax) cycling heat stress test (HST) was completed in the heat (40 °C, 50% relative humidity) on the first (HSTPRE), seventh (HSTSTHA) and thirteenth (HSTMTHA) visit. Participants completed 5 consecutive days of a 60 min isothermic HA protocol (target Tre 38.5 °C) between HSTPRE and HSTSTHA and 5 more between HSTSTHA and HSTMTHA. Heart rate (HR), rectal (Tre), skin (Tsk) and mean body temperature (Tbody), perceived exertion (RPE), thermal comfort (TC) and sensation (TS) were recorded every 5 min. During HSTs, cortisol was measured pre and post and expired air was collected at 15, 30 and 45 min.ResultsAt rest, Tre and Tbody were lower in HSTSTHA and HSTMTHA compared to HSTPRE, but resting HR was not different between trials. Mean exercising Tre, Tsk, Tbody, and HR were lower in both HSTSTHA and HSTMTHA compared to HSTPRE. There were no differences between HSTSTHA and HSTMTHA. Perceptual measurements were lowered by HA and further reduced during HSTMTHA.ConclusionA 60 min a day isothermic STHA was successful at reducing physiological and perceptual strain experienced when exercising in the heat; however, MTHA offered a more complete adaptation.

Поєднані ушкодження нервових та сухожилково-м’язових структур на передпліччі, що супроводжуються їх значними дефектами: роль вимушеної транспозиції м’язів у відновленні основних функцій кисті

Мета роботи: оцінити ефективність “вимушених” транспозицій при ушкодженнях сухожилково-м’язових та нервових структур на відновлення основних захватів кисті.&#x0D; Матеріали і методи. Проведено ретроспективний аналіз результатів реконструктивних втручань у 9 пацієнтів (6 чоловіків та 3 жінки) віком від 9 до 70 року (середній вік 36,4 року) із наслідками проксимальних поєднаних ушкоджень довгих нервів та сухожилково-м’язового апарату передньої поверхні передпліччя. Травма сухожилково-м’язового апарату була поєднана із ушкодженням в 4 випадках серединного нерва, в 4 випадках серединного та ліктьового нервів, в одному випадку – серединного нерва та поверхневої гілки променевого нерва. Термін, в який проводились реконструктивні втручання, складав у середньому 5 місяців (від 2 до 11 місяців) після травми. У 6 пацієнтів хірургічна реконструкція нервів полягала у виконанні автологічної пластики, у 2 пацієнтів – невролізу, в одного пацієнта – шва нерва. У 5 випадках “вимушена” транспозиція була виконана з метою відновлення незалежної функції довгого згинача 1 пальця, у 6 випадках – незалежної функції глибоких згиначів 2–3 пальців. Відновлення неврологічних функцій оцінювали за MRC Scale, класифікацією за Seddon, відновленням 4 захватів кисті, власною оцінкою відновлених функцій за Brief Michigan Hand Questionnaire.&#x0D; Результати досліджень та їх обговорення. У всіх 4 пацієнтів із ушкодженням лише серединного нерва відновлення чутливості становило в середньому 3,75 за Seddon. У 4 пацієнтів із ушкодженням серединного та ліктьового нервів відновлення чутливості становило в середньому 3 та 2 за Seddon відповідно. Неефективне відновлення протиставлення першого пальця в 2 пацієнтів скореговано транспозицією за Bunnel. У 4 пацієнтів із ушкодженням серединного та ліктьового нервів ми спостерігали незадовільне відновлення “внутрішніх” м’язів кисті. У 5 пацієнтів «вимушені» транспозиції відновили незалежну функцію довгого згинача 1 пальця, у 6 пацієнтів – незалежну функцію глибоких згиначів 2–3 пальців. У 9 пацієнтів комплексна хірургічна реконструкція відновила функцію поперечного долонного, діагонального долонного та щипкового захватів. У 4 пацієнтів (44 %) не досягнуто відновлення ключового захвату, у зв’язку із незадовільним відновленням “внутрішніх” м’язів кисті (ліктьовий нерв). Середня власна оцінка функції кисті за MBHQ відповідала задовільній у 9 пацієнтів – 70,12 балів в середньому (від 43,75 до 89,6).

The relationships between sensation seeking and a spectrum of e-cigarette use behaviors: Cross-sectional and longitudinal analyses specific to Texas adolescents

IntroductionSensation seeking is strongly associated with cigarette use in adolescents. However, few studies have investigated its relationship with adolescent e-cigarette use. This study examined cross-sectional and longitudinal associations between sensation seeking and a variety of e-cigarette use behaviors among Texas adolescents. MethodsThis study utilized two waves of data collected 6months apart through the Texas Adolescent Tobacco and Marketing Surveillance System (TATAMS) in 2014–2015 (n=2,488/N=461,069). TATAMS employs a complex probability-sampling design and is representative of students in 6th, 8th and 10th grades from five counties surrounding the four largest cities in Texas (Houston, Dallas/Ft. Worth, San Antonio, Austin). Weighted multivariable logistic regression was used to examine the cross-sectional and longitudinal associations between sensation seeking and susceptibility to e-cigarette use, ever e-cigarette use, and current (past 30day) e-cigarette use. ResultsIn the cross-sectional analyses, higher mean sensation seeking scores were associated with higher odds of both susceptibility to e-cigarette use and ever e-cigarette use (AOR=1.25, 95% CI=1.07, 1.47; AOR=1.24, 95% CI=1.08, 1.43, respectively). For the longitudinal analyses, only the association between higher mean sensation seeking scores and transition to ever e-cigarette use remained statistically significant (AOR=1.45, 95% CI=1.01, 2.08). There were no significant associations between sensation seeking and current e-cigarette use in either the cross-sectional or longitudinal analyses. ConclusionsHigher sensation seeking scores were consistently and significantly related to experimentation with e-cigarette use among Texas adolescents. Future interventions (e.g., communication campaigns) should target high sensation seeking adolescents to reduce initiation of e-cigarette use among this population.

The association between sensation seeking and e-cigarette use in Texas young adults: A cross-sectional study

ABSTRACTObjective: To examine the associations between sensation seeking and ever and current e-cigarette use in Texas young adults (18–29 years old). Current cigarette use was examined as a potential effect modifier of the associations. Participants: Participants included college students enrolled in four-year and two-year colleges in four metropolitan areas in Texas (n = 5,418) who completed the survey between November 2014 and February 2015. Methods: This cross-sectional study utilized mixed effects logistic regression to determine the associations between mean sensation seeking scores and ever and current e-cigarette use after controlling for covariates. Results: After controlling for covariates, significant associations between sensation seeking and both ever and current e-cigarette use were observed; however, these associations were significant for noncurrent smokers only (adjusted odds rations [AOR] = 1.55, 95% confidence interval (CI) = 1.39, 1.73; AOR = 1.82, 95% CI = 1.54, 2.15, respectively). Conclusions: Sensation seeking is an important factor in identifying college students who may be at increased risk for e-cigarette use behaviors.

Summer Thermal Environment and Human Comfort of Shaded Outdoor and Semi-Outdoor Spaces to Living in the Urban Area of Chiang Mai City

Outdoor and semi-outdoor spaces are important to sustainable cities because they accommodate leisure and activities of citizens, and contributing to urban livability and vitality. In the urban context of climate environments especially in summer, public spaces that provide a pleasurable thermal comfort experience for citizens effectively improve the quality of urban living. Consequently, in this paper, a quantitative field study was applied to investigate outdoor and semi-outdoor thermal comfort conditions in hot and humid tropical climate of Chiang Mai, Thailand. Thermal conditions of both spaces were evaluated based upon the measurement of major climatic parameters, while the thermal perception and thermal acceptability of subjects was captured simultaneously using a questionnaire survey. Meanwhile, the Physiologically Equivalent Temperature (PET) thermal comfort index was utilized to assess the thermal comfort conditions of selected spaces. The measurement period was conducted during the daytime from 8 am to 4 pm on April within the year 2557 BE, which is the most representative a hottest month of summer in Chiang Mai city. A total of 296 questionnaires were collected in the outdoor (72.3%) and semi-outdoor (27.7%) urban spaces during the survey, which was carried out on days with suitable weather and avoid rainy days. The majority of the respondents (99.8%) stayed under trees or buildings shaded conditions. The thermal neutrality was derived by solving the simple linear equations for a mean sensation vote of zero, which are determined by analyzing the relationship between the Mean Thermal Sensation Vote (MTSV) and PET values. The results found that, the neutral sensation PET temperatures (MTSV=0) of outdoor and semi-outdoor spaces were 27.1 °C and 28.5 °C PET, respectively. And the acceptable thermal conditions ranges were 31.0-23.1°C PET and 32.0-22.4°C PET, respectively. Compared with the thermal acceptable range between both spaces was found that the thermal acceptable range in different spaces have different thermal requirements in summer, even if they are feeling comfort.

Thinned chimeric radial collateral artery perforator flap in complex distal thumb reconstruction.

Tissue loss accompanied by bone defects in the thumb is a challenging reconstruction problem. Traditional repair methods are unsatisfactory. Microsurgical thumb reconstruction was performed using 13 thinned chimeric radial collateral artery (RCA) perforator flaps. The flap was created with a thinned skin paddle and humeral bone segments using independent perforators. Primary defatting was completed when the thickness of the perforator entry was approximately similar to that in the periphery. The posterior cutaneous nerve of the arm was carried to make a sensory flap. Defects were 8.5 × 4.5 cm(2) on average (ranging in size from 4.5 × 1.5 to 15.0 × 6.0 cm(2)), and flap size was 9.0 × 5.5 cm(2) on average (ranging in size from 5.0 × 2.0 to 16.0 × 7.0 cm(2)), whereas the humeral fragments were 2.0 × 1.0 cm(2) on average (ranging in size from 1.5 × 0.5 to 4.0 × 1.5 cm(2)). All data were expressed as mean ± SD. The cosmetic appearance of the donor and recipient sites, Kapandji opposition score and static two-point discrimination of the operated thumb were evaluated during a follow-up visit. Follow-up time was 16.6 months (ranging from 14 to 28 months). Flap thickness before defatting, measured immediately after flap elevation was 14.5 mm (ranging from 10.0 to 25.0 mm). Average flap thickness after defatting was 3.5 mm (ranging from 3.0 to 6.0 mm). Venous congestion occurred in two cases. Successful microsurgical revision was achieved in both cases. All flaps survived. Bone components achieved union in all cases at an average period of 4.8 months (ranging from 3 to 6 months). Based on Kapandji opposition score, the mean thumb opposition score was 6. The mean sensation of flap was 7.5 mm (ranging from 6 to 11 mm). No further flap revision or defatting procedures were required in all cases. Cosmetically acceptable results were achieved for all patients. Findings proved that thinned chimeric RCA perforator flap is a beneficial microsurgical alternative for reconstructing complex bone and soft tissue defects in thumb.

Suppression of Sleep Bruxism: Effect of Electrical Stimulation of the Masseter Muscle Triggered by Heart Rate Elevation

To examine whether electrical stimulation of the masseter muscle triggered by heart rate elevation preceding sleep bruxism (SB) can actively suppress SB. Ten volunteers who were aware of their SB habits participated in the study. Baseline electromyogram (EMG) activity of the unilateral masseter muscle and electrocardiogram (ECG) signal were recorded on the first night. The individual mean sensation and pain thresholds to electrical stimulation of the unilateral masseter muscle were determined in awake subjects before the experiment. On the second night, electrical stimulations at either of the two threshold intensities were automatically generated and delivered to the masseter muscle on the opposite side from where electrodes were placed immediately after the heart rate exceeded 110%. On the third night, electrical stimulations at the other threshold intensity were delivered. The numbers of SB events per night and per hour, the number of EMG bursts per SB event, and the duration of SB events decreased significantly on the nights when stimulation was applied compared with the baseline data. There were no significant differences between cases where the sensation threshold was used as the stimulation intensity and those in which the pain threshold was used as the stimulation intensity. The results suggest that electrical stimulation of the masseter muscle triggered by heart rate elevation can significantly suppress SB.

The assessment of a novel electrical stimulation waveform recently introduced for the treatment of overactive bladder

Transdermal amplitude modulated signal (TAMS) is a novel electrical stimulus which has been recently introduced for the treatment of overactive bladder (OAB) syndrome. It has been suggested that it has advantages over conventional waveforms by providing more effective penetration of the skin to enhance the efficacy of therapy. As there is no literature which supports this, we performed this study to evaluate potential advantages of the TAMS signal for electrical stimulation of subcutaneous nerves as compared to conventional stimuli. The stimuli were applied on forearms of ten healthy volunteers and electrical parameters of stimuli and sensation measurements were recorded. None of the recorded electrical parameters showed significant differences (paired t-test p ≥ 0.250) between the TAMS and conventional waveforms. Similarly, the mean sensation recorded at motor threshold level and at 50% of maximal motor response level showed no differences (paired t-test p = 0.242 and p = 0.687 respectively). It is unlikely, based on the results of this study, that TAMS provides any enhancement of the efficacy of conventional stimuli. We would recommend that further studies are carried out to clearly demonstrate in man what, if any, advantages the TAMS waveform has over conventional stimulation before it is widely deployed into clinical practice.

The Effect of Prolapse Surgery on Vaginal Sensibility

Prolapse surgery has been shown to have major impact on sexual function. Since prolapse surgery not only influences psychological factors but might also influence physiological conditions such as vaginal innervation, there is a need for objective outcome measurements to better understand the effects of prolapse surgery on sexual function. To assess the effects of prolapse surgery with or without stress incontinence surgery on vaginal sensibility and to assess the relationship between vaginal wall sensibility and sexual well-being. This study was performed parallel to a randomized controlled trial comparing vaginal and abdominal prolapse surgery with or without incontinence surgery in women with uterine prolapse stage 2 or more. Vaginal wall sensibility was defined as mean sensation threshold to electrical stimulation of the vaginal wall at four standardized places, measured before and 6 months after surgery. Higher sensation thresholds postsurgery relative to presurgery indicate diminished vaginal wall sensibility. Sexual function was assessed at the same time points using a questionnaire. Data on vaginal wall sensibility were obtained from 65 patients. The sensibility of the distal posterior (P = 0.02) and distal anterior (P = 0.10) vaginal wall decreased after vaginal surgery compared to abdominal surgery. Abdominal prolapse surgery with incontinence surgery decreased sensibility of the distal part of the anterior vaginal wall significantly more than abdominal prolapse surgery only (P = 0.01). Before surgery, vaginal wall sensibility was lower in women who reported vaginal dryness or anorgasmia. The presence of genital pain was associated with higher vaginal wall sensibility. Postoperative vaginal wall sensibility was similar in women with and without sexual problems. Vaginal prolapse surgery as well as abdominal prolapse surgery with additional incontinence surgery resulted in decreased vaginal wall sensibility. This pilot study shows no influence of the decreased vaginal wall sensibility on sexual well-being. Larger studies are needed to better understand the association between changes in vaginal wall sensibility and changes in sexual well-being.

Sensation seeking predicts established smoking and binge drinking in adolescents

QUESTION Question: Can sensation seeking be used to predict binge drinking and established smoking among adolescents and target adolescents for substance use interventions? Patients: 6522 adolescents aged 10–14 years at baseline, contacted by random digit dial telephone survey. Comparing the age, sex and census region of the participants, and income groupings of their parents with the US 2000 Census data confi rmed that the participants were a representative sample. Ethnicity was 62% white, 18.2% Hispanic and 13.6% black. Setting: Telephone survey, USA; recruitment June to October 2003. Test: Sensation seeking was measured using a four-item scale: thrill seeking, adventure seeking, boredom susceptibility and intensity seeking. Scores for individual items ranged from one to four and were summed across items (total scores 4–16). Receiver operating characteristics (ROC) curves were used to analyse effectiveness of sensation seeking as a predictor of binge drinking and established smoking. Diagnostic standard: Participant report of binge drinking or established smoking at 24 months. Participants were surveyed three times at 8-month intervals. If 24-month data was not available, data from the 16- or 8-month assessments was used. At each time point participants were asked if they had ever had more than fi ve drinks within a couple of hours; answering yes indicated binge drinking. Participants were asked how many cigarettes they had smoked in their lifetime, with more than 100 indicating an established smoker. Outcomes: Area under receiver operating curve (AROC), sensitivity and specifi city, false positive and false negative rates. METHODS Design: Cohort study. MAIN RESULTS 5834 participants had one or more follow-up assessments and were used in the analyses. Retention was 71% at 24 months (n=4575). At baseline, 3.4% (n=200) adolescents were binge drinkers, and 0.55% were established smokers (n=32). Among the non-binge drinkers at baseline, binge drinking was reported at follow-up interviews by 12.7% (n=717). Among non-established smokers at baseline, established smoking was reported by 2.5% (n=144). Mean sensation seeking score at baseline was 8.0 (SD 2.5), and median sensation seeking score was 7.0. A cut-off level at the median score of 7 would identify 52% of the population at risk. A cut-off of 9 would identify 25%, and a cut-off of 11 would identify 9% of the population at risk. Sensation seeking at baseline was a moderately good predictor of binge drinking at follow-up (AROC 0.71, 95% CI 0.69 to 0.73). Sensation seeking at baseline was a better predictor of established smoking at follow-up (AROC 0.80, 95% CI 0.76 to 0.83). For binge drinking, using a cut-off of 1 SD above the mean, 16% of the population would be identifi ed for intervention and would include approximately one-third of future binge drinkers (sensitivity 31%, false positive rate 12%). Half the population would be identifi ed using a median split cut-off and would include 77% of future binge drinkers (false positive rate 46%). For established smoking, using a cut-off of 1 SD above the mean would identify approximately 50% of future smokers (sensitivity 53%, false positive rate 14%). Using a median split cut-off would include 92% of future smokers (false positive rate 50%). CONCLUSIONS Sensation seeking is an effective predictor of established smoking and a moderately effective predictor of binge drinking in adolescents.

Reducing procedural pain and discomfort associated with transcranial direct current stimulation

Transcranial direct current stimulation (tDCS) appears to have modulatory effects on the excitability of cortical brain tissue. Though tDCS as presently applied causes no apparent harm to brain structure or function, a number of uncomfortable sensations can occur beneath the electrodes during stimulation, including tingling, pain, itching, and burning sensations. Therefore, we investigated the effect of topically applied Eutectic mixture of local anesthetics (EMLA) on tDCS-related discomfort. Nine healthy adults received both anodal and cathodal 2.0 mA tDCS for 5 minutes over the prefrontal cortex with the skin pretreated for 20 minutes with either EMLA or placebo cream. Participants rated procedural discomfort six times across eight dimensions of sensation. On average, the mean sensation ratings for EMLA-associated tDCS stimulation were significantly lower than placebo-associated stimulation for every cutaneous sensation evaluated. Cathodal stimulation was associated with higher ratings of "sharpness" and intolerability than anodal stimulation. Topical EMLA may reduce tDCS-related discomfort.

Changes in the sensation of hunger and well-being before and after meals in overweight/obese women following two types of hypoenergetic diet

To analyse changes in the sensation of hunger and the sensation of well-being of young overweight/obese women following two hypoenergetic diets. Fifty-seven women (BMI = 24-35 kg/m2) were randomly assigned to one of two hypoenergetic diets: diet V, in which the consumption of vegetables was increased; or diet C, in which the consumption of cereals (especially breakfast cereals) was increased. Dietetic and anthropometric data and an evaluation of the sensation of hunger and well-being were collected at the start and end of the study, 6 weeks later. The diets led to a reduction in weight and BMI in both groups. The sensation of hunger at the end of meals was higher at the end of the study than at the start in both groups. At 6 weeks, the sensation of well-being after breakfast, morning snack and lunch, as well as the mean sensation of well-being after all meals, was greater in diet C. Compared with that recorded at the beginning of the study, the capacity to experience satiety at the end of meals also increased with diet C, as did the capacity to experience well-being at 6 weeks (for breakfast, lunch, dinner and for the mean for all meals). This capacity to experience well-being was also greater in diet C than in diet V with respect to the mid-morning snack and lunch. The more positive results obtained with diet C may contribute to the increased weight loss seen in that group and their lower withdrawal rate.

Clinicopathologic Comparison of Radiofrequency Versus Scalpel Incision for Upper Blepharoplasty

To compare the sensation recovery, scar formation, and histopathologic aspects of upper blepharoplasty eyelid incision performed with radiofrequency or scalpel. In a prospective, randomized, blind, comparative, interventional study, 46 eyelids from 23 subjects underwent upper blepharoplasty using radiofrequency incision on one side and a scalpel on the other side. Exclusion criteria were diseases resulting in peripheral neuropathy such as diabetes mellitus, previous upper eyelid surgery or trauma, and history of skin disease. Eyelid sensation was measured preoperatively and 1 week, 1 month, and 6 to 7 months after surgery by a masked observer. Eyelid scar was evaluated by 2 masked observers at final follow-up. Histologic examination for zone and depth of tissue damage, hemorrhage, and inflammatory cell reaction was performed in a masked fashion on 16 eyelids. The mean patient age was 52 years (SD, 5.48 years). Mean aesthesiometry reading significantly decreased in both groups at all follow-up visits in comparison with preoperative measurement (p = 0.000). Mean sensation recovery was insignificantly (0.2 < p < 0.6) higher in the radiosurgery group at all follow-up visits. Mean scar score was insignificantly (p = 0.055 for observer 1, and 0.241 for observer 2) less in the radiosurgery group. The scar score was not significantly different between Fitzpatrick skin types 3 and 4, scored by either observer. The zone and depth of tissue damage on histopathologic examination was greater in the radiofrequency group. However, the hemorrhage and infiltration of inflammatory cells were the same. There was no significant difference between radiofrequency and scalpel incision in upper blepharoplasty with regard to sensation recovery and scar formation. Histologic zone and depth of tissue damage were greater in the radiofrequency group.