Alternative Medical Treatment Research Articles

Investigating the potential effect of Holothuria scabra extract on osteogenic differentiation in preosteoblast MC3T3-E1 cells

The present medical treatments of osteoporosis come with adverse effects. It leads to the exploration of natural products as safer alternative medical prevention and treatment. The sea cucumber, Holothuria scabra, has commercial significance in Asian countries with rising awareness of its properties as a functional food. This study aims to investigate the effects of the inner wall (IW) extract isolated from H. scabra on extracellular matrix maturation, mineralization, and osteogenic signaling pathways on MC3T3-E1 preosteoblasts. The IW showed the expression of several growth factors. Molecular docking revealed that H. scabra BMP2/4 binds specifically to mammal BMP2 type I receptor (BMPR-IA). After osteogenic induction, the viability of cells treated with IW extract was assessed and designated with treatment of 0.1, 0.5, 1, and 5 µg/ml of IW extract for 21 consecutive days. On days 14 and 21, treatments with IW extract at 1 and 5 µg/ml showed increased alkaline phosphatase (ALP) activity and calcium deposit levels in a dose-dependent manner compared to the control group. Moreover, the transcriptomic analysis of total RNA of cells treated with 5 µg/ml of IW extract exhibited upregulation of TGF-β, PI3K/Akt, MAPK, Wnt and PTH signaling pathways at days 14. This study suggests that IW extract from H. scabra exhibits the potential to enhance osteogenic differentiation and mineralization of MC3T3-E1 preosteoblasts through TGF-β, PI3K/Akt, MAPK, Wnt and PTH signaling pathways. Further investigation into the molecular mechanisms underlying the effect of IW extract on osteogenesis is crucial to support its application as a naturally derived supplement for prevention or treatment of osteoporosis.

The socioeconomic dimension of forest therapy: A contribution to human well-being and sustainable forest management

Forests provide a variety of ecosystem services that contribute in various ways to human well-being. In times of land-use pressures, urbanisation, and nature degradation, the societal demand for forest-based therapeutic uses is increasing. Although nature-related therapies and the beneficial effects of nature on health and well-being are an old concept in cultures such as Asia and, more recently, Europe, forest therapy offers are increasingly taking hold in the forest recreation landscape. This Commentary paper identifies recent forest therapy offers and research in Asia and Europe that focus on the therapeutic effects of forests and examine their underlying rationales, practices, and status. In particular, we elaborate the socioeconomic potential of forest therapy to contribute to human health and sustainable forest management. Based on a scoping review on forest therapy offers and research, we found that countries such as Japan and South Korea are ahead of European countries in the professionalization of forest therapy offers and respective studies. While the number of studies that demonstrate the positive health benefits of forests are increasing, there is a lack of understanding the link with forest management approaches and forest and health policies. A lack of socioeconomic evaluation hinders its successful integration into policy frameworks, and prevents its use as an alternative forestry product or preventive medical treatment. For forest therapy to become part of the forestry portfolio and a medical alternative, we recommend:•Interdisciplinary research approaches and new actor alliances that link societal demands for forest therapy with insights from forest management and medical health research,•Transdisciplinary research and multi-actor approaches to link insights from forest and medical research with practitioners’ skills for forest management, service design, and communication,•To identify trade-offs and conflict potentials with forest therapy, for example in relation to timber production or questions of insurance in case of injuries by falling branches etc., that allow to develop integrated and sustainable solutions,•Policy backup and economic support for forest managers and owners to compensate for their efforts to manage their forests for therapeutic purposes•Recognition of forest therapy as an explicit part of the forestry portfolio and an alternative medical offer for clinical treatments.

Spatial attention-based CSR-Unet framework for subdural and epidural hemorrhage segmentation and classification using CT images

BackgroundAutomatic diagnosis and brain hemorrhage segmentation in Computed Tomography (CT) may be helpful in assisting the neurosurgeon in developing treatment plans that improve the patient’s chances of survival. Because medical segmentation of images is important and performing operations manually is challenging, many automated algorithms have been developed for this purpose, primarily focusing on certain image modalities. Whenever a blood vessel bursts, a dangerous medical condition known as intracranial hemorrhage (ICH) occurs. For best results, quick action is required. That being said, identifying subdural (SDH) and epidural haemorrhages (EDH) is a difficult task in this field and calls for a new, more precise detection method.MethodsThis work uses a head CT scan to detect cerebral bleeding and distinguish between two types of dural hemorrhages using deep learning techniques. This paper proposes a rich segmentation approach to segment both SDH and EDH by enhancing segmentation efficiency with a better feature extraction procedure. This method incorporates Spatial attention- based CSR (convolution-SE-residual) Unet, for rich segmentation and precise feature extraction.ResultsAccording to the study’s findings, the CSR based Spatial network performs better than the other models, exhibiting impressive metrics for all assessed parameters with a mean dice coefficient of 0.970 and mean IoU of 0.718, while EDH and SDH dice scores are 0.983 and 0.969 respectively.ConclusionsThe CSR Spatial network experiment results show that it can perform well regarding dice coefficient. Furthermore, Spatial Unet based on CSR may effectively model the complicated in segmentations and rich feature extraction and improve the representation learning compared to alternative deep learning techniques, of illness and medical treatment, to enhance the meticulousness in predicting the fatality.

A Single Injection of ADRCs Does Not Prevent AAA Formation in Rats in a Randomized Blinded Design.

There is a pressing need for alternative medical treatments for abdominal aortic aneurysms (AAAs). Mesenchymal regenerative cells derived from adipose tissue (ADRCs) have shown potential in modulating the inflammation and immune responses that drive AAA progression. We hypothesized that ADRCs could reduce inflammation and preserve vascular integrity, potentially slowing the progression of AAA. In our study, subcutaneous adipose tissue was harvested from male Sprague Dawley rats, from which ADRCs were isolated. AAA was induced in these rats using intraluminal porcine pancreatic elastase, followed by intravenous administration of either ADRCs (106 cells) or saline (0.1 mL). We monitored the progression of AAA through weekly ultrasound, and the rats were sacrificed on day 28 for histological analysis. Our results showed no significant difference in the inner abdominal aortic diameter at day 28 between the control group (172% ± 73%, n = 17) and the ADRC-treated group (181% ± 75%, n = 15). Histological analyses of AAA cross-sections also revealed no significant difference in the infiltration of neutrophils or macrophages between the two groups. Furthermore, the integrity and content of elastin in the tunica media were similar between groups. These findings indicate that a single injection of ADRCs does not inhibit the development of AAA in rats in a randomized blinded study.

Decriminalizing Marijuana Use as an Alternative Medical Treatment

The discourse surrounding the legalization of Class I narcotics, particularly marijuana (Cannabis Sativa), as one of the alternative medical treatments, has been continuously debated for the past few years. Various studies have been advancing with technological progress, prompting some other countries to start legalizing marijuana for medical purposes with certain restrictions. In Indonesia, there is a clear law, namely Law Number 35 of 2009 concerning Narcotics, which imposes restrictions and prohibitions on the use of various narcotics. Violators of these regulations are subject to criminal sanctions. In this legal research, the author will conduct a literature study using a statutory approach, which involves examining all relevant laws and legal regulations related to narcotics and the legality of the policy on the use of Class I narcotics as alternative medical treatments, such as the 1945 Constitution of the Republic of Indonesia (UUD 45), Law Number 35 of 2009 concerning Narcotics, Law Number 17 of 2023 concerning Health, and Law Number 39 of 1999 concerning Human Rights. The research findings indicate that juridically, the Narcotics Law, especially Article 6 paragraph (1) letter a and Article 8 paragraph (1), prohibits the use of Class I narcotics for medical purposes, which is clearly contradictory to Article 28C paragraph (1) of the 1945 Constitution where every person has the right to develop themselves through the fulfillment of their basic needs, the right to education, and to benefit from science and technology, arts, and culture, for the purpose of improving their quality of life and the welfare of humanity. Furthermore, the Health Law does not specifically regulate the use of marijuana for medical purposes, but only addresses general regulations regarding the use of narcotics. It is hoped that the results of this research can become a reference for policy makers to legalize the use of marijuana as an alternative treatment.

Ethics and integrity challenges during COVID-19 in China

This paper describes a scoping review of China’s academic resource databases, relevant official websites, news reports and public accounts spanning a period from the end of 2019 to the end of 2022, to investigate the challenges in scientific integrity and ethical soundness of research conducted during and immediately after the COVID-19 pandemic in China. By conducting the scoping review with keywords related to the research questions in Chinese, relevant data were extracted and classified into four categories: challenges in research, challenges in ethics review, challenges in publishing academic work, and research ethics guidelines during and after the pandemic. The paper points out that problematic studies and findings increased with the escalation in medical research projects during the pandemic in China. The situation faced by researchers was more difficult than before the pandemic. The mode of informed consent, and ethics review and oversight systems also underwent changes. In addition, Traditional Chinese Medicine as an alternative medical treatment for COVID-19, attracted attention from the research community and became a topic of discussion. We conclude that the various challenges and concerns identified indicate a need for a proper and timely response system be formulated in preparation for possible future occurrences of new pandemics or other critical situations.

BEE PRDUCTS AND THE POTENTIAL HEALTH ISSUES ARISING FROM THEIR UNCONTROLLED USE

In Turkiye, as well as worldwide, traditional and alternative medical practices are employed for the preservation of health and the treatment of various diseases. Among these practices, Apitherapy has gained particular attention, especially in recent years. Since drug use causes serious side effects, especially on human health, people are increasingly turning to alternative medical treatment methods with minimal or no side effects.
 Apitherapy is a treatment method involving bee products such as honey, pollen, Royal Jel, propolis, and bee venom. It is primarily used for the purpose of promoting a healthier lifestyle. While these products have been traditionally used in various treatments for many years, their systematic use has gained prominence in recent years. Studies have shown that these products strengthen the immune system, provide protection against various types of cancer, and exhibit antimicrobial and antioxidant properties.
 Furthermore, the high content of protein, vitamins, minerals, and amino acids in these products enhances their therapeutic potential. However, alongside the benefits of these supportive and therapeutic substances, there is a possibility of various toxic effects when used irregularly and without medical supervision. Sometimes, these situations can lead to various organ failures. This review aims to reveal the undesirable effects encountered in the use of bee products and apitherapy applications, and emphasizes that all natural products, especially bee products, should not be used uncontrolled.

The Supreme Court’s decision in McCulloch v Forth Valley Health Board: Does it condone healthcare injustice?

The UK Supreme Court’s recent judgement in McCulloch v Forth Valley Health Board clarifies the standard for the identification of ‘reasonable’ alternative medical treatments. The required standard is that of...

Historical Therapies for Suspected Autonomic Dysregulation in Meniere's Disease.

This narrative review examines how speculative belief that the autonomic nervous system causes Meniere's Disease (MD) led otolaryngologists to adopt invasive surgical procedures and medical treatments still offered today. Google Scholar, PubMed. A comprehensive literature review (1860-2022) was performed using the terms "Meniere AND (sympathetic OR sympathectomy OR vasomotor OR cervical ganglion)," returning 5360 items. All abstracts were briefly reviewed, relevant publications selected for further study, and key articles discussed by all authors. As it became clear that betahistine was related to the historical narrative, an additional search was performed using "Betahistine AND Meniere AND (vasomotor OR sympathetic OR sympathectomy OR cervical ganglion OR autonomic)," which yielded 336 results. In the 19th and 20th centuries, growing knowledge of human anatomy led the scientific community to speculate that autonomic dysregulation caused many medical conditions. Excessive sympathetic mediated vasomotor changes were thought to cause hypertension, ischemia, and tissue damage. Clinicians applied the hypothesis to MD, assigning the sympathetic nervous system responsible for vertigo secondary to paroxysmal vasospasm and for hearing loss to poor cochlear nutrition. Despite limited animal experiments and isolated clinical observations, otolaryngologists performed sympathectomies, and, in the 1970s, replaced the procedure with betahistine as an alternative medical treatment. Premature excitement about a plausible hypothesis led to unnecessary and unwarranted operations. Despite absent evidence of sympathetic overactivation in MD, surgeons eagerly adopted sympathectomies, and later betahistine. Rigorous evaluation of the validity of these treatment practices is needed. 5 Laryngoscope, 134:535-542, 2024.

Patient-specific stent for hemolytic anemia due to a kinked ascending aortic graft.

Hemolytic anemia after thoracic aortic surgery is rare. A 69-year-old female patient, who underwent ascending aorta replacement for acute type A aortic dissection 7 years ago, was transferred from another hospital due to hemolytic anemia necessitating regular blood transfusions. After engaging in interdisciplinary discussions, we ruled out alternative medical diagnoses and treatments, ultimately identifying the kinked aortic graft as the primary cause of hemolysis. Due to the patient's comorbidity, it was deemed high-risk to perform a redo thoracic aorta surgery for the replacement of the kinked aortic graft. Therefore, we decided to insert a patient-specific bare-metal stent into the kinked aortic graft to alleviate the kinking and promote improvement in hemolysis. We decided to perform the stent procedure under local anesthesia. The bare-metal stent was designed to be approximately 15% larger than the size of the pre-existing kinked aortic graft. A stent measuring 32 mm × 80 mm was successfully inserted and ballooned within the patient's ascending aortic graft. As a result, the patient's hemolytic condition showed gradual improvement over time. In this way, we aim to share our experience of inserting a patient-specific bare-metal stent under local anesthesia in patients who exhibit mechanical hemolysis due to a kinked aortic graft, especially when redo surgery is considered high-risk.

Supporting Machine Learning Model in the Treatment of Chronic Pain.

Conventional therapy options for chronic pain are still insufficient and patients most frequently request alternative medical treatments, such as medical cannabis. Although clinical evidence supports the use of cannabis for pain, very little is known about the efficacy, dosage, administration methods, or side effects of widely used and accessible cannabis products. A possible solution could be given by pharmacogenetics, with the identification of several polymorphic genes that may play a role in the pharmacodynamics and pharmacokinetics of cannabis. Based on these findings, data from patients treated with cannabis and genotyped for several candidate polymorphic genes (single-nucleotide polymorphism: SNP) were collected, integrated, and analyzed through a machine learning (ML) model to demonstrate that the reduction in pain intensity is closely related to gene polymorphisms. Starting from the patient's data collected, the method supports the therapeutic process, avoiding ineffective results or the occurrence of side effects. Our findings suggest that ML prediction has the potential to positively influence clinical pharmacogenomics and facilitate the translation of a patient's genomic profile into useful therapeutic knowledge.

#6417 IMPLEMENTATION OF ALTERNATIVE THERAPY PRACTICES DOES NOT INFLUENCE DIETARY COMPLIANCE IN CHRONIC KIDNEY DISEASE: A CROSS-SECTIONAL STUDY

Abstract Background and Aims Implementation of alternative therapies is a common practice in patients with chronic disease. Frequency in different countries is varying, highly dependant on local cultural habits. Furthermore, alternative therapy, especially if taken seriously, might be associated with reduced compliance to conventional interventions. Chronic Kidney disease (CKD) is a progressive chronic illness with a really high mortality, which ends up with renal replacement treatment. In CKD certain dietary restrictions are central part of conventional treatment. The scope of the presented study was to determine prevalence of self implementation of alternative therapies and its relationship with compliance to dietary restrictions in CKD patients in Greece. Respective epidemiological data are still totally missing. Method Consecutive patients of the Outpatient Nephrology Wards and all patients of the Peritoneal Dialysis (PD) and Haemodialysis (HD) Units of the University Hospital of Larissa, the General Hospital of Veria and the University Hospital Attikon in Athens (Greece) were studied after informed consent from June to December 2019. The international Complementary and Alternative Medicine questionnaire (I-CAM-Q), was applied. The questionnaire registers all visits to complementary or alternative health-care providers, the respective treatments, the use of herbals, of dietary supplements, and self-help practices. Patients’ 24h recollection data were used to calculate dietary intake of protein, sodium, potassium and phosphorus. Albumin, phosphate, sodium, potassium, creatinine and urea were determined with routine methods in the central Laboratory of the University Hospital of Larissa. Results Overall 261 patients (165 males, aged 66.1±13 years) witk CKD were included. Among them102 were on chronic haemodialysis and 59 on peritoneal dialysis treatment. The prevalence of alternative treatment practices was overall 45%, significantly higher in female patients (OR 1,494, ci 1,085-2,057, P = .015). The frequency in PD patients and in CKD patients was significantly higher than in HD patients (PD 69.5%, CKD 55% and HD 21.6%; p<0.01). There was no significant variation due to profession or education. The prayers and confession (31.1%) as well as the use of herbs (25.3%) were the most frequent alternative practices applied. In HD prayers (prevalence 8.9%) and the use of herbs (8.9%) are less frequently practiced than in the other groups. The dietary compliance was for phosporus about 24% and when all relevant diet parameters were considered 18%. Compliance to dietary restrictions was better in females (P = .024) but was independent of the patient's profession (P = .42) and educational status (P = .89). No significant influence of the alternative treatment practices application was determined on the compliance to diet of either CKD, PD or HD patients. Conclusion The autonomous implementation of alternative medical and other treatment and self-help practices is common among patients with CKD with a predominace of females. In Greece the most commonly applied practices are herbs and prayers or the confession. There is overall a lower prevalence of alternative practices n HD patients than CKD and PD patients. The initial hypothesis, namely that alternative therapy implementation might combine with reduced compliance of patients to conventional interventions was not confirmed at least as far as the dietary restrictions prescrıbed for CKD patients are concerned. The role alternative treatment practices in CKD and its relationship to the patients’ physical and mental health deserves further investigation.

A Review of Biomarkers in Delirium Superimposed on Dementia (DSD) and Their Clinical Application to Personalized Treatment and Management.

Delirium superimposed on dementia (DSD) occurs when patients with pre-existing dementia develop delirium. This complication causes patients to become impaired, posing safety concerns for both hospital staff and patients. Furthermore, there is an increased risk of worsening functional disability and death. Despite medical advances, DSD provides both diagnostic and therapeutic challenges to providers. Identifying at-risk patients and providing personalized medicine and patient care can decrease disease burden in a time-efficient manner. This review delves into bioinformatics-based studies of DSD in order to design and implement a personalized medicine-based approach. Our findings suggest alternative medical treatment methods based on gene-gene interactions, gene-microRNA (miRNA) interactions, gene-drug interactions, and pharmacogenetic variants involved in dementia and psychiatric disorders. We identify 17 genes commonly associated with both dementia and delirium including apolipoprotein E(ApoE), brain-derived neurotrophic factor (BDNF), catechol-O-methyltransferase (COMT), butyrylcholinesterase (BChE), acetylcholinesterase(AChE), DNA methyltransferase 1 (DNMT1), prion protein (PrP), tumor necrosis factor (TNF), serine palmitoyltransferase long chain base subunit 1 (SPTLC1), microtubule-associated protein tau (MAPT), alpha-synuclein (αS), superoxide dismutase 1(SOD1), amyloid beta precursor protein (APP), neurofilament light (NFL), neurofilament heavy, 5-hydroxytryptamine receptor 2A (HTR2A), and serpin family A member 3 (ERAP3). In addition, we identify six main genes that form an inner concentric model, as well as their associated miRNA. The FDA-approved medications that were found to be effective against the six main genes were identified. Furthermore, the PharmGKB database was used to identify variants of these six genes in order to suggest future treatment options. We also looked at previous research and evidence on biomarkers that could be used to detect DSD. According to research, there are three types of biomarkers that can be used depending on the stage of delirium. The pathological mechanisms underlying delirium are also discussed. This review will identify treatment and diagnostic options for personalized DSD management.

Genipin Analogue (G300) Inhibits Adipogenic Differentiation of Human Bone Marrow-Derived Mesenchymal Stem Cells through the Suppression of Adipogenic Promoting Factors.

While obesity is a well-known health threatening condition worldwide, effective pharmacological interventions for obesity suppression have been limited due to adverse effects. Therefore, it is important to explore alternative medical treatments for combating obesity. Inhibition of the adipogenesis process and lipid accumulation are critical targets for controlling and treating obesity. Gardenia jasminoides Ellis is a traditional herbal remedy for various ailments. A natural product from its fruit, genipin, has major pharmacological properties; it is anti-inflammatory and antidiabetic. We investigated the effects of a genipin analogue, G300, on adipogenic differentiation in human bone marrow mesenchymal stem cells (hBM-MSCs). G300 suppressed the expression of adipogenic marker genes and adipokines secreted by adipocytes at concentrations of 10 and 20 μM, which effectively reduced the adipogenic differentiation of hBM-MSCs and lipid accumulation in adipocytes. It also improved adipocyte function by lowering inflammatory cytokine secretion and increasing glucose uptake. For the first time, we show that G300 has the potential to be a novel therapeutic agent for the treatment of obesity and its related disorders.

Alternative medical treatments for prolactinomas

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Auricular therapy for primary dysmenorrhea: A protocol for systematic review and meta-analysis of randomized controlled trials.

Primary dysmenorrhea (PD) is a common problem among women. It is defined as any degree of perceived cramping pain during menstruation without any evident pathology. Auricular therapy (AT), a widely used alternative medical treatment method as part of traditional Chinese acupuncture, lacks reliable evidence to support its safety and effectiveness for PD. We aimed to conduct a meta-analysis to investigate the efficacy and safety of AT in PD and to investigate possible factors impacting the particular efficacy of AT in PD by meta-regression. This protocol followed the PRISMA guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. The following 9 sources will be searched for randomized control trials of AT for PD: the Cochrane Central Register of Controlled Trials, PubMed, Medline, Embase, Web of Science, Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure, Chinese Science and Technology Periodicals (VIP) database and WanFang Database from inception to January 1, 2023. Primary outcomes include visual rating scales and clinical efficacy rates, while secondary outcomes include endocrine hormone indicators related to PD and adverse events. Two reviewers will work independently on study selection, data extraction, and coding, including the risk of bias assessment in the included studies. While conducting a meta-analysis, Review Manager version 5.3 will be employed. Otherwise, a descriptive analysis will be performed. The results will be displayed as a risk ratio with 95% confidence intervals for dichotomous data as well as weight mean difference or standardized mean difference with 95% confidence intervals for continuous data. This study's protocol will investigate the efficacy and safety of AT in the treatment of PD in a systematic way. This systematic evaluation will objectively and systematically assess the efficacy and safety of AT in PD based on the available evidence, as well as provides clinicians with evidence to support the treatment of the disease.

“AOR” Discharge in Paediatrics: An Ethical Conundrum

At own risk (AOR) discharge in the paediatric setting is a complex phenomenon due to the triad of patient, caregiver, and clinician’s involvement. It would cross disciplines from legal (child protection), moral (professional conducts and legal decisions), and ethical (age, condition, and nationality) perspectives in managing these situations. There are certain ethically acceptable practices that can be approached in the decision-making process such as respecting autonomy, individual’s competence, the truth, patient’s confidentiality and avoidance of paternalism, and all conflicts of interest. We should aim for a collaborative effort in decision-making to prevent AOR. Here, we illustrate a case where parent have opted for an AOR discharge to seek for alternative medical treatment. The article discusses the ethical dilemma when dealing with potentially life-saving conditions.

Infants less than or equal to 2.5 kg have increased mortality and worse motor neurodevelopmental outcomes at 2 years of age after Norwood–Sano palliation

ObjectivesIn infants with single-ventricle congenital heart disease, prematurity and low weight at the time of the Norwood operation are risk factors for mortality. Reports assessing outcomes (including neurodevelopment) post Norwood palliation in infants ≤2.5 kg are limited. MethodsAll infants who underwent a Norwood–Sano procedure between 2004 and 2019 were identified. Infants ≤2.5 kg at the time of the operation (cases) were matched 3:1 with infants >3.0 kg (comparisons) for year of surgery and cardiac diagnosis. Demographic and perioperative characteristics, survival, and functional and neurodevelopmental outcomes were compared. ResultsTwenty-seven cases (mean ± standard deviation: weight 2.2 ± 0.3 kg and age 15.6 ± 14.1 days at surgery) and 81 comparisons (3.5 ± 0.4 kg and age 10.9 ± 7.9 days at surgery) were identified. Post-Norwood, cases had a longer time to lactate ≤2 mmol/L (33.1 ± 27.5 vs 17.9 ± 12.2 hours, P < .001), longer duration of ventilation (30.5 ± 24.5 vs 18.6 ± 17.5 days, P = .005), greater need for dialysis (48.1% vs 19.8%, P = .007), and greater need for extracorporeal membrane oxygenation support (29.6% vs 12.3%, P = .004). Cases had significantly greater postoperative (in-hospital) (25.9% vs 1.2%, P < .001) and 2-year (59.2% vs 11.1%, P < .001) mortality. Neurodevelopmental assessment showed the following for cases versus comparisons, respectively: cognitive delay (18.2% vs 7.9%, P = .272), language delay (18.2% vs 11.1%, P = .505), and motor delay (27.3% vs 14.3%, P = .013). ConclusionsInfants ≤2.5 kg at Norwood–Sano palliation have significantly increased postoperative morbidity and mortality up to 2-year follow-up. Neurodevelopmental motor outcomes were worse in these infants. Additional studies are warranted to assess the outcome of alternative medical and interventional treatment plans in this patient population.

Natural IgG Anti-F (ab')2 Autoantibody Activity in Children with Autism.

Background: Many and diverse autoimmune abnormalities have been reported in children with autism. Natural autoantibodies (NAAbs) play important immunoregulatory roles in recognition of the immune self. The objective of this study was to examine the presence of NAAbs in the sera of children with autism and across severity subgroups of autistic behavioral impairments. Methods: NAAbs were titrated in sera through an ELISA procedure in 60 low-functioning children with autism and 112 typically developing controls matched for age, sex and puberty. Results: Serum titers of IgG anti-F(ab')2 autoantibodies were significantly lower in children with autism compared to typically developing controls (p < 0.0001), and were significantly negatively associated with autism severity (p = 0.0001). This data appears to be related more specifically to autism than to intellectual disability, given that IgG anti-F(ab')2 levels were significantly negatively correlated with IQ scores in the autism group (p = 0.01). Conclusions: This is the first report in autism of abnormally low natural anti-F(ab')2 autoantibody activity. The findings suggest a dysfunction of self-recognition mechanisms which may play a role in the pathogenesis of autism, especially for the severely affected children. These findings strengthen the hypothesis of an autoimmune process in autism and open the prospect of alternative medical treatment. Further neuroimmunological research is warranted to understand the exact mechanisms underlying this reduced natural IgG anti-F (ab')2 autoantibody activity, and to assess its impact on the pathophysiology and behavioral expression of autism.

Pain management in German specialized outpatient palliative care : Across-sectional study to present the current pain management of palliative patients in the home environment

With the help of specialized outpatient palliative care teams (German abbreviation: SAPV), seriously ill and dying patients in Germany can be adequately cared for in their home environment until the end of their lives; however, there are no uniform standards or guidelines for well-executed pain management right now. This approach serves as basic research in the field of public health research. This is intended to present which methods (use of different professional groups, use of pain medications, alternative medical treatment etc.) the individual SAPV teams use for pain management. From this it can be deduced which procedures can be considered particularly effective. This cross-sectional study was conducted in May 2021. All German SAPV teams (n = 307) listed on the homepage of the German Association for Palliative Medicine (DGP) were contacted by post and invited to participate. Atotal of 175 teams (57%) responded to the request and were included in the evaluation. Adescriptive data analysis was performed. Pain management in the German outpatient care of palliative patients is based on several components. All common pain medications are used, but primarily metamizole (99.4%) as anon-opioid analgesic, morphine (98.3%) from the opiate series and pregabalin (96.6%) as aco-analgesic are mainly prescribed. If pain therapy fails, 22.5% of the SAPV teams perform palliative sedation for symptom control on aregular basis. This cross-sectional study is the first of its kind to provide ageneral overview of the treatment options for pain management in German outpatient palliative care. In comparison with international studies, the question arises as to whether uniform therapy schemes and areduction in the medication available in the individual SAPV teams could lead to an improvement in patient care.