Clinical Disorders Research Articles

Effect of automated health monitoring based on rumination, activity, and milk yield alerts versus visual observation on herd health monitoring and performance outcomes

A primary objective of this randomized trial was to compare the percentage of cows that underwent clinical examination and were diagnosed with clinical health disorders (CHD) with a health monitoring program that relied only on automated monitoring system alerts vs a program that relied only on visual observation of clinical signs of disease to select cows for clinical examination. Another objective was to compare the effects of these health monitoring programs on milk yield, the herd exit dynamics (i.e., cows sold and dead), and first service reproductive outcomes. Lactating Holstein cows (n = 1,204) enrolled in the experiment were fitted with a neck-attached sensor of an automated monitoring system (HR Tags; Merck & Co., Inc.) that generated health alerts based on rumination time and activity. Milk yield was monitored 3 times per day by automated milk meters (MM27BC, DeLaval). Cows were blocked by parity, close-up period diet, and stratified by previous lactation milk yield, and then were randomly assigned within block to different programs for monitoring health from 3 to 21 d in milk (DIM). Cows in the visual observation group (VO; n = 597) were selected for clinical examination exclusively based on visual observation of clinical signs of disease, whereas cows in the automated health monitoring group (AHM; n = 607) were selected for clinical examination based on health alerts consisting of the following: a Health Index Score < 86 arbitrary units, daily rumination < 250 min, or a reduction of > 20% in daily milk yield. Once selected for examination, the clinical exam was the same for both treatment groups. Binary data such as the occurrence of CHD, herd exit, and pregnancies per AI were analyzed with logistic regression. Daily and weekly milk yield were analyzed using ANOVA with repeated measurements. More cows underwent a clinical examination, more cows were diagnosed with at least one CHD, and more cows received treatment in the AHM than the VO treatment group. Cows in the AHM treatment had more accumulated milk than cows in the VO treatment from 2 to 21 DIM. Cows in the AHM treatment diagnosed with at least one CHD produced more milk from 3 to 18 and 20 to 21 DIM than cows diagnosed with a CHD in the VO treatment. Fewer cows left the herd up to 21 DIM for the AHM than the VO treatment. Pregnancies per AI at first service were greater for the VO than the AHM treatment at 30 d but not at 50 d after AI and no difference in pregnancy loss was detected. In conclusion, a health monitoring strategy that used automated health alerts increased the risk of undergoing clinical examination and having CHD diagnosed compared with a program that selected cows for clinical examination based exclusively on visual observation. Cows monitored with the program that relied on automated alerts also had greater milk yield in the first 21 DIM. Thus, monitoring cow health based on automated behavior and milk yield alerts might be a more effective alternative for health monitoring than exclusive use of visual observation of clinical signs of disease.

Studyholism and Attachment Style: A Study among Italian University Students.

Studyholism (or obsession with studying) is a new potential clinical condition introduced in the literature in 2017. Since then, growing research has supported its conceptualization as a clinical disorder and highlighted some potential intervention targets, namely trait worry, social anxiety, negative interpretation bias, and defense mechanisms. The present study aims to extend the literature concerning psychodynamic-related constructs that might constitute targets for interventions aimed at reducing Studyholism by investigating the role of attachment in 1073 students (Mage = 23.48 ± 3.77), balanced concerning civil status (i.e., currently being single or involved in a relationship/non-single). Among the main findings, we found that insecure attachment-mainly preoccupied attachment-is a positive predictor of Studyholism in both non-single and single students. However, there are also some differences depending on the civil status. Finally, (single) disengaged studyholics have a statistically significant lower level of secure attachment than (single) engaged studyholics. In conclusion, this study showed the value of distinguishing between non-single and single students when investigating the role of attachment. Regarding problematic overstudying specifically, the study provided support for its definition as a clinical disorder, also with evidence of the appropriateness of its OCD-related conceptualization. Finally, it suggests preoccupied (insecure) attachment as a target to reduce Studyholism by fostering in students the feeling of being loved and deserving of being loved in their current adult relationships.

Dysbiosis and fecal microbiota transplant: Contemplating progress in health, neurodegeneration and longevity.

The gut-brain axis plays an important role in mental health. The intestinal epithelial surface is colonized by billions of commensal and transitory bacteria, known as the Gut Microbiota (GM). However, potential pathogens continuously stimulate intestinal immunity when they find the place. The last two decades have witnessed several studies revealing intestinal bacteria as a key factor in the health-disease balance of the gut, as well as disease-emergent in other parts of the body. Various neurological processes, such as cognition, learning, and memory, could be affected by dysbiosis in GM. Additionally, the aging process and longevity are related to systemic inflammation caused by dysbiosis. Commensal GM affects brain development, behavior, and healthy aging suggesting that building changes in GM might be a potential therapeutic method. The innovation in GM dysbiosis is intervention by Fecal Microbiota Transplantation (FMT), which has been confirmed as a therapy for recurrent Clostridium difficile infections and is promising for other clinical disorders, such as Parkinson's disease, Multiple Sclerosis (MS), Alzheimer's disease, anddepression. Additionally, FMT may be possible to promote healthy aging, and extend longevity. This review aims to connect dysbiosis, neurological disorders, and aging and the potential of FMT as a therapeutic strategy to treat these disorders, and to enhance the quality of life in the elderly.

Measuring Anxiety in Autistic Children: Assessing the Validity of the Anxiety Scale for Children with Autism Spectrum Disorder.

The present study assessed the validity of one of the first autism-specific anxiety measures, the Anxiety Scale for Children with Autism Spectrum Disorder (ASC-ASD), and compared its ability to predict parent-reported clinical anxiety to a 'traditional' anxiety measure, the Spence Children's Anxiety Scale (SCAS). Whether the inclusion of the child form for each measure improved the predictive ability of the parent forms was also examined. Eighty-seven parents of autistic children, aged 8-12 years, completed the ASC-ASD, the SCAS, and the Social Communication Questionnaire (SCQ), a screener for autism characteristics. Of these parents, 56 had their child complete the ASC-ASD and SCAS. The children with a reported anxiety diagnosis were rated significantly higher by their parents on both the SCAS and the ASC-ASD compared to the non-anxious children. Pearson's correlation coefficients indicated that the ASC-ASD had good divergent and convergent validity, as demonstrated by a poor, non-significant correlation with the SCQ and a strong, significant correlation with the SCAS. Regression analyses indicated that while the ASC-ASD was a significant predictor of parent-reported clinical anxiety in autistic children, the SCAS was not. Neither model was improved with the inclusion of the respective child form. This study is the first to demonstrate the ability of the ASC-ASD to predict child clinical anxiety disorder status and adds to the growing body of evidence for the validity of this measure. The findings also suggest that parent reports of anxiety may be sufficient to identify autistic children warranting further clinical investigation of anxiety in this age group.

Short-term safety and effectiveness of conversion from sleeve gastrectomy to Ring augmented Roux-en-Y gastric bypass

BackgroundWeight recurrence, suboptimal clinical response and functional disorder (such as reflux) after a Sleeve Gastrectomy (SG) are problems that may require conversional surgery. For reflux, conversion to Roux-en-Y Gastric Bypass (RYGB) is considered effective. Regarding treatment for suboptimal clinical response, the technique of choice remains a subject of debate. This study aims to evaluate the safety and effectiveness of conversion from SG to Ring-augmented RYGB ( RaRYGB).MethodsAll laparoscopic SG to RaRYGB conversions performed between January 2016 and January 2022 were included. Primary outcome was percentage total weight loss (%TWL) after 1-year follow-up. Secondary outcomes consisted of cumulative %TWL, complications (with a focus on ring-related complications), and resolution of medical-associated problems.ResultsWe included 50 patients of whom 44 were female. Mean pre-conversion BMI was 37.6 kg/m2. All patients have reached the 1-year follow-up point, however 10 were lost to follow-up. After 1-year mean TWL was 17.8% while mean cumulative TWL, calculated from primary SG, was 32%. A total of 10 complications occurred in 8 patients within 30 days, 6 of which were ≤ CD3a and 4 ≥ CD3b. One MiniMizer was removed for complaints of severe dysphagia. Of the 35 medical-associated problems present at screening 5 remained unchanged(14.2%), 15 improved(42.9%) and 15 achieved remission(42.9%).ConclusionOur series of 50 patients undergoing conversion from SG to RaRYGB is adequate and successful regarding additional weight loss 1 year after conversion, cumulative weight loss, complication rate and achievement of improvement or remission of medical-associated problems.

Newer formulations of oral testosterone undecanoate: development and liver side effects.

Testosterone deficiency is a clinical disorder due to either failure of the testes to produce testosterone or failure of the hypothalamus or pituitary to produce sufficient gonadotropins. Previous formulations of oral testosterone therapy, particularly methyltestosterone, have been associated with adverse liver effects. Many different routes of testosterone delivery have been developed, each with their own administrative benefits and challenges. Newer formulations of oral testosterone undecanoate (TU) provide a convenient administration option, although their use has been limited by hepatotoxicity concerns based on older methyltestosterone data, and prescribing physicians may still be concerned about adverse liver effects. In this review, we discuss the history of oral testosterone development, clarify the mechanism of action of oral TU, and describe the relevant liver safety findings. Relevant literature was allocated to present a review on the history of oral TU development and the mechanism of action of oral TU. We pooled data from individual studies of oral TU products to present a safety summary. Overall, safety results from studies of the newer formulations of oral TU showed that increased liver function test values are not generally associated with oral TU formulations and that no clinically significant liver toxicities were noted in clinical trials of oral TU. Continued research into the safety of oral TU will contribute to a better understanding of the potential risks in patients receiving this therapy, an outcome that highlights the importance of providing patient education and reassurance regarding oral TU safety.

Psychiatric predictors of quality of life in Parkinson's disease: A three-year longitudinal study

IntroductionParkinson's disease (PD) is associated with worsened quality of life (QOL) over time. Few longitudinal studies exist investigating the relationship of psychiatric comorbidities with QOL in people with PD (PwP). We sought to determine specific psychiatric symptoms associated with decreasing QOL in PwP over time. MethodsWe recruited PwP without dementia from a movement disorders clinic at an academic medical center. Participants were evaluated annually with motor and neuropsychological assessments at each visit. QOL was measured using the Parkinson's Disease Questionnaire-39 (PDQ-39). We assessed psychiatric symptoms, including depression (Beck Depression Inventory II, BDI-II), anxiety (Beck Anxiety Index, BAI), and apathy (Apathy Scale). Psychosis and impulse control disorders (ICDs) were recorded as present or absent. Using random coefficient regression, we analyzed psychiatric features associated with worsened QOL in PwP over three years. ResultsFrom the 105 participants enrolled at baseline, 67 completed three years of follow up. Mean PDQ-39 scores increased from 16.0 at baseline to 19.8 at year three. In multivariate analysis, higher BDI-II scores, BAI scores, and apathy scores were uniquely associated with worsened QOL over time (p < 0.001 for all measures), while presence of ICDs (p = 0.18) or psychosis (p = 0.10) were not. Changes in the BAI score and the BDI-II score exerted similar effects on the overall PDQ-39 score. ConclusionDepression, anxiety, and apathy are all associated with worsening quality of life over time in PwP, while presence of ICDs and psychosis are not. Treatment of these symptoms may lead to improved QOL in PwP.

Traditional Chinese medicine for functional gastrointestinal disorders and inflammatory bowel disease: narrative review of the evidence and potential mechanisms involving the brain-gut axis.

Functional gastrointestinal disorders (FGIDs) and inflammatory bowel disease (IBD) are common clinical disorders characterized by recurrent diarrhea and abdominal pain. Although their pathogenesis has not been fully clarified, disruptions in intestinal motility and immune function are widely accepted as contributing factors to both conditions, and the brain-gut axis plays a key role in these processes. Traditional Chinese Medicine (TCM) employs a holistic approach to treatment, considers spleen and stomach impairments and liver abnormality the main pathogenesis of these two diseases, and offers a unique therapeutic strategy that targets these interconnected pathways. Clinical evidence shows the great potential of TCM in treating FGIDs and IBD. This study presents a systematic description of the pathological mechanisms of FGIDs and IBD in the context of the brain-gut axis, discusses clinical and preclinical studies on TCM and acupuncture for the treatment of these diseases, and summarizes TCM targets and pathways for the treatment of FGIDs and IBD, integrating ancient wisdom with contemporary biomedical insights. The alleviating effects of TCM on FGID and IBD symptoms are mainly mediated through the modulation of intestinal immunity and inflammation, sensory transmission, neuroendocrine-immune network, and microbiota and their metabolism through brain-gut axis mechanisms. TCM may be a promising treatment option in controlling FGIDs and IBD; however, further high-quality research is required. This review provides a reference for an in-depth exploration of the interventional effects and mechanisms of TCM in FGIDs and IBD, underscoring TCM's potential to recalibrate the dysregulated brain-gut axis in FGIDs and IBD.

A rare case of Wilkie`s syndrome with infantile hypertrophic pyloric stenosis

Wilkie’s syndrome is a rare clinical disorder characterized by partial or complete obstruction of the duodenum. Infantile hypertrophic pyloric stenosis (IHPS) is defined as hyperplasia of the smooth muscle fibers of the pylorus, which is considered responsible for narrowing the pyloric canal and eventually obstructing the gastric outlet. This paper presents a case of a 3-month-old boy who had been vomiting after feeding for one month. The main symptoms, postprandial vomiting, dehydration, alkalosis, and weight reduction, point to the IHPS disease. Imaging studies also confirmed the diagnosis. During the surgical treatment, a concomitant condition known as Wilkie’s syndrome was also evidenced. The team performed a complex surgical treatment of a patient diagnosed with both Wilkie’s syndrome and IHPS within one single surgical operation. Surgical treatment with pyloromyotomy and duodenal-duodenal anastomosis within one operation is an optimal option for one-stage treatment of patients with IHPS and Wilkie’s syndrome.

Detection and differentiation of antinuclear antibodies in serum of dengue suspected patients with or without systemic autoimmune disease in Kolkata, India

ABSTRACT The pathophysiology of dengue may be influenced by antibodies released during infection. Several autoimmune diseases are accompanied by antinuclear antibodies (ANAs) but 8–10% of the general population have positive ANA tests. To test the hypothesis that an ANA-positive test indicates an immune dysregulated state that modifies the risk for certain clinical disorders in people with or without an autoimmune disease, we examined the various ANA profiles and their relationships to various autoimmune disorders, as well as the severity of these relationships, in patients infected with dengue fever. Enzyme-linked immunosorbent assay (ELISA) and reverse transcription-polymerase chain reaction (RT-PCR) methods were used. Indirect immunofluorescence assay (IIFA) and line immunoassay (LIA) were performed to detect and differentiate the ANAs among dengue infected patients. Out of 135 dengue virus-positive patients, 94.07% were positive by ELISA and 5.93% positive by RT-PCR method. ANAs by IIFA and LIA were detected in 54.8% and 18.5% of the dengue positive patients, respectively, and 10.3% and 7.1% of the 126 dengue negative patients, respectively. This study showed that dengue was associated with an increased risk of autoimmune myositis and mixed connective tissue disease (MCTD), a rare complication of dengue. The risk of other autoimmune diseases did not seem to increase after DENV infection.

Clinical pharmacology functional disorders of narcolepsy in central nervous system

Excessive daytime sleepiness (EDS), cataplexy, and/or other dissociated REM sleep symptoms such hypnagogic hallucinations and sleep paralysis are characteristics of narcolepsy. Antidepressants are being used to treat cataplexy and EDS in narcolepsy patients. These medications have an amphetamine-like effect on the central nervous system (CNS). Other kinds of medications are also used, including gamma-hydroxybutyrate (GHB), a short-acting sedative for EDS/fragmented nighttime sleep, and modafinil, a non-amphetamine wake-promoting drug for EDS. Based on the identification of narcolepsy genes in animals, the primary pathophysiology of human narcolepsy has recently been clarified. The genes responsible for the pathogenesis of canine narcolepsy (hypocretin/orexin ligand and its receptor) have been discovered using both forward (positional cloning) and reverse (mouse gene knockout) genetics. Novel hypothalamic neuropeptides called hypocretins and orexins have a role in a number of hypothalamic processes, including neuroendocrine and energy balance. Although hypocretin-related gene mutations are uncommon in humans, hypocretin-ligand deficiency is a common cause of narcolepsy-cataplexy. The clinical, pathophysiological, and pharmacological facets of narcolepsy are covered in this review.

Longitudinal Assessment of Selective Motor Dysfunction in Service Members With Combat-Related Mild TBI.

Evaluations of clinical outcomes in service members with mild traumatic brain injury (TBI) sustained in combat have largely focused on neurobehavioral and somatic symptoms, neurocognitive functioning, and psychological/psychiatric health. Questions remain regarding other domains, such as gross or fine motor abilities, that could be impacted and are mission-critical to functional warfighters. The objective of the current study was to evaluate longitudinal motor function in U.S. Military personnel with and without mild TBI sustained in combat to assess the possible long-term impact. Data from the EValuation Of Longitudinal outcomes in mild TBI active duty military and VEterans (EVOLVE) study were leveraged for analysis. The EVOLVE study has evaluated and followed service members from combat and following medical evacuation with and without blast-related mild TBI, as well as blunt impact mild TBI, and noninjured combat-deployed service members, tracking 1-, 5-, and 10-year outcomes. Longitudinal demographic, neuropsychological, and motor data were leveraged. Cross-sectional differences in outcomes at each year among the 4 injury groups were assessed using rank regression, adjusting for age, education, sex, branch of service (Army vs. other), subsequent head injury exposure, and separation from service. To understand the possible performance impact of time on all the measures, mixed-effects rank regression was employed, assessing time with adjustments for group, age, education, subsequent head injury exposure, and service separation status, followed by Benjamini-Hochberg correction for multiple comparisons. Evaluation for cognitive performance across 19 primary measures of interest at 1, 5, and 10 years did not identify any significant differences; however, gross motor function was found to be significantly different across groups at all time points (adjusted P < .001 at 1 year, P = .004 at 5 years, and P < .001 at 10 years) with both TBI groups consistently performing slower on the 25-Foot Walk and Grooved Pegboard than the nonblast control groups. While there were no cross-sectional differences across groups, many cognitive and motor measures were found to have significant changes over time, though not always in the direction of worse performance. Selective motor impairment in both TBI groups was identified compared to nonblast controls, but all groups were also found to exhibit a level of motor slowing when comparing performance at 1- to 10-year follow-ups. Assessment of gross motor function reflected a consistent pattern of significantly slower performances for blast and nonblast TBI groups compared to controls, over all follow-up intervals. Fine motor function performance reflected a similar significant difference pattern at 1- and 5-year follow-up intervals, with a reduced difference from control groups at the 10-year follow-up. Maintenance of high-level motor functions, including overall motor speed, coordination, and reaction time, is a primary component for active warfighters, and any motor-related deficits could create an increased risk for the service member or unit. While the service members in this longitudinal study did not meet criteria for any specific clinical motor-related diagnoses or movement disorders, the finding of motor slowing may reflect a subclinical but significant change that could be a focus for intervention to return to preinjury levels.

Characterizing within-person variance in, and menstrual cycle associations with, event-related potentials associated with positive and negative valence systems: The reward positivity and the error-related negativity

Event-related potentials (ERPs) are widely employed as measures of transdiagnostic cognitive processes that are thought to underlie various clinical disorders (Hajcak et al., 2019). Despite their prevalent use as individual difference measures, the effects of within-person processes, such as the human menstrual cycle, on a broad range of ERPs are poorly understood. The present study leveraged a within-subject design to characterize between- and within-person variance in ERPs as well as effects of the menstrual cycle in two frequently studied ERPs associated with positive and negative valence systems underlying psychopathology—the Reward Positivity (RewP) and the Error- Related Negativity (ERN). Seventy-one naturally-cycling participants completed repeated EEG and ecological momentary assessments of positive and negative affect in the menstrual cycle's early follicular, periovulatory, and mid-luteal phases. We examined the mean degree of change between cycle phases in both ERPs, the between-person variability in the degree of change in both ERPs, and whether an individual’s degree of cyclical change in these ERPs show coherence with their degree of cyclical change in positive and negative affect recorded across the cycle. Results revealed no significant changes in positive and negative affect across the cycle and rather small changes in ERP amplitudes. Significant random slopes in our model revealed larger individual differences in trajectories of change in ERP amplitudes and affect, in agreement with prior evidence of heterogeneity in dimensional hormone sensitivity. Additionally, state-variance in these ERPs correlated with positive and negative affect changes across the cycle, suggesting that cycle-mediated ERP changes may have relevance for affect and behavior. Finally, exploratory latent class growth mixture modeling revealed subgroups of individuals that display disparate patterns of change in ERPs that should be further investigated.

Repeat expansions inRFC1gene in Refractory Chronic Cough

IntroductionRefractory chronic cough (RCC), persisting despite addressing contributory diagnoses, is likely underpinned by neurally-mediated cough hypersensitivity.RFC1-disorders are genetic neurodegenerative conditions caused by biallelicRFC1repeat expansion sequences, commonly presenting with cough, followed by neurological features including cerebellar ataxia with neuropathy and vestibular areflexia syndrome (CANVAS). The prevalence and identifying clinical characteristics ofRFC1repeat-expansion disorders in patients with RCC are unknown.MethodsConsecutive patients with RCC underwentRFC1genotyping, cough severity visual analogue scale (VAS), and cough-specific health status assessment (Leicester Cough Questionnaire, LCQ). Participants with biallelicRFC1repeat expansions (RFC1++) also underwent nerve conduction studies, brain imaging (MRI), and cough reflex sensitivity testing.ResultsFifty-one participants with RCC were recruited; 36 (71%) female, median (IQR) age 65 (56–70) years, duration of cough 12.8 (6.9–20.0) years. Four (8%) wereRFC1++, five (10%) monoallelic carriers (RFC1+−), and 42 (82%) of wild type genotype (RFC1−−). No difference was observed in age, sex, cough duration, spirometry, VAS or LCQ scores between RFC1++ and RFC1--subjects (p&gt;0.05). The symptom of pins and needles was more frequent in RFC1++ (n=4, 100%) compared to RFC1−− (n=12, 33%) (p=0.01). RFC1++ participants had impaired sensory action potentials, and one had cerebellar atrophy. RFC1++ participants had heightened cough reflex sensitivity to capsaicin, similar to previous CANVAS and RCC studies.ConclusionBiallelic RFC1 repeat expansions (RFC1++) were present in 8% of RCC patients. RFC1++ participants demonstrated features of cough reflex hypersensitivity. RFC1++ chronic cough had few identifying features, although symptoms of pins and needles were more common.

A - 93 How Normal Is Normal? Comparison of “within Normal Limits” Patients in a Memory Clinic with Cognitively Healthy Community Volunteers

Abstract Objective Among patients who present for evaluation at a Memory Disorder Clinic (MDC), a small number are found to have “cognition within normal limits” (WNL). The fact they sought an evaluation suggests WNL may overstate their level of functioning. We compared performance on a brief neurocognitive battery of a recruited sample of healthy older volunteers (HV) to a WNL group from an MDC. Methods 183 HVs with MoCA score ≥ 25 (M age = 75.07, SD = 5.60; 73% female) and 178 (MDC) patients diagnosed WNL (M age = 77.08, SD = 6.62; 53% female) were administered the Shepherd Verbal Learning Test (SVLT; Gifford &amp; Webbe, 2008); the TOMM; a shortened version of the BNT (MACK-SF4); and the Trailmaking Test (TMT-A&amp;B). Results Independent-samples t-tests revealed that HVs had significantly better TMT A &amp; B scores than WNL patients: (M = 33.23, SD = 11.69) vs. (M = 41.19, SD = 15.76), p &amp;lt; 0.001 and (M = 88.98, SD = 35.20) vs. (M = 115.96, SD = 59.61), p &amp;lt; 0.001, respectively. HVs also had significantly better MACK-SF4 scores than WNL (M = 14.31, SD = 1.15) vs. (M = 13.28, SD = 2.27), p &amp;lt; 0.001. No significant group differences were found among SVLT or TOMM scores. WNL was slightly older and less well-educated. Conclusion TOMM scores for both groups were above 47, suggesting good effort. Both HVs and WNL patients performed equally well on all SVLT measures. HVs scored significantly better in Trail-making and confrontational naming, suggesting that in WNL executive function and language might be less than “normal.” These mixed outcomes suggest that WNL performance at a Memory Clinic may still fall short of true normal.

10. Complex regional pain syndrome.

Complex regional pain syndrome (CRPS) is a clinical disorder that can develop following surgery or trauma. Based on the most prominent underlying pathophysiological mechanisms, CRPS can be classified into different subtypes, namely inflammatory, nociplastic/neuropathic, vasomotor, and motor. Depending on the subtype, personalized treatment can be applied. If conservative treatments are insufficient or ineffective, more invasive treatments may be recommended. This article provides an overview of the most recent insights into CRPS and discusses the most common invasive treatments. The literature regarding interventional treatments for CRPS has been systematically reviewed and summarized. Bisphosphonates are effective in treating the inflammatory subtype, while ketamine can provide pain relief for the nociplastic/neuropathic subtype. Sympathetic blocks are effective in addressing vasomotor disturbances. For patients with refractory symptoms, neurostimulation is a viable option due to its multimechanistic properties for all subtypes. End-of-line motor disturbances may benefit from intrathecal baclofen. CRPS is a debilitating condition with an unpredictable course. The effectiveness of treatment varies from patient to patient. When conservative approaches prove insufficient, gradual progression to invasive treatments based on the underlying subtype is recommended.

Poly-methionine/graphitic carbon nitride modified screen-printed electrodes: A metal-free, bio-interface for tryptophan sensing

Tryptophan (TRP) is an essential amino acid needed for the growth and proper functioning of the human body. A balanced intake of TRP-rich food products is essential to meet the daily requirements. As both low and high levels of TRP are associated with clinical disorders, an optimum amount of TRP intake is critical. Hence, developing a method to efficiently detect TRP in food and nutritional supplements is essential. Accordingly, this study reports the electrochemical detection of TRP using poly-methionine/graphitic carbon nitride modified screen-printed electrode (gCN.Meth|SPE). To our knowledge, this study is the first attempt to decipher the electrodeposition of gCN.Meth on a conducting substrate through a systematic analysis of the electro-functionalized gCN.Meth surface using XRD, FT-IR, HR-SEM, EDX, and AFM. The synergistic benefits of both the gCN and conducting poly(methionine) resulted in augmented electrochemical performance exhibiting a pronounced TRP oxidation peak in both cyclic voltammetry (CV) and square wave voltammetry (SWV). The improved electrochemical response can be ascribed to the specific interactions between the TRP and gCN through π- π interactions and hydrogen bonding and electrostatic interaction between TRP and methionine. This facilitated interaction resulted in the electro-catalytic oxidation of TRP with a negative potential shift of 0.126 V and a 16.6-fold increase in the current response compared to unmodified SPE. The gCN.Meth|SPE exhibited a 25.12 times higher sensitivity compared to bare SPE, with a linear response in the concentration ranges of 1.0–300.0 μM and a low detection limit of 29.9 nM. The interference study further indicated that gCN.Meth-modified SPEs is highly effective for the precise and reliable detection of tryptophan in real samples.

Vasopressor-Inotropic Score: Review of Literature.

Patients undergoing cardiac surgery often receive vasopressor and inotropic medications during the surgical procedure and during intensive care unit (ICU) management following surgery. Patients with cardiogenic shock, septic shock, and other clinical disorders associated with shock also receive vasopressor medications during their ICU care. The level of support and the duration of support are likely associated with outcomes, including mortality and new organ dysfunction, such as acute kidney injury. The vasopressor-inotropic score provides a simple method to determine the level of support during the care of these patients; this score includes the infusion rates of norepinephrine, epinephrine, dopamine, dobutamine, and other inotropic medications. It has been studied in patients undergoing cardiac surgery, coronary artery bypass grafting, cardiac transplantation, left ventricular assist device implantation, septic shock, and traumatic brain injury. Higher scores are associated with poor outcomes and complications during ICU care. The studies analyzed in this review demonstrate the utility of the vasopressor-inotropic score in a variety of clinical disorders associated with shock. Electronic medical record systems should develop algorithms to calculate this score and provide continuous up-to-date measurements. This could help clinicians identify patients at risk for mortality and important complications, such as acute kidney injury.

Understanding the Contributions of the Hippocampus

The hippocampus plays an important role in human memory, with its anterior portion contributing to coarse-grained representations and its posterior portion contributing to fine-grained ones (Poppenk et al., 2013). My USRA project is focused on understanding the role of the hippocampus in a potential third type of memory representation; a general synthesis of stimuli. Beyond memory, the hippocampus has also been hypothesize to influence clinical disorders. For instance, preliminary research in our lab has found meta-cognitive memory abilities to be organized into factors resembling clinical disorders, when organized by variance in brain structure. My USRA project also aims to understand the contribution of the hippocampus to clinical disorders. My role in this project has been to develop administrative and experimental structure for the protocol, which involves extensive testing. Participants will complete approximately 27 hours of memory tasks, designed to evaluate the nature of their memory, and whether it is oriented towards detail, gist, or a synthesis of all stimuli. To do so, I have developed an extensive task of reading and evaluating reviews, as well as a recall task of lab-generated stories. Participants will also complete approximately 3-4 hours of online questionnaires, administered through Qualtrics. Over the summer, I conducted research to identify validated questionnaires that assess metacognitive abilities, in the domains of memory, attention, language, motor control, social cognition and perception. Results on these questionnaires will be used to validate preliminary findings on the relationship between metacognitive memory, brain variance and sub-threshold levels of clinical disorders, and to investigate whether these findings expand to other forms of metacognition. Finally, participants will complete a number of structural and functional MRI scans (including DTI). This work may help us understand the pure science of the function of human memory, as well as the nature of clinical disorders.

Narrating lives across 16 years: Developmental trajectories of coherence and relations to well-being in a lifespan sample.

The ability to narrate a life coherently develops first in adolescence, but little is known about its course across adulthood and into old age. Also, the potential association of life narrative coherence with well-being has never been studied. Our aim was to investigate lifespan development of coherence and associations with well-being using data from the longitudinal MainLife study. A total of 172 urban Germans (8-80 years; 87 females) narrated their lives up to six times across 16 years (N = 803 brief entire life narratives). Most were highly educated, and the proportion of a migration background was typical for the local population. Life narratives were rated for three types of global coherence (temporal, causal-motivational, and thematic) and coded for two types of autobiographical arguments (stability maintaining and change engendering). Multilevel models were used to investigate their lifespan development and relations to well-being. While most life narrative measures increased up to emerging adulthood and then remained stable, thematic coherence continued to increase into middle adulthood. Only change-engendering autobiographical arguments slowly decreased from midlife onward. Unexpectedly, neither autobiographical arguments nor global coherence correlated significantly with well-being. Data exploration suggested an association between thematic coherence and self-continuity. We conclude that life narrative coherence may only be related to well-being if samples include cases with more extreme noncoherence (e,g., clinical disorders). Our findings add to understanding the development of the life story across the lifespan, especially in older age, and suggest studying relations of coherence, self-continuity, and well-being specifically in life crises and in clinical samples. (PsycInfo Database Record (c) 2024 APA, all rights reserved).