Persistent Disturbances Research Articles

Predicting new-onset persistent conduction disturbance following transcatheter aortic valve replacement: the usefulness of FEOPS finite element analysis

BackgroundDespite the frequency of persistent new-onset conduction disturbances after transcatheter aortic valve replacement (TAVR), few preoperative methods of prediction exist.MethodsPatients who underwent TAVR in the Department of Cardiology of the Second Affiliated Hospital of the Army Medical University from December 2020 to September 2021 and postoperative aortic root modeling via the FEOPS finite element analysis were included in this single-center case–control study, divided into persistent conduction disturbances (PCD) and non-PCD groups according to their pre- and postoperative electrocardiograms in the first month. Risk factors affecting PCD were identified by comparing the baseline data of these two groups, including echocardiograms, computed tomography angiography of the aortic root, surgical decision-making, and FEOPS data. Independent risk factors were screened using logistic regression modeling, and the receiver operating characteristic (ROC) curve was used to test the predictive ability.ResultsA total of 56 patients were included in this study, 37 with bicuspid aortic valve (BAV) and 19 with trileaflet aortic valve (TAV), with 17 cases of PCD. The contact pressure index (CPI) of FEOPS, valve oversize ratio, differences between membranous interventricular septum length and implantation depth (ΔMSID) and valve implantation depth were statistically different (P < 0.05). CPI could be used as an independent risk factor for PCD (P < 0.05), and the ROC curve comparison showed that the CPI was more predictive (AUC = 0.806, 95% CI: 0.684–0.928, P = 0.001).ConclusionsThe CPI of FEOPS has better predictive value for new-onset conduction disturbance after TAVR compared to other known predictors.

Thematic and intertextual analysis from a feasibility study of the Bonny Method of Guided Imagery and Music with clients in eating disorder treatment.

Eating disorders (ED) are characterized by serious and persistent disturbances with eating, weightcontrol, and body image. Symptoms impact physical health, psychosocial functioning, and can be life-threatening. Individuals diagnosed with an ED experience numerous medical and psychiatric comorbidities due to issues caused by or underlying the ED. Therefore, it is vital to address the complex nature of an ED, as well as the comorbid and underlying issues. This necessitates a psychotherapeutic approach that can help to uncover, explore, and support working through unresolved emotions and experiences. Guided Imagery and Music (GIM) is an in-depth music psychotherapy approach utilizing therapist-programmed music to support the client in uncovering and examining underlying and unresolved issues. The literature surrounding the use of GIM with clients in ED treatment is anecdotal and comprised primarily of clinical case studies. This secondary analysis, based on a descriptive feasibility study that integrated GIM sessions into the client's regular ED treatment and examined 116 transcripts from a series of sessions of eight clients. Thematic analysis of the transcripts identified nine subthemes and three themes that emerged. These themes include emotional landscape (feeling stuck, acknowledging emotions, and working through unresolved emotions), relationships (self, others, and eating disorders), and transformation and growth (finding strength, change, and empowerment). A short series of GIM sessions helped ED clients identify and address issues underlying the ED and to gain or reclaim a sense of self that enabled them to make choices for their life that support their recovery and sense of empowerment. Intertextual analysis revealed imagery indicative of the Hero's Journey. Further, how engagement in this embodied aesthetic experience stimulates perceptual, cognitive, and affective brain functions which are key in fostering behavioural and psychological change is explicated as it relates to ED treatment and recovery.

Cusp-overlap technique to reduce permanent pacemaker implantation rate after transcatheter aortic valve implantation

Abstract Background Persistent conduction disturbances requiring permanent pacemaker (PPM) implantation are one of the most common complications after Transcatheter Aortic Valve Implantation (TAVI). Cusp-Overlap Technique (COT) is a novel approach for self-expandable valve implantation to minimize the rate of procedural complications, mainly PPM implantation. Purpose To determine if the COT during TAVI with self-expandable valves leads to a reduction of PPM implantation rate in the real-world setting. Methods A retrospective analysis of consecutive patients undergoing TAVI between January 2020 and November 2023 in one high-volume tertiary care center in Portugal was conducted. Two groups were defined, the COT group and the control group based on the fluoroscopic approach. A baseline comparison between the 2 groups was made using independent-samples t-test and chi-square analysis to determine if there was a difference between the prevalence of known risk factors for PPM implantation after TAVI. Afterwards, chi-square analysis was used to determine if COT led to a reduction in the PPM implantation rate. Results Of the 539 completed procedures in this timeframe, 289 were excluded due to previous pacemaker implantation, use of a valve not amenable to COT or valve-in-valve implantation. COT was used in 57.6% of eligible cases. Baseline comparison did not show a significant difference in the prevalence of several known risk factors for PPM implantation, including complete right bundle branch block, atrio-ventricular block, calcium score, aortic ring dimensions and pre/post-dilation. PPM implantation after TAVI was required in 31.6% of cases. In the COT group the PPM implantation rate was 22.9% and in the control group 43.4%. Chi-square analysis showed a very statistically significant difference between the 2 analyzed groups (p-value = 0.001). Conclusion PPM implantation remains a frequent complication of TAVI. However, this study showed that the utilization of COT leads to a reduction of the PPM implantation rate.

HV interval measure immediately before TAVI with SEV for predicting pacemaker implantation

Abstract Introduction Although improvements, new onset persistent disturbances in electrocardiogram (ECG) after transcatheter aortic valve implantation (TAVI) remains up to 34% at hospital discharge (1), needing permanent pacemaker implantation (PPM) in self-expanding valves (SEV) as high as 15-27% (2,3). In post TAVI scenario, European Society of Cardiology guidelines recommend an electrophyisiologic study centered in His-ventricular electrogram (HV) interval measure for assessing risk of progression to high auriculoventricular block (AVB), if abnormal a PPM is indicated (4,5). We aim to predict PPM through basal HV interval measurement prior TAVI with SEV. Furthermore, we aim to compare different current SEV with basal HV interval and the distinct rate of PPM before discharge. Methods and Results Single-center prospective cohort study, patients with severe aortic stenosis scheduled for TAVI, sinus rhythm at intervention day, without PPM or history of PPM indication were included. At time of TAVI, contralateral venous puncture to femoral arterial access was made, a tetrapolar catheter was advanced and placed at the septal aspect of tricuspid valve searching for His electrogram. A mobile polygraph was used to measure ECG parameters and HV interval before TAVI. Then, a tetrapolar catheter was advanced to ventricle to perform rapid stimulation as part of habitual valve implantation protocol. After procedure, we performed rhythm surveillance for at least &amp;gt;48-72 hours and based in electrical evolution one of three decisions was made: 1)PPM implant, 2)late post TAVI HV interval re-measure or 3)clinical daily ECG vigilance, if this last was normal, unchanged from basal or with new but stable conduction disturbances, discharge were indicated following ESC guidelines. A total of 41 patients were enrolled, median age 84±4 years, 24 females (54.5%), PR mean 198±42ms, QRS mean 112±30ms. 18 had a 1st degree AVB (40.9%) of whom 13 (72.5%) had a PR ˂240ms. EPS data showed prior HV interval mean of 55±9ms. A Mild abnormal HV interval (56-69ms) were seen in 21 patients (51.2%), of whom 12 had a narrow QRS. SEV implanted were 11 (25%) Medtronic CoreValve Evolut+, 5 (11.4%) Biosensors Allegra, 25 (56.8%) Abbott Navitor. Post TAVI procedure, 5 (12.2%) women and 8 (19.5%) men met criteria for PPM implantation before discharge. One woman was implanted 6 days after discharge due to high AVB (66ms HV interval prior TAVR). In a multivariate analysis including sex, age, PR, QRS and HV interval &amp;gt;55ms, valve type the RR (IC 95% 1.37-30.99) risk of PPM was 6.52 folds higher (p=0.019). Conclusions An HV interval &amp;gt;55ms before TAVI with SEV increases risk of PPM after TAVI and before hospital discharge. There was no difference in PPM implantation after TAVI between different SEV types in our center.

7643 Acute blindness due to Metformin associated lactic acidosis

Abstract Disclosure: K.N. Pereira: None. K. Desai: None. T. Khan: None. S. Yong: None. Metformin, one of the most commonly prescribed oral hypoglycemic agents, effectively lowers basal and postprandial blood glucose. However, Metformin carries a black box warning for lactic acidosis, which is more common in setting of liver and kidney dysfunction. With an incidence rate of ∼ 4.3 cases per 100,000 patient-years, Metformin associated lactic acidosis (MALA) can present with nausea, vomiting, diarrhea, encephalopathy, hypothermia, respiratory failure and hypotension. Blindness is a rarely reported outcome of MALA. We present a case of a 48 year old intellectually disabled female with a history of type 2 diabetes (on Metformin) who presented with progressive encephalopathy insetting of intractable nausea and vomiting with poor oral intake, since starting lisinopril &amp; rosuvastatin for newly diagnosed hypertension and hyperlipidemia. She was encephalopathic, hypothermic, hypotensive, tachycardic and tachypneic. Labs were notable for leukocytosis, AKI, hyperkalemia, elevated anion gap metabolic acidosis with a lactate of 13.6 and elevated lipase. She also tested positive for Influenza A. CT head showed no acute intracranial abnormality. CT chest, abdomen &amp; pelvis was concerning for aspiration, multifocal pneumonia or a combination of both as well as acute interstitial pancreatitis. She was admitted to the ICU for further management including hemodialysis. She continued to have improving but persistent lactic acidosis despite multiple dialysis sessions. On day 5 of ICU stay, with resolution of her encephalopathy, she reported new onset complete bilateral painless vision loss. General eye and neurologic exam was unrevealing except for sluggishly reactive pupils to light. MRI brain showed an new acute 2 mm lacunar infarct in the right temporal lobe. Neurology ruled out stroke as the cause for her vision loss. Emergent ophthalmology evaluation revealed no retinopathy, macular edema, acute glaucoma or thromboembolic event. The new onset vision loss was suspected to be due to MALA due to persistent metabolic disturbances. Some animal studies have shown that retinal horizontal cells are sensitive to low pH, resulting in interruption of signal transmission to the visual neurons and consequent blindness. The presence of factors like metformin metabolites may contribute to impaired function of retinal cells.On extensive literature review it was noted that only 5 cases of vision loss associated with MALA have been reported. However, in these cases, vision loss was transient and reversed following correction of acidosis with dialysis. Our case highlights a rare consequence of MALA, which can be irreversible and cause lifelong disability. Presentation: 6/1/2024

Visuell snø – forstyrrende, men ufarlig

Visual snow is a persistent visual disturbance in which small dots of light appear across the visual field of both eyes, like snowfall. The condition is not widely known, but an increasing number of cases have been described in the last 5-6 years. Many patients have consulted a number of specialists without receiving an explanation for their symptoms, and in this clinical review article we therefore wish to make the condition known to more clinicians.

Dysgeusia and paresthesia following suspension microlaryngoscopy: review and recommendations for risk reduction

BackgroundDysgeusia or altered taste is a rare complication following suspension microlaryngoscopy with the incidence ranging from 2.9 to 12.1%. We report this with recommendations to avoid similar complications following suspension laryngoscopy, tonsillectomy, and tongue base surgery which require pressure to be placed on the tongue for better surgical field visualization.Case presentationA 53-year-old man with underlying diabetes mellitus presented with long standing history of irritative cough, globus sensation, and evidence of laryngopharyngeal reflux. A left ventricle swelling was noted on flexible laryngoscopy and neck. He underwent direct laryngoscopy and biopsy of the left ventricle lesion which revealed to be acute on chronic inflammation. Day 1 postoperatively, patient complained of reduced sensation over left hemi-tongue. A referral to a neurologist was made for further examination and he was found to have loss of taste over anterior two-third of tongue and treated with vitamin B complex. To date, dysgeusia remains persistent. Patient relayed his grievances to the hospital following these complications. Review of literature on relevant topic was made through PubMed, Web of Science, and Cochrane Library Database by two reviewers, working independently. Twenty-three papers, available in full, written in English language, containing number of cases, type of surgery, and complications were extracted and studied.ConclusionsRisk of dysgeusia and paresthesia postoperatively should be informed during consent taking for all patients undergoing tonsillectomy, laryngeal microsurgery, and tongue base surgery. Zinc deficiency should be investigated in patients with persistent taste disturbance post-tonsillectomy. Intermittent release during suspension laryngoscopy beyond 30 min to reduce post-surgical complications. Greater care should be taken to reduce the amount of force during the suspension laryngoscopy due to smaller oral and oropharyngeal structure in female. Keeping close to the tonsillar capsule particularly in mid and lower pole areas should be done in tonsillectomy using diathermy dissection.

Finite-Time Neural Network-Based Hierarchical Sliding Mode Antiswing Control for Underactuated Dual Ship-Mounted Cranes With Unmatched Sea Wave Disturbances Suppression.

As typical mechanical transportation equipment, cooperative dual ship-mounted cranes are widely used to transport large goods or containers in the marine environment. However, the control problem of the dual ship-mounted crane system is much more complex due to its underactuated characteristic and persistent unmatched disturbances. To solve these problems, we propose a novel neural network (NN)-based hierarchical sliding mode adaptive (HSMA) control method in this article. More specifically, an appropriate hierarchical sliding mode surface is first designed to connect the actuated and underactuated system state variables effectively. At the same time, the NNs are constructed to compensate for the unmatched interference of ship motions induced by sea waves simultaneously. Not only can the booms and the rope lengths reach their desired positions in finite time, but also the synchronous swing angles of the payload can be effectively eliminated. The asymptotic convergence of the closed-loop system's equilibrium points is achieved through rigorous mathematical proofs. Furthermore, the stability of each sliding mode surface is also analyzed utilizing the Lyapunov technique and Barbalat's lemma. Finally, numerous groups of compared numerical simulation results are investigated to further show the effectiveness and strong robustness of the proposed NN-based HSMA controller.

Effect of probiotic administration in adult atopic dermatitis patients

Introduction: Atopic dermatitis (AD) is a chronic skin disease characterized by abnormal skin barrier function and heightened immunologic sensitization. Its incidence has surged recently, with approximately 60% of cases diagnosed within the first year of life. AD can persist or recur, significantly deteriorating the quality of life due to persistent itching and sleep disturbances. Individuals with AD are at increased risk of developing other atopic disorders like asthma and allergic rhinitis. Various dietary approaches, including low carbohydrate, calorie, and fat diets, have been associated with enhanced quality of life by regulating immune responses. Probiotics have been used as adjuvant therapy in allergic conditions, though their effectiveness varies due to the complex nature of allergies. Method: A literature search was conducted using PubMed, Cochrane Library, and Google Scholar. MeSH terms, advanced search strategies, and predefined eligibility criteria were employed to identify relevant studies. Duplicate studies were excluded, and critical assessment tools and levels of evidence were defined per Oxford Center for Evidence-based Medicine standards. Results: One systematic review and meta-analysis of randomized controlled trials (RCTs) met the PICO and eligibility criteria. The meta-analysis demonstrated that probiotics significantly decreased AD severity in adults, enhancing their overall quality of life. Other meta-analyses and systematic reviews supported that probiotics reduce clinical severity and improve life quality in adult AD patients. Conclusion: Probiotic supplementation is a viable option to improve the quality of life for adult AD patients, offering potential therapeutic benefits in managing this condition.

Assessment of the Potential of Modern Diagnostic Tools in Differentiation of Minimum Conscious State from the Vegetative State.

The problem of treatment of patients in coma and persistent disturbances of consciousness is difficult and often neglected. The study validated the effectiveness of functional magnetic resonance imaging, electroencephalography and isotopic brain perfusion in differentiating vegetative state from minimal conscious state. The study was performed in a group of 61 patients with persistent disturbances of consciousness. All patients underwent CRS-R differentiation of consciousness and functional magnetic resonance imaging, EEG, and SPECT/CT studies according to a uniform diagnostic protocol. Analysis has shown that functional magnetic resonance imaging is an effective tool for detecting of consciousness. Analysis of the EEG showed that the occurrence of primary alpha rhythm in patients with impaired consciousness coincides with the state of minimal conscious and may indicate a favourable prognosis. Sector analysis of isotopic cerebral perfusion allowed to put forward the thesis that the key role in the maintenance of consciousness plays a medial part of the left parietal lobe. On the basis of these results, diagnostic protocol was developed for patients with disturbances of consciousness.

Synbiotics as Treatment for Irritable Bowel Syndrome: A Review.

Irritable bowel syndrome is a persistent disturbance of the function of the gastrointestinal tract with a prevalence of about 11.2% in the population at large. While the etiology of the disorder remains unclear, there is mounting evidence that the disturbance of the gut microbiota is at least one contributing factor. This insight resulted in clinical trials investigating the therapeutic effects of products containing probiotic microorganisms. Most studies with IBS patients have evaluated the therapeutic effects of mono- and multi-strain probiotics, but only a few studies have investigated the efficacy of synbiotics (combinations of probiotic bacteria and one or more prebiotic components). This review summarizes the results from eight randomized, placebo-controlled clinical trials that investigated the efficacy of synbiotic preparations (three mono-strain and five multi-strain products) in adult IBS patients. While data remain sparse, some of the surveyed clinical trials have demonstrated interesting efficacy results in IBS patients. To allow a judgment of the role played by synbiotics in the treatment of IBS patients, more high-quality clinical trials are needed.

Axonal injury, sleep disturbances, and memory following traumatic brain injury.

Traumatic brain injury (TBI) is associated with sleep deficits, but it is not clear why some report sleep disturbances and others do not. The objective of this study was to assess the associations between axonal injury, sleep, and memory in chronic and acute TBI. Data were acquired from two independent datasets which included 156 older adult veterans (69.8 years) from the Alzheimer's Disease Neuroimaging Initiative (ADNI) with prior moderate-to-severe TBIs and 90 (69.2 years) controls and 374 (39.6 years) from Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) with a recent mild TBI (mTBI) and 87 controls (39.6 years), all who completed an MRI, memory assessment, and sleep questionnaire. Older adults with a prior TBI had a significant association between axonal injury and sleep disturbances [β = 9.52, 95% CI (4.1, 14.9), p = 0.01]. Axonal injury predicted changes in memory over 1-year in TBI [β = -8.72, 95% CI (-18, -2.7), p = 0.03]. We externally validated those findings in TRACK-TBI where axonal injury within 2 weeks after mTBI was significantly associated with higher sleep disturbances in the TBI group at 2 weeks[β = -7.2, 95% CI (-14, -0.50), p = 0.04], 6 months [β = -16, 95% CI (-24, -7.6), p ≤ 0.01], and 12 months post-injury [β = -11, 95% CI (-19, -0.85), p = 0.03]. These associations were not significant in controls. Axonal injury, specifically to the left anterior internal capsule is robustly associated with sleep disturbances in multiple TBI populations. Early assessment of axonal injury following mTBI could identify those at risk for persistent sleep disturbances following injury.

Autoimmune glial fibrillary acidic protein astrocytopathy with anti-NMDAR and sulfatide-IgG-positive encephalitis overlap syndrome: A case report and literature review.

Autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy is a rare autoimmune disease of the central nervous system that affects the meninges, brain, spinal cord, and optic nerves. GFAP astrocytopathy can coexist with a variety of antibodies, which is known as overlap syndrome. Anti-NMDAR-positive encephalitis overlap syndrome has been reported; however, encephalitis overlap syndrome with both anti-NMDAR and sulfatide-IgG positivity has not been reported. The patient was a 50-year-old male who was drowsy and had chills and weak limbs for 6 months. His symptoms worsened after admission to our hospital with persistent high fever, dysphoria, gibberish, and disturbance of consciousness. Positive cerebrospinal fluid NMDA, GFAP antibodies, and serum sulfatide antibody IgG were positive. Autoimmune GFAP astrocytopathy with anti-NMDAR and sulfatide-IgG-positive encephalitis overlap syndrome. In addition to ventilator support and symptomatic supportive treatment, step-down therapy with methylprednisolone (1000 mg/d, halved every 3 days) and pulse therapy with human immunoglobulin (0.4 g/(kg d) for 5 days) were used. After 6 days of treatment, the patient condition did not improve, and the family signed up to give up the treatment and left the hospital. Patients with autoimmune GFAP astrocytopathy may be positive for anti-NMDAR and sulfatide-IgG, and immunotherapy may be effective in patients with severe conditions. Autoimmune GFAP astrocytopathy with nonspecific symptoms is rarely reported and is easy to be missed and misdiagnosed. GFAP astrocytopathy should be considered in patients with fever, headache, disturbance of consciousness, convulsions, and central infections that do not respond to antibacterial and viral agents. Autoimmune encephalopathy-related antibody testing should be performed as soon as possible, early diagnosis should be confirmed, and immunomodulatory therapy should be administered promptly.

Sleep Disturbance in Children with Fetal Alcohol Spectrum Disorder and the Relationship to the Neurodevelopmental Profile.

Sleep disturbance is an important feature of fetal alcohol spectrum disorder (FASD). We sought to describe sleep patterns in school-aged children with FASD, in comparison with a typically developing community group, and investigate the relationship between sleep and neurodevelopmental profiles. The FASD cohort (N = 36) was recruited from a tertiary Australian FASD diagnostic center, and the typically developing group (N = 36) was previously recruited as a control cohort for a separate study. Sleep disturbance was assessed with the caregiver-completed Sleep Disturbance Scale for Children (SDSC) questionnaire. Neurodevelopmental assessment results for the 10 domains impaired in FASD were used for correlations with sleep disturbance. In the FASD group, 80% of children scored above the SDSC cutoff, compared with 22% of the control group ( p < 0.001). Statistically significant group differences were seen for all 6 subscales of the SDSC ( p < 0.05). The most frequently affected domains in the FASD group related to difficulties with initiating and maintaining sleep (58%), sleep-wake transition disorders (44%), and disorders of arousal (42%). A statistically significant relationship was not found between sleep and the severity of neurodevelopmental impairment or impairment of a particular domain, acknowledging the limitations of our small sample size. Half of the FASD sample (52%) were taking a pharmaceutical agent to support sleep, which was not associated with lower SDSC scores. In this small study, sleep disturbances were frequently reported by carers of children with FASD, independent of the severity of their neurodevelopmental impairments. Persistent sleep disturbance despite the use of sleep medications highlights the need for prospective studies exploring sleep interventions in this population. Integration of behavioral sleep medicine into management is recommended for all children with FASD.

Homeostasis in networks with multiple inputs

Homeostasis, also known as adaptation, refers to the ability of a system to counteract persistent external disturbances and tightly control the output of a key observable. Existing studies on homeostasis in network dynamics have mainly focused on ‘perfect adaptation’ in deterministic single-input single-output networks where the disturbances are scalar and affect the network dynamics via a pre-specified input node. In this paper we provide a full classification of all possible network topologies capable of generating infinitesimal homeostasis in arbitrarily large and complex multiple inputs networks. Working in the framework of ‘infinitesimal homeostasis’ allows us to make no assumption about how the components are interconnected and the functional form of the associated differential equations, apart from being compatible with the network architecture. Remarkably, we show that there are just three distinct ‘mechanisms’ that generate infinitesimal homeostasis. Each of these three mechanisms generates a rich class of well-defined network topologies—called homeostasis subnetworks. More importantly, we show that these classes of homeostasis subnetworks provides a topological basis for the classification of ‘homeostasis types’: the full set of all possible multiple inputs networks can be uniquely decomposed into these special homeostasis subnetworks. We illustrate our results with some simple abstract examples and a biologically realistic model for the co-regulation of calcium (Ca\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\ extrm{Ca}$$\\end{document}) and phosphate (PO4\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\ extrm{PO}_4$$\\end{document}) in the rat. Furthermore, we identify a new phenomenon that occurs in the multiple input setting, that we call homeostasis mode interaction, in analogy with the well-known characteristic of multiparameter bifurcation theory.

The ugly truth about eating disorders. A case illustration of Anorexia Nervosa

Eating Disorders are behavioral conditions characterized by severe and persistent disturbance in eating behaviors and associated distressing thoughts and emotions. Eating Disorders have become a major health issue in our current society for both men and women. People with eating disorders, in particular those with Anorexia Nervosa, are at high risk in terms of their health and safety. Unfortunately, they have the highest mortality of any psychiatric illness. Mortality rates are over 5 times higher than the general population. Both their physical and suicidal behaviors contribute to this risk. The risk of others is less of a concern. Disturbed eating behaviors such as dietary restriction, episodes of binge eating, excessive exercise, self-induced vomiting and the use of laxatives make it difficult for a person to maintain a healthy body weight and lead to the development of physical and psychological symptoms of nutritional imbalance and starvation. The factors involved in the assessment of risk in people with eating disorders include medical risk, psychological risk, psychosocial risk and insight/capacity and motivation.

Ion Channel and Transporter Involvement in Chemotherapy-Induced Peripheral Neurotoxicity.

The peripheral nervous system can encounter alterations due to exposure to some of the most commonly used anticancer drugs (platinum drugs, taxanes, vinca alkaloids, proteasome inhibitors, thalidomide), the so-called chemotherapy-induced peripheral neurotoxicity (CIPN). CIPN can be long-lasting or even permanent, and it is detrimental for the quality of life of cancer survivors, being associated with persistent disturbances such as sensory loss and neuropathic pain at limb extremities due to a mostly sensory axonal polyneuropathy/neuronopathy. In the state of the art, there is no efficacious preventive/curative treatment for this condition. Among the reasons for this unmet clinical and scientific need, there is an uncomplete knowledge of the pathogenetic mechanisms. Ion channels and transporters are pivotal elements in both the central and peripheral nervous system, and there is a growing body of literature suggesting that they might play a role in CIPN development. In this review, we first describe the biophysical properties of these targets and then report existing data for the involvement of ion channels and transporters in CIPN, thus paving the way for new approaches/druggable targets to cure and/or prevent CIPN.

Phylogeographic Structure and Population Dynamics of Baoxing Osmanthus (Osmanthus serrulatus), an Endemic Species from the Southwest Sichuan Basin, China.

The mountainous regions of southwest China are recognized as pivotal centers for the origin and evolution of Osmanthus species. Baoxing Osmanthus (Osmanthus serrulatus Rehder), a rare and endemic species known for its spring blooms, is sparsely distributed within the high altitude evergreen broad-leaved forests surrounding the southwestern Sichuan Basin. However, persistent anthropogenic disturbances and habitat fragmentation have precipitated a significant decline in its natural population size, leading to the erosion of genetic resources. To assess the genetic status of O. serrulatus and formulate effective conservation strategies, we conducted sampling across ten wild populations, totaling 148 individuals in their natural habitats. We employed two cpDNA fragments (matK and trnS-trnG) to elucidate the phylogeographic structure and historical population dynamics. The results revealed low species-level genetic diversity, alongside pronounced regional differentiation among populations (FST = 0.812, p < 0.05) and a notable phylogeographic structure (NST = 0.698 > GST = 0.396, p < 0.05). Notably, genetic variation was predominantly observed among populations (81.23%), with no evidence of recent demographic expansion across the O. serrulatus distribution range. Furthermore, divergence dating indicated a timeline of approximately 4.85 Mya, corresponding to the late Miocene to early Pleistocene. This temporal correlation coincided with localized uplift events in the southwestern mountains and heightened Asian monsoons, suggesting pivotal roles for these factors in shaping the current phylogeographic pattern of O. serrulatus. These findings support the effective conservation of O. serrulatus germplasm and offer insights into the impact of Quaternary climate oscillations on companion species within evergreen broad-leaved forests. They also enhance our understanding of the origin and evolution of these forests in the southwestern mountains, aiding biodiversity conservation efforts in the region.

Relação entre stress, índice de massa corporal e risco de transtornos alimentares

Introduction: Eating disorders are characterized by a persistent disturbance in eating or related behaviors, involving insufficient or excessive food intake, which is considered abnormal eating habits, with harmful effects on physical health and psychosocial function, divided into three main types, anorexia nervosa, bulimia nervosa and binge eating. The development of eating disorders is multifactorial and may be related to stress and BMI. Objectives: To analyze the relationship between stress and BMI with the risk of eating disorders in adult individuals. Methodology: Quantitative, observational, analytical and cross-sectional study. Sample of 302 individuals, adults over 18 years of age. A questionnaire was used to obtain data, using the Perceived Stress Scale (PSS-10) and the Eating Attitudes Test (EAT-26) instruments. Data processing was performed using SPSS, version 29. Results: Most individuals were at normal weight (62,6%), at a moderate stress level (64%) and with a low risk of eating disorders (79%). A statistically significant relationship was found between stress and eating disorders and between BMI and eating disorders. Conclusion: Both stress and BMI influence eating attitudes and after obtaining statistically significant evidence that proves the correlation between the variables, we can conclude that the existing relationship cannot be neglected.

Management of Fibromyalgia: An Update.

Fibromyalgia, a chronic pain condition marked by abnormal pain processing, impacts a significant part of the population, leading to reduced quality of life and function. Hallmark symptoms include widespread persistent pain, sleep disturbances, fatigue, cognitive dysfunction, and mood changes. Through this updated review, we aim to contribute to the evolving understanding and management of fibromyalgia, offering insights into the diverse tools available to improve the lives of those affected by this challenging condition. Management begins with educating patients to ultimately relieve them of unnecessary testing and provide reassurance. Treatment emphasizes a comprehensive approach, combining nonpharmacological interventions such as aforementioned education, exercise, and psychotherapy, alongside pharmacologic management-namely duloxetine, milnacipran, pregabalin, and amitriptyline-which have consistent benefits for a range of symptoms across the spectrum of fibromyalgia. Notably, drugs like nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen are generally not recommended due to limited efficacy and associated risks. Lastly, a variety of other medications have shown promise, including NMDA-receptor antagonists, naltrexone, and cannabinoids; however, they should be used with caution due to a small amount of evidence and potential for adverse effects.