Related Symptoms Research Articles

Examining the Psychometric Network Structure of Social Anxiety: A Scoping Review.

The network approach offers a novel perspective for conceptualizing the psychopathology of social anxiety disorder (SAD). This scoping review aimed to map the existing literature on the psychometric network structures of social anxiety symptoms and identify future research directions. A total of 61 studies were identified through searches in PubMed, PsycINFO, ScienceDirect, Cochrane Library, ClinicalTrials.gov and the Open Science Framework databases, employing the keywords ('social anxiety disorder' OR 'social phobia' OR 'social anxiety') AND ('network analysis'). Of these, 10 studies examined the network structures of social anxiety symptoms in patients with SAD, 17 investigated such structures in individuals without an SAD diagnosis and 34 explored networks of other symptoms that included social anxiety symptoms. Most studies were conducted on Western and Chinese populations, underscoring the need for broader cross-cultural comparisons. The central symptoms in SAD networks were fear and anxiety related to performing and interacting with groups, engaging with strangers or unfamiliar individuals, participating in events and being the center of attention. However, the network structures of SAD and related symptoms remain underexplored, with existing studies offering only partial insights. This review emphasizes the need for future research to comprehensively assess social anxiety symptoms and adopt cross-cultural comparative designs to deepen the understanding of SAD psychopathology. These findings provide a foundation for future research on SAD utilizing network analysis.

P-906. Diagnosis, Treatment, and Outcomes in Patients with Central Nervous System Blastomycosis

Abstract Background Blastomyces is a dimorphic fungus found in the soil and is endemic to regions of the Ohio River basin and Southeastern United States. It can cause both local and systemic infections in several organs regardless of immunity status. Infection occurs through inhalation of aerosolized conidia. Blastomycoses most commonly affects the lungs and infection of the central nervous system (CNS) is rarely found representing approximately 5-10% of individuals with extra-pulmonary blastomycosis. Demographics of Patients with CNS Blastomycosis Methods Given the limited information on this rare form of blastomycoses, a retrospective review was conducted at a major tertiary center in Minnesota of adult inpatients diagnosed with proven or probable CNS blastomycoses between 2005 and 2020. Institutional Review Board approval at the Mayo Clinic was obtained. Data pertaining to diagnostic evaluation, treatment and outcomes were collected from eight medical charts found to meet criteria for proven or probable CNS Blastomycosis. Diagnosis, Treatment, and Outcomes in Patients with CNS Blastomycosis Results As seen in prior studies, most patients were male. The most common CNS related symptom on presentation was headache. Frequent comorbidities included diabetes, COPD, and alcohol use. Findings on MRI varied greatly. Blastomyces serum antibody was positive in only half of patients and urine antigen was frequently negative, however this test was not performed in one patient in this study. All but one patient survived to at least one year post diagnosis. All patients were treated with liposomal amphotericin B ranging from nine days to six weeks and voriconazole was the most frequently used azole. All patients treated with voriconazole survived at least one year following completion of treatment. Diagnosis, Treatment, and Outcomes in Patients with CNS Blastomycosis (continued) Conclusion This study emphasizes the importance of having a high suspicion when CNS symptoms are present in a patient with evidence of Blastomyces. Additionally, patients can have proven CNS blastomycoses without Blastomyces positive antibodies and/or antigen in blood or urine as well as variable MRI findings. Laboratory and Culture Results in Patients Found to Have CNS Blastomyces Disclosures All Authors: No reported disclosures

P-2017. Patient Reported Outcomes of Nirmatrelvir/Ritonavir Treatment for High-risk, Nonhospitalized Adults with Symptomatic COVID-19

Abstract Background Nirmatrelvir/ritonavir (NMV/r) is an oral antiviral treatment for coronavirus disease 2019 (COVID-19). We describe patient-reported outcomes (PROs) with NMV/r in nonhospitalized adults with COVID-19 at high risk of severe disease. Percentage of participants in each treatment group in the mITT2 population reporting return to usual health on each study day through Day 28 on the Global Impressions Questionnaire. n=number of patients with event; mITT2=modified intent-to-treat 2; N=number of patients with nonmissing data. CI=confidence interval; HR=hazard ratio Methods In a phase 2/3 double-blind study, high-risk adults with confirmed COVID-19 and ≤ 5 days of symptoms were randomized 1:1 to receive NMV/r or placebo twice daily for 5 days. All PRO analyses included participants randomly assigned to a study intervention who received ≥ 1 dose of the study intervention and had ≥ 1 postbaseline visit through Day 28 (modified intent-to-treat 2 [mITT2] population). Patients recorded responses to three Global Impression Questions (GIQ) daily through Day 28 to assess return to usual health, return to usual activities, and overall severity of COVID-19 related symptoms. COVID-19–specific Work Productivity and Activity Impairment Questionnaire (WPAI-COVID-19), and the EuroQol Quality of Life 5-Dimension 5-Level Scale (EQ-5D-5L) were completed at specified visits through Week 24. Percentage of participants in each treatment group in the mITT2 population reporting return to usual activities on each study day through Day 28 on the Global Impressions Questionnaire. n=number of patients with event; N=number of patients with nonmissing data. CI=confidence interval; HR=hazard ratio; mITT2=modified intent-to-treat 2 Results Compared with placebo, patients receiving NMV/r had a significant 3-day reduction in median time to return to usual health (hazard ratio [HR], 1.3; 95% confidence interval [CI], 1.2–1.4), 1-day reduction in median time to return to usual activities (HR, 1.2; 95% CI, 1.1–1.4), and significantly shorter time to sustained resolution of any overall symptoms (HR, 1.2; 95% CI, 1.1–1.3) and sustained alleviation of any overall symptoms (HR, 1.2; 95% CI, 1.1–1.3) based on the GIQ. There were no significant differences between treatment groups on the WPAI or EQ-5D-5L. Conclusion High risk patients receiving NMV/r for COVID-19 reported a reduced duration and severity of COVID-19 symptoms based on their global impression of overall symptom burden and quicker return to usual heath and usual activities compared with those receiving placebo. The main limitation of this analysis was the lack of sufficient ePRO data collection of WPAI and EQ-5D-5L questionnaires. As such, no meaningful conclusions could be drawn regarding the impact of NMV/r on work productivity or activity impairment of HRQoL. Disclosures Ashley S. Cha-Silva, PharmD, MS, Pfizer Inc.: Employee|Pfizer Inc.: Stocks/Bonds (Public Company) Jinma Ren, PhD, Pfizer Inc.: Employee|Pfizer Inc.: Stocks/Bonds (Public Company) Amie Scott, MPH, Pfizer: Employee|Pfizer: Stocks/Bonds (Public Company) Joseph C. Cappelleri, PhD, Pfizer Inc.: Employee|Pfizer Inc.: Stocks/Bonds (Public Company) Wajeeha Ansari, MPH, Pfizer: Employee|Pfizer: Stocks/Bonds (Public Company) Heidi Leister-Tebbe, BSN, Pfizer: Employee|Pfizer: Stocks/Bonds (Public Company)

Evolution of primary mitral regurgitation during echocardiographic follow-up

Abstract Background Routine echocardiographic follow-up of patients with mitral regurgitation (MR) is common practice recommended by clinical practice guidelines. However, there is limited contemporary data on the natural course of primary mitral regurgitation, particularly in those without severe regurgitation at presentation. Purpose To evaluate outcomes in patients undergoing repeated echocardiograms due to mild, moderate and severe primary mitral regurgitation. Methods We identified all patients at a tertiary referral center who were in follow-up due to MR between the years 2004-2019. Patients with a history of heart failure or secondary MR were excluded. Additional age and sex matched individuals without history of cardiac disease and in whom echocardiography showed no valvular heart disease were included as a control group. Data on echocardiographic severity of mitral regurgitation, all-cause mortality, stroke, myocardial infarction, diabetes mellitus and mitral valve interventions were collected from electronic medical records. Primary endpoints were all-cause mortality and survival free from intervention. Results The study cohort consisted of 614 patients with a mean follow-up duration of 6.1 ± 3.8 years. At baseline, 275 (45%) had mild (age 65 years, 58% men), 221 (36%) moderate (age 68 years, 66% men) and 118 (19%) severe (age 65 years, 85% men) MR. The control group consisted of 647 individuals (age 66 years, 66% men). Compared to patients with moderate MR at baseline, significantly fewer patients with mild MR at baseline progressed to severe MR during follow-up (27% vs. 4%, p<0.001). Out of patients with mild MR at baseline, 9 (3.3%) underwent mitral valve intervention (surgical mitral valve repair in 7 and implantation of mitral valve prosthesis in 2) during follow-up. Out of these, referral for intervention was based on development of symptoms in 7 (acute heart failure in 2 and atrial fibrillation in 1), endocarditis in 1, whereas 1 patient was operated due to asymptomatic severe MR. All 9 patients had an uncomplicated course of intervention and post-operative left ventricular ejection fraction was >50%. Out of patients with moderate and severe MR at baseline, 47 (21%) and 77 (64%) underwent intervention during follow-up, respectively. Based on a Kaplan-Meier analysis adjusted for stroke, myocardial infarction and diabetes mellitus, survival of patients with mild MR did not differ from control patients without valvular heart disease (Figure). Conclusions Our findings indicate that only few patients with mild MR progress to severe MR during 6 years of follow-up and out of these only one asymptomatic patient had surgery. The likelihood of left ventricular function remaining normal in those who have had mitral valve intervention triggered by MR related symptoms seems high. Survival by time in follow-up (years)

Effectiveness of Video Teletherapy in Treating Obsessive-Compulsive Disorder in Children and Adolescents With Exposure and Response Prevention: Retrospective Longitudinal Observational Study.

An effective primary treatment for obsessive-compulsive disorder (OCD) in children and adolescents as well as adults is exposure and response prevention (ERP), a form of intervention in the context of cognitive-behavioral therapy. Despite strong evidence supporting the efficacy and effectiveness of ERP from studies in research and real-world settings, its clinical use remains limited. This underuse is often attributed to access barriers such as the scarcity of properly trained therapists, geographical constraints, and costs. Some of these barriers may be addressed with virtual behavioral health, providing ERP for OCD through video teletherapy and supplemented by app-based therapeutic tools and messaging support between sessions. Studies of teletherapy ERP in adults with OCD have shown benefits in research and real-world settings in both small and large samples. However, studies of teletherapy ERP in children and adolescents thus far have been in small samples and limited to research rather than real-world settings. This study reports on the real-world effectiveness of teletherapy ERP for OCD in the largest sample (N=2173) of child and adolescent patients to date. Children and adolescents with OCD were treated with live, face-to-face video teletherapy sessions, with parent or caregiver involvement, using ERP. Assessments were conducted at baseline, after 7-11 weeks, and after 13-17 weeks. Additionally, longitudinal assessments of OCD symptoms were performed at weeks 18-30, 31-42, and 43-54. We analyzed longitudinal outcomes of OCD symptoms, depression, anxiety, and stress using linear mixed models. Treatment resulted in a median 38.46% (IQR 12.50%-64.00%) decrease in OCD symptoms at 13-17 weeks, and 53.4% of youth met full response criteria at this point. Improvements were observed in all categories of starting symptom severity: mild (median 40.3%, IQR 8.5%-79.8%), moderate (median 38.4%, IQR 13.3%-63.6%), and severe (median 34.1%, IQR 6.6%-58.5%). In addition, there were significant reductions in the severity of depression, anxiety, and stress symptoms. The median amount of therapist involvement was 13 (IQR 10.0-16.0) appointments and 11.5 (IQR 9.0-15.0) hours. Further, symptom improvements were maintained or improved upon in the longitudinal assessment periods of weeks 18-30, 31-42, and 43-54. These results show that remote ERP treatment, assisted by technology, can effectively improve both core OCD and related depression, anxiety, and stress symptoms in children and adolescents with OCD in a real-world setting. Notable outcomes were achieved in a relatively small amount of therapist time, demonstrating its efficiency. Demonstrating the usefulness of a delivery format that overcomes several traditional barriers to treatment, these findings have implications for widespread dissemination of accessible, evidence-based care for children and adolescents with OCD.

Acute Kidney Injury Due to Ureter Compression Following Iliac Venous Stenting.

To report the occurrence of acute postrenal kidney failure caused by external ureteral obstruction after iliac venous stent placement. A 73-year-old male patient presented with a chronic swelling and feeling of heaviness of his right leg. The presence of venous thrombosis was excluded by duplex ultrasound (DUS). However, DUS revealed a high-grade non-thrombotic stenosis of the right external iliac vein which was confirmed by computed tomography venography. This stenosis was attributed to local scarring following prostatectomy, lymphadenectomy, and adjuvant radiation therapy for prostate cancer 7 years before. According to the clinical presentation, the patient underwent catheter-based revascularization by implantation of a dedicated venous stent in the external iliac vein. One day after this procedure, the patient experienced acute kidney failure, which was attributable to an incipient right-sided grade II hydronephrosis. Subsequent ureterorenoscopy demonstrated a stenotic lesion of the intermediate part of the ureter at the same level as the venous stent. Finally, ureteral stent placement resulted in the restoration of urinary drainage as well as resolution of acute kidney failure. This case report highlights the importance of considering nonvascular complications after venous stent placement and it stresses the importance of postprocedural clinical and laboratory surveillance and follow-up. In recent years the number of endovenous stent implantations has significantly increased. In patients with clinically relevant iliofemoral obstructions, endovenous stent placement potentially reduces related symptoms and improves quality of life. However, endovenous stent placement may have an impact on peri-vascular structures, such as the ureters. This case report highlights the awareness of potential nonvascular complications, which might be caused by iliofemoral stent implantation.

Association between Chinese visceral adiposity index and lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH): a national cohort study

BackgroundBenign prostatic hyperplasia (BPH) and its related lower urinary tract symptoms (LUTS) are commonly observed among aging males and have a substantial effect on quality of life. Metabolic syndrome, with a specific focus on obesity, is believed to play a role in the development of BPH. This study intends to explore the relationship between several obesity-related metrics, including the Chinese Visceral Adiposity Index (CVAI), and LUTS/BPH within a national cohort of Chinese men.MethodsData from the China Health and Retirement Longitudinal Study (CHARLS) 2015 were analyzed, encompassing a sample of 5,735 male participants aged 45 and older. Eight obesity-related indices—namely Body mass index (BMI), Waist-height ratio (WHtR), Triglyceride-glucose.BMI (TyG.BMI), TyG. Waist circumference (TyG.WC), TyG.WHtR, CVAI, Visceral adiposity index (VAI), and A body shape index (ABSI)—were examined. Logistic regression models, adjusted for potential confounders, were utilized to evaluate the associations between these indices and LUTS or BPH. The predictive capabilities of these indices were further assessed using receiver operating curves (ROC).ResultsAmong the participants, 718 (12.5%) were diagnosed with LUTS/BPH. All obesity-related indices were significantly higher in the LUTS/BPH group compared to the healthy group. CVAI demonstrated the highest predictive ability for LUTS/BPH, with an area under the curve (AUC) of 0.58. The study highlighted a nonlinear relationship between LUTS/BPH and several obesity-related indices, including CVAI.ConclusionsThis study underscores the significant association between visceral fat, as measured by CVAI, and the risk of LUTS/BPH in Chinese men. CVAI emerged as the most effective predictor among the indices evaluated, suggesting its potential utility in identifying individuals at risk for LUTS/BPH. Further prospective studies are needed to confirm these findings and elucidate the underlying mechanisms.

Targeting Nanotherapeutics for Highly Efficient Diagnosis and Treatment of Systemic Lupus Erythematosus through Regulation of Immune Response

Systemic lupus erythematosus (SLE) is characterized by the production of pathogenic autoantibodies, particularly antidouble‐stranded (ds) DNA antibodies, which contribute to multiorgan damage (lupus nephritis, LN). Hence, there is an urgent need to recognize and eliminate SLE‐specific anti‐ds DNA antibodies to enhance the SLE treatment. Herein, mesoporous silica (MSNs) loaded with SeC and surface‐modified ctDNA are constructed to effectively specific bind and eliminate pathogenic anti‐dsDNA antibodies for treatment SLE in 125 plasm and enabling swift LN diagnosis in 36 kidney tissue from SLE patients. As expected, the clearance ratio of anti‐dsDNA antibodies by nanotherapeutics is significantly greater compared to other products commonly used in clinical therapies and exhibits biocompatibility and safety in patients. Moreover, MSNs‐DNA can also help visualize the distribution of anti‐dsDNA antibodies in the lesions of the kidney. Importantly, the combination strategy (MSNs‐DNA@SeC) can effectively remove antibodies and reduce UP production by the regulation of B cells and T cells in female MRL/lpr SLE model mice to alleviate related symptoms. Collectively, the resultant data not only presents a straightforward method for the systematic design of nanomedicine targeting SLE to enhance the effects on diagnosis and treatment, but also elucidates the potential mechanisms involving anti‐dsDNA antibodies in the pathogenesis and progression of SLE.

What does it mean when the pleasant smells come and go? Correlation between UPSIT odor identification status and fluctuation of non-motor symptoms in Parkinson's disease.

Parkinson's disease (PD) is characterized by motor and non-motor symptoms, including olfactory dysfunction. Prior studies have shown that olfaction deteriorates with disease progression, however fluctuations in olfaction and related PD symptoms have been less explored. This study aimed to investigate correlations between changes in odor identification ability and PD symptoms. PD patients recruited from Taichung Veterans General Hospital underwent at least two consecutive Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) and University of Pennsylvania Smell Identification Test (UPSIT) evaluations. The patients were grouped based on changes in olfactory identification ability between evaluations, and fluctuations in PD symptoms were compared between groups. Ninety-seven PD patients with 114 complete sets of data were analyzed. Significant divergent results were observed between changes in five MDS-UPDRS non-motor subscores and the conversion status of five pleasant odors, including anxiety vs. bubble gum, apathy vs. banana, dizziness vs. coconut, urination vs. root beer, and dopamine dysregulation syndrome (DDS) vs. grape. Fluctuations in the ability to detect pleasant odors, may have a complex interaction with other non-motor symptoms, including in the neurobehavioral and autonomic domains. Serial monitoring of olfactory function, particularly with pleasant odors, may provide valuable insights for tracking non-motor symptoms in PD and warrants further investigation into their therapeutic implications.

P0373 CLINICAL RECURRENCE AFTER ILEOCOLIC RESECTION FOR CROHN’S DISEASE: Interest of the REMIND group’s endoscopic score

Abstract Background The Rutgeerts score is the most commonly used score for assessing endoscopic recurrence after ileocolic resection in Crohn’s disease. However, a significant drawback of this score is that it combines lesions localized to the anastomosis with those in the neo-terminal ileum in the same category, assigning them equal prognostic significance. The aim of this study was to evaluate the performance of the REMIND score in predicting postoperative recurrence of Crohn’s disease and compare its performance with the Rutgeerts score. Methods We conducted a monocentric, retrospective, evaluative study of patients operated for Crohn’s disease. All patients had a follow-up colonoscopy within one year of surgery. The REMIND score was derived from endoscopic details documented in the colonoscopy reports. Clinical relapse was defined by the Crohn’s disease related symptoms or complications, such as intra-abdominal collection or occlusion, or subsequent surgery Postoperative. Statistical analysis was performed using SPSS.25 for Windows. Results Eighty patients were included, with a mean age of 35.7 years, and a gender ratio H/F=2,2. Median follow-up was 5 years from surgery. Clinical recurrence-free survival was significantly shorter in patients with ileal lesions whatever their severity was I(1,2,3,4)A(x), compared with patients without ileal lesions I(0)A(x): p<0,001 and not significantly different between patients without anastomotic lesions I(x)A(0) and patients with anastomotic lesions whatever their severity was I(x)A(1,2,3): p=0,2. However, patients with at least semicircumferential anastomotic ulcerations A(2,3) had more anastomotic occlusive complications than patients classified A0 or A1: A0 VS A2 p=0,01 A0 VS A3 p<0,001 A0 VS A1 p=0,9. The I(x) score, compared with the Rutgeerts and A(x) scores, had the best values in terms of discriminative capacity (Area under the curve= 0,83 VS 0,73 VS 0,61), monotonicity (linearity test χ2 of 26,77 VS 12,36 VS 3,89), and homogeneity (likelihood ratio χ2 of 33,91 vs 18,45 VS 5,49). Conclusion In contrast to the Rutgeerts and A(x) scores, the I(x) score seems to exhibit superior performance in predicting postoperative recurrence. Therefore, the use of a score describing separately ileal and anastomotic lesions might be more appropriate to define postoperative endoscopic recurrence. References Hammoudi N, Auzolle C, Tran Minh ML, Boschetti G, Bezault M, Buisson A, et al. Postoperative endoscopic recurrence on the neoterminal ileum but not on the anastomosis is mainly driving long-term outcomes in crohn’s disease. Am J Gastroenterol. 2020 Jul;115(7):1084-93.

Lower Urinary Tract Symptoms in Relation to Leiomyoma Volume, Location, and Position in Reproductive-aged Women in the USA.

Uterine leiomyomata are widely believed to contribute to lower urinary tract symptoms in women, but it is unclear whether leiomyoma size, position, and location have important implications for these symptoms. We assessed whether greater leiomyoma volume, anterior position, and subserosal location were associated with urinary incontinence and frequent urination in a racially diverse, nationwide sample of premenopausal women in the USA. A cross-sectional analysis of 477 premenopausal women from 12 USA sites undergoing evaluation for laparoscopic radiofrequency ablation or myomectomy for leiomyomata was carried out. Multivariable logistic regression models examined associations between leiomyoma volume, position, and location documented in clinical imaging reports and participant-reported urinary incontinence and distressing urination frequency, adjusting for age, race, parity, and body mass index. Among the 477 participants, 27.9% reported at least weekly incontinence, 72.8% distressing daytime urination frequency, and 63.4% frequent night-time urination. Greater total leiomyoma volume was associated with at least weekly incontinence of any type (OR 1.05, 95% CI 1.02-1.07, per 20-ml increase) and at least weekly stress-predominant incontinence (OR 1.04, 95% CI 1.01-1.07, per 20-ml increase), but not distressing daytime or night-time urination frequency. Although subserosal leiomyoma position was associated with a 2.01-fold (95% CI 1.14-3.56) greater odds of frequent night-time urination, no significant associations between leiomyomata location or position and incontinence were detected. In this multicenter sample of women seeking treatment for symptomatic leiomyomata, greater leiomyomata volume was associated with weekly any-type and stress-type incontinence, but leiomyoma position and location were not independently associated with urinary incontinence.

'A boy actually said I looked like a fire victim': Exploring the psychosocial impacts of psoriasis, eczema and acne amongst young women in the UK through thematic analysis.

Our knowledge of the psychosocial implications of skin conditions continues to broaden, as research identifies multiple psychological morbidities relating to psoriasis, eczema and acne. This includes findings of poor body image, as a result of the change in physical appearance to the skin. However, there is limited qualitative research in the UK that explores how young women with skin conditions experience unique psychosocial impacts, including body image issues. The present study explored the experiences of seven young women with psoriasis, eczema and acne. Four main themes were developed: Embarrassment over appearance related symptoms; An unrealistic female beauty standard; Change in appearance attacking personal identity; and Lack of support. The implications of these findings are discussed, including a call for a biopsychosocial approach to skin condition treatment, that prioritises the psychological and social well being of young female skin condition patients, as well as their physical health.

Efficacy of peripheral nerve stimulation in refractory postamputation pain: A narrative review.

The management of postamputation pain remains a significant clinical challenge, with existing therapeutic approaches often yielding inconsistent outcomes. Neuromodulation techniques, particularly peripheral nerve stimulation (PNS), have emerged as promising interventions. However, the evidence supporting their effectiveness in treating phantom limb pain (PLP) and residual limb pain (RLP) remains limited. This narrative review consolidates previous findings of PNS as a postamputation agent and amasses the most recent data on its effectiveness in clinical settings. A literature review was conducted using MEDLINE via PubMed, EMBASE, and Cochrane Library, yielding 115 references. After removing duplicates and applying inclusion criteria, three studies were included. The studies reviewed demonstrate that PNS can offer varying degrees of sustained pain relief, mood enhancement, reduction in opioid use, and functional improvement. However, discrepancies in study design, patient demographics, devices used, and methodological approaches significantly limit the generalizability and reliability of these findings. Currently, the evidence supporting PNS for the treatment of RLP and PLP is limited, with minimal data affirming its efficacy in alleviating postamputation pain and related symptoms. More studies, especially larger, well-designed comparative and observational studies are needed to extrapolate these conclusions for PNS and postamputation pain.

Motor functional hierarchical organization of cerebrum and its underlying genetic architecture in Parkinson's disease.

Hierarchy has been identified as a principle underlying the organization of human brain networks. However, it remains unclear how the network hierarchy is disrupted in Parkinson's disease (PD) motor symptoms and, how it is modulated by the underlying genetic architecture. The aim of this study was to explore alterations in the motor functional hierarchical organization of the cerebrum and their underlying genetic mechanism. In this study, the brain network hierarchy of each group was described through a connectome gradient analysis among 68 healthy controls (HC), 70 postural instability and gait difficulty (PIGD) subtype, 69 tremor-dominant (TD) subtype, including both male and female participants, according to its motor symptoms. Furthermore, transcription-neuroimaging association analyses using gene expression data from Allen Human Brain Atlas and case-control gradient differences were performed to identify genes associated with gradient alterations. Different PD motor subtypes exhibited contracted principal and secondary functional gradients relative to HC. The identified genes in different PD motor subtypes enriched for shared biological processes like metal ion transport, inorganic ion transmembrane transport. In addition, these genes were overexpressed in Ntsr+ neurons cell, enriched in extensive cortical regions and wide developmental time windows. Aberrant cerebral functional gradients in PD related motor symptoms have been detected, and the motor-disturbed genes have shared biological functions. The present findings may contribute to a more comprehensive understanding of the molecular mechanisms underlying hierarchical alterations in PD.Significant statement The pattern of network hierarchy in different Parkinson's disease (PD) motor subtypes remains unclear. In our study, we used connectome gradient analysis to characterize alterations in the functional hierarchical organization of the cerebrum across PD motor subtypes. Additionally, transcription-neuroimaging association analyses were employed to investigate the genetic mechanisms underlying these gradient changes. Our findings suggest that distinct PD motor subtypes exhibit contracted functional gradients, with genes associated with these gradient alterations enriched in similar biological functions.

Idiopathic multicentric Castleman disease in children: a single-center retrospective analysis

ObjectiveTo investigate the clinical features, pathological phenotype, treatment and prognosis of idiopathic multicenter Castleman disease (iMCD)in children.MethodsFrom January 2017 to September 2023, basic information, laboratory tests, treatment and prognosis of children diagnosed with iMCD who attended Beijing Children's Hospital of Capital Medical University were collected.ResultsA total of 9 children were enrolled, with a median age of onset of median 11 (2–15) years, 6 males and 3 female. 3 cases were pathologically typed as plasma cell type, 1 case was mixed type, and the remaining 5 cases were hyaline vascular type. 9 children received different regimens of chemotherapy. The median follow-up time was 26 (13, 58) months, with no deaths, 7/9 cases showing improvement, 1/9 cases showing stable condition, and 1/9 cases showing active condition.ConclusionChildren with multicentric CD often have systemic symptoms, lymph node enlargement and related compression symptoms are the most common manifestations, followed by fever, malaise and other systemic symptoms. Anti-IL-6-based therapy combined with hormones lenalidomide and other medications have a specific therapeutic effect on multicentric CD.

Psychometric Evaluation of the Scleroderma Skin Questionnaire: A Novel Patient-Reported Outcome for Skin Disease in Patients With Systemic Sclerosis.

We aimed to evaluate the psychometric properties of the Scleroderma Skin Questionnaire (SSQ), a novel patient-reported outcome (PRO) to assess systemic sclerosis (SSc)-related skin symptoms. Participants were recruited from the SSc Collaborative National Quality and Efficacy Registry (CONQUER). Internal consistency was determined using Cronbach α and McDonald ω total (ωt). The correlation of the SSQ was assessed with the modified Rodnan skin score (mRSS), physician global assessment (PGA), Scleroderma Health Assessment Questionnaire, 29-item Patient-Reported Outcomes Measurement Information System (PROMIS-29), and patient global assessment to assess criterion, convergent, and divergent validity. Correlations were also assessed between patients' self-reported recall of skin changes over the past 6 months ("SSQ 6-Month") and 6-month change in mRSS. The SSQ was administered to 799 adults (mean age 52.7; 83% female) enrolled in CONQUER. Cronbach α was 0.90 and ωt was 0.92, indicating high internal consistency. The SSQ was moderately correlated with mRSS (r 0.56), with stronger correlations in diffuse (r 0.54) vs limited cutaneous subtypes (r 0.24; all P < 0.05). The SSQ was also moderately-to-strongly correlated with PROMIS-29 physical function (r -0.50) and pain interference subscales (r 0.61), strongly with Health Assessment Questionnaire score (r 0.63) and severity subscale (r 0.62), and moderately with PGA SSc activity score (r 0.48; all P < 0.05). SSQ 6-Month correlated weakly with the 6-month change in mRSS (r 0.26; P < 0.05). SSQ demonstrated high reliability and moderate correlation with mRSS and legacy PROs. This study provides initial support for SSQ, but not SSQ 6-Month, to assess skin symptoms in patients with SSc.

Selected determinants of anxiety and depression symptoms in adolescents aged 11-15 in relation to the pandemic COVID-19 and the war in Ukraine.

The ongoing COVID-19 pandemic, which began in early 2020, and the outbreak of war in Ukraine in 2022 (a country bordering Poland on the east) have significantly impacted the mental health of young people in Poland, leading to increased rates of depression, anxiety, and other mental health issues. The rising number of individuals struggling to cope with daily stressors, as well as non-normative stressors, may indicate a decrease in the individual's potential, specifically in skills, attitudes, and competencies required to overcome difficulties that they encounter. It can be assumed that for young people, maintaining mental health under the influence of social stressors, such as the pandemic and the ongoing war in Ukraine, depends on the ability to adapt positively, which is the ability of young individuals to adjust to situational demands in a way that allows them to effectively manage those situations. The aim of the conducted study was to determine whether social stressors, namely the pandemic and the war in Ukraine, and intrapsychic factors such as beliefs about oneself, others, life, and the world, influence the occurrence of anxiety and depression symptoms in Polish youth. An attempt was made to assess the significance of external stressors and internal potential resources for maintaining psychological balance among young people. The study was conducted using the Revised Children's Anxiety and Depression Scale (RCADS), the Questionnaire of Intrapersonal, Interpersonal, and World Attitudes (QIIWA), as well as a survey created by the researchers containing questions about well-being in relation to the pandemic, remote learning, and the ongoing war in Poland's neighboring country. Ethical approval for the planned research was obtained from the Bioethics Committee. The study included 945 adolescents aged 11-15 years (M = 13.10; SD = 1.11), representing a sample of youth from 14 regions of Poland. The results and analyses are presented from three perspectives: (A) the occurrence of anxiety and depression symptoms in relation to the gender and age of the respondents, (B) the significance of situational experiences, such as the COVID-19 pandemic (Q1), remote learning (Q2), and the outbreak of the war in Ukraine (Q3) for the occurrence of anxiety and depression symptoms in Polish youth, and (C) other determinants of anxiety and depression symptoms in Polish youth, such as intrapsychic variables including self-esteem, satisfaction with relationships with others, and views on the world and life. It can be concluded that in the case of young people, maintaining mental health under the influence of social stressors such as the pandemic and the ongoing war in Ukraine depends mainly on intrapsychic variables, including the beliefs and attitudes of young people towards themselves, toward other people, the world and life.

Relational Victimization, Coping Styles and Depressive Symptoms: A Test of Bidirectional Associations in Adolescence.

Although evidence from previous studies suggests that adolescents with negative coping styles who experienced victimization are more likely to exhibit depressive symptoms, these associations have not yet been disentangled to separate between-person differences from within-person effects. To investigate the within-person bidirectional relationships among relational victimization, coping styles and depressive symptoms, this study conducted a four-wave random intercept cross-lagged panel model analysis. The final sample consisted of 1506 adolescents, 72.6% of whom were male, with a mean age of 10.90 years (SD = 1.12) at the first time point. The findings revealed a prospective within-person association between relational victimization and depressive symptoms, and a reciprocal within-person relationship between depressive symptoms and avoidance coping. The approach coping style negatively predicted depressive symptoms over time, whereas depressive symptoms did not affect the approach coping style. These findings show how depressive symptoms, relational victimization, and coping styles are related at the individual level, extending previous research through the demonstration of stable within-person associations over time.

Intravenous trazodone for the treatment of psychomotor agitation and associated symptoms in major depressive disorder patients experiencing a depressive episode with mixed features.

Psychomotor agitation is a challenging symptom of major depressive disorder with mixed features (MDD-MF), often worsening outcomes and complicating treatment. This retrospective study assessed the efficacy and tolerability of intravenous trazodone in 97 hospitalized patients with MDE-MF. Symptom severity was evaluated using montgomery asberg depression rating Scale (MADRS), young mania rating scale, hamilton anxiety rating scale, GAD-7, and clinical global impression scale-severity of illness (CGI-S) scales, with significant reductions in agitation, anxiety, and irritability observed early during treatment. Correlation analyses revealed significant negative associations between intravenous (IV) trazodone dosage and improvements in MADRS (r = -0.23; P < 0.05), item 5 of GAD-7 (r = -0.27; P < 0.001), and CGI-S scores (r = -0.22; P < 0.05). Therapy duration also correlated negatively with improvements in GAD-7 item 5 (r = -0.29; P < 0.001) and CGI-S (r = -0.27; P < 0.001), indicating diminishing returns with prolonged treatment. Regression analyses showed that therapy duration, but not dosage, significantly influenced improvements in GAD-7 item 5 and CGI-S. Trazodone was well-tolerated, with only mild side effects in 11.3% of patients. These findings suggest that IV trazodone effectively reduces agitation and related symptoms in MDD-MF, particularly in the early treatment phase, emphasizing the importance of optimizing treatment duration. Future studies should investigate individualized dosing strategies and explore long-term outcomes in this population.

Does SARS-CoV-2 Infection Increase Risk of Neuropsychiatric and Related Conditions? Findings from Difference-in-Differences Analyses.

The COVID-19 pandemic has been associated with increased neuropsychiatric conditions in children and youths, with evidence suggesting that SARS-CoV-2 infection may contribute additional risks beyond pandemic stressors. This study aimed to assess the full spectrum of neuropsychiatric conditions in COVID-19 positive children (ages 5-12) and youths (ages 12-20) compared to a matched COVID-19 negative cohort, accounting for factors influencing infection risk. Using EHR data from 25 institutions in the RECOVER program, we conducted a retrospective analysis of 326,074 COVID-19 positive and 887,314 negative participants matched for risk factors and stratified by age. Neuropsychiatric outcomes were examined 28 to 179 days post-infection or negative test between March 2020 and December 2022. SARS-CoV-2 positivity was confirmed via PCR, serology, or antigen tests, while negativity required negative test results and no related diagnoses. Risk differences revealed higher frequencies of neuropsychiatric conditions in the COVID-19 positive cohort. Children faced increased risks for anxiety, OCD, ADHD, autism, and other conditions, while youths exhibited elevated risks for anxiety, suicidality, depression, and related symptoms. These findings highlight SARS-CoV-2 infection as a potential contributor to neuropsychiatric risks, emphasizing the importance of research into tailored treatments and preventive strategies for affected individuals.