Specific Diagnostic Criteria Research Articles

Enhancing assessment practices: Incorporating developmental distress in adolescent depression diagnosis

Depression is a prevalent mental health problem, particularly in the middle to late stages of adolescence. There are certain characteristics of depression that make it difficult to diagnose and require a thorough evaluation. Primary care doctors are often the first to see teens and have a critical role in recognizing and treating the symptoms of this condition. In addition, there are groups that advise testing for depression at this time. To summarize, the major objective of this paper is to conduct a comprehensive review of the scientific literature about the screening, diagnosis, and treatment of depression in adolescents, with a particular focus on primary care settings. There are a number of environmental and genetic elements that are related with the development of depression in teenagers, making it a difficult job to comprehend the pathophysiology of this condition. Diagnosing this ailment can be challenging because of its wide range of clinical manifestations, even though there are specific screening tests and diagnostic criteria. Furthermore, it can be mistakenly identified with other mental illnesses, which is why a variety of other differential diagnoses must be used. The feasible options for therapy are determined in part by the severity of the ailment, associated risk factors, and the resources at hand. These substitutes might consist of pharmaceuticals (mostly fluoxetine) and psychotherapies (relationships and cognitive behavioural). Under no circumstances can treatment be completed without psychological education, a supportive attitude, and family involvement. Preventive measures not only have a major impact on reducing the prevalence of this illness, but they also have a major positive impact on community health generally. Because of its unpredictable clinical course and the fact that it is significantly underdiagnosed all over the globe, depression in adolescents is a disorder that is of concern to the medical profession. General practitioners are able to give early diagnosis, the beginning of therapy, and referrals to mental health experts when it is important to do so.

Immunoglobulin G4 related sclerosing disease mimicking a lytic lesion of the mandible: a case report and review of literature.

Immunoglobulin G4 related disease (IgG4-RD) is an immune-mediated, multifocal, fibroinflammatory disease with varied clinical manifestations. The involvement of head and neck region is infrequent. The objective was to report a case of localized IgG4-RD of mandible that clinically mimicked a lytic lesion. A 22 year old female presented with restricted mouth opening and swelling over right ramus and angle region of mandible. Radiographic imaging showed an ill-defined radiolucent lytic lesion infiltrating adjacent muscles. An incisional biopsy was performed and histopathological picture was suggestive of benign spindle cell neoplasm. Immunohistochemistry was suggestive of IgG4-RD involving mandible adjoining soft tissues. Elevated serum IgG4 levels were noted. Oral steroid therapy was initiated and tapered without maintenance dose. The patient progressed without any sequelae. Imaging 2 years after completion of treatment showed complete resolution of the radiolucent lesion. The precise diagnosis of this lesion is challenging and depends on many different factors. A non-specific localized lesion should be investigated as a systemic condition. Early diagnosis and prompt initiation of steroid therapy should be favored. Continued follow up is critical due to the indolent nature of this disease. The future of management of this disease is the development of specific diagnostic criteria and targeted therapy of head & neck lesions.

The use of antibiotics in the management of odontogenic facial swellings in children and adolescents: A scoping review.

To identify evidence and guidelines relating to the use of antibiotics in the management of odontogenic facial swellings in children and adolescents. Articles relating to odontogenic facial swellings in children and adolescents aged 0-16 years were included. Articles in which paediatric data could not be differentiated from adult data or where the age of participants were unknown were excluded. Also excluded were guidelines that did not provide age-specific recommendations. Resources that exclusively focused on localised odontogenic infections, Ludwig's Angina, neck infections, orbital cellulitis and sepsis and those that pooled data related to odontogenic facial swelling and other medical or dental conditions were excluded. MEDLINE, PubMed and EMBASE were searched with no date restrictions. Google Advanced Search was used to identify grey literature. Of the 5251 identified articles, 22 primary studies and 32 secondary sources of evidence were included after full text review. No articles evaluated the use of specific diagnostic criteria used to support antibiotic prescribing. Three studies evaluated the effectiveness of antibiotic regimes in the management of odontogenic facial swellings in young people. Antibiotic regimes varied; oral amoxicillin was the most frequently recommended first-line therapy, followed by phenoxymethylpenicillin. Most articles recommended antibiotics as an adjunct to dental treatment. The weight of the child, penicillin allergy/ hypersensitivity and clinical response to therapy were commonly reported to influence antibiotic prescribing. Inconsistencies between guidelines were identified which is likely due to a lack of evidence regarding the use of antibiotics in the paediatric population. High quality, robust research with clearly defined outcome measures and thorough reporting is required to develop comprehensive, evidence-based guidelines for children and adolescents with odontogenic facial swellings. This paper allows clinicians to compare guideline recommendations, understand the context of these guidelines and review local practices.

Guidelines for the standardized diagnosis and treatment of non-specific orbital inflammation (2024).

Non-specific orbital inflammation (NSOI) is a non-infectious orbital inflammation. Although it is often considered the most common diagnosis in orbital biopsies, it is an exclusionary diagnosis that requires ruling out systemic disease or other possible causes. Its characteristics include acute orbital signs and symptoms, including pain, proptosis, periorbital edema, chemosis, diplopia, and visual impairment. The clinical manifestations and histological findings of NSOI are heterogeneous, without specific diagnostic criteria or treatment guidelines, which poses significant challenges for diagnosis and treatment. This guideline provides a detailed description of the definition, classification, diagnosis, and treatment of NSOI.

Evolution of diagnostic criteria for allergic bronchopulmonary aspergillosis

Allergic bronchopulmonary aspergillosis (ABPA) is a lung disease characterized by sensitization to Aspergillus fumigatus. Patients often present with recurrent wheezing, fleeting pulmonary infiltrates, and bronchiectasis. Due to the atypical clinical manifestations, unclear pathogenesis, and lack of unified diagnostic criteria, ABPA is often misdiagnosed or overlooked. In 1977, Rosenberg criteria were introduced as the first diagnostic criteria for ABPA, but without further elaboration on the weighting of diagnostic items and thresholds. In 2013, the International Society for Human and Animal Mycology (ISHAM) proposed more specific diagnostic criteria. As the understanding of fungal sensitization disease has progressed, the concept of allergic bronchopulmonary mycosis (ABPM) has been proposed and has received increasing attention. In 2021, Asano et al. proposed the ABPM diagnostic criteria and found that their diagnostic sensitivity was superior to that of Rosenberg and ISHAM criteria. In 2024, ISHAM again revised the ABPA diagnostic criteria and proposed diagnostic criteria for ABPM. This article provided an analysis and interpretation of the diagnostic criteria for ABPA/ABPM in order to help the diagnosis and treatment of this disease.

Doença mineral e óssea da doença renal crônica em indivíduos em hemodiálise e a suas correlações com as condições clínicas, antropométricas e laboratoriais

Introduction: Chronic Kidney Disease-Mineral and Bone Disease is one of the main complications of individuals on hemodialysis. Objective: this research aims to analyze the correlations of the laboratory components of Chronic Kidney Disease-Mineral and Bone Disease with clinical, anthropometric and laboratory factors of individuals on hemodialysis. Methods: this is a cross-sectional study with 790 patients on hemodialysis, in southeastern Brazil. Chronic Kidney Disease-Mineral and Bone Disease was evaluated according to specific laboratory diagnostic criteria already defined in the literature. Assessment was carried out regarding the existence of a linear correlation between the dependent and independent variables. References used: r < 0.4 (weak correlation); r ≥ 0.4 and < 0.6 (moderate correlation); r ≥ 0.6 (strong correlation). The Significance level adopted was 5%. Results: parathyroid hormone and duration of renal replacement therapy showed a moderate positive correlation with each other (r 0.582, p <0.001). Phosphorus levels had a moderate positive correlation with potassium (r 0.556, p 0.020) and negative correlation with age (r -0.413, p 0.036). 25-hydroxyvitamin D levels had a positive correlation with adductor pollicis muscle thickness (r 0.602, p 0.018) and right hand grip strength (r 0.402, p <0.001), and a negative correlation with tricipital skinfold (r -0.600, p 0.020) and corrected arm muscle area (r -0.769, p 0.024). Ionic calcium levels had a strong positive correlation with duration of renal replacement therapy (r 0.961, p 0.015) and a strong negative correlation with Body Mass Index (r -0.82, p 0.046). Conclusion: all laboratory elements of Chronic Kidney Disease-Mineral and Bone Disease showed important correlations with clinical, anthropometric and laboratory components of individuals on hemodialysis.

Leo Kanner: The Physician and Pioneer of Autism.

Dr. Chaskel Leib (Leo) Kanner is widely regarded as the father of child psychiatry in the United States. He was a pioneering figure in autism research who paved the way for child psychiatry and our modern-day understanding of autism. His monumental efforts distinguished autism as a distinct neurodevelopmental condition, contributing to the establishment of specific diagnostic criteria that helped shape our current perception of autism. Kanner's observations and theories recognized autism as an inherent condition, and his lasting contributions continue to influence diagnostic approaches while propelling ongoing, cutting-edge research.

Distinguishing Psychiatric Illnesses from Character Flaws: An Integrative Analysis of Biological, Environmental, And Social Factors

This paper considers the fine line dividing psychiatric illnesses from character flaws: an integrative multidisciplinary perspective. Biological predisposition, and environmental and social factors are analyzed to show how these aspects contribute to the formation and manifestations of mental health issues as opposed to personality characteristics. The study challenges simplistic classifications by showing that what is behind human behavior and psychological states results from an intricate interplay of genetic inheritance with environmental influences. Our position is that while psychiatric illnesses are more biological in origin, based on specific diagnostic criteria, character flaws are more dependent on environmental factors and social constructs. This nuanced conceptualization has significant diagnostic, treatment, and societal implications regarding mental health and personality.

8114 The Need For Autoantibody Screening And Diagnostic Criteria For Immune-Checkpoint Inhibitor-Induced Type 1 Diabetes

Abstract Disclosure: A. Gupta: None. H. Sanekommu: None. A.B. Ravin: None. M. Akula: None. J. Cheng: None. Background: Immune-checkpoint inhibitors (ICIs) such as Nivolumab have been extensively studied, especially in relation to their side-effect profiles. Patients on Nivolumab are prone to immune-related adverse events (irAEs) including type 1 diabetes mellitus, thyroiditis, and hypopituitarism. Prior studies have indicated that ICIs can unmask existing diabetic autoimmunities, but currently no specific guidelines exist for autoantibody screening prior to initiating treatment. We report a unique case of a young patient with newly diagnosed immune-checkpoint inhibitor-induced type 1 diabetes (ICI-T1DM) who was found to have mixed autoantibody results. Clinical Case: This is a 31-year-old male who was diagnosed with fibrolamellar hepatocellular carcinoma (pT23N0) and underwent partial hepatic resection later that year. Repeat imaging showed new hepatic lesions, thus Nivolumab was initiated. He received a total of three cycles, after which he presented to the hospital with symptoms of fever and nausea; labs were consistent with diabetic ketoacidosis (DKA) for which he was treated with IV insulin and aggressive hydration with successful resolution. Nivolumab was stopped and the patient was discharged on a basal-bolus insulin regimen. Further outpatient workup was significant for A1c 5.9% (n<5.7%), C-peptide (with glucose 220mg/dL) 0.7 (n=0.8-3.9ng/mL), glutamic acid decarboxylase autoantibody (GAD Ab) 11 (n<5.0U/mL). Insulin antibody and islet cell antibody IgG were negative. Due to the acute onset in the presentation and the recent use of Nivolumab, the patient was diagnosed with ICI-T1DM. He remained insulin-dependent after discharge. Unfortunately, soon after, he began showing signs of liver failure and ultimately underwent liver transplantation. Conclusion: This case highlights two crucial aspects - the importance of screening for autoantibodies prior to initiating an ICI and the necessity for guidelines in diagnosing ICI-T1DM. Given the evidence linking positive GAD Ab to a higher risk of developing DKA and earlier onset ICI-T1DM, it is beneficial to screen patients for these autoantibodies prior to ICI initiation to identify those more susceptible to developing ICIDM1. It may also be beneficial to obtain a C-peptide level prior to initiation to evaluate for endogenous insulin production. Additionally, while several factors support the diagnosis of ICI-T1DM such as recent ICI use, acute DKA presentation, low C-peptide levels, and the need for exogenous insulin, there is currently no specific criteria for the formal diagnosis of ICI-T1DM. Consequently, the decision to continue an ICI remains uncertain until specific diagnostic criteria are established for healthcare providers. Presentation: 6/2/2024

High Somatization Rates, Frequent Spontaneous Recovery, and a Lack of Organic Biomarkers in Post-Covid-19 Condition.

Many patients report neuropsychiatric symptoms after SARS-CoV-2 infection. Data on prevalence of post-COVID-19 condition (PCC) vary due to the lack of specific diagnostic criteria, the report of unspecific symptoms, and reliable biomarkers. PCC patients seen in a neurological outpatient department were followed for up to 18 months. Neurological examination, SARS-CoV-2 antibodies, Epstein-Barr virus antibodies, and cortisol levels as possible biomarkers, questionnaires to evaluate neuropsychiatric symptoms and somatization (Patient Health Questionnaires D [PHQ-D]), cognition deficits (Montreal Cognitive Assessment [MoCA]), sleep disorders (ISS, Epworth Sleepiness Scale [ESS]), and fatigue (FSS) were included. A total of 175 consecutive patients (78% females, median age 42 years) were seen between May 2021 and February 2023. Fatigue, subjective stress intolerance, and subjective cognitive deficits were the most common symptoms. Specific scores were positive for fatigue, insomnia, and sleepiness and were present in 95%, 62.1%, and 44.0%, respectively. Cognitive deficits were found in 2.3%. Signs of somatization were identified in 61%, who also had an average of two symptoms more than patients without somatization. Overall, 28% had a psychiatric disorder, including depression and anxiety. At the second visit (n=92), fatigue (67.3%) and insomnia (45.5%) had decreased. At visit three (n=43), symptom load had decreased in 76.8%; overall, 51.2% of patients were symptom-free. Biomarker testing did not confirm an anti-EBV response. SARS-CoV-2-specific immune reactions increased over time, and cortisol levels were within the physiological range. Despite high initial symptom load, 76.8% improved over time. The prevalence of somatization and psychiatric disorders was high. Our data do not confirm the role of previously suggested biomarkers in PCC patients.

Incidence and Risk Factors for Lumbar Sympathetic Chain Injury After Oblique Lumbar Interbody Fusion.

Oblique lumbar interbody fusion (OLIF), performed using a retroperitoneal approach, can lead to complications related to the approach, such as lumbar sympathetic chain injury (LSCI). Although LSCI is a common complication of OLIF, its reported incidence varies across studies due to an absence of specific diagnostic criteria. Moreover, research on the risk factors of postoperative sympathetic chain injuries after OLIF remains limited. Therefore, this study aimed to describe the incidence, and identify independent risk factors for LSCI, in patients with degenerative lumbar spinal diseases who underwent OLIF. Between October 2020 and August 2023, a retrospective review was conducted at our institute on 200 patients who underwent OLIF at 1 to 4 consecutive spinal levels (L1-5) for degenerative spinal diseases including spinal stenosis, spondylolisthesis, degenerative scoliosis. We excluded those with infections, trauma, tumors, and lower extremity edema/warmth due to other causes. The patients were categorized into 2 groups: those with and without LSCI symptoms. Demographic data, operative data, and pre- and postoperative parameters were evaluated for their association with LSCI using a univariate logistic regression model. Variables with a p-value <0.1 in the univariate analysis were included in a multivariate model to identify the independent risk factors. Thirty-five of 200 patients (17.5%) developed LSCI symptoms after OLIF. Multivariate logistic regression analysis indicated that prolonged retraction time, particularly exceeding 31.5 miniutes, remained an independent risk factor (adjusted odds ratio, 12.59; p<0.001). This study demonstrated that prolonged retraction time was an independent risk factor for LSCI following OLIF, particularly when it exceeded 31.5 minutes. Protecting the lumbar sympathetic chain during surgery and minimizing retraction time are crucial to avoiding LSCI following OLIF.

CENTRAL POST-STROKE PAIN: A SCOPING REVIEW

Introduction: Central post-stroke pain (CPSP) is a neuropathic pain syndrome that can affect individuals who have suffered a stroke and which is still under-recognized by doctors. CPSP has an estimated prevalence of 11% and is more common in lesions involving the thalamus. Diagnosis is challenging due to the variable clinical manifestations and the lack of specific diagnostic criteria. The study aims to gather up-to-date information on this condition and highlight the importance of its early recognition. Methodology: This is a descriptive review of the literature in Medline databases, including articles from 2014 to 2024. A total of 468 articles were initially found, of which 43 were selected after applying inclusion and exclusion criteria. Results and discussion: Risk factors were identified as involvement of the spinothalamic pathway, presence of sensory deficits, female gender, young age, and initial stroke severity. The clinical characteristics of CPSP include pain and sensory abnormalities in the regions corresponding to the injured brain territory. The differential diagnosis includes other etiologies, such as post-stroke spasticity, complex regional pain syndrome, headache and shoulder pain. CPSP has a significant impact on quality of life and is associated with psychological disorders and functional limitations. Conclusion: It is understood that early recognition and appropriate management of CPSP are essential for improving patients' quality of life, highlighting the need for clear diagnostic criteria and effective treatments.

Nomogram for assistant diagnosing acute suppurative cholangitis: a case-control study

BackgroundAcute suppurative cholangitis (ASC) lacks sensitive and specific preoperative diagnostic criteria. Some researchers suggest treating ASC as severe cholangitis. This study aimed to explore the relationship between the Tokyo Guidelines 2018 (TG18) grading system for acute cholangitis (AC) and the diagnosis of acute suppurative cholangitis (ASC), searching for independent risk factors of ASC and develop a nomogram to discriminate ASC from acute nonsuppurative cholangitis (ANSC) accurately.MethodsAfter applying the inclusion and exclusion criteria, 401 patients with acute cholangitis (AC) were retrospectively analyzed at Nanjing First Hospital between January 2015 and June 2023. SPSS version 27.0 and R studio software were used to analyze data obtained from medical records. The results were validated in a prospective cohort of 82 AC patients diagnosed at Nanjing First Hospital between July 2023 and February 2024.ResultsAmong the 401 patients, 102 had suppurative bile (the ASC group; AC grade I: 40 [39.2%], AC grade II: 27 [26.5%], AC grade III: 35 [34.3%]), whereas 299 did not have (the ANSC group; AC grade I: 157 [52.5%], AC grade II: 92 [30.8%], AC grade III: 50 [16.7%]). The specificity of ASC for diagnosing moderate-to-severe cholangitis is 79.7%. Multivariate logistic regression analysis identified concurrent cholecystitis, CRP, PCT, TBA, and bile duct diameter as independent risk factors for suppurative bile, and all of these factors were included in the nomogram. The calibration curve exhibited consistency between the nomogram and the actual observation, and the area under the curve was 0.875 (95% confidence interval: 0.835–0.915), sensitivity was 86.6%, and specificity was 75.5%.ConclusionSuppurative bile is a specific indicator for diagnosing moderate-to-severe cholangitis. However, diagnosing ASC with AC grade II and AC grade III has the risk of missed diagnosis as the sensitivity is only 60.8%. To improve the diagnostic rate of ASC, this study identified concurrent cholecystitis, CRP, PCT, TBA, and preoperative bile duct diameter as independent risk factors for ASC, and a nomogram was developed to help physicians recognize patients with ASC.

Rett Syndrome: The Emerging Landscape of Treatment Strategies.

Rett syndrome (RTT) has enjoyed remarkable progress in achieving specific therapies. RTT, a unique neurodevelopmental disorder first described in 1966, progressed slowly until the landmark paper of Hagberg and colleagues in 1983. Thereafter, rapid advances were achieved including the development of specific diagnostic criteria and the active search for a genetic etiology, resulting 16 years later in identification of variants in the methyl-CpG-binding protein (MECP2) gene located at Xq28. Shortly thereafter, the NIH Office of Rare Diseases funded the RTT Natural History Study (NHS) in 2003, initiating the acquisition of natural history data on clinical features from a large population of individuals with RTT. This information was essential for advancement of clinical trials to provide specific therapies for this disorder. In the process, the International Rett Syndrome Association (IRSA) was formed (now the International Rett Syndrome Foundation-IRSF), which participated directly in encouraging and expanding enrollment in the NHS and, subsequently, in developing the SCOUT program to facilitate testing of potential therapeutic agents in a mouse model of RTT. The overall objective was to review clinical characteristics developed from the NHS and to discuss the status of specific therapies for this progressive neurodevelopmental disorder. The NHS study provided critical information on RTT: growth, anthropometrics, longevity, key comorbidities including epilepsy, breath abnormalities, gastroesophageal dysfunction, scoliosis and other orthopedic issues, puberty, behavior and anxiety, and progressive motor deterioration including the appearance of parkinsonian features. Phenotype-genotype correlations were noted including the role of X chromosome inactivation. Development of clinical severity and quality of life measures also proved critical for subsequent clinical trials. Further, development of biochemical and neurophysiologic biomarkers offered further endpoints for clinical trials. Initial clinical trials prior to the NHS were ineffective, but advances resulting from the NHS and other studies worldwide promoted significant interest from pharmaceutical firms resulting in several clinical trials. While some of these have been unrewarding such as sarizotan, others have been quite promising including the approval of trofinetide by the FDA in 2023 as the first agent available for specific treatment of RTT. Blarcamesine has been trialed in phase 3 trials, 14 agents have been studied in phase 2 trials, and 7 agents are being evaluated in preclinical/translational studies. A landmark study in 2007 by Guy et al. demonstrated that activation of a normal MECP2 gene in a null mouse model resulted in significant improvement. Gene replacement therapy has advanced through translational studies to two current phase 1/2 clinical trials (Taysha102 and Neurogene-401). Additional genetic therapies are also under study including gene editing, RNA editing, and X-chromosome reactivation. Taken together, progress in understanding and treating RTT over the past 40 years has been remarkable. This suggests that further advances can be expected.

Association patterns of antisocial personality disorder across substance use disorders

There is a high prevalence of antisocial personality disorder (ASPD) in individuals affected by substance use disorders (SUD). However, there is limited information on the specific patterns of association of ASPD with SUD severity and specific SUD diagnostic criteria. We investigated the association of alcohol, cannabis, cocaine, opioid, and tobacco use disorders (AUD, CanUD, CocUD, OUD, and TUD, respectively) in 1660 individuals with ASPD and 6640 controls matched by sex (24% female), age, and racial/ethnic background in a sample ascertained for addiction-related traits. Generalized linear regressions were used to test ASPD with respect to the five DSM-5 SUD diagnoses, their severity (i.e., mild, moderate, severe), and their diagnostic criteria. We found that ASPD is associated with the diagnosis and severity of AUD (Odds Ratio, ORs = 1.89 and 1.25), CanUD (ORs = 2.13 and 1.32), and TUD (ORs = 1.50 and 1.21) (ps < 0.003). Of the specific diagnostic criteria, the “hazardous use” criterion showed the strongest association with ASPD across the five SUDs investigated (from ORTUD = 1.88 to ORCanUD = 1.37). However, when criteria of different SUDs were included in the same model, ASPD was independently associated only with TUD “hazardous use” and CocUD “attempts to quit”. Attempting to quit cocaine was inversely related to the presence of ASPD and remained significant (OR = 0.57, 95% confidence interval = 0.36–0.89) after controlling for interactive effects with sex. The current work provides novel insights into ASPD-SUD comorbidity, supporting the existence of different SUD patterns among individuals affected by ASPD.

Practical diagnosis and treatment of premenstrual syndrome and premenstrual dysphoric disorder by psychiatrists and obstetricians/gynecologists in Japan.

To investigate and compare the diagnoses and treatment of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) from the perspectives of psychiatrists and obstetricians/gynecologists (OB/GYNs) in Japan. Between December 2021 and February 2022, a web-based survey was conducted among the members of the Japanese Association of Neuro-Psychiatric Clinics. Data from 262 psychiatrists who responded to the aforementioned survey were compared with data from 409 OB/GYNs from a survey conducted in 2021 among members of the Japanese Society of Obstetrics and Gynecology. Overall, 79.8% of psychiatrists and 97.3% of OB/GYNs were involved in practicing PMS/PMDD diagnosis and treatment. Most psychiatrists believed that PMS should be treated by OB/GYNs (74.4%) and PMDD by psychiatrists (75.6%). Only vague medical interviews were conducted by 86.6% of psychiatrists, and only 9.7% maintained a two-cycle symptom diary. Psychiatrists mostly prescribed selective serotonin/serotonin and noradrenaline reuptake inhibitor (SSRI/SNRI) continuous dosing (91.1%), followed by Kampo medicines, especially Kamishoyosan (73.3%); only 2.8% chose oral contraceptive pills, unlike OB/GYNs, while SSRI continuous (32.8%) and luteal phase dosing (20.6%) and Kampo medicine (42.1%) were the most common first-line treatments. Lifestyle guidance was prescribed by 63.6% of psychiatrists, followed by cognitive behavioral therapy (13.8%) and the symptom diary observation method (11.1%), which were similar to OB/GYNs' choices. Many Japanese psychiatrists and OB/GYNs do not base PMS/PMDD diagnoses on prospective monitoring methods using specific diagnostic criteria and therefore do not provide evidence-based treatment. Moreover, a tendency of being biased toward treatments in which the department specialized was observed.

Age-related differences in the prevalence of premature ejaculation: taking a second and more detailed look.

Research indicates an inconsistent relationship between age and the prevalence of premature ejaculation (PE), with studies reporting an increase, decrease, or no change with age. To reexamine the possible relationship between age and PE prevalence, implementing methodological improvements that enhance the likelihood of detecting real effects. From a sample of 2772 men, we analyzed a subset of 418 classified as having probable or definite PE based on the Premature Ejaculation Diagnostic Tool. We not only analyzed men with lifelong PE (LPE; n = 316) and acquired PE (APE; n = 102) separately but assessed prevalence differences across age groups using an omnibus measure to establish PE status and specific PE diagnostic criteria, individually and in multifactorial combination. Prevalence of PE in younger vs older men. LPE, but not APE, showed age-related differences in prevalence, with LPE being lower in the higher age group. This pattern was most discernible when a multifactorial approach was used to establish PE status. Older men may be less distressed about their dysfunction or may benefit from diminishing ejaculatory function with age. This cross-sectional study used an improved methodology to detect age-related differences in PE prevalence. Future studies would benefit from a larger sample size that enables a breakdown of prevalence using a greater number of age categories. According to an improved methodology, men with LPE showed a decline in prevalence with aging. A methodology aimed at exploring this relationship should-at the very least-not only distinguish between LPE and APE subtypes but also consider using a multifactorial method of determining PE status that includes a measure of bother/distress.

Surgical advantage of modified labial salivary gland biopsy using chalazion forceps: a prospective randomized controlled study

Labial salivary gland biopsy (LSGB) is one of the specific diagnostic criteria for primary Sjögren's syndrome (pSS). In traditional LSGB, there is no lower lip fixation device, the field of view is unclear due to intraoperative bleeding, and the incision is large, which is unfavourable for healing. The use of auxiliary devices to improve the shortcomings of traditional LSGB technique would be meaningful. Therefore, this case–control study aimed to assess the value of modified LSGB using chalazion forceps as compared with traditional LSGB. After obtaining written informed consent from all participating parents and patients, we randomly assigned 217 eligible participants to undergo LSGB using chalazion forceps (n = 125) or traditional LSGB (n = 92). The outcome variables were surgical time, incision length, intraoperative bleeding, pain score at 24 h after surgery, incision healing status at 7 days after surgery, gland collection, and pathological results. The final diagnostic results of the two surgical methods were compared, and the match rates between the pathological results and the final clinical diagnoses were compared between the two groups. The data were analysed using parametric and nonparametric tests. Compared with the traditional group, the modified group had a smaller incision, shorter operative time, less blood loss, lower 24 h pain score, and better Grade A incision healing at 7 days after surgery (p < 0.01). There was no statistically significant difference between the patients in the two surgical-method groups in terms of the positive biopsy results and the final diagnosis based on expert opinions (p > 0.05). By multivariable regression analysis, only a focus score (FS) of ≥ 1 (p < 0.01), dry eye disease (p < 0.05) and anti-nuclear antibodies (ANA) titre ≥ 1:320 (p < 0.05) were correlated with the diagnosis of pSS. The positive biopsy results of patients in the different surgical-method groups had a biopsy accuracy of > 80.0% for the diagnosis of pSS. The positive biopsy results in the different surgical-method groups were consistent with the expert opinions and the 2016 ACR-EULAR primary SS classification criteria. The modified LSGB using an auxiliary chalazion forceps offers a good safety with a small incision, shorter operative time, less bleeding, reduced pain and a low incidence of postoperative complications.The match rate of LSGB pathological results of the proposed surgical procedure with the final diagnosis of pSS is high.

The relationship between dehydration and etiologic subtypes of major neurocognitive disorder in older patients.

Studies investigating associations between etiologic subtypes of major neurocognitive disorder (MND) and dehydration frequency are lacking. The aim of this study was to investigate the prevalence and risk factors of dehydration among older adults with and without MND (dementia), and across different etiologic subtypes of MND. This cross-sectional study included adults aged ≥ 65years old from one geriatric outpatient clinic. Dehydration was defined as a calculated [1,86 × (Na + K) + 1,15 × glucose + urea + 14] plasma osmolarity of > 295mOsm/L.Clinical characteristics and measures of comprehensive geriatric assessments of patients with dehydration and normohydration were compared. MND was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition criteria. The underlying etiologic subtypes were determined by specific diagnostic criteria. Of the 1377 patients 72% were female, the mean age was 80 ± 8years, and 575 had dementia. Dehydration was more common in patients with dementia than those without dementia (58% vs. 53%, p = 0.044). The prevelance of dehydration was 57%, 62%, 54%, 57% and 68% in Alzheimer's disease, Parkinson's disease dementia, fronto-temporal dementia, dementia with Lewy bodies, and vascular dementia, respectively (p ≥ 0.05). MND was associated with dehydration (OR 1.26, 95% CI 1.01-1.57; p = 0.037) after adjustment for age and sex. In multivariable analysis, among patients with dementia, hypertension, DM, CKD, and dysphagia were more common while mean Mini-Mental State Examination score was lower in those who had dehydration versus no dehydration in older patients with dementia (p < 0.05). Dehydration is slightly associated with the presence of MND independent of age and sex. However, dehydration is also quite common in older patients without cognitive disorders. Therefore, hydration status should be monitored in older adults irrespective of neurocognitive status. Hypertension, DM, CKD, dysphagia and severity of cognitive dysfunction were associated with dehydration in patients with dementia. The prevalence of dehydration is highest in patients with vascular dementia.

A Bibliometric and Visualised Analysis of Proliferative Verrucous Leucoplakia From 2003 to 2023

BackgroundProliferative verrucous leucoplakia (PVL) is a rare but slow-growing, aggressive leucoplakia lesion associated with the highest malignant transformation rate in oral potentially malignant disorders (OPMDs). With increasing attention paid to PVL, it is urgent for us to analyse and summarise the publications globally using comprehensive bibliometric studies to help researchers propose possible future research directions and guide them to further conduct relevant studies in the domain. ObjectivesThe purpose of the study was to evaluate global academic productivity, impact, and collaboration of potentially malignant oral disorder PVL utilising bibliometrics based on annual number of publications, countries and regions, institution, authors, journals, citations and co-occurrences of author keywords over the last 20 years. MethodsThis study searched publications pertaining to proliferative verrucous leucoplakia in the Web of Science Core Collection, spanning from 2003 to 2023. Utilizing VOSviewer, R software, Bibliometric online analysis platform, CiteSpace software, and Microsoft Excel, we conducted a bibliometric and visualised analysis of PVL. ResultsThe quantity of pertinent publications in this research domain displays a fluctuating but overall upward trend. In aggregate, there are 148 articles and 61 reviews, encompassing research contributions from 44 countries, 45 institutions, and involving 831 authors. Among these publications, the USA, Spain, and UK emerged as the predominant contributing nations. Predominantly, articles found their publication venue in “Pathology Research and Practice.” Notably, the author with the highest number of publications and most influence is Warnakulasuriya S. The top 3 keywords include “Proliferative Verrucous Leucoplakia,” “Squamous-Cell Carcinoma,” “Oral Leucoplakia,” and “Potentially Malignant Disorders.” ConclusionIn this investigation, statistical analysis and network visualisation were conducted to reveal the research progress, trends, and trending topics on PVL via a thorough bibliometric analysis. We found that current publications comprise mainly case reports, there is a significant research need to explore the molecular mechanisms, specific diagnostic criteria, and effective management options for PVL. Our work should serve as a key reference and a directional guide for future research in this domain.