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Normative Modeling of Brain Morphometry in Clinical High Risk for Psychosis.
No full textIMPORTANCE
The lack of robust neuroanatomical markers of psychosis risk has been traditionally attributed to heterogeneity. A complementary hypothesis is that variation in neuroanatomical measures in individuals at psychosis risk may be nested within the range observed in healthy individuals.
OBJECTIVE
To quantify deviations from the normative range of neuroanatomical variation in individuals at clinical high risk for psychosis (CHR-P) and evaluate their overlap with healthy variation and their association with positive symptoms, cognition, and conversion to a psychotic disorder.
DESIGN, SETTING, AND PARTICIPANTS
This case-control study used clinical-, IQ-, and neuroimaging software (FreeSurfer)-derived regional measures of cortical thickness (CT), cortical surface area (SA), and subcortical volume (SV) from 1340 individuals with CHR-P and 1237 healthy individuals pooled from 29 international sites participating in the Enhancing Neuroimaging Genetics Through Meta-analysis (ENIGMA) Clinical High Risk for Psychosis Working Group. Healthy individuals and individuals with CHR-P were matched on age and sex within each recruitment site. Data were analyzed between September 1, 2021, and November 30, 2022.
MAIN OUTCOMES AND MEASURES
For each regional morphometric measure, deviation scores were computed as z scores indexing the degree of deviation from their normative means from a healthy reference population. Average deviation scores (ADS) were also calculated for regional CT, SA, and SV measures and globally across all measures. Regression analyses quantified the association of deviation scores with clinical severity and cognition, and 2-proportion z tests identified case-control differences in the proportion of individuals with infranormal (z 1.96) scores.
RESULTS
Among 1340 individuals with CHR-P, 709 (52.91%) were male, and the mean (SD) age was 20.75 (4.74) years. Among 1237 healthy individuals, 684 (55.30%) were male, and the mean (SD) age was 22.32 (4.95) years. Individuals with CHR-P and healthy individuals overlapped in the distributions of the observed values, regional z scores, and all ADS values. For any given region, the proportion of individuals with CHR-P who had infranormal or supranormal values was low (up to 153 individuals [<11.42%]) and similar to that of healthy individuals (<115 individuals [<9.30%]). Individuals with CHR-P who converted to a psychotic disorder had a higher percentage of infranormal values in temporal regions compared with those who did not convert (7.01% vs 1.38%) and healthy individuals (5.10% vs 0.89%). In the CHR-P group, only the ADS SA was associated with positive symptoms (β = -0.08; 95% CI, -0.13 to -0.02; P = .02 for false discovery rate) and IQ (β = 0.09; 95% CI, 0.02-0.15; P = .02 for false discovery rate).
CONCLUSIONS AND RELEVANCE
In this case-control study, findings suggest that macroscale neuromorphometric measures may not provide an adequate explanation of psychosis risk
ASSIP vs. Crisis Counseling for Preventing Suicide Re-attempts: Outcome Predictor Analysis of a Randomized Clinical Trial Data
No full textObjective: Knowledge of the effectiveness and limits of the suitability of brief interventions in suicide prevention is greatly needed. We investigated subgroup differences and predictors for suicide re-attempts within a clinical trial population recruited for a brief intervention to prevent re-attempts.
Methods: Consenting adult patients receiving treatment for a suicide attempt in Helsinki City general hospital emergency rooms in 2016-2017 (n = 239) were randomly allocated to (a) the Attempted Suicide Short Intervention Program (ASSIP) or (b) Crisis Counseling (CC). Participants also received their usual treatment. Information on primary outcome repeat attempts and secondary outcomes was collected via telephone and from medical and psychiatric records for 2 years. As proportions of re-attempts did not differ significantly between ASSIP and CC (29.2 vs. 35.2%), patients were pooled and predictors for suicide re-attempts were analyzed using Kaplan-Meier and logistic regression analyses.
Results: Re-attempts were predicted by participants' younger age (OR 0.965 [0.933-0.998]), previous suicide attempts (OR 2.437 [1.106-5.370]), psychiatric hospitalization in the year preceding baseline (OR 3.256 [1.422-7.458]), and clinical diagnosis of a personality disorder (OR 4.244 [1.923-9.370]), especially borderline personality disorder (OR 5.922 [2.558-13.709]).
Conclusions: Within a population of suicide attempters consenting to a brief intervention trial, the risk of re-attempt was strongly predicted by subjects' young age, history of previous attempts, psychiatric hospitalizations, and personality disorder, particularly borderline personality disorder. The composition of treated populations with regard to these characteristics may strongly influence the observed success of brief interventions. Their potential as moderators of treatment effectiveness and as indicators of the utility of brief interventions warrants further investigation.HIGHLIGHTSDuring the 2-year follow-up, 32% of trial participants reattempted suicide.Rates of reattempts varied and were strongly predicted by clinical subgroup.Subgroup composition may strongly influence brief interventions' observed outcome.
Keywords: ASSIP; intervention studies; outcome; suicide attempt
Body painting, ultrasound, clinical examination, and peer-teaching: A student-centered approach to enhance musculoskeletal anatomy learning.
No full textThe presented course, established 2016 as a compulsory elective for 22nd-year bachelor medical students, aimed to enhance deep learning of upper and lower limb anatomy from a clinical perspective by a maximum of student-centered activities combining hands-on skills training with team-learning. Three cohorts (in total 60 students) participated in this study. Students rotated through body painting, ultrasound, and clinical investigation supervised by faculty or an experienced clinician. Teams of 3-4 students prepared presentations on clinical anatomy and pathological conditions, which by teacher- and peer assessments on average achieved >85% (mean 17.8/20 points ± 1.06). After each activity session, the students reported their learning experience through a reflective diary. Fifty students (83%) evaluated the course by a voluntary anonymous questionnaire combining Likert-type scale and free-text questions to assess, predominantly, perception of course activities and their perceived influence on learning anatomy. Journal reports and questionnaires revealed that the students highly valued the course, and 92% (29 females, 17 males) rated group work satisfying or well-perceived. The highest appreciation achieved ultrasound followed by clinical examination and body painting, which one third proposed to integrate into the regular dissection course. All students recommended the course to their younger peers. This course was feasible to integrate in the pre-existing curriculum. Limiting factors to offer this elective course to more students are availability of clinical teachers, technical equipment, and education rooms. Being student-directed tasks, body painting and reflective diary-writing would be feasible to implement without additional faculty, which we recommend to educators for student engagement activation
Biological disease-modifying anti-rheumatic drugs are equally effective in psoriatic arthritis patients with low and high joint counts.
Get PDFOBJECTIVE
A lack of representation in pivotal trials currently limits guidance for the use of biological disease-modifying anti-rheumatic drugs (bDMARDs) in psoriatic arthritis (PsA) patients with a low number of actively inflamed joints. The aim of this study was to compare the effectiveness of a first bDMARD in PsA patients with low vs high number of affected joints.
METHODS
PsA patients with available 66/68 joint count assessments were divided into low joint count (LJC) patients when presenting with =3 joints in both categories. We studied drug retention as a joint count independent effectiveness variable in LJC and HJC patients in univariate and multivariable adjusted Cox regression models.
RESULTS
197 LJC patients differed not only in joint counts, but also had lower enthesitis scores, less often dactylitis, less disability and a better health related quality of life at first bDMARD initiation than 190 HJC patients. However, LJC were less often on conventional synthetic (cs) DMARDs. Despite these differences at baseline, bDMARD retention was not significantly different between LJC and HJC in both crude and adjusted analyses (Hazard Ratio (HR) 1.09 [0.76-1.58], p= 0.52). Furthermore, bDMARD retention was significantly better (HR 0.63 [0.47-0.85], p< 0.002) when administered with csDMARD co-therapy.
CONCLUSIONS
Biological DMARDs were similarly effective in terms of drug retention in patients with low and high joint counts. In the setting of absent remission and a significant disease burden, bDMARDs should not be withheld from patients because they exhibit only a low joint count
A systematic review and meta-analysis investigating the relationship between metabolic syndrome and the incidence of thyroid diseases.
Get PDFPURPOSE
To assess the prospective association between metabolic syndrome (MetS), its components, and incidence of thyroid disorders by conducting a systematic review and meta-analysis.
METHODS
A systematic search was performed in Ovid Medline, Embase.com, and Cochrane CENTRAL from inception to February 22, 2023. Publications from prospective studies were included if they provided data on baseline MetS status or one of its components and assessed the incidence of thyroid disorders over time. A random effects meta-analysis was conducted to calculate the odds ratio (OR) for developing thyroid disorders.
RESULTS
After full-text screening of 2927 articles, seven studies met our inclusion criteria. Two of these studies assessed MetS as an exposure (N = 71,727) and were included in our meta-analysis. The association between MetS at baseline and incidence of overt hypothyroidism at follow-up yielded an OR of 0.78 (95% confidence interval [CI]: 0.52-1.16 for two studies, I2 = 0%). Pooled analysis was not possible for subclinical hypothyroidism, due to large heterogeneity (I2 = 92.3%), nor for hyperthyroidism, as only one study assessed this association. We found evidence of an increased risk of overt (RR: 3.10 (1.56-4.64, I2 = 0%) and subclinical hypothyroidism (RR 1.50 (1.05-1.94), I2 = 0%) in individuals with obesity at baseline. There was a lower odds of developing overt hyperthyroidism in individuals with prediabetes at baseline (OR: 0.68 (0.47-0.98), I2 = 0%).
CONCLUSIONS
We were unable to draw firm conclusions regarding the association between MetS and the incidence of thyroid disorders due to the limited number of available studies and the presence of important heterogeneity in reporting results. However, we did find an association between obesity at baseline and incidence of overt and subclinical hypothyroidism
Effect of coffee thermocycling on the surface roughness and stainability of denture base materials with different chemical compositions manufactured with additive and subtractive technologies.
Get PDFOBJECTIVE
To evaluate the effect of coffee thermocycling (CTC) on the surface roughness (Ra ) and stainability of denture base materials with different chemical compositions fabricated by using additive and subtractive manufacturing.
MATERIALS AND METHODS
Disk-shaped specimens were additively (FREEPRINT denture, AM) or subtractively (G-CAM, GSM and M-PM, SM) fabricated from three pink denture base materials in different chemical compositions (n = 10). Ra was measured before and after polishing, while color coordinates were measured after polishing. Specimens were subjected to CTC (5000 cycles) and measurements were repeated. Color differences (ΔE00 ) after CTC were calculated. Ra among different time intervals within materials was evaluated by using repeated measures analysis of variance (ANOVA), while 1-way ANOVA was used to evaluate the Ra of different materials within each time interval and the ΔE00 values. Color coordinates within each material were compared by using paired samples t-tests (α = 0.05).
RESULTS
Ra before polishing was the highest for all materials (p < 0.001), while SM had its lowest Ra after CTC and AM had its lowest Ra after polishing (p ≤ 0.008). Before polishing, AM had the highest Ra among the materials (p < 0.001). After polishing, SM had higher Ra than AM (p < 0.001). After CTC, GSM had the lowest Ra (p ≤ 0.048). SM had the lowest (p ≤ 0.031) and AM had the highest (p < 0.001) ΔE00 . CTC decreased the a* and b* values of SM and AM (p ≤ 0.017), and increased the L* values of AM (p < 0.001).
CONCLUSIONS
Polishing significantly reduced the surface roughness of all materials. CTC did not increase the surface roughness of materials above the clinically acceptable threshold. Only AM had perceptible color change when previously reported threshold values for denture base materials were considered.
CLINICAL SIGNIFICANCE
Tested denture base materials may have similar surface stability after coffee thermocycling. However, subtractively manufactured denture base materials may have improved color stability when subjected to long-term coffee consumption
Can vitamins improve periodontal wound healing/regeneration?
Get PDFPeriodontitis is a complex inflammatory disorder of the tooth supporting structures, associated with microbial dysbiosis, and linked to a number if systemic conditions. Untreated it can result in an irreversible damage to the periodontal structures and eventually teeth loss. Regeneration of the lost periodontium requires an orchestration of a number of biological events on cellular and molecular level. In this context, a set of vitamins have been advocated, relying their beneficial physiological effects, to endorse the biological regenerative events of the periodontium on cellular and molecular levels. The aim of the present article is to elaborate on the question whether or not vitamins improve wound healing/regeneration, summarizing the current evidence from in vitro, animal and clinical studies, thereby shedding light on the knowledge gap in this field and highlighting future research needs. Although the present review demonstrates the current heterogeneity in the available evidence and knowledge gaps, findings suggest that vitamins, especially A, B, E, and CoQ10 , as well as vitamin combinations, could exert positive attributes on the periodontal outcomes in adjunct to surgical or nonsurgical periodontal therapy
Sex Differences in the Association Between Cumulative Use of Cannabis and Cognitive Function in Middle Age: The Coronary Artery Risk Development in Young Adults Study.
Get PDFBackground: Cannabis use may impair cognitive function (CF) differently in men and women, due to sex-specific differences in neurobiological mechanisms and environmental risk factors. Objective: Assess sex differences in the association between cumulative exposure to cannabis and cognitive performance in middle age. Methods: We studied participants from the Coronary Artery Risk Development in Young Adults (CARDIA) Study, including Black and White men and women 18-30 years old at baseline followed over 30 years. Our cross-sectional analysis of CF scores at year 30 was stratified by sex. We computed categories of cumulative exposure in "cannabis-years" (1 cannabis-year=365 days of use) from self-reported use every 2 to 5 years over 30 years. At years 25 and 30, we assessed CF with the Rey Auditory Verbal Learning Test (verbal memory), the Digit Symbol Substitution Test (processing speed), and the Stroop Interference Test (executive function). At year 30, additional measures included Category and Letter Fluency Test (verbal ability) and the Montreal Cognitive Assessment (global cognition). We computed standardized scores for each cognitive test and applied multivariable adjusted linear regression models for self-reported cumulative cannabis use, excluding participants who used cannabis within 24 h. In a secondary analysis, we examined the association between changes in current cannabis use and changes in CF between years 25 and 30. Results: By year 30, 1,352 men and 1,793 women had measures of CF; 87% (N=1,171) men and 84% (N=1,502) women reported ever cannabis use. Men had a mean cumulative use of 2.57 cannabis-years and women 1.29 cannabis-years. Self-reported cumulative cannabis use was associated with worse verbal memory in men (e.g., -0.49 standardized units [SU] for ≥5 cannabis-years of exposure; 95% CI=-0.76 to -0.23), but not in women (SU=0.02; 95% CI=-0.26 to 0.29). Other measures of CF were not associated with cannabis. Changes in current cannabis use between years 25 and 30 were not associated with CF in men or women. Conclusions: Self-reported cumulative cannabis exposure was associated with worse verbal memory in men but not in women. Researchers should consider stratified analyses by sex when testing the association between cannabis and cognition
Comments and illustrations of the WFUMB CEUS liver guidelines: Rare benign focal liver lesion, part I.
Get PDFImproved detection and characterization of common focal liver lesions (FLL) are the main topics of the World Federation for Ultrasound in Medicine and Biology (WFUMB) guidelines on the use of contrast-enhanced ultrasound (CEUS). On stateof-the-art CEUS imaging, to create a library of rare FLL, especially concerning their atypical imaging characteristics, might be helpful for improving clinical diagnostic efficiency. In this review, we aim to summarize the ultrasound and CEUS features of rare benign FLL. Currently there are limited reports and images published
Multicenter evaluation of blood-based biomarkers for the detection of endometriosis and adenomyosis: A prospective non-interventional study.
Get PDFOBJECTIVE
To evaluate blood-based biomarkers to detect endometriosis and/or adenomyosis across nine European centers (June 2014-April 2018).
METHODS
This prospective, non-interventional study assessed the diagnostic accuracy of 54 blood-based biomarker immunoassays in samples from 919 women (aged 18-45 years) with suspicion of endometriosis and/or adenomyosis versus symptomatic controls. Endometriosis was stratified by revised American Society for Reproductive Medicine stage. Symptomatic controls were "pathologic symptomatic controls" or "pathology-free symptomatic controls". The main outcome measure was receiver operating characteristic-area under the curve (ROC-AUC) and Wilcoxon P values corrected for multiple testing (q values).
RESULTS
CA-125 performed best in "all endometriosis cases" versus "all symptomatic controls" (AUC 0.645, 95% confidence interval [CI] 0.600-0.690, q < 0.001) and increased (P < 0.001) with disease stage. In "all endometriosis cases" versus "pathology-free symptomatic controls", S100-A12 performed best (AUC 0.692, 95% CI 0.614-0.769, q = 0.001) followed by CA-125 (AUC 0.649, 95% CI 0.569-0.729, q = 0.021). In "adenomyosis only cases" versus "symptomatic controls" or "pathology-free symptomatic controls", respectively, the top-performing biomarkers were sFRP-4 (AUC 0.615, 95% CI 0.551-0.678, q = 0.045) and S100-A12 (AUC 0.701, 95% CI 0.611-0.792, q = 0.004).
CONCLUSION
This study concluded that no biomarkers tested could diagnose or rule out endometriosis/adenomyosis with high certainty
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