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Chronic hepatitis C virus (HCV) infection can be associated with neuropsychiatric symptoms like fatigue and cognitive impairment, independent of the liver status. The present study aims to assess changes in the pattern and extent of neuropsychological symptoms after successful treatment with interferon (IFN)-based and IFN-free therapy. HCV-infected patients who underwent neuropsychological assessment in previous studies were invited to a follow-up examination. Patients were grouped according to the treatment status: Sustained virological response (SVR) after IFN treatment (IFN SVR, n = 14) or after therapy with direct acting antivirals (DAA SVR, n = 28) or ongoing HCV infection (HCV RNA+, n = 11). A group of 33 healthy controls served as reference. Patients completed self-report questionnaires addressing health-related quality of life (HRQoL), mood and sleep quality and a neuropsychological test battery including tests of memory and attention (Luria's list of words, PSE test, cancelling "d" test, Word-Figure-Memory Test and computer-based test battery for the assessment of attention [TAP]). At baseline, all three patient groups had worse fatigue, depression, anxiety and HRQoL scores compared to healthy controls. Longitudinal analysis revealed that fatigue and mood slightly improved in all patient groups over time, while HRQoL improved in SVR patients but not in HCV RNA+ patients. Memory test results improved significantly in all patient groups, irrespective of their virological status. In contrast, the attention test results showed no clear change from baseline to follow-up. Our data can be considered as a hint that HCV eradication-independent of therapy regimen-does not substantially ameliorate neuropsychiatric symptoms in HCV-afflicted patients., (© 2024 The Author(s). Journal of Viral Hepatitis published by John Wiley & Sons Ltd.)

Background and Aims: Current guidelines recommend the assessment for minimal HE in patients with liver cirrhosis. Various efforts were made to find tools that simplify the diagnosis. Here, we compare the 6 most frequently used tests for their validity and their predictive value for overt hepatic encephalopathy (oHE), rehospitalization, and death., Approach and Results: One hundred thirty-two patients with cirrhosis underwent the Portosystemic Encephalopathy-Syndrome-Test yielding the psychometric hepatic encephalopathy score (PHES), Animal Naming Test (ANT), Critical Flicker Frequency (CFF), Inhibitory Control Test (ICT), EncephalApp (Stroop), and Continuous Reaction Time Test (CRT). Patients were monitored for 365 days regarding oHE development, rehospitalization, and death. Twenty-three patients showed clinical signs of HE grade 1-2 at baseline. Of the remaining 109 neurologically unimpaired patients, 35.8% had abnormal PHES and 44% abnormal CRT. Percentage of abnormal Stroop (79.8% vs. 52.3%), ANT (19.3% vs. 51.4%), ICT (28.4% vs. 36.7%), and CFF results (18.3% vs. 25.7%) changed significantly when adjusted norms were used for evaluation instead of fixed cutoffs. All test results correlated significantly with each other ( p <0.05), except for CFF. During follow-up, 24 patients developed oHE, 58 were readmitted to the hospital, and 20 died. Abnormal PHES results were linked to oHE development in the multivariable model. No other adjusted test demonstrated predictive value for any of the investigated endpoints., Conclusions: Where applicable, the diagnosis of minimal HE should be made based on adjusted norm values for the tests, exclusively. The minimal HE tests cannot be equated with one another and have an overall limited value in predicting clinical outcomes., (Copyright © 2024 American Association for the Study of Liver Diseases.)

Background: The Post-COVID-19 syndrome (PCS), which can occur after acute respiratory syndrome coronavirus 2 infection, leads to restrictions in everyday activity. Our study assessed the impact of an online-guided intervention which intended to facilitate physical activity on the mental and physical capability of PCS patients., Methods: We randomized 62 patients with PCS (20 male/ 42 female; age: 46 ± 12 years; body mass index: 28.7 ± 6.7 kg/m 2 ) with a score ≥ 22 in the fatigue assessment scale (FAS) to a 3-month exercise-focused intervention (IG n = 30) or control period (CG n = 32). We assessed changes in exercise capacity (bicycle exercise test with measurements of gas exchange), fatigue, markers of health-related quality of life (HrQoL) and mental health., Results: The FAS score decreased significantly in both study groups (IG: 35.1 ± 7.4 to 31.8 ± 8.5 points; CG: 35.6 ± 7.4 to 32.6 ± 7.5 points, both p < 0.01). Exercise capacity did not increase in the CG or IG (within-group changes for IG: peak oxygen uptake: 0.9 ± 2.6 ml/min/kg, p = 0.098; peak power output: 6.1 ± 17.8 W, p = 0.076) with no significant changes in HrQoL and work ability. Patients with a FAS score at baseline ≥ 35 (severe fatigue) showed no change in exercise capacity with the 3-month intervention whereas the sub-group of patients with FAS < 35 points (moderate fatigue) showed improvements, independent of the study group., Conclusions: Our 3-month intervention seems appropriate for patients with moderate fatigue, whereas those with more severe fatigue appear to be too restricted with respect to their mental or physical health status to perform exercise at a level which is sufficient to improve markers of physical performance., Trial Registration: German Clinical Trials Register (registration trial number: DRKS00026245) on September 2 2021., (© 2024. The Author(s).)

Despite social awareness of the problem of slut-shaming for adolescent girls, no existing measure captures this construct. Using data from a sample of 202 girls from Québec, Canada (ages 14-17; 68% White), preliminary validation is provided for the Slut-Shaming Instrument, a seven-item measure of negative peer experiences related to being perceived as too sexually active, sexualized, or flirtatious. The measure showed strong psychometric properties including good reliability and factor structure, expected associations with daily experiences of slut-related victimization and sexual harassment, and links with number of sexual partners and other forms of peer victimization. Slut-shaming was associated with distress accounting for these other forms of victimization (including sexual harassment), suggesting the pertinence of addressing this type of gender-based victimization., (© 2023 The Authors. Journal of Research on Adolescence published by Wiley Periodicals LLC on behalf of Society for Research on Adolescence.)

Academic health centers are faced with limited resources to navigate placement of advanced practice RN (APRN) students at the same time as APRN programs continue to increase. Clinical practicum sites are in higher demand due to clinical hour increases by accrediting organizations. This article describes a successful approach to the inefficient use of administration and preceptor resources for APRN student practicum placements via an innovative academic health system partnership., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Previous research shows that adolescents who experience dating violence most often disclose their victimization to a peer or friend, more so than to other sources of support. However, surprisingly little research has explored how adolescents respond to peer disclosures of dating violence. Addressing this gap, the present study assessed variations in adolescents' perceptions of blame, interpretations of the incident as violence, and intentions to respond across physical, psychological, sexual, cyber-psychological, and cyber-sexual dating violence scenarios., Methods: As part of a national research project across Canada, 663 high school adolescents (432 girls, 65.2%) between the ages of 14-17 were randomly assigned to complete a questionnaire which included one of five different hypothetical dating violence scenarios. Next, participants responded to questions about their perceptions of the incident, as well as victim and perpetrator blame and responsibility, and their intentions to respond., Results: Results indicated that the type of dating violence experienced and the age and gender of participants all played a role in perceptions of blame, understandings of violence, and intentions to respond., Conclusions: As one of the first studies to explore how adolescents perceived and responded to dating violence, considering both in-person and cyber forms of dating violence, this study fills an important gap in the literature. Findings underscore the uniqueness of cyber forms of dating violence and how pre/intervention programs must address the specific contexts and issues unique to each type of dating violence., (© 2023 The Authors. Journal of Adolescence published by Wiley Periodicals LLC on behalf of Foundation for Professionals in Services to Adolescents.)

Background: Federal and national entities urge organizations to assess healthcare professionals' mental health and well-being as the COVID-19 pandemic has compounded the issue., Aims: This study aimed to (1) describe rates of mental health issues, healthy lifestyle behaviors, and perceptions of COVID-19's impact among Big 10 University nursing and health sciences faculty, staff, and students; (2) identify predictors of depression, anxiety, stress, and burnout; and (3) assess the relationships among perceived school wellness support, healthy lifestyle behaviors, physical/mental health, and mattering., Methods: A cross-sectional descriptive correlational design was used. Nursing and health science deans emailed invitations to faculty, staff, and students concerning an anonymous wellness assessment survey. Correlation coefficients tested associations among mental health indicators and wellness cultures. Multiple linear regression examined factors associated with mental health indicators., Results: Faculty, staff, and students responded (N = 1345). Findings indicated that most respondents were not getting adequate sleep, meeting physical activity recommendations, or eating the daily recommended number of fruits/vegetables. Fourteen to 54.9 % of participants reported depression, anxiety, and burnout. Overall, students, faculty and staff at colleges that operated under a strong wellness culture had better outcomes., Conclusion: Wellness cultures impact the mental and physical health of faculty, staff, and students., Competing Interests: Declaration of competing interest Bernadette Melnyk created the MINDSTRONG and MINDBODYSTRONG programs discussed in this paper and has a company, COPE2Thrive, LLC that disseminates the COPE programs. At the time the study took place, each author was employed by a Big 10 University. Beyond these associations, the Authors declare no other conflicts of interest., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background & Aims: Hepatic encephalopathy (HE) is a frequent and severe complication in patients after transjugular intrahepatic portosystemic shunt (TIPS) insertion. However, risk factors for post-TIPS HE remain poorly defined. Minimal HE (mHE) is a well-known risk factor for overt HE in patients with cirrhosis without TIPS. We aimed to evaluate three tools frequently used for diagnosing mHE for their dynamic changes and their predictive value for overt HE after TIPS., Methods: We prospectively recruited 84 consecutive patients before TIPS insertion and monitored them for 180 days for post-TIPS HE. Before TIPS insertion, the patients underwent the portosystemic encephalopathy (PSE) syndrome test, the animal naming test (ANT), and the critical flicker frequency (CFF). Patients were retested after TIPS insertion., Results: The majority of patients were male (67.9%), and the predominant indication for TIPS was refractory ascites (75%). Median age was 59 years, model for end-stage liver disease score was 12, and 66.3%, 64.6%, and 28.4% patients had evidence for mHE according to the PSE syndrome test, ANT, and CFF, respectively. Overall, 25 patients developed post-TIPS HE within 180 days after TIPS insertion. Post-TIPS incidence of overt HE was 22.2, 28.6, 45.5, and 55.6% in those with no, one, two, and three pathological tests at baseline, respectively. However, none of the three tests was significantly associated with post-TIPS HE. Of note, mean performance in all tests remained stable over time after TIPS insertion., Conclusions: PSE syndrome test, ANT and CFF, which are frequently used for diagnosing mHE have limited value for predicting HE after TIPS insertion. We could not find evidence that TIPS insertion leads to a psychometric decline in the long term., Impact and Implications: This prospective observational study compared three diagnostic tests for mHE and showed the limited value of these tests for predicting overt HE in patients with cirrhosis undergoing TIPS insertion. In addition, the results suggest that cognitive performance generally remains stable after TIPS insertion. These results are important for physicians and researchers involved in the management of patients with cirrhosis undergoing TIPS procedures. The study's findings serve as a starting point for further investigations on the development of more effective strategies for predicting and managing post-TIPS HE., Clinical Trial Number: ClinicalTrials.gov NCT04801290., Competing Interests: KW has taken part in the development of the Psychometric Hepatic Encephalopathy Score (PHES), and the copyright of this test is held by Hannover Medical School. BM received lecture fees from Norgine. HW received fees from Falk, Intercept, Norgine, and Pfizer. Please refer to the accompanying ICMJE disclosure forms for further details., (© 2023 The Authors.)

Background: Herpes simplex viruses (HSV) cause ubiquitous human infections. For vaccine development, knowledge concerning correlates of protection is essential. Therefore, we investigated (I) if humans are in principle capable producing cell-to-cell spread inhibiting antibodies against HSV and (II) whether this capacity is associated with a reduced HSV-1 reactivation risk., Methods: We established a high-throughput HSV-1-ΔgE-GFP reporter virus-based assay and evaluated 2,496 human plasma samples for HSV-1 glycoprotein E (gE) independent cell-to-cell spread inhibiting antibodies. Subsequently, we conducted a retrospective survey among the blood donors to analyze the correlation between the presence of cell-to-cell spread inhibiting antibodies in plasma and the frequency of HSV reactivations., Results: In total, 128 of the 2,496 blood donors (5.1%) exhibited high levels of HSV-1 gE independent cell-to-cell spread inhibiting antibodies in the plasma. None of the 147 HSV-1 seronegative plasmas exhibited partial or complete cell-to-cell spread inhibition, demonstrating the specificity of our assay. Individuals with cell-to-cell spread inhibiting antibodies showed a significantly lower frequency of HSV reactivations compared to subjects without sufficient levels of such antibodies., Conclusion: This study contains two important findings: (I) upon natural HSV infection, some humans produce cell-to-cell spread inhibiting antibodies and (II) such antibodies correlate with protection against recurrent HSV-1. Moreover, these elite neutralizers may provide promising material for immunoglobulin therapy and information for the design of a protective vaccine against HSV-1., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Alt, Wolf, van de Sand, Dittrich, Tertel, Brochhagen, Dirks, Aufderhorst, Thümmler, Otte, Rainer, Dittmer, Giebel, Trilling, Silke Heilingloh, Lotfi, Roggendorf, Witzke and Krawczyk.)

Background: It is known that specimen collection followed by histopathological workup is the core of evidence-based medical therapy of musculoskeletal tumors. There exist many controversies about how a biopsy should be performed. While some centers recommend minimal invasive biopsy procedures, mostly the core needle biopsy (CNB), others prefer the incisional biopsy., Purpose of the Study: This study aimed to determine the accuracy of incisional biopsy for malignant tumors in the musculoskeletal system. Moreover, advantages and disadvantages to other biopsy methods are discussed., Methods: This retrospective, single-center study about 844 incisional biopsies (benign and malignant) analysis the diagnostic accuracy of 332 malignant tumors, concerning the final histopathological result. In addition, surgical complications are analyzed to find the best way to plan and treat patients timely and correct. Secondary endpoints are the patients age, the pure operation time, as well as the type of tumor, and the subsequent therapy., Results: In summary, incisional biopsy corresponded a sensitivity of 100% for malignancy in 844 incisional biopsies and a specificity of 97.6% in 332 malignant tumors, but it features greater operative expense (incision/suture 23.5 min) and the risk of general anesthesia., Conclusion: The method of biopsy should be tailored to the individual patient and the experience of the center performing the procedure., (© 2023. The Author(s).)

Peer relationships become increasingly important during adolescence. The success of these relationships may rely on the ability to attend to and decode subtle or ambiguous emotional expressions that are common in social interactions. However, most studies examining youths' processing and labeling of facial emotion have employed adult faces and faces that depict emotional extremes as stimuli. In this study, 40 adolescents and 40 young adults viewed blends of angry-neutral, fearful-neutral, and happy-neutral faces (e.g., 100% angry, 66% angry, 33% angry, neutral) portrayed by adolescent and adult actors as electroencephalogram (EEG) was recorded. Participants also labeled these faces according to the emotion expressed (i.e., angry, fearful, happy, or neutral). The Late Positive Potential (LPP), an event-related potential (ERP) component that reflects sustained attention to motivationally salient information, was scored from the EEG following face presentation. Among adolescents, as peer-age faces moved from ambiguous (33%) to unambiguous (100%) emotional expression, the LPP similarly increased. These effects were not found when adolescents viewed emotional face blends portrayed by adult actors. Additionally, while both adolescents and young adults showed greater emotion labeling accuracy as faces increased in emotional intensity from ambiguous to unambiguous emotional expression, adolescent participants did not show greater accuracy when labeling peer-compared to adult-age faces. Together, these data suggest that adolescents attend more to subtle differences in peer-age emotional faces, but they do not label these emotional expressions more accurately than adults., (© 2022 Society for Psychophysiological Research.)

Acute severe colitis (ASC) may occur within 3 months of ulcerative colitis diagnosis in 9%-15% of children and the rate of colectomy is up to 40%-50% within 5 years after an ASC. The aim of this publication is to present recent and relevant data on the success of medical treatment with tofacitinib in ASC., Methods: We report a challenging case of a teenage boy with ASC at diagnosis and conduct a discussion after a review of the literature regarding the use of tofacitinib in inflammatory bowel disease, especially in pediatric patients and in ASC., Results: The patient was hospitalized for 10 weeks and was refractory to conventional therapies: intravenous corticosteroids, infliximab, methotrexate, and vedolizumab. He received 7 blood transfusions and also presented with a severe malnutrition requiring a total parenteral nutrition. Tofacitinib was considered as a medical last resort before colectomy and was started at week 8. Thirteen days after starting tofacitinib, he was asymptomatic and was discharged on tofacitinib as sole treatment. By week 9 of tofacitinib, a colonoscopy showed both endoscopic and histological remission. He has remained in clinical remission at 6-month follow-up., Conclusions: Tofacitinib may be an alternative medical treatment to avoid colectomy in ASC. It is a small molecule with a rapid onset and few severe adverse events. It has been used for ASC in adult patients, allowing to avoid colectomy in more than 60%. To our knowledge, this is one of the few pediatric patients with refractory ASC at initial diagnosis who responded to tofacitinib., Competing Interests: Dr Deslandres served as advisory board member and speaker for AbbVie and Janssen. The remaining authors report no conflicts of interest., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.)

Interpersonal stress in adolescence has been associated with alterations in neural responses to peer feedback, and increased vulnerability to psychopathology. However, it is unclear whether the associations of interpersonal problems with neural responses are global across event-related potentials (ERPs) or might result in alterations only in specific ERPs. We examined associations between multiple informants of peer stress (self-reported, parent-reported, and peer-reported) and multiple ERPs (N1, P2, RewP, and LPP) to social feedback in a sample of 46 early adolescents (aged 12-13 years). Reports of peer stress were only moderately correlated with one another, indicating different informants capture different aspects of peer stress. Regressions using informant reports to predict ERPs revealed greater parent-reported peer stress was associated with a smaller RewP, whereas self-reported stress was associated with a smaller P2, to acceptance. In contrast, greater peer-reported stress was associated with larger P2, RewP, and LPP to acceptance. Findings suggest that different sources of stress measurement are differentially associated with ERPs. Future research using social feedback-related ERPs should consider multiple sources of information as well as multiple ERP components across the time-course of feedback processing, to gain a clearer understanding of the effects of peer stress on neural responses to feedback., (© 2022 Wiley Periodicals LLC.)

Introduction: There is currently little knowledge on factors associated with the relapse of Crohn's disease (CD) in children. The aims of this study were to describe the risk factors associated with relapse in pediatric CD and the changes in the relapse rate over the past decade., Methods: Patients younger than 18 years and diagnosed between 2009 and 2019 were included in this retrospective cohort study. Clinical, endoscopic, histological, and laboratory data, as well as induction and maintenance treatments, were collected from the medical records. Survival analyses and Cox regression models were used to assess the impact of these risk factors on relapse., Results: Six hundred thirty-nine patients were included. There was a decrease in the clinical relapse rate over the past decade: 70.9% of the patients diagnosed between 2009 and 2014 relapsed as compared with 49.1% of the patients diagnosed between 2015 and 2019 (P < 0.0001). The following variables were associated with clinical relapse: female sex (adjusted hazard ratio [aHR] = 1.52, P = 0.0007), exposure to oral 5-ASA (aHR = 1.44, P = 0.04), use of immunomodulatory agents compared with tumor necrosis factor-alpha inhibitors (methotrexate aHR = 1.73, P = 0.003; thiopurines aHR = 1.63, P = 0.002), presence of granulomas (aHR = 1.34, P = 0.02) and increased eosinophils on intestinal biopsies (aHR = 1.36, P = 0.02), high levels of C-reactive protein (aHR = 1.01, P < 0.0001) and fecal calprotectin (aHR = 1.08, P < 0.0001), and low serum infliximab levels (aHR = 2.32, P = 0.001)., Discussion: Relapse of pediatric CD has decreased in the past decade. The risk of relapse is significantly associated with clinical, endoscopic, histological, and laboratory variables and treatment strategies., (Copyright © 2022 by The American College of Gastroenterology.)

Background and Aims: Neuropsychiatric symptoms in hepatitis C (HCV) patients resemble those of patients with autoimmune hepatitis (AIH) or primary biliary cholangitis (PBC), whilst the mechanisms behind them are unknown. Here we looked for cerebral metabolic and/or microstructural alterations in patients with HCV, AIH or PBC as possible causes behind these symptoms., Methods: Patients with HCV infection (n = 17), AIH (n = 14) or PBC (n = 11) and age-adjusted healthy controls (n = 18) underwent brain magnetic resonance imaging (MRI), magnetic resonance spectroscopy (MRS) and psychometric assessment of memory and attention. Brain relative proton density (PD) and T2 relaxation time (T2) were determined in 17 regions of interest (ROIs), as were the concentrations of N-acetyl-aspartate, choline, creatine, myo-inositol and glutamine + glutamate in frontal- (fWM) and parietal white matter (pWM). One-way analysis of variance and Kruskal-Wallis tests were used for group comparison. Correlations between altered neuropsychological findings and MRI/MRS observations were estimated with the Spearman ρ test., Results: HCV, AIH and PBC patients revealed similar alterations in brain PD and metabolites compared to controls: significantly decreased PD in 7/17 ROIs in the HCV group, 16/17 ROIs in the PBC group and 14/17 ROIs in the AIH group, significantly increased N-acetyl-aspartate in fWM in all patients, significantly increased choline in the PBC group in both fWM and pWM, in the AIH group only in pWM and with a trend in the HCV group in pWM. Correlation analysis did not reveal significant associations between MRI/MRS alterations and neuropsychological dysfunction., Conclusion: The findings suggest similar pathophysiological mechanisms behind neuropsychiatric symptoms associated with HCV infection, AIH and PBC., (© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background and Aims: The aims of this study were to describe the trends in the behavior of pediatric CD during the last decade and to describe the seasonal variation of disease presentation., Methods: Patients under 18 years old and diagnosed between 2009 and 2019 were included. The clinical, endoscopic, histological, and laboratory data were collected from the medical records. We analyzed the trends of these parameters according to the year and season of diagnosis., Results: 654 patients were included in the study. The number of incident CD cases increased yearly. Patients diagnosed between 2015 and 2019 were younger at diagnosis (OR 2.53, p = 0.02), had more perianal diseases (OR: 2.30, p < 0.0001) and more granulomas (OR: 1.61, p = 0.003), but fewer eosinophils (OR: 0.35, p < 0.0001) and less chronic lymphoplasmacytic infiltrate (OR: 0.56, p = 0.008) as compared to the 2009-2014 cohort. There was fewer CD diagnosis during winter. Patients diagnosed in the fall had lower PCDAIs, less failure to thrive and less extensive digestive involvement. Colonic disease was significantly more frequent during summer and fall., Conclusion: The clinical and histological phenotype of CD has changed over time and there are important seasonal trends in the frequency and severity on disease behavior suggesting possible disease triggers., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Chronic kidney disease (CKD) has emerged as a risk factor for cognitive impairment. Living kidney donation results in reduction of the donors' renal function. This is considered acceptable in general but possible associations with cognitive function have not yet been studied., Methods: Sixty living kidney donors (LKD), who had donated between 2003 and 2012 at Hannover Medical School, underwent neurocognitive testing including attentional and memory testing. In a cross-sectional design results were compared with data of healthy controls (n = 40) and with norm data given in the respective test manuals adjusted for age, sex, and education., Results: The median age of the LKD was 58 (range 39-70) years and the median time since donation was 7 (range 4-14) years. The LKD did not differ from controls in most of the cognitive test results and a composite attention test sum score. However, LKD did worse than controls in tests of working memory, parallel processing of stimuli, and sustained attention. No differences were found regarding quality of life. In LKD cognitive test results correlated significantly only with educational level but not with time since transplantation, eGFR, somatic comorbidity, quality of life and levels of fatigue, distress, depression, and anxiety., Conclusions: Our data show a fairly normal performance of LKD in most attentional and memory tests. However, our pilot study also suggests some cognitive impairment in attention tests in LKD which would need to be confirmed in longitudinal prospective studies., Competing Interests: The authors have declared that no competing interests exist.

Permanent makeup (PMU) is a descendant of tattoo ink products and used with the intention of giving the face more advantageous contours. PMU makes it possible to condense eyelashes and eyebrows with fine lines or to visually correct them with cleverly placed contour lines. Even the correction of most subtle irregularities on the skin is possible through skillful pigmentation. Microblading describes a special technique in which the skin is carved with a certain "needle blade." The ink is then applied on the fresh wound and massaged into the cuts in order to depose the pigments in the skin. The field of medical tattooing belongs to PMU as well. Hence, PMU can be regarded as versatile as classic tattooing. Investigating online advertisements, the frequent use of the terms biological-organic or mineral pigments is notable. In opposition to the claim of being permanent, the cosmetical tattoo is often considered temporal. Web-based statements claim the use of special pigments for PMU, 100% free of heavy metals and therefore not aging to reddish, bluish, or greenish altered marks after healing. Statements are made to convey safety to consumers. Facts are mixed with fiction. This review will deal with the general structure of tattoo colorants and explain the differences and parallels to PMU ink. Certain raw material groups will be clarified further, and possible risks linked to certain material groups shall be listed and explained as well., (© 2023 S. Karger AG, Basel.)

Purpose: Calcineurin inhibitors (CNI) can cause long-term impairment of brain function. Possible pathomechanisms include alterations of the cerebral immune system. This study used positron emission tomography (PET) imaging with the translocator protein (TSPO) ligand 18 F-GE-180 to evaluate microglial activation in liver-transplanted patients under different regimens of immunosuppression., Methods: PET was performed in 22 liver-transplanted patients (3 CNI free, 9 with low-dose CNI, 10 with standard-dose CNI immunosuppression) and 9 healthy controls. The total distribution volume (V T ) estimated in 12 volumes-of-interest was analyzed regarding TSPO genotype, CNI therapy, and cognitive performance., Results: In controls, V T was about 80% higher in high affinity binders (n = 5) compared to mixed affinity binders (n = 3). Mean V T corrected for TSPO genotype was significantly lower in patients compared to controls, especially in patients in whom CNI dose had been reduced because of nephrotoxic side effect., Conclusion: Our results provide evidence of chronic suppression of microglial activity in liver-transplanted patients under CNI therapy especially in patients with high sensitivity to CNI toxicity., (© 2021. The Author(s).)

Data from 790 older school-age (Mage = 10.2 years, SD = 1.2 years) girls (N = 427) and boys from Barranquilla, Colombia (N = 449) and Montréal, Canada (N = 331) were used to replicate findings reported by Valdivia et al. (2005). This prior study revealed contextual variations in the association between two measures of social behavior, specifically aggression and withdrawal, and two measures of effective functioning with peers, specifically sociometric preference and friendship. The Montréal participants were primarily from families with European backgrounds. The ethnicity of the participants from Barranquilla can be described as Latinx/Caribbean. Multilevel analyses provided evidence of replication of place differences only for the associations between measures of aggression and sociometric preference. Stronger negative associations were observed between (a) measures of aggression and sociometric preference, (b) measures of withdrawal and sociometric preference, and (c) withdrawal and friendship in peer groups that were high in collectivism. These findings are interpreted as largely replicating the deep structure of the findings from the Valdivia et al. study. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Introduction: Adolescents typically spend decreasing amounts of time with family members, but the COVID-19 pandemic changed this pattern for many youth. The objective of the current study was to better understand adolescents' perceived change in family relationship quality, and how these perceptions were related to psychosocial functioning during the COVID-19 pandemic, accounting for more traditional measures of family relationship quality. Understanding how adolescents perceived change in relationship quality with family members during the pandemic offers novel insight into adolescents' relationships with their families and psychosocial functioning during this period., Method: A sample of Canadian adolescents (N = 605, ages 14 to 18, 53% girls), was employed to examine patterns of adolescents' perceived change in relationship quality with parents and siblings since the start of the pandemic, accounting for relationship quality, pandemic-related characteristics, and demographic variables., Results: Four latent profiles were identified: youth who perceived (1) low change, (2) improvement only, (3) moderate instability and (4) high instability in relationship quality. Higher perceived instability was associated with poorer functioning, with youth who reported only improvement reporting the highest overall level of functioning., Conclusions: Adolescent perceptions of change in relationship quality were heterogeneous, and contribute to psychosocial functioning over and above their general evaluations of relationship quality. In particular, youth who perceive considerable change in their relationships with siblings and parents may require additional support in response to the COVID-19 pandemic., (Copyright © 2021 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.)

Background and Aim: Data on factors influencing time to remission in pediatric Crohn's disease (CD) are very limited in the literature. The aim of this retrospective cohort study was to describe the trends of time to clinical remission over the past decade and to identify factors associated with time to clinical remission in children with luminal CD., Methods: Patients under 18 years old diagnosed between 2009 and 2019 were included. All data were collected from the patients' medical records. Survival analyses and linear regression models were used to assess the impact of clinical, laboratory, endoscopic, histological, and therapeutic factors on time to clinical remission., Results: A total of 654 patients were included in the study. There was no change in the time to clinical remission over the decade. Female sex in adolescents (adjusted bêta regression coefficient [ aβ ] = 31.8 days, P  = 0.02), upper digestive tract involvement ( aβ  = 46.4 days, P  = 0.04) perianal disease ( aβ  = 32.2 days, P  = 0.04), presence of active inflammation on biopsies at diagnosis ( aβ  = 46.7 days, P  = 0.01) and oral 5-aminosalicylates (5-ASA) exposure ( aβ  = 56.6 days, P  = 0.002) were associated with longer time to clinical remission. Antibiotic exposure ( aβ  = -29.3 days, P  = 0.04), increased eosinophils ( aβ  = -29.6 days, P  = 0.008) and combination of exclusive enteral nutrition with tumor-necrosis-factor-alpha (TNF-alpha) inhibitors as induction therapy ( aβ  = -36.8 days, P  = 0.04) were associated with shorter time to clinical remission., Conclusion: In children with newly diagnosed Crohn's disease, time to clinical remission did not shorten during the decade. It was associated with baseline clinical and histological data and treatment strategies. Combination of enteral nutrition and TNF-alpha inhibitors was associated with faster clinical remission., (© 2021 The Authors. JGH Open published by Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.)

Background: Significant growth in advanced practice registered nurse (APRN) student placements for clinical practicums have forced APRN preceptors, hospitals, and clinics to restrict the volume of APRN students they can accommodate., Purpose: Describe the experiences and opinions of APRNs regarding their precepting experiences of APRN students in three main areas; placement antecedents, placement postcedents, and preceptor incentives., Methods: Quality improvement study conducted via electronic survey that contained quantitative short answer and a qualitative open-ended question of APRNs licensed in the State of REDACTED in June, 2019., Findings: A total of 757 surveys were quantitatively analyzed. Qualitative thematic analysis resulted in identifying one overarching theme, the need for shared responsibility and accountability, and six unique primary themes., Discussion: Our findings indicate that APRN preceptors recognize their critical role but lack support and preparation to fully execute academic and profession strategic goals and objectives. There is the need for academic and professional ownership of APRN education at every level., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: Neuralgic amyotrophy (NA) has been described as a possible extrahepatic manifestation of hepatitis E virus (HEV) infection. Usually, HEV-associated NA occurs bilaterally. The clinical characteristics determining the course of HEV-associated NA have still not been defined., Methods: In this retrospective multicentric case series, 16 patients with HEV-associated NA were studied and compared to 176 HEV patients without NA in terms of their age, sex, and ALT levels., Results: Neither gender distribution (75% vs. 67% male) nor age (47 vs. 48 years median) differed significantly between the NA patients and controls. Eight NA patients (50%) presented with bilateral involvement-seven of these had right-side dominance and one had left-side dominance. Thirteen cases (81%) were hospitalized. Eight of these patients stayed in hospital for five to seven days, and five patients stayed for up to two weeks. The time from the onset of NA to the HEV diagnosis, as well as the diagnostic and therapeutic proceedings, showed a large variability. In total, 13 (81%) patients received treatment: 1/13 (8%) received intravenous immunoglobulins, 8/13 (62%) received glucocorticoids, 3/13 (23%) received ribavirin, and 6/13 (46%) received pregabalin/gabapentin. Patients with ages above the median (47 years) were more likely to be treated ( p = 0.001)., Conclusion: HEV-associated NA causes a relevant morbidity. In our case series neither the type of treatment nor the time of initiation of therapy had a significant effect on the duration of hospitalization or the course of the disease. The clinical presentation, the common diagnostic and therapeutic procedures, and the patients' characteristics showed large variability, demonstrating the necessity of standardized protocols for this rare but relevant disease.

Purpose: Tracer kinetic modeling of tissue time activity curves and the individual input function based on arterial blood sampling and metabolite correction is the gold standard for quantitative characterization of microglia activation by PET with the translocator protein (TSPO) ligand 18 F-GE-180. This study tested simplified methods for quantification of 18 F-GE-180 PET., Methods: Dynamic 18 F-GE-180 PET with arterial blood sampling and metabolite correction was performed in five healthy volunteers and 20 liver-transplanted patients. Population-based input function templates were generated by averaging individual input functions normalized to the total area under the input function using a leave-one-out approach. Individual population-based input functions were obtained by scaling the input function template with the individual parent activity concentration of 18 F-GE-180 in arterial plasma in a blood sample drawn at 27.5 min or by the individual administered tracer activity, respectively. The total 18 F-GE-180 distribution volume (V T ) was estimated in 12 regions-of-interest (ROIs) by the invasive Logan plot using the measured or the population-based input functions. Late ROI-to-whole-blood and ROI-to-cerebellum ratio were also computed., Results: Correlation with the reference V T (with individually measured input function) was very high for V T with the population-based input function scaled with the blood sample and for the ROI-to-whole-blood ratio (Pearson correlation coefficient = 0.989 ± 0.006 and 0.970 ± 0.005). The correlation was only moderate for V T with the population-based input function scaled with tracer activity dose and for the ROI-to-cerebellum ratio (0.653 ± 0.074 and 0.384 ± 0.177). Reference V T , population-based V T with scaling by the blood sample, and ROI-to-whole-blood ratio were sensitive to the TSPO gene polymorphism. Population-based V T with scaling to the administered tracer activity and the ROI-to-cerebellum ratio failed to detect a polymorphism effect., Conclusion: These results support the use of a population-based input function scaled with a single blood sample or the ROI-to-whole-blood ratio at a late time point for simplified quantitative analysis of 18 F-GE-180 PET.

Risk-taking peaks in adolescence and reflects, in part, hyperactivity of the brain's reward system. However, it has not been established whether the association between reward-related brain activity and risk-taking varies across adolescence. The present study investigated how neural reward sensitivity is associated with laboratory risk-taking in a sample of female adolescents as a function of age. Sixty-three female adolescents ages 10-19 completed the Balloon Analogue Risk Task, a laboratory measure of risk-taking behavior, as well as a forced choice monetary gambling task while an electroencephalogram (EEG) was recorded. This gambling task elicits the reward positivity (RewP), a frontocentral event-related potential component that is sensitive to feedback signaling reward. We observed a negative quadratic association between age and risk-taking, such that those in early and late adolescence had lower relative risk-taking compared to mid-adolescence, with risk-taking peaking at around 15 years of age. In predicting risk-taking, we observed an interaction between age and RewP, such that reward-related brain activity was not associated with risk-taking in early adolescence but was associated with a greater propensity for risk in later adolescence. These findings suggest that for females, neural response to rewards is an important factor in predicting risk-taking only in later adolescence., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Although peer relations are recognized as a fundamental developmental context, they have been rarely studied as a means of understanding the effects of socioeconomic status and inequality. In this paper, we show how and why peer relations provide a unique and powerful opportunity to assess the differential risks and resources available in the peer system to children and adolescents from different SES spectra. We argue that research on the intersection between SES and peer relations will enrich both these domains of study., (© 2020 Wiley Periodicals LLC.)

Background: While acute neurotoxic side effects of calcineurin inhibitors (CNI) are well-known, data upon long-term effects on brain structure and function are sparse. We hypothesize that long-term CNI therapy affects the neuroimmune system, thereby, increasing the risk of neurodegeneration. Here, we measured the impact of CNI therapy on plasma levels of brain- and T cell-derived cytokines in a cohort of patients after liver transplantation (LT)., Methods: Levels of T cell-mediated cytokines (e.g. Interferon-γ (IFN-γ)) and brain-derived cytokines (e.g. brain derived neurotrophic factor (BDNF), platelet derived growth factor (PDGF)) were measured by multiplex assays in plasma of 82 patients about 10 years after LT (17 with CNI free, 35 with CNI low dose, 30 with standard dose CNI immunosuppression) and 33 healthy controls. Data were related to psychometric test results and parameters of cerebral magnetic resonance imaging., Results: IFN-γ levels were significantly higher in the CNI free LT patient group (p=0.027) compared to healthy controls. BDNF levels were significantly lower in LT patients treated with CNI (CNI low: p<0.001; CNI standard: p=0.016) compared to controls. PDGF levels were significantly lower in the CNI low dose group (p=0.004) and for PDGF-AB/BB also in the CNI standard dose group (p=0.029) compared to controls. BDNF and PDGF negatively correlated with cognitive function and brain volume (p<0.05) in the CNI low dose group., Conclusion: Our results imply that long-term treatment with CNI suppresses BDNF and PDGF expression, both crucial for neuronal signaling, cell survival and synaptic plasticity and thereby may lead to cognitive dysfunction and neurodegeneration., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Although intravenous thrombolysis (IVT) with recombinant tissue-plasminogen-activator represents a highly effective treatment in acute ischemic stroke patients, not every patient benefits. We hypothesized that pretreatment levels of mediators of hemostasis (VWF and ADAMTS13) and dimethylarginines (ADMA and SDMA) are associated with early neurological improvement and outcome after IVT in ischemic stroke. Moreover we aimed to investigate the link between ADAMTS13 and markers of inflammation (CRP, IL-6, MMP-9 and MCP-1). In 43 patients with acute ischemic stroke treated with IVT blood samples for determination of the different markers were strictly taken before treatment, as well as at 24 h, 3, 7 and 90 days after symptom onset. Early neurological improvement was assessed using the shift between National Institutes of Health Stroke Scale (NIHSS) at baseline and at 24 h. Outcome at 90 days was assessed using the modified Rankin Scale. The lowest quartile of ADAMTS13 activity was independently associated with less improvement in NIHSS (baseline-24 h) (OR 1.298, p = 0.050). No independent association of ADMA or SDMA levels at baseline with outcome could be shown. Furthermore, IL-6, MCP-1 and CRP levels at 90 days significantly differed between patients with low and high ADAMTS13 activity. Thus, ADAMTS13 might indicate or even influence efficacy of IVT.

Cognitive dysfunction caused by hepatic encephalopathy (HE) improves within the first year after liver transplantation (LT). However, cognitive restitution seems to be incomplete in a subset of patients and after LT a new-onset cognitive decline was described. Data about the longterm development of cognitive function after liver transplantation (LT) are sparse. This prospective study analyzed whether a history of hepatic encephalopathy (HE) before LT had an impact on the longterm outcome of cognitive function after LT and if patients who underwent LT 5 years earlier showed worse cognitive function than healthy controls. The cognitive function of 34 patients was assessed before LT and at 1 year and 5 years after LT by psychometric tests, including the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and the portosystemic encephalopathy syndrome test, which provides the psychometric hepatic encephalopathy score (PHES). Furthermore, patients completed surveys to assess health-related quality of life (HRQOL). An 22 additional patients were included after LT. Patients were subdivided by having a history of HE before LT. The control group consisted of 55 healthy patients adjusted for age and education. Before LT, patients performed significantly worse than controls in the psychometric tests: RBANS Total Scale (TS), mean ± standard deviation (SD), 92.6 ± 13.3 versus 99.9 ± 12.0, P = 0.01; and PHES, median (interquartile range [IQR]), 0 (-3 to 1) versus 1 (0-2), P < 0.001. At 1 year after LT, patients with a history of HE still showed cognitive impairment compared with controls: RBANS TS, mean ± SD, 89.8 ± 15.1 versus 99.9 ± 12.0, P < 0.01; and PHES, median (IQR), 0 (-2 to 1.25) versus 1 (0-2), P = 0.03. At 5 years after LT, patients with and without a history of HE showed normal cognitive function and improved HRQOL. In conclusion, HE-associated cognitive impairment seems to be reversible within 5 years after LT., (Copyright © 2019 The Authors. Liver Transplantation published by Wiley Periodicals, Inc., on behalf of American Association for the Study of Liver Diseases.)

Importance: While the association between income inequality and interpersonal violence has been attributed to the psychosocial effects of inequality (eg, increased class anxiety, reduced social capital), longitudinal evidence for this pathway is limited by a reliance on small ecological studies and cross-sectional data. The developmental consequences of early-life inequality for subsequent involvement in violence have not been investigated., Objective: To examine the association between income inequality during infancy and early childhood and adolescents' involvement in bullying others, experiences of being bullied, or both., Design, Setting, and Participants: The Health Behavior in School-aged Children survey study was conducted in European and North American schools. This analysis used individual data on bullying (being bullied, bullying others, or both) from 6 consecutive school-based surveys of 11-year-old to 15-year-old students carried out in 40 countries between February 1994 to March 2014. Data analysis occurred from March 2018 to January 2019., Exposure: National Gini indices of income inequality for every year of life spanning a 35-year period (1979 to 2014)., Main Outcomes and Measures: Being bullied, bullying others, and both outcomes were measured using a common definition and questions adapted from the Bully-Victim Questionnaire and translated to many languages., Results: The sample included 425 938 male students and 448 265 female students from 162 country-survey year groups in 29 196 schools. Linear regression coefficients indicated that early-life income inequality from birth to 4 years was positively associated with being bullied (male students: linear regression coefficient, 18.26 [95% CI, 11.04-25.47]; P < .001; female students: linear regression coefficient, 15.67 [95% CI, 10.02-21.33]; P < .001), and dual involvement in being bullied and bullying others (male students: linear regression coefficient, 5.55 [95% CI, 2.67-8.44]; P < .001; female students: linear regression coefficient, 2.45 [95% CI, 0.93-3.97]; P < .001), after differences in lifetime mean income inequality (from birth to when bullying was measured), national per capita income, family socioeconomic position, age, and cohort were controlled. No such association was found with bullying others after differences in being bullied were controlled., Conclusions and Relevance: Being bullied is associated with early-life exposure to income inequality. Although further research on the underlying pathways is needed to guide intervention, these results suggest temporality in the association between inequality and violence and suggest that growing up in areas of high income inequality is associated with victimization in adolescence.

Neuropsychiatric symptoms and cognitive impairment have been consistently reported in patients with hepatitis C virus (HCV) infection. Since the mechanisms behind remain to be established, the present study attempted to assess whether neuropsychological impairments in HCV-infected patients are accompanied by structural alterations in the brain. Therefore, 19 anti-HCV-antibody-positive women with mild liver disease and 16 healthy controls underwent extensive neuropsychological testing and cranial magnetic resonance imaging (MRI) examination. Nine of the patients and five controls were followed up after 6-7 years. Voxel-based morphometry and magnetization transfer imaging were utilized to study HCV-associated structural gray and white matter changes. The HCV-infected patients had significantly worse fatigue and depression scores and significantly poorer performance on attention and memory tests than controls. The patients displayed gray matter (GM) atrophy in the bilateral insula and thalamus and a profound GM volume increases in the cerebellum. Microstructural GM changes in the insula were also evident by a reduced magnetization transfer ratio. Structural white matter changes were observed along several descending and crossing fiber tracts. Follow-up at 7 years revealed increased GM atrophy in the left amygdala and left parahippocampal regions over time. We conclude that our data provide evidence for structural alterations in the brains of patients with chronic HCV infection. Disturbances of cerebellothalamocortical regions and circuits, linking cerebellar projections to the prefrontal cortex through the thalamus, underpin the emotional and cognitive dysfunction characteristically observed in these patients.

Chronic fatigue, mood alterations and cognitive impairment are frequent accessory symptoms of HCV infection. Fatigue and mood alterations have also been observed in autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC), but not in hepatitis B virus (HBV)-infection, thus indicating an autoimmune response as possible cause of HCV infection-associated encephalopathy. Data, however, are sparse. This study aimed to prove that HCV patients feature similar to those with autoimmune liver disease but contrary to HBV patients regarding neuropsychiatric symptoms. A total of 132 noncirrhotic patients (HCV: 46, HBV: 22, AIH: 27, PBC: 29, AIH/PBC: 8) completed questionnaires addressing the domains mentioned above. Eighty-eight underwent a comprehensive neuropsychological assessment. Patient groups were compared among each other and to 33 healthy controls. Fatigue, anxiety and depression scores were significantly increased, and the SF-36 mental score significantly decreased in all patient groups compared to controls. Fatigue was significantly more pronounced in HCV than in HBV patients. HCV patients scored significantly worse than HBV patients but not AIH and PBC patients in the SF-36. HCV, AIH and PBC but not HBV patients did significantly worse than controls in word learning. Recognition of words was impaired in HCV, AIH and PBC patients and recognition of figures in HCV patients, exclusively (P ≤ 0.002). HCV patients did also worse than controls and HBV patients concerning alertness and working memory (P ≤ 0.001). The neuropsychiatric profiles of HCV patients are similar to those of AIH and PBC patients but differ from those of HBV patients, suggesting an autoimmune response as a possible cause for these differences., (© 2018 John Wiley & Sons Ltd.)

Objective: Hepatic encephalopathy is a common complication of cirrhosis; it is characterised by neuropsychometric/neurophysiological abnormalities. Its pathophysiology is complex but glial neuronal communication is likely to be disrupted and to impact on oscillatory networks and cortical connectivity. The aim of this study was to use multichannel electroencephalography (EEG) to investigate functional connectivity, as a surrogate for cortical networks, in patients with cirrhosis., Methods: Resting EEGs were recorded in 98 healthy controls and in 264 patients with cirrhosis characterised psychometrically using the Psychometric Hepatic Encephalopathy Score (PHES). Functional connectivity was calculated using the phase-lag index with stratification into standard EEG frequency bands. The findings were validated in a further cohort of 39 healthy controls and 106 patients with cirrhosis., Results: Widespread disruption in functional connectivity was observed in the patients compared with the controls; connectivity was increased in the theta (4-8 Hz) band and decreased in the delta (1-3.5 Hz), alpha (8.5-13 Hz) and beta (13.5-26.5 Hz) bands. Changes were apparent even in patients who were psychometrically unimpaired compared with healthy controls viz mean ± SEM theta 0.107 ± 0.001 vs. 0.103 ± 0.002 (p < 0.05) and alpha 0.139 ± 0.003 vs. 0.154 ± 0.003 (p < 0.01); more pronounced changes were observed with increasing neuropsychometric impairment. The findings were replicated in the second cohort., Conclusions: Cortical networks are disturbed in patients with cirrhosis even in the absence of psychometric impairment., Significance: These findings will facilitate further exploration of the pathophysiology of this condition and provide a robust means for assessing treatment effects in research settings., (Copyright © 2018 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.)

Allogeneic stem cell transplantation (alloSCT) of homozygous CCR5 Δ32 stem cells once resulted in the cure of human immunodeficiency virus (HIV) infection. We have recently reported a viral breakthrough in a similar setting. Here, we demonstrate that the rapid rebound after alloSCT was related to a highly replicative CXCR4-tropic HIV variant, which could already be detected before alloSCT.

Lignocellulosic biomass is the only renewable source of carbon for the chemical industry. Alkylmethoxyphenols can be obtained in good yield from woody biomass by reductive fractionation, but these compounds are of limited value for large-scale applications. We present a method to convert lignocellulose-derived alkylmethoxyphenols to phenol that can be easily integrated in the petrochemical industry. The underlying chemistry combines demethoxylation catalyzed by a titania-supported gold nanoparticle catalyst and transalkylation of alkyl groups to a low-value benzene-rich stream promoted by HZSM-5 zeolite. In this way, phenol can be obtained in good yield, and benzene can be upgraded to more valuable propylbenzene, cumene, and toluene. We demonstrate that intimate contact between the two catalyst functions is crucial to transferring the methyl groups from the methoxy functionality to benzene instead of phenol. In a mixed-bed configuration, we achieved a yield of 60% phenol and 15% cresol from 4-propylguaiacol in a continuous one-step reaction at 350 °C at a weight hourly space velocity of ∼40 h -1 ., Competing Interests: The authors declare no competing financial interest.

Background & Aims: Chronic inflammatory liver diseases are frequently associated with neuropsychiatric and cognitive dysfunctions. We hypothesized that symptomatic patients may show altered levels of soluble inflammatory mediators (SIMs) as well as changes in immune cell phenotypes., Methods: A comprehensive immune-phenotyping including investigation of 50 SIMs as well as ex-vivo phenotypes of NK-cells, CD3+, CD4+, CD8+ and regulatory T cells in 40 patients with viral and autoimmune chronic liver diseases was performed. The patients' cognitive functions were assessed using an extensive battery of neuropsychological testing., Results and Conclusion: Overall, our data indicate that while SIMs are significantly up-regulated, NK- and T-cells are less-activated in patients with neuropsychiatric symptoms accompanying chronic inflammatory liver diseases compared to patients without these symptoms. Moreover, HCV patients showed a unique pattern of immune alterations as compared to patients with HBV, autoimmune hepatitis and primary biliary cirrhosis. These findings hint towards potential mechanisms explaining these symptoms in patients with chronic liver diseases., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

The goal of the present investigation was to clarify and compare the structure of genetic and environmental influences on different types (e.g., physical, verbal) of peer victimization experienced by youth in pre-/early adolescence and mid-/late adolescence. Physical, verbal, social, and property-related peer victimization experiences were assessed in two twin samples (306 pairs, ages 9-14 and 294 pairs, ages 15-20). Cholesky decompositions of individual differences in victimization were conducted, and independent pathway (IP) and common pathway (CP) twin models were tested in each sample. In the younger sample, a Cholesky decomposition best described the structure of genetic and environmental contributors to peer victimization, with no evidence that common additive genetic or environmental factors influence different types of peer victimization. In the older sample, common environmental factors influenced peer victimization types via a general latent liability for peer victimization (i.e., a CP model). Whereas the pre-/early adolescent sample demonstrated no evidence of a shared genetic and environmental structure for different types of peer victimization, the mid-/late adolescent sample demonstrates the emergence of an environmentally-driven latent liability for peer victimization across peer victimization types.

Purpose: Renal impairment is a common complication after liver transplantation (LT). While BK polyomavirus (BKV) has been linked to renal failure in kidney transplant recipients, Torque teno virus (TTV) is a surrogate marker for immunosuppression that does not have a clear association with any human disease. The impact of BKV and TTV on renal impairment after LT is unknown., Methodology: In this retrospective study, urine and serum samples from 136 liver transplant recipients were screened for BKV and TTV by quantitative PCR. In addition, serum was screened for BKV-specific antibodies and the VP1 typing region was sequenced for BKV genotyping. All parameters were correlated with clinical data.Results/Key findings. BK viruria was detected up to 21 years after transplantation in 16.9 % of cases. BK viraemia was detected in 8.7 % of patients with BK viruria up to 4 years after LT. BKV-specific antibodies were detected in 93.6 % of all LT recipients and correlated with BKV viral load in urine. There was no correlation between renal impairment and the detection of BK DNA in urine (OR 0.983). TTV DNA was detected in 84.6 % of serum samples and in 66.6 % of urine samples. The TTV viral load in serum correlated with the BKV viral load but had no impact on renal impairment., Conclusion: Our data indicate that the detection of BKV and TTV is not a risk factor for renal impairment after LT. A correlation of TTV and BKV viral load seems to be an indicator for the immune status of the host.

Introduction: We aimed to develop and validate a prognostic score for disability at discharge and functional outcome at three months in patients with acute ischemic stroke based on clinical information available on admission., Patients and Methods: The Dutch Stroke Score (DSS) was developed in 1227 patients with ischemic stroke included in the Paracetamol (Acetaminophen) In Stroke study. Predictors for Barthel Index (BI) at discharge ('DSS-discharge') and modified Rankin Scale (mRS) at three months ('DSS-3 months') were identified in multivariable ordinal regression. The models were internally validated with bootstrapping techniques. The DSS-3 months was externally validated in the PRomoting ACute Thrombolysis in Ischemic StrokE study (1589 patients) and the Preventive Antibiotics in Stroke Study (2107 patients). Model performance was assessed in terms of discrimination, expressed by the area under the receiver operating characteristic curve (AUC), and calibration., Results: At model development, the strongest predictors of Barthel Index at discharge were age per decade over 60 (odds ratio = 1.55, 95% confidence interval (CI) 1.41-1.68), National Institutes of Health Stroke Scale (odds ratio = 1.24 per point, 95% CI 1.22-1.26) and diabetes (odds ratio = 1.62, 95% CI 1.32-1.91). The internally validated AUC was 0.76 (95% CI 0.75-0.79). The DSS-3 months, additionally consisting of previous stroke and atrial fibrillation, performed similarly at internal (AUC 0.75, 95% CI 0.74-0.77) and external validation (AUC 0.74 in PRomoting ACute Thrombolysis in Ischemic StrokE (95% CI 0.72-0.76) and 0.69 in Preventive Antibiotics in Stroke Study (95% CI 0.69-0.72)). Observed outcome was slightly better than predicted. Discussion: The DSS had satisfactory performance in predicting BI at discharge and mRS at three months in ischemic stroke patients., Conclusion: If further validated, the DSS may contribute to efficient stroke unit discharge planning alongside patients' contextual factors and therapeutic needs.

Background: Tattooed persons examined with magnetic resonance imaging (MRI) can develop burning sensation suggested in the literature to be thermal burn from the procedure. MRI-induced thermal effect and magnetic behavior of known tattoo pigments were examined ex vivo., Materials and Methods: Magnetic resonance imaging effects on 3 commonly used commercial ink stock products marketed for cosmetic tattooing was studied. A main study tested 22 formulations based on 11 pigment raw materials, for example, one line of 11 called pastes and another called dispersions. Samples were spread in petri dishes and tested with a 0.97 T neodymium solid magnet to observe visual magnetic behavior. Before MRI, the surface temperature of the ink was measured using an infrared probe. Samples were placed in a clinical 3T scanner. Two scans were performed, that is, one in the isocenter and one 30 cm away from the center. After scanning, the surface temperature was measured again. Chemical analysis of samples was performed by mass spectroscopy., Results: Mean temperature increase measured in the isocenter ranged between 0.14 and 0.26°C (P < .01) and in the off-center position from -0.16 to 0.21°C (P < .01). Such low increase of temperature is clinically irrelevant. Chemical analysis showed high concentrations of iron, but also nickel and chrome were found as contaminants. High concentration of iron was not associated with any increase of temperature or any physical draw or move of ink., Conclusion: The study could not confirm any clinically relevant temperature increase of tattoo pigments after MRI., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Endovascular treatment improves outcome in patients with acute ischaemic stroke due to large vessel occlusion in general. But outcome in some of these patients is jeopardized by recanalization failure or bleeding., Objectives: This study aimed to determine a possible association of mediators of inflammation and haemostasis (C-reactive protein, interleukin-6, matrix metalloproteinase-9, monocyte chemoattractant protein-1, asymmetric dimethylarginine [ADMA], symmetric dimethylarginine, von Willebrand factor and a disintegrin and metalloproteinase with a thrombospondin type 1 motif 13 [ADAMTS-13]) with the post-intervention grade of reperfusion, complications and clinical outcome in patients who underwent endovascular treatment of ischaemic stroke., Patients/methods: Forty-one patients with acute ischaemic stroke due to large vessel occlusion were prospectively enrolled into the study. Peripheral venous blood was taken prior to treatment and 24 hours and 3, 7 and 90 days after symptom onset. The post-intervention grade of reperfusion was determined using the modified Treatment in Cerebral Infarction (mTICI) score. Clinical outcome on day 90 was assessed using the modified Rankin's scale (mRS)., Results: Low ADAMTS-13 activity ( p  = 0.009) and missing of statin therapy ( p  = 0.038) on admission were independently associated with unfavourable outcome (mRS: 5-6). Patients with unsuccessful reperfusion (mTICI: 0-1) showed higher ADMA levels on admission ( p  = 0.018). However, this association could not be confirmed in the binary logistic regression analysis., Conclusion: Low ADAMTS-13 activity is a predictor of unfavourable outcome in patients with ischaemic stroke undergoing endovascular therapy. Further studies are warranted to elucidate the clinical and potential therapeutic role of ADAMTS-13 in acute ischaemic stroke., Competing Interests: This study was funded by a scholarship of TUI Stiftung, Germany, to H. Worthmann.Heinrich Lanfermann reports industry-funded travel and honoraria for speaking engagements from Bender Imaging and Radiopharm., (Schattauer GmbH Stuttgart.)

Background: Nonagenarians are under-represented in thrombolytic trials for acute ischemic stroke (AIS). The effectiveness of intravenous thrombolytics in nonagenarians in terms of safety and outcome is not well established., Materials and Methods: We used a multinational registry to identify patients aged 90 years or older with good baseline functional status who presented with AIS. Differences in outcomes-disability level at 90 days, frequency of symptomatic intracerebral hemorrhage (sICH), and mortality-between patients who did and did not receive thrombolytics were assessed using multivariable logistic regression, adjusted for prespecified prognostic factors. Coarsened exact matching (CEM) was utilized before evaluating outcome by balancing both groups in the sensitivity analysis., Results: We identified 227 previously independent nonagenarians with AIS; 122 received intravenous thrombolytics and 105 did not. In the unmatched cohort, ordinal analysis showed a significant treatment effect (adjusted common odds ratio [OR]: .61, 95% confidence interval [CI]: .39-.96). There was an absolute difference of 8.1% in the rate of excellent outcome in favor of thrombolysis (17.4% versus 9.3%; adjusted ratio: .30, 95% CI: .12-.77). Rates of sICH and in-hospital mortality were not different. Similarly, in the matched cohort, CEM analysis showed a shift in the primary outcome distribution in favor of thrombolysis (adjusted common OR: .45, 95% CI: .26-.76)., Conclusions: Nonagenarians treated with thrombolytics showed lower stroke-related disability at 90 days than those not treated, without significant difference in sICH and in-hospital mortality rates. These observations cannot exclude a residual confounding effect, but provide evidence that thrombolytics should not be withheld from nonagenarians because of age alone., (Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.)

Background: Asymmetric dimethylarginine (ADMA)--the most potent endogenous NO-synthase inhibitor, has been regarded as mediator of endothelial dysfunction and oxidative stress. Considering experimental data, levels of ADMA and its structural isomer symmetric dimethylarginine (SDMA) might be elevated after intracerebral hemorrhage (ICH) and associated with clinical outcome and secondary brain injury., Methods: Blood samples from 20 patients with acute ICH were taken at ≤ 24 h and 3 and 7 days after the event. Nine patients had favorable (modified Rankin Scale (mRS) at 90 days 0-2) outcome, and 11 patients unfavorable outcome (mRS 3-6). Patients' serum ADMA, SDMA, and L-arginine levels were determined by high-performance liquid chromatography-tandem mass spectrometry. Levels were compared to those of 30 control subjects without ICH. For further analysis, patients were grouped according to outcome, hematoma and perihematomal edema volumes, occurrence of hematoma enlargement, and cytotoxic edema as measured by computed tomography and serial magnetic resonance imaging., Results: Levels of ADMA--but not SDMA and L-arginine--were elevated in ICH patients compared to controls (binary logistic regression analysis: ADMA ≤ 24 h, p = 0.003; 3 days p = 0.005; 7 days p = 0.004). If patients were grouped according to outcome, dimethylarginines were increased in patients with unfavorable outcome. The binary logistic regression analysis confirmed an association of SDMA levels ≤ 24 h (p = 0.048) and at 3 days (p = 0.028) with unfavorable outcome. ADMA ≤ 24 h was increased in patients with hematoma enlargement (p = 0.003), while SDMA ≤ 24 h was increased in patients with large hematoma (p = 0.029) and perihematomal edema volume (p = 0.023)., Conclusions: Our data demonstrate an association between dimethylarginines and outcome of ICH. However, further studies are needed to confirm this relationship and elucidate the mechanisms behind.