Search

Acute variceal bleeding is a complication of portal hypertension, usually due to cirrhosis, with high morbidity and mortality. There are 3 scenarios for endoscopic treatment of esophageal varices: prevention of first variceal bleed, treatment of active variceal bleed, and prevention of rebleeding. Patients with cirrhosis should be screened for esophageal varices. Recommended endoscopic therapy for acute variceal bleeding is endoscopic variceal banding. Although banding is the first-choice treatment, sclerotherapy may have a role. Treatment with Sengstaken-Blakemore tube or self-expanding covered metallic esophageal stent can be used for acute variceal bleeding refractory to standard pharmacologic and endoscopic therapy.

Introduction Studies of Gaming Disorder (GD) consistently identify co-morbidity with various psychiatric disorders including major depression, obsessive compulsive disorder and anxiety disorders. One of the strongest associations has been with Attention Deficit Hyperactivity Disorder (ADHD). We present a systematic review of this association by pooling and integrating available evidence. Methods PubMed, EMBASE, PsychInfo and CINHAHL were searched for articles that reported a quantitative association between GD and ADHD and its dimensions, using equivalent search terms. Quality appraisal was done using criteria adapted from the Critical Appraisal Skills Package (CASP) checklists. Results 1028 articles were identified, of which 29 studies were included for systematic review (n = 56650 participants). Most of these studies were observational in nature, and were of moderate quality, with deficits particularly in the domains of generalisability and confounding. Community surveys (n = 18) of purposive samples constituted the majority, with fewer clinic-based samples (n = 11). While ADHD symptoms were consistently associated with GD, More frequent associations were displayed with inattention associations with GD than other ADHD subscales. There were no conclusive findings regarding the type of game on severity of either condition, or on completion of treatment. Conclusions The findings suggest an association between ADHD and GD, although the direction of the relationship is unclear. This has implications for clinical practice, policy and research. We recommend that ADHD is screened for when evaluating IGD as part of routine practice.”

Background Endoscopic resection of non-invasive lesions is now the standard of care for lesions in the GI tract. However, resection techniques require extensive training, are not available in all endoscopy centers and are prone to complications. Endoscopic mucosal ablation (EMA) is a combination of resection and ablation techniques and it may offer an alternative in the management of such lesions. Case summary In this case series we report the successful treatment of three flat colonic polyps using the EMA technique. Two lesions were treatment naive and 1 was a recurrence after an endoscopic mucosal resection. The sizes ranged from 2 to 4 cm. All three polyps were ablated successfully with no immediate or delayed complications. The recurrence rate at 1 year of follow up was 0%. Conclusion Based on this initial experience, we conclude that EMA is a safe and effective technique for the treatment of non-invasive colonic polyps when endoscopic resection techniques are not available.

OBJECTIVES The aim of this study was to compare a standard versus segmental withdrawal during screening colonoscopy and its effect on the adenoma detection rate (ADR). METHODS We performed a single-center clinical trial of average-risk patients 50 years of age and older undergoing screening colonoscopy. Patients were randomized into four groups: a standard withdrawal of at least 6 or 8 minutes and a segmental withdrawal, in which ≥3 or ≥4 minutes were dedicated to the right side of the colon, with a minimum withdrawal time of at least 6 or 8 minutes, respectively. RESULTS There were 311 patients in the study. There was no difference in ADR between the standard and segmental groups (relative ratio [RR] 0.91, P = 0.50), even after stratifying for right-sided adenomas. During standard withdrawal, an increased continuous withdrawal time was associated with a higher ADR (RR 1.08, P

BACKGROUND A recent expert panel issued recommendations about the technical aspects of direct endoscopic necrosectomy (DEN) for pancreatic walled-off necrosis (WON). However, significant technical heterogeneity still exists among endoscopists. AIM To report the outcomes of our DEN technique and how it differs from a recent expert consensus statement and previous studies. METHODS Medical records of patients with WON who underwent DEN from September 2016 - May 2019 were queried for the following information: Age, gender, ethnicity, etiology of acute pancreatitis, WON location and size, DEN technical information, adverse events (AEs) and outcomes. Adverse events were graded according to the American Society of Gastrointestinal Endoscopy Lexicon grading system. Technical success was defined as adequate lumen apposing metal stent (LAMS) deployment plus removal of ≥ 90% of necrosum. Clinical success was defined as complete resolution of WON cavity by imaging and resolution of symptoms at ≤ 3 months (mo) after last DEN. Data analysis was performed using mean and standard deviation for continuous variables, frequency and proportion for categorical variables, and median and range for interval data. RESULTS A total of 21 patients underwent DEN. Most of them were Hispanic and their mean age was 51 ± 17 years. The majority of the collections were located in the body of the pancreas and the mean size was 13 cm ± 5 cm. The most common indication was persistent vomiting. Antibiotics were administered only in cases of infected necrosis. All LAMS were placed without radiological guidance, dilated the same day of deployment and removed after a mean of 27 ± 11 d. Routine cross-sectional imaging immediately after drainage was not performed. The mean interval between DEN sessions was 7 ± 4 d and the mean number of DEN/patient was 3 ± 2. Technical and clinical success rates were both 95%. AEs were seen in 5 patients and included: Sepsis (2), stent migration (1), stent maldeployment (1), perforation (1). The sensitivity and positive predictive value of an occluded LAMS leading to sepsis was 50% and 0.11 respectively. No fatalities were observed. CONCLUSION Our DEN technique differed significantly from the one recommended by a recent expert panel and the one published in previous studies. Despite these differences excellent clinical outcomes were obtained.

Neurodevelopmental disorders are a heterogeneous group of conditions with overlapping symptomatology and fluctuating developmental trajectories that transcend current diagnostic categorisation. There is a need for validated screening instruments which dimensionally assess symptomatology from a holistic, transdiagnostic perspective. The primary aim is to co-design a Neurodevelopment Assessment Scale (NAS), a user-friendly transdiagnostic assessment inventory that systematically screens for all signs and symptoms commonly encountered in neurodevelopmental disorders. Our first objective is to undertake development of this tool, utilising co-design principles in partnership with stakeholders, including both those with lived experience of neurodevelopmental disorders and service providers. Our second objective is to evaluate the face validity, as well as the perceived utility, user-friendliness, suitability, and acceptability (i.e., ‘social validity’), of the NAS from the perspective of parents/caregivers and adults with neurodevelopmental disorders, clinicians, and service providers. Our third objective is to ascertain the psychometric properties of the NAS, including content validity and convergent validity. The NAS will provide an efficient transdiagnostic tool for evaluating all relevant signs, symptoms, and the dimensional constructs that underpin neurodevelopmental presentations. It is anticipated that this will maximise outcomes by enabling the delivery of personalised care tailored to an individual’s unique profile in a holistic and efficient manner.

Since December 2019, the emergence of a novel coronavirus responsible for a severe acute respiratory syndrome (SARS-CoV-2) is accountable for a major pandemic situation. As consequence, a major effort worldwide has been performed for the development of viral diagnostics strategies aiming at (i) reducing the diagnostics time, (ii) decrease the costs per assay, and (iii) providing population-scale solutions.Beyond the diagnostics requirements, the description of the B.1.1.7 strain, originated in the south of England, as a highly transmissible variant has strongly accelerated the world-wide interest in tracking SARS-CoV-2 variants’ occurrence. Since then, other extremely infectious variants, were described and unsurprisingly further others are expected to be discovered, notably due to the long period of time on which the pandemic situation is lasting.Interestingly, all currently described SARS-CoV-2 variants present systematically several mutations within the gene encoding the Spike protein, involved in host receptor recognition and entry into the cell. Hence, instead of sequencing the whole viral genome for variants’ tracking, our proposed strategy focuses on the SPIKE region, as a way to increase the number of candidate samples to screen at once; an essential aspect to accelerate SARS-CoV-2 diagnostics, but also improve variants’ emergence and progression surveillance.Herein we present a proof of concept study, for performing both at once, population-scale SARS-CoV-2 diagnostics and variants’ tracking. This strategy relies on (i) the use of the portable and affordable MinION DNA sequencer; (ii) a DNA barcoding strategy and a SPIKE gene-centered variant’s tracking, for largely increasing the number of candidates per assay; and (iii) a real-time diagnostics and variant’s tracking monitoring thanks to our software RETIVAD.As a whole, this strategy represents an optimal solution for addressing the current needs on SARS-CoV-2 progression surveillance, notably due to its affordable implementation, allowing its implantation even in remote places over the world.

Parents of children with a neurodevelopmental disorder (NDD) report higher levels of distress compared to those of typically developing children. Distress levels may be heightened by the restrictions associated with the COVID-19 pandemic. However, it is unclear whether distress levels of parents varied by the diagnosis of neurodevelopmental disorder in children during the COVID-19 pandemic. This study aims to investigate whether parental distress was influenced by the type of NDD. Participants were from Australia (N = 196) and Italy (N = 200), the parents of children aged 3–18 were invited to complete an online self-reported survey which included the 6-item Kessler Psychological Distress Scale (K6) to determine parental distress. The results show that intellectual or learning disorder (ILD) is a major contributor to parental distress compared to other NDDs in both Australia and Italy. Moreover, the worsening of symptomatic changes in children with NDDs was significantly associated with parental distress. The differences between the two countries in terms of the pandemic impact, however, were not statistically significant. The results suggest that intervention strategies need to be tailored for individual clinical information and factor in the society’s stringency level of anti-contagion policies to improve parental wellbeing.

International audience; Microglia, the immune cells in the brain involved in both homeostasis and injury/infection control, play a predominant role in neurodegenerative diseases. In vivo studies on microglia are limited due to the requirement of surgical intervention, which can lead to the destruction of the tissues. Over the last few years, multiple protocols—presenting a variety of strategies—have described microglia differentiation issued from human pluripotent stem cells. Herein, we have reanalyzed the transcriptomes released on six different microglia differentiation protocols and revealed a consensus core of master transcription regulatory circuitry defining microglia identity. Furthermore, we have discussed the major divergencies among the studied protocols and have provided suggestions to further enhance microglia differentiation assays.

Background: The COVID-19 pandemic and its concomitant impacts have been unevenly shared across society, this is particularly true for children with neurodevelopmental disorders (NDD), who often rely on a network of services and social connections for their well-being. Children with NDD during the COVID-19 pandemic have had worrying trends regarding their worsening well-being and poorer parental mental health. This study’s aim was to test whether these two factors were associated in a survey of Australian parents.Methods: This cross-sectional study of Australian parents of children with neurodevelopmental disorders (n = 304, ages 2 – 17, 63.8% male) sought to test the association between parental distress (as captured by the Kessler-6 distress scale) and two child outcomes, worsening NDD symptoms and worsening health behaviours (i.e., sleep, diet, exercise, and media use).Results: Parent distress was significantly associated with a worsening of symptoms of NDD and associated mental health comorbidities, and poorer child well-being. These results were significant even when including other variables of interest such as the families’ sociodemographic characteristics, indicating parental distress is a key factor for the well-being of children and parents.Conclusions: Overall, this study found relatively high levels of parental psychological distress, anxiety and poor well-being and demonstrated that parental psychological distress was significantly associated with parent-reported worsening of child diagnostic symptoms as well as poorer child well-being in relation to sleep, diet, exercise, and use of electronics. Together these findings suggest that deteriorating parental mental health (distress) due to COVID-19 is associated with adverse child mental health symptoms and well-being, as indexed by the behaviours described above.

Nonsteroidal anti-inflammatory drugs (NSAIDs) have been linked recently to a lower expression of pro-inflammatory cytokines in humans with acute pancreatitis. Because it is unclear if this effect results in clinical benefits, the aim of this study was to determine if prior NSAID exposure improves immediate clinical outcomes.Retrospective medical record review of adult patients admitted with acute pancreatitis. Cases were extracted from a national Veterans Affairs database using International Classification of Diseases, Ninth Revision codes. Prior NSAIDs use was determined through pharmacy data claims. The rates of acute kidney injury, respiratory failure, cardiovascular failure, and in-hospital mortality were compared between those with prior NSAID use (AP+NSAID) and those without it (AP-NSAID) using univariate and multivariate analysis.A total of 31,340 patients were identified: 28,364 AP+NSAID and 2976 AP-NSAID. The median age was 60 years, 68% were white, and the median hospital stay was 4 days. Approximately 2% of patients died during the hospitalization. After adjusting for demographics and other covariates, patients in the AP+NSAID arm had lower rates of acute kidney injury, P = .0002), cardiovascular failure (P = .025), any organ failure (P ≤ .0001), and in-hospital mortality (P.0001).Prior use of NSAIDs is associated with a lower incidence of organ failure and in-hospital mortality in adult patients with acute pancreatitis. The role of NSAIDs as therapeutic agents in this condition should be evaluated in interventional trials.

Antecedentes: La dermatitis por contacto es una reacción eccematosa en piel causada por la exposición repetida y directa de un alérgeno; se estima que la prevalencia de dermatitis de contacto al níquel es de 17 % en mujeres y 3 % en hombres y que 1 a 3 % de la población general presenta dermatitis de contacto alérgica a cobalto y cromo. El níquel es la causa más importante de dermatitis ocupacional y presenta reactividad a otros metales, principalmente cromo y cobalto.Caso clinico: Hombre de 47 años, con previa sensibilización a níquel en la infancia, trabajador de la industria metalúrgica, con exposición laboral a níquel y cobalto, quien presentó dermatosis de predominio en miembros superiores.Conclusión: La sensibilización previa a níquel en la infancia y el trabajo en la industria metalúrgica incrementó el riesgo de nuevas sensibilizaciones a metales, como cobalto.

BACKGROUND AND AIMS Data on adequacy of EUS guided biopsies using different tissue acquisition techniques and fine needle aspiration needle designs have been inconclusive. Data on newer fine needle biopsy (FNB) needles are scarce. This study compared the performance of 3 acquisition techniques and 2 fine needle biopsy designs in solid pancreatic lesions. METHODS Single-center, randomized, pilot clinical trial (Trial registration number NCT03264092). Patients undergoing EUS biopsy of pancreatic lesions were randomized to 1 of 3 acquisition techniques (dry suction, wet suction, slow pull) and 1 of 2 22G FNB needle designs. The primary outcome was specimen cellularity. Secondary outcomes included blood contamination and number of passes needed for diagnosis. RESULTS A total of 52 (35.3%), 49 (33.3%) and 46 (31.3%) specimens were obtained with slow pull, dry suction and wet suction, respectively. A total of 56 (38%) and 91 (62%) specimens were obtained with each needle, respectively. No difference in cellularity scores was identified by technique (3.28 vs 3.55 vs 2.94; p = 0.081) or needle type (3.45 vs 3.15; p = 0.19). The same was true for blood contamination and diagnostic pass. A diagnosis was reached after 3 passes in 51 patients (93%). Histological diagnosis was possible in 45 specimens (82%). No severe adverse events occurred. CONCLUSIONS Cellularity of pancreatic specimens obtained with FNB needles via EUS was not influenced by technique and needle design. Three passes were enough to obtain a histological diagnosis in most patients. Larger clinical trials are required to validate the results of this study.

Background Nitazoxanide shows adequate in vitro activity against coronavirus. The aim of this study was to describe the behavior of coronavirus disease 2019 (COVID-19) in pregnant women treated with nitazoxanide. Methodology This cross-sectional study included the files of COVID-19 positive pregnant women treated with nitazoxanide 500 mg every 6 hours, levofloxacin every 12 hours, and clarithromycin 500 mg every 12 hours. Results The data of 51 women (mean age: 27.4 ± 7.2 years) were analyzed. Eleven (21.56%) patients had to receive medical attention in the intensive care unit. There were 22 (43.13%) preterm deliveries, 21 by cesarean and one by vaginal delivery. The medical attention of this population was as follows: 31 cesareans, five vaginal deliveries, nine still pregnant, two requiring manual vacuum aspiration, two ectopic pregnancies, one requiring curettage, and one requiring hysterotomy. There were seven (13.72%) cases of preeclampsia, and there were two (3.92%) deaths. Conclusion Nitazoxanide prescription could be an option against COVID-19 in pregnancy due to its safety profile.

Background: The early detection of developmental conditions such as autism is vital to ensure children can access appropriate and timely evidence-based supports, services, and interventions. Children who have undetected developmental conditions early in life are more likely to develop later health, developmental, learning, and behavioral issues, which in turn can have a cumulative effect over the life course.Methods: The current protocol describes a multi-site, cluster randomized control trial comparing a developmental surveillance pathway for autism to usual care, using opportunistic visits to general practitioners (GPs). Units of randomization are GP clinics across two Australian states (New South Wales and Victoria), with thirty clinics within each state, each of which will aim to recruit approximately forty children aged between ~18- and 24-months, for a total of ~2,400 participants. Children will be randomized to two clusters; namely, an autism surveillance pathway (ASP) or surveillance as usual (SaU). The screening process for the ASP arm involves primary and secondary screenings for developmental concerns for autism, using both parent and GP reports and observations. Children in both arms who show signs of developmental concerns for autism will be offered a full developmental assessment by the research team at 24 months of age to determine the efficacy of developmental surveillance in successfully identifying children with autism.Trial Registration: The trial is registered with ANZCTR (ACTRN12619001200178) and reporting of the trial results will be according to recommendations in the CONSORT Statement.

BACKGROUNDThe lethality rate of COVID-19 in Mexico is one of the highest worldwide, but in-hospital factors associated with this increased rate have yet to be explored. This study aims to evaluate those factors that could be associated with mortality at 28-days in critically ill COVID-19 patients in Mexico.METHODSThis is a retrospective analysis of the patients included in the clinical trial (NCT04381858) which recruited patients with severe COVID-19 with high oxygen requirement or mechanical ventilation from May to October 2020. The primary outcome, death at 28, was analyzed.RESULTSBetween May and October 2020, 196 predominantly male patients (n=122, 62.2%) with an average of 58.1 years (± 15.5), were included in the cohort. Mortality at 28 days was 44.3 % (n= 84). Patients included in the second trimester had a greater mortality rate when compared with those recruited in the first trimester (54.1 vs 32.1, p< 0.01). On multivariate analysis, the detected protective factors were the use of fentanyl HR 0.51 (95%CI 0.31 – 0.85, p=0.01), the use of antibiotics HR 0.22 (95% CI 0.13 – 0.36, pCONCLUSIONSIn-hospital mortality in critically ill COVID-19 patients has increased in our center. The appropriate use of antibiotics, the type of sedation, and AKIN3 are modifiable factors directly related to this increased mortality. The increase in mortality observed in the second trimester is explained by hospital overcrowding that began in August 2020.

International audience; Cancer is a multi-step disease where an initial tumour progresses through critical steps shaping, in most cases, life-threatening secondary foci called metastases. The oncogenic cascade involves genetic, epigenetic, signalling pathways, intracellular trafficking and/or metabolic alterations within cancer cells. In addition, pre-malignant and malignant cells orchestrate complex and dynamic interactions with non-malignant cells and acellular matricial components or secreted factors within the tumour microenvironment that is instrumental in the progression of the disease. As our aptitude to effectively treat cancer mostly depends on our ability to decipher, properly diagnose and impede cancer progression and metastasis formation, full characterisation of molecular complexes and cellular processes at play along the metastasis cascade is crucial. For many years, the scientific community lacked adapted imaging and molecular technologies to accurately dissect, at the highest resolution possible, tumour and stromal cells behaviour within their natural microenvironment. In that context, the NANOTUMOR consortium is a French national multi-disciplinary workforce which aims at a providing a multi-scale characterisation of the oncogenic cascade, from the atomic level to the dynamic organisation of the cell in response to genetic mutations, environmental changes or epigenetic modifications. Ultimately, this program aims at identifying new therapeutic targets using innovative drug design.

Aims To examine the impact of COVID-19 pandemic on child mental health and socio-emotional and physical well-being (including sleep, diet, exercise, use of electronic media; care giver perceptions of symptoms of child neurodevelopmental disability [NDD] and comorbidities), and care giver mental health and well-being, social support and service use. Methods An online cross-sectional self-report survey was distributed via disability service providers and support groups. Care givers of children aged 2-17 years with a NDD were invited to respond to questions on child symptom severity and well-being, parent well-being and service access and satisfaction. Results Overall, 302 care givers (94.7% female) completed the survey. Average child age was 9.7 years and 66.9% were male. Worsening of any child NDD or comorbid mental health symptom was reported by 64.5% of respondents and 76.9% reported child health and well-being was impacted by COVID-19. Children were viewing more television and digital media (81.6%), exercising less (68.0%), experiencing reduced sleep quality (43.6%) and had a poorer diet (32.4%). Almost one fifth (18.8%) of families reported an increase in the dosage of medication administered to their child. Parents reported COVID-19 had impacted their own well-being (76.1%). Over half of respondents were not satisfied with services received during COVID-19 (54.8%) and just 30% reported that telehealth works well for their child. Conclusion Targeted interventions are required to address worsening child neurodevelopmental disability, mental health symptoms and poor diet, sleep and exercise patterns. Improved access to telehealth services is indicated, as is further research on barriers and enablers of effective telehealth services.

Pancreatic ductal adenocarcinoma (PDAC) is a worldwide public health concern. Despite extensive research efforts toward improving diagnosis and treatment, the 5-year survival rate at best is approximately 15%. This dismal figure can be attributed to a variety of factors including lack of adequate screening methods, late symptom onset, and treatment resistance. Pancreatic ductal adenocarcinoma remains a grim diagnosis with a high mortality rate and a significant psy-chological burden for patients and their families. In recent years artificial intelligence (AI) has permeated the medical field at an accelerated pace, bringing potential new tools that carry the promise of improving diagnosis and treatment of a variety of diseases. In this review we will summarize the landscape of AI in diagnosis and treatment of PDAC.

There is a significant gap between the need for child mental health services and use of these services by families. Parental attributions may play a role in this. This study examined whether mothers’ attributions about their child’s problems influence professional help-seeking intentions in a general sample of community mothers. Secondary analysis re-examined this hypothesis in a subgroup of mothers of children with clinically elevated mental health symptoms. Cross-sectional survey data were collected from mothers (N = 184) of children aged between 2 and 12 years recruited from the community. Mothers completed self-report questionnaires measuring parental attributions: child-responsible attributions and parental self-efficacy; professional help-seeking intentions; and psychosocial covariates: child mental health, mothers’ anxiety and depression, child age, gender, marital status, education, and professional help-seeking experience. Hierarchical regression modelling indicated that parental attributions explained professional help-seeking intentions after controlling for covariates in both the general sample (ΔF = 6.07; p = .003) and subgroup analysis (ΔF = 10.22, p = .000). Professional help-seeking intentions were positively associated with child-responsible attributions (β = .19, p = .002) but not parental self-efficacy (β = – .01, p = .865) in the general sample, while positively associated with child-responsible attributions (β = .20, p = .009) and negatively associated with parental self-efficacy (β = – .16, p = .034) in the subgroup analysis. Findings were independent of the presence of clinically elevated symptoms, problem type, and severity. Overall, the findings support models suggesting that parental attributions have a role in professional help-seeking for child mental health problems.

Inflammatory bowel disease (IBD) is a devastating immune-mediated disease on the rise in Hispanics living in the USA. Prior observational studies comparing IBD characteristics between Hispanics and non-Hispanic whites (NHW) have yielded mixed results. We performed a meta-analysis of observational studies examining IBD phenotype in Hispanics compared to NHW. We conducted a systematic search of US-based studies comparing IBD subtype (Ulcerative Colitis: UC or Crohn’s disease: CD) and phenotype (disease location and behavior) between Hispanics and NHW. We evaluated differences in age at IBD diagnosis, the presence of family history and smoking history. A random effects model was chosen “a priori.” Categorical and continuous variables were analyzed using odds ratio (OR) or standard mean difference (SMD), respectively. Seven studies were included with 687 Hispanics and 1586 NHW. UC was more common in Hispanics compared to NHW (OR 2.07, CI 1.13–3.79, p = 0.02). Location of disease was similar between Hispanics and NHW except for the presence of upper gastrointestinal CD, which was less common in Hispanics (OR 0.58, CI 0.32–1.06, p = 0.07). Hispanics were less likely to smoke (OR 0.48, CI 0.26–0.89, p = 0.02) or have a family history of IBD (OR 0.35, CI 0.22–0.55, p

[EN] The circular economy concept boosts the use of wastes as secondary raw materials in the EU renewable and sustainable framework. In wastewater treatment plants (WWTP), sludge is one of the most important wastes, and its management is being widely discussed in the last years. In this work, sewage sludge from WWTP was employed as raw material for producing activated carbon (AC) by physical-chemical activation. The prepared AC was subsequently tested for hydrogen sulphide removal in view of its further use in deodorization in a WWTP. The effects of the activation temperature and the chemical agent used (NaOH and KOH) during the activation process were studied. On the one hand, the characteristics of each AC fabricated were analysed in terms of BET (Brunauer-Emmett-Teller) surface area, pore and micropore volume, pore diameter, surface morphology and zeta potential. On the other hand, BET isotherms were also calculated. Finally, both the prepared AC and a commercial AC were tested for H2S removal from a gas stream. Results demonstrated that the optimum physical and chemical activation temperature was 600 degrees C and 1000 degrees C, respectively, and the best activated agent tested was KOH. The prepared AC showed excellent properties (specific surface area around 300 m(2)/g) for H2S removal, even better efficiencies than those achieved by the tested commercial AC.

[EN] Nowadays, alternative options to conventional wastewater treatment should be studied due to rising concerns emerged by the presence of pharmaceuticals compounds (PhCs) in the aquatic environment. In this work, a combined system including biological treatment by activated sludge plus adsorption with activated carbon is proposed to remove three selected drugs (acetaminophen (ACT), caffeine (CAF) and ibuprofen (IBU)) in a concentration of 2 mg L-1 of each one. For it three sequencing batch reactors (SBR) were operated. SBR-B treated a synthetic wastewater (SWW) without target drugs and SBR-PhC and SBR-PhC + AC operated with SWW doped with the three drugs, adding into SBR-PhC + AC 1.5 g L-1 of a mesoporous granular activated carbon. Results showed that the hybrid system SBR-activated carbon produced an effluent free of PhCs, which in addition had higher quality than that achieved in a conventional activated sludge treatment in terms of lower COD, turbidity and SMP concentrations. On the other hand, five possible routes of removal for target drugs during the biological treatment were studied. Hydrolysis, oxidation and volatilization pathways were negligible after 6 h of reaction time. Adsorption mute only was significant for ACT, which was adsorbed completely after 5 h of reaction, while only 1.9% of CAF and 5.6% of IBU were adsorbed. IBU was the least biodegradable compound., This work was supported by Spanish grants AICO/2018/292 of the Generalitat Valenciana.

Support for the clinical importance of callous and unemotional (CU) traits has grown considerably in recent years, yet tools for the assessment of CU traits in clinical settings have largely been limited to questionnaires. This study examined the validity of the Clinical Assessment of Prosocial Emotions (CAPE 1.1), a newly developed clinician-rating measure of CU traits in children and adolescents. Participants were children aged 3 to 15 years (N = 82; 75% male) who were referred for treatment of conduct problems. Diagnoses of conduct disorder and oppositional defiant disorder were formulated based on semistructured diagnostic interviews prior to treatment. The CAPE 1.1 was scored based on structured interviews administered jointly to mothers and fathers and was validated with questionnaire measures of CU traits and other correlates of CU traits from multiple informants. Evidence of criterion validity was found in significant associations between CAPE 1.1 scores and questionnaire measures of CU traits completed by mothers, fathers, and teachers. Evidence of construct validity was found in significant associations between CAPE 1.1 scores and established correlates of CU traits, including severity of oppositional defiant disorder/conduct disorder symptoms indexed via diagnostic interview with parents, teacher ratings of proactive aggression, and reports of affective empathy by mothers and fathers. These findings provide support for the clinical utility of the CAPE 1.1 and its inclusion as part of a comprehensive assessment of children and adolescents with conduct problems. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Summary Neuropathic pain (NP) is associated with profound gene expression alterations within the nociceptive system. DNA mechanisms, such as epigenetic remodeling and repair pathways have been implicated in NP. Here we have used a rat model of peripheral nerve injury to study the effect of a recently developed RARβ agonist, C286, currently under clinical research, in NP. A 4-week treatment initiated 2 days after the injury normalized pain sensation. Genome-wide and pathway enrichment analysis showed that multiple mechanisms persistently altered in the spinal cord were restored to preinjury levels by the agonist. Concomitant upregulation of DNA repair proteins, ATM and BRCA1, the latter being required for C286-mediated pain modulation, suggests that early DNA repair may be important to prevent phenotypic epigenetic imprints in NP. Thus, C286 is a promising drug candidate for neuropathic pain and DNA repair mechanisms may be useful therapeutic targets to explore., Graphical Abstract, Highlights • RARβ drug (C286) prevents neuropathic pain after nerve injury • C286 restores multiple pain pathways to preinjury levels, including MAPK and WNT • C286 modulates the DNA repair mechanisms BRCA1 and ATM • BRCA1 is required for C286's effects in neuropathic pain, Biological Sciences; Neuroscience; Transcriptomics

OBJECTIVE We examined the relative efficacy of an online versus face-to-face (FTF) parenting intervention for reducing the severity of child conduct problems and related parent and child outcomes in 2 randomized controlled trials. METHOD In Study 1, rural families (n = 133) with a child 3-9 years of age with a full or subclinical primary diagnosis of oppositional defiant or conduct disorder traveled to Sydney, Australia for a comprehensive assessment and randomization to receive either AccessEI, a 6-10 week online therapist-assisted parenting program, or FTF treatment, whereby they received the same program presented FTF during a 1-week treatment. To control for unavoidable treatment dosage differences in the first study, Study 2 was conducted in which urban families (n = 73) with a child aged 3 to 14 years meeting similar criteria as Study 1 were randomized to receive AccessEI versus FTF treatment. RESULTS In both studies, improvements in severity of child diagnoses and maternal measures of child behavior showed very large effect sizes for both treatments at posttreatment and 3-month follow-up and did not differ across treatment conditions. There were moderate effect sizes for improvements in parent mental health and no differences across treatment conditions. CONCLUSIONS It is concluded that the effects of the therapist-assisted online parenting interventions for the treatment of child conduct problems were similar to a FTF intervention, providing evidence for the effectiveness of an accessible treatment for rural and remote families. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The involvement of young people in the planning of research continues to be rare, particularly for young people from culturally and linguistically diverse communities. This paper describes our experience in establishing a Youth Research Advisory Group (YRAG) in South West Sydney (SWS), including barriers and successful strategies. One hundred and fifteen students between school Years 7 and 12 (ages 11–18) took part in at least one of five sessions between 2019 and 2021. In total, we carried out 26 YRAG sessions, with between five and 30 students in each. Sessions focused on mapping the health priorities of the participants and co-developing research project proposals related to their health priorities. Our work with students revealed that their main areas of concern were mental health and stress. This led to material changes in our research strategy, to include “Mental Health” as a new research stream and co-develop new mental health-related projects with the students. Important strategies that enabled our research included maintaining flexibility to work seamlessly with organisational and individual preferences, and ensuring our processes were directed by the schools and—most importantly—the students themselves. Strategies such as maintaining an informal context, responding rapidly to student preference, and regularly renegotiating access enabled us to engage with the students to deepen our understanding of their experiences.

In this study, two strains of Bdellovibrio were isolated from soil samples using the culture‐dependent technique and two members of the family Enterobacteriaceae (Klebsiella sp. and Salmonella sp.) as prey. The Bdellovibrio strains were bacteriolytic, plaque‐forming, and highly motile gram‐negative bacteria. We identified and confirmed the Bdellovibrio strains using microscopy, PCR amplification, and sequencing of the 16S rRNA gene. They were observed to be different strains based on hit locus and prey range analyses. Here, the first report on Bdellovibrio strains isolated from soil in Mexico corroborates earlier report indicating that populations of Bdellovibrio found in soil are heterogeneous thereby the need to identify the various strains.

Background: The most frequent pancreatic tumours are derived from insulin-secreting β cells, commonly called insulinomas; these are characterised by high insulin secretion causing hypoglycaemia and clinical signs such as seizures, tremors, weakness, and polyphagia, among others. In dogs, this tumour represents 30 is indicative of insulinoma. Unfortunately, the specificity of the amended insulin:glucose ratio is poor. In the past, there has been confusion with respect to their biological nature, because, based on histological and electron microscopic evaluations, 60% of these neoplasms are carcinomas and 40% are adenomas. Nevertheless, these claims were not substantiated and most insulinomas are currently considered to be malignant (carcinomas). The objective of this paper was to present a rare case of a Boxer dog that had three β cell tumours of the pancreas, which produced hyperinsulinemia and hypoglycemia. Although this is not a malignant tumour, we demonstrated, as described in the literature, that regardless of the histopathological classification, insulin-producing tumours have a poor prognosis in dogs.

Background and Aims Combining simethicone (SIM) with a colon preparation agent has been shown to improve mucosal visibility during screening colonoscopy, but its effect on the adenoma detection rate (ADR) remains unclear. SIM is commonly used through the endoscope to eliminate bubbles during endoscopy. However, this practice recently has been associated with endoscope-transmitted infections. Our aims were to determine the role of SIM added to a polyethylene glycol preparation on the ADR, procedure times, colon preparation, and intraprocedural use of SIM. Methods This was a randomized, controlled, observer-blinded, clinical trial of patients undergoing screening colonoscopy. Patients with a high risk of colorectal cancer were excluded. Patients were randomly assigned to 2 different preparations: polyethylene glycol plus SIM or polyethylene glycol. Two endoscopists blinded to patient preparation regimens scored its quality by using the Boston Bowel Preparation scale (BBPS) and the bubble scale. Interobserver agreement was calculated. The polyp detection rate, ADR, intraprocedural use of SIM, cecal intubation time, and withdrawal time were recorded. For study purposes, cecal intubation time and withdrawal time were combined to determine the effective procedure time. Results No significant difference between the polyethylene glycol plus SIM and polyethylene glycol arms was seen regarding the ADR (33.3% vs 38.8%; P = .881) and effective procedure time (759.3 ± 253.1 seconds vs 800.2 ± 459.6 seconds; P = .373), respectively. Intraprocedural use of SIM as well as the bubble scale score were significantly lower in the polyethylene glycol plus SIM arm (1.6% vs 48.9%; P ≤ .05) and (0.1 vs 2.1; P ≤ .05), respectively. Conversely, no difference was found in the BBPS scores. The interobserver agreement for both scores was strong (bubble scale score kappa = .537; P Conclusion Adding SIM to a polyethylene glycol preparation did not improve the ADR or effective procedure time. Nevertheless, it resulted in lower bubble scale scores, and more importantly, in less intraprocedural use of SIM. This simple and inexpensive intervention may have the potential to reduce the risk of endoscope-transmitted infections. (Clinical trial registration number: NCT03119168.)

Herein, we report the rational design, synthesis and biological evaluation of conjugates consisting of the synthetic retinoid Am580 and biotin connected via a linker moiety. We found that the linking substructure between the retinoid part and the biotin part is critical for retaining the biological activity. Conjugate 4 with a shorter linker showed similar potency to endogenous retinoid ATRA ( 1 ) and the parent compound Am580 ( 2 ) for neural differentiation of mouse embryotic carcinoma P19 cells, and showed the same pattern of induction of gene expression. It is expected to be useful as a probe for investigations of retinoid function. The design rationale and structure-activity relationship of the linker moiety are expected to be helpful for developing biotin conjugates of other nuclear receptor ligands.

Behavioral/emotional difficulties in children are the first sign of mental health problems. These problems are however, heterogeneous. A domain that may identify homogenous subgroups is hypothalamic-pituitary-adrenal function. This study tested whether epigenetic regulation of glucocorticoid receptor gene could explain the co-occurrence of anxiety problems in children with behavior problems. Four- to 16-year-old clinically referred children (N = 241) were measured for psychiatric symptoms, methylation of target CpG sites in blood or saliva, and morning cortisol levels in those who gave blood. Increased methylation of promoter 1F CpG sites was associated with higher vulnerability to co-occurring internalizing symptoms and morning cortisol. The results support increasing optimism that epigenetic regulation of key neuroendocrine systems might help explain hitherto unfathomable individual differences in susceptibility to psychiatric symptom profiles.

This study investigated the stability of callous and unemotional (CU) traits across generations by assessing self-report assessments of psychopathy factors in parents and their relationship to children's CU traits in a clinical sample: 223 boys (M age = 7.65) and 83 girls (M = 7.35) referred for treatment of disruptive behavior disorders. First, we expanded previous findings showing a positive relationship between maternal psychopathy scores and CU traits in boys. Second, we tested whether parental psychopathy scores predicted CU traits in children over and above general indicators of mental health risk: parental psychopathology, parental warmth, and harsh parenting. Fathers' psychopathy factor 1 was uniquely related to CU traits. In contrast, the relationship between mothers' psychopathy factor 2 and children's CU traits disappeared when maternal warmth was included. Gender differences suggested these results are most applicable to boys. These findings support the intergenerational stability of psychopathy factor 1 between children and their fathers.

BACKGROUND Direct diagnosis of small intestinal bacterial overgrowth (SIBO) requires the collection and culture of fluid from the jejunal lumen, with a finding of over 105 viable bacteria per mL. More often, SIBO is diagnosed indirectly, using a non-invasive test of the exhaled hydrogen and methane generated by microbial fermentation when ingested glucose reaches the jejunum. Our objective was to determine how well this breath test detects chronic overgrowth of jejunal bacteria that is unrelated to gastrointestinal surgery. METHODS Eighteen patients reporting symptoms consistent with SIBO received a glucose breath test. On a later day, the jejunal lumen was sampled via aspiration during enteroscopy. Jejunal aspirates were cultured on aerobic and anaerobic media. DNA was extracted from the same samples and analyzed by quantitative pan-bacterial PCR amplification of 16S ribosomal rRNA genes, which provided a culture-independent bacterial cell count. KEY RESULTS Combined bacterial colony counts ranged from 5.7 x 103 to 7.9 x 106 CFU/mL. DNA-based yields ranged from 1.5 x 105 to 3.1 x 107 bacterial genomes per mL. Microbial viability ranged from 0.3% to near 100%. We found no significant correlation of glucose breath test results with either the number of bacterial colonies or with the DNA-based bacterial cell counts. Instead, higher signals in the hydrogen-methane breath test were significantly correlated with a lower viability of jejunal bacteria, at a P-value of .014. CONCLUSIONS & INFERENCES The glucose-based hydrogen and methane breath test is not sensitive to the overgrowth of jejunal bacteria. However, a positive breath test may indicate altered jejunal function and microbial dysbiosis.

Background The upper half of the human small intestine, known as the jejunum, is the primary site for absorption of nutrient-derived carbohydrates, amino acids, small peptides, and vitamins. In contrast to the colon, which contains 1011–1012 colony forming units of bacteria per ml (CFU/ml), the normal jejunum generally ranges from 103 to 105 CFU per ml. Because invasive procedures are required to access the jejunum, much less is known about its bacterial microbiota. Bacteria inhabiting the jejunal lumen have been investigated by classical culture techniques, but not by culture-independent metagenomics. Results The lumen of the upper jejunum was sampled during enteroscopy of 20 research subjects. Culture on aerobic and anaerobic media gave live bacterial counts ranging from 5.8 × 103 CFU/ml to 8.0 × 106 CFU/ml. DNA from the same samples was analyzed by 16S rRNA gene-specific quantitative PCR, yielding values from 1.5 × 105 to 3.1 × 107 bacterial genomes per ml. When calculated for each sample, estimated bacterial viability ranged from effectively 100% to a low of 0.3%. 16S rRNA metagenomic analysis of uncultured bacteria by Illumina MiSeq sequencing gave detailed microbial composition by phylum, genus and species. The genera Streptococcus, Prevotella, Veillonella and Fusobacterium, were especially abundant, as well as non-oral genera including Escherichia, Klebsiella, and Citrobacter. The jejunum was devoid of the genera Alistipes, Ruminococcus, Faecalibacterium, and other extreme anaerobes abundant in the colon. In patients with higher bacterial loads, there was no significant change in microbial species composition. Conclusions The jejunal lumen contains a distinctive bacterial population consisting primarily of facultative anaerobes and oxygen-tolerant obligate anaerobes similar to those found in the oral cavity. However, the frequent abundance of Enterobacteriaceae represents a major difference from oral microbiota. Although a few genera are shared with the colon, we found no evidence for retrograde movement of the most abundant colonic microbes to the jejunum. Some individuals had much higher bacterial loads, but this was not correlated with decreases in bacterial species diversity or other evidence of dysbiosis. Electronic supplementary material The online version of this article (doi:10.1186/s12866-017-1059-6) contains supplementary material, which is available to authorized users.