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Background: This multicentre case–control study aimed to identify risk factors associated with non-operative treatment failure for patients with CT scan Hinchey Ib-IIb and WSES Ib-IIa diverticular abscesses. Methods: This study included a cohort of adult patients experiencing their first episode of CT-diagnosed diverticular abscess, all of whom underwent initial non-operative treatment comprising either antibiotics alone or in combination with percutaneous drainage. The cohort was stratified based on the outcome of non-operative treatment, specifically identifying those who required emergency surgical intervention as cases of treatment failure. Multivariable logistic regression analysis to identify independent risk factors associated with the failure of non-operative treatment was employed. Results: Failure of conservative treatment occurred for 116 patients (27.04%). CT scan Hinchey classification IIb (aOR 2.54, 95%CI 1.61;4.01, P < 0.01), tobacco smoking (aOR 2.01, 95%CI 1.24;3.25, P < 0.01), and presence of air bubbles inside the abscess (aOR 1.59, 95%CI 1.00;2.52, P = 0.04) were independent predictors of failure. In the subgroup of patients with abscesses > 5 cm, percutaneous drainage was not associated with the risk of failure or success of the non-operative treatment (aOR 2.78, 95%CI − 0.66;3.70, P = 0.23). Conclusions: Non-operative treatment is generally effective for diverticular abscesses. Tobacco smoking's role as an independent risk factor for treatment failure underscores the need for targeted behavioural interventions in diverticular disease management. IIb Hinchey diverticulitis patients, particularly young smokers, require vigilant monitoring due to increased risks of treatment failure and septic progression. Further research into the efficacy of image-guided percutaneous drainage should involve randomized, multicentre studies focussing on homogeneous patient groups. Graphical abstract: (Figure presented.)

Background and purpose: In 2020, health professionals witnessed a dramatic increase in referrals of young people with rapid onset of severe tic-like behaviours. We assembled a working group to develop criteria for the clinical diagnosis of functional tic-like behaviours (FTLBs) to help neurologists, pediatricians, psychiatrists, and psychologists recognize and diagnose this condition. Methods: We used a formal consensus development process, using a multiround, web-based Delphi survey. The survey was based on an in-person discussion at the European Society for the Study of Tourette Syndrome (ESSTS) meeting in Lausanne in June 2022. Members of an invited group with extensive clinical experience working with patients with Tourette syndrome and FTLBs discussed potential clinical criteria for diagnosis of FTLBs. An initial set of criteria were developed based on common clinical experiences and review of the literature on FTLBs and revised through iterative discussions, resulting in the survey items for voting. Results: In total, 24 members of the working group were invited to participate in the Delphi process. We propose that there are three major criteria and two minor criteria to support the clinical diagnosis of FTLBs. A clinically definite diagnosis of FTLBs can be confirmed by the presence of all three major criteria. A clinically probable diagnosis of FTLBs can be confirmed by the presence of two major criteria and one minor criterion. Conclusions: Distinguishing FTLBs from primary tics is important due to the distinct treatment paths required for these two conditions. A limitation of the ESSTS 2022 criteria is that they lack prospective testing of their sensitivity and specificity.

In 2011, the European Society for the Study of Tourette Syndrome (ESSTS) published the first European guidelines for Tourette Syndrome (TS). We now present an update of the part on pharmacological treatment, based on a review of new literature with special attention to other evidence-based guidelines, meta-analyses, and randomized double-blinded studies. Moreover, our revision took into consideration results of a recent survey on treatment preferences conducted among ESSTS experts. The first preference should be given to psychoeducation and to behavioral approaches, as it strengthens the patients’ self-regulatory control and thus his/her autonomy. Because behavioral approaches are not effective, available, or feasible in all patients, in a substantial number of patients pharmacological treatment is indicated, alone or in combination with behavioral therapy. The largest amount of evidence supports the use of dopamine blocking agents, preferably aripiprazole because of a more favorable profile of adverse events than first- and second-generation antipsychotics. Other agents that can be considered include tiapride, risperidone, and especially in case of co-existing attention deficit hyperactivity disorder (ADHD), clonidine and guanfacine. This view is supported by the results of our survey on medication preference among members of ESSTS, in which aripiprazole was indicated as the drug of first choice both in children and adults. In treatment resistant cases, treatment with agents with either a limited evidence base or risk of extrapyramidal adverse effects might be considered, including pimozide, haloperidol, topiramate, cannabis-based agents, and botulinum toxin injections. Overall, treatment of TS should be individualized, and decisions based on the patient’s needs and preferences, presence of co-existing conditions, latest scientific findings as well as on the physician’s preferences, experience, and local regulatory requirements.

Contains fulltext : 291641.pdf (Publisher’s version ) (Open Access), Tourette Syndrome (TS) is a complex neurodevelopmental disorder characterized by vocal and motor tics lasting more than a year. It is highly polygenic in nature with both rare and common previously associated variants. Epidemiological studies have shown TS to be correlated with other phenotypes, but large-scale phenome wide analyses in biobank level data have not been performed to date. In this study, we used the summary statistics from the latest meta-analysis of TS to calculate the polygenic risk score (PRS) of individuals in the UK Biobank data and applied a Phenome Wide Association Study (PheWAS) approach to determine the association of disease risk with a wide range of phenotypes. A total of 57 traits were found to be significantly associated with TS polygenic risk, including multiple psychosocial factors and mental health conditions such as anxiety disorder and depression. Additional associations were observed with complex non-psychiatric disorders such as Type 2 diabetes, heart palpitations, and respiratory conditions. Cross-disorder comparisons of phenotypic associations with genetic risk for other childhood-onset disorders (e.g.: attention deficit hyperactivity disorder [ADHD], autism spectrum disorder [ASD], and obsessive-compulsive disorder [OCD]) indicated an overlap in associations between TS and these disorders. ADHD and ASD had a similar direction of effect with TS while OCD had an opposite direction of effect for all traits except mental health factors. Sex-specific PheWAS analysis identified differences in the associations with TS genetic risk between males and females. Type 2 diabetes and heart palpitations were significantly associated with TS risk in males but not in females, whereas diseases of the respiratory system were associated with TS risk in females but not in males. This analysis provides further evidence of shared genetic and phenotypic architecture of different complex disorders.

In this contribution, I explore the encounter between a pandemic-mitigation event initiated by the local administration of Central Java, Indonesia, and a Buddhist village in the highland region of Temanggung. For the minority Buddhist community in the area, the event signified a possibility to pursue media presence. In the previous few years, the village of Surjosari had launched various projects of community and religious revitalization. On the one hand, such projects progressively included the community within the nationwide reach of Theravāda Buddhism. On the other hand, these projects were increasingly aimed at the implementation of a specific ethnopreneurial vision of highland eco-tourism, particularly endorsed by a host of local activists. The article shows how the government’s Candi Siaga initiative offered an unprecedented opportunity to advance the residents’ idea of community development, which braids together religious, ethnic and economic strands. By tracing long-term pre- and post-event developments in the village, I frame this opportunity in terms of affordance. Rather than mobilizing vocabularies of coping and responses that are intrinsic in recent virological discourses, affordances can provide an open-ended and undetermined horizon for encounters between broad processes such as a pandemic and the particular practices of a rural community. This requires us to extend the definition of the concept beyond its applicability to the restricted domain of immediate ecological perception.

The novel coronavirus disease (COVID-19) was identified as the cause of an outbreak of respiratory disease in China at the end of 2019. It then spread with enormous rapidity and by mid-March 2020 was declared a world pandemic. Gilles de la Tourette Syndrome (GTS) is a childhood-onset neurodevelopmental disorder with a worldwide prevalence of about 1% of the population. The clinical symptoms include multiple motor and one or more phonic (vocal) tics. Germane to this communication is that 85% of patients with GTS have associated psychiatric co-morbidities, many of which are being exacerbated in the current global health crisis. In addition, several symptoms of GTS may mimic COVID-19, such as a dry cough and sniffing (phonic tics), while other symptoms such as spitting, inappropriate touching of others and "non-obscene socially inappropriate symptoms" can potentially get patients with GTS into trouble with the law. We suggest that a clear explanation of the COVID-19 illness and GTS is important to enable colleagues of various specialities who tend to patients with GTS. It is important to acknowledge at the outset that the information available on the COVID-19 pandemic changes daily, including cases infected, deaths reported, and how various national health systems are planning and or coping or not. It is fair to say that having read the current medical and lay press we conclude that it is not easy to reassure our patients with absolute certainty. However, notwithstanding that, we hope our documentation is of some assistance.

Contains fulltext : 281802.pdf (Publisher’s version ) (Open Access), Tourette syndrome (TS) is characterized by multiple motor and vocal tics, and high-comorbidity rates with other neuropsychiatric disorders. Obsessive compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), autism spectrum disorders (ASDs), major depressive disorder (MDD), and anxiety disorders (AXDs) are among the most prevalent TS comorbidities. To date, studies on TS brain structure and function have been limited in size with efforts mostly fragmented. This leads to low-statistical power, discordant results due to differences in approaches, and hinders the ability to stratify patients according to clinical parameters and investigate comorbidity patterns. Here, we present the scientific premise, perspectives, and key goals that have motivated the establishment of the Enhancing Neuroimaging Genetics through Meta-Analysis for TS (ENIGMA-TS) working group. The ENIGMA-TS working group is an international collaborative effort bringing together a large network of investigators who aim to understand brain structure and function in TS and dissect the underlying neurobiology that leads to observed comorbidity patterns and clinical heterogeneity. Previously collected TS neuroimaging data will be analyzed jointly and integrated with TS genomic data, as well as equivalently large and already existing studies of highly comorbid OCD, ADHD, ASD, MDD, and AXD. Our work highlights the power of collaborative efforts and transdiagnostic approaches, and points to the existence of different TS subtypes. ENIGMA-TS will offer large-scale, high-powered studies that will lead to important insights toward understanding brain structure and function and genetic effects in TS and related disorders, and the identification of biomarkers that could help inform improved clinical practice.

Tourette syndrome (TS) is characterized by multiple motor and vocal tics, and high-comorbidity rates with other neuropsychiatric disorders. Obsessive compulsive disorder (OCD), attention deficit hyperactivity disorder (ADHD), autism spectrum disorders (ASDs), major depressive disorder (MDD), and anxiety disorders (AXDs) are among the most prevalent TS comorbidities. To date, studies on TS brain structure and function have been limited in size with efforts mostly fragmented. This leads to low-statistical power, discordant results due to differences in approaches, and hinders the ability to stratify patients according to clinical parameters and investigate comorbidity patterns. Here, we present the scientific premise, perspectives, and key goals that have motivated the establishment of the Enhancing Neuroimaging Genetics through Meta-Analysis for TS (ENIGMA-TS) working group. The ENIGMA-TS working group is an international collaborative effort bringing together a large network of investigators who aim to understand brain structure and function in TS and dissect the underlying neurobiology that leads to observed comorbidity patterns and clinical heterogeneity. Previously collected TS neuroimaging data will be analyzed jointly and integrated with TS genomic data, as well as equivalently large and already existing studies of highly comorbid OCD, ADHD, ASD, MDD, and AXD. Our work highlights the power of collaborative efforts and transdiagnostic approaches, and points to the existence of different TS subtypes. ENIGMA-TS will offer large-scale, high-powered studies that will lead to important insights toward understanding brain structure and function and genetic effects in TS and related disorders, and the identification of biomarkers that could help inform improved clinical practice.

In this article I explore the contemporary practice of establishing garden shrines in Buddhist rural Java. While on the surface the placement of shrines follows the demands of environmental upgrading and beautification strategies, often in accord with eco-tourist imaginaries, the practice reveals a complex aggregation of material and discursive threads. The article situates the project, ethnographically, as a sensorial practice in which environmental awareness and a sense of “atmosphere” are directly involved. This perceptual domain, particularly the relationship of the villagers to the Sakyamuni statuettes, is simultaneously articulated in continuity with the religious field of Javanese Buddhism, as it encompasses notions of sacralization and rituality. I recover the idea of aesthetic practice in order to bring these sensorial stems on a common platform. In blending discursive and materialist approaches, the article converses with the idea of strata as devised by Deleuze and Guattari as a pivotal image in their work on rhizomes. Through the concept of stratification, I argue, it is possible to apprehend Buddhist shrines as cultural formations in which “everything is involved,” that is, as multiplicities in which layers of materiality and discourse are intertwined in meaningful and generative ways.

La tesi restituisce un resoconto etnografico del revival buddhista sull'isola di Giava, in Indonesia. Il lavoro di tesi è basato su due periodi di fieldwork multisituati a Giava centrale e orientale. L'etnografia segue i processi tramite i quali comunità buddhiste rurali e urbane mettono in atto pratiche percepite come "di revitalizzazione", un processo che è sempre tanto religioso quanto economico-sociale. Repositori discorsivi di questo percorso di revival sono, alternativamente, i mondi religiosi della Giava pre-islamica e/o la comunità religiosa precedentemente all'espansione egemonica contemporanea dell'Islam e del Cristianesimo. La tesi segue questi processi utilizzando come cartina di tornasole la pratica degli eventi e dei festival culturali, oltre che ai rituali religiosi tradizionalmente intesi. Oltre a un'evidente influenza del Buddhismo Theravada di matrice thai e birmana, queste pratiche evidenziano anche quanto il religioso si ponga in relazione di continuità con altre sfere del sociale e la misura in cui i "revival" si costituiscano in realtà come complessi multiformi che assemblano vari processi discorsivi e fenomenici. Analiticamente il lavoro di tesi fa uso degli apparati teorici derivati dal nuovo materialismo e del vocabolario filosofico di Deleuze e Guattari., The thesis returns an ethnographic account of the Buddhist revival on the island of Java, Indonesia. The thesis work is based on two periods of multi-site fieldwork located in Central and Eastern Java. The ethnography follows the processes by which rural and urban Buddhist communities carry out practices perceived as "revitalization", processes that are always about the religious experience as much as they are about the socio-economic domain. Discursive repositories of these paths of revival are, alternatively, the religious worlds of pre-Islamic Java and / or the perceived compactness of the religious community prior to the contemporary hegemonic expansion of Islam and Christianity. The thesis follows these processes using as a litmus test the practice of cultural events and festivals, as well as more traditionally understood religious rituals. In addition to the increasing influence of Theravada Buddhism of Thai and Burmese lineages, these practices also highlight how the religious is on a complex continuum with other spheres of the social and reveals the extent to which "revivals" are constituted as multiform complexes, in that they assemble various discursive and phenomenal processes. Analytically, the thesis work makes use of the theoretical grids derived from new materialism and of the philosophical vocabulary of Deleuze and Guattari.