Disgust and anxiety: What came first, the chicken or the egg?

Introduction

Disgust is a basic emotion characterized by the feeling of revulsion and evoked by unpleasant stimuli such as contaminated food, poor hygiene and contact with sick or dead organisms. Disgust is a contributing factor to the development of several mental disorders including anxiety disorders (AD). Several studies have tried to explore the relationship between disgust and eating disorders (ED), with heterogeneous findings. Subjects with ED showed a heightened level of disgust sensitivity (DS) when compared with healthy controls (HC).

Objectives

Our study aims to evaluate levels of disgust and anxiety in ED, AD and HC in order to assess associations between these two emotions.

Methods

We enrolled 74 patients admitted to Psychiatric Unit of Careggi, 41 with diagnosis of Eating Disorder, 33 with Anxiety Disorders, and 40 healthy controls. We administered to all groups: Zung Anxiety Scale (ZSAS) and Disgust Propensity and Sensitivity Scale-revised (DPSS-r).

Results

Both patients with anxiety disorders and eating disorders showed higher levels of disgust propensity and sensitivity than healthy controls. Moreover, there was no significant differences in anxiety, Disgust Propensity (DP) and Disgust Sensitivity levels between patients with eating disorders and anxiety disorders. Among healthy controls there was a significant association between DS and Anxiety levels (B: 0.579, T:3,416 p:0,001).

Conclusions

Anxiety and disgust are typical emotions of anxiety disorders and eating disorders. However, they are increased both in anxiety and eating disorders and they are associated in healthy controls. The nature of this association needs to be deeply investigated.

Disclosure

No significant relationships.

Anxiety disorders and childhood exposure to emotional abuse: The mediating role of disgust

Introduction

Several studies demonstrate that disgust, defined as a revulsion response aimed at distancing an individual from a potentially harmful or noxious stimulus, is linked to post-traumatic stress following sexual trauma even when accounting for associated fear and anxiety. One of the suggested mechanisms implicated in this association is a feeling of mental contamination. Recent neuroimaging studies demonstrated that exposure to contamination activates the insular cortex. In addition, disgust sensitivity correlates with the activation of the insular cortex.

Objectives

We aimed to investigate the psychopathological role of the emotion of disgust in the developement of anxiety symptoms in patient with an history of abuse.

Methods

We enrolled 84 patients admitted in Psychiatric Unit of Careggi with diagnosis of Anxiety Disorders. We administered to them: Zung Anxiety Scale (ZSAS), Childhood Trauma Questionnaire (CTQ), Disgust Propensity and Sensitivity Scale-revised (DPSS-r).

Results

Results showed a significant mediation of the association between CTQ emotional abuse scores and total ZSAS scores via DPSS disgust sensitivity scores in patients with anxiety disorders (p=0.022). Total effect and indirect effect of emotional abuse on severity of anxiety symptoms were significant (total effect = 0.494; p=0.051, indirect effect: 0.256, p=0.022), while there was no significant direct effect from emotional abuse to anxiety symptoms in the total model (direct effect: 0.237, p=0.356). The model explained 18% of variance in anxiety symptomatology (R²=0.18).

Conclusions

Such preliminary data suggest a possible mediating role of disgust in development and maintenance of childhood abuse-related anxiety, making it a potential target for psychotherapy.

Disclosure

No significant relationships.

Anxiety disorders and eating disorder symptoms: The role of disgust sensitivity

Introduction

The comorbidity between anxiety disorders (AD) and eating disorders (ED) has already been well discovered, and because of the link between disgust, food choice and rejection (which appear to be key factors of eating psychopathology), it can be suggested that these three aspects may be related. Accordingly, it can be hypothesized that individuals who express heightened levels of both disgust and eating concerns are at a higher risk to develop an AD. By contrast, disgust, as a negative emotion, influences ED symptoms through a greater level of anxiety.

Objectives

We aimed to investigate the psychopathological role of disgust and eating disorder symptoms in the development and maintenance of anxiety symptoms in patients with AD.

Methods

We enrolled 84 patients admitted in the Psychiatric Unit of Careggi with diagnosis of Anxiety Disorders. We administered them: Zung Anxiety Scale (ZSAS), Disgust Propensity and Sensibility Scale-revised (DPSS-r) and Eating Disorders Examination Questionnaire (EDE-Q).

Results

A multiple regression model having ZSAS total as dependent variable, and EDE-Q total and DPSS disgust sensitivity subscale as independent variables explained 29% of ZSAS total variance (R²=0.290). The effect of EDE-Q total was positive, significant (β=0.331, t=2.631, p=0.011) and explained 11.9% of ZSAS total variance (pr²=0.119). The effect of DPSS disgust sensitivity was positive, significant (β=0.326, t=2.595, p=0.012) and explained 11.6% of ZSAS total variance (pr²=0.116) (Fig.1).

Conclusions

Such preliminary data suggest a possible role of feelings of disgust and eating disorder symptoms in development and maintenance of anxiety symptoms in patients with AD, making them a potential target for psychotherapy.

Disclosure

No significant relationships.

Transdiagnostic effect of contamination disgust on asceticism

Introduction

There is a growing literature suggesting disgust plays a major role in religiosity. Asceticism is a personality trait characterized by abstinence from sensual pleasures, often for the purpose of pursuing spiritual goals. Since few studies suggested that higher disgust levels may lead to greater fear of sin, contamination disgust may serve as effective mechanisms for inflated scrupulosity.

Objectives

We aimed to investigate the role of contamination disgust on a specific religious belief in two clinical groups: eating disorders and anxiety disorders.

Methods

We enrolled 84 patients admitted in the Psychiatric Unit of Careggi with diagnosis of Anxiety Disorders (AD) and Eating Disorders (ED). We administered them: Disgust Scale Revised (DS-R) and Eating Disorders Inventory 2 (EDI-2)

Results

A t-test for independent samples between AD patients and ED patients showed no difference in DS-R contamination disgust subscale (t=1.437, p=0.153), while significantly higher EDI-2 asceticism scores were detected in ED patients (t=2.452, p=0.010). An ANCOVA model having EDI2 Asceticism subscale as dependent variable, and DS contamination disgust subscale, diagnosis, and interaction between contamination disgust and diagnosis was estimated. The overall model was significant (F(1,136)=4.854, p=0.003) and accounted for 9.7% of variance of EDI2 Asceticism subscale (R²=0.097). The effect of contamination disgust was positive and significant (β=0.302, t=2.781, p=0.006), and accounted for 5.4% of variance of EDI2 Asceticism (partial η²=0.054). No effect was detected for diagnosis (F(1,136)=0.012, p=0.912) or interaction between contamination disgust and diagnosis (F(1,136)=1.346, p=0.248).

Conclusions

Contamination disgust may have a trans-diagnostic effect on asceticism and may be a possible driver for specific religious behaviors.

Disclosure

No significant relationships.

Timing for Safe Return to Sport after Medial Patellofemoral Ligament Reconstruction: The Role of a Functional Test Battery

The purpose of this article was to analyze clinical and functional results after medial patellofemoral ligament (MPFL) reconstruction and to establish if a computer-assisted physical test battery could determine a "safe timing" to return to sport. We hypothesized that "time-based" criteria to declare safe return to sport could not be reliable to predict functional recover. Fifty-eight young athletic patients were selected after isolated reconstruction of MPFL. The minimum follow-up was 8 months. All the patients were evaluated subjectively with Kujala and Short Form 36 (SF-36) scores and objectively through a standardized computer-assisted physical battery of seven tests (Back in Action, Corehab). No patient was lost at the end point of follow-up and no recurrence of patellar dislocation was reported. At 8 months, 31 patients (53.4%) returned to sport at preoperative levels, and 23 (39.6%) participated in sports at lower levels. The subjective evaluation reported an increase of Kujala (60-92.7) and SF-36 score (28.6/25.4-52.2/53.6). At computer-assisted objective assessment, only 23 patients (39.6%) fulfilled the criteria for safe return to sport, while 31 (53.4%) got an insufficient outcome and 4 (6.9%) failed to complete the test. From our data, clinical scores after MPFL reconstruction provide only little insight into return to sport. The introduction of a computer-assisted objective analysis in the decision-making process for proper return to sport is necessary to evaluate functional recovery and dynamic knee stability.

The Fundamental and Underrated Role of the Base Electrolyte in the Polymerization Mechanism. The Resorcinol Case Study

The Kane-Maguire polymerization mechanism is disassembled at a molecular level by using DFT-based quantum mechanical calculations. Resorcinol electropolymerization is selected as a case study. Stationary points (transition states and intermediate species) leading to the formation of the dimer are found on the potential energy surface (PES), and elementary reactions involved in the dimer formation are characterized. The latter allow to further propagate the polymerization chain reaction, when applied recursively. In this paper, the fundamental role of the sulfate anion (a typical base electrolyte) is addressed. Investigation of the PES in terms of both stationary-state properties and of ab initio molecular dynamics results (dynamic reaction coordinate) allows the appreciation in detail of the critical role of the base electrolyte anion in making the proton dissociation from the initial radical ion, a feasible (downhill in energy) process.

"Anterolateral" approach to the hip: a systematic review of the correct definition of terms

PURPOSE

The Watson-Jones interval plane between tensor fascia lata (TFL) and the gluteus medius (GM) has come back into fashion in the past few years - Röttinger described the anterolateral minimal invasive approach (ALMI) for use in total hip replacement, in which the standard Watson-Jones interval was used, but with a completely intermuscular plane. However, the term anterolateral is often still utilised to describe intramuscular approaches in which the GM was violated, thus creating a potential misunderstanding in the literature. Accordingly, we have designed a study to answer the following questions: (1) are there articles in the recent literature that use the term "anterolateral" to describe different approaches; (2) which would be the correct description of the anterolateral approach?

METHODS

We did a systematic review of the literature based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, to look for peer reviewed papers of any evidence level focusing on the definition of anterolateral approach; MEDLINE and EMBASE were searched.

RESULTS

73 manuscripts met the criteria of the systematic search. 53 papers (72.6%) reported the term anterolateral approach to describe a complete intermuscular approach between the interval between GM and TFL. Nonetheless, in the remaining 20 papers (27.4%) the term anterolateral was used to describe intramuscular approaches in which the gluteus medius was violated.

CONCLUSION

In about 1 out of 4 papers in the recent literature, the term anterolateral was utilised to describe approaches that are completely different both in terms of anatomy and function.

Joint replacement for the management of haemophilic arthropathy in patients with inhibitors: A long-term experience at a single Haemophilia centre

INTRODUCTION

The association between haemophilia and the so-called 'inhibitors', alloantibodies against the infused factor able to neutralize its clotting activity, is a very rare condition. Those sporadic patients suffer of an even more severe arthropathy and performing primary or revision arthroplasty become truly challenging. Literature about this topic is scarce, consisting in small case series, high rates of complications and mid-term follow-ups.

AIM

The purpose of this study is the assessment of the long-term outcomes of primary and revision arthroplasty performed in a population of patients with inhibitors, the more consistent to date reported at a single haemophilia centre.

METHODS

We reviewed the records of 18 patients with inhibitors (26 procedures) between 1999 and 2017, divided in two groups. Group A [primary total Knee-Hip arthroplasty (TKA-THA)]: 13 patients underwent 19TKA and 2THA; and B (revision): 5 subjects underwent 3rTKA and 2rTHA. All patients received the same haematological prophylaxis (rFVIIa). Haemophilic Joint Health score and VAS, and X-rays were recorded pre- and postoperatively. The survival rate of all primary implants was assessed.

RESULTS

The median follow-up was 12.2 years (3-21) for group A, 8.6 years (4-12) for B. Few complications have been reported; the overall survival rate was 94.7% at 15 years. All patients reported satisfaction, pain reduction and improved functional ability.

CONCLUSION

Primary and revision TKA/THA in haemophilic subjects and inhibitors may be nowadays considered safe and effective if performed in dedicated multidisciplinary centres. The use of continuous infusion of rFVIIa showed an adequate haemostatic effect and low rate of complications. As expected, revisions are more prone to complications compared to primary arthroplasty.

Thickness determination of metal multilayers by ED-XRF multivariate analysis using Monte Carlo simulated standards

We present the thickness measurement of multilayer samples by X-ray fluorescence (XRF) using calibration curves obtained from simulated spectra through Monte Carlo (MC) algorithm. The XRF is a widespread technique for the analysis of single and multilayer films but the accuracy of quantitative analysis must be increased. Moreover, the use certified standards is not easy to implement due to the high variability of combination and/or concentration in layered samples. The results of this work were compared with fundamental parameter (FP) method and focussed ion beam scanning electron microscopy (FIB-SEM) analysis. The results show good quantitative values even without the use of any standard with known thickness. In addition to having built the calibration curves with a simple univariate approach, also multivariate data analysis was performed to consider multiple variables simultaneously. From the comparison of the obtained results, it can be inferred that the univariate analysis worked well in the case of single layer samples and in the determination of the upper layer in multilayer samples but only multivariate analysis, taking into account the matrix effect of each layer, provided maximum accuracy on each layer of multilayer samples.

The identification of pathogens associated with periprosthetic joint infection in two-stage revision

OBJECTIVE

Identification of periprosthetic joint infection (PJI)-related pathogens is crucial to decide what is the correct surgical strategies and the most secure timing to re-implant in case of two-stage revision. The purpose of the present study is to review the literature to identify the features of each exams which are used to identify the pathogens associated with PJI, to evaluate which are the most sensitive and specific and to set up an algorithm to decide when, in the field of two-stage revision, it's the ideal timing to re-implant.

MATERIALS AND METHODS

We did a systematic review of the literature to look for peer-reviewed papers of any evidence level focusing on: (1) Microbiological and molecular exams for identification of PJI-related pathogens. (2) Nuclear imaging methods, which can help in the identification of a PJI. Special attention was focused to analyse which is the sensitivity and specificity of these exams.

RESULTS

Overall, 64 manuscripts met the criteria of the systematic search at point 1 and 7 manuscripts at point 2. Among microbiological and molecular exams, the average of sensitivity and specificity were respectively 65.6% and 94.4% for cultural exams, 74.1% and 95.2% for molecular diagnosis and 86.9% and 96% for MicroDTTect. Among nuclear imaging methods, the average of sensitivity and specificity were respectively 94% and 69 % for three-phase bone scintigraphy and 100% and 62.5% for [18F] Fluoro-2-deoxyglucose-positron emission tomography/computed tomography.

CONCLUSIONS

In two-stage revision after PJI, taking into account the sensitivity and specificity values, just a few microbiological and molecular exams and nuclear imaging methods should be considered in the decision process to re-implant the components.

Analysis of mass transport in ionic liquids: a rotating disk electrode approach

Ionic Liquids are a promising alternative to water electrolytes for the electrodeposition of metals. These solvents have a much larger electrochemical window than water that expands the potential of electrodeposition. However, mass transport in Ionic Liquids is slow. The slow mass transport dramatically affects the rate of reactions at the solid-liquid interface, hampering the exploitation of Ionic Liquids in high-throughput electrodeposition processes. In this paper, we clarify the origin of such poor mass transport in the diffusion-advection (convection) regime. To determine the extent and the dynamics of the convection boundary layers, we performed Rotating Disk Electrode (RDE) experiments on model reactions along with the finite element simulation. Both the experiments and the finite element modelling showed the occurrence of peaks in the RDE curves even at relatively high rotation rates (up to 2000 rpm). The peak in the RDE is the fingerprint of partial diffusion control that happens for the relative extent of the diffusion and convection boundary layers. In looking for a close match between the experiments and the simulations, we found that the ohmic drop plays a critical role and must be considered in the calculation to find the best match with the experimental data. In the end, we have shown that the combined approach consisting of RDE experiments and finite elements modelling providing a tool to unravel of the structure of the diffusion and convection boundary layers both in dynamic and stationary conditions.

[Results of a vertebral deformity screening in the students of the district of Florence (Tuscany Region, Central Italy)]

OBJECTIVES

to observe the prevalence of vertebral deformities in an adolescent population in the 178 schools of the District of Florence (Tuscany Region, Central Italy), correlating these results with clinical aspects as ligamentous laxity and verifying if these data are in agreement with what emerged in literature in studies of the same type.

DESIGN

prevalence study.

SETTING AND PARTICIPANTS

report of the results of a school screening for vertebral deformities in an adolescent population of 11,820 students of the Schools of District of Florence held between November 2010 and June 2013.

MAIN OUTCOMES MEASURES

asymmetry of waist triangle; trunk imbalance using plumb-line from C7; leg length discrepancies; presence of gibbus and measurement of Angle of Trunk Rotation using Bunnell scoliometer; measure of thoracic kyphosis (a value of kyphosis> 50° was considered to be at high risk of hyperkyphosis making it necessary to request an X-ray); ligamuentuos laxity using Beighton Score.

RESULTS

11,820 students were screened; 85.95% of them had no significant spinal deformities; 14,05% of the students showed significant clinical signs of scoliosis; 28.46% of the students had a thoracic hyperkyphosis (>40°), 1.55% of those presented a non-reducible thoracic hyperkyphosis. Results show a statistically significant correlation between the severity of the deformities and the score of the Beighton Score.

CONCLUSIONS

the results confirm the association between vertebral deformities and ligament laxity. The prevalence of vertebral deformities in the school age population of the Municipality of Florence is 14.05%, in accordance with what emerged in the literature from similar studies.

Patients Following Revision Total Hip Arthroplasty With Modular Dual Mobility Components and Cobalt-Chromium Inner Metal Head are at Risk of Increased Serum Metal Ion Levels

BACKGROUND

Modular dual-mobility (MDM) total hip arthroplasty (THA) is designed with a cobalt-chromium liner inserted into a titanium acetabular component. The purpose of this study is to investigate the potential risks for fretting corrosion at this junction, by measuring serum metal ions, after MDM acetabular revision.

METHODS

Thirty-seven patients with well-functioning revision THAs participated in a cross-sectional study at mean 5.1 (2-10) years after surgery. All received a trabecular titanium MDM acetabular component. The serum levels of cobalt and chromium were measured using mass spectrometry.

RESULTS

The mean values of chromium and cobalt were 2.08 μg/L (95% confidence interval 0.9-3.2, range 0.02-11.8) and 1.99 μg/L (95% confidence interval 0.81-3.17, range 0.07-16.05), respectively. Eleven patients (29, 7%) had ion levels above the normal range, with 6 (16.2%) above 5 μg/L and 5 (13.5%) between 1 and 5 μg/L. A significant correlation was found between an elevated serum metal ion level and University of California Los Angeles score (P = .016).

CONCLUSION

We conclude that serum metal level elevation may occur secondary to metal debris resulting from corrosion of the index MDM THA. This potential risk should be included in the decision-making process when dealing with revision arthroplasty in young and active patients.

A Mid- to Long-Term Follow-Up Experience with a Specific Metal-on-Metal Total Hip Arthroplasty Design

Purrpose  Metal-on-metal (MoM) total hip arthroplasty (THA) has been a subject of recent discussion and concern due to the early failures caused by local and systemic adverse reactions related to specific designs. The aim of this study is to analyze the outcomes and survival rates of a single brand of MoM implants implanted in a consecutive series of patients at a single institution.

Methods  Between 2007 and 2012, 116 (118 hips) patients were evaluated at a mean follow-up of 6.6 years after primary THA. The diagnosis leading to surgery was osteoarthritis (80 patients) and proximal femoral fracture (36 patients). A single design of THA was implanted. All patients were evaluated before surgery and postoperatively at 1, 3, 6, and 12 months by clinical scores and radiographic studies. The data analysis was made using Student's t -test.

Results  The minimum follow-up was of 4 years, with a mean follow-up of 6.6 years. Two aseptic loosenings of the acetabular component were recorded (one per group), which were not associated with local or systemic complications related to metal ion release. Both were revised by an isolated acetabular cup substitution with metal-on-polyethylene couplings. Nonprogressive radiolucency lines < 2 mm in zone 2 were observed in other six patients around the acetabular component without clinical manifestation (four in the arthritis group and two in the fracture group). Postoperative Harris Hip Score and SF-36 (36-Item Short Form Survey) score improved in both groups.

Conclusion  Despite several MoM implants showing early complications and failures, a specific MoM design may be associated with good clinical results at a mid- to long-term follow-up.

Level of Evidence  This is a therapeutic case series, Level 4 study.

Partial rupture of anterior cruciate ligament: preliminary experience of selective reconstruction

Background

Partial lesions of the anterior cruciate ligament (ACL) are more common than is generally thought, accounting for about 10–12% of ACL injuries. Selective reconstruction may be considered as an option in isolated bundle rupture. The purpose of this study is to evaluate both subjective and objective clinical results, as well as functional recovery time, after selective arthroscopic single-bundle reconstruction in a consecutive series of patients affected by partial ACL rupture.

Materials and methods

Thirty-six patients undergoing selective reconstruction of a single ACL bundle were retrospectively evaluated from a series of 354 ACL reconstructions performed over a 3-year period. Although the suspicion of partial lesions was present at clinical and magnetic resonance imaging (MRI) evaluation, final diagnosis was obtained during arthroscopy. All patients were operated using the same technique and type of fixation, and undergoing the same functional recovery protocol.

Results

Mean follow-up was 64 months (48–84 months). All patients but one achieved good functional recovery and returned to their sports within a mean period of 6.1 months. A single patient complained of postoperative instability 1 year after the index operation and needed further surgery. No complications were recorded.

Conclusions

Selective reconstruction of partial ACL injury is a method to bear in mind because it offers quick functional recovery. Specific technical and diagnostic steps should be performed and discussed with patients preoperatively.

Level of evidence

Level 4, retrospective study.

Green and scalable synthesis of nanocrystalline kuramite

The new generation of solar cells aims to overcome many of the issues created by silicon-based devices (e.g., decommissioning, flexibility and high-energy production costs). Due to the scarcity of the resources involved in the process and the need for the reduction of potential pollution, a greener approach to solar cell material production is required. Among others, the solvothermal approach for the synthesis of nanocrystalline Cu-Sn-S (CTS) materials fulfils all of these requirements. The material constraints must be considered, not only for the final product, but for the whole production process. Most works reporting the successful synthesis of CTS have employed surfactants, high pressure or noxious solvents. In this paper, we demonstrate the synthesis of nanocrystalline kuramite by means of a simpler, greener and scalable solvothermal synthesis. We exploited a multianalytical characterization approach (X-ray diffraction, extended X-ray absorption fine structure, field emission scanning electron microscopy, Raman spectroscopy and electronic microprobe analysis (EMPA)) to discriminate kuramite from other closely related polymorphs. Moreover, we confirmed the presence of structural defects due to a relevant antisite population.

Accelerometer-Based Navigation in Total Knee Arthroplasty for the Management of Extra-Articular Deformity and Retained Femoral Hardware: Analysis of Component Alignment

Purpose  Recent advances in total knee arthroplasty (TKA) include an accelerometer portable system designed to improve component position and alignment. The purpose of this study is to evaluate whether accelerometer navigation system can be a valuable option in complex TKAs for extra-articular deformity of the lower limb or in case of retained femoral hardware. Methods  A group of 13 patients underwent TKA with an accelerometer navigation system. Three patients had a tibial extra-articular deformity, six had a femoral extra-articular deformity, and four had an intramedullary nail in the femur. Preoperative and postoperative mechanical axes were measured from full-length lower extremity radiographs to evaluate alignment. The alignment of prosthetic components in the frontal and sagittal planes was determined by postoperative radiographs. Results  At 30-days postoperative radiographic check, the hip knee ankle angle was within 2.0° (0 ± 1) of the neutral mechanical axis. The alignment of the tibial component on the frontal plane was 90.0° (range 89-91) and on the sagittal plane 5.0° (range 3-7). The alignment of the femoral component on the frontal plane was 90.0° (range 89-91) and on the sagittal plane 3.0° (range 0-5). Conclusion  The alignment of the prosthetic components has been accurate and comparable to other navigation systems in literature without any increase in surgical times. The accelerometer-based navigation system is therefore a useful technique that can be used to optimize TKA alignment in patients with extra-articular deformity or with lower limb hardware, where the intramedullary guides cannot be applied. Level of Evidence  This is an observational study without a control group, Level III.