Dissociative Amnesia with Fugue vs. Shenjing Shuairuo: A Clinical Case Report. Are DSM-5 Distress Cultural Considerations Truly Transcultural Relevant?

Introduction

We present the case report of a 21-year-old Chinese female, who was brought to the emergency department. We open the debate between the operative criteria stablished by DSM-5 of the clinical entity dissociative amnesia and Shenjing Shuairuo - the Chinese “culture-bound syndrome”.

Objectives

To expose the relevance of the cultural formulation in the clinical evaluation of patients with a different non-Western culture in Psychiatry.

Aims

The Shenjing Shuairuo syndrome (“nervous system weakness”) was originally descripted in China, it has a gradual onset, usually after a stressful event. It involves a minimum 3 of 5 symptoms group: weakness, emotions, excitement, neurological pain and sleep. This complex group of symptoms overlap with dissociative syndrome such as dissociative amnesia.

Methods/results

The cultural formulation interview (CFI) was used for the diagnostic and subsequent treatment of dissociative amnesia with fugue in a different culture patient who met the clinical criteria of this two divergent clinic entities.

Conclusions

In our clinical practice, we will deal with different culture patients, who could present common clinical entities or with the so-called “culture-bound syndromes”. The cultural formulation of the clinical cases will help the clinicians to diagnose and have better treatment's options in clinical manifestations do not correspond to the conventional entities included in mostly Western-based nomenclatures.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Phenanthrene degradation in soil by ozonation: Effect of morphological and physicochemical properties

The aim of this study was to characterize the ozone reaction with phenanthrene adsorbed in two types of soils (sand and agricultural). The effect of soil physicochemical properties (texture, bulk density, particle density, porosity, elemental composition, permeability, surface area and pore volume) on the phenanthrene decomposition was evaluated. Commercial sand has a uniform morphology (spherical) with a particle size range between 0.178 and 0.150 mm in diameter, regular elemental composition SiO₂, specific density of 1701.38 kg/m³, a true density of 2492.50 kg/m³, with an effective porosity of 31%. On the other hand, the agricultural soil had heterogeneous morphology, particle size between 0.1779 and 0.05 mm in diameter, elemental composition was montmorrillonite silicon oxide, apparent density of 999.52 kg/m³, a true density of 2673.55 kg/m³, surface area of 34.92 m²/g and porosity of 57%. The percentage of phenanthrene decomposition in the sand was 79% after 2 h of treatment. On the other hand, the phenanthrene degradation in the agricultural soil was 95% during the same reaction time. The pore volume of soil limited the crystal size of phenanthrene and increased the contact surface with ozone confirming the direct impact of physicochemical properties of soils on the decomposition kinetics of phenanthrene. In the case of agricultural soil, the effect of organic matter on phenanthrene decomposition efficiency was also investigated. A faster decomposition of initial contaminant and byproducts formed in ozonation was obtained in natural agricultural soil compared to the sand. The partial identification of intermediates and final accumulated products produced by phenanthrene decomposition in ozonation was developed. Among others, phenanthroquinone, hydroquinone, phenanthrol, catechol as well as phthalic, diphenic, maleic and oxalic acids were identified.

Risk, coping and PTSD symptom trajectories in World Trade Center responders

Trajectories of disaster-related posttraumatic stress disorder (PTSD) symptoms are often heterogeneous, and associated with common and unique risk factors, yet little is known about potentially modifiable psychosocial characteristics associated with low-symptom and recovering trajectories in disaster responders. A total of 4487 rescue and recovery workers (1874 police and 2613 non-traditional responders) involved during and in the aftermath of the unprecedented World Trade Center (WTC) attacks, were assessed an average of 3, 6, 8, and 12 years post-9/11/2001. Among police responders, WTC-related PTSD symptoms were characterized by four trajectories, including no/low-symptom (76.1%), worsening (12.1%), improving (7.5%), and chronic (4.4%) trajectories. In non-traditional responders, a five-trajectory solution was optimal, with fewer responders in a no/low-symptom trajectory (55.5%), and the remainder in subtly worsening (19.3%), chronic (10.8%), improving (8.5%), and steeply worsening (5.9%) trajectories. Consistent factors associated with symptomatic PTSD trajectories across responder groups included Hispanic ethnicity, pre-9/11 psychiatric history, greater WTC exposure, greater medical illness burden, life stressors and post-9/11 traumas, and maladaptive coping (e.g., substance use, avoidance coping). Higher perceived preparedness, greater sense of purpose in life, and positive emotion-focused coping (e.g., positive reframing, acceptance) were negatively associated with symptomatic trajectories. Findings in this unique cohort indicate considerable heterogeneity in WTC-related PTSD symptom trajectories over 12 years post-9/11/2001, with lower rates of elevated PTSD symptoms in police than in non-traditional responders. They further provide a comprehensive risk prediction model of PTSD symptom trajectories, which can inform prevention, monitoring, and treatment efforts in WTC and other disaster responders.

Mid-term oncologic outcome of a novel approach for locally advanced colon cancer with neoadjuvant chemotherapy and surgery

PURPOSE

Neoadjuvant chemotherapy is being actively tested as an emerging alternative for the treatment of locally advanced colon cancer (LACC) patients, resembling its use in other gastrointestinal tumors. This study assesses the mid-term oncologic outcome of LACC patients treated with oxaliplatin and fluoropyrimidines-based preoperative chemotherapy followed by surgery.

METHODS AND PATIENTS

Patients with radiologically resectable LACC treated with neoadjuvant therapy between 2009 and 2014 were retrospectively analyzed. Radiological, metabolic, and pathological tumor response was assessed. Both postoperative complications, relapse-free survival (RFS), and overall survival (OS) were studied.

RESULTS

Sixty-five LACC patients who received treatment were included. Planned treatment was completed by 93.8 % of patients. All patients underwent surgery without delay. The median time between the start of chemotherapy and surgery was 71 days (65-82). No progressive disease was observed during preoperative treatment. A statistically significant tumor volume reduction of 62.5 % was achieved by CT scan (39.8-79.8) (p < 0.001). It was also observed a median reduction of 40.5 % (24.2-63.7 %) (p < 0.005) of SUV_max (Standard Uptake Value) by PET-CT scan. Complete pathologic response was achieved in 4.6 % of patients. Postoperative complications were observed in 15.4 % of patients, with no cases of mortality. After a median follow-up of 40.1 months, (p ₂₅-p ₇₅: 27.3-57.8) 3-5 year actuarial RFS was 88.9-85.6 %, respectively. Five-year actuarial OS was 95.3 %.

CONCLUSION

Preoperative chemotherapy in LACC patients is safe and able to induce major tumor regression. Survival times are encouraging, and further research seems warranted.

Regulation of black-hole accretion by a disk wind during a violent outburst of V404 Cygni

Accretion of matter onto black holes is universally associated with strong radiative feedback and powerful outflows. In particular, black-hole transients have outflows whose properties are strongly coupled to those of the accretion flow. This includes X-ray winds of ionized material, expelled from the accretion disk encircling the black hole, and collimated radio jets. Very recently, a distinct optical variability pattern has been reported in the transient stellar-mass black hole V404 Cygni, and interpreted as disrupted mass flow into the inner regions of its large accretion disk. Here we report observations of a sustained outer accretion disk wind in V404 Cyg, which is unlike any seen hitherto. We find that the outflowing wind is neutral, has a large covering factor, expands at one per cent of the speed of light and triggers a nebular phase once accretion drops sharply and the ejecta become optically thin. The large expelled mass (>10(-8) solar masses) indicates that the outburst was prematurely ended when a sizeable fraction of the outer disk was depleted by the wind, detaching the inner regions from the rest of the disk. The luminous, but brief, accretion phases shown by transients with large accretion disks imply that this outflow is probably a fundamental ingredient in regulating mass accretion onto black holes.

Thermodynamics of the structural transition in metal–organic frameworks

A thermodynamic study of the structural large-pore (LP) to narrow pore (NP) transition in various Metal Organic Frameworks (MOFs) is presented.

Quantification of obeche wood allergen: Development of a sensitive sandwich-ELISA for occupational exposure assessment

Obeche wood is a prominent cause of allergic occupational asthma. To reduce the risk of immunoglobulin E (IgE)-mediated sensitization it is important to assess airborne obeche wood allergen concentrations at exposed workplaces. Therefore, a highly sensitive obeche wood allergen immunoassay was developed and applicability was proven on airborne passive dust samples in Spanish wood workshops. Obeche wood sandwich enzyme-linked immunosorbent assay (ELISA) polyclonal antibodies (pAbs) were developed. Test specificity was verified by different wood and mold extracts. Obeche wood allergen monitoring was conducted in four Spanish wood workshops, including wood-dust-exposed and nonexposed areas inside and outside the workplaces, as well as controls. Dust was collected with electrostatic dust collectors (EDC). Measuring range of the obeche wood sandwich-ELISA was between 36 pg/ml and 1.6 µg/ml. The test system showed only marginal reactivity to other hardwoods and no reactivity to softwoods and molds. Obeche allergen was detected in all EDC from workplaces. The highest concentration was measured in the workshop with the longest obeche wood exposure (geometric mean [GM]: 7548 µg/m²); shorter obeche wood processing periods resulted in lower amounts of allergen (GM: 29 µg/m²). Obeche wood allergen transfer from exposed workplaces to nonexposed areas inside and outside the workshop was assessed. In control EDC from nonexposed facilities/homes no obeche wood allergen was found. The new obeche wood sandwich-ELISA is a valid tool to quantify obeche allergen exposure. Evidence indicates it will be possible to monitor obeche allergen exposure during different processes, as well as transfer effects in nonexposed areas.