Hypothesizing That Pediatric Autoimmune Neuropsychiatric Associated Streptococcal (PANDAS) Causes Rapid Onset of Reward Deficiency Syndrome (RDS) Behaviors and May Require Induction of "Dopamine Homeostasis"

Pediatric autoimmune neuropsychiatric disorders associated with group A streptococcal infections (PANDAS) is a concept that is used to characterize a subset of children with neuropsychiatric symptoms, tic disorders, or obsessive-compulsive disorder (OCD), whose symptoms are exacerbated by group A streptococcal (GAS) infection. PANDAS has been known to cause a sudden onset of reward deficiency syndrome (RDS). RDS includes multiple disorders that are characterized by dopaminergic signaling dysfunction in the brain reward cascade (BRC), which may result in addiction, depression, avoidant behaviors, anxiety, tic disorders, and/or OCD. According to research by Blum et al., the dopamine receptor D2 (DRD2) gene polymorphisms are important prevalent genetic determinants of RDS. The literature demonstrates that infections like Borrelia and Lyme, as well as other infections like group A beta-hemolytic streptococcal (GABHS), can cause an autoimmune reaction and associated antibodies target dopaminergic loci in the mesolimbic region of the brain, which interferes with brain function and potentially causes RDS-like symptoms/behaviors. The treatment of PANDAS remains controversial, especially since there have been limited efficacy studies to date. We propose an innovative potential treatment for PANDAS based on previous clinical trials using a pro-dopamine regulator known as KB220 variants. Our ongoing research suggests that achieving "dopamine homeostasis" by precision-guided DNA testing and pro-dopamine modulation could result in improved therapeutic outcomes.

Trauma-Informed Intervention with Children: Integrating the CANS Assessment with the ARC Framework in a Clinical Setting

Ongoing trauma-focused assessment is critical to developing trauma-informed treatment plans. The current study examines the clinical benefits of utilizing the Child and Adolescent Needs and Strengths (CANS) assessment to guide intervention based on the Attachment, Self-Regulation, and Competency (ARC) model to address children's trauma related symptoms in a rural state. WV CANS was developed by adapting the language of original CANS to be culturally specific to the state's unique situation and culture in consultation with the original CANS developer. This study included the data from children who received mental health services under WV CANS-ARC mapping from 2017 to 2019. Children's trauma-related symptoms are assessed using the WV CANS at intake and every 90 days to identify any changes in their symptoms. In order to examine the changes of traumatic symptoms over time, the study was limited to children who have at least three time points, with a total of 362 children used for the current analyses using Multilevel modeling with SAS PROC MIXED. The study found that children's trauma related symptoms significantly decreased in all ARC outcome domains over time after adjusting for basic demographic variables. The current study contributes to the evidence on treatment for children's trauma-related symptoms, especially with the application of the CANS-ARC mapping in a real-world clinical setting. The findings have significant implications for clinicians in integrating the assessment and treatment process using CANS-ARC mapping and for cross-system collaboration with continuity of care serving children who have experienced trauma.

Association between non-alcoholic fatty liver disease and impaired cardiac sympathetic/parasympathetic balance in subjects with and without type 2 diabetes-The Cooperative Health Research in South Tyrol (CHRIS)-NAFLD sub-study

BACKGROUND AND AIMS

Cardiovascular disease (CVD) is the leading cause of death in patients with non-alcoholic fatty liver disease (NAFLD), both with and without type 2 diabetes mellitus (T2DM). Cardiac autonomic dysfunction is a risk factor for CVD morbidity and mortality. The aim of this pilot study was to assess whether there is an association between NAFLD and impaired cardiac autonomic function.

METHODS AND RESULTS

Among the first 4979 participants from the Cooperative Health Research in South Tyrol (CHRIS) study, we randomly recruited 173 individuals with T2DM and 183 age- and sex-matched nondiabetic controls. Participants underwent ultrasonography and vibration-controlled transient elastography (Fibroscan®, Echosens) to assess hepatic steatosis and liver stiffness. The low-to-high-frequency (LF/HF) power ratio and other heart rate variability (HRV) measures were calculated from a 20-min resting electrocardiogram (ECG) to derive a measure of cardiac sympathetic/parasympathetic imbalance. Among the 356 individuals recruited for the study, 117 had NAFLD and T2DM, 56 had T2DM alone, 68 had NAFLD alone, and 115 subjects had neither condition. Individuals with T2DM and NAFLD (adjusted odds ratio [OR] 4.29, 95% confidence intervals [CI] 1.90-10.6) and individuals with NAFLD alone (adjusted OR 3.41, 95% CI 1.59-7.29), but not those with T2DM alone, had a substantially increased risk of having cardiac sympathetic/parasympathetic imbalance, compared with those without NAFLD and T2DM. Logistic regression models were adjusted for age, sex, body mass index (BMI), hypertension, dyslipidemia, insulin resistance, hemoglobin A1c (HbA1c), C-reactive protein (CRP), and Fibroscan®-measured liver stiffness.

CONCLUSIONS

NAFLD was associated with cardiac sympathetic/parasympathetic imbalance, regardless of the presence or absence of T2DM, liver stiffness, and other potential confounding factors.

Depositing a Titanium Coating on the Lithium Neutron Production Target by Magnetron Sputtering Technology

Lithium (Li) is one of the commonly used target materials for compact accelerator-based neutron source (CANS) to generate neutrons by ⁷Li(p, n)7 Be reaction. To avoid neutron yield decline caused by lithium target reacting with the air, a titanium (Ti) coating was deposited on the lithium target by magnetron sputtering technology. The color change processes of coated and bare lithium samples in the air were observed and compared to infer the chemical state of lithium qualitatively. The surface topography, thickness, and element distribution of the coating were characterized by SEM, EDS and XPS. The compositions of samples were inferred by their XRD patterns. It was found that a Ti coating with a thickness of about 200 nanometers could effectively isolate lithium from air and stabilize its chemical state in the atmosphere for at least nine hours. The Monte Carlo simulations were performed to estimate the effects of the Ti coating on the incident protons and the neutron yield. It turned out that these effects could be ignored. This research indicates that depositing a thin, titanium coating on the lithium target is feasible and effective to keep it from compounds' formation when it is exposed to the air in a short period. Such a target can be installed and replaced on an accelerator beam line in the air directly.

Immune system and obsessive-compulsive disorder

BACKGROUND

Recently, much attention has been devoted to the possible alterations of the immune system in obsessive-compulsive disorder (OCD). Therefore, the aim of this paper was to review the current literature on the relationships between OCD and immune system.

METHODS

A PubMed and Google Scholar search was performed with specific keywords.

RESULTS

In the childhood, much emphasis has been given to the relationship between group A Streptococcus (GAS) infection and the development of a group of clinical syndromes characterized by neuropsychiatric symptoms known as "pediatric autoimmune neuropsychiatric disorders associated with streptococcus" (PANDAS). However, more recently, PANDAS has been reconsidered and evolved towards pediatric acute-onset neuropsychiatric syndrome (PANS) and/or Childhood Acute Neuropsychiatric Syndrome (CANS) all characterized by the presence of typical of OCD symptoms and tics. In adult OCD patients, different immunological parameters have been described to differ from those of healthy control subjects, although a few numbers of studies were carred out and most of them performed in small samples.

CONCLUSIONS

Although the exact relationships between OCD and immune processes are still unclear, available literature supports their role in the pathophysiology of OCD, while providing a fascinating hint for possible immunotherapeutic treatments in OCD.

The course of complaints of arm, neck and/or shoulder: a cohort study in a university population participating in work or study

Background

Not much is known about the characteristics, course and prognosis of complaints of arm, neck and/or shoulder that have not been caused by a trauma or systemic disease (CANS), in a screened population. This study aims to: (1) describe personal and complaint characteristics in a screened population; (2) describe the course during one-year follow-up, in terms of the three different domains of functioning of the International Classification of Functioning, Disability and Health (ICF); and (3) to explore prognostic factors for the different domains of functioning at one-year follow-up. Additionally, this study aims to investigate the manifestation of selection effects (i.e. tertiary selection effects), in order to understand their impact on the interpretation of results.

Methods

A cross-sectional survey was conducted in a university population. Survey respondents who fulfilled eligibility criteria were asked to participate in a longitudinal cohort study. The course of CANS was assessed in terms of the three ICF domains of functioning. Possible prognostic factors across the different components of the ICF were selected to investigate their influence on outcome at one-year follow-up. Non-response analyses were performed to investigate the presence of tertiary selection effects.

Results

The results revealed a population with relatively mild complaints at baseline, and a relatively stable course during follow-up. Because of the small change in scores between baseline and follow-up measurements, examination of prognostic factors was not feasible. The results of the non-response analyses revealed some indications for the potential presence of tertiary selection effects, which may imply that the results obtained are a slight overestimation of the true results.

Conclusion

The results of this study demonstrate mild complaints at baseline and an overall stable course during one-year follow-up. Since selection effects cannot be ruled out, the true course might possibly be somewhat less favourable than our results suggest.

Shielding design of a target station and radiation dose level investigation of proton linac for a compact accelerator-driven neutron source applied at industrial sites

The shielding design for a compact accelerator-driven neutron source (CANS) that is applied in industries was studied using both theoretical simulations and experimental measurements. Neutron shielding material composition for CANS was optimized by coupling the genetic algorithm with the Monte Carlo code. A multi-layer shielding structure was developed and successfully applied to a CANS target station. The high radiation dose of CANS proton linac was investigated in detail on the basis of experimental measurements, and the radiation dose was significantly reduced by replacing the material of its bellow pipes.

The Strengths of Youth in a Public Behavioral Health System: Measurement Choices, Prevalence Rates, and Group Differences

Youth with severe emotional and behavioral problems receiving services in public behavioral health systems have strengths that are understudied in research and underutilized in practice. This study explores four alternative strategies (individual item scores, the number of "actionable" strengths, subscales, and a total composite) for summarizing the strengths of youth assessed with the Child and Adolescent Needs and Strengths (CANS) in a large, urban, public behavioral health system. The paper examines whether these summarization strategies produce divergent understandings of the prevalence of strengths across gender, age, and racial groups. Analyses suggest that youth enter this system with high levels of strengths. There are few group differences in strengths across the diverse summarization strategies. Though the practice-preferred method of using individual strengths items provides the most interpretable information about strengths, the aggregation strategies may be useful for programs and systems. Implications for policy and practice are discussed.

The Child and Adolescent Needs and Strengths as an Outcome Measure in Community Mental Health: Factor Analysis and a Validation of the Short Form

The goal of the study was to create a short-form measure based on the child and adolescent needs and strengths assessment tool. The measure was designed to be short and easy to use, relevant to youth treated in community-based mental health settings, useful for both treatment planning and program evaluation, and psychometrically valid. Factor analyses of the chosen items revealed two mental health factors and four functioning factors. The mental health factors included internalization and externalization, and the functioning factors included family, social, caregiver, and educational functioning. In support of validity, internalization and externalization subscales distinguished between clients diagnosed with internalizing and externalizing disorders and correlated with caregiver and self-report scores on the Youth Outcome Questionnaire.

Development of a self-management program for employees with complaints of the arm, neck, and/or shoulder: an intervention mapping approach

Purpose

To develop a self-management program with an additional eHealth module, using the six steps of the intervention mapping (IM) protocol, to help employees with complaints of the arm, neck, and/or shoulder (CANS) cope with their problems.

Methods

In Step 1 of the IM protocol, a needs assessment was performed consisting of a review of the Dutch multidisciplinary guidelines on CANS, and of focus group sessions with employees with CANS (n=15) and with relevant experts (n=17). After the needs assessment, the objectives of the intervention and the determinants of self-management at work were formulated (Step 2). Furthermore, theory-based intervention methods and practical strategies were selected (Step 3), and an intervention program (including the eHealth module) was developed (Step 4). Finally, plans for implementation and evaluation of the program were developed (Steps 5 and 6).

Results

Step 1 of the IM protocol revealed that employees with CANS should be stimulated to search for information about the cause of their complaints, about how to deal with their complaints, and in which manner they can influence their complaints themselves. In Step 2, the overall goal of the intervention was defined as “self-management behavior at work” with the aim to alleviate the perceived disability of the participants. Step 3 described how the intervention methods were translated into practical strategies, and goal setting was introduced as an important method for increasing self-efficacy. The product of Step 4 was the final program plan, consisting of 6-weekly group sessions of 2.5 hours each and an eHealth module. In Step 5, a recruitment plan and course materials were developed, a steering committee was set up, trainers were recruited, and the final program was tested. In Step 6, an evaluation plan was developed, which consists of a randomized controlled trial with a 12-month follow-up period and a qualitative evaluation (interviews) with some of the participants.

Conclusion

This study resulted in a theory- and practice-based self-management program, based on behavioral change theories, guideline-related evidence, and practice-based knowledge that fits the needs of employees with CANS.

Development of a self-management intervention for employees with complaints of the arm, neck and/or shoulder (CANS): a focus group study with experts

Background

Many people suffer from complaints of the arm, neck and/or shoulder (CANS). The complaints are persistent and there is a need for intervention programs for those with longstanding CANS. Studies suggest that a behavioural change is needed in employees with CANS. A self-management program with an add-on eHealth module might be an effective option to achieve the behavioural change needed to manage the complaints in employees with CANS. The aim of this study was to determine the content and strategies of the intervention and to gain insight into possible barriers and facilitators for implementation. Therefore, we examined the views of experts on the problems and characteristics associated with employees with CANS as well as their opinion on a self-management program consisting of self-management sessions and an eHealth module.

Methods

A qualitative study was performed consisting of three focus groups involving a total of 17 experts (with experience with CANS, self-management and/or eHealth interventions). Experts were asked their opinion about the content and requirements of a self-management program for employees with CANS, including an eHealth module. Data were analysed using qualitative data analysis. After coding, the emergent themes were used to organise the data into main categories, expressing the ideas and opinions of experts on CANS, self-management and/or eHealth interventions.

Results

The experts pointed out that the intervention should focus on increasing employees’ self-efficacy and empowerment, and address topics related to the possible risk factors for CANS, symptoms, work environment, social environment and personal factors. The eHealth module should be self-explanatory and attractive, and the information provided should be brief, clear and concise.

Conclusions

Experts appeared to see a role for a self-management program for employees with CANS. They indicated that the combination of group sessions and eHealth can work well. Experts provided valuable information with regard to the content of the self-management intervention and the design of the eHealth module.

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS): An Evolving Concept

Pediatric autoimmune neuropsychiatric disorders associated with streptococcus infections (PANDAS) originated from the observational work of Swedo and collaborators, who formalized their definition in 1998 in a set of operational criteria. The application of these criteria, which focuses on tics and obsessive-compulsive symptoms as core symptoms, has encountered difficulties, eventually leading to a high rate of misdiagnosis. In particular, the core feature represented by the association between newly diagnosed infections and neuropsychiatric symptom relapses in youths with this diagnosis could not be demonstrated by longitudinal studies. Exploratory studies aiming to identify clinical or cognitive features that could discriminate PANDAS from other pediatric obsessive-compulsive and tic disorders present methodological limitations, and therefore are not conclusive. Other behavioral features, in addition to obsessive-compulsive symptoms and tics, have been included in pediatric acute-onset neuropsychiatric syndromes (PANS) and childhood acute neuropsychiatric syndromes (CANS), two new concepts recently proposed in order to define a much broader clinical spectrum encompassing etiologically diverse entities. Given the uncertainties on the clinical definition of PANDAS, it is not surprising that evidence in support of a post-infectious, immune-mediated pathophysiology is also insufficient. Anti-dopamine receptor antibodies might be relevant to both Sydenham's chorea (SC)-the prototypical post-streptococcal neuropsychiatric disorder-and some rare forms of encephalitis targeting the basal ganglia specifically, but studies exploring their association with children fulfilling Swedo's criteria for PANDAS have been inconclusive. Moreover, we lack evidence in favor of the efficacy of antibiotic prophylaxis or tonsillectomy in patients fulfilling Swedo's criteria for PANDAS, whereas a response to immune-mediated treatments like intravenous immunoglobulins has been documented by one study, but needs replication in larger trials. Overall, the available evidence does not convincingly support the concept that PANDAS are a well-defined, isolated clinical entity subdued by definite pathophysiological mechanisms; larger, prospective studies are necessary to reshape the nosography and disease mechanisms of post-streptococcal acute neuropsychiatric disorders other than SC. Research is also under way to shed further light on a possible relationship between streptococcal infections, other biological and psychosocial stressors, and the complex pathobiology of chronic tic disorders.