Chinese readers utilize emotion information for word segmentation

We reported a large-scale Internet-based experiment to investigate the impact of emotion information on Chinese word segmentation, in which participants completed an overlapping ambiguous string (OAS) segmentation task and the Chinese version of Beck Depression Inventory-II in a counterbalanced order. OAS is a three-character string (ABC) in which the middle character can form a distinct word with both the character on its left side (word AB) and the character on its right side (word BC). Participants were presented with isolated OASs and were asked to report the word they identified first. Emotional OAS was constructed by a combination of a neutral word and an emotional word, with the neutral and emotional words sharing character B. We orthogonally manipulated the valence of the emotional words (positive vs. negative) and their position in the OAS (left-side vs. right-side). The results showed that compared with neutral words, both positive and negative words were more likely to be segmented, and this segmentation outcome was not affected by readers with different depression tendencies. These findings suggest that emotion information can influence word segmentation, and that both positive and negative words take precedence over neutral words in the word segmentation process. This study provides a new perspective and evidence to understand the impact of emotion information on word processing.

Impact of accounting for correlation between COVID-19 and influenza vaccination in a COVID-19 vaccine effectiveness evaluation using a test-negative design

Test-negative-design COVID-19 vaccine effectiveness (VE) studies use symptomatic SARS-CoV-2-positive individuals as cases and symptomatic SARS-CoV-2-negative individuals as controls to evaluate COVID-19 VE. To evaluate the potential bias introduced by the correlation of COVID-19 and influenza vaccination behaviors, we assessed changes in estimates of VE of bivalent vaccines against COVID-19-associated hospitalizations and emergency department/urgent care (ED/UC) encounters when considering influenza vaccination status or including or excluding influenza-positive controls using data from the multi-state VISION vaccine effectiveness network. Analyses included encounters during October 2022 - February 2023, a period of SARS-CoV-2 and influenza cocirculation. When considering influenza vaccination status or including or excluding influenza-positive controls, COVID-19 VE estimates were robust, with most VE estimates against COVID-19-associated hospitalization and ED/UC encounters changing less than 5 percentage points. Higher proportions of influenza-positive patients among controls, influenza vaccination coverage, or VE could impact these findings; the potential bias should continue to be assessed.

Prognostic role of the number of resected and negative lymph nodes in Spanish patients with gastric cancer

INTRODUCTION

Lymph node (LN) involvement is one of the most critical prognostic factors in resected gastric cancer (GC). Some analyses, mainly conducted in Asian populations, have found that patients with a higher number of total lymph nodes (NTLN) and/or negative lymph nodes (NNLN) have a better prognosis, although other authors have failed to confirm these results.

MATERIALS AND METHODS

Retrospective study including all patients with GC resected in a tertiary hospital in Spain between 2001 and 2019 (n = 315). Clinicopathological features were collected and patients were categorized according to the NTLN and the NNLN. Statistical analyses were performed.

RESULTS

Mean NNLN was 17. The NNLN was significantly related to multiple clinicopathological variables, including recurrence and tumor-related death. The classification based on the NNLN (N1: ≥16, N2: 8-15, N3: ≤7) effectively stratified the entire cohort into three distinct prognostic groups and maintained its prognostic value within both the pN0 and pN+ patient subsets. Furthermore, it was an independent prognostic indicator for both overall and disease-free survival. Conversely, the mean NTLN was 21.9. Patients with ≤16 LN retrieved exhibited distinct clinicopathological features compared to those with >16 LN, but no significant differences were observed in terms of recurrence or disease-associated death. The application of alternative cut-off points for NTLN (10, 20, 25, 30, and 40) showed no prognostic significance.

CONCLUSIONS

In Spanish patients with resected GC the NNLN hold prognostic significance, while the NTLN does not appear to be prognostically significant. Incorporating the NNLN into GC staging may enhance the accuracy of the TNM system.

Effort-related effects of chronic administration of the DA D2 receptor antagonist haloperidol via subcutaneous programmable minipumps: Reversal by co-administration of the adenosine A2A antagonist istradefylline

RATIONALE

Long-acting antipsychotics such as haloperidol decanoate are becoming more commonly used. Long-acting depot formulations have several advantages, but secondary negative effects of prolonged delivery, including motivational dysfunctions, could have debilitating effects. Assessing the behavioral changes that emerge during chronic antipsychotic administration in rats could provide insight regarding the development of motivational dysfunctions and drug tolerance.

OBJECTIVES

Acute administration of dopamine D2 antagonists such as haloperidol induce motivational deficits in rats, as marked by a shift towards a low-effort bias during effort-based choice tasks. In the present studies, programmable subcutaneous infusion pumps provided continuous and controlled drug delivery of haloperidol. Animals were assessed using a fixed ratio (FR) 5 lever pressing schedule and the FR5/chow feeding test of effort-based choice. The adenosine A2A antagonist istradefylline was studied for its ability to reverse the effects of chronic haloperidol.

RESULTS

Continuous chronic infusions of haloperidol produced significant reductions in FR5 performance and a shift from lever pressing to chow intake in rats tested on FR5/chow feeding choice, with no evidence of tolerance over the 4-week infusion period. Behavior returned to baseline during the vehicle-infusion washout period. Istradefylline significantly reversed the effects of haloperidol, increasing lever pressing and decreasing chow intake in haloperidol-treated rats.

CONCLUSIONS

These studies provide an important behavioral characterization of the effects of chronically infused haloperidol, and demonstrate that A2A antagonism reverses the effects of chronic haloperidol. This research could contribute to the understanding and treatment of motivational dysfunctions seen in schizophrenia, Parkinson's disease, and other disorders involving dopamine.

Clinical characteristics of and risk factors for poor outcomes in children with bacterial culture-negative septic arthritis of the hip

BACKGROUND

Septic arthritis of the hip is a serious infection in children. However, blood and joint fluid cultures are often negative, which makes the diagnosis and treatment challenging. We analyzed the clinical features of children with septic arthritis of the hip with negative bacterial cultures and identified the risk factors for poor outcomes.

METHODS

The clinical data of children with septic arthritis of the hip with negative bacterial cultures who were treated at our hospital from January 2010 to December 2020 were retrospectively analyzed. The clinical characteristics and outcomes of the culture-negative cohort were compared with those of children with positive bacterial cultures treated during the same period. Culture-negative patients were divided into a group with good outcomes and a group with poor outcomes. The differences between the two groups were compared.

RESULTS

Thirty-nine children with culture-negative septic arthritis of the hip were compared with 37 children with culture-positive sepsis. Compared with the culture-positive group, the culture-negative group had a significantly younger mean age and a significantly lower mean serum C-reactive protein concentration. Logistic regression analysis of culture-negative patients with good versus poor outcomes revealed that the independent risk factors for poor outcomes were an increased serum C-reactive protein concentration and prolonged time from onset to surgery. The cut-off values for predicting a poor outcome in the culture-negative group were a time from onset to surgery of greater than 21 days and a C-reactive protein concentration of greater than 23 mg/L.

CONCLUSIONS

Culture-negative septic arthritis of the hip has similar clinical features to culture-positive septic arthritis of the hip and can result in sequelae of varying severity. Therefore, active anti-infective and hip drainage therapy should be performed when children present with clinical symptoms, inflammatory marker concentrations, and imaging findings that are clinically diagnostic for septic arthritis of the hip.

LEVEL OF EVIDENCE

Level II, retrospective study.

The local communities' perceptions on the social impact of tourism and its implication for sustainable development in Amhara regional state

Tourism is a current and global industry that has a multidimensional impact on destinations. As an emerging industry, it has an immense contribution to make to the development of the local community if all stakeholders participate in a responsible manner. The social impact of tourism is, among other things, one that needs the attention of scholars. The social impact of tourism is immense and diverse, and it is embedded with other tourism impacts. So, studying it is very essential to managing tourism in a responsible way. To address the stated objective, mixed research approaches were used. The result of the study indicated that tourism has both positive as and negative impacts on tourist destinations. The positive social impact of tourism was expressed in moderate terms and stated in terms of the expansion of hotels, road transportation, air transportation, electricity, internet, banking, and other infrastructures. The negative social impact was expressed in small terms and conveyed in terms of the unequal access to the aforementioned social services, the expansion of prostitution, the persistence of theft and illicit trade in heritage, and the random adoption of the lifestyles and manners of tourists by residents.

Outcomes of deferred revascularisation following negative fractional flow reserve in diabetic and non-diabetic patients: a meta-analysis

BACKGROUND

Fractional Flow Reserve (FFR) is a widely applied invasive physiological assessment, endorsed by major guidelines to aid in the decision to perform or defer revascularisation. While a threshold of  > 0.8 has been applied universally, clinical outcomes may be affected by numerous factors, including the presence of diabetes. This meta-analysis aims to investigate the outcomes of diabetic versus non-diabetic patients in whom revascularisation was deferred based on negative FFR.

METHODS

We performed a meta-analysis investigating the outcomes of diabetic and non-diabetic patients in whom revascularisation was deferred based on negative FFR. A search was performed on MEDLINE, PubMed and EMBASE, and peer-reviewed studies that reported MACE for diabetic and non-diabetic patients with deferred revascularisation based on FFR  > 0.8 were included. The primary end point was MACE.

RESULTS

The meta-analysis included 7 studies in which 4275 patients had revascularisation deferred based on FFR > 0.8 (1250 diabetic). Follow up occurred over a mean of 3.2 years. Diabetes was associated with a higher odds of MACE (OR = 1.66, 95% CI 1.35-2.04, p =  < 0.001), unplanned revascularisation (OR = 1.48, 95% CI 1.06-2.06, p = 0.02), all-cause mortality (OR = 1.74, 95% CI 1.20-2.52, p = 0.004) and cardiovascular mortality (OR = 2.08, 95% CI 1.07-4.05, p = 0.03).

CONCLUSIONS

For patients with stable coronary syndromes and deferred revascularisation based on FFR > 0.8, the presence of diabetes portends an increased long-term risk of MACE compared to non-diabetic patients. Trail registration URL:  https://www.crd.york.ac.uk/PROSPERO/ ; Unique identifier: CRD42022367312.

A prospective randomized study

Introduction

Despite of their extensive use, drains remain controversial without clear guidelines, and there is unclear evidence on drain use in spine procedures. Negative pressure drainage is theoretically more effective in preventing postoperative hematomas. On the contrary, it may result in excessive drainage and blood loss.The aim of this study was to compare the outcome between the uses of negative versus natural drainage in single level posterior lumbar interbody fusion (PLIF).

Research question

The aim is to compare between negative versus natural drainage after single-level PLIF as regard to postoperative wound infection, wound healing, temperature, pain and neurological deficits.

Materials and methods

A prospective randomized study of consecutive PLIF patients at a single level for lumbar disc prolapse was performed between January 2019 and January 2020. The patients were randomly assigned to either the negative suction drainage group or natural drainage group. Negative suction was created by maximum compression of the reservoir to create negative pressure. In the other group, natural pressure drainage was kept without any negative pressure.Our study included a total of 62 patients who met the inclusion criteria. They were divided into two groups; 33 patients had negative suction drains and 29 patients had natural drainage. There were 32 female (51.6%) and 30 male (48.4%). Their ages ranged between of 23-69 years, with a mean age of 42.11 ​± ​8.89 years.

Results

Drainage volume was statistically higher in the negative group on the day of surgery (day 0) as well as the 1st and second days after. However, no significant differences were observed as regards to postoperative temperature, pain, wound infection, temperature, or neurological deficits.

Discussion &conclusion

In this prospective randomized study, our results revealed that natural drainage in short term can reduce the total amount of blood in the drain, and therefore the blood loss without significant differences in postoperative wound infection, wound healing, temperature, pain, or neurological deficits in single-level PLIF.

Compensation of overall physical activity in (pre)adolescent girls - the CReActivity project

BACKGROUND

According to the ActivityStat hypothesis more physical activity (PA) in one timespan is compensated by increased sedentary time (ST) in the following timespan and vice versa to maintain an overall stable PA level. Until now, existing literature revealed inconsistent results regarding compensatory behaviour across children and adolescents. Thus, the aim of the present study is (1) to investigate whether ST in the morning is compensated by active behaviour in the afternoon and (2) whether ST during the week is compensated by active behaviour during the weekend in (pre)adolescent girls. Additionally, we aimed to differentiate between positive and negative compensatory behaviour and examine whether it is moderated by socioeconomic status (SES), age or weight status.

METHODS

The participants were 370 sixth grade school girls (mean age 11.6 years) from Munich that participated in the CReActivity study, a school based intervention study aiming to identify the mechanisms of behavioural changes in PA among girls. ST and PA were measured over seven consecutive days using accelerometery. Descriptive determination of compensatory behaviour, as well as Bayesian multivariate multilevel analysis were conducted with data clustered on the individual (ID), class and school level.

RESULTS

Descriptive analysis revealed rather constant compensatory behaviour of about 60% for after-school days and weekends over all observation points. However, regarding all girls, compensation was predominantly negative. Differentiated analysis indicated that all girls with low ST levels in the morning or on weekdays, compensated for this behaviour with lower PA levels in the afternoon or on weekends. Multilevel covariate analysis indicated great variability between the participants. Furthermore, differences in compensatory behaviour can also be seen on class and school levels. Interestingly, PA compensatory behaviour is not associated with age, weight status or SES.

CONCLUSION

Our findings could neither confirm nor reject the ActivityStat Hypothesis. Overall, due to the great variability across the girls, it seems that compensation depends on individual factors. In the future, to prevent negative compensation, school-based interventions that have the potential to provide opportunities to be physically active, should not neglect (pre)adolescents' leisure time behaviour.

TRIAL REGISTRATION

DRKS00015723 (date of registration: 2018/10/22 retrospectively registered).

Synchronous early gastric and intestinal mucosa-associated lymphoid tissue lymphoma in a Helicobacter pylori-negative patient: A case report

BACKGROUND

Mucosa-associated lymphoid tissue (MALT) lymphoma occurs largely in the digestive tract, with the stomach being the most commonly affected organ, followed by the small intestine, large intestine, and esophagus. It is rarely found in both the stomach and colon. Helicobacter pylori (H. pylori) infection is strongly associated with gastric MALT lymphoma, although there is a small number of H. pylori-negative gastric MALT lymphomas. Diagnosis of MALT lymphoma is challenging because of nonspecific symptoms and diverse presentations of endoscopic findings.

CASE SUMMARY

We report a case of an asymptomatic patient who during screening endoscopy and was found to have stromal tumor-like submucosal uplift lesions in the stomach body and polypoid lesions in the rectum. After endoscopic resection, the patient was diagnosed with multiple early simultaneous gastrointestinal MALT lymphomas.

CONCLUSION

This study may help improve our understanding of MALT lymphomas and multifocal lesions treated using early endoscopy.

The Use of Hepatitis C Virus-Positive Organs in Hepatitis C Virus-Negative Recipients

The use of hepatitis C virus (HCV) -positive organs in HCV-negative recipients with posttransplant antiviral treatment has increasingly been studied since the introduction of new direct-acting antivirals. This article reviews existing experience in liver and kidney transplant. Fifteen studies with 218 HCV D+/R- liver transplants, with 182 from viremic donors, show a sustained viral response for 12 weeks (SVR12) rate of 99.5%. Nine studies involving 204 HCV donor-positive recipient-negative kidney transplant recipients had an SVR12 rate of 99.5%. Complications are infrequent. Preemptive treatment in kidney transplant of for only 4 weeks or even 4 days showed surprising success rates.

When Elon Musk Changes his Tone, Does Bitcoin Adjust Its Tune?

We present a textual analysis that explains how Elon Musk's sentiments in his Twitter content correlates with price and volatility in the Bitcoin market using the dynamic conditional correlation-generalized autoregressive conditional heteroscedasticity model, allowing less sensitive to window size than traditional models. After examining 10,850 tweets containing 157,378 words posted from December 2017 to May 2021 and rigorously controlling other determinants, we found that the tone of the world's wealthiest person can drive the Bitcoin market, having a Granger causal relation with returns. In addition, Musk is likely to use positive words in his tweets, and reversal effects exist in the relationship between Bitcoin prices and the optimism presented by Tesla's CEO. However, we did not find evidence to support linkage between Musk's sentiments and Bitcoin volatility. Our results are also robust when using a different cryptocurrency, i.e., Ether this paper extends the existing literature about the mechanisms of social media content generated by influential accounts on the Bitcoin market.

Demographics and clinical characteristics of hospitalised patients under investigation for COVID-19 with an initial negative SARS-CoV-2 PCR test result

Background

The COVID-19 pandemic is placing abnormally high and ongoing demands on healthcare systems. Little is known about the full effect of the COVID-19 pandemic on diseases other than COVID-19 in the South African setting.

Objective

To describe a cohort of hospitalised patients under investigation for SARS-CoV-2 that initially tested negative.

Methods

Consecutive patients hospitalised at Khayelitsha Hospital from April to June 2020, whose initial polymerase chain reaction test for SARS-CoV-2 was negative were included. Patient demographics, clinical characteristics, ICD-10 (International Statistical Classification of Diseases and Related Health Problems 10th Revision) diagnosis, referral to tertiary level facilities and ICU, and all-cause in-hospital mortality were collected. The 90-day re-test rate was determined and comparisons were made using the χ²-test and the independent samples median test.

Results

Overall, 261 patients were included: median age 39.8 years, 55.6% female (n = 145). Frequent comorbidities included HIV (41.4%), hypertension (26.4%), and previous or current tuberculosis (24.1%). Nine (3.7%) patients were admitted to ICU and 38 (15.6%) patients died. Ninety-three patients (35.6%) were re-tested and 21 (22.6%) were positive for SARS-CoV-2. The top primary diagnoses related to respiratory diseases (n = 82, 33.6%), and infectious and parasitic diseases (n = 62, 25.4%). Thirty-five (14.3%) had a COVID-19 diagnostic code assigned (26 without microbiological confirmation) and 43 (16.5%) had tuberculosis. Older age (p = 0.001), chronic renal impairment (p = 0.03) and referral to higher level of care (all p < 0.001; ICU p = 0.03) were more frequent in those that died.

Conclusion

Patients with tuberculosis and other diseases are still presenting to emergency centres with symptoms that may be attributable to SARS-CoV-2 and requiring admission. Extreme vigilance will be necessary to diagnosis and treat tuberculosis and other diseases as we emerge from the COVID-19 pandemic.

Assessing Emotion Regulation Ability for Negative and Positive Emotions: Psychometrics of the Perth Emotion Regulation Competency Inventory in United States Adults

People regulate both negative and positive emotions, and their ability to do this successfully is a cornerstone of adaptive psychological functioning. However, few measures have been available to assess emotion regulation ability across both valence domains. The Perth Emotion Regulation Competency Inventory (PERCI) was recently developed for this purpose. Here we present the first psychometric study of the PERCI in the United States (N = 508). Confirmatory factor analyses supported the intended eight-factor structure, which was invariant across age, gender, and education. PERCI scores had high internal consistency, and were associated with measures of psychopathology, emotional reactivity, and emotion regulation strategies in expected ways. These observed relationships between the PERCI and various regulation strategies may serve to establish a profile of what strategy patterns characterize differences in emotion regulation ability. Overall, the PERCI had strong psychometrics. Its capacity to assess both valence domains should enable more comprehensive assessments of emotion regulation ability.

A rare case of a novel coagulase negative Staphylococcus native valve endocarditis in a 28-year-old male

Coagulase negative staphylococci (CoNS) are an emerging cause of native valve endocarditis in community and healthcare settings. We describe a case of a 28-year-old man with no significant risk factors who presented with Staphylococcus pettenkoferi native valve endocarditis. During our patient’s initial hospitalization, he was treated for CoNS bacteraemia and subsequently discharged after a protracted hospital course with a transthoracic echocardiogram (TTE) showing no valvular vegetations. However, during the course of his second hospitalization, speciation identified S. pettenkoferi and transoesophageal echocardiogram (TEE) showed aortic valve perforations with new regurgitation raising concern for left sided endocarditis. We postulate that our patient may have been infected with the same CoNS species causing aortic valve endocarditis during his initial hospitalization. This case highlights the importance of recognizing CoNS as a possible causative bacterium in NVE, as well as the importance of obtaining a TEE when evaluating a patient for suspected endocarditis.

[How can the well-being of family caregivers of people with dementia be identified?]

This paper discusses what well-being means to caregivers and how it can be measured to confirm its acquisition by using previous research on theoretical and practical aspects.Within the field of psychology, the two types of well-being (subjective and psychological well-being) are combined to form "feeling good and functioning well", which refers to "pleasant subjective experiences, meaningful activities and the realization of human potential in an individual's life".On the other hands, a review study reported on the Global Measure of well-being, that is, depressive symptoms, mental health, QOL, satisfaction with life and health, also on caregiver-specific well-being measures that are burden, role strain, personal strain, stress, competence and self-efficacy. The majority of measures focused on the negative aspects of well-being.If there is no simple measurement tool that captures both the positive and negative aspects of well-being, a comprehensive and quantitative evaluation of dementia care, so for the present there is no alternative but to using multiple tools for evaluation.The Eco-map of the Ecological Social Work method, which was used in a psycho-educational intervention for caregivers, was shown to provide a hint as to how to take a macroscopic and comprehensive view of dementia care and how to easily grasp an understanding of the well-being of caregivers.

Manipulating avoidance motivation to modulate attention bias for negative information in dysphoria: An eye-tracking study

BACKGROUND AND OBJECTIVES

Instrumentality plays a key role in guiding attention, such that stimuli associated with achieving current goals of an individual prioritize attention. However, in depression, attention is prioritized to negative stimuli even when they are not relevant to current goals. In the current study, we tested whether attention is prioritized to stimuli that are associated with avoidance of imminent negative consequences over negative affective stimuli.

METHODS

Using an eye-tracking based attention engagement-disengagement task, we presented pairs of negative faces, and neutral faces associated with avoidance of punishment (white noise and lost money) to a group of dysphoric and non-dysphoric individuals.

RESULTS

First, we replicated previous evidence on difficulties to disengage attention from negative stimuli, when prompted to direct eye-gaze towards simple neutral stimuli, in dysphoric compared to non-dysphoric individuals. Further, we found that both dysphoric and non-dysphoric individuals were faster to disengage their attention from negative pictures when prompted to direct eye-gaze towards punishment avoidance-related neutral stimuli, versus towards simple neutral stimuli.

LIMITATIONS

Although we seek to clarify the attention processes underlying depression, the current study employed a sub-clinical sample in order to serve as proof-of-concept study.

CONCLUSIONS

Our results indicate that stimuli instrumental to the goal of avoiding negative consequences receive preference in the attention system over simple negative affective stimuli. Our findings suggest that manipulating the instrumentality of avoidance motivation can effectively modulate the attention bias for negative information in dysphoria, and also possibly in depression, akin to the modulation patterns in non-dysphoric individuals.

High-risk HPV-positive and -negative high-grade cervical dysplasia: Analysis of 5-year outcomes

OBJECTIVE

To evaluate the outcomes of high-risk (HR) HPV-positive and -negative women affected by high-grade cervical dysplasia.

METHODS

This is a retrospective multi-institutional study. Medical records of consecutive patients with high-grade cervical dysplasia undergoing conization between 2010 and 2014 were retrieved. All patients included had at least 5 years of follow-up. A propensity-score matching was adopted in order to reduce the presence of confounding factors between groups. Kaplan-Meir and Cox hazard models were used to estimate 5-year outcomes.

RESULTS

Overall, data of 2966 women, affected by high-grade cervical dysplasia were reviewed. The study population included 1478 (85%) and 260 (15%) women affected by HR-HPV-positive and HR-HPV-negative high-grade cervical dysplasia. The prevalence of CIN2 and CIN3 among the HR-HPV-positive and -negative cohort was similar (p = 0.315). Patients with HR-HPV-positive high-grade cervical dysplasia were at higher risk of 5-year recurrence (after primary conization) that HR-HPV-negative patients (p < 0.001, log-rank test). Via multivariate analysis, HR-HPV-negative women were at low risk of recurrence (HR: 1.69 (95%CI: 1.05, 4.80); p = 0.018, Cox Hazard model). A propensity-score matched comparison was carried out in order to reduce biases that are related to the retrospective study design. In comparison to HR-HPV-negative patients, thosewith HR-HPV-positive CIN3 was associate with a 8-fold increase in the risk of recurrence (p < 0.001, log-rank test).

CONCLUSIONS

HR-HPV-negative high-grade cervical dysplasia is not uncommon, accounting for 15% of our study population. Those patients experience more favorable outcomes than patients with documented HR-HPV infection(s). Further prospective studies are needed to corroborate our data.

Characteristics and prognosis of acute type A aortic dissection with negative D-dimer result

BACKGROUND

Evidence regarding the characteristics and prognosis in acute type A aortic dissection (AAD) patients with negative D-dimer result is limited. We aimed to investigate the characteristics and prognosis in AAD patients with negative D-dimer result.

METHODS AND RESULTS

370 AAD patients within 24 h of symptom onset were enrolled in a hospital in China from January 2014 to December 2018. Nine (2.43%) and 361 (97.57%) exhibited negative and positive D-dimer results, respectively. The average age of nine negative D-dimer result participants was 47.67 ± 10.95 years old, and about seven (77.78%) of them were male. The negative group showed a significantly lower blood pressure, white blood cell, hemoglobin, activated partial thromboplastin, ejection fraction and symptom with pain than the positive group. Multivariate analysis showed white blood cell (×10⁹/L) (P = 0.008; odds ratio, 0.566) and symptom with pain (P < 0.001; odds ratio, 0.013) were significantly related to a negative result. The result of the fully-adjusted model showed negative D-dimer result was negatively associated with in-hospital mortality compared with positive group in AAD patients after adjusting confounders (OR = 0.34, 95%CI 0.01 to 10.82).

CONCLUSIONS

Negative D-dimer result is strongly influenced by white blood cell and symptom with pain. Negative D-dimer result was negatively associated with in-hospital mortality compared with positive group in AAD patients.

Clinicopathological features of early gastric cancers arising in Helicobacter pylori uninfected patients

BACKGROUND

Persistent Helicobacter pylori (H. pylori) infection causes chronic inflammation, atrophy of the gastric mucosa, and a high risk of developing gastric cancer. In recent years, awareness of eradication therapy has increased in Japan. As H. pylori infections decrease, the proportion of gastric cancers arising from H. pylori uninfected gastric mucosa will increase. The emergence of gastric cancer arising in H. pylori uninfected patients though rarely reported, is a concern to be addressed and needs elucidation of its clinicopathological features.

AIM

To evaluate the clinicopathological features of early gastric cancer in H. pylori-uninfected patients.

METHODS

A total of 2462 patients with 3375 instances of early gastric cancers that were treated by endoscopic submucosal dissection were enrolled in our study between May 2000 and September 2019. Of these, 30 lesions in 30 patients were diagnosed as H. pylori-uninfected gastric cancer (HpUIGC). We defined a patient as H. pylori-uninfected using the following three criteria: (1) The patient did not receive treatment for H. pylori, which was determined by investigating medical records and conducting patient interviews; (2) Lack of endoscopic atrophy; and (3) The patient was negative for H. pylori after being tested at least twice using various diagnostic methods, including serum anti-H. pylori-IgG antibody, urease breath test, rapid urease test, and microscopic examination.

RESULTS

The frequency of HpUIGC was 1.2% (30/2462) for the patients in our study. The study included 19 males and 11 females with a mean age of 59 years. The location of the stomach lesions was divided into three sections; upper third (U), middle third (M), lower third (L). Of the 30 lesions, 15 were U, 1 was M, and 14 were L. Morphologically, 17 lesions were protruded and flat elevated type (0-I, 0-IIa, 0-IIa + IIc), and 13 lesions were flat and depressed type (0-IIb, 0-IIc). The median tumor diameter was 8 mm (range 2-98 mm). Histological analysis revealed that 22 lesions (73.3%) were differentiated type.The HpUIGC lesions were classified into fundic gland type adenocarcinoma (7 cases), foveolar type well-differentiated adenocarcinoma (8 cases), intestinal phenotype adenocarcinoma (7 cases), and pure signet-ring cell carcinoma (8 cases). Among 30 HpUIGCs, 24 lesions (80%) were limited to the mucosa; wherein, the remaining 6 lesions showed submucosal invasion. One of the submucosal invasive lesions showed more than 500 μm invasion. The mucin phenotype analysis identified 7 HpUIGC with intestinal phenotype and 23 with gastric phenotype.

CONCLUSION

We elucidated the clinicopathological characteristics of HpUIGC, revealing recognition not only undifferentiated-type but also differentiated-type. In addition, intestinal phenotype tumors were also observed and could be an important tip.

How does an increased freeway speed limit influence the frequency of crashes on adjacent roads?

Urban arterial roads carry the most traffic on urban road networks and experience the highest percentage of crashes in urban areas. Safety on urban arterials that are adjacent to a higher speed freeway may be impacted by speed spillover or adaptation. The objective of this study was to determine the effects of raising freeway speed limits on the frequency of crashes on urban arterial roads adjacent to freeways (spillover effects). Crash data within Michigan were collected on 1393 urban arterial road segments before and after freeway speed limits were altered. Before-and-after data was collected simultaneously on 1470 comparison segments of urban arterial where speed limits did not change to control for the regression-to-the-mean bias. The mixed effects negative binomial (MENB) regression model was developed to analyze crash frequency on urban arterials. The results indicate that raising speed limits of freeways by as little as five miles per hour had a likelihood of increasing crash frequency on adjacent arterial roads by as much as 13.9 percent. To investigate if the safety impact of speed spillover changes with the distance from the freeway, influence areas (0-1 mile, 1-2 mile, and 2-3 mile) were used. The findings of this study provide insights into the effects of speed spillover on crash occurrences, and it demonstrates that increasing freeway speed limit has a negative influence on driver compliance with the speed limit on adjacent arterial roads. Correspondingly, the influence of freeway speed on drivers' speeding behavior on adjacent urban arterials fades away with the distance from the freeway.

Predictors and Results of Negative Ureteroscopy for Treatment of Consecutive Ureteric Stones Done as a Primary Procedure: Prospective Outcomes from a University Hospital

INTRODUCTION

While negative ureteroscopy (URS) can be considered as an unnecessary procedure with medico-legal consequences, this avoids radiation from repeat CT scan and sometimes may be the only way to reassure patients with ongoing symptoms. We wanted to analyze our predictors and results of negative URS for treatment of ureteric stones.

METHODS AND MATERIALS

Between March 2012 and August 2018, data on consecutive patients with ureteric stones undergoing a primary URS (without a pre-operative stent) were prospectively collected for patient demographics and outcomes. Comparison was done for patients with diagnostic and therapeutic primary URS for ureteric stones. Patients with renal stones were excluded from the study.

RESULTS

A total of 270 patients underwent URS for ureteric stones during the study period of which 35 (13%) had a negative diagnostic URS. The patients who had negative URS were younger (p = 0.001), had smaller stones (p < 0.001), and more stones located in the distal ureter or vesico-ureteric junction (VUJ; p= 0.036). None of the patients who underwent negative URS had a postoperative stent inserted or any complications.

CONCLUSION

Although the rates of negative URS should be as low as possible, it seems to be safe and reassures patients with on-going symptoms. Based on our data, patients with small distal ureteric or VUJ stones should undergo a repeat imaging to avoid this unnecessary procedure. Informed consent, patient counseling, and appropriate up-to-date imaging seem to be key to minimizing negative diagnostic URS.

How Does the Media Portray Neurosurgeons?

BACKGROUND

It is not unusual to find neurosurgeons in the news and entertainment. The present study examined the portrayal of neurosurgeons by major print and online media sources.

METHODS

Two search strategies identified articles from October 1, 2012 to October 1, 2017 containing the keyword "neurosurgeon." The top 25 newspapers in the United States, determined by their circulation, were searched using the LexisNexis Academic or NewsBank databases; a layman's Google News search was used to collect online stories. Each identified article was evaluated to confirm the relevance and then examined for content. Relevant characteristics for each article and neurosurgeon were determined and analyzed.

RESULTS

Our searches returned 1005 articles comprising 561 unique stories about 203 different neurosurgeons. One particular neurosurgeon had 459 reports (45.7%). More articles were reported in 2015 (405; 40.3%) than any other single year. Most articles featured male neurosurgeons (879; 87.1%) and neurosurgeons who had been practicing for >20 years (636; 63.0%), with just 10 institutions accounting for the training of most of them (733; 72.6%). The articles were classified as positive (270; 26.9%), negative (356; 35.4%), or neutral (379; 37.7%) in terms of their reflection on the field of neurosurgery. The odds of a negative story were greater for male neurosurgeons, within 10 years of residency completion, and in a nonacademic position.

CONCLUSIONS

Neurosurgeons are naturally subject to media coverage, and we must be cognizant that this predilection can serve as both an occupational advantage and an occupational hazard.

Intracranial subarachnoid hemorrhage resulting from non-cervical spinal arteriovenous lesions: Analysis of possible cause of bleeding and literature review

Subarachnoid hemorrhage (SAH) or intraventricle hemorrhage (IVH) with negative cerebral digital subtraction angiography (DSA) results, which are due to non-cervical spinal arteriovenous lesions, are uncommon. In this article we presented three cases from our hospital and nineteen cases from prior published literature and discussed clinical features, possible mechanisms underlying the hemorrhage and therapeutic strategies for managing this unusual entity. Our analysis revealed that headache was the most common initial symptom. Almost 60% of patients had symptoms related to the spinal cord at admission. Intramedullary arteriovenous malformations (AVM) were the most common type of malformation, and the thoracic segment was the most common location of the non-cervical spinal arteriovenous lesions. More than half of the patients had additional aneurysms. Surgery was chosen as the primary treatment modality in this series. Therefore, we speculate that thoracolumbar spinal arteriovenous lesions are an unusual cause of intracranial SAH with negative cerebral DSA results. If non-cervical spinal AVMs were associated with DSA-negative SAH, the pattern of hemorrhage could be manifested as the blood in supratentorial cisterns, the fourth ventricle or no copious blood around the foramen magnum as well (somewhat paradoxically), it depends on the timing of detection and image evaluation. The formation and the rupture of associated aneurysms were the most likely immediate cause of the intracranial SAH. If non-cervical spinal AVMs were not associated with DSA-negative SAH and all cases were genuine cases of 'SAH-of-unknown origin', the spinal AVM could be considered as incidental finding. Magnetic resonance imaging (MRI) of the complete spinal neuraxis is recommended to either exclude or identify a spinal lesion in these patients. Catheter-based spinal angiography remains the gold standard for the diagnosis of spinal vascular diseases. The decision regarding a therapeutic strategy is based on the angioarchitecture and on the type of spinal arteriovenous lesions.

'Negative Ureteroscopy' for Stone Disease: Evidence from a Systematic Review

PURPOSE OF REVIEW

While ureteroscopy (URS) is a common procedure for ureteric stones, this window between diagnosis and treatment leaves the possibility for a 'negative', 'stoneless' or 'diagnostic' URS. We perform a systematic review to look at the rate of 'negative ureteroscopy' and risk factors associated with it.

RECENT FINDINGS

From a total of 3599 articles and 68 abstracts, 4 studies (1336 patients) were selected. The negative URS rate varied from 4 to 14%. Common predictors seem to be female gender, small stones, radiolucent stones and distal ureteric stones. Although infrequent, negative ureteroscopy should be avoided in patients with ureteric stones by performing a low-dose CT scan on the day of surgery. This should especially be performed for females and those with smaller, radiolucent or distal ureteric stones.

Altered glutamatergic response and functional connectivity in treatment resistant schizophrenia: the effect of riluzole and therapeutic implications

RATIONALE

Anterior cingulate cortex (ACC) glutamatergic abnormalities are reported in treatment-resistant schizophrenia (TRS) and implicated in functional dysconnectivity and psychopathology. Preclinical evidence indicates riluzole reduces synaptic glutamate. However, it is unknown whether riluzole can modulate glutamate metabolite levels and associated functional connectivity in TRS.

OBJECTIVES

To examine the relationship between glutamatergic function and cortical connectivity and determine if riluzole can modulate glutamate metabolite levels and cortical functional connectivity in TRS.

METHODS

Nineteen TRS patients and 18 healthy volunteers (HV) underwent magnetic resonance imaging consisting of MR spectroscopy measuring ACC glutamate plus glutamine (Glx), fMRI measuring resting ACC-functional connectivity, and arterial spin labelling measuring regional cerebral blood flow (rCBF), and clinical measures. They then received 50 mg riluzole twice daily for 2 days when imaging was repeated.

RESULTS

Baseline (pre-riluzole) Glx levels were correlated directly with negative symptom severity (r = 0.49; p = 0.03) and inversely with verbal learning in TRS (r = - 0.63; p = 0.002), but not HV (r = - 0.24; p = 0.41). Connectivity between the ACC and anterior prefrontal cortex (aPFC) was correlated with verbal learning in TRS (r = 0.49; p = 0.04), but not HV (r = 0.28; p = 0.33). There was a significant group × time interaction effect on Glx levels (p < 0.05) and on ACC connectivity to the aPFC (p < 0.05, FWE-corrected). Riluzole decreased Glx and increased ACC-aPFC connectivity in TRS relative to HV. Change in Glx correlated inversely with change in ACC-aPFC connectivity in TRS (r = - 0.52; p = 0.02) but not HV (r = 0.01; p = 0.98). Riluzole did not alter rCBF (p > 0.05), indicating absence of a non-specific blood flow effect.

CONCLUSION

Results indicate glutamatergic function and cortical connectivity are linked to symptoms and cognitive measures and that it is possible to pharmacologically modulate them in TRS.

The Value of Negative Diagnosis in Thyroid Fine-Needle Aspiration: a Retrospective Study with Histologic Follow-Up

The Bethesda System for reporting thyroid cytopathology (BSRTC) predicts an incidence of malignancy of less than 5% in thyroid nodules with a benign diagnosis on fine-needle aspiration (FNA). However, recent series have suggested that the true rate of malignancy might be significantly higher in this category of patients. We reviewed our experience by performing a retrospective analysis of patients with benign thyroid FNA results who underwent thyroidectomy between 2008 and 2013 at a large academic center. Information including demographics, ultrasound features, FNA diagnosis, and surgical follow-up information were recorded. Slides were reviewed on cytology-histology discrepant cases, and it was determined whether the discrepancy was due to sampling or interpretation error. A total of 802 FNA cases with a benign diagnosis and surgical follow-up were identified. FNA diagnoses included 738 cases of benign goiter and 64 cases of lymphocytic thyroiditis. On subsequent surgical resection, 144 cases were found to be neoplastic, including 117 malignant cases. False negative, defined as interpretation error and inadequate biopsy of the nodule harboring malignancy, was 6%. When cases of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) were excluded from the analysis, false-negative rate was 5%. When microPTC cases were excluded, false-negative rate was 3% and was slightly less than 3% when both microPTC and NIFTP cases were excluded from the analysis. Retrospective review of neoplastic cases showed that 57% were due to sampling error and 43% were due to interpretation error. Interpretation error was more likely to occur in follicular patterned neoplasms (75%), while sampling error was more common in non-follicular variants of papillary thyroid carcinoma (non-FVPTC) (61%). With the exclusion of microPTC, interpretation errors were still more likely to occur in follicular neoplasms (79%) but there was no significant difference in sampling error between non-FVPTC (37%) and follicular patterned neoplasms (42%). Tumor size was larger in cases with interpretation error (mean = 2.3 cm) compared to cases with sampling error (mean = 1.4 cm). This study shows that the false-negative rate of thyroid FNA at our institution is not significantly above the rate suggested by the BSRTC. Interpretation errors were more likely to occur in follicular patterned neoplasms, while non-FVPTC was more frequently found in false negative cases due to inadequate sampling.

Assessing the subjective experience of participating in a clinical trial (AVATAR)

This study assessed the subjective experience of participating in a clinical trial, specifically positive and negative experiences and the experience of audio recording assessment sessions. The study was cross-sectional from a single blinded randomised controlled trial. Forty participants with a primary diagnosis of non-organic psychosis completed baseline and 12-week follow-up questionnaires assessing their experiences. Participants rated research interviews as moderately helpful in facilitating their therapy and talking to the interviewer as moderately helpful at baseline and 12-week follow-up. Self-report ratings of the degree of self-realisation promoted by the research questionnaires were significantly higher at 12-week follow-up compared to baseline. Participants adjusted quickly to being audio recorded and rated interviews as not at all disruptive and not at all to slightly intrusive. On average there were neutral emotional reactions, positive gains and minimal inconveniences as a result of participation. The main reasons for taking part were: 'To help myself', 'I was curious' and 'To help others'. The findings offer support to previous research reporting that individuals with mental health problems find participating in clinical trials a beneficial experience. This may alleviate concerns that participation in similar studies may be personally intrusive or harmful.

Treatment outcome in patients with clinically defined carpal tunnel syndrome but normal electrodiagnostic test results: a randomized controlled trial

Little is known about treatment effect of carpal tunnel release in patients with clinically defined carpal tunnel syndrome (CTS), but normal electrodiagnostic test results (EDX). The aim of this study was to determine whether this category of patients will benefit from surgical treatment. 57 patients with clinically defined CTS and normal EDX were randomized for surgical treatment (n = 39) or non-surgical treatment (n = 18). A six-point scale for perceived improvement as well as the Boston Carpal Tunnel Questionnaire was completed at baseline and at follow-up after 6 months. A significant improvement of complaints was reported by 70.0% of the surgically treated patients and 39.4% reported full recovery 6 months after surgery. Furthermore, both Functional Status Score and Symptom Severity Score improved significantly more in the surgically treated group (p = 0.036 and p < 0.001, respectively). This study demonstrates that most patients with clinically defined CTS and normal EDX results will benefit from carpal tunnel release. Therefore, this group of CTS patients must not a priori be refrained from surgery.

Self-construal differences in neural responses to negative social cues

Cultures differ substantially in representations of the self. Whereas individualistic cultural groups emphasize an independent self, reflected in processing biases towards centralized salient objects, collectivistic cultures are oriented towards an interdependent self, attending to contextual associations between visual cues. It is unknown how these perceptual biases may affect brain activity in response to negative social cues. Moreover, while some studies have shown that individual differences in self-construal moderate cultural group comparisons, few have examined self-construal differences separate to culture. To investigate these issues, a final sample of a group of healthy participants high in trait levels of collectivistic self-construal (n=16) and individualistic self-construal (n=19), regardless of cultural background, completed a negative social cue evaluation task designed to engage face/object vs context-specific neural processes whilst undergoing fMRI scanning. Between-group analyses revealed that the collectivistic group exclusively engaged the parahippocampal gyrus (parahippocampal place area) - a region critical to contextual integration - during negative face processing - suggesting compensatory activations when contextual information was missing. The collectivist group also displayed enhanced negative context dependent brain activity involving the left superior occipital gyrus/cuneus and right anterior insula. By contrast, the individualistic group did not engage object or localized face processing regions as predicted, but rather demonstrated heightened appraisal and self-referential activations in medial prefrontal and temporoparietal regions to negative contexts - again suggesting compensatory processes when focal cues were absent. While individualists also appeared more sensitive to negative faces in the scenes, activating the right middle cingulate gyrus, dorsal prefrontal and parietal activations, this activity was observed relative to the scrambled baseline, and given that prefrontal and occipital regions were also engaged to neutral stimuli, may suggest an individualistic pattern to processing all social cues more generally. These findings suggest that individual differences in self-construal may be an important organizing framework facilitating perceptual processes to emotionally salient social cues, beyond the boundary of cultural group comparisons.

Triple negative invasive lobular carcinoma of the breast presents as small bowel obstruction

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Metastatic breast carcinoma rarely spreads to the Gastrointestinal Tract (GIT).

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GIT breast carcinoma rarely has triple: ER, PR and HER2-neu negative histology.

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We report a case of triple negative breast carcinoma that spread to the jejunum.

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This is the first reported case in the U.S.

Metastasis from breast carcinoma to the gastrointestinal tract (GIT) is very uncommon. To date, only a few cases have been described worldwide. Of those which do metastasize to the GIT, only estrogen receptor (ER), progesterone receptor (PR) and HER2-neu receptor positive cancers have been reported and none have been mentioned in the U.S. We report a case of a 70-year-old white female with history of triple negative lobular carcinoma eight years earlier who presented with solitary jejunal mass causing obstruction.

Capillary electrophoresis coupled to negative mode electrospray ionization-mass spectrometry using an electrokinetically-pumped nanospray interface with primary amines grafted to the interior of a glass emitter

We demonstrate an electrokinetically pumped sheath flow nanospray interface for capillary electrophoresis coupled to negative mode electrospray mass spectrometry. In this interface, application of an electric field generates electro-osmotic flow at the interior of a glass emitter that is pulled to a 10-20µm inner diameter orifice. Electro-osmotic flow pumps liquid around the distal tip of the separation capillary, ensheathing analyte into the electrospray electrolyte. In negative ion mode, negative potential applied to an untreated glass emitter drives sheath flow away from the emitter orifice, decreasing the stability and efficiency of the spray. In this manuscript, we treat a portion of the interior of the electrospray emitter with 3-aminopropyltrimethoxysilane, which grafts primary amines to the interior. The amines take on a positive charge, which reverses electro-osmosis and generates stable sheath flow to the emitter orifice under negative potential. Negative mode operation is demonstrated by analyzing a metabolite extract from stage 1 Xenopus laevis embryos. Production of the treated emitters was quite reproducible. We evaluated the performance of three emitters using a set of amino acids; the relative standard deviation in peak intensity was 7% for the most intense component.

How People with Facial Acne Scars are Perceived in Society: an Online Survey

INTRODUCTION

Atrophic scarring occurs throughout the course of inflammatory acne and across the spectrum of severity. This study evaluates perceptions of the general population toward individuals with clear skin and acne scars.

METHODS

An online survey administered in the USA, UK, Japan, Germany, France and Brazil to respondents 18 years and over presented three facial pictures of clear skin or digitally superimposed acne scars (but no active acne lesions) in a random fashion. At least one clear and one scar picture were presented to each participant.

RESULTS

Among the 4618 responders, 33% themselves had facial acne scars. The skin was the first thing noticed about the face by 41% when viewing pictures with scars vs 8% viewing clear skin (p < 0.05). Those with scars were less likely to be considered attractive (17% vs 25%), confident (25% vs 33%), happy (23% vs 30%), healthy (21% vs 31%) and successful (17% vs 24%), and more likely to be perceived as insecure (15% vs 8%) and shy (23% vs 14%) compared with those with clear skin (all p < 0.05). The significance of the responses obtained varied according to the acne and scar status of the respondent. Skin care was cited as the habit most in need of improvement by 59% vs 13% of respondents viewing pictures with scars vs clear skin, respectively (p < 0.05). All respondent subgroups cited skin care irrespective of their own acne and scar status (all p < 0.05 vs pictures with clear skin). Those with scars were thought less likely to have a promising future (78% vs 84%) than those with clear skin (p < 0.05). The majority of respondents reported willingness to pay money to eradicate scars.

CONCLUSION

The results of this multi-national survey demonstrate that facial acne scars are perceived negatively by society, confirming the importance of preventing acne scars with early treatment of inflammatory acne.

FUNDING

Galderma International S.A.S France.

How People with Facial Acne Scars are Perceived in Society: an Online Survey

Introduction

Atrophic scarring occurs throughout the course of inflammatory acne and across the spectrum of severity. This study evaluates perceptions of the general population toward individuals with clear skin and acne scars.

Methods

An online survey administered in the USA, UK, Japan, Germany, France and Brazil to respondents 18 years and over presented three facial pictures of clear skin or digitally superimposed acne scars (but no active acne lesions) in a random fashion. At least one clear and one scar picture were presented to each participant.

Results

Among the 4618 responders, 33% themselves had facial acne scars. The skin was the first thing noticed about the face by 41% when viewing pictures with scars vs 8% viewing clear skin (p < 0.05). Those with scars were less likely to be considered attractive (17% vs 25%), confident (25% vs 33%), happy (23% vs 30%), healthy (21% vs 31%) and successful (17% vs 24%), and more likely to be perceived as insecure (15% vs 8%) and shy (23% vs 14%) compared with those with clear skin (all p < 0.05). The significance of the responses obtained varied according to the acne and scar status of the respondent. Skin care was cited as the habit most in need of improvement by 59% vs 13% of respondents viewing pictures with scars vs clear skin, respectively (p < 0.05). All respondent subgroups cited skin care irrespective of their own acne and scar status (all p < 0.05 vs pictures with clear skin). Those with scars were thought less likely to have a promising future (78% vs 84%) than those with clear skin (p < 0.05). The majority of respondents reported willingness to pay money to eradicate scars.

Conclusion

The results of this multi-national survey demonstrate that facial acne scars are perceived negatively by society, confirming the importance of preventing acne scars with early treatment of inflammatory acne.

Funding

Galderma International S.A.S France.

Electronic supplementary material

The online version of this article (doi:10.1007/s13555-016-0113-x) contains supplementary material, which is available to authorized users.

Early attentional bias for negative words when competition is induced

Previous research (Zeelenberg, Wagenmakers, & Rotteveel, 2006) revealed that emotionally meaningful words were identified significantly better than neutral words, with no difference between positive and negative words. Since in that study only a single target word was displayed at a time, we hypothesized that the equivalent performances for positive and negative words were due to a lack of competition. To test this, in our Experiment 1, we replicated Zeelenberg and colleagues' finding, using emotion-laden Chinese words and the identical data-limited method, which measured the accuracy of a briefly shown target. We then introduced competition in Experiment 2 by simultaneously presenting two words during the target frame, and found evidence for an early attentional bias to negative words. In Experiment 3, we confirmed that the bias in Experiment 2 was not due to the inevitable repetition of stimuli. Taken together, these results support our hypothesis that, in the presence of competition, negative words receive attentional priority and consequently have enhanced perceptual representations.

A temporal examination of co-activated emotion valence networks in schizophrenia and schizotypy

Emotional abnormalities are prominent across the schizophrenia spectrum. To better define these abnormalities, we examined state emotional functions across opposing ends of the spectrum, notably in chronic outpatients with schizophrenia (Study 1) and college students with psychometrically defined schizotypy (Study 2). In line with existing studies, we predicted that individuals with schizophrenia would show unusually co-activated positive and negative emotions while college students with schizotypy would show abnormally low positive and abnormally high negative emotions. Drawing from the affective science literature, we employed continuous emotion ratings in response to a dynamic and evocatively "bittersweet" stimulus. Participants included 27 individuals with schizophrenia, 39 individuals with psychometrically defined schizotypy and 26 community and 35 college control participants. Participants continuously rated their state happiness and sadness throughout a six-minute clip from a tragicomic film (i.e., Life is Beautiful). In contrast to expectations as well as the extant literature, there were no state emotional abnormalities noted from either schizophrenia-spectrum group. Of particular note, neither individuals with schizophrenia nor individuals with schizotypy were abnormal in their experience of state negative, positive or coactivated emotions. Conversely, abnormalities in trait emotion were observed in both groups relative to their respective control groups. These results help confirm that the schizophrenia-spectrum is not characterized by deficits in state emotional experience and suggest that sadness is not abnormally co-activated with pleasant emotions. These results are critical for clarifying the "chronometry" of emotional dysfunctions across the schizophrenia-spectrum.

Metapsychological and clinical issues in psychosomatics research

The author starts by treating the general epistemological problems inherent to research and emphasizes that all investigation takes place between two poles: a creative pole and one that is defensive in relation to the unknown and formlessness. In the psychosomatic field, an additional difficulty resides in the western dualistic vision of the relationship between psyche and soma which influences our way of thinking about the body as well as about otherness. The author continues by exploring Pierre Marty's psychosomatic model. Its psychosomatic monism is revolutionary but incomplete and creates a distance with the other, the somatizing patient, resulting in a medically oriented nosology symptomatic of the impossibility to think about some of the most important aspects of counter-transference. With the help of clinical material, the author considers these unthought aspects and some of their theoretical implications, particularly the way of understanding the negative often so prevalent with these patients. Based on these reflections as well as Freud's on beyond the pleasure principle and Winnicott's theorization on the fear of breakdown, the author suggests some directions for research. Somatic illness might occur when the attempts at filling the cracks created by a breakdown are unsuccessful.

A systematic review of patients with Merkel cell carcinoma of the head and neck and a negative sentinel lymph node biopsy

Background

A negative sentinel lymph node biopsy (SLNB) from patients with head and neck Merkel cell carcinoma (HNMCC) may allow the patient to avoid further adjunctive therapies. However, there is considerable regional variability of lymphatic drainage from primary sites involving the head and neck, and Merkel cell carcinoma (MCC) has aggressive biologic behavior.

Objective

The primary aim of this systematic review was to document the incidence of regional recurrence and mortality from HNMCC patients after a negative SLNB.

Methods

A systematic search of the English literature was conducted via Ovid Medline and Embase from inception until 2013 and the Cochrane Central Register of Controlled Trials from 1991 to January 2014.

Results

Twenty-three studies, with a total of 81 patients matched the inclusion criteria. The incidence of regional recurrence from the entire cohort was 12.3%, and there was a 5% mortality rate. The mean follow-up time, excluding the 30 patients who did not have individual follow-up times specified, was 32.8 months.

Limitations

This review included studies had variable follow-up durations and treatments for MCC.

Conclusions

Despite negative pathologic staging of the neck using SLNB in HNMCC patients, there is still a high incidence of regional recurrence and mortality, over a short follow-up period.

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Merkel cell carcinoma is an aggressive neoplasm.

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Patients with a negative sentinel lymph node biopsy from head and neck Merkel cell carcinoma showed a high incidence of future regional lymph node involvement.

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In this context, a negative sentinel lymph node biopsy is not necessarily reassuring for the patient or the clinician.

Antinuclear antibody-negative systemic sclerosis

OBJECTIVE

To examine the demographic and clinical characteristics of systemic sclerosis (SSc) patients without antinuclear antibodies (ANA) compared to ANA-positive patients.

METHODS

SSc patients enrolled in the Scleroderma Family Registry and DNA Repository were included. Relevant demographic and clinical data were entered by participating sites or obtained by chart review. ANA and SSc-related antibodies were determined in all investigated patients using commercially available kits at our laboratories.

RESULTS

This study included 3249 patients, of whom 208 (6.4%) were ANA negative. The proportion of male patients was higher in the ANA-negative group (OR = 1.65; p = 0.008). ANA-negative patients experienced less vasculopathic manifestations of SSc. The percent predicted diffusing capacity of carbon monoxide (DLCO) was higher in ANA-negative patients (p = 0.03). Pulmonary arterial hypertension (PAH) per right heart catheterization was less common in the ANA-negative group (OR = 0.28; p = 0.03). Furthermore, patients with negative ANA had a lower prevalence of telangiectasias and digital ulcers/pits (OR = 0.59, p = 0.03 and OR = 0.38, p = 0.01, respectively). Although diffuse cutaneous involvement was more common, the modified Rodnan Skin Score (mRSS) was lower in the ANA-negative group (2.4 points lower, p = 0.05). Furthermore, they experienced more malabsorption (p = 0.05). There was no difference in the frequency of pulmonary fibrosis or scleroderma renal crisis. All-cause mortality was not different between the 2 groups (p = 0.28).

CONCLUSIONS

In conclusion, the results of this study suggest that SSc patients who are ANA negative constitute a distinct subset of SSc with less vasculopathy (less PAH, digital ulcers, and fewer telangiectasias), a greater proportion of males, and possibly, more frequent lower gastrointestinal involvement.

What do we really know about blunted vocal affect and alogia? A meta-analysis of objective assessments

Deficits in nonverbal vocal expression (e.g., blunted vocal affect, alogia) are a hallmark of schizophrenia and are a focus of the Research Domain Criteria initiative from the National Institute of Mental Health. Results from studies using symptom rating scales suggest that these deficits are profound; on the order of four to six standard deviations. To complement this endeavor, we conducted a meta-analysis of studies employing objective analysis of natural speech in patients with schizophrenia and nonpsychiatric controls. Thirteen studies, collectively including 480 patients with schizophrenia and 326 nonpsychiatric controls, were identified. There was considerable variability across studies in which aspects of vocal communication were examined and in the magnitudes of deficit. Overall, speech production (reflecting alogia) was impaired at a large effects size level (d=-.80; k=13), whereas speech variability (reflecting blunted affect) was much more modest (d=-.36; k=2). Regarding the former, this was largely driven by measures of pause behavior, as opposed to other aspects of speech (e.g., number of words/utterances). On the other hand, ratings of negative symptoms across these studies suggested profound group differences (d=3.54; k=4). These data suggest that only certain aspects of vocal expression are affected in schizophrenia, and highlight major discrepancies between symptom rating and objective-based measures. The discussion centers on advancing objective analysis for understanding vocal expression in schizophrenia and for identifying and defining more homogenous patient subsets for study.

Demographic features and premorbid personality disorder traits in relation to age of onset and sex in paranoid schizophrenia

Personality disorders in the premorbid period of schizophrenia and particularly in relation to age of onset and sex, seem to be a rather under-researched area. In the present study, 88 patients with paranoid schizophrenia were examined, regarding demographic characteristics and premorbid personality disorder traits, in order to investigate for differences in the premorbid period of the disease, in relation to age of onset and sex. Age cutoff points were set at <30 years and ≥35 years of age for young and late onset groups, respectively. The Structured Clinical Interview for DSM-IV-Patient Edition for Axis I disorders (SCID-P) was used prospectively for diagnoses. Premorbid personality disorder traits were retrospectively assessed by using the Structured Clinical Interview for DSM-IV-Patient Edition for Axis II disorders (SCID-II). Comparisons were performed by applying the two-tailed Wilcoxon rank-sum and the χ(2) statistical tests. Young onset patients were characterized by significantly higher proportion of urban birth, single status, more avoidant premorbid personality disorder traits, and less passive-aggressive premorbid personality disorder traits, than late onset counterparts. Differences were more prominently shown in men. Earlier age of onset seems to be associated to increased social inhibition and worse psychosocial adaptation in the premorbid period of paranoid schizophrenia.

Computerized facial analysis for understanding constricted/blunted affect: initial feasibility, reliability, and validity data

Diminished expression is a diagnostic feature of a range of schizophrenia-spectrum disorders/conditions and is often unresponsive to treatment, is present across premorbid, first episode and various clinical states, and is considered a poor prognostic indicator. Surprisingly, little is known about diminished expression. The present study sought to address this issue by evaluating a commercially-available computerized facial analysis software for understanding diminished expressivity. We analyzed natural facial expression from a series of laboratory interaction tasks in 28 individuals with psychometric schizotypy - defined as the personality organization reflecting a putative genetic schizophrenia liability, and 26 matched controls. We evaluated (a) feasibility - defined in terms of the number of video frames recognized by the software, (b) reliability - defined in terms of correlations between facial expression variables across the three laboratory interactions, and (c) construct validity - defined in terms of relationships to clinical variables. For most subjects (~80%), approximately three-quarters of the video frames were analyzable by the software; however, a minority of the videos were essentially unreadable. The facial expression variables showed excellent reliability across interaction conditions. In terms of construct validity, facial expression variables were significantly related to a measure of psychoticism, tapping subjective cognitive concerns and "first-rank" schizophrenia symptoms, but were generally not different between groups. Facial expression variables were generally not significantly related to measures of depression, anxiety, paranoia or, surprisingly, self-reported negative schizotypy. While computerized facial analysis appears to be a reliable and promising method of understanding diminished expressivity across the schizophrenia-spectrum, some work remains. Implications are discussed.

GATA Negative Pressure Wound Therapy System

The use of negative pressure wound therapy (NPWT) systems has been shown to promote wound healing. NPWT systems promise a fast and efficient way of preparing wounds for closure by either secondary intention or delayed primary closure, as well as for skin grafting and flap covering. While many of its benefits are established, commercial NPWT systems are not readily available and may be extremely costly for the patient. In the current report, we describe an equivalent alternative of NPWT at a substantially lower cost.

Sertindole: a clinical efficacy profile

Sertindole is an effective atypical antipsychotic drug that is associated with significant improvements in the symptoms of schizophrenia. It is at least as efficacious as haloperidol and risperidone in treating the overall and positive symptoms of schizophrenia and has been shown to have advantages over these two drugs with respect to the treatment of the negative symptoms of schizophrenia. In clinical trials, notable improvements in patients' quality of life were observed, which suggest that patients prescribed sertindole would be more likely to adhere to treatment and continue taking the drug as part of their long-term treatment regimen. Continued treatment gives patients the best chance of avoiding relapse. Indeed, other benefits of sertindole demonstrated in clinical trials include relatively low relapse and re-admission rates. Sertindole could theoretically reduce the financial burden of schizophrenia on health- and social-care systems by reducing the need for re-hospitalization and by enabling patients to manage their illness and to live as normal a life as possible.