Niveau d’anxiété et refus scolaire dans les troubles anxieux chez l’adolescent

ObjectivesThe primary objective was to compare the level of anxiety on the Multidimensional Anxiety Scale for Children in two groups of anxious secondary school children, one group out of school meeting the criteria of School Refusal and the other in school. The secondary objective was to compare these groups on other clinical, sociodemographic and therapeutic parameters.Patient and methodRetrospective observational study of 34 school-going anxious teenagers recruited at the University Hospital of Montpellier, compared with 55 out of school anxious teenagers meeting the criteria of Anxious School Refusal recruited in a multicentre study.ResultsThere was no significant intergroup difference in median scores on the Multidimensional Anxiety Scale for Children (P = 0.49), but a significant intergroup difference in median scores was found on the Behavioural Anxiety and Phobia Scale with higher total scores in the School Refusal group (151.5 [130.5; 169.0] vs. 125.0 [94.0; 139.0], P < 0.01). The School Refusal group was more likely to have a panel of anxiety disorders including agoraphobia, separation anxiety, depressive disorders, more impaired global functioning and more likely to receive psychotropic medication (P < 0.01). There were no significant intergroup differences in sociodemographic characteristics except age.DiscussionThe absence of significant intergroup differences in the level of anxiety measured with the Multidimensional Anxiety Scale for Children could be related to a lower level of anxiety in the school refusal group due to school refusal. The higher anxiety score with the Behavioural Anxiety and Phobia Scale in the refusal group could be related to their better sensitivity. The clinical picture in the refusal group, both more severe and with co-morbidities, is comparable to what is described in the literature.ConclusionA higher level of anxiety was not associated with school refusal according to main endpoints in teenagers with anxiety disorders. However, this group had other criteria of greater clinical severity that justify early identification.     

Emergency readmissions following geriatric ground-level falls: How does frailty factor in?

BackgroundGround-level falls (GLFs) in older adults are increasing as life expectancy increases, and more patients are being discharged to skilled nursing facilities (SNFs) for continuity of care. However, GLF patients are not a homogenous cohort, and the role of frailty remains to be assessed. Thus, the aim of this study is to examine the impact of frailty on the in-hospital and 30-day outcomes of GLF patients.Materials and MethodsThis is a cohort analysis from the Nationwide Readmissions Database 2017. Geriatric (age ≥65 years) trauma patients presenting following GLFs were identified and grouped based on their frailty status. The associations between frailty and 30-day mortality and emergency readmission were examined by multivariate regression analyses adjusting for patient demographics and injury characteristics.ResultsA total of 100,850 geriatric GLF patients were identified (frail: 41% vs. non-frail: 59%). Frail GLF patients were younger (81[74–87] vs. 83[76–89] years; p<0.001) and less severely injured–Injury Severity Score [ISS] (4[1–9] vs. 5[2–9]; p<0.001). Frail patients had a higher index mortality (2.9% vs. 1.9%; p<0.001) and higher 30-day readmissions (14.0% vs. 9.8%; p<0.001). Readmission mortality was also higher in the frail group (15.2% vs. 10.9%; p<0.001), with 75.2% of those patients readmitted from an SNF. On multivariate analysis, frailty was associated with 30-day mortality (OR 1.75; p<0.001) and 30-day readmission (OR 1.49; p<0.001).ConclusionFrail geriatric patients are at 75% higher odds of mortality and 49% higher odds of readmission following GLFs. Of those readmitted on an emergency basis, more than one in seven patients died, 75% of whom were readmitted from an SNF. This underscores the need for optimization plans that extend to the post-discharge period to reduce readmissions and subsequent high-impact consequences.     

The effect of lycopene supplement from different sources on prostate specific antigen (PSA): A systematic review and meta-analysis of randomized controlled trials

BackgroundProstate cancer is a major malignancy, affecting men, worldwide. The protective effect of dietary or supplemental lycopene on prostate cancer has been reported in several studies; however, the findings are equivocal.ObjectiveThe aim of this study was to evaluate the effects of supplemental lycopene on PSA level, by conducting a systematic review and meta-analysis of randomized controlled trials.MethodsWe searched online databases, including PubMed, Scopus, and Web of Science, up to 9 Jun 2020, to obtain relevant publications. The publication search was not limited by language or date.ResultsA total of 1036 records were identified in the systematic search; from these, 9 were included in the systematic review and 6 in meta-analysis. The pooled analysis of the 6 studies showed no significant differences in PSA levels in subjects treated with lycopene or tomato extract containing lycopene (WMD= −0.12 ng/ml; 95% CI: −0.62, 0.38 ng/ml; P = 0.64) compared to the control.ConclusionOverall, tomato extracts or lycopene treatment yielded no significant effect on PSA level compared to the control. However, more consistent clinical trials, with larger sample sizes, are required to better discern the actual effect of tomato extract or lycopene on PSA level.     

Anatomically constrained minimum variance beamforming applied to EEG

Neural activity as measured non-invasively using electroencephalography (EEG) or magnetoencephalography (MEG) originates in the cortical gray matter. In the cortex, pyramidal cells are organized in columns and activated coherently, leading to current flow perpendicular to the cortical surface. In recent years, beamforming algorithms have been developed, which use this property as an anatomical constraint for the locations and directions of potential sources in MEG data analysis. Here, we extend this work to EEG recordings, which require a more sophisticated forward model due to the blurring of the electric current at tissue boundaries where the conductivity changes. Using CT scans, we create a realistic three-layer head model consisting of tessellated surfaces that represent the cerebrospinal fluid-skull, skull-scalp, and scalp-air boundaries. The cortical gray matter surface, the anatomical constraint for the source dipoles, is extracted from MRI scans. EEG beamforming is implemented on simulated sets of EEG data for three different head models: single spherical, multi-shell spherical, and multi-shell realistic. Using the same conditions for simulated EEG and MEG data, it is shown (and quantified by receiver operating characteristic analysis) that EEG beamforming detects radially oriented sources, to which MEG lacks sensitivity. By merging several techniques, such as linearly constrained minimum variance beamforming, realistic geometry forward solutions, and cortical constraints, we demonstrate it is possible to localize and estimate the dynamics of dipolar and spatially extended (distributed) sources of neural activity.     

A Novel Way to Measure and Predict Development: A Heuristic Approach to Facilitate the Early Detection of Neurodevelopmental Disorders

Purpose of Review

Substantial research exists focusing on the various aspects and domains of early human development. However, there is a clear blind spot in early postnatal development when dealing with neurodevelopmental disorders, especially those that manifest themselves clinically only in late infancy or even in childhood.

Recent Findings

This early developmental period may represent an important timeframe to study these disorders but has historically received far less research attention. We believe that only a comprehensive interdisciplinary approach will enable us to detect and delineate specific parameters for specific neurodevelopmental disorders at a very early age to improve early detection/diagnosis, enable prospective studies and eventually facilitate randomised trials of early intervention.

Summary

In this article, we propose a dynamic framework for characterising neurofunctional biomarkers associated with specific disorders in the development of infants and children. We have named this automated detection ‘Fingerprint Model’, suggesting one possible approach to accurately and early identify neurodevelopmental disorders.

     

Validity study of the Autism Spectrum Disorders-Diagnostic for Children (ASD-DC)

The Autism Spectrum Disorders-Diagnostic for Children (ASD-DC) is a 40-item Likert format scale designed to serve in the diagnosis of children and adolescents from 2 to 16 years of age. The reliability and factor structure of the scale have been established in previous research. Studies 1 and 2 were designed to evaluate the validity of the measure by establishing cut-off scores for 161 participants falling into the categories of typical development, atypical development/psychopathology, and ASD (i.e., autism, PDD-NOS, and Asperger's syndrome), as assessed by a licensed psychologist using ICD-10 and DSM-IV-TR criteria and in conjunction with standardized measures of autism (ADI-R, CARS, or CHAT) and Asperger's syndrome (CAST, GADS, or KADI). In study 3, the accuracy of ASD scores was compared with ICD-10 and DSM-IV-TR criteria for autism, PDD-NOS, and Asperger's syndrome in 219 children. The ASD-DC, which can be administered in 10–15 min proved to be a relatively accurate and valid diagnostic instrument when compared to the diagnostic methods described above. The implications of these data for further development of this scale are discussed.     

In vitro and in vivo evaluation of PLAGA (50/50) microspheres containing 5-fluorouracil prepared by a solvent evaporation method

Poly (DL-lactide-co-glycolide) PLAGA (50/50) microspheres containing an antineoplastic drug, 5-fluorouracil (5-FU) were prepared by a solvent evaporation process in order to passively target liver carcinomas. The microspheres were spherical with diameters 2–5 μm and encapsulated more than 70% (w/w) of the 5-FU. In vitro release patterns of 5-FU from microspheres were determined for various systems. It was found that drug release depended upon the amount of entrapped drug, the polymer molecular weight and pH of the dissolution medium. The in vitro release mechanism was diffusion controlled and followed a square-root of time relationship. In vivo distribution of ^99mTc labeled microspheres after intravenous injection into mice was characterized by an initially high uptake by organs of the mononuclear phagocyte system (MPS). Following i.v. administration of fluorescein-labeled PLAGA microspheres, accumulation was into the MPS, mainly the Kupffer cells cytoplasm and near the liver sinusoids.