What should we do about monkeypox?

<正>Over the past 3 years, the COVID-19 pandemic has posed a significant global challenge to the public health system. However, other diseases, such as hepatitis of unknown origin in children and monkeypox,havebeenrecentlyreportedinEuropean,African,and American countries. These data showed that monkeypox and other emerging or re-emerging viruses are novel global threats.Monkeypoxiscausedbyinfectionwiththemonkeypoxvirus(MPXV),alinear,enveloped,double-strandedDNA(dsDNA)virusbelongingtotheOrth...     

How should we grade CIN?

How should we grade CIN? The grading of cervical intraepithelial neoplasia (CIN) is problematic. CIN represents a morphological continuum, but biopsies displaying this lesion are classified into two (e.g. Bethesda) or three grade categories, sometimes with poor reproducibility. There are also difficulties in reliably distinguishing low‐grade CIN from its reactive simulants. Because of problems with inter‐ and intra‐observer disagreement in the grading of CIN and the diagnosis of low‐grade lesions, three expert contributions were commissioned to address the question `how should we grade CIN?'.     

Incisional or core biopsies of salivary gland tumours: how far should we go?

Trends in the evaluation of salivary gland masses have changed as imaging studies have improved and sampling techniques have evolved over the past several decades. Whether clinically palpable or detected by imaging studies, salivary gland masses have been readily evaluated by fine needle aspiration. More recently, imaging guided core-needle biopsy has been employed with mixed results. The literature on these techniques is reviewed and analyzed with particular attention to tissue adequacy and diagnostic accuracy. Comparison is made using selected case presentations to highlight the advantages and disadvantages of establishing a diagnosis when core-needle biopsy is utilized. Core-needle biopsy of salivary gland tumours may be a useful first diagnostic approach as long as the limitations of the procedure are well understood and managed.     

What can we learn from the therapist's body?

I suggest a re-theorization of the relationship between psyche and soma in which the body is no longer seen as 'mere' receptacle for unwanted contents of the mind but in which a body subjectivity has a developmental history in its own right. I argue that the body has its own history arising out of the attachment nexus and the internalization of the bodies of its caregivers and the bodies they are able to recognize in their infants and children. I illustrate the way developmental body issues appear in the clinical setting and how the therapist's body can be used to locate and identify the troubled bodies of our clients. A long history of work with women with eating problems and troubled bodies shows that bodies are not born but are acquired in relationship with key caregivers.     

What do we know about the inflammasome in humans?

The inflammasome complex is part of the innate immune system, which serves to protect the host against harm from pathogens and damaged cells. It is a term first proposed by Tschopp's group in 2002, with numerous original research articles and reviews published on the topic since. There have been many types of inflammasome identified, but all result in the common pathway of activation of caspases and interleukin 1β along with possible cell death called pyroptosis. Despite a growing body of research investigating the structure and function of the inflammasome in animal models, there is still limited evidence identifying inflammasome components in human physiology and disease. In this review, we explore the molecular structure and mechanism of activation of the inflammasome with a particular focus on inflammasome complexes expressed in humans. Inflammasome components have been identified in several human peripheral and brain tissues using both in vivo and ex vivo work, and the inflammasome complex has been shown to be associated with several genetic and acquired inflammatory and neoplastic disorders. We discuss the strengths and weaknesses of the information available on the inflammasome with an emphasis on the importance of prioritizing work on human tissue. There is a huge demand for more effective treatments for a number of inflammatory and neurodegenerative diseases. Modulation of the inflammasome has been proposed as a novel treatment for several of these diseases and there are currently clinical trials ongoing to test this theory.     

How can we Understand the Demise of Kids Company?

The sudden closure of the charity Kids Company was headline news in the UK on 6 August 2015. In this piece the author shares her feeling of shock, her questions and her concerns arising from the BBC interviews with the charity's founder Camila Batmanghelidjh who had been at the helm for 19 years. While alluding to the vision of charismatic leaders and their extraordinary ability to bring about social transformations, the author refers to Weber and others highlighting that charismatic leadership must be transitional if the enterprise is to survive. However, charisma can lead to idealization which puts the enterprise at risk.     

How can we improve the interpretation of systematic reviews?

A study conducted by Lai and colleagues, published this week in BMC Medicine, suggests that more guidance might be required for interpreting systematic review (SR) results. In the study by Lai and colleagues, positive (or favorable) results were influential in changing participants' prior beliefs about the interventions presented in the systematic review. Other studies have examined the relationship between favorable systematic review results and the publication of systematic reviews. An international registry may decrease the number of unpublished systematic reviews and will hopefully decrease redundancy, increase transparency, and increase collaboration within the SR community. In addition, using guidance from the Preferred Items for Systematic Reviews and Meta-analyses (PRISMA: ) Statement and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE: ) approach can also be used to improve the interpretation of systematic reviews. In this commentary, we highlight important methodological issues related to the conduct and reporting of systematic reviews and also present our own guidance on interpreting systematic reviews.     

What should we expect from psychotherapy?

In addressing the very general question of what we should expect from psychotherapy, this article begins by discussing what constitutes relevant evidence on which to base the efficacy and effectiveness of psychotherapy. In this context, an important distinction is made between empirically supported treatments and evidence-based practice. Although there is evidence that psychotherapy does indeed work, there are also findings that there are times when our patients are harmed by our interventions. It is noted that the therapeutic alliance plays an extremely important role in the change process, and that ruptures in the alliance can contribute to our therapeutic failures. In pointing to directions for the future, modifications of how we investigate the outcome of treatment, as well as how to close the gap between research and practice, are offered.     

How far will we need to go to reach HIV-infected people in rural South Africa?

Background

The South African Government has outlined detailed plans for antiretroviral (ART) rollout in KwaZulu-Natal Province, but has not created a plan to address treatment accessibility in rural areas in KwaZulu-Natal. Here, we calculate the distance that People Living With HIV/AIDS (PLWHA) in rural areas in KwaZulu-Natal would have to travel to receive ART. Specifically, we address the health policy question 'How far will we need to go to reach PLWHA in rural KwaZulu-Natal?'.

Methods

We developed a model to quantify treatment accessibility in rural areas; the model incorporates heterogeneity in spatial location of HCFs and patient population. We defined treatment accessibility in terms of the number of PLWHA that have access to an HCF. We modeled the treatment-accessibility region (i.e. catchment area) around an HCF by using a two-dimensional function, and assumed that treatment accessibility decreases as distance from an HCF increases. Specifically, we used a distance-discounting measure of ART accessibility based upon a modified form of a two-dimensional gravity-type model. We calculated the effect on treatment accessibility of: (1) distance from an HCF, and (2) the number of HCFs.

Results

In rural areas in KwaZulu-Natal even substantially increasing the size of a small catchment area (e.g. from 1 km to 20 km) around an HCF would have a negligible impact (~2%) on increasing treatment accessibility. The percentage of PLWHA who can receive ART in rural areas in this province could be as low as ~16%. Even if individuals were willing (and able) to travel 50 km to receive ART, only ~50% of those in need would be able to access treatment. Surprisingly, we show that increasing the number of available HCFs for ART distribution ~ threefold does not lead to a threefold increase in treatment accessibility in rural KwaZulu-Natal.

Conclusion

Our results show that many PLWHA in rural KwaZulu-Natal are unlikely to have access to ART, and that the impact of an additional 37 HCFs on treatment accessibility in rural areas would be less substantial than might be expected. There is a great length to go before we will be able to reach many PLWHA in rural areas in South Africa, and specifically in KwaZulu-Natal.     

How should we report on perinatal outcome?

Authors should report on neonatal outcome after ART in a well-defined and uniform way, to enable readers to compare the outcome of different studies. For reporting on birthweight, SD scores (z-scores) are to be preferred, customized for the most important physiological variables affecting birthweight, e.g. gestational age, gender of the child and whether it is a singleton or part of a multiple. It may be suggested that ESHRE should support the construction of European customized birthweight tables and make available a software for calculating the z-scores in cohorts.     

What can we learn from physical capacity about biological age? A systematic review

ObjectiveTo systematically investigate the relationship between objective measures of physical capacity (e.g., cardio-respiratory fitness or daily step count) and biological age, measured in different ways.Data sourcePubMed; SCOPUS - Elsevier API; and Web of Science - ISI 1984-present, as well as contextual search engines used to identify additional relevant publications.Study selectionCross-sectional and longitudinal studies that assessed the association between objectively measured physical capacity and biological aging in adult individuals (age>18).ResultsAnalysis of 28 studies demonstrated that physical capacity is positively associated with biological aging; the most dominant measures of physical capacity are muscular strength or gait speed. The majority of the studies estimated biological aging by a single methodology – either Leukocyte Telomere Length or DNA methylation levels.ConclusionsThis systematic review of the objective physical capacity measures used to estimate aging finds that the current literature is limited insofar as it overlooks the potential contribution of many feasible markers. We recommend measuring physical capacity in the context of aging using a wide range of modifiable behavioral markers, beyond simple muscle strength or simple gait speed. Forming a feasible and diversified method for estimating physical capacity through which it will also be possible to estimate biological aging in wide population studies is essential for the development of interventions that may alleviate the burden of age-related disease.     

Understanding the preterm human heart: What do we know so far?

Globally, preterm birth affects more than one in every 10 live births. Although the short-term cardiopulmonary complications of prematurity are well known, long-term health effects are only now becoming apparent. Indeed, preterm birth has been associated with elevated cardiovascular morbidity and mortality in adulthood. Experimental animal models and observational human studies point toward changes in heart morphology and function from birth to adulthood in people born preterm that may contribute to known long-term risks. Moreover, recent data support the notion of a heterogeneous cardiac phenotype of prematurity, which is likely driven by various maternal, early, and late life factors. This review aims to describe the early fetal-to-neonatal transition in preterm birth, the different structural and functional changes of the preterm human heart across developmental stages, as well as potential factors contributing to the cardiac phenotype of prematurity.