Parent‐child relationships of boys in different offending trajectories: a developmental perspective

Background: This study tested the theoretical assumption that transformations of parent‐child relationships in late childhood and adolescence would differ for boys following different offending trajectories. Methods: Using longitudinal multiinformant data of 503 boys (ages 7–19), we conducted Growth Mixture Modeling to extract offending trajectories. Developmental changes in child reports of parent‐child joint activities and relationship quality were examined using Latent Growth Curves. Results: Five offending trajectories were found: non‐offenders, moderate childhood offenders, adolescent‐limited offenders, serious childhood offenders, and serious persistent offenders. Non‐offenders reported high and stable levels of relationship quality between age 10 and 16. Adolescent‐limited offenders reported a similarly high relationship quality as non‐offenders at ages 7 and 10, but a lower and decreasing relationship quality in adolescence. Compared with non‐offenders, serious persistent offenders reported poorer parent‐child relationship quality at all ages, and a decreasing relationship quality in adolescence. Serious persistent offenders and adolescent‐limited offenders reported similar levels and changes in parent‐child relationship quality in adolescence. Although serious persistent offenders reported fewer joint activities at age 10 and 13 than non‐offenders, a similar linear decrease in joint activities in early to middle adolescence was found for boys in each trajectory. Conclusion: Developmental changes in parent‐child relationship quality differ for different types of offenders. This finding has scientific and practical implications.     

Atherosclerotic plaque volume and composition in symptomatic carotid arteries assessed with multidetector CT angiography; relationship with severity of stenosis and cardiovascular risk factors

The purpose of this study was to examine the volume and the composition of atherosclerotic plaque in symptomatic carotid arteries and to investigate the relationship between these plaque features and the severity of stenosis and the presence of cardiovascular risk factors. One hundred patients with cerebrovascular symptoms underwent CT angiography. We measured plaque volume (PV) and the relative contribution of plaque components (calcifications, fibrous tissue, and lipid) in the symptomatic artery. The contribution of different components was measured as the number of voxels within defined ranges of HU values (calcification >130 HU, fibrous tissue 60–130 HU, lipid core <60 HU). Fifty-seven patients had atherosclerotic plaque in the symptomatic carotid artery. The severity of stenosis and PV were moderately correlated. Age and smoking were independently related to PV. Patients with hypercholesterolemia had significantly less lipid and more calcium in their plaques than patients without hypercholesterolemia. Other cardiovascular risk factors were not significantly related to PV or plaque composition. Luminal stenosis of the carotid artery partly reflects the amount of atherosclerotic carotid disease. Plaque volume and plaque composition are associated with cardiovascular risk factors.     

Three-day treatment with imipenem for unexplained fever during prolonged neutropaenia in haematology patients receiving fluoroquinolone and fluconazole prophylaxis: A prospective observational safety study

BackgroundGuidelines advocate >7 d of broad-spectrum antibiotics for unexplained fever (UF) during neutropaenia. However, effective antimicrobial prophylaxis reduces the incidence of gram-negative infections, which may allow shorter treatment. This study evaluates the safety of discontinuing empirical broad-spectrum antibiotics if no microbial source is documented after an initial work-up of 72 h.MethodsProspective observational study at a tertiary-care haematology-unit in patients suffering from haematologic malignancies and treatment-induced prolonged neutropaenia of ?10 d. Oral fluoroquinolone and fluconazole prophylaxis was given from day 1. Fever was empirically treated with imipenem which was discontinued after 72 h if, following a standardised protocol, no infectious aetiology was documented. Duration of fever, antimicrobial therapy and overall mortality were registered.ResultsOne hundred and sixty six patients were evaluated during 276 neutropaenic episodes. One hundred and thirty six patients (82.5%) experienced ?1 febrile episode. A total of 317 febrile episodes were observed, of which 177 (56%) were diagnosed as UF. In 135 febrile episodes (43%), a probable/definite infectious origin was documented. Mean duration of fever in neutropaenic periods with 1 febrile episode was 5 d, and mean time of treatment with imipenem was 4.7 d. In patients without documented infection, mean time of imipenem treatment was only 3.7 d. Overall mortality 30 d after neutrophil recovery was 3.6% (6/166); no patient died from untreated bacterial infection.ConclusionDiscontinuation of broad-spectrum antibiotics during neutropaenia in haematology patients on fluoroquinolone and fluconazole prophylaxis is safe, provided that no infectious aetiology is established after 72 h.     

Receptor-Binding Domain (RBD) Antibodies Contribute More to SARS-CoV-2 Neutralization When Target Cells Express High Levels of ACE2

Neutralization assays are experimental surrogates for the effectiveness of infection- or vaccine-elicited polyclonal antibodies and therapeutic monoclonal antibodies targeting SARS-CoV-2. However, the measured neutralization can depend on the details of the experimental assay. Here, we systematically assess how ACE2 expression in target cells affects neutralization by antibodies to different spike epitopes in lentivirus pseudovirus neutralization assays. For high ACE2-expressing target cells, receptor-binding domain (RBD) antibodies account for nearly all neutralizing activity in polyclonal human sera. However, for lower ACE2-expressing target cells, antibodies targeting regions outside the RBD make a larger (although still modest) contribution to serum neutralization. These serum-level results are mirrored for monoclonal antibodies: N-terminal domain (NTD) antibodies and RBD antibodies that do not compete for ACE2 binding incompletely neutralize on high ACE2-expressing target cells, but completely neutralize on cells with lower ACE2 expression. Our results show that the ACE2 expression level in the target cells is an important experimental variable, and that high ACE2 expression emphasizes the role of a subset of RBD-directed antibodies.     

Study protocol: Effectiveness of dual-mobility cups compared with uni-polar cups for preventing dislocation after primary total hip arthroplasty in elderly patients — design of a randomized controlled trial nested in the Dutch Arthroplasty Registry

Background and purpose — Dislocation is the leading reason for early revision surgery after total hip arthroplasty (THA). The dual-mobility (DM) cup was developed to provide more stability and mechanically reduce the risk of dislocation. Despite the increased use of DM cups, high-quality evidence of their (cost-)effectiveness is lacking. The primary objective of this randomized controlled trial (RCT) is to investigate whether there is a difference in the number of hip dislocations following primary THA, using the posterolateral approach, with a DM cup compared with a unipolar (UP) cup in elderly patients 1 year after surgery. Secondary outcomes include the number of revision surgeries, patient-reported outcome measures (PROMs), and cost-effectiveness.Methods and analysis — This is a prospective multicenter nationwide, single-blinded RCT nested in the Dutch Arthroplasty Registry. Patients ≥ 70 years old, undergoing elective primary THA using the posterolateral approach, will be eligible. After written informed consent, 1,100 participants will be randomly allocated to the intervention or control group. The intervention group receives a THA with a DM cup and the control group a THA with a UP cup. PROMs are collected preoperatively, and 3 months, 1 and 2 years postoperatively. Primary outcome is the difference in number of dislocations between the UP and DM cup within 1 year, reported in the registry (revisions), or by the patients (closed or open reduction). Data will be analyzed using multilevel models as appropriate for each outcome (linear/logistic/survival). An economic evaluation will be performed from the healthcare and societal perspective, for dislocation and quality adjusted life years (QALYs).Trial registration — This RCT is registered at www.clinicaltrials.gov with identification number {"type":"clinical-trial","attrs":{"text":"NCT04031820","term_id":"NCT04031820"}}NCT04031820.

Dislocation after total hip arthroplasty (THA) is the leading reason for early revision surgery (Bozic et al. 2009, Gwam et al. 2017). Most dislocations occur during the first year after surgery, of which approximately half within the first 3 months (Woo and Morrey 1982, Phillips et al. 2003, Meek et al. 2006, Hailer et al. 2012). Especially in patients with recurrent dislocation and the need for revision surgery, this leads to reduced physical functioning and quality of life (Enocson et al. 2009). Dislocations also increase healthcare costs (Sanchez-Sotelo et al. 2006, Abdel et al. 2015). A single dislocation adds 19% to the hospital costs of an uncomplicated THA, and of a revision surgery up to 148% (Sanchez-Sotelo et al. 2006).Despite the increased and, in some countries, broad use of DM cups, high-quality evidence of their effectiveness is lacking (Darrith et al. 2018). Recent reviews did not identify any randomized controlled trials (RCT) comparing DM cups with UP cups (De Martino et al. 2017a, 2017b, Darrith et al. 2018, Jonker et al. 2020) and the existing studies are of low methodological quality and at high risk of bias due to the lack of experimental design. So far only one—non randomized—cost-effectiveness study has been performed, suggesting that the DM cup may result in cost savings compared with a UP cup (Epinette et al. 2016). Although promising, the results of this cost-effectiveness database study are not transferrable outside France.Therefore we initiated an RCT to establish the effectiveness of DM cups for primary THA. The primary objective is to investigate whether there is a difference in the number of hip dislocations following primary total hip arthroplasty (THA), using the posterolateral approach, for a DM cup compared with a UP cup in elderly patients within 1 year after surgery. Several secondary outcomes will be specified in the methods section. The registry-nested design will facilitate long-term follow-up for all study participants.     

Adherence and barriers in e‐health self‐control training for enhancing childhood multidisciplinary obesity treatment

Training self‐control as the assumed underlying mechanism for weight loss is a promising pathway for improving long‐term outcomes of childhood multidisciplinary obesity treatment (MOT). The present study is the first to analyse adherence to e‐health self‐control training in paediatric obesity. We hypothesized that low adherence would relate to child characteristics and to contextual treatment barriers. Participants were recruited as a part of a larger randomized controlled trial, evaluating an e‐health self‐control training during inpatient MOT (intensive phase) and its outpatient aftercare (booster phase). A number of 68 youngsters with severe obesity between 11 to 19 years old were included in the present study. Excellent adherence was observed in the intensive phase during inpatient MOT, but rates decreased in the booster phase. As predicted, the low adherence group had a significantly higher weight status throughout the entire study period. Differences in contextual treatment barriers did not appear. Further in‐depth analysis showed that the low adherence group frequently experienced practical obstacles. The end of inpatient MOT and high weight status can be considered important risk factors for low adherence in an additional self‐control training aimed at facilitating weight loss.     

Associations of Pretreatment Physical Status Parameters with Tolerance of Concurrent Chemoradiation and Survival in Patients with Non-small Cell Lung Cancer

Objective

The aim of this study was to evaluate associations between pretreatment physical status parameters and tolerance of concurrent chemoradiation (cCHRT) and survival among patients with stage III non-small cell lung cancer (NSCLC).

Methods

A retrospective cohort study was conducted among patients with stage III NSCLC who had received cCHRT between 2006 and 2015. Multivariate independent associations were analysed between the pretreatment parameters age, Charlson comorbidity index, World Health Organization performance status (WHO performance status), body mass index (BMI), fat-free mass index (FFMI), maximal handgrip strength, forced expiratory volume in one second and carbon monoxide lung diffusion capacity on the one hand with tolerance of cCHRT (defined as a received radiation dose at least equal to the prescribed radiation dose) and survival on the other hand.

Results

527 of 577 patients (91.3%) tolerated cCHRT. A WHO performance status ≥ 2 (odds ratio (OR) 0.43) and BMI < 18.5 kg/m² (OR 0.36) were associated with poorer tolerance of cCHRT. In the total group, a WHO performance status ≥ 2 (hazard ratio (HR) 1.73), low FFMI (HR 1.23) and intolerance of cCHRT (HR 1.55) were associated with poorer survival.

Conclusion

In patients with stage III NSCLC receiving cCHRT, poor WHO performance status and BMI < 18.5 kg/m² were independently associated with tolerance of cCHRT. Physical status parameters and intolerance of cCHRT were independently associated with poorer survival. Besides using this information for treatment decisions, optimizing physical status in patients at risk for intolerance of cCHRT might be a next step for improving treatment outcomes.

Graphic Abstract

     

Contribution of the DST (dexamethasone suppression test) to the diagnosis, prognosis and treatment of depression

Reviewing biological research in depressive illness, this work focuses on the DST as most practical and useful investigation in today's psychiatry. This study is empirically based on more than 10,000 test results from in- and outpatients recruited over six years. This work might be the missing link between highly selective and sometimes difficult to integrate university research and the daily practice. This experience with the DST on various areas is illustrated with numerous cases. Considerable attention goes to DST as diagnostic marker, prognostic indicator, DST and postpartum psychosis, DST and schizo-affective disorder, DST and masked depression. Possibilities and limits of this important aid in psychiatry are discussed in connection with measuring psychiatric illness and integrate approach.