Disentangling Intolerance of Uncertainty and Threat Appraisal in Everyday Situations

Publication date: Available online 6 April 2018
Source:Journal of Anxiety Disorders
Author(s): E. Pepperdine, C. Lomax, M.H. Freeston
Intolerance of Uncertainty is a transdiagnostic risk and maintenance factor in a range of anxiety disorders and major depressive disorder. However, the mechanism of action in the development and maintenance of anxiety disorders is poorly understood, with the relationship between the constructs of uncertainty and threat appraisal remaining unclear. Most research to date has investigated IU in situations that are explicitly or implicitly threatening (i.e. where they have a negative outcome), which makes it difficult to establish whether it is the uncertainty or the prospect of a negative outcome (or threat) that people find aversive. If the construct of IU is about uncertainty (and not threat), it should also be operating in situations where there are no negative outcomes possible. Participants (N = 224) completed a battery of online measures in tasks designed to evaluate level of situational uncertainty and perception of threat level. These tasks required responses to scenarios which displayed or implied varying levels of estimated threat. Regression analyses indicated that IU was related to perceiving threat and uncertainty in negative situations and positive situations, with the greatest contribution from uncertainty within the situations, supporting the conceptualisation of IU as a response to uncertainty that is largely independent of threat although may contribute to perceptions of threat.



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A rare case of septic shock due to Neisseria meningitidis serogroup B infection despite prior vaccination in a young adult with paroxysmal nocturnal haemoglobinuria receiving eculizumab

Publication date: Available online 7 April 2018
Source:Vaccine
Author(s): Dominik Reher, Valentin Fuhrmann, Stefan Kluge, Axel Nierhaus
Paroxysmal nocturnal haemoglobinuria (PNH) is a rare acquired haematopoietic stem cell disease which causes defects in complement inhibiting proteins. The disease presents classically with the triad of haemolytic anaemia, pancytopenia and thrombosis. Eculizumab, a humanized antibody that blocks the cleavage of complement factor 5, was approved for PNH treatment in 2007 and has improved patients' survival since then. However, several cases of invasive meningococcal disease (IMD) have been reported in eculizumab-treated patients, mostly caused by serogroup B infection which was not covered by the previously administered vaccine (MenACWY). We report a rare case of septic shock due to infection with Neisseria meningitis serogroup B despite prior vaccination with 4CMenB in a young PNH patient treated with eculizumab. There are increasing doubts over whether vaccination ensures sufficient immunoprotection against IMD in patients receiving eculizumab. Therefore, besides monitoring the immune response, lifelong chemoprophylaxis should be considered.



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Hemifacial microsomia (oculo-auriculo-vertebral spectrum) in an individual from the Teramo Sant’Anna archaeological site (7th–12th centuries of the Common Era, Italy)

Publication date: Available online 6 April 2018
Source:Archives of Oral Biology
Author(s): Joan Viciano, Ruggero D'Anastasio
BackgroundThis study is based in an analysis of the skeletal remains of an adult male from the Teramo Sant'Anna archaeological site (7th–12th centuries of the Common Era, Teramo, Italy).Results and DiscussionThe individual shows distinct abnormalities that principally involve asymmetric hypoplasia and dysmorphogenesis of the facial skeleton. The combination of these findings and the absence of abnormalities of the spine strongly suggest diagnosis of the congenital malformation known as hemifacial microsomia. This very heterogeneous syndrome affects primarily aural, ocular, oral and mandibular development. Despite the lack of clinical information and the absence of soft tissue, it was possible to perform a differential diagnosis for this palaeopathological case. Mastication was probably altered considering that the mandible is extremely asymmetric and lacks true condyles. The temporomandibular joints are present, but the right one is hypoplastic and abnormal in shape. There is evidence of bilateral dislocation, and the facial muscles are hypertrophic.ConclusionsThis case represents an important contribution to the palaeopathological literature because this is an uncommon condition that has not been widely documented in ancient skeletal remains.



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Hydroalcoholic extracts of Myracrodruon urundeuva All. and Qualea grandiflora Mart. leaves on Streptococcus mutans biofilm and tooth demineralization

Publication date: Available online 6 April 2018
Source:Archives of Oral Biology
Author(s): Juliana Gonçalves Pires, Sara Salustiano Zabini, Aline Silva Braga, Rita de Cássia Fabris, Flaviana Bombarda de Andrade, Rodrigo Cardoso de Oliveira, Ana Carolina Magalhães
ObjectivesThis study evaluated the effect of the hydroalcoholic extracts of Myracrodruon urundeuva All. and Qualea grandiflora Mart. leaves (alone or combined) on the viability of Streptococcus mutans biofilm and on the prevention of enamel demineralization.MethodsStrain of S. mutans (ATCC 21175) was reactivated in BHI broth. Minimum inhibitory concentration, minimum bactericidal concentration, minimum inhibition biofilm concentration and minimum eradication biofilm concentration were determined in order to choose the concentrations to be tested under biofilm model. S. mutans biofilm (5 × 10⁵ CFU/ml) was produced on bovine enamel, using McBain saliva under 0.2% sucrose exposure, for 3 days. The biofilm was daily treated with the extracts for 1 min. The biofilm viability was tested by fluorescence and the enamel demineralization was measured using TMR.ResultsMyracrodruon urundeuva All. (Isolated or combined) at the concentrations ≥ 0.625 mg/ml was able to reduce bacteria viability, while Qualea Grandflora Mart. alone had antimicrobial effect at 5 mg/ml only (p < 0.05). On the other hand, none of the extracts were able to reduce enamel demineralization.ConclusionsThe hydroalcoholic extracts of Myracrodruon urundeuva All. and Qualea grandiflora Mart. leaves (isolated or combined) have antimicrobial action; however, they do not prevent enamel caries under S. mutans biofilm model.



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Physician assessed and patient reported lower limb edema after definitive radio(chemo)therapy and image-guided adaptive brachytherapy for locally advanced cervical cancer: A report from the EMBRACE study

Publication date: Available online 6 April 2018
Source:Radiotherapy and Oncology
Author(s): Dina Najjari Jamal, Richard Pötter, Christine Haie-Meder, Jacob C. Lindegaard, Ina Maria Juergenliemk-Schulz, Umesh Mahantshetty, Barbara Segedin, Kjersti Bruheim, Peter Hoskin, Bhavana Rai, Ericka Wiebe, Rachel Cooper, Kari Tanderup, Kathrin Kirchheiner
Background/purposeTo evaluate the pattern of manifestation and risk factors for lower limb edema (LLE) within the prospective, observational, multi-center EMBRACE study on radiochemotherapy and MRI-guided brachytherapy in locally advanced cervical cancer (LACC).Material/methodsLLE was prospectively assessed according to the physician-reported CTCAE v.3 and patient-reported EORTC QLQ-CX24 questionnaire at baseline and regular follow-up.ResultsIn total, 1176 patients were evaluated with a median follow-up of 27 months. Actuarial analyses revealed 3/5-year estimates of 27%/31% of CTCAE G ≥ 1, 6.1%/6.6% of G ≥ 2 and 0.5%/0.5% for G ≥ 3.Prevalence rates for G ≥ 1 LLE at 3 months, 1, 3 and 5 years after end of treatment were 7%, 12%, 12%, 15% for physician-assessed and 25%, 30%, 30%, 34% for any patient-reported symptoms and showed a steady increase over time.Invasive lymph node staging and obesity at diagnosis are independent significant risk factors for G ≥ 1 LLE, whereas nodal boost has no impact. Extended radiation fields including para-aortic and/or inguinal nodes show a tendency to increase the risk.ConclusionSevere LLE after definitive radiochemotherapy in LACC is rare. However, the risk for mild LLE is considerable, and related to patient-, diagnostic- and treatment characteristics.Less invasive diagnostic surgical procedures or non-invasive assessment, less invasive radiotherapy management and active rehabilitation are important pathways for future developments.



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Early Response Assessment on Mid-Treatment CT Predicts Loco-Regional Recurrence in Oropharyngeal Cancer Patients Treated with Definitive Radiation Therapy

Publication date: Available online 6 April 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Rafi Kabarriti, N. Patrik Brodin, George Lundgren, Nitin Ohri, Wolfgang A. Tomé, Shalom Kalnicki, Madhur K. Garg
Purpose/Objective(s)To evaluate if response assessment based on mid-treatment computed tomography (CT) scans during definitive radiation therapy (RT) for oropharyngeal head and neck cancer (HNC) can predict for loco-regional recurrence (LRR).Materials/MethodsHNC patients treated at our institution with RT undergo CT rescans at 15^th fraction and are replanned in case of inadequate dose to gross disease or increased dose to organs-at-risk. A retrospective cohort analysis was performed on 96 consecutive patients with oropharyngeal cancer treated in 2007-2015 with mid-treatment rescans. The volume of primary disease and involved lymph nodes were delineated on pre- and mid-treatment CT. Univariable and multivariable Cox proportional hazards regression analysis were used to evaluate the efficacy of mid-treatment reduction in tumor volume as a predictor of LRR. Risk-stratification was performed by dichotomizing patients into high- and low-risk groups based on mid-treatment response as well as p-16 status and smoking history.ResultsWith a median follow-up of 34 months, 14 patients experienced LRR. The median reduction in total tumor volume was 18.7% (IQR: 8.4%-30.9%). Reduction in total tumor volume > median is an independent predictor of LRR (HR: 0.22; 95%CI: 0.05–0.89; p=0.020), and the reduction in primary tumor volume is an even stronger predictor (HR: 0.11; 95%CI: 0.02–0.57; p=0.002). Stratifying patients into a high-risk group with reduction in total tumor volume at mid-treatment ≤ median, p-16 negative status, and smoking status >10 pack years, and a low-risk group without these factors, there was a clear separation in Kaplan-Meier curves with actuarial 3-year loco-regional control, progression-free survival and overall survival rates for the high-risk patients of 45.7%, 38.2%, 71.8% compared to 90.7%, 70.6%, 89.8% for low-risk patients, respectively (p≤0.021 for all).ConclusionOur study shows that early response assessment based on mid-treatment CT is an independent predictor of LRR and can be used to effectively distinguish high-risk and low-risk patients, allowing for risk-adaptive treatment stratification at the midway point.

Teaser

In a cohort study of 96 oropharyngeal cancer patients undergoing definitive radiation therapy, we identified early response assessment based on mid-treatment CT at the 15^th RT fraction as an independent predictor of locoregional recurrence. Combining this with p-16 and smoking status, we were able to effectively distinguish high-risk and low-risk patients, potentially allowing for more precise risk-adaptive treatment stratification.


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Neurocognitive testing in West African children 3 to 6 years of age: challenges and implications for data analyses

Publication date: Available online 6 April 2018
Source:Brain Research Bulletin
Author(s): Florence Bodeau-Livinec, Leslie L. Davidson, Roméo Zoumenou, Achille Masosugbodji, Michel Cot, Michael J. Boivin
ObjectiveWhen testing African children with developmental and cognitive standardized tests from high-income countries (HIC), investigators are uncertain as to whether to apply the HIC norms for these tests when standardizing a child's raw-score performance on the basis of age. The present study compared the construct validity of both raw and HIC-based standardized scores for the Mullen Scales of Early Learning (MSEL) and the Kaufman Assessment Battery in Children − 2nd edition (KABC-II) for Beninese children in a rural setting from three to six years of age.MethodsSeventy-four children 3 to 4 yrs of age were assessed with the MSEL, and 61 eligible older children (5 to 6 yrs of age) were assessed with the KABC-II. Assessors spoke the instructions to the children and caregivers for the assessment items in the local language. The developmental quality of the home environment was evaluated with the Caldwell HomeObservationfor Measurement of the Environment (HOME) inventory, and a material possessions and housing quality checklist was used as a measure of socio-economic status (SES). Children's mothers were given the Raven's Progressive Matrices test (nonverbal cognitive ability), and the Edinburgh Postpartum Depression Scale (EPDS) (emotional wellbeing).ResultsFor the MSEL, the 4-yr old group performed significantly better than the 3-yr old group on both the raw and standardized score comparisons for all scales. These differences were attenuated when using standardized scores, although the MSEL standardized cognitive composite score was still highly significant between years of age. When comparing 5- to 6-yr olds on KABC-II subtest and global scale performance, comparisons between the raw and standardized mean score performances were much less consistent. Generally, 6-yr olds performed significantly better than 5-yr olds on the raw score comparisons on the KABC-II subtests, but not so for standardized scores. Parent-child interactions assessed through the HOME measure was associated with both raw and standardized MSEL cognitive composite score outcomes on a multiple regression analysis. SES was the only significant predictor for KABC-II raw and standardized outcomes.ConclusionStandardization using HIC norms was not optimal, resulting in minimal impact to account for age when using the MSEL, and lower scores for oldest children compared with youngest children when using the KABC2. This is likely due to children in Benin drifting away from HIC-based norms with each passing year of age, systematically lowering standardized performance measures. These findings support the importance of having a local comparison group of reference or control children to allow for adjusted (for age, HOME, and SES) raw score comparisons when using western-based tests for developmental and neuropsychological evaluation.



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