Still an Unsolved Question: The Place of Cranial Magnetic Resonance Imaging in Acute Acquired Concomitant Esotropia.

PURPOSE: The aim of this study was to collect further data to estimate the risk of relevant intracranial pathology and thereby better assess the need for cranial imaging in children with acute acquired comitant esotropia (AACE). To date, there is still not enough literature on this topic to enable a consensus on the diagnostic algorithm. METHODS: We analyzed data from patients with convergent strabismus who received cranial imaging via magnetic resonance imaging (MRI). Twenty-one patients received a cranial MRI for the diagnostic evaluation of AACE. The age range was from 2 to 12 years, and the mean age at the time of diagnosis was 5.5 years. Of these patients, only one exhibited insignificant MRI findings, with no therapeutic consequences. CONCLUSIONS: Our data add further evidence that AACE without neurological findings or other ophthalmologic anomalies might not be an indication for cranial MRI as a diagnostic screening tool.

Effects of Dietary Supplementation of Lacticaseibacillus Chiayiensis AACE3 on Hepatic Antioxidant Capacity, Immune Factors and Gut Microbiology in Nandan Yao Chicks.

The growing issue of antibiotic resistance has restrained the utilization of antibiotics as growth enhancers in the poultry industry. Probiotics are candidates for replacing antibiotics in the poultry industry. However, probiotics are strain-specific and their efficacy needs to be investigated before applying them. The aim of this study was to assess the positive effects of Lacticaseibacillus chiayiensis AACE3 on the health and gut microbiota of Nandan Yao chicks. The results showed that compared with the blank control (NC) and aureomycin (PC) groups, L. chiayiensis AACE3 increased final body weight (BW), villus height and improved the ratio of villus height to crypt depth in chicken jejunal tissues. L. chiayiensis AACE3 also increased the activity of hepatic antioxidant enzymes (SOD, CAT and T-AOC) and reduced hepatic oxidative damage (MDA). Furthermore, compared to NC, L. chiayiensis AACE3, the activity of intestinal digestive enzymes (i.e., α-amylase, lipase and trypsin) was increased. L. chiayiensis AACE3 upregulated the production of IgA and IgG and downregulated the production of IL-6, IL-1ß and TNF-α in chicken serum. Moreover, supplementation of L. chiayiensis AACE3 enhances the diversity of gut microbes. At the phylum level, the abundance of Actinobacteriota and Proteobacteria decreased with L. chiayiensis AACE3 supplementation, while the abundance of Verrucomicrobiota and Bacteroidetes increased. At the genus level, there was an increase in the abundance of potential probiotics Akkermansia, Romboutsia, Subdoligranulum, and Lactobacillus. This study confirms that L. chiayiensis AACE3 is an excellent feed additive as an alternative to aureomycin and offers various advantages for the healthy growth of chickens during the brooding period by positively affecting their gut microbiome.

The efficacy of botulinum toxin type A treatment and surgery for acute acquired comitant esotropia.

Aim: To compare the long-term efficiency of botulinum toxin type A (BTXA) injection and surgery on acute acquired comitant esotropia (AACE). Methods: This retrospective study enrolled patients with AACE from January 2020 to August 2022. The horizontal angle of deviation pre- and post-treatment was measured. Deviations in BTXA and surgical treatment were compared. The BTXA group was divided into adequate treatment (AT) and inadequate treatment (inAT) subgroup based on the deviation of no more than 4 prism diopters (at near and distance) or temporary exotropia at the 2 week follow-up. The two subgroups were compared to determine the long-term efficacy of BTXA treatment. Results: Ninety-two patients with AACE were included. Follow-up was 6 months. The deviations of the surgery and BTXA group were significantly smaller at the 6 month follow-up than at pre-treatment (p < 0.001). The deviation before treatment in the surgery group was larger than in the BTXA groups (p < 0.001) but smaller at the 6 month follow-up (p < 0.001). The deviation was similar in the AT-BTXA and inAT-BTXA subgroups before treatment (p = 0.322 for distance and p = 0.051 for near) but smaller in the AT-BTXA subgroup at 6 month follow-up (p < 0.001 for near and distance). Conclusion: Surgery and BTXA successfully treat AACE. Surgery has a more precise and lasting therapeutic effect than BTXA. AACE patients adequately treated with BTXA and with deviations of no more than 4 prism diopters at 2 weeks follow-up had better outcomes.

Romosozumab Efficacy in Postmenopausal Women With No Prior Fracture Who Fulfill Criteria for Very High Fracture Risk.

OBJECTIVE: We evaluated the efficacy of romosozumab in women from FRAME who had no prior fracture but met other criteria for very high fracture risk (VHFR). METHODS: In FRAME, postmenopausal women received romosozumab or placebo for 12 months (year 1) followed by denosumab for 12 months (year 2). In this post hoc analysis, we applied the following criteria from the American Association of Clinical Endocrinology to define VHFR: lumbar spine or total hip T-score <-3.0 and/or Fracture Risk Assessment Tool probability of major osteoporotic fracture >30% or hip fracture >4.5% to women with no fracture history at baseline (no fracture-VHFR [NF-VHFR]). Incidence of new vertebral, clinical, and nonvertebral fractures and mean bone mineral density (BMD) percentage change from baseline were assessed at years 1 and 2. RESULTS: Of the 7180 women in FRAME, 2825 were included in the NF-VHFR subgroup analysis. At year 1, romosozumab versus placebo reduced the incidence of new vertebral fracture (relative risk reduction [RRR]: 76%), clinical fracture (RRR: 60%), and nonvertebral fracture (RRR: 54%) (all P <.05). This fracture reduction was maintained through year 2 in women receiving the romosozumab-to-denosumab sequence versus the placebo-to-denosumab sequence for new vertebral, clinical, and nonvertebral fractures (RRR: 77%, 54%, and 46%, respectively; all P <.05). The mean BMD changes in both treatment groups were similar to those in the overall FRAME population at years 1 and 2. CONCLUSION: Romosozumab significantly reduced vertebral, clinical, and nonvertebral fracture risk and increased the BMD more than placebo in women at VHFR.

When not teaming up puts parents at risk: Coparenting and parental burnout in dual-parent heterosexual families in Switzerland.

Parental burnout refers to loss of energy and pleasure in the parental role. It is predictive of psychopathological outcomes in parents and dysfunctional parenting behaviors. Support of parental duties is central to alleviation of parental burden and prevention of burnout. Coparenting is the concept related to interparental mutual support in rearing a child. However, the links between coparenting and parental burnout have yet to be assessed. We thus aimed in this study to assess which dimensions of coparenting are linked with parental burnout. A total of 306 participants from the French-speaking part of Switzerland (120 fathers, 186 mothers) completed online questionnaires about parental burnout, their coparental relationship, and sociodemographic characteristics. We performed hierarchical regressions, entering sociodemographic characteristics in a first block and coparenting dimensions in a second block. Results showed that (i) a higher number of children and having younger children are linked to higher burnout; (ii) coparenting exposure to conflict is related to higher burnout, whereas endorsement of the partner's parenting is related to lower burnout; and (iii) no interaction effect occurs between sociodemographic characteristics and coparenting variables. Coparenting thus significantly contributes to the occurrence of burnout syndrome. Working on the coparental relationship preventively in parental educational programs or at a relational systemic level in therapy may help prevent burnout. Treating one parent only may not be sufficient to alleviate burnout, as negative coparenting could counter the effect of individual therapy.

LPS-induced macrophage exosomes promote the activation of hepatic stellate cells and the intervention study of total astragalus saponins combined with glycyrrhizic acid.

Huangqi decoction, also known as Huangqi Liuyi decoction, was first recorded in the prescriptions of the Bureau of Taiping People's Welfare Pharmacy. It comprises astragalus and licorice, which is a commonly used prescription in traditional Chinese medicine for the clinical treatment of chronic liver disease, especially liver cirrhosis. Total astragalus saponins (AST) is the main component of astragalus, and glycyrrhizic acid (GA) is the main component of licorice. In this study, normal macrophage exosomes were extracted, and the exosomes incubated with lipopolysaccharides (LPS) and those incubated with LPS + AST + GA were co-cultured with JS1 cells (hepatic stellate cell line). The survival rate and the activation of key signaling pathways of JS1 cells in each group were detected and compared. We found that the co-culture of LPS-induced macrophage exosomes with JS1 cells could significantly increase the expression levels of Collagen-1 (Col-1) and Alpha smooth muscle actin (α-SMA)in JS1 cells. However, a significant reversal effect was observed after pretreatment with AST combined with GA. Further evaluation found that the expression levels of phospho (p)-Smad2 and p-Smad3 in the JS1 cells were significantly increased after macrophages were induced with LPS, whereas pretreatment with AST + GA could significantly decrease the expression levels of p-Smad2 and p-Smad3. Preliminary results of this study indicated that LPS-induced macrophage exosomes can promote the activation of hepatic stellate cells, and the pretreatment of AST combined with GA can exert a significant intervention effect. In this study, the new mechanism of anti-hepatic fibrosis effect of traditional Chinese medicine components of Huangqi Decoction was analyzed from the perspective of exosomes.

Acute acquired comitant esotropia precipitated by excessive near work during the COVID-19-induced home confinement.

Purpose: To evaluate the causes of acute acquired comitant esotropia (AACE) in young adults and children in the setting of COVID-19-induced home confinement. Methods: A retrospective, clinical study of all patients, who presented to the Pediatric Ophthalmology and Strabismus services of a tertiary eye care center in South India from August 2020 to January 2021 during the COVID-19 pandemic, with acute-onset, comitant esotropia. Results: 11 (73.3%) of the total 15 patients were students, above 10 years and with a mean age of 16.8 years. 12 patients (80%) had more than 8 hours of near activity a day with a mean duration of 8.6 hours per day. The most common near activity was online classes, followed by job-related work and mobile games, and 86.7% used smartphones for near work. The average esotropia was 22.73 prism diopter (PD) for distance and 18.73 PD for near. Majority (66.6%) had hyperopia with basic or divergence insufficiency esotropia, and the remaining 33.3% had myopia and fitted in to the Bielschowsky type AACE. There was no precipitating event other than sustained near work in all, except in one patient who also had fever prior to the onset of esotropia. Conclusion: The habit of long-time and sustained near work, especially on smartphones, may increase the risk of inducement of AACE.

Safety and Efficacy of Saroglitazar in Nonalcoholic Fatty Liver Patients With Diabetic Dyslipidemia-A Prospective, Interventional, Pilot Study.

BACKGROUND: Saroglitazar-a unique dual peroxisome proliferator-activated receptor agonist was approved marketing authorization in India in 2013 for diabetic dyslipidemia. Postmarketing studies have additionally shown improvement in liver parameters in diabetic dyslipidemia patients with nonalcoholic fatty liver disease (NAFLD) who received saroglitazar. AIM: The aim of this study was to evaluate the effect of saroglitazar on liver function test, liver fibrosis score by FibroScan, lipid profiles, HbA1c in NAFLD patients with diabetic dyslipidemia in southern India. METHODOLOGY: A prospective, interventional, pilot study was performed to study the safety and efficacy of saroglitazar in NAFLD patients having type 2 diabetes mellitus. About 97 patients were screened, of which 85 patients were involved in the study based on the inclusion criteria. The clinical parameters and liver stiffness were measured at the baseline and also after 12 weeks of treatment with administration of saroglitazar 4 mg once daily. The change in the parameters at the baseline and after the end of the treatment was measured and was subjected to statistical analysis using SPSS software. RESULTS: The recruited patients received saroglitazar and were followed up for a period of 12 weeks. The clinical parameters such as fasting blood sugar, postprandial blood sugar, HbA1c, total cholesterol, triglycerides, SGPT, and liver stiffness showed significant difference after 12 weeks of treatment when compared with the baseline values. No adverse drug reaction was reported in patients receiving saroglitazar during the study. CONCLUSION: Saroglitazar was found to show significant improvement in liver parameters in NAFLD patients with a significant reduction in liver fibrosis and triglycerides level.

Essential anxiety: COVID-19 in analytic practice.

This paper explores the impact of the COVID-19 pandemic on my relationship with analysands and my inner world. I reflect on the role of the archetypal Self during times of existential anxiety that may lead to an experience of 'essential anxiety'. This term refers to a meeting by a fearful ego with an inward recognition of the Self, when faced with threat. The efforts to curb the spread of the pandemic changed our ways of life, while the virus itself threatened our existence in debilitating or outright destructive ways. But what also came into view, in sessions of analysis and supervision, was the creative instinct, and a celebration of life. The soul-to-soul relationship, and the connection with images of the archetypal Self, made the experience of existential anxiety at times an essential experience that facilitated psychological growth. I discuss some advantages of on-line Jungian analysis where, despite distance and partial view, the body still serves as container to hold important psychological material, conferring a sense of wholeness for analyst and analysand. The COVID-19 crisis is terrible and terrifying but it also provides an opportunity for self-regulation and individuation.

Cet article explore l'impact de la pandémie de COVID-19 sur ma relation avec mes analysants et avec mon monde intérieur. Je réfléchis au rôle du Soi archétypal durant les périodes d'angoisse existentielle pouvant mener à une expérience 'd'angoisse essentielle'. Ce terme fait référence à la rencontre entre un moi craintif et l'acceptation intérieure du Soi, lors d'une confrontation avec une menace. Les efforts pour atténuer la diffusion de la pandémie ont changé nos manières de vivre, pendant que le virus lui-même menaçait notre existence de manière écrasante ou carrément destructive. Mais ce qui s'est également profilé, dans les séances d'analyse et de supervision, fut l'instinct créatif, et une célébration de la vie. La relation d'âme à âme et le lien avec des images du Soi archétypal ont parfois fait de l'expérience d'angoisse existentielle une expérience essentielle qui a facilité la croissance psychologique. J'aborde certains bénéfices de l'analyse Jungienne en ligne quand, malgré l'éloignement et la vision rétrécie à l'écran, le corps sert encore en tant que contenant pour détenir du matériel psychologique important, ce qui confère à l'analyste et à l'analysant un sentiment de complétude. La COVID-19 est terrible et terrifiante mais elle offre aussi une opportunité pour l'autorégulation et l'individuation.

El presente trabajo explora el impacto de la pandemia de COVID-19 en mi relación con mis analizandos y con mi mundo interno. Reflexiono sobre el rol del Sí Mismo arquetípico durante estos tiempos de ansiedad existencial que pueden conducir a una experiencia de 'ansiedad esencial'. Este término hace referencia al encuentro de un ego atemorizado con un reconocimiento interno del Sí Mismo, cuando es confrontado con una amenaza. Los esfuerzos por reducir la propagación de la pandemia cambiaron nuestro modo de vida, mientras el virus mismo amenazaba nuestra existencia ya sea debilitándola, o en formas directamente destructivas. Pero lo que también se hizo visible, en sesiones de análisis y supervisión, fue el instinto creativo y la celebración de la vida. La relación de alma-a-alma, y la conexión con imágenes del Sí Mismo arquetípico, hizo de a momentos la experiencia de ansiedad existencial, una experiencia esencial que facilitó el crecimiento psicológico. Analizo algunas ventajas del análisis Junguiano online, donde, aún la distancia y cierta parcialidad en el campo visual, el cuerpo sirve todavía de contenedor para alojar importante material psicológico, brindando un sentido de totalidad al analista y al analizando. La crisis por el COVID-19 es terrible y aterradora, pero al mismo tiempo provee una oportunidad para la autorregulación y la individuación.

Expression of Human ACE2 N-terminal Domain, Part of the Receptor for SARS-CoV-2, in Fusion With Maltose-Binding Protein, E. coli Ribonuclease I and Human RNase A.

The SARS-CoV-2 viral genome contains a positive-strand single-stranded RNA of ∼30 kb. Human ACE2 protein is the receptor for SARS-CoV-2 virus attachment and infection. We propose to use ribonucleases (RNases) as antiviral agents to destroy the viral genome in vitro. In the virions, the RNA is protected by viral capsid proteins, membrane proteins, and nucleocapsid proteins. To utilize RNases as antiviral strategy, we set out to construct RNase fusion with human ACE2 receptor N-terminal domain (ACE2NTD). We expressed six proteins in E. coli cells: (1) MBP-ACE2NTD, (2) ACE2NTD-GFP, (3) RNase I (6×His), (4) RNase III (6×His), (5) RNase I-ACE2NTD (6×His), and (6) human RNase A-ACE2NTD (6×His). We evaluated fusion expression in different E. coli strains, partially purified MBP-ACE2NTD protein from the soluble fraction of bacterial cell lysate, and refolded MBP-ACE2NTD protein from inclusion body. The engineered RNase I-ACE2NTD (6×His) and hRNase A-ACE2NTD (6×His) fusions are active in cleaving SARS-CoV-2 RNA fragment in vitro. The recombinant RNase I (6×His) and RNase III (6×His) are active in cleaving RNA and dsRNA in test tube. This study provides a proof-of-concept for construction of fusion protein between human receptor and nuclease that may be used to degrade viral nucleic acids.

Postmenopausal Osteoporosis: Latest Guidelines.

Significant development has occurred in the treatment of postmenopausal osteoporosis. We review the most recent guidelines from the American Association of Clinical Endocrinologists/American College of Endocrinology, Endocrine Society, and the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis/International Osteoporosis Foundation Guidelines.

Acute Acquired Comitant Esotropia: Etiology, Clinical Course, and Management.

PURPOSE: To identify the etiologies, clinical course and management of acute acquired comitant esotropia in Ramathibodi Hospital, Thailand. METHODS: Thirty patients who were diagnosed with acute acquired comitant esotropia at Ramathibodi Hospital from January 1 2017 to December 31 2019 were identified using electronic medical records, from which demographic, etiology, clinical course and management, laboratory, and neuroimaging data were collected. RESULTS: The etiologies of acute acquired comitant esotropia were Swan (16.67%), Burian-Franceschetti (30.00%), Bielschowsky (36.67%), Arnold Chiari malformation (3.33%) and decompensated esophoria (13.33%). Mean age of onset was 19.8 ± 18.3 years. Mean angle of esodeviation was 28.4 ± 12.1 prism diopters for distance fixation and 29.3 ± 11.8 prism diopters for near fixation. Refraction differed between age groups: children under 10 years had mild hyperopia (median +0.63 diopters, first quartile +0.25 diopters, third quartile +0.75 diopters) and teenagers (10-18 years old) had emmetropia to mild myopia (median +0.25 diopters, first quartile -2.50 diopters, third quartile +0.75 diopters), whereas adults had mild to moderate myopia (median -0.75 diopters, first quartile -5.25 diopters, third quartile ±0.00 diopters). Twelve patients (40.00%) were prescribed spectacles and surgical intervention was performed in 26 patients (86.67%). All patients except one case of Arnold Chiari malformation (96.67%) maintained normal binocular function and alignment following strabismus surgery or spectacles correction. CONCLUSION: Bielschowsky was the most common etiology of acute acquired comitant esotropia in our study. We suggest that refraction should be performed in all patients with acute acquired comitant esotropia. Most etiologies were benign and might not require neuroimaging. However, neuroimaging is recommended in those with atypical presentations, such as nystagmus, headache, or cerebellar signs. Surgical intervention with a 0.5-1.0 mm increase in recession was effective for restoring ocular alignment and binocular function in our patients.

Ultrasound risk stratification systems for thyroid nodule: between lights and shadows, we are moving towards a new era.

Ultrasound (US) has long played a major role in the assessment of thyroid nodules and their risk of malignancy, and its importance has been further enhanced over the past decade by the development of a number of US-based risk stratification systems (US-RSSs), referred to in some cases as TIRADS (Thyroid Imaging Reporting And Data Systems). The high-risk categories of all currently available US-RSSs display strong associations to cytological diagnostic classes of "malignant/suspicious-for-malignancy" and the low-risk classes are clearly associated to "not neoplastic/benign" cytology. The introduction of these systems has elevated the diagnostic performance of US to a level approaching that of fine-needle aspiration (FNA) cytology. The time seems ripe to exploit this new level of accuracy to reduce the number of FNAs for nodules likely to be benign (i.e., sonographically classified as low-risk with no suspicious clinical features). In the near future, US-RSS could also become the main tool for diagnosing papillary thyroid cancers. The establishment of a new "international TIRADS"-currently in progress-will be critical to guide us towards a new era.

The Role of Children's Neurophysiological Functioning in the Links Between Emotion-Parenting Behaviors and Child Anxiety Symptoms: A Biological Sensitivity to Context Framework.

A plethora of data supports links between parenting behaviors and child anxiety, but few studies have examined factors that can contribute to variability in these relations. Adopting a biological sensitivity to context framework, this study explored the role of children's physiological stress reactivity in the links between emotion-parenting and child anxiety symptoms in a group of Chinese families. Sixty-one parent-child dyads (child Mage  = 8.21 years, SD = 1.40, range = 6-12 years) participated in an acute stress protocol, from which children's physiological (cortisol and respiratory sinus arrhythmia) responses to a social speech task were recorded. Participants then completed questionnaires assessing parents' emotion-parenting behaviors and children's anxiety symptoms. Results showed that the relation between supportive emotion-parenting and child anxiety was stronger in the context of greater child RSA suppression to acute stress, such that children higher in RSA suppression exhibited lower anxiety symptoms when supportive emotion-parenting was higher than when it was lower. Thus, these findings supported the biological sensitivity to context model. No significant moderation effect was detected for cortisol reactivity or recovery. Instead, exploratory mediation analyses showed that supportive emotion-parenting was negatively related to child anxiety via greater cortisol recovery. There was also a significant indirect path where unsupportive emotion-parenting was related to blunted cortisol recovery, which in turn was associated with higher child anxiety. The results highlight the importance of coaching parents to respond in supportive ways to children's emotional expressions, particularly in the context of greater child reactivity, to help buffer against childhood anxiety symptoms.

Una plétora de datos respaldan las conexiones entre las conductas de crianza y la ansiedad infantil, pero pocos estudios han analizado los factores que pueden contribuir a la variabilidad en estas relaciones. Mediante la adopción de una sensibilidad biológica al marco del contexto, el presente estudio analizó el papel de la reactividad fisiológica al estrés de los niños en los vínculos entre las conductas de crianza emocional y los síntomas de ansiedad infantil en un grupo de familias chinas. Sesenta y una díadas padre-hijo (edad promedio de los niños = 8.21 años, desviación típica = 1.40, rango = 6-12 años) participaron en un protocolo de estrés agudo, del cual se registraron las respuestas fisiológicas de los niños (el cortisol y la arritmia sinusal respiratoria) a una tarea de habla social. Luego, los participantes contestaron cuestionarios que evaluaban las conductas de crianza emocional de los padres y los síntomas de ansiedad de los niños. Los resultados demostraron que la relación entre la crianza emocional comprensiva y la ansiedad de los niños fue más fuerte en el contexto de una mayor supresión de la arritmia sinusal respiratoria del niño ante el estrés agudo, de manera que los niños con mayor supresión de la arritma sinusal respiratoria demostraron menos síntomas de ansiedad cuando la crianza emocional comprensiva fue mayor que cuando fue menor. Por lo tanto, estos resultados respaldaron la sensibilidad biológica al modelo del contexto. No se detectó ningún efecto de moderación importante para la reactividad o recuperación del cortisol. En cambio, los análisis exploratorios de mediación demostraron que la crianza emocional comprensiva estuvo relacionada negativamente con la ansiedad de los niños mediante una mayor recuperación de cortisol. También hubo una vía indirecta significativa donde la crianza emocional incomprensiva estuvo relacionada con la recuperación disminuida de cortisol, que a su vez estuvo asociada con una mayor ansiedad infantil. Los resultados destacan la importancia de capacitar a los padres para responder de maneras comprensivas a las expresiones emocionales de los niños, particularmente en el contexto de una mayor reactividad infantil, a fin de contribuir a atenuar los síntomas de ansiedad en la niñez.

No one here gets out alive: the Bluebeard story in therapy and in the culture.

In this paper, the Bluebeard story is used to highlight mechanisms underlying an individual analytic case and some cultural phenomena from a Jungian perspective. I describe a patient whose psyche was dissociated into a tormenting monstrous figure and a regressed childish self, which Kalsched explains as activation of the archetypal defence system. As her analyst, I had to survive attacks of the patient's persecuting inner object, which she related to Bluebeard as a representation of relentless murderousness. At the cultural level, Bluebeard pertains to the concept of the totalitarian object (Sebek 1996) and to the pole of grandiosity of the Russian cultural complex.

Dans cet article, l'histoire de Barbe Bleue est utilisée afin de souligner les mécanismes à l'œuvre dans un cas analytique et quelques phénomènes culturels à partir d'une perspective Jungienne. Je décris un patient dont la psyché a été dissociée en un personnage monstrueux et torturant, et en un soi infantile régressé, ce que Kalsched explique en tant que l'activation du système défensif archétypal. En tant que son analyste, j'eus à survivre les attaques de l'objet intérieur persécuteur du patient, qu'elle rapprochait de Barbe Bleue en tant que représentation d'une envie de tuer irrépressible. Au niveau culturel, Barbe Bleue se rapporte au concept d'objet totalitaire (Sebek 1996) et au pôle grandiose dans le complexe culturel russe.

En el presente trabajo, la historia de Barba Azul es utilizada para esclarecer los mecanismos que subyacen a un caso analítico individual, y ciertos fenómenos culturales desde una perspectiva Junguiana. Describo a un paciente cuya psique fue disociada entre una figura monstruosa y atormentadora, y un self infantil regresivo, lo cual Kalsched ha explicado como la activación del sistema arquetipal de defensa. Como su analista, he tenido que sobrevivir a los ataques de un objeto interno persecutorio de la paciente, el cual ella relacionó con Barba Azul como representación de un incesante impulso homicida. A nivel cultural, Barba Azul pertenece al concepto de objeto totalitario (Sebek 1996) y al polo de grandiosidad del complejo cultural Ruso.

Maternal experience of their infants' crying in the context of war trauma: Determinants and consequences.

We examined, first, how prenatal maternal mental health and war trauma predicted mothers' experience of their infant crying, indicated by emotions, cognitions, and behavior; and second, how these experiences influenced the mother-infant interaction and infant development. Participants were 511 Palestinian mothers from the Gaza Strip, reporting their war trauma, symptoms of posttraumatic stress disorder (PTSD), depression, and perceived stress during pregnancy (Time 1). They reported experiences of infant crying at 4 months (Time 2), and the mother-infant interaction and infant sensorimotor and language development at 12 months of infants' age (Time 3). Results revealed that maternal mental health problems, but not war trauma, were important to experiences of infant crying. A high level of PTSD symptoms predicted negative emotions evoked by infant crying, and high depressive symptoms predicted low active and positive responses to crying. Unexpectedly, high prenatal perceived stress predicted high active and positive responsiveness. Concerning the consequences, mothers' sensitive interpretation of infant crying predicted optimal infant sensorimotor development, and mothers' active and positive responses predicted high emotional availability in mother-infant interaction. Crying is the first communication tool for infants, and mothers' sensitive responses to crying contribute to infant well-being. Therefore, reinforcing mother's optimal responses is important when helping war-affected dyads.

Examinamos, primero, cómo la prenatal salud mental materna y el trauma de guerra predecían la manera como las madres experimentan el llanto de sus infantes, según lo indicaban las emociones, la cognición y la conducta, y segundo, cómo esas experiencias influían en la interacción madre-infante y el desarrollo del infante. Las participantes fueron 511 madres palestinas de la franja territorial de Gaza, quienes reportaron sobre su trauma de guerra, los síntomas del trastorno de estrés postraumático (PTSD), la depresión y la percepción de estrés durante el embarazo (T1). Ellas reportaron experiencias de llanto del infante a los cuatro meses (T2), y la interacción madre-infante y el desarrollo sensorial-motor y de lenguaje del infante a los 12 meses de edad del infante (T3). Los resultados revelaron que los problemas de salud mental maternos, aunque no así el trauma de guerra, eran importantes para experimentar el llanto del infante. Un alto nivel de síntomas de PTSD predijo las negativas emociones evocadas por el llanto del infante, y altos síntomas depresivos reducen las activas y positivas respuestas al llanto. Inesperadamente, la alta precepción de estrés prenatal predijo una alta sensibilidad activa y positiva. Con respecto a las consecuencias, la sensible interpretación que las madres tenían del llanto de sus infantes predijo el desarrollo sensorial-motor del infante, y las respuestas activas y positivas de la madre predijeron la alta disponibilidad emocional en la interacción madre-infante. El llanto es la primera herramienta de comunicación para los infantes, y las respuestas sensibles de las madres al llanto contribuyen al bienestar del infante. Por tanto, es importante reforzar las respuestas óptimas de las madres cuando se trata de ayudar a díadas afectadas por la guerra.

Nous avons d'abord examiné comment la santé mentale maternelle prénatale et le traumatisme de guerre ont prédit l'expérience que les mères se faisaient de leur nourrisson pleurant, indiquée par les émotions, les cognitions et le comportement, et ensuite comment ces expériences ont influencé l'interaction mère-bébé et le développement du nourrisson. Les participantes ont consisté en 511 mères palestiniennes de la bande de Gaza, faisant état de leur traumatisme lié à la guerre, de symptômes de stress posttraumatique (TSPT), de dépression et de stress perçu durant la grossesse (T1). Ces participantes ont fait état d'expériences de leur nourrisson pleurant au cours de quatre mois (T2) et de l'interaction mère-nourrisson et du développement sensorimoteur et du développement du langage à douze mois d'âge pour le nourrisson (T3). Les résultats ont révélé que les problèmes de santé mentale de la mère, et non le trauma de la guerre, étaient importants pour l'expérience du bébé pleurant. Un niveau élevé de symptômes TSPT a prédit les émotions négatives évoquées par le bébé pleurant, et des symptômes dépressifs élevés ont prédit des réactions positives et peu actives aux pleurs. Contre toute attente, un stress perçu prénatal élevé a prédit une réaction positive et active élevée. Pour ce qui concerne les conséquences, l'interprétation sensible des mères de leur bébé pleurant a prédit le développement sensorimoteur optimal du bébé et les réactions actives et positives des mères ont prédit une disponibilité émotionnelle élevée dans l'interaction mère-nourrisson. Pleurer est le premier outil de communication pour les bébés et les réactions sensibles des mères aux pleurs contribuent au bien-être du bébé. Il est donc important de renforcer les réactions optimales des mères lorsqu'on aide les dyades affectées par la guerre.

Ketogenic diet: situational analysis of current nutrition guidelines.

Ketogenic diet is gaining popularity as a nonpharmacological intervention for weight loss and glycaemic control. There is abundant literature on this topic, which serves to confuse the reader. No scientific recommendations have been formulated to guide evidence-based or rational use of ketogenic diet in obesity and diabetes management. This article is a situational analysis of leading professional guidelines on diabetes care, with regards to their coverage of ketogenic diet. It underscores the need for leading experts to pay attention to this upcoming field of metabolic medicine..

Inadequate dietary energy intake associates with higher prevalence of metabolic syndrome in different groups of hemodialysis patients: a clinical observational study in multiple dialysis centers.

BACKGROUND: Metabolic syndrome (MetS) has been established as a risk for cardiovascular diseases and mortality in hemodialysis patients. Energy intake (EI) is an important nutritional therapy for preventing MetS. We examined the association of self-reported dietary EI with metabolic abnormalities and MetS among hemodialysis patients. METHODS: A cross-sectional study design was carried out from September 2013 to April 2017 in seven hemodialysis centers. Data were collected from 228 hemodialysis patients with acceptable EI report, 20 years old and above, underwent three hemodialysis sessions a week for at least past 3 months. Dietary EI was evaluated by a three-day dietary record, and confirmed by 24-h dietary recall. Body compositions were measured by bioelectrical impedance analysis. Biochemical data were analyzed using standard laboratory tests. The cut-off values of daily EI were 30 kcal/kg, and 35 kcal/kg for age ≥ 60 years and < 60 years, respectively. MetS was defined by the American Association of Clinical Endocrinologists (AACE-MetS), and Harmonizing Metabolic Syndrome (HMetS). Logistic regression models were utilized for examining the association between EI and MetS. Age, gender, physical activity, hemodialysis vintage, Charlson comorbidity index, high sensitive C-reactive protein, and interdialytic weight gains were adjusted in the multivariate analysis. RESULTS: The prevalence of inadequate EI, AACE-MetS, and HMetS were 60.5%, 63.2%, and 53.9%, respectively. Inadequate EI was related to higher proportion of metabolic abnormalities and MetS (p <  0.05). Results of the multivariate analysis shows that inadequate EI was significantly linked with higher prevalence of impaired fasting glucose (OR = 2.42, p <  0.01), overweight/obese (OR = 6.70, p <  0.001), elevated waist circumference (OR = 8.17, p <  0.001), AACE-MetS (OR = 2.26, p <  0.01), and HMetS (OR = 3.52, p <  0.01). In subgroup anslysis, inadequate EI strongly associated with AACE-MetS in groups of non-hypertension (OR = 4.09, p = 0.004), and non-cardiovascular diseases (OR = 2.59, p = 0.012), and with HMetS in all sub-groups of hypertension (OR = 2.59~ 5.33, p <  0.05), diabetic group (OR = 8.33, p = 0.003), and non-cardiovascular diseases (OR = 3.79, p <  0.001). CONCLUSIONS: Inadequate EI and MetS prevalence was high. Energy intake strongly determined MetS in different groups of hemodialysis patients.

IMPLEMENTATION OF AN EVIDENCED-BASED PARENTING PROGRAM IN A COMMUNITY MENTAL HEALTH SETTING.

The process of mental health intervention implementation with vulnerable populations is not well-described in the literature. The authors worked as a community-partnered team to adapt and pilot an empirically supported intervention program for mothers of infants and toddlers in an outpatient mental health clinic that primarily serves a low-income community. We used qualitative ethnographic methods to document the adaption of an evidence-based intervention, Mothering from the Inside Out, and the pilot implementation in a community mental health clinic. Seventeen mothers and their identified 0- to 84-month-old children were enrolled in the study. Key lessons from this implementation include (a) the importance of formative work to build community relationships and effectively adapt the intervention to meet the needs of the therapists and their clients, (b) the importance of designing plans for training and reflective supervision that fit within the flow of the clinic and can tolerate disruptions, and (c) that use of an interdisciplinary approach is feasible with the development of a plan for communication and the support of a trained reflective clinical supervisor. These key lessons advance the scientific knowledge available to healthcare managers and researchers who are looking to adapt mental health clinical interventions previously tested in clinical trials to implementation in community settings.

ANTENATAL DETERMINANTS OF PARENTAL ATTACHMENT AND PARENTING ALLIANCE: HOW DO MOTHERS AND FATHERS DIFFER?

Parental (parent-to-infant) attachment and parenting alliance are defined as two important components of psychoaffective adjustment to the parental role. This study aimed to build a predictive model of parental attachment and parenting alliance for mothers and fathers using partial least squares-structural equation modeling. Specifically, we were interested in assessing how adult romantic attachment, marital quality, and psychological distress influenced parental attachment (parent-to-infant) and parenting alliance. Forty heterosexual couples completed questionnaires during the third trimester of pregnancy and 2 months after childbirth. Results showed that adult romantic attachment, marital quality, and psychological distress were important antenatal determinants of parental attachment and parenting alliance, although they behaved differently for mothers and fathers. Hence, different predictive models were therefore proposed for mothers and fathers. Mothers' attachment to the child was influenced by internal factors as adult attachment dimensions; for fathers, it also depended on mothers' antenatal attachment to the child and on marital quality. Concerning parenting alliance, both mothers and fathers depended on own and partner's variables. Antenatal variables are important for what occurs during the transition to parenthood in terms of parenting adjustment and act differently for mothers and fathers. It thus is important to assess the psychological functioning of both mothers and fathers.