A Comprehensive Study of Positive Body Image as a Predictor of Psychological Well-Being in Anorexia Nervosa.

Recent data suggest a close association between positive body image (PBI) and eating disorder recovery. Nevertheless, the specific mechanisms through which PBI may facilitate recovery from anorexia nervosa (AN) remain unknown. To advance understanding of these mechanisms, this study examined core indices of PBI within AN, exploring its association with emotion regulation and well-being outcomes. Data were collected from 159 female participants, 64 with AN diagnosis and 95 healthy controls (HCs), who completed measures of PBI (body appreciation, functionality appreciation, and body responsiveness), emotion regulation, and psychological well-being (depression, anxiety, stress, and psychological quality of life). The AN group reported lower levels of PBI and psychological well-being, along with greater difficulties in regulating emotions, relative to HCs. PBI variables significantly predicted emotion regulation and psychological well-being in AN, accounting for 36% to 72% of the variance, with body appreciation emerging as the strongest predictor. These findings lend credence to the view that PBI can serve as a catalyst for psychological health. We hypothesize that enhancing PBI can improve interoceptive awareness, which is crucial for emotion regulation and reducing maladaptive food-related coping. Emphasizing a mind-body connection in lifestyle could be a relevant element to consider for both treating and preventing AN.

Mediators of Outcome in Trauma-Focused Psychotherapy with Youth: A Systematic Review.

This article aimed to provide a systematic narrative synthesis of existing studies on the mediators of change in psychotherapy with adolescents (10-19 years) and transition age youth (TAY) (20-29 years) who have experienced trauma-related symptoms or posttraumatic disorder. Additionally, we were interested in identifying psychotherapy-, trauma type-, and clients' age- and gender-specific mediators of treatment outcome. Following the preferred reporting items for systematic reviews and meta-analyses, a total of 3,723 studies published in PubMed and PsycINFO databases were screened against inclusion criteria, revealing 15 eligible studies. No studies with only TAY were found; therefore, all results were limited to therapy with adolescents. Cognitive mediators were tested in 66% of selected studies, followed by parents/family-related, mental-health-related, therapy-related, and behavioral mediators. Moderate evidence was found for posttraumatic cognitions, whereas therapeutic alliance seemed to be a promising candidate for future research. Striking absence of non-cognitive-behavioral therapy interventions, emotional and adolescent-specific mediators, as well as studies with males and in non-Western societies was evident. Future original studies would benefit from applying methodological rigor in respect to mediation testing.

Psychometric analysis of the body responsiveness questionnaire in the Portuguese population.

Body responsiveness refers to the tendency to be attuned to the body's needs and use interoceptive information to guide behavior. Despite its potential beneficial effect on the development of positive body image, this construct is currently understudied. To boost research in this area, we examined the factor structure, gender invariance, and psychometric properties of a Portuguese translation of the Body Responsiveness Questionnaire (BRQ). A total of 650 men and women (aged 18-80 years) completed the Portuguese BRQ. To assess its convergent validity, participants also completed measures of body appreciation, emotion regulation, depression symptoms, and psychological quality of life. Exploratory factor analysis indicated a two-factor structure of the BRQ, which was upheld using confirmatory factor analysis: "Importance of Interoceptive Awareness" (ω = .85-.87) and "Perceived Connection" between body and mind (ω = .71-.74). BRQ scores had partial scalar invariance across gender, and no significant gender differences. Convergent and known-groups validity was supported. Participants with overweight/obesity (vs. normal weight) and middle-aged adults (vs. young adults) assigned higher importance to body signals to guide behavior. The Portuguese version of the BRQ is a psychometrically sound measure of body responsiveness and it may contribute to a comprehensive assessment of positive body image to guide intervention.

Mediators of outcome in adolescent psychotherapy and their implications for theories and mechanisms of change: a systematic review.

Psychotherapeutic treatment of adolescents requires age-specific approaches and thus plausibly also involves different change mechanisms than adult psychotherapy. To guide further research and improve therapeutic outcomes for adolescents, we reviewed all RCTs investigating mechanisms of change in the psychological treatment of adolescents to identify the most promising age-, disorder- or treatment-specific mediators. Following the preferred reporting items for systematic reviews (PRISMA), 106 studies were included that reported 252 statistical mediation tests assessed with 181 different measures. Most often studied and significant mediators were cognitive, followed by family-related, and behavioral variables. Several mediators were identified to be promising for future investigations: changes in negative thoughts, dysfunctional beliefs and metacognitive skills; family functioning and parenting skills; as well as successful engagement in therapy activities and increased impulse control. Symptom change during therapy was least often a mediator for other therapeutic changes. Relational and emotional mediators were largely understudied, whereas peer-influence appeared a promising mediator for intervention outcomes. Adolescence-specific mediators were most commonly investigated. Majority of studied mediators were not disorder-specific. There was a tendency to mainly test change mechanisms of specific theoretical models without considering other possible change theories. Further, virtually no studies fulfilled all criteria for rigorously investigating mediation and only nine were classified with an overall good study quality. While bearing in mind the current limitations in study designs, methodological rigor and reporting, there appears to be substantial evidence for transdiagnostic age-specific change models in the psychological treatment of adolescents. For future research, need for consensus on a core set of transdiagnostic and transtheoretical mediators and measures is highlighted. These should address likely core mechanisms of change, as well as take into account age-relevant developmental challenges and biological markers.

Salt Poisoning Due to Inadequate Infant Formula Preparation: A Rare Cause of Hypernatremia and Massive Cerebral Hemorrhage in a Newborn.

Salt poisoning is a rare cause of severe hypernatremia in children resulting from the ingestion of toxic amounts of sodium chloride, either from accidental or intentional administration of salted solutions. We present the case of a newborn admitted to a pediatric emergency department for lethargy and reduced oral intake; his laboratory evaluation showed severe hypernatremia ([Na+] of 174 mmol/L). The infant developed convulsive status epilepticus during treatment. Neuroimaging showed a tetraventricular hemorrhage, a large right-sided parenchymal hemorrhage with midline shift, and several left hemorrhagic foci. Etiologic evaluation for hypernatremia did not reveal a renal or extrarenal source of water loss nor an intercurrent illness to explain the reduced oral intake. A careful review of how the parents prepared the infant formula revealed an error in dosing the ratio of powder/water, resulting in hyperosmolar infant formula. The infant was diagnosed with salt poisoning as the major cause of hypernatremia. After careful correction of hypernatremia and the use of antiseizure medication, the patient improved and was discharged. The parents were given a careful review of instructions for infant formula preparation. Due to its rarity, a high index of suspicion is mandatory for a correct diagnosis of salt poisoning. Timely and adequate treatment is needed due to the high risk of intracerebral bleeding, seizures, and irreversible neurologic injury. Children, particularly newborns and infants, depend upon adults to ingest water and, thus, have more difficulty in maintaining electrolyte balance. Therefore, it is of utmost importance that parents are educated about childcare, particularly on the importance of careful infant formula preparation.

Quality of life in patients with inflammatory bowel disease: the role of positive psychological factors.

OBJECTIVE: To identify differences in quality of life (QoL) of patients with inflammatory bowel disease (IBD) between diagnosis (Crohn's Disease and Ulcerative Colitis), gender (male and female), treatment condition (with and without surgery), and attachment styles (secure, preoccupied, and disconnected); to examine associations between QoL, sociodemographic, clinical, and positive psychological variables; to determine whether sociodemographic, clinical, and positive psychological variables predict QoL. METHOD: The sample included 70 participants diagnosed with IBD (Mage = 43.37 years, SD = 12.81), of whom 71.4% were females and 67.1% had Crohn's Disease. Positive psychological variables (meaning in life, positive body image, and attachment styles), sociodemographic (age, education, gender) and clinical variables (diagnosis, disease duration, surgery) were assessed as independent variables. QoL was the dependent variable, analyzed through four domains (physical, psychological, social, environment). RESULTS: Participants with a secure attachment style reported higher QoL (physical, psychological, and social) than participants with a preoccupied attachment style. Strong positive correlations were found between positive psychological variables and QoL. Body appreciation was a significant predictor of three QoL domains (physical, psychological, and environment). Meaning in life made a unique contribution to the social QoL regression model, and it was also a significant predictor of psychological QoL. Body acceptance by others was a significant predictor of physical QoL, whereas disease duration and education predicted environment QoL. Attachment styles did not predict any QoL domain. CONCLUSION: The most significant predictors of QoL in patients with IBD were body appreciation and meaning in life. Body acceptance by others and body appreciation were the main predictors of physical QoL. Psychological interventions for patients who suffer from IBD should address body appreciation and meaning in life.

Mediators and Theories of Change in Psychotherapy for Young People With Personality Disorders: A Systematic Review Protocol.

Background: Personality disorders (PDs) are a severe health issue already prevalent among adolescents and young adults. Early detection and intervention offer the opportunity to reduce disease burden and chronicity of symptoms and to enhance long-term functional outcomes. While psychological treatments for PDs have been shown to be effective for young people, the mediators and specific change mechanisms of treatment are still unclear. Aim: As part of the "European Network of Individualized Psychotherapy Treatment of Young People with Mental Disorders" (TREATme), funded by the European Cooperation in Science and Technology (COST), we will conduct a systematic review to summarize the existing knowledge on mediators of treatment outcome and theories of change in psychotherapy for young people with personality disorders. In particular, we will evaluate whether mediators appear to be common or specific to particular age groups, treatment models, or outcome domains (e.g., psychosocial functioning, life quality, and adverse treatment effects). Method: We will follow the reporting guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement recommendations. Electronic databases (PubMed and PsycINFO) have been systematically searched for prospective, longitudinal, and case-control designs of psychological treatment studies, which examine mediators published in English. Participants will be young people between 10 and 30years of age who suffer from subclinical personality symptoms or have a personality disorder diagnosis and receive an intervention that aims at preventing, ameliorating, and/or treating psychological problems. Results: The results will be published in a peer-reviewed journal and at conference presentations and will be shared with relevant stakeholder groups. The data set will be made available to other research groups following recommendations of the open science initiative. Databases with the systematic search will be made openly available following open science initiatives. The review has been registered in PROSPERO (evaluation is pending, registration number ID 248959). Implications: This review will deliver a comprehensive overview on the empirical basis to contribute to the further development of psychological treatments for young people with personality disorders.

Mediators in Psychological Treatments for Anxiety and Depression in Adolescents and Young People: A Protocol of a Systematic Review.

INTRODUCTION: Anxiety and depressive disorders are a significant problem that starts in childhood or adolescence and should be addressed early to avoid chronic mental conditions. There is strong evidence to demonstrate that psychological treatments are effective for these disorders, however, little is known on mediators and mechanisms of change of psychological treatment in adolescents and young adults. Understanding the pathways through which psychological treatments operate will facilitate more effective treatments. AIM: We aim to conduct a systematic review, exploring the available evidence on mediators of psychological treatments for anxiety and depression in adolescents and young adults. METHODS: A systematic search has been performed on PubMed and PsycINFO databases to identify studies from inception to 23rd February 2020. Eligible studies include randomized controlled trials and trials (quasi-experimental) designs that have enrolled adolescents and young adults presenting with depression and/or anxiety and that have examined mediators of psychological treatments. A group of 20 reviewers from the COST-Action TREATme (CA16102) divided into 10 pairs independently screen studies for inclusion, extract information from the included studies, and assess the methodological quality of the included studies and the requirements for mediators. The methodological quality will be assessed by The Mixed Methods Appraisal Tool. Extracted data from the included studies will be collected and presented using a narrative approach. DISCUSSION: This systematic review will summarize and provide a comprehensive overview of the current evidence on mediators of psychological treatments for anxiety and depression for adolescents and young adults. Results will allow the identification of strategies to optimize intervention to enhance clinical outcomes. ETHICS AND DISSEMINATION: Ethics approval is not required. Findings from this systematic review will be published in a peer-reviewed journal and disseminated at conferences and meetings. PROSPERO registration number: CRD42021234641.

Mediators and theories of change in psychotherapy with adolescents: a systematic review protocol.

INTRODUCTION: Approximately 75% of mental disorders emerge before the age of 25 years but less than half receive appropriate treatment. Little is known about the mechanisms underlying the therapeutic change of adolescents in psychotherapy. The 'European Network of Individualised Psychotherapy Treatment of Young People with Mental Disorders', funded by the European Cooperation in Science and Technology, will conduct the first systematic review to summarise the existing knowledge on mediators and theories of change in psychotherapy for adolescents. METHOD: A systematic review will be conducted, conforming to the reporting guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement recommendations. Electronic databases (PubMed and PsycINFO) have been systematically searched on 23 February 2020, for prospective, longitudinal and case-control designs which examine mediators of change. Participants will be adolescents between 10 and 19 years of age who suffer from a mental disorder or psychological difficulties and receive an intervention that aims at preventing, ameliorating and/or treating psychological problems. ETHICS AND DISSEMINATION: Ethical approval is not required for this systematic review as no primary data will be collected. The results will be published in a peer-reviewed journals and at conference presentations and will be shared with stakeholder groups. The whole data set will be offered to other research groups following recommendations of the open science initiative. Databases with the systematic search will be made openly available following open science initiatives. PROSPERO REGISTRATION NUMBER: CRD42020177535.

Vital and Nonvital Pulp Therapy in Primary Dentition: An Umbrella Review.

Dental caries is the most common non-communicable disease in children with significant aesthetic, functional, and quality of life deterioration. Depending on the depth, two approaches may be considered in primary dentition: vital pulp therapy (VPT) or non-vital therapy (NPT). This umbrella review aimed to critically assess the available systematic reviews (SRs) on VPT and NPT. An electronic database search was conducted (PubMed, Embase, Scopus, Cochrane, Web of Science, and LILACS) until June 2021. The Risk of Bias (RoB) of SRs was analyzed using the Measurement Tool to Assess SRs criteria 2 (AMSTAR2). From 272 entries, 33 SRs were included. Regarding the methodological quality, three studies were critically low, nine low, seventeen moderate, and six were rated as high quality. The quality of evidence produced by the available SRs was moderate. Future high standard SRs and well-designed clinical trials are warranted to better elucidate the clinical protocols and outcomes of VPT and NPT.

Theories of Change and Mediators of Psychotherapy Effectiveness in Adolescents With Externalising Behaviours: A Systematic Review.

BACKGROUND: Externalising behaviours are becoming a remarkably prevalent problem during adolescence, often precipitating both externalising and internalising disorders in later adulthood. Psychological treatments aim to increase the social functioning of adolescents in order for them to live a more balanced life and prevent these negative trajectories. However, little is known of the intervening variables and mediators involved in these treatments' change mechanisms. We conducted a systematic review, exploring the available evidence on mediators of psychological treatments for externalising behaviours and symptoms amongst adolescents (10 to 19 years old). METHODS: A systematic search was performed on Medline and PsycINFO databases, which identified studies from inception to February 23, 2020. Eligible studies included randomised controlled trials that enrolled adolescents with externalising symptoms and behaviours as, at least, one of the primary outcomes. A group of 20 reviewers from the COST-Action TREATme (CA16102) were divided into 10 pairs. Each pair independently screened studies for inclusion, extracted information from the included studies, and assessed the methodological quality of the included studies and the requirements for mediators, following Kazdin's criteria. Risk of bias of RCTs was assessed by the Mixed Methods Appraisal Tool. Extracted data from the included studies were reported using a narrative synthesis. RESULTS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA), after removing duplicates, 3,660 articles were screened. Disagreements were resolved by consensus. In a second stage, 965 full-text articles were assessed for eligibility. A total of 14 studies fulfilled all inclusion criteria. The majority were related to systemic psychological treatment approaches. Two types of mediators were identified as potentially being involved in the mechanisms of change for better social improvements of adolescents: to increase healthier parent-adolescent relationships and parental discipline. However, there were significant and non-significant results amongst the same mediators, which led to discussing the results tentatively. CONCLUSIONS: Family variables were found to be the largest group of investigated mediators, followed by relational, behavioural, and emotional variables. No cognitive or treatment-specific mediators were identified. Both adequate behavioural control of adolescents' peer behaviour and a better positive balance in their relationships with their parents seemed to buffer the effects of externalising behaviours in adolescents. Several methodological limitations concerning mediation testing design, outcome measures, and mediator selection have been identified. ETHICS AND DISSEMINATION: Ethical approval was not required. PROSPERO registration number: CRD42021231835.

The Impact of [C16Pyr][Amp] on the Aggressiveness in Breast and Prostate Cancer Cell Lines.

Breast (BrCa) and prostate (PCa) cancers are the most common malignancies in women and men, respectively. The available therapeutic options for these tumors are still not curative and have severe side effects. Therefore, there is an urgent need for more effective antineoplastic agents. Herein, BrCa, PCa, and benign cell lines were treated with two ionic liquids and two quinoxalines and functional experiments were performed-namely cell viability, apoptosis, cytotoxicity, and colony formation assays. At the molecular level, an array of gene expressions encompassing several molecular pathways were used to explore the impact of treatment on gene expression. Although both quinoxalines and the ionic liquid [C2OHMIM][Amp] did not show any effect on the BrCa and PCa cell lines, [C16Pyr][Amp] significantly decreased cell viability and colony formation ability, while it increased the apoptosis levels of all cell lines. Importantly, [C16Pyr][Amp] was found to be more selective for cancer cells and less toxic than cisplatin. At the molecular level, this ionic liquid was also associated with reduced expression levels of CPT2, LDHA, MCM2, and SKP2, in both BrCa and PCa cell lines. Hence, [C16Pyr][Amp] was shown to be a promising anticancer therapeutic agent for BrCa and PCa cell lines.

Congenital SARS-CoV-2 Infection in a Neonate With Severe Acute Respiratory Syndrome.

Coronavirus disease, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is mainly transmitted through droplets, but other ways of transmission have been hypothesized. We report a case of vertical transmission of SARS-CoV-2 in a preterm born to an infected mother, confirmed by the presence of the virus in the neonatal blood, nasopharyngeal and oropharyngeal swabs collected in the first half an hour of life. The neonate presented with acute respiratory distress, similar to the findings in severely affected adults. This case highlights the importance of pregnancy, labor and neonatal period surveillance of affected mothers and their newborns.

Eu gosto é do verão: psicodrama com adolescentes nas férias de verão / What I do like is the summer: psychodrama with adolescents on summer holidays / Me gusta lo verano: psicodrama con adolescentes en vacaciones de verano

Este artigo apresenta uma intervenção psicodramática com sete adolescentes ao longo de oito sessões no período de férias escolares de verão, que decorreu numa clínica hospitalar de Psiquiatria e Saúde Mental do norte de Portugal. A pertinência da manutenção do processo psicoterapêutico já iniciado em alguns adolescentes, e a necessidade de dar uma resposta psicoterapêutica a outros, fez com que se desse continuidade a um grupo de intervenção durante o verão, altura em que o acompanhamento grupal é habitualmente suspenso. Considera-se que a presença nestas sessões, para além da ação terapêutica, pôde constituir-se como uma continuidade do cumprimento de um compromisso semanal extrínseco ao contexto sociofamiliar pela promoção de trocas sociais com pares comprometidas pela interrupção escolar. O estudo, de caráter retrospectivo, teve como objetivo identificar os problemas/dificuldades, assim como compreender a experiência subjetiva dos adolescentes sobre o processo terapêutico em grupo de psicodrama. Para tal, foi aplicado um conjunto de instrumentos ideográficos antes, durante e após a intervenção. Os resultados deste estudo serão discutidos tendo em conta as implicações para a investigação e prática clínica psicodramática. A avaliação final da experiência sugere que o psicodrama promoveu mudanças ao nível do comportamento e funcionamento psicológico dos adolescentes, nomeadamente na diminuição da percepção de ansiedade e de desadequação no desempenho social, na melhoria do autoconceito e da identificação/expressão emocional que são reveladoras de saúde mental.

This article reports a psychodramatic intervention with seven adolescents over eight sessions during the summer school holidays, which took place in a hospital clinic of Psychiatry and Mental Health in Northern Portugal. The relevance for some of the adolescents to maintain the psychotherapeutic process already started, as well as the need to provide a psychotherapeutic response to others, has led to an intervention group during summer vacation, a period during which group monitoring is usually suspended. Besides the therapeutic effect, attendance of those sessions was regarded as the opportunity to fulfill a weekly commitment external to the socio-family context, by promoting social exchanges with peers, compromised by the school interruption. This retrospective analysis aimed to identify problems/difficulties, as well as to understand the subjective experience of adolescents about the therapeutic process in a group of psychodrama. To this end, a set of ideographic instruments was applied before, during and after the intervention. The results of this study will be discussed taking into account the implications for research and clinical psychodrama practice. The final evaluation of the experience suggests that psychodrama promoted changes in the behavior and psychological functioning of adolescents, namely in decreasing the perception of anxiety and inadequate social performance, in improving self-concept and identification/emotional expression revealing mental health.

Este artículo presenta una intervención psicodramática con siete adolescentes durante ocho sesiones durante las vacaciones escolares de verano, que tuvo lugar en una clínica hospitalaria de psiquiatría y salud mental en el norte de Portugal. La relevancia de algunos adolescentes para mantener el proceso psicoterapéutico ya iniciado y la necesidad de proporcionar una respuesta psicoterapéutica a otros ha llevado a un grupo de intervención durante el verano, cuando el monitoreo grupal generalmente se suspende. Se considera que la presencia en estas sesiones, más allá de la acción terapéutica, podría constituirse como una continuidad del cumplimiento de un compromiso semanal externo al contexto socio-familiar, promoviendo intercambios sociales con compañeros, comprometidos por la interrupción escolar. El estudio retrospectivo tuvo como objetivo identificar problemas/dificultades, así como comprender la experiencia subjetiva de los adolescentes sobre el proceso terapéutico en un grupo de psicodrama. Para ello, se aplicó un conjunto de instrumentos ideográficos antes, durante y después de la intervención. Los resultados de este estudio se discutirán teniendo en cuenta las implicaciones para la investigación y la práctica del psicodrama clínico. La evaluación final de la experiencia sugiere que el psicodrama promovió cambios en el comportamiento y funcionamiento psicológico de los adolescentes incluyendo disminución de la percepción de ansiedad y de desempeño social inadecuado, mejora del autoconcepto y la identificación/expresión emocional, revelando salud mental.

Emotion-Focused Cognitive Behavioral Therapy in Comorbid Obesity With Binge Eating Disorder: A Pilot Study of Feasibility and Long-Term Outcomes.

Obesity coupled with binge eating disorder (BED) is an increasing problem. Incorporation of treatment strategies that address both problems in people with comorbid symptoms is of major interest. This study aimed to investigate the feasibility and preliminary long-term outcomes of a brief emotion-focused cognitive behavioral therapy (EF-CBT) program. Seven out of 10 women with obesity and BED completed the intervention. Standardized outcome measures to assess the intensity of distress caused by complaints, psychological distress, emotional processing, eating behavior, and weight loss were completed at baseline, end-of-treatment, 6- and 18-month follow-ups. Individualized outcome measures were also applied to describe the personal experiences during the intervention. Findings suggest the program's long-term efficacy for improving psychological distress, emotional processing, and alexithymia. Positive reliable changes in emotional processing and alexithymia were observed in almost all participants. The mean intensity of distress caused by complaints also decreased at the end of the intervention, with a large effect size (d = 0.89). Reliable changes in these outcome measures were observed at all time-points, despite the mean scores for the 18-month follow-up suggest a retraction in improvement. Weight loss was below expectations at all time-points, as were changes in emotional and external eating. Restrained eating mean scores remained stable throughout the study. Participants perceived the program to be useful in improving emotional awareness and eating control. Program feasibility was supported by the retention rate (70%) and the average number of attended sessions (M = 9.71; SD = 2.06). Further studies are needed to examine the effectiveness of EF-CBT interventions.

Therapeutic Mask: An Intervention Tool for Psychodrama With Adolescents.

Psychodrama is an effective psychotherapeutic model but interventions with adolescents require age-tailored techniques that maximize engagement and facilitate communication processes. This study describes a novel adaptation of a therapeutic mask technique to psychodrama with adolescents. Over the course of eight group sessions of psychodrama, five adolescents (16 to 18 years-old) created their own mask and explored its therapeutic use. Their experiences were captured at the end of each session with the Helpful Aspects of Therapy (HAT) form, and at the end of the study with the Clinical Change Interview (CCI). Awareness/insight/self-understanding, empowerment and relief were the most significant aspects experienced by the adolescents, along with perceived increase of calmness and world connection, satisfaction in interpersonal communication and better emotional expression and regulation. The mask technique was experienced as a playful and engaging task that facilitated insight and interpersonal communication. Findings provide preliminary evidence on the clinical utility of mask-based psychodrama with adolescents.

Expression of EMT-Related Genes CAMK2N1 and WNT5A is increased in Locally Invasive and Metastatic Prostate Cancer.

Purpose: Prostate cancer (PCa) varies clinically from very indolent, not requiring therapeutic intervention, to highly aggressive, entailing radical treatment. Currently, stratification of PCa aggressiveness is mostly based on Gleason score, serum PSA and TNM stage, but outcome prediction in an individual basis is suboptimal. Thus, perfecting pre-therapeutic discrimination between indolent and aggressive PCa, avoiding overtreatment is a major challenge. Epithelial to mesenchymal transition (EMT) allows epithelial cells to acquire mesenchymal properties, constituting a critical step in tumor invasion and metastization. Thus, we hypothesized that EMT-related markers might allow for improved assessment of PCa aggressiveness. Methods and Results: Using RealTime ready Custom Panel 384 assay, 93 EMT-related genes were assessed in normal prostate tissues (NPT, n=5), stage pT2a+b-PCa (n=5) and stage pT3b-PCa (n=5), from which CAMK2N1, CD44, KRT14, TGFß3 and WNT5A genes emerged as the most significantly altered. Expression levels were then evaluated in a larger series (16 NPT and 94 PCa) of frozen tissues using quantitative RT-PCR. Globally, CAMK2N1, CD44 and WNT5A displayed higher expression levels at higher stages and less differentiated PCa. CAMK2N1 and WNT5A immunoexpression analysis disclosed significantly lower expression in NPT and increasing proportion of high-expression cases from pT2a+b to pT3b and metastatic PCa. Furthermore, higher CAMK2N1 and WNT5A transcript levels associated with shorter disease-free and disease-specific survival. In multivariable analysis, a trend for WNT5A expression levels to independently predict DFS was disclosed (p=0.056). Conclusions: Globally, our findings suggest an association between PCa aggressiveness and increased expression of CAMK2N1 and WNT5A, reflecting the acquisition of effective EMT characteristics by PCa cells.

Pneumomediastinum and subcutaneous emphysema: complication of cocaine use.

Pneumomediastinum is more frequent in young men and usually presents in association with subcutaneous emphysema. It can occur in case of oesophageal or chest trauma, be iatrogenic or develop spontaneously, in case of emesis, coughing or forceful straining. Use of illicit drugs, such as cocaine, has been associated with multiple respiratory complications, including pneumomediastinum and subcutaneous emphysema. The pathogenesis of subcutaneous emphysema and pneumomediastinum after cocaine inhalation is not completely known, but it is thought that the physical manoeuvers used to increase its absorption and effect may lead to alveolar rupture, resulting in air escaping into the mediastinum and fascial planes of the neck and chest. Chest X-ray is usually diagnostic, but CT can be used as complementary study, allowing evaluation of adjacent structures. A case of pneumomediastinum and subcutaneous emphysema after cocaine inhalation in an otherwise healthy man is presented.

[Metabolic Bone Disease of Prematurity in Very Low Birthweight Infants: Retrospective Observational Study]. / Doença Metabólica Óssea da Prematuridade em Recém-Nascidos de Muito Baixo Peso: Estudo Observacional Retrospetivo.

INTRODUCTION: Metabolic bone disease of prematurity consists in a decrease of bone matrix mineral content, in comparison with the level expected for gestational age. Screening of this condition is based on serum alkaline phosphatase and phosphate levels. The aim of this study is to evaluate the prevalence of metabolic bone disease of prematurity, to assess the aspects associated with a higher risk of this disease and to describe the growth of newborns with birth weight below 1500 g and metabolic bone disease of prematurity. MATERIAL AND METHODS: Observational, retrospective, multicenter and descriptive study in three neonatal intensive care units in Portugal, from May 1st 2016 to April 30th 2017. A convenience sample of very low birthweight newborns was obtained. Demographic, clinical, and laboratory variables were described in newborns with and without metabolic bone disease of prematurity. RESULTS: A total of 53 newborns were included in this study: 30 males, 16 with gestational age ≤ 28 weeks. Five cases of metabolic bone disease of prematurity were diagnosed. In this group, the majority of patients was male and presented a lower gestational age and birth weight, in comparison with the group without metabolic bone disease of prematurity. The average duration of parenteral nutrition was higher in newborns with metabolic bone disease of prematurity and the calcium/phosphate ratio was lower than the recommended values. Growth was similar in both groups. No patient with metabolic bone disease of prematurity underwent physical rehabilitation. DISCUSSION: The prevalence of metabolic bone disease of prematurity was 9.43%, which is lower than what is described in the literature. However, only 50% of newborns completed the screening according to the recommendations. The main risk factors identified concur with the literature. CONCLUSION: Metabolic bone disease of prematurity is a frequent but underdiagnosed comorbidity in very low birthweight newborns. It is essential to screen newborns at risk for this condition, using biochemical markers, as well as structure nutritional interventions and physical stimulation in order to avoid short and long-term consequences of this disease.

Introdução: A doença metabólica óssea da prematuridade consiste numa diminuição da matriz óssea, relativamente ao nível esperado para a idade gestacional. O rastreio baseia-se no doseamento sérico da fosfatase alcalina e fósforo. O objetivo deste estudo é avaliar a prevalência da doença metabólica óssea da prematuridade, analisar os aspetos associados a maior risco para esta doença e descrever o crescimento estaturo-ponderal dos recém-nascidos com peso ao nascer inferior a 1500 g, com doença metabólica óssea da prematuridade. Material e Métodos: Estudo multicêntrico, retrospetivo, observacional e descritivo em três unidades de apoio perinatal diferenciado, entre 1 de maio de 2016 e 30 de abril de 2017; foi obtida uma amostra de conveniência de recém-nascidos com muito baixo peso ao nascer. Descrevem-se as variáveis demográficas, clínicas e laboratoriais dos recém-nascidos com e sem doença metabólica óssea da prematuridade. Resultados: Neste estudo foram incluídos 53 recém-nascidos: 30 do sexo masculino, 16 com idade gestacional ≤ 28 semanas. Foram diagnosticados cinco casos de doença metabólica óssea da prematuridade. Neste grupo, a maioria dos doentes era do sexo masculino e apresentavam idade gestacional e peso ao nascer inferior aos do grupo sem doença metabólica óssea da prematuridade. A duração média de nutrição parentérica foi superior nos recém-nascidos com doença metabólica óssea da prematuridade e a relação cálcio/fósforo utilizada foi inferior às recomendações nacionais. A evolução estaturo-ponderal foi semelhante nos recém-nascidos com e sem doença. Nenhum doente com doença metabólica óssea da prematuridade teve intervenção por medicina física e reabilitação. Discussão: A prevalência de doença metabólica óssea da prematuridade foi de 9,43%, valor inferior ao descrito na literatura. Contudo, apenas 50% dos recém-nascidos cumpriram o rastreio de acordo com as recomendações. Os principais fatores de risco identificados estão de acordo com a literatura. Conclusão: A doença metabólica óssea da prematuridade é uma comorbilidade frequente nos recém-nascidos de muito baixo peso, mas encontra-se subdiagnosticada. É fundamental rastrear os recém-nascidos em risco para esta patologia, utilizando marcadores bioquímicos, assim como estruturar intervenções nutricionais e estimulação física para evitar as consequências da doença a curto e longo prazo.

Mirizzi syndrome: when the gallbladder meets bile ducts.

A 64-year-old female presented to the Emergency Department with jaundice, choluria, fever and abdominal pain over the last few days. The abdomen was tender with epigastric pain on palpation.