Oxytocin as a treatment for high-risk psychosis or early stages of psychosis: a mini review.

Individuals at clinical high risk for psychosis (CHR-P) present as help-seeking individuals with social deficits as well as cognitive and functional impairment and have a 23-36% risk of transition to first-episode psychosis. The therapeutic role of intranasal oxytocin (ΟΤ) in psychiatric disorders has been widely studied during the last decades, concerning its effects on social behavior in humans. A literature search was conducted via Pubmed and Scopus, using the search terms "oxytocin" and "psychosis." Six studies were included in the current review. There were differences in terms of demographics, intervention type, and outcome measures. ΟΤ may affect the social cognition skills of people at prodromal and early stages of psychosis, but its effect on clinical symptoms is ambiguous. Because of the high level of heterogeneity of existing studies, more original studies are needed to examine and clarify whether OT improves high-risk and early psychosis populations.

Modified Anterolateral Minimally Invasive Surgery (ALMIS) for Total Hip Replacement: Anatomical Considerations, Range of Motion and Clinical Outcomes.

Background and Objectives: In the modified anterolateral minimally invasive surgery (ALMIS) for total hip arthroplasty (THA), the intermuscular plane between the tensor fasciae latae and the gluteus maximus (GM) is exposed, while the anterior » of the GM is detached. There are scarce data regarding this surgical approach. The purpose of the present study is to thoroughly describe this approach, encompassing the anatomical background, and to present the results of a retrospective two-center study of 603 patients. Materials and Methods: The present study includes a two-center retrospective observational cohort of 603 patients undergoing the ALMIS technique with minimum 5-year follow-up. Demographics were recorded, while range of motion (ROM) of the hip joint and the Harris Hip Score (HHS) were evaluated preoperatively, at 1, 3 and 12 months postoperatively and at the final follow-up (>5 years). Surgery-related complications were also recorded. Results: The studied population's mean age was 69.4 years, while most of them were females (397; 65.8%). The mean follow-up was 6.9 years. The median HHS at the 1-month follow-up was 74, compared to the 47 preoperatively (p-value < 0.0001). At the final follow-up, median HHS was 94. At the 1-month follow-up, mean adduction was 19.9° (compared to 15.4° preoperatively; p < 0.0001), mean abduction 24.3° (18.2° preoperatively; p < 0.0001), mean flexion 107.8° (79.1° preoperatively; p < 0.0001), mean external rotation 20.1° (12.1° preoperatively; p < 0.0001) and mean internal rotation 15.3° (7.2° preoperatively; p < 0.0001). ROM further improved until the final follow-up; mean adduction reached 22°, mean abduction 27.1°, mean flexion 119.8°, mean external rotation 24.4° and mean internal rotation 19.7°. Regarding complications, 1.3% of the sample suffered anterior traumatic dislocation, in 1.8% an intraoperative femoral fracture occurred, while 1.2% suffered periprosthetic joint infection. Conclusions: The modified ALMIS technique exhibited excellent clinical outcomes at short-, mid- and long-term follow-up, by significantly improving hip ROM and the HHS. Careful utilization of this technique, after adequate training, should yield favorable outcomes, while minimal major complications should be expected.

Nursing Students' Computer Anxiety and Attitudes Before and During the COVID-19 Pandemic.

Purpose of this research was to investigate how the COVID-19 pandemic affected the level of computer anxiety of nursing students and also their attitude related to computer use. A cross-sectional study was conducted in two periods, one before the COVID-19 pandemic (1st period) and the second during the COVID-19 pandemic (2nd period). The research instrument consisted of three parts, a questionnaire with questions about demographic and educational characteristics such as gender and semester of study, the Computer Anxiety Rating Scale (CARS), that used to assess the nursing students' levels of computer anxiety and the Computer Attitude Scale (CAS) that used to measure nursing students' positive and negative attitudes towards computers. Data from 957 undergraduate nursing students were obtained. Specifically, in the 1st period, 370 nursing students participated (38.66%), while in the 2nd period 587 (61.34%) undergraduates participated. The anxiety of participants during COVID-19 pandemic period was reduced compared to that of participants before the COVID-19 period. Respondents during the COVID-19 pandemic have fewer negative feelings towards computers, based on their answers in contrast to the participants in the study before the COVID-19 pandemic. Computer anxiety and attitudes have change among nursing students among COVID-19 pandemic. Nursing students after the implementation of online training are reporting positive feeling towards computer use and are more confident for their ICT skills.

Early Clinical and Radiographic Outcomes of Total Hip Arthroplasty with DELTA ST-C Cup and MINIMA S Stem.

Background and Objectives: The uncemented threaded DELTA ST-C cup was introduced in last few years. It has a hemispheric shell, consisting of Ti6Al4V titanium alloy. The MINIMA S stem was developed according to the principles of proximal-loading and extended metaphyseal geometry applied to a short stem. The purpose of the study was to assess the clinical and radiographic outcomes and the short- and mid-term survivorship of the DELTA ST-C cup and MINIMA S stem in patients undergoing total hip arthroplasty (THA). The present is the first study to report outcomes and implant survivorship of the DELTA ST-C cup coupled with the MINIMA S femoral stem. Materials and Methods: The present study is a retrospective observational cohort study of a prospectively maintained database, evaluating clinical outcomes and implant survivorship in 95 patients undergoing THA with the MINIMA stem coupled with the DELTA ST-C cup with at least a 3-year follow-up. The clinical evaluation was assessed with a change in the Harris hip score (HHS), while the radiographic evaluation included anteroposterior views of the pelvis and lateral views of the affected hip. Results: The enrolled population's mean age was 69.3 years and most patients were female (64%). The MINIMA S standard stem was implanted in 68 patients (72%), the lateralized stem was implanted in 27 (28%), and the mean acetabular inclination was 48.2°. The HHS improved significantly from the preoperative value (median 46, IQR: 38-55), already at 1 month after surgery (median 76, IQR: 66-77), reaching excellent results at 1 year and 3 years postoperatively (median 96, IQR: 91-100). X-rays demonstrated good implant stability and biomechanics parameter restorations revealed no sign of subsidence, and the presence of radiolucent lines greater than 2 mm in the short stem area in five cases and in the acetabulum in one were not clinically significant. No revisions have been performed so far. Conclusions: The MINIMA S stem coupled with the DELTA ST-C cup demonstrated very good clinical and radiological results with a significant increase of the Harris hip score at short- and mid-term follow-up. This is the first study evaluating the DELTA ST-C cup, showing promising outcomes during the study's follow-up. The MINIMA S stem has been evaluated in a very few studies. However, the combination with this particular cup had not yet been studied. The design of the stem and the cup ensures primary stability and excellent early term outcomes, moreover the study demonstrates extraordinary implant survivorship, equal to 100%.

Splenic Artery Infarct Requiring Surgery: A Rare Complication of COVID-19 Infection.

Introduction. Coronavirus disease (COVID-19) from SARS-CoV-2 infection is linked to a hypercoagulable state, leading to arterial and venous thrombotic events, of which pulmonary embolism is the most frequent. However, arterial thromboembolisms may also occur as visceral infracts in unusual sites, such as the renal, splenic, and intestinal arteries. Case Report. A 46-year-old unvaccinated male with a COVID-19 infection was admitted to the COVID-19 isolation ward with symptoms of respiratory infection. He complained of epigastric pain and fever for several days; radiological imaging of the abdomen revealed complete splenic arterial occlusion due to a large infarct. He was treated with low molecular weight heparin (enoxaparin) in therapeutic doses, resulting in minimal improvement. However, the pain worsened, and eventually, a laparotomy and splenectomy were performed. He was hospitalized for another 36 days before he was discharged in good condition. A second surgery was performed to remove a noninfected encapsulated hematoma from the subdiaphragmatic space. The patient remained healthy afterward, with no relapses. Discussion. Although rare, the number of cases of visceral infarcts in COVID-19 patients has increased. Splenic artery infarct is an exceptional case of acute abdominal pain that can be treated successfully with anticoagulant medication. Splenectomy may be required to manage refractory pain after failure of conservative management.

Quality of Life in Patients With Inflammatory Bowel Disease: Importance of Psychological Symptoms.

Background Depressive, anxiety, and stress symptoms are prevalent in patients with inflammatory bowel disease (IBD) and may negatively influence the disease course and quality of life. The study aimed to assess the relationship between psychological factors and patients' quality of life (QoL). Materials and methods A cross-sectional study with the use of a structured questionnaire among 38 patients with Crohn's disease and 30 with ulcerative colitis was conducted. The inflammatory bowel disease questionnaire (IBDQ-32) was used to evaluate the patients' quality of life, and the Depression, Anxiety, Stress Scale (DASS21) was used to evaluate these psychological factors. Pearson descriptive statistics and multiple regression analyses were performed. Results According to the findings of the multiple regression analysis, depressive, anxiety, and stress symptoms were negatively associated with quality of life. Participants with higher scores of anxiety had inferior QoL in intestinal symptoms (p=0.013) and in systemic symptoms (p=0.013), with higher scores of depression had inferior QoL in emotional function (p<0.001), and higher scores of stress had inferior QoL in the domain of social support (p=0.002). Psychological symptoms of emotional disorders appear to be associated with lower quality of life in IBD patients. Conclusion This study examined levels of depression, anxiety, and stress in Greek patients with IBD, which were associated with lower levels of their quality of life. Interventions to improve QoL in patients with IBD should consider the effect of psychological symptoms.

Self-efficacy, stress levels and daily style of living among older patients with type 2 diabetes in a rural primary care setting: a cross-sectional study.

Aims: To identify to what extent stress and self-efficacy may be associated with specific features in the elderly with type 2 diabetes, such as lifestyle habits, multi-morbidity, sleep quality and duration, and treatment regimen. Methods: A cross-sectional study of 92 out of 103 recruited patients ≥65 year old with a diagnosis of type 2 diabetes was conducted at a rural primary care unit in Northern Greece. The General Self-Efficacy Scale (GSES), the Short Anxiety Screening Test (SAST) and an original questionnaire to assess health habits and disease monitoring information were completed after structured personal interviews. Results: In the multiple linear regression analysis, patients with higher education, with more night sleeping hours and physical exercise weekly had a higher GSES score than their counterparts (p<0.05). Stress levels assessed with SAST were shown mostly associated with poor sleep quality, fewer days of meat and legumes consumption, increased body mass index and multi-morbidity (p<0.05), as emerged from the multiple linear regression analysis. Glycemic control in the elderly does not have a significant correlation with stress levels or general self-efficacy. Conclusions: Self-efficacy and stress levels are not predictors for glycemic control, but can indirectly be seen as co-determinants, contributing to the overall daily life quality among patients with diabetes. Mental health well-being, expressed by higher self-efficacy and less stress scale rating, showed positive interferences with eating, sleep and daily life attitudes among elderly with diabetes.

Neutrophil-to-Lymphocyte, Monocyte-to-Lymphocyte, Platelet-to-Lymphocyte Ratio and Systemic Immune-Inflammatory Index in Different States of Bipolar Disorder.

The neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR) and systemic immune-inflammatory (SII) index, which provide a simple, rapid, inexpensive method to measure the level of inflammation, have been examined as potential inflammatory biomarkers of bipolar disorder (BD) in several studies. We conducted a case-control study recruiting 180 BD patients and 407 healthy controls. BD patients who met the inclusion criteria and were hospitalized due to BD at the psychiatry clinic of the University General Hospital of Larisa, Greece, until September 2021 were included in the study. Among them, 111 patients experienced a manic episode and 69 patients experienced a depressive episode. Data including a complete blood count were retrieved from their first admission to the hospital. Bipolar patients had a higher NLR, MLR and SII index compared to healthy controls when they were experiencing a manic episode (p < 0.001) and a depressive episode (p < 0.001). MLR was increased with large effect size only in patients expressing manic episodes. Neutrophils and NLR had the highest area under the curve with a cutoff of 4.38 and 2.15 in the ROC curve, respectively. Gender-related differences were mainly observed in the SII index, with males who were expressing manic episodes and females expressing depressive episodes having an increased index compared to healthy controls. The NLR, MLR and SII index were significantly higher in patients with BD than in healthy controls, which implies a higher grade of inflammation in BD patients.

Watch Out for Burnout in COVID-19: A Greek Health Care Personnel Study.

The aim of the current study was to examine the mental well-being of healthcare personnel (HCP) working in COVID-19 units in Greece and to calculate the prevalence of burnout (BO) amongst them. A questionnaire based on the Maslach Burnout Inventory for Medical Personnel was utilized between February 21st, 2021 and March 5th, 2021. A total of 190 HCP responded to the questionnaire, of which 73.7% were nurses and midwives. The mean age of the participants was 38.3 (8.4) years. Overall, 71.6% of the participants had a high BO score, while 20.5% had a moderate and 7.9% had a low BO score. Night shifts in COVID-19 wards and job dissatisfaction were significantly associated with a high BO score (P = .03 and P < .0001, respectively). The majority of HCP working in COVID-19 wards in Greece is experiencing high levels of overall BO and emotional exhaustion.

"The effects of family therapeutic interventions on mental health and quality of life of children with cancer: A systematic review".

BACKGROUND: The diagnosis of a childhood malignancy and the following period are very stressful for the little patient and the whole family. Depression, anxiety, and poor quality of life (QoL) are some of the negative effects of pediatric cancer to the children and their parents. Family therapeutic interventions aim to improve mental health and QoL of these children. METHODS: A systematic search of the electronic database PubMed was conducted for articles that studied the effect of family therapeutic interventions on mental health and QoL of children with cancer. RESULTS: A total of 634 articles were evaluated, of which 10 articles met the inclusion criteria. A percentage of 70% of the studies, representing seven different types of interventions, seemed to be beneficial for the participant's mental health and QoL. The remaining three studies did not significantly improve mental health and QoL. CONCLUSION: The results of our review indicate that family psychosocial interventions are beneficial for children with cancer. These children and their families are a growing population requiring more patient-centered, time flexible interventions which may enhance family bonding and patients' positive emotions.

Glutathione and glutamate in schizophrenia: a 7T MRS study.

In schizophrenia, abnormal neural metabolite concentrations may arise from cortical damage following neuroinflammatory processes implicated in acute episodes. Inflammation is associated with increased glutamate, whereas the antioxidant glutathione may protect against inflammation-induced oxidative stress. We hypothesized that patients with stable schizophrenia would exhibit a reduction in glutathione, glutamate, and/or glutamine in the cerebral cortex, consistent with a post-inflammatory response, and that this reduction would be most marked in patients with "residual schizophrenia", in whom an early stage with positive psychotic symptoms has progressed to a late stage characterized by long-term negative symptoms and impairments. We recruited 28 patients with stable schizophrenia and 45 healthy participants matched for age, gender, and parental socio-economic status. We measured glutathione, glutamate and glutamine concentrations in the anterior cingulate cortex (ACC), left insula, and visual cortex using 7T proton magnetic resonance spectroscopy (MRS). Glutathione and glutamate were significantly correlated in all three voxels. Glutamine concentrations across the three voxels were significantly correlated with each other. Principal components analysis (PCA) produced three clear components: an ACC glutathione-glutamate component; an insula-visual glutathione-glutamate component; and a glutamine component. Patients with stable schizophrenia had significantly lower scores on the ACC glutathione-glutamate component, an effect almost entirely leveraged by the sub-group of patients with residual schizophrenia. All three metabolite concentration values in the ACC were significantly reduced in this group. These findings are consistent with the hypothesis that excitotoxicity during the acute phase of illness leads to reduced glutathione and glutamate in the residual phase of the illness.

Abnormal visuomotor processing in schizophrenia.

Subtle disturbances of visual and motor function are known features of schizophrenia and can greatly impact quality of life; however, few studies investigate these abnormalities using simple visuomotor stimuli. In healthy people, electrophysiological data show that beta band oscillations in sensorimotor cortex decrease during movement execution (event-related beta desynchronisation (ERBD)), then increase above baseline for a short time after the movement (post-movement beta rebound (PMBR)); whilst in visual cortex, gamma oscillations are increased throughout stimulus presentation. In this study, we used a self-paced visuomotor paradigm and magnetoencephalography (MEG) to contrast these responses in patients with schizophrenia and control volunteers. We found significant reductions in the peak-to-peak change in amplitude from ERBD to PMBR in schizophrenia compared with controls. This effect was strongest in patients who made fewer movements, whereas beta was not modulated by movement in controls. There was no significant difference in the amplitude of visual gamma between patients and controls. These data demonstrate that clear abnormalities in basic sensorimotor processing in schizophrenia can be observed using a very simple MEG paradigm.

A Modular Repository-based Infrastructure for Simulation Model Storage and Execution Support in the Context of In Silico Oncology and In Silico Medicine.

The plethora of available disease prediction models and the ongoing process of their application into clinical practice - following their clinical validation - have created new needs regarding their efficient handling and exploitation. Consolidation of software implementations, descriptive information, and supportive tools in a single place, offering persistent storage as well as proper management of execution results, is a priority, especially with respect to the needs of large healthcare providers. At the same time, modelers should be able to access these storage facilities under special rights, in order to upgrade and maintain their work. In addition, the end users should be provided with all the necessary interfaces for model execution and effortless result retrieval. We therefore propose a software infrastructure, based on a tool, model and data repository that handles the storage of models and pertinent execution-related data, along with functionalities for execution management, communication with third-party applications, user-friendly interfaces to access and use the infrastructure with minimal effort and basic security features.

Workflow-driven clinical decision support for personalized oncology.

BACKGROUND: The adoption in oncology of Clinical Decision Support (CDS) may help clinical users to efficiently deal with the high complexity of the domain, lead to improved patient outcomes, and reduce the current knowledge gap between clinical research and practice. While significant effort has been invested in the implementation of CDS, the uptake in the clinic has been limited. The barriers to adoption have been extensively discussed in the literature. In oncology, current CDS solutions are not able to support the complex decisions required for stratification and personalized treatment of patients and to keep up with the high rate of change in therapeutic options and knowledge. RESULTS: To address these challenges, we propose a framework enabling efficient implementation of meaningful CDS that incorporates a large variety of clinical knowledge models to bring to the clinic comprehensive solutions leveraging the latest domain knowledge. We use both literature-based models and models built within the p-medicine project using the rich datasets from clinical trials and care provided by the clinical partners. The framework is open to the biomedical community, enabling reuse of deployed models by third-party CDS implementations and supporting collaboration among modelers, CDS implementers, biomedical researchers and clinicians. To increase adoption and cope with the complexity of patient management in oncology, we also support and leverage the clinical processes adhered to by healthcare organizations. We design an architecture that extends the CDS framework with workflow functionality. The clinical models are embedded in the workflow models and executed at the right time, when and where the recommendations are needed in the clinical process. CONCLUSIONS: In this paper we present our CDS framework developed in p-medicine and the CDS implementation leveraging the framework. To support complex decisions, the framework relies on clinical models that encapsulate relevant clinical knowledge. Next to assisting the decisions, this solution supports by default (through modeling and implementation of workflows) the decision processes as well and exploits the knowledge embedded in those processes.

High hip center technique using a biconical threaded Zweymüller cup in osteoarthritis secondary to congenital hip disease.

BACKGROUND: The high hip center technique used for a deficient acetabulum is reconstruction of the hip at a high center of rotation. In the literature, there is no consensus regarding the value of this technique. QUESTIONS/PURPOSES: We investigated whether the new-generation biconical threaded Zweymüller cup fixed in a high nonanatomic position in patients with arthritis secondary to congenital hip disease experienced different rates of polyethylene wear and long-term survivorship when compared with anatomically positioned cups. PATIENTS AND METHODS: We studied the polyethylene wear rate and Kaplan-Meier survivorship of 104 titanium threaded Zweymüller cups in 88 patients (81 females), placed in 70 hips at near-normal hip center and in 34 hips at a high hip center position at a distance of 31.1 to 60 mm (mean, 39.7 mm) from the interteardrop line. Minimum followup was 2 years (mean +/- SD, 8.6 +/- 3.5 years; range, 2-15 years). RESULTS: The mean linear polyethylene wear rates in the near-normal and high hip center groups were not different (0.110 +/- 0.050 mm and 0.113 +/- 0.057 mm, respectively). The Kaplan-Meier 15-year cup survivorship rates with revision for any reason as an event of interest in the near-normal and high hip center groups also were not different (97.2% [95% confidence interval, 88.5%-99.3%] and 97.1% [95% confidence interval, 73.8%-99.3%], respectively). CONCLUSIONS: The high hip center technique using a biconical threaded Zweymüller cup in patients with arthritis secondary to congenital hip disease results in a polyethylene wear rate and long-term cup survivorship comparable to those observed in anatomically positioned cups. LEVEL OF EVIDENCE: Level III, therapeutic study. See the Guidelines for Authors for a complete description of level of evidence.

High tibial osteotomies: indications and techniques.

The rationale, definition, and techniques of high tibial osteotomies are discussed. The principle indication includes unicompartmental medial or varus knee gonarthrosis with a well-maintained range of motion. Preservation of bone stock and intraarticular structures and realignment during chondral resurfacing procedures are the major advantages of high tibial osteotomies. Newer techniques have provided for less invasive surgical methods, more rigid fixation, accelerated rehabilitation, and improved accuracy of correction for high tibial osteotomies. However, permanent pain relief with high tibial osteotomies is unlikely; overall survival approximates 8 to 10 years. Subsequent conversion to a total knee arthroplasty may at times be technically demanding but the long-term results are likely to be similar to a primary total knee replacement.

Ankle arthrodesis using a tibio-calcaneal external fixator.

The results of open ankle arthrodesis in 23 patients with primary and secondary ankle-talar arthritis are presented. All patients were treated with open ankle arthrodesis using the Citieffe/CH-N external fixator with pins inserted in the tibia and the calcaneus. Union rate was 91% (21 patients) at an average of 13 weeks (range, 12-16 weeks). Mean follow-up was 6 years. Most of the patients (91%) were satisfied with the end results of the operation.