Changes in adolescents with borderline personality features and caregivers after dialectical behaviour multifamily group therapy / Cambios en adolescentes con rasgos de trastorno límite de personalidad y cuidadores tras un grupo multifamiliar de terapia dialéctico conductual

Dialectical Behaviour Therapy (DBT) is an effective treatment for symptoms of Borderline Personality Disorder (BPD) and has been adapted to adolescent population (DBT-A). The objective of this pilot study was to determine if DBT-A skill group as a stand-alone treatment could improve rearing styles and emotion regulation in adolescents with BPD features and their parents. We designed a 12-week skills group intervention with 14 adolescents with BPD features and their caregivers. Participants (81.82% female) ranged in age from 14 to 17 (M= 15.55 SD=.82).We tested the results of the intervention using the non-parametric Wilcoxon test and calculated effect sizes. To understand individual changes, we reported clinical reliable change (CRC). Acceptability of the intervention was also evaluated. The intervention was effective for improving rearing styles (more affectionate and less criticism) in parents and adolescents. Changes in emotion regulation processes were mixed. Some of the changes were stable 6 months after intervention. Participants reported good levels of satisfaction with the intervention. A DBT-A multifamily group intervention could modify potential mechanisms related with the developing BPD as rearing styles. The duration of the intervention could not be enough to improve emotion regulation processes. Developing early interventions with adolescents with BPD features could modify mechanisms that prevent the establishment of BDP. (AU)

La Terapia Dialéctico Conductual (TDC) es efectiva para el tratamiento de los síntomas del Trastorno Límite de Personalidad (TLP) y ha sido adaptada a población adolescente (TDC-A). El objetivo de este estudio piloto fue determinar si el grupo de habilidades de TDC-A como tratamiento independiente podría mejorar los estilos de crianza y la regulación emocional en adolescentes con características de TLP y sus padres. Diseñamos una intervención grupal de habilidades de 12 semanas de duración con 14 adolescentes con características de TLP y sus cuidadores. Los partici-pantes (81.82% mujeres) tenían edades desde 14 a 17 años (M= 15.55 SD= .82).Evaluamos los resultados de la intervención mediante la prueba no paramétrica de Wilcoxon y el cálculo de los tamaños del efecto. Para conocer los cambios individuales, informamos el cambio clínico significativo (CCS). También se evaluó la aceptabilidad de la intervención. La intervención fue efectiva para mejorar los estilos de crianza (más afectivo y menos crítico) en padres y adolescentes. Los cambios en los procesos de regulación emocional fueron mixtos. Algunos de los cambios se mantuvieron estables 6 meses después de la intervención. Los participantes reportaron buenos niveles de satisfacción con la intervención. Una intervención multifamiliar grupal de TDC-A podría modificar los potenciales mecanismos relacionados con el desarrollo del TLP como son los estilos de crianza. La intervención podría no ser suficiente para mejorar los procesos de regulación emocional. Desarrollar una intervención temprana con adolescentes con rasgos de TLP podría modificar los mecanismos que previenen el establecimiento de TLP. (AU)

ACOD frente a AVK en pacientes con fibrilación auricular y bioprótesis: revisión sistemática y metanálisis / DOAC versus VKA in patients with atrial fibrillation and bioprosthetic valves: a systematic review and meta-analysis

Introducción y objetivos: Los anticoagulantes orales directos (ACOD) se han mostrado eficaces y seguros en pacientes con fibrilación auricular; sin embargo, los pacientes con FA y bioprótesis están infrarrepresentados en los ensayos clínicos, por lo que la evidencia en este grupo es menor. Nuestro objetivo fue analizar la seguridad y eficacia de los ACODs en esta población revisando la información existente en la literatura. Métodos: Se realizó una búsqueda y revisión sistemática con los ensayos clínicos aleatorizados y estudios observacionales comparativos desde 2017 a enero de 2022, que comparasen ACODs y antagonistas de vitamina K (AVK) en pacientes con FA y bioprótesis. Se utilizó la hazard ratio al 95% del intervalo de confianza para comparar ambos grupos en términos de mortalidad total y cardiovascular, ictus/embolia sistémica y hemorragia mayor. Se realizó un metanálisis combinando los resultados de los estudios incluidos. Resultados: Se incluyeron 12 estudios (un total de 30.283 pacientes). Los ACODs se asociaron a una reducción significativa del 9% de la mortalidad total (HR=0,91; IC95%, 0,85-0,97; p=0,0068; I2=8%), sin diferencias significativas en el riesgo de ictus/embolismo sistémico (HR=0,87; IC95%, 0,67-1,14; p=0,29; I2=45%) o hemorragia mayor (HR=0,82; IC95%, 0,67-1,00; p=0,054; I2=48.7%). Conclusiones: En pacientes con FA portadores de bioprótesis, los ACODs podrían asociarse a una reducción de la mortalidad total sin reducción de eficacia en la prevención de ictus/embolia sistémica o aumento del riesgo de hemorragia mayor.(AU)

Introduction and objectives: Direct oral anticoagulant (DOAC) therapy has been shown to be safe and effective in patients with atrial fibrillation (AF). However, outcomes in AF patients with bioprosthetic valves are unclear, as this population has been underrepresented in clinical trials. The aim of this study was to assess the safety and efficacy of DOACs in this population based on the existing published literature. Methods: A systematic search and review were conducted to identify randomized clinical trials and comparative observational studies published from 2017 to January 2022 that compared DOACs and vitamin K antagonists (VKAs) in AF patients with bioprosthetic valves. Hazard ratios (HR) were collected to compare the 2 treatments in terms of cardiovascular and all-cause mortality, stroke/systemic embolism, and major bleeding. A meta-analysis combining the results was performed. Results: We included 12 studies (30 283 patients). DOACs and VKAs were compared based on HRs at the 95% confidence interval. DOAC therapy was associated with a significant 9% reduction in all-cause mortality (HR, 0.91; 95%CI, 0.85-0.97; P=.0068; I2=8%), with no significant differences in the risk of stroke/systemic embolism (HR, 0.87; 95%CI, 0.67-1.14; P=.29; I2=45%) or major bleeding (HR, 0.82; 95%CI, 0.67-1.00; P=.054; I2=48.7%). Conclusions: DOAC therapy in AF patients with bioprosthetic valves may be associated with a significant reduction in all-cause mortality, with no reduction in the efficacy of stroke/systemic embolism prevention or increase in major bleeding risk.(AU)

Stacked or Folded? Impact of Chelate Cooperativity on the Self-Assembly Pathway to Helical Nanotubes from Dinucleobase Monomers.

Self-assembled nanotubes exhibit impressive biological functions that have always inspired supramolecular scientists in their efforts to develop strategies to build such structures from small molecules through a bottom-up approach. One of these strategies employs molecules endowed with self-recognizing motifs at the edges, which can undergo either cyclization-stacking or folding-polymerization processes that lead to tubular architectures. Which of these self-assembly pathways is ultimately selected by these molecules is, however, often difficult to predict and even to evaluate experimentally. We show here a unique example of two structurally related molecules substituted with complementary nucleobases at the edges (i.e., G:C and A:U) for which the supramolecular pathway taken is determined by chelate cooperativity, that is, by their propensity to assemble in specific cyclic structures through Watson-Crick pairing. Because of chelate cooperativities that differ in several orders of magnitude, these molecules exhibit distinct supramolecular scenarios prior to their polymerization that generate self-assembled nanotubes with different internal monomer arrangements, either stacked or coiled, which lead at the same time to opposite helicities and chiroptical properties.

Dialectical Behavioral Skills Group Therapy for Parents of Adolescents With Borderline Personality Disorder: A Pilot Study.

Research has indicated the effectiveness of Dialectical behavior therapy in adolescents (DBT-A) with severe emotion dysregulation and other symptoms of Borderline Personality Disorder (BPD). The objective was to determine if DBT skills group with caregivers only could influence in potential mediators of DBT outcomes including rearing styles, emotion regulation and mindfulness skills, evaluated in both parents and adolescents. We implemented a 12-week group intervention based on DBT-A addressed to seven parents of adolescents with features of BPD. We tested differences after treatment using the non-parametric Wilcoxon test and calculated effect sizes. To understand individual changes, we reported clinical reliable change (CRC). The intervention was effective for improving rearing styles, emotion regulation and mindfulness skills in adolescents. Changes were stable after 6 months. The intervention showed good levels of satisfaction reported by parents. A short DBT group-only intervention with caregivers could modify relevant processes related with features of BPD in adolescents. Early interventions with adolescents with symptoms of BPD could prevent the development of BPD influencing in potential mediation mechanisms.

Imaging Follow-Up of Nonsurgical Therapies for Lung Cancer: AJR Expert Panel Narrative Review.

Lung cancer continues to be the most common cause of cancer-related death worldwide. In the past decade, with the implementation of lung cancer screening programs and advances in surgical and nonsurgical therapies, the survival of patients with lung cancer has increased, as has the number of imaging studies that these patients undergo. However, most patients with lung cancer do not undergo surgical re-section, because they have comorbid disease or lung cancer in an advanced stage at diagnosis. Nonsurgical therapies have continued to evolve with a growing range of systemic and targeted therapies, and there has been an associated evolution in the imaging findings encountered at follow-up examinations after such therapies (e.g., with respect to posttreatment changes, treatment complications, and recurrent tumor). This AJR Expert Panel Narrative Review describes the current status of nonsurgical therapies for lung cancer and their expected and unexpected imaging manifestations. The goal is to provide guidance to radiologists regarding imaging assessment after such therapies, focusing mainly on non-small cell lung cancer. Covered therapies include systemic therapy (conventional chemotherapy, targeted therapy, and immunotherapy), radiotherapy, and thermal ablation.

Complex post-traumatic stress disorder (CPTSD) of ICD-11 in youths with childhood maltreatment: Associations with age of exposure and clinical outcomes.

BACKGROUND: Exposure to childhood maltreatment (CM) increases the risk of psychiatric morbidity in youths. The new Complex Post-Traumatic Stress Disorder (CPTSD) diagnosis captures the heterogeneity and complexity of clinical outcomes observed in youths exposed to CM. This study explores CPTSD symptomatology and its association with clinical outcomes, considering the impact of CM subtypes and age of exposure. METHODS: Exposure to CM and clinical outcomes were evaluated in 187 youths aged 7-17 (116 with psychiatric disorder; 71 healthy controls) following the Tools for Assessing the Severity of Situations in which Children are Vulnerable (TASSCV) structured interview criteria. CPTSD symptomatology was explored by confirmatory factor analysis, considering four subdomains: post-traumatic stress symptoms, emotion dysregulation, negative self-concept and interpersonal problems. RESULTS: Youths exposed to CM (with or without psychiatric disorders) showed greater internalizing, externalizing and other symptomatology, worse premorbid adjustment and poorer overall functioning. Youth with psychiatric disorder and exposed to CM reported more CPTSD symptomatology, psychiatric comorbidity and polypharmacy and earlier onset of cannabis use. Different subtypes of CM and the developmental stage of exposure differentially impact CPTSD subdomains. LIMITATIONS: Small percentage of resilient youths was studied. It was not possible to explore specific interactions between diagnostic categories and CM. Direct inference cannot be assumed. CONCLUSIONS: Gathering information on type and age of exposure to CM is clinically useful to understand the complexity of psychiatric symptoms observed in youths. Inclusion of the CPTSD diagnosis should increase the implementation of early specific interventions, improving youths' functioning and reducing the severity of clinical outcomes.

Conventional and radiomic features to predict pathology in the preoperative assessment of anterior mediastinal masses.

OBJECTIVES: The aim of this study was to differentiate benign from malignant tumors in the anterior mediastinum based on computed tomography (CT) imaging characteristics, which could be useful in preoperative planning. Additionally, our secondary aim was to differentiate thymoma from thymic carcinoma, which could guide the use of neoadjuvant therapy. MATERIALS AND METHODS: Patients referred for thymectomy were retrospectively selected from our database. Twenty-five conventional characteristics were evaluated by visual analysis, and 101 radiomic features were extracted from each CT. In the step of model training, we applied support vector machines to train classification models. Model performance was assessed using the area under the receiver operating curves (AUC). RESULTS: Our final study sample comprised 239 patients, 59 (24.7 %) with benign mediastinal lesions and 180 (75.3 %) with malignant thymic tumors. Among the malignant masses, there were 140 (58.6 %) thymomas, 23 (9.6 %) thymic carcinomas, and 17 (7.1 %) non-thymic lesions. For the benign versus malignant differentiation, the model that integrated both conventional and radiomic features achieved the highest diagnostic performance (AUC = 0.715), in comparison to the conventional (AUC = 0.605) and radiomic-only (AUC = 0.678) models. Similarly, regarding thymoma versus thymic carcinoma differentiation, the model that integrated both conventional and radiomic features also achieved the highest diagnostic performance (AUC = 0.810), in comparison to the conventional (AUC = 0.558) and radiomic-only (AUC = 0.774) models. CONCLUSION: CT-based conventional and radiomic features with machine learning analysis could be useful for predicting pathologic diagnoses of anterior mediastinal masses. The diagnostic performance was moderate for differentiating benign from malignant lesions and good for differentiating thymomas from thymic carcinomas. The best diagnostic performance was achieved when both conventional and radiomic features were integrated in the machine learning algorithms.

DOAC versus VKA in patients with atrial fibrillation and bioprosthetic valves: a systematic review and meta-analysis.

INTRODUCTION AND OBJECTIVES: Direct oral anticoagulant (DOAC) therapy has been shown to be safe and effective in patients with atrial fibrillation (AF). However, outcomes in AF patients with bioprosthetic valves are unclear, as this population has been underrepresented in clinical trials. The aim of this study was to assess the safety and efficacy of DOACs in this population based on the existing published literature. METHODS: A systematic search and review were conducted to identify randomized clinical trials and comparative observational studies published from 2017 to January 2022 that compared DOACs and vitamin K antagonists (VKAs) in AF patients with bioprosthetic valves. Hazard ratios (HR) were collected to compare the 2 treatments in terms of cardiovascular and all-cause mortality, stroke/systemic embolism, and major bleeding. A meta-analysis combining the results was performed. RESULTS: We included 12 studies (30 283 patients). DOACs and VKAs were compared based on HRs at the 95% confidence interval. DOAC therapy was associated with a significant 9% reduction in all-cause mortality (HR, 0.91; 95%CI, 0.85-0.97; P=.0068; I2=8%), with no significant differences in the risk of stroke/systemic embolism (HR, 0.87; 95%CI, 0.67-1.14; P=.29; I2=45%) or major bleeding (HR, 0.82; 95%CI, 0.67-1.00; P=.054; I2=48.7%). CONCLUSIONS: DOAC therapy in AF patients with bioprosthetic valves may be associated with a significant reduction in all-cause mortality, with no reduction in the efficacy of stroke/systemic embolism prevention or increase in major bleeding risk.

Childhood maltreatment disrupts HPA-axis activity under basal and stress conditions in a dose-response relationship in children and adolescents.

BACKGROUND: This study investigates the impact of childhood maltreatment (CM) on hypothalamic-pituitary-adrenal (HPA)-axis functioning and on anxiety perception. Moreover, the influence of CM severity and frequency was also explored. METHODS: In total, 187 participants aged 7-17 were assessed for CM history using validated questionnaires and ad hoc interviews to be classified according to the criteria of the Tool for Assessing the Severity of Situations in which Children are Vulnerable (TASSCV). Psychopathology was ascertained using the K-SADS-PL5. To assess HPA-axis functioning, salivary cortisol samples were collected throughout a normal day and during an acute psychosocial stressor, the Trier Social Stress Test for children (TSST-C). Subjective anxiety was evaluated using STAI/-C. RESULTS: Youth with a CM history had higher overall diurnal cortisol levels (p = 0.001), blunted cortisol response to acute psychosocial stress (p = 0.002) and greater perceived anxiety (p = 0.003), than those without CM. Specifically, participants exposed to moderate/severe or often/frequent CM showed the greater diurnal cortisol output (pseverity = 0.002; pfrequency = 0.003), and blunted cortisol response during the TSST-C (pseverity = 0.006; pfrequency = 0.008). Meanwhile, youth with low CM severity/frequency exhibited a similar cortisol response to those without CM. However, perceived anxiety was higher in those exposed to CM (p < 0.001), regardless of its severity/frequency. CONCLUSIONS: Disturbances in HPA-axis functioning are already evident early after CM exposure, while psychological and physiological responses to an acute stressor are dissociated in youth exposed to CM. The dose-response relationship described in this paper highlights the need to comprehensively evaluate CM so that vulnerable children can be identified and assigned to proper interventions.

The Cognitive Processes Behind Commercialized Board Games for Intervening in Mental Health and Education: A Committee of Experts.

Background: The use of modern board games has been growing past years in education, research, and mental health attendance. Often one professional selects games by his/her criteria depending on his/her objective with them. We evaluated the cognitive processes inherent to each modern board game to obtain a consensus of the cognitive profile of each. We explain how to choose the most suitable board games in future interventions. Materials and Methods: Fifteen education, mental health, and neuroscience research professionals with board games experience participated in an online assessment of 27 modern board games. Experts received a virtual neuroeducation formation and played the games selection for further analysis. Participants answered a Likert scale about 12 cognitive processes activated with each game. Results: All modern board games obtained a high level of agreement (intraclass correlation [ICC] > 0.75). Besides, most cognitive processes reached a high agreement, except for cognitive flexibility and problem-solving (moderate range: 0.5 > ICC > 0.75). Differentiated cognitive profiles have been obtained for each game, some of which could work on more than one cognitive domain at a time. Finally, initial evidence about which board game mechanisms activate with cognitive domain was found. Conclusion: To conclude, this expert consensus methodology became a useful tool for assessing the cognitive profile behind modern board and card games. The results obtained may facilitate the choice of games to be used in future studies depending on the objective cognitive domain to be trained under a criterion based on the observations of a group of experts and not just the researcher's individual criteria.

The environmental pollution caused by cemeteries and cremations: A review.

In recent years the funeral industry has drawn attention from the scientific community concerning the potential pollution of the environment and the urban environment. In this review, the pollution caused by the cemeteries and crematoria around the world was addressed. The traditional burial leads to the production of ions, in the form of organic and heavy metals, bacteria, fungi, and viruses, that spread along with the soil and underwater. The crematoria produce small particles, trace gases (SOx, NOx, CO), and toxic organic volatiles. The effluent generated by both methods can lead to several environmental problems and further threaten human health. The current solution for the cemeteries in the development of a system in which effluent generated by the traditional burials are collected and treated before realizing in the environment. In addition to that, the green burial should be an alternative, since the corpse does not go through the embalming process, thus eliminating the presence of any undesired chemicals, that are further leached onto the environment. The crematoria should be employed as it is, however, the gas treatment station should be employed, to ensure the minimization of the impact on the environment. Last, future researches regarding the treatment of the cemeteries leached still need to be explored as well as the optimization and further development of the crematoria gas treatment process.

Secretory immunoglobulin A (s-IgA) reactivity to acute psychosocial stress in children and adolescents: The influence of pubertal development and history of maltreatment.

BACKGROUND: Mucosal secretory immunoglobulin A (s-IgA) is an antibody protein-complex that plays a crucial role in immune first defense against infection. Although different immune biomarkers have been associated with stress-related psychopathology, s-IgA remains poorly studied, especially in youth. OBJECTIVES: The present study investigated how s-IgA behaves in front of acute psychosocial stress in children and adolescents, including possible variability associated with developmental stage and history of childhood maltreatment (CM). METHODS: 94 children and adolescents from 7 to 17 years (54 with a current psychiatric diagnostic and 40 healthy controls) drawn from a larger Spanish study were explored (EPI-Young Stress Project). To assess biological reactivity, participants provided five saliva samples during an acute laboratory-based psychosocial stressor, the Trier Social Stress Test for Children (TSST-C). Samples were assayed for s-IgA, as well as for cortisol. Pubertal development was ascertained by Tanner stage and CM following TASSCV criteria. RESULTS: We observed s-IgA fluctuations throughout the stressor, indicating the validity of TSST-C to stimulate s-IgA secretion (F(4,199) = 6.200, p <.001). Although s-IgA trajectories followed a reactivity and recovery pattern in adolescents, children exhibited no s-IgA response when faced with stress (F(4,197) = 3.406, p =.010). An interaction was found between s-IgA and CM (F(4,203) = 2.643, p =.035). Interestingly, an interaction between developmental stage, CM history and s-IgA reactivity was identified (F(12,343) = 2.036, p =.017); while children non-exposed to maltreatment exhibited no s-IgA changes to acute stress, children with a history of CM showed a similar response to adolescents, increasing their s-IgA levels after the psychosocial stressor. CONCLUSION: Acute psychosocial stress stimulates s-IgA secretion, but only after puberty. However, children with a history of maltreatment exhibited a response resembling that of adolescents, suggesting an early maturation of the immune system. Further studies are needed to clarify the validity of s-IgA as an acute stress biomarker, including additional measures during stress exposure.

Self-Sorting Governed by Chelate Cooperativity.

Self-sorting phenomena are the basis of manifold relevant (bio)chemical processes where a set of molecules is able to interact with no interference from other sets and are ruled by a number of codes that are programmed in molecular structures. In this work, we study, the relevance of chelate cooperativity as a code for achieving high self-sorting fidelities. In particular, we establish qualitative and quantitative relationships between the cooperativity of a cyclic system and the self-sorting fidelity when combined with other molecules that share identical geometry and/or binding interactions. We demonstrate that only systems displaying sufficiently strong chelate cooperativity can achieve quantitative narcissistic self-sorting fidelities either by dictating the distribution of cyclic species in complex mixtures or by ruling the competition between the intra- and intermolecular versions of a noncovalent interaction.

Radiogenomics in personalized management of lung cancer patients: Where are we?

With the rise of artificial intelligence, radiomics has emerged as a field of translational research based on the extraction of mineable high-dimensional data from radiological images to create "big data" datasets for the purpose of identifying distinct sub-visual imaging patterns. The integrated analysis of radiomic data and genomic data is termed radiogenomics, a promising strategy to identify potential imaging biomarkers for predicting driver mutations and other genomic parameters. In lung cancer, recent advances in whole-genome sequencing and the identification of actionable molecular alterations have led to an increased interest in understanding the complex relationships between imaging and genomic data, with the potential of guiding therapeutic strategies and predicting clinical outcomes. Although the integration of the radiogenomics data into lung cancer management may represent a new paradigm in the field, the use of this technique as a clinical biomarker remains investigational and still necessitates standardization and robustness to be effectively translated into the clinical practice. This review summarizes the basic concepts, potential contributions, challenges, and opportunities of radiogenomics in the management of patients with lung cancer.

CT Radiomic Features for Predicting Resectability and TNM Staging in Thymic Epithelial Tumors.

BACKGROUND: To explore the performance of a computed tomography based radiomics model in the preoperative prediction of resectability status and TNM staging in thymic epithelial tumors. METHODS: We reviewed the last preoperative computed tomography scan of patients with thymic epithelial tumors prior to resection and pathology evaluation at our institution between February 2008 and June 2019. A total of 101 quantitative features were extracted and a radiomics model was trained using elastic net penalized logistic regressions for each aim. In the set-aside testing sets, discriminating performance of each model was assessed with area under receiver operating characteristic curve. RESULTS: Our final population consisted of 243 patients with: 153 (87%) thymomas, 23 (9%) thymic carcinomas, and 9 (4%) thymic carcinoids. Incomplete resections (R1 or R2) occurred in 38 (16%) patients, and 67 (28%) patients had more advanced stage tumors (stage III or IV). In the set-aside testing sets, the radiomics model achieved good performance in preoperatively predicting incomplete resections (area under receiver operating characteristic curve: 0.80) and advanced stage tumors (area under receiver operating characteristic curve: 0.70). CONCLUSIONS: Our computed tomography radiomics model achieved good performance to predict resectability status and staging in thymic epithelial tumors, suggesting a potential value for the evaluation of radiomic features in the preoperative prediction of surgical outcomes in thymic malignancies.

Value of diffusion-weighted magnetic resonance imaging in the diagnosis of pyomyoma.

Pyomyomas are rare lesions that develop from the suppurative degeneration of ischemic leiomyomas. Pyomyomas can lead to sepsis, so early diagnosis is crucial. Due to their rarity and often nonspecific findings on ultrasonography and computed tomography diagnosis is often delayed. We present a case of a woman who presented with abdominal pain and fever. The computed tomography showed a large hypodense uterine lesion with slight peripheral enhancement without gas in the lesion. The diffusion-weighted magnetic resonance imaging showed restricted diffusion, demonstrating the presence of pus and confirming the diagnosis of pyomyoma. Diffusion-weighted imaging should be done in cases of suspected pyomyomas when computed tomography findings are nonspecific.

Impact on Executive Dysfunctions of Gamification and Nongamification in Playing Board Games in Children at Risk of Social Exclusion.

Objective: Modern board and card game-based cognitive interventions and gamification practices showed effectiveness in boosting executive functions and decreasing behavioral problems in children. However, the combination of both game-based methods has not been tested. Therefore, the main aim of this study was to test the effectiveness of gamification in modern board and card game-based cognitive interventions in Spanish schoolchildren at risk of social exclusion. Materials and Methods: In this multicenter single-blind study with a quasi-experimental design, 176 schoolers (6-13 years old) were assigned to a gamified group (with a narrative context and a rewarding system) and 107 to a nongamified group (with no narrative context or rewarding system). The interventions were implemented in regular classes. Behavioral executive dysfunction was assessed using the Behavior Rating Inventory of Executive Function, Second Revision (BRIEF-2) (Teacher form), pre- and postintervention. Results: We found significant time effects in all BRIEF-2 domains with small and medium effect sizes (d = -0.35 to d = -0.62). The nongamified group showed significantly higher decreases in all measures than those who used gamification. Conclusions: It is possible that playing for the joy of playing in the nongamified group was enough motivation to focus on the task, while adding gamification elements did not favor greater effectiveness of the program.

Pathological response to neoadjuvant therapy with chemotherapy vs chemoradiotherapy in stage III NSCLC-contribution of IASLC recommendations.

BACKGROUND: Neoadjuvant treatment (NT) with chemotherapy (Ch) is a standard option for resectable stage III (N2) NSCLC. Several studies have suggested benefits with the addition of radiotherapy (RT) to NT Ch. The International Association for the Study of Lung Cancer (IASLC) published recommendations for the pathological response (PHR) of NSCLC resection specimens after NT. AIM: To contribute to the IASLC recommendations showing our results of PHR to NT Ch vs NT chemoradiotherapy (ChRT). METHODS: We analyzed 67 consecutive patients with resectable stage III NSCLC with positive mediastinal nodes treated with surgery after NT Ch or NT ChRT between 2013 and 2020. After NT, all patients were evaluated for radiological response (RR) according to Response Evaluation Criteria in Solid Tumours criteria and evaluated for surgery by a specialized group of thoracic surgeons. All histological samples were examined by the same two pathologists. PHR was evaluated by the percentage of viable cells in the tumor and the resected lymph nodes. RESULTS: Forty patients underwent NT ChRT and 27 NT Ch. Fifty-six (83.6%) patients underwent surgery (35 ChRT and 21 Ch). The median time from ChRT to surgery was 6 wk (3-19) and 8 wk (3-21) for Ch patients. We observed significant differences in RR, with disease progression in 2.5% and 14.8% of patients with ChRT and Ch, respectively, and partial response in 62.5% ChRT vs 29.6% Ch (P = 0.025). In PHR we observed ≤ 10% viable cells in the tumor in 19 (54.4%) and 2 cases (9.5%), and in the resected lymph nodes (RLN) 30 (85.7%) and 7 (33.3%) in ChRT and Ch, respectively (P = 0.001). Downstaging was greater in the ChRT compared to the Ch group (80% vs 33.3%; P = 0.002). In the univariate analysis, NT ChRT had a significant impact on partial RR [odds ratio (OR) 12.5; 95% confidence interval (CI): 1.21 - 128.61; P = 0.034], a decreased risk of persistence of cancer cells in the tumor and RLN and an 87.5% increased probability for achieving downstaging (OR 8; 95%CI: 2.34-27.32; P = 0.001). CONCLUSION: We found significant benefits in RR and PHR by adding RT to Ch as NT. A longer follow-up is necessary to assess the impact on clinical outcomes.

Risk of Suicidal Behavior in Children and Adolescents Exposed to Maltreatment: The Mediating Role of Borderline Personality Traits and Recent Stressful Life Events.

Childhood maltreatment (CM) is associated with increased non-suicidal self-injury (NSSI) and suicidal behavior (SB), independently of demographic and mental health conditions. Self-Trauma Theory and Linehan's Biopsychosocial Model might explain the emergence of Borderline Personality Disorder (BPD) symptoms as mediators of the association between CM and the risk of SB. However, little is known regarding such relationships when the exposure is recent for young persons. Here, we study 187 youths aged 7-17, with or without mental disorders. We explore CM experiences (considering the severity and frequency of different forms of neglect and abuse), recent stressful life events (SLEs), some BPD traits (emotion dysregulation, intense anger and impulsivity), and the risk of SB (including NSSI, suicide threat, suicide ideation, suicide plan and suicide attempt). We study the direct and mediating relationships between these variables via a structural equation analysis using the statistical software package EQS. Our findings suggest that youths exposed to more severe/frequent CM have more prominent BPD traits, and are more likely to have experienced recent SLEs. In turn, BPD traits increase the risk of SLEs. However, only emotion dysregulation and recent SLEs were found to be correlated with SB. Therefore, targeted interventions on emotion dysregulation are necessary to prevent NSSI or SB in children and adolescents exposed to CM, as is the minimization of further SLEs.

Fronto-Parietal Gray Matter Volume Loss Is Associated with Decreased Working Memory Performance in Adolescents with a First Episode of Psychosis.

Cognitive maturation during adolescence is modulated by brain maturation. However, it is unknown how these processes intertwine in early onset psychosis (EOP). Studies examining longitudinal brain changes and cognitive performance in psychosis lend support for an altered development of high-order cognitive functions, which parallels progressive gray matter (GM) loss over time, particularly in fronto-parietal brain regions. We aimed to assess this relationship in a subsample of 33 adolescents with first-episode EOP and 47 matched controls over 2 years. Backwards stepwise regression analyses were conducted to determine the association and predictive value of longitudinal brain changes over cognitive performance within each group. Fronto-parietal GM volume loss was positively associated with decreased working memory in adolescents with psychosis (frontal left (B = 0.096, p = 0.008); right (B = 0.089, p = 0.015); parietal left (B = 0.119, p = 0.007), right (B = 0.125, p = 0.015)) as a function of age. A particular decrease in frontal left GM volume best predicted a significant amount (22.28%) of the variance of decreased working memory performance over time, accounting for variance in age (14.9%). No such association was found in controls. Our results suggest that during adolescence, EOP individuals seem to follow an abnormal neurodevelopmental trajectory, in which fronto-parietal GM volume reduction is associated with the differential age-related working memory dysfunction in this group.