Subtyping youngsters with obesity: A theory-based cluster analysis.

Psychological mechanisms play a crucial role in explaining weight gain. Aim of the present study was to identify subtypes in youngsters with obesity in line with these mechanisms. Defining homogeneous clusters within this heterogeneous group provides relevant information for personalized treatments. Data were collected in N = 572 participants (51% boys, aged 7-19) with extreme obesity (%BMI M = 187.8; SD = 30.9) recruited in an inpatient treatment centre. Based on psychological models of overweight/obesity, the Affect Regulation Model, the Reward Deficiency Model and The Dual Pathway Model, cluster variables were selected assessing emotional eating, reward reactivity and regulative capacities. Youngsters reported on emotional eating (DEBQ Emotional Eating) and reward sensitivity (BAS), while parents reported on children's regulative Executive Functions (BRIEF). Characteristics of the different clusters were examined concerning weight variables (pre and post treatment) and variables indexing problematic eating (DEBQ External Eating, Ch-EDE), affect regulation (FEEL-KJ) and depressive symptoms (CDI). Hierarchical cluster analyses supported the presence of three clusters, further evaluated by K-means cluster analyses. The cluster solutions differed according to age and sex (boys 7-13, boys 14-19, girls 7-13, girls 14-19). In all four age and gender subsamples, an "Emotional Eating" cluster displaying a vulnerable profile (high depression, maladaptive emotion regulation, problematic eating) and a "Reward Deficiency" cluster displaying a more resilient profile were detected. In girls 7-13, a "Weak Executive Functioning" indicative of insufficient self-regulative capacities, showed moderate to high emotional problems and problematic eating. In the other subgroups, the "Mean Level Functioning" cluster also showed elevated emotional problems and problematic eating. Given that different clusters can be identified, and given that these clusters have different profiles on emotional problems and problematic eating, subtyping youngsters with severe obesity is indicated, setting the stage for personalized treatments.

The drive for thinness: Towards a mechanistic understanding of avoidance behaviors in a non-clinical population.

Fear of weight gain is a cardinal feature of eating disorders, including Anorexia Nervosa (AN). This fear motivates behaviors aimed at avoiding weight gain, such as restricting food intake. Of note, avoidance in AN is not confined to food-related items but extends to intense emotional states. Despite the presence of several forms of excessive avoidance in AN, little is known about the mechanisms underpinning avoidance behavior in AN. In the present exploratory study, we investigated whether university students with an elevated desire to avoid weight gain (as measured through self-reported Drive for Thinness, DT) show deficits in generic avoidance learning. Two-hundred and seventy-five female students filled in the Eating Disorder Inventory-II (EDI-II) and performed a food-unrelated avoidance task. Generalized and linear mixed models (GLMM) revealed that students scoring higher on the DT scale of the EDI-II showed more ineffective avoidance, suggesting a tendency for excessive avoidance in at-risk individuals for AN. Similar results might extend to other eating disorders.

Obstetrical outcome after B-Lynch sutures and ligation of uterine arteries: A case report.

OBJECTIVE: To illustrate the obstetrical outcome after B-Lynch sutures and ligation of the uterine arteries. CASE: A 26-year-old nulliparous woman. A caesarean section performed for obstructed labour was complicated by uterine atony. A B-Lynch uterine compression suture technique was used combined with ligation of the ascending branches of the uterine arteries. Before the subsequent fertility treatment, gel instillation sonography and power Doppler imaging showed a normal uterine cavity and restored myometrial vascularization. Subsequent caesarean section showed external adhesions on the anterior uterine serosa. A healthy baby of normal weight was delivered. There was focal placenta accreta; the underlying myometrium was strikingly thinner and prone to inversion. DISCUSSION: After B-Lynch sutures and ligation of the ascending branches of the uterine arteries, the pregnancy was subsequently uncomplicated. The potential association between B-Lynch sutures and placenta accreta or uterine inversion in a subsequent pregnancy has to be assessed in further studies. This case report illustrates how 3D gel instillation sonography is a valuable tool to evaluate the integrity of the uterine cavity.

The direction of tissue strain affects the neovascularization in the fracture-healing zone.

Sufficient vascularization of the fracture-healing zone is a prerequisite for undisturbed bone healing. One important factor affecting the vascularization is the interfragmentary movement in the fracture-healing zone. Many studies have demonstrated that stable fixation with predominatly moderate interfragmentary compression movement can stimulate vascularization and the healing process whereas unstable fracture fixation delays the vascularization and bone healing process. Instability of fracture fixation, in particular large shearing interfragmentary movement, can cause delayed healing or non-unions. We hypothesize that the direction of interfragmentary movement affects vascularization in the fracture-healing zone. Cyclic compressive strain stimulates greater vessel formation than tensile or shearing strain. This is due to differences in the local mechanical environment which are not delineated by the direction-independent characterization of interfragmentary movement typically reported. We propose that new vessel formations buckle under compressive loading without significant load transfer across endothelial cell junctions while both tensile and shearing deformations result in disruptive loads despite a biochemically angiogenic environment. From a clinical perspective, this means that the optimal conditions for rapid vascularization result from fracture fixation that minimizes cyclic tensile and shearing movements in the healing zone while allowing moderate compressive movements.

Predicting the incidence of non-suicidal self-injury in college students.

BACKGROUND: Despite increased awareness that non-suicidal self-injury (NSSI) poses a significant public health concern on college campuses worldwide, few studies have prospectively investigated the incidence of NSSI in college and considered targeting college entrants at high risk for onset of NSSI. METHODS: Using data from the Leuven College Surveys (n = 4,565; 56.8%female, Mage = 18.3, SD = 1.1), students provided data on NSSI, sociodemographics, traumatic experiences, stressful events, perceived social support, and mental disorders. A total of 2,163 baseline responders provided data at a two-year annual follow-up assessment (63.2% conditional response rate). RESULTS: One-year incidence of first onset NSSI was 10.3% in year 1 and 6.0% in year 2, with a total of 8.6% reporting sporadic NSSI (1-4 times per year) and 7.0% reporting repetitive NSSI (≥ 5 times per year) during the first two years of college. Many hypothesized proximal and distal risk factors were associated with the subsequent onset of NSSI (ORs = 1.5-18.2). Dating violence prior to age 17 and severe role impairment in daily life were the strongest predictors. Multivariate prediction suggests that an intervention focused on the 10% at highest risk would reach 23.9% of students who report sporadic, and 36.1% of students who report repetitive NSSI during college (cross-validated AUCs = .70-.75). DISCUSSION: The college period carries high risk for the onset of NSSI. Individualized web-based screening may be a promising approach for detecting young adults at high risk for self-injury and offering timely intervention.

Histomorphometric Analysis of Callus Formation Stimulated by Axial Dynamisation in a Standardised Ovine Osteotomy Model.

The cyclic axial dynamisation of a stabilised fracture is intended to promote callus formation and bone healing. Most studies focused on biomechanical properties or the quantity of new bone formation. Far less is known about the quality of newly formed callus tissues, such as tissue distribution and arrangement within the callus. The aim of this current study was to investigate the effect of cyclic, axial dynamisation on the quantity and quality of callus in an established delayed fracture healing model. In 41 sheep transverse osteotomies with a gap size of 3 mm were stabilised with a unilateral external fixator. In 32 of these, fracture ends were axially stimulated with displacement amplitudes of 0.8 mm, 0.4 mm, 0.2 mm, or 0.0 mm, respectively, for six weeks. In the remaining 9 sheep of the control group, an additional external fixator was mounted to achieve almost total rigidity. Animal material originating from a past animal experiment was reanalysed in this study. Histological thin-ground sections were histomorphometrically analysed regarding the histological structure and composition of the defect region. A slight tendency towards an increase in size of total callus area, area of new bone (nB.Ar), and cartilage (Cg.Ar) was detected with increasing displacement amplitudes compared to the control group. At the anterior callus side nB.Ar and Cg.Ar were significantly larger than at the posterior side in all groups independent of treatment. Regarding the quality of callus, areas of very compact bone were predominant in the treatment groups whereas in the control group a slight shift to more porous bone was observed. No difference of callus compactness was observed between the anterior and the posterior side. The established method to assess the local compactness of callus areas is a useful tool to quantitatively determine the spatial distribution of new bone tissue within the callus. The application of this method in combination with biomechanical testing might reveal interesting relations between tissue distribution and bone strength that, with traditional histomorphometry, cannot be identified.

The associations between non-suicidal self-injury and first onset suicidal thoughts and behaviors.

BACKGROUND: Theoretical and empirical literature suggests that non-suicidal self-injury (NSSI) is an important correlate of suicide risk. The present study was designed to evaluate: (a) whether NSSI is associated with increased odds of subsequent onsets of suicidal thoughts and behaviors (STB) independent of common mental disorders, (b) whether NSSI is associated with increased risk of transitioning from suicide ideation to attempt, and (c) which NSSI characteristics are associated with STB after NSSI. METHOD: Using discrete-time survival models, based on retrospective age of onset reports from college students (n = 6,393, 56.8% female), we examined associations of temporally prior NSSI with subsequent STB (i.e., suicide ideation, plan, and attempt) controlling mental disorders (i.e., MDD, Broad Mania, GAD, Panic Disorder, and risk for Alcohol Dependence). NSSI characteristics associated with subsequent STB were examined using logistic regressions. RESULTS: NSSI was associated with increased odds of subsequent suicide ideation (OR = 2.8), plan (OR = 3.0), and attempt (OR = 5.5) in models that controlled for the distribution of mental disorders. Further analyses revealed that NSSI was associated with increased risk of transitioning to a plan among those with ideation, as well as attempt among those with a plan (ORs = 1.7-2.1). Several NSSI characteristics (e.g., automatic positive reinforcement, earlier onset NSSI) were associated with increased odds of experiencing STB. LIMITATIONS: Surveys relied on self-report, and thus, there is the potential for recall bias. CONCLUSIONS: This study provides support for the conceptualization of NSSI as a risk factor for STB. Investigation of the underlying pathways accounting for these time-ordered associations is an important avenue for future research.

[Dynamization of fracture fixation : Timing and methods]. / Dynamisierung der Osteosynthese : Zeitpunkt und Methoden.

The dynamization of fracture fixation is a frequently used method to improve the fracture healing process; however, the term dynamization is used for different methods of altering the fixation of fractures during the bone healing process. The dynamization of intramedullary nail fixation by removing the interlocking screws is the most frequently applied method. This method can cause a telescopic movement between the nail and tubular bone that closes gaps in bony continuity and potentially compresses the fracture fragments. Experimental and clinical studies showed that this dynamization can accelerate the bone healing process. In particular dynamization may improve the outcome for fractures with residual fracture gaps following reduction but which allows support of the fragments. An alternative dynamization method involves decreasing the stiffness of the fracture fixation during the healing process. This method is used mainly with external fixation. In this procedure, stabilizing elements of the fixator are removed at some time during the treatment leading to greater flexibility of the fixation. Good results are reported for this method when the dynamization is performed in the late phase of the fracture healing process. If sufficient callus formation has taken place, callus bridging and maturation can be achieved. For reverse dynamization, which starts with a flexible fixation and is later stabilized, no significant advantages could be shown. The aim of fracture treatment should be stable fixation from the beginning. If the fracture fixation is unstable, it should be stabilized as soon as possible.

[Mechanobiology of fracture healing part 2 : Relevance for internal fixation of fractures]. / Mechanobiologie der Frakturheilung Teil 2 : Bedeutung für die Osteosynthese.

Clinical studies do not allow a quantitative correlation between stability of fracture fixation and outcome of bone healing. This limits the biomechanical improvement of fracture fixation techniques. The most practical quantitative parameter to describe the stability of a fracture fixation is the stiffness. This can be determined for several types of fixation through biomechanical methods and in some clinical studies in vivo. By using numerical fracture healing models, it is now possible to use the tissue differentiation rules found in basic research to calculate optimal stiffness parameters for various fixation techniques. For a tibial fracture as an example the possibilities of a numerical fracture healing simulation have been demonstrated. The effects of the diameter of an intramedullary nail, type of fracture, fracture gap size and nail material on healing could be demonstrated. To circumvent complex and time consuming calculations for several fixations a map was calculated which shows the expected bone healing quality as a function of the axial stiffness and the shear stiffness of the fixation device. By comparing the stiffness of various fixation techniques with the stiffness map it becomes evident that the methods most often used (e.g. unreamed nail, plate and external fixator) have a low shear and/or rotational stiffness that is too low to achieve the optimal healing outcome. The high axial stiffness of plates next to the plate surface can lead to very low tissue strain directly adjacent to the plate and can delay the bone healing process at this location.

[Mechanobiology of fracture healing part 1 : Principles]. / Mechanobiologie der Frakturheilung Teil 1 : Grundlagen.

It is undisputed that the stability of fracture fixation influences the fracture healing process; however, up until now the mechanical conditions which guide bone healing were unknown and it was therefore not possible to optimize the design of fracture fixation devices. This article presents how the stability of fracture fixation, interfragmentary movement and interfragmentary tissue strain depend on each other and how the mechanical environment influences the cellular processes in the healing tissue. A tissue transformation hypothesis is presented which was developed taking into consideration the results of animal experimental studies, cellular biomechanical investigations and numerical methods. This tissue differentiation hypothesis allows the prediction of bone healing by intramembranous and endochondral bone formation as a function of the local mechanical environment in the fracture healing zone. This allows the possibility for selection of a fracture fixation stability to achieve high-quality bone healing.

[Reliability of OTC advertisement Relevance and quality of cited literature]. / Quelle est la fiabilité de la publiciteé pour les produits non soumis à prescription? Pertinence et qualité de la littérature mentionée.

Introduction Pharmacist receive a lot of publicity for OTC products. Often one or more literature references are mentioned to support the advertising claims. Objective In this study we examine: [1) whether the advertising claim is consistent with what is stated in the literature references mentioned on the leaflet and [2] whether these literature references are trustworthy. Method Through 60 randomly selected community pharmacies, pharmacist-directed advertisements for OTC products I= medicines, medical devices, dietary supplements and parapharmacy) with at least one bibliographic reference, were collected. The literature references listed in these leaflets were assessed in terms of content [= is the claim consistent with the information in the reference) and technically [= evaluation of the quality of the references]. Results The 85 collected OTC advertisements made 214 claims that referred to 243 references. Of these, 128 references did not support the promotional claim. The remaining 84 references did support the corresponding claim. From 31 references no full text was obtained. Of the 84 supporting references 44 were of dubious quality. The remaining 40 references were found to be reliable. Conclusion This study shows that the literature references in advertising leaflets for OTC-products are not a reliable source of information on the advertised product. Pharmacists should deal critically with this information and should be encouraged to consult reliable scientific sources.

Clinical, Psychopathological, and Personality Characteristics Associated with ADHD among Individuals Seeking Treatment for Gambling Disorder.

OBJECTIVES: (1) To assess the current presence of ADHD symptoms among patients seeking treatment for gambling disorder; (2) to explore clinical and sociodemographic differences between patients who score high and low on the measure of ADHD symptoms; (3) to analyze whether the presence of ADHD symptoms is associated with more severe psychopathology and with specific personality traits; (4) to analyze the mediating role of ADHD symptoms in the relationship between novelty seeking and gambling severity. METHOD: A total of 354 consecutive patients were administered an extensive battery assessing gambling behavior, psychopathology, and personality traits. RESULTS: Male and female gamblers did not differ significantly in their mean scores on the ADHD measure. However, younger participants aged 18-35 scored higher. Higher ADHD scores were also associated with greater severity of gambling disorder and more general psychopathology. Regarding personality traits, high persistence and self-directedness were negatively related to ADHD scores, while in women alone a positive correlation was found between ADHD scores and scores on harm avoidance and self-transcendence. CONCLUSION: The presence of ADHD symptoms in both male and female gambling disorder patients may act as an indicator of the severity of gambling, general psychopathology, and dysfunctional personality traits.

Non-suicidal self-injury among Dutch and Belgian adolescents: Personality, stress and coping.

BACKGROUND: This study examines: (1) the prevalence of Non-Suicidal Self-Injury (NSSI) among Dutch and Belgian adolescents, (2) the associations between Big Five personality traits and NSSI engagement/versatility (i.e., number of NSSI methods), and (3) whether these associations are mediated by perceived stress and coping. METHODS: A total of 946 Flemish (46%) and Dutch (54%) non-institutionalized adolescents (Mean age=15.52; SD=1.34, 44% females) were surveyed. Measures included the NSSI subscale of the Self-Harm-Inventory, the Dutch Quick Big Five Personality questionnaire, the Perceived Stress Scale and the Utrecht Coping List for Adolescents. Examination of zero-order correlations was used to reveal associations, and hierarchical regression analysis was used to reveal potential mediators which were further examined within parallel mediation models by using a bootstrapping-corrected procedure. RESULTS: Lifetime prevalence of NSSI was 24.31%. Neuroticism; perceived stress; and distractive, avoidant, depressive, and emotional coping were positively associated with NSSI engagement, whereas Agreeableness, Conscientiousness; and active, social, and optimistic coping were negatively associated with NSSI engagement. Observed relationships between personality traits and NSSI engagement were consistently explained by perceived stress and depressive coping. A higher versatility of NSSI was not associated with any Big Five personality trait, but was associated with higher scores on perceived stress and depressive coping and with lower scores on active and optimistic coping. CONCLUSION: Our study suggests that a specific personality constellation is associated with NSSI engagement via high stress levels and a typical depressive reaction pattern to handle stressful life events.

Intrauterine transfusion for fetal anemia due to red blood cell alloimmunization: 14 years experience in Leuven.

OBJECTIVE: The purpose of this study is to report on the pregnancy and neonatal outcome of intrauterine transfusion (IUT) for red blood cell (RBC-)alloimmunization. MATERIAL AND METHODS: Retrospective cohort study of all IUT for RBC-alloimmunization in the University Hospital of Leuven, between January 2000 and January 2014. The influence of hydrops, gestational age and technique of transfusion on procedure related adverse events were examined. RESULTS: 135 IUTs were performed in 56 fetuses. In none of the cases fetal or neonatal death occurred. Mild adverse events were noted in 10% of IUTs, whereas severe adverse events occurred in 1.5%. Hydrops and transfusion in a free loop were associated with an increased risk of adverse events whereas gestational age (GA) at transfusion after 34 weeks was not. Median GA at birth was 35.6 weeks and 9% was born before 34 weeks. Besides phototherapy 65.4% required additional neonatal treatment for alloimmune anemia. Non-hematologic complications occurred in 23.6% and were mainly related to preterm birth. CONCLUSION: In experienced hands, IUT for RBC-alloimmunization is a safe procedure in this era. Patients should be referred to specialist centers prior to the development of hydrops. IUT in a free loop of cord and unnecessary preterm birth are best avoided.

Systematic review and meta-analysis of prevalence studies in transsexualism.

BACKGROUND: Over the last 50 years, several studies have provided estimates of the prevalence of transsexualism. The variation in reported prevalence is considerable and may be explained by factors such as the methodology and diagnostic classification used and the year and country in which the studies took place. Taking these into consideration, this study aimed to critically and systematically review the available literature measuring the prevalence of transsexualism as well as performing a meta-analysis using the available data. METHODS: Databases were systematically searched and 1473 possible studies were identified. After initial scrutiny of the article titles and removal of those not relevant, 250 studies were selected for further appraisal. Of these, 211 were excluded after reading the abstracts and a further 18 after reading the full article. This resulted in 21 studies on which to perform a systematic review, with only 12 having sufficient data for meta-analysis. The primary data of the epidemiological studies were extracted as raw numbers. An aggregate effect size, weighted by sample size, was computed to provide an overall effect size across the studies. Risk ratios and 95% confidence intervals (CIs) were calculated. The relative weighted contribution of each study was also assessed. RESULTS: The overall meta-analytical prevalence for transsexualism was 4.6 in 100,000 individuals; 6.8 for trans women and 2.6 for trans men. Time analysis found an increase in reported prevalence over the last 50 years. CONCLUSIONS: The overall prevalence of transsexualism reported in the literature is increasing. However, it is still very low and is mainly based on individuals attending clinical services and so does not provide an overall picture of prevalence in the general population. However, this study should be considered as a starting point and the field would benefit from more rigorous epidemiological studies acknowledging current changes in the classification system and including different locations worldwide.

Trichinella infection in wild boars and synanthropic rats in northwest Vietnam.

Trichinellosis is an emerging parasitic zoonosis in North Vietnam. In this survey, hunted and farm-bred wild boars as well as synanthropic rats were sampled in two provinces of northwest Vietnam where outbreaks of trichinellosis have recently occurred. Evidence of Trichinella infection was studied by parasitological, serological and molecular methods. The results showed relatively low prevalence of Trichinella spiralis in hunted wild boars (2/62 (3.2%; 95% CI: 0.8- 4.8)) and rats (23/820 (2.8%; 95% CI: 13.7-32.3)). Parasite burdens in the muscle tissues were between 0.1 and 0.03 larvae/g, and 0.1 and 7 larvae/g in wild boars and rats, respectively. Seroprevalence in farm-bred wild boars was negative. The findings of Trichinella-infected rats in 7 of the 20 districts of Dien Bien and Son La provinces suggest that the parasite is circulating in these regions. These results indicate that the local population and health centers should be made aware of the risks of eating raw or undercooked meat dishes prepared from wild animals.

Rodent animal models of delayed bone healing and non-union formation: a comprehensive review.

Despite the growing knowledge on the mechanisms of fracture healing, delayed healing and non-union formation remain a major clinical challenge. Animal models are needed to study the complex process of normal and impaired fracture healing and to develop new therapeutic strategies. Whereas in the past mainly large animals have been used to study normal and impaired fracture healing, nowadays rodent models are of increasing interest. New osteosynthesis techniques for rat and mice have been developed during the last years, which allowed for the first time stable osteosynthesis in these animals comparable to the standards in large animals and humans. Based on these new implants, different models in rat and mice have been established to study delayed healing and non-union formation. Although in humans the terms delayed union and non-union are well defined, in rodents definitions are lacking. However, especially in scientific studies clear definitions are necessary to develop a uniform scientific language and allow comparison of the results between different studies. In this consensus report, we define the basic terms "union", "delayed healing" and "non-union" in rodent animal models. Based on a review of the literature and our own experience, we further provide an overview on available models of delayed healing and non-union formation in rats and mice. We further summarise the value of different approaches to study normal and delayed fracture healing as well as non-union formation, and discuss different methods of data evaluation.

A case for optimising fracture healing through inverse dynamization.

The mechanical conditions in the repair tissues are known to influence the outcome of fracture healing. These mechanical conditions are determined by the stiffness of fixation and limb loading. Experimental studies have shown that there is a range of beneficial fixation stiffness for timely healing and that fixation stiffness that is either too flexible or too stiff impairs callus healing. However, much less is known about how mechanical conditions influence the biological processes that make up the sequence of bone repair and if indeed mechanical stimulation is required at all stages of repair. Secondary bone healing occurs through a sequence of events broadly characterised by inflammation, proliferation, consolidation and remodelling. It is our hypothesis that a change in fixation stiffness from very flexible to stiff can shorten the time to healing relative to constant fixation stiffness. Flexible fixation has the benefit of promoting greater callus formation and needs to be applied during the proliferative stage of repair. The greater callus size helps to stabilize the fragments earlier allowing mineralization to occur faster. Together with stable/rigid fixation applied during the latter stage of repair to ensure mineralization of the callus. The predicted benefits of inverse dynamization are shortened healing in comparison to very flexible fixation and healing time comparable or faster than stable fixation with greater callus stiffness.

[Factor structure of the German version of the BIS/BAS Scales in a population-based sample]. / Faktorenstruktur der deutschsprachigen version der BIS/BAS-Skalen in einer bevölkerungsstichprobe.

BACKGROUND: The Behavioural Inhibition System/Behavioural Activation System Scale (BIS/BAS-Scales) developed by Carver and White 1 is a self-rating instrument to assess the dispositional sensitivity to punishment and reward. The present work aims to examine the factor structure of the German version of the BIS/BAS-Scales. MATERIAL AND METHODS: In a large German population-based sample (n = 1881) the model fit of several factor models was tested by using confirmatory factor analyses. RESULTS: The best model fit was found for the 5-factor model with two BIS (anxiety, fear) and three BAS (drive, reward responsiveness, fun seeking) scales, whereas the BIS-fear, the BAS-reward responsiveness, and the BAS-fun seeking subscales showed low internal consistency. The BIS/BAS scales were negatively correlated with age, and women reported higher BIS subscale scores than men. CONCLUSION: Confirmatory factor analyses suggest a 5-factor model. However, due to the low internal reliability of some of the subscales the use of this model is questionable.