Differences between subclinical attention-deficit/hyperactivity and autistic traits in default mode, salience, and frontoparietal network connectivities in young adult Japanese.

Attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are associated with attentional impairments, with both commonalities and differences in the nature of their attention deficits. This study aimed to investigate the neural correlates of ADHD and ASD traits in healthy individuals, focusing on the functional connectivity (FC) of attention-related large-scale brain networks (LSBNs). The participants were 61 healthy individuals (30 men; age, 21.9 ± 1.9 years). The Adult ADHD Self-Report Scale (ASRS) and Autism Spectrum Quotient (AQ) were administered as indicators of ADHD and ASD traits, respectively. Performance in the continuous performance test (CPT) was used as a behavioural measure of sustained attentional function. Functional magnetic resonance imaging scans were performed during the resting state (Rest) and auditory oddball task (Odd). Considering the critical role in attention processing, we focused our analyses on the default mode (DMN), frontoparietal (FPN), and salience (SN) networks. Region of interest (ROI)-to-ROI analyses (false discovery rate < 0.05) were performed to determine relationships between psychological measures with within-network FC (DMN, FPN, and SN) as well as with between-network FC (DMN-FPN, DMN-SN, and FPN-SN). ASRS scores, but not AQ scores, were correlated with less frequent commission errors and shorter reaction times in the CPT. During Odd, significant positive correlations with ASRS were demonstrated in multiple FCs within DMN, while significant positive correlations with AQ were demonstrated in multiple FCs within FPN. AQs were negatively correlated with FPN-SN FCs. During Rest, AQs were negatively and positively correlated with one FC within the SN and multiple FCs between the DMN and SN, respectively. These findings of the ROI-to-ROI analysis were only partially replicated in a split-half replication analysis, a replication analysis with open-access data sets, and a replication analysis with a structure-based atlas. The better CPT performance by individuals with subclinical ADHD traits suggests positive effects of these traits on sustained attention. Differential associations between LSBN FCs and ASD/ADHD traits corroborate the notion of differences in sustained and selective attention between clinical ADHD and ASD.

Evaluation of the Impact of ABCDEF Bundle Compliance Rates on Postintensive Care Syndrome: A Secondary Analysis Study.

OBJECTIVES: This study aimed to examine the association between ABCDEF bundles and long-term postintensive care syndrome (PICS)-related outcomes. DESIGN: Secondary analysis of the J-PICS study. SETTING: This study was simultaneously conducted in 14 centers and 16 ICUs in Japan between April 1, 2019, and September 30, 2019. PATIENTS: Adult ICU patients who were expected to be on a ventilator for at least 48 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Bundle compliance for the last 24 hours was recorded using a checklist at 8:00 am The bundle compliance rate was defined as the 3-day average of the number of bundles performed each day divided by the total number of bundles. The relationship between the bundle compliance rate and PICS prevalence (defined by the 36-item Short Form Physical Component Scale, Mental Component Scale, and Short Memory Questionnaire) was examined. A total of 191 patients were included in this study. Of these, 33 patients (17.3%) died in-hospital and 48 (25.1%) died within 6 months. Of the 96 patients with 6-month outcome data, 61 patients (63.5%) had PICS and 35 (36.5%) were non-PICS. The total bundle compliance rate was 69.8%; the rate was significantly lower in the 6-month mortality group (66.6% vs 71.6%, p = 0.031). Bundle compliance rates in patients with and without PICS were 71.3% and 69.9%, respectively ( p = 0.61). After adjusting for confounding variables, bundle compliance rates were not significantly different in the context of PICS prevalence ( p = 0.56). A strong negative correlation between the bundle compliance rate and PICS prevalence ( r = -0.84, R 2 = 0.71, p = 0.035) was observed in high-volume centers. CONCLUSIONS: The bundle compliance rate was not associated with PICS prevalence. However, 6-month mortality was lower with a higher bundle compliance rate. A trend toward a lower PICS prevalence was associated with higher bundle compliance in high-volume centers.

Information flow and dynamic functional connectivity during electroconvulsive therapy in patients with depression.

BACKGROUND: Electroconvulsive therapy is effectively used for treatment-resistant depression; however, its neural mechanism is largely unknown. Resting-state functional magnetic resonance imaging is promising for monitoring outcomes of electroconvulsive therapy for depression. This study aimed to explore the imaging correlates of the electroconvulsive therapy effects on depression using Granger causality analysis and dynamic functional connectivity analyses. METHODS: We performed advanced analyses of resting-state functional magnetic resonance imaging data at the beginning and intermediate stages and end of the therapeutic course to identify neural markers that reflect or predict the therapeutic effects of electroconvulsive therapy on depression. RESULTS: We demonstrated that information flow between the functional networks analyzed by Granger causality changes during electroconvulsive therapy, and this change was correlated with the therapeutic outcome. Information flow and the dwell time (an index reflecting the temporal stability of functional connectivity) before electroconvulsive therapy are correlated with depressive symptoms during and after treatment. LIMITATIONS: First, the sample size was small. A larger group is needed to confirm our findings. Second, the influence of concomitant pharmacotherapy on our results was not fully addressed, although we expected it to be minimal because only minor changes in pharmacotherapy occurred during electroconvulsive therapy. Third, different scanners were used the groups, although the acquisition parameters were the same; a direct comparison between patient and healthy participant data was not possible. Thus, we presented the data of the healthy participants separately from that of the patients as a reference. CONCLUSIONS: These results show the specific properties of functional brain connectivity.

The Japanese version of the Generalized Problematic Internet Use Scale 2 (GPIUS2): Psychometric evaluation and analysis of the theoretical model.

BACKGROUND: The Generalized Problematic Internet Use Scale 2 (GPIUS2) is a self-administered questionnaire that evaluates problematic internet use (PIU) from a multidimensional perspective. We analysed the psychometric properties and adequacy of the theoretical model of Japanese version of the GPIUS2. METHODS: This study included 291 healthy Japanese adults (median age = 25 years; interquartile range 22-43 years; 128 women) who completed the GPIUS2 and several other questionnaires evaluating the degree of PIU, self-esteem, depression, and impulsivity. RESULTS: Exploratory factor analysis (EFA) revealed a similar factor structure between the original and Japanese versions of the GPIUS2, with only minor differences in item composition. Higher-order confirmatory factor analyses revealed a good overall fit for the factorial model suggested by EFA, indicating adequate construct validity. The model showed acceptable internal consistency. Partial correlation analyses between GPIUS2 and other measures, with age as a control variable, revealed good convergent validity. Finally, structural equation modelling showed a good fit to the data, supporting the cognitive-behavioural model of Caplan (2010). CONCLUSIONS: The Japanese version of the GPIUS2 has good psychometric properties and the theoretical model of the original GPIUS2 is applicable to Japanese adults.

Use of broad-spectrum antimicrobials for more than 72 h and the detection of multidrug-resistant bacteria in Japanese intensive care units: a multicenter retrospective cohort study.

BACKGROUND: Large multicenter studies reporting on the association between the duration of broad-spectrum antimicrobial administration and the detection of multidrug-resistant (MDR) bacteria in the intensive care unit (ICU) are scarce. We evaluated the impact of broad-spectrum antimicrobial therapy for more than 72 h on the detection of MDR bacteria using the data from Japanese patients enrolled in the DIANA study. METHODS: We analyzed the data of ICU patients in the DIANA study (a multicenter international observational cohort study from Japan). Patients who received empirical antimicrobials were divided into a broad-spectrum antimicrobial group and a narrow-spectrum antimicrobial group, based on whether they received broad-spectrum antimicrobials for more or less than 72 h, respectively. Differences in patient characteristics, background of infectious diseases and empirical antimicrobial administration, and outcomes between the two groups were compared using the chi-square tests (Monte Carlo method) for categorical variables and the Mann-Whitney U-test for continuous variables. We also conducted a logistic regression analysis to investigate the factors associated with the detection of new MDR bacteria. RESULTS: A total of 254 patients from 31 Japanese ICUs were included in the analysis, of whom 159 (62.6%) were included in the broad-spectrum antimicrobial group and 95 (37.4%) were included in the narrow-spectrum antimicrobial group. The detection of new MDR bacteria was significantly higher in the broad-spectrum antimicrobial group (11.9% vs. 4.2%, p = 0.042). Logistic regression showed that broad-spectrum antimicrobial continuation for more than 72 h (OR [odds ratio] 3.09, p = 0.047) and cerebrovascular comorbidity on ICU admission (OR 2.91, p = 0.041) were associated with the detection of new MDR bacteria. CONCLUSIONS: Among Japanese ICU patients treated with empirical antimicrobials, broad-spectrum antimicrobial usage for more than 72 h was associated with the increased detection of new MDR bacteria. Antimicrobial stewardship programs in ICUs should discourage the prolonged use of empirical broad-spectrum antimicrobial therapy. Trial registration ClinicalTrials.gov, NCT02920463, Registered 30 September 2016, https://clinicaltrials.gov/ct2/show/NCT02920463.

Online Behaviours during the COVID-19 Pandemic and Their Associations with Psychological Factors: An International Exploratory Study.

This cross-sectional study aimed to explore specific online behaviours and their association with a range of underlying psychological and other behavioural factors during the COVID-19 pandemic. Eight countries (Italy, Spain, the United Kingdom, Lithuania, Portugal, Japan, Hungary, and Brazil) participated in an international investigation involving 2223 participants (M = 33 years old; SD = 11), 70% of whom were females. Participants were surveyed for specific type of Internet use severity, appearance anxiety, self-compassion, and image and use of performance-enhancing drugs (IPEDs). Results were compared cross-culturally. The mean time spent online was 5 h (SD = ±3) of daily browsing during the pandemic. The most commonly performed activities included social networking, streaming, and general surfing. A strong association between these online behaviours and appearance anxiety, self-compassion, and IPEDs use was found after adjustment for possible confounders, with higher scores being associated with specific online activities. Significant cross-cultural differences also emerged in terms of the amount of time spent online during the initial stages of the COVID-19 pandemic.

Activities of daily living and psychiatric symptoms after intensive care unit discharge among critically ill patients with or without tracheostomy: a single center longitudinal study.

Aim: Tracheostomy is widely performed in critically ill patients who require prolonged mechanical ventilation. Long-term morbidity (post-intensive care syndrome) in tracheostomized patients is not widely reported, however, so we evaluate it here. Methods: This is a sub-analysis of a single center prospective longitudinal study, which assessed activities of daily living (ADL) and psychiatric symptoms in adult patients emergently admitted to the intensive care unit (ICU). We evaluated association between these symptoms and tracheostomy by posting questionnaires at 3 and 12 months after ICU discharge. Results: We analyzed 107 patients (15 patients with tracheostomy) at 3 months and 74 patients (13 patients with tracheostomy) at 12 months after ICU discharge. ADL tended to be lower in patients with tracheostomy than in those without tracheostomy at 3 months after ICU discharge (65 [10-100] versus 95 [59-100]; P = 0.28, 7/15 [47%] versus 30/102 [30%] Barthel Index scored ≤ 60; P = 0.23), however there were no significant differences. Psychiatric symptoms were not different between the groups at 3 months and again at 12 months. Conclusion: Activities of daily living disability and psychiatric symptoms were not significantly worse in patients with tracheostomy at 3 and 12 months from ICU discharge compared with patients without tracheostomy. Despite the limited number in our cohort, our study may inform shared decision making concerning tracheostomy for critically ill patients and their families.

Incidence and Risk Factors of Worsened Activities of Daily Living Status Three Months after Intensive Care Unit Discharge among Critically Ill Patients: A Prospective Cohort Study.

Background: We aimed to determine risk factors associated with worsened activity of daily living (ADL) status three months after intensive care unit (ICU) discharge. Methods: In this prospective, observational study, we enrolled critically ill adult patients that were emergently admitted to an ICU. We assessed ADL status by Barthel index score prior to ICU admission and three months after ICU discharge. The primary outcome was worsened ADL status, defined as a ≥10 decrease in Barthel index score. Results: We enrolled 102 patients (median age was 72 years old, 55% were male, and 87% received mechanical ventilation during ICU stay), and 42 patients (41%) had worsened ADL status three months after discharge from ICU. Multivariate analysis revealed that older age (>70 years old; adjusted odds ratio (aOR) 3.68; 95% confidence interval (95%CI) 1.33−10.19), high burden of chronic illness (aOR 4.11; 95%CI 1.43−11.81), and longer duration of mechanical ventilation (≥4 days; aOR 2.83; 95%CI 1.04−7.69) were independent risk factors for worsened ADL status at three months. Conclusions: Almost half of the critically ill adult patients in this cohort had worsened ADL status after ICU discharge. Older age, high burden of chronic illness, and longer duration of mechanical ventilation were risk factors for worsened ADL status.

Life Habits and Mental Health: Behavioural Addiction, Health Benefits of Daily Habits, and the Reward System.

In this review, the underlying mechanisms of health benefits and the risk of habitual behaviours such as internet use and media multitasking were explored, considering their associations with the reward/motivation system. The review highlights that several routines that are beneficial when undertaken normally may evolve into excessive behaviour and have a negative impact, as represented by "the inverted U-curve model". This is especially critical in the current era, where technology like the internet has become mainstream despite the enormous addictive risk. The understanding of underlying mechanisms of behavioural addiction and optimal level of habitual behaviours for mental health benefits are deepened by shedding light on some findings of neuroimaging studies to have hints to facilitate better management and prevention strategies of addictive problems. With the evolution of the world, and the inevitable use of some technologies that carry the risk of addiction, more effective strategies for preventing and managing addiction are in more demand than before, and the insights of this study are also valuable foundations for future research.

An international cross-sectional investigation on social media, fitspiration content exposure, and related risks during the COVID-19 self-isolation period.

With the global COVID-19 pandemic, governments from many countries in the world implemented various restrictions to prevent the SARS-Cov-2 virus's spread, including social distancing measures, quarantine, in-home lockdown, and the closure of services and public spaces. This led to an in-creased use of social media platforms to make people feel more connected, but also to maintain physical activity while self-isolating. Concerns about physical appearance and the desire to keep or reach a muscular and toned ideal body, might have further reinforced the engagement in fitness-related social media activities, like sharing progresses in training achievements or following more fitness contents on popular profiles. To better understand the underlying relation among these factors, the present study investigates 729 responses to the Exercise Addiction Inventory (EAI), the Appearance Anxiety Inventory (AAI), the Self-Compassion Scale (SCS) and their association to social media usage and compares the results cross-culturally in five countries (Spain, Lithuania, United Kingdom, Japan, and Hungary). Findings highlight significant differences between males and females, espe-cially in regard to the time spent online (U = 477.5, p = 0.036). Greater levels of appearance anxiety were associated with the exposure to fitness-related contents on social media. These results strongly confirm the previously highlighted association between fitspiration media and body image anxiety predominantly in females. Clinical implications and future considerations in terms of prevention and treatment in a situation of global emergency are also discussed.

Multisystem inflammatory syndrome in adults after acute coronavirus disease 2019 in a Japanese woman: A case report.

Multisystem inflammatory syndrome in adults (MIS-A) is a rare and emerging syndrome after coronavirus disease 2019 (COVID-19). To the best of our knowledge, Japanese cases of MIS-A are rarely reported. Here, we describe a case of MIS-A in a 44-year-old Japanese woman presenting with multiorgan dysfunction (i.e., cardiovascular and mucocutaneous involvement) and markedly elevated inflammatory markers 2 weeks after recovery from COVID-19. Treatment with intravenous immunoglobulins and corticosteroids resolved her symptoms. On the 13th day, she was discharged from the hospital with no recurrences on follow-up. This study highlights the importance of recognizing this emerging syndrome when treating patients with multiorgan dysfunction after COVID-19.

Subjective symptoms and their association with psychiatric symptoms 3 months after ICU discharge: sub-analysis of a single-center prospective observational study.

BACKGROUND: Despite a growing volume of literature on post-intensive care syndrome, we know little about how subjective symptoms affect intensive care unit survivors in the long term. AIMS: This study aimed to elucidate the prevalence of subjective symptoms and to determine the clinical importance of post-intensive care syndrome by evaluating the association between these symptoms and psychiatric symptoms. We evaluated new-onset or worsening subjective symptoms and psychiatric symptoms in 81 patients at 3 months after discharge from an intensive care unit. RESULTS: More than half of patients had at least one subjective symptom, such as weakness (n = 31), fatigue (n = 23), malaise (n = 14), body pain (n = 14), or insomnia (n = 9). CONCLUSIONS: The presence of subjective symptoms is associated with worse psychiatric symptoms (post-traumatic stress disorder, anxiety, and depression) at 3 months after ICU discharge. We found insomnia was particularly strongly associated with psychiatric symptoms in our study group. TRIAL REGISTRATION: UMIN Clinical Trial Registry no. UMIN000023743, September 1, 2016.

The impact of relative hypotension on acute kidney injury progression after cardiac surgery: a multicenter retrospective cohort study.

BACKGROUND: Cardiac surgery is performed worldwide, and acute kidney injury (AKI) following cardiac surgery is a risk factor for mortality. However, the optimal blood pressure target to prevent AKI after cardiac surgery remains unclear. We aimed to investigate whether relative hypotension and other hemodynamic parameters after cardiac surgery are associated with subsequent AKI progression. METHODS: We retrospectively enrolled adult patients admitted to 14 intensive care units after elective cardiac surgery between January and December 2018. We defined mean perfusion pressure (MPP) as the difference between mean arterial pressure (MAP) and central venous pressure (CVP). The main exposure variables were time-weighted-average MPP-deficit (i.e., the percentage difference between preoperative and postoperative MPP) and time spent with MPP-deficit > 20% within the first 24 h. We defined other pressure-related hemodynamic parameters during the initial 24 h as exploratory exposure variables. The primary outcome was AKI progression, defined as one or more AKI stages using Kidney Disease: Improving Global Outcomes' creatinine and urine output criteria between 24 and 72 h. We used multivariable logistic regression analyses to assess the association between the exposure variables and AKI progression. RESULTS: Among the 746 patients enrolled, the median time-weighted-average MPP-deficit was 20% [interquartile range (IQR): 10-27%], and the median duration with MPP-deficit > 20% was 12 h (IQR: 3-20 h). One-hundred-and-twenty patients (16.1%) experienced AKI progression. In the multivariable analyses, time-weighted-average MPP-deficit or time spent with MPP-deficit > 20% was not associated with AKI progression [odds ratio (OR): 1.01, 95% confidence interval (95% CI): 0.99-1.03]. Likewise, time spent with MPP-deficit > 20% was not associated with AKI progression (OR: 1.01, 95% CI 0.99-1.04). Among exploratory exposure variables, time-weighted-average CVP, time-weighted-average MPP, and time spent with MPP < 60 mmHg were associated with AKI progression (OR: 1.12, 95% CI 1.05-1.20; OR: 0.97, 95% CI 0.94-0.99; OR: 1.03, 95% CI 1.00-1.06, respectively). CONCLUSIONS: Although higher CVP and lower MPP were associated with AKI progression, relative hypotension was not associated with AKI progression in patients after cardiac surgery. However, these findings were based on exploratory investigation, and further studies for validating them are required. Trial Registration UMIN-CTR, https://www.umin.ac.jp/ctr/index-j.htm , UMIN000037074.

Exploring the Relationship Between Mental Well-Being, Exercise Routines, and the Intake of Image and Performance Enhancing Drugs During the Coronavirus Disease 2019 Pandemic: A Comparison Across Sport Disciplines.

Introduction: Physical distancing under the coronavirus disease 2019 (COVID-19) pandemic had a significant impact on lifestyles, including exercise routines. In this study, we examined the relationship between mental health and addictive behaviors, such as excessive exercise and the use of image and performance enhancing drugs (IPEDs) across 12 sport disciplines. Materials and methods: A large cross-sectional sample of the adult population (N = 2,295) was surveyed. The mean age was 33.09 (SD = 11.40). The number of male participants was 668 (30.0%). The use of IPEDs was assessed in conjunction with psychometric measures such as the Exercise Addiction Inventory (EAI) and the Appearance Anxiety Inventory (AAI). The participants were grouped into activity group (AG) and non-activity group (NAG) according to the presence or absence of their exercise habits. The results were compared between these groups, as well as across sport disciplines, while taking into account the relationship between different psychological measures and IPEDs consumption. Results: The frequency of IPEDs use was higher among AG (34.6%) than NAG (14.6%), although AG participants reported less history of addictions (7.1%) than NAG (11.8%). The logistic regression analysis revealed that scores equal to or above cutoff points, in both the EAI and AAI, predicted the IPEDs use. Regarding the differences across the various sport disciplines, those who were involved in practicing Weight Lifting and Cross Fit were found to be more at risk of excessive exercising and more inclined to use a wide range of IPEDs. Conclusions: Although exercise could help to increase well-being and prevent addictions during the COVID-19 pandemic, our results show that those in the AG are particularly vulnerable to excessive IPEDs use. Sport disciplines associated with higher EAI and AAI scores have also shown a higher tendency to excessive IPEDs use. Furthermore, the factor of having above the cutoff scores in EAI or AAI in each sport could indicate larger IPEDs consumption regardless of the discipline. In light of the current findings, it is necessary to better define the "non-excessive" levels of exercise in various sport disciplines and an adequate intake of IPEDs to ensure the safety and well-being of people during a pandemic.

Impaired neuronal activity and differential gene expression in STXBP1 encephalopathy patient iPSC-derived GABAergic neurons.

Syntaxin-binding protein 1 (STXBP1; also called MUNC18-1), encoded by STXBP1, is an essential component of the molecular machinery that controls synaptic vesicle docking and fusion. De novo pathogenic variants of STXBP1 cause a complex set of neurological disturbances, namely STXBP1 encephalopathy (STXBP1-E) that includes epilepsy, neurodevelopmental disorders and neurodegeneration. Several animal studies have suggested the contribution of GABAergic dysfunction in STXBP1-E pathogenesis. However, the pathophysiological changes in GABAergic neurons of these patients are still poorly understood. Here, we exclusively generated GABAergic neurons from STXBP1-E patient-derived induced pluripotent stem cells (iPSCs) by transient expression of the transcription factors ASCL1 and DLX2. We also generated CRISPR/Cas9-edited isogenic iPSC-derived GABAergic (iPSC GABA) neurons as controls. We demonstrated that the reduction in STXBP1 protein levels in patient-derived iPSC GABA neurons was slight (approximately 20%) compared to the control neurons, despite a 50% reduction in STXBP1 mRNA levels. Using a microelectrode array-based assay, we found that patient-derived iPSC GABA neurons exhibited dysfunctional maturation with reduced numbers of spontaneous spikes and bursts. These findings reinforce the idea that GABAergic dysfunction is a crucial contributor to STXBP1-E pathogenesis. Moreover, gene expression analysis revealed specific dysregulation of genes previously implicated in epilepsy, neurodevelopment and neurodegeneration in patient-derived iPSC GABA neurons, namely KCNH1, KCNH5, CNN3, RASGRF1, SEMA3A, SIAH3 and INPP5F. Thus, our study provides new insights for understanding the biological processes underlying the widespread neuropathological features of STXBP1-E.

Exercise and Use of Enhancement Drugs at the Time of the COVID-19 Pandemic: A Multicultural Study on Coping Strategies During Self-Isolation and Related Risks.

Introduction: Little is known about the impact of restrictive measures during the COVID-19 pandemic on self-image and engagement in exercise and other coping strategies alongside the use of image and performance-enhancing drugs (IPEDs) to boost performance and appearance. Objectives: To assess the role of anxiety about appearance and self-compassion on the practice of physical exercise and use of IPEDs during lockdown. Methods: An international online questionnaire was carried out using the Exercise Addiction Inventory (EAI), the Appearance Anxiety Inventory (AAI), and the Self-Compassion Scale (SCS) in addition to questions on the use of IPEDs. Results: The sample consisted of 3,161 (65% female) adults from Italy (41.1%), Spain (15.7%), the United Kingdom (UK) (12.0%), Lithuania (11.6%), Portugal (10.5%), Japan (5.5%), and Hungary (3.5%). The mean age was 35.05 years (SD = 12.10). Overall, 4.3% of the participants were found to engage in excessive or problematic exercise with peaks registered in the UK (11.0%) and Spain (5.4%). The sample reported the use of a wide range of drugs and medicines to boost image and performance (28%) and maintained use during the lockdown, mostly in Hungary (56.6%), Japan (46.8%), and the UK (33.8%), with 6.4% who started to use a new drug. Significant appearance anxiety levels were found across the sample, with 18.1% in Italy, 16.9% in Japan, and 16.7% in Portugal. Logistic regression models revealed a strong association between physical exercise and IPED use. Anxiety about appearance also significantly increased the probability of using IPEDs. However, self-compassion did not significantly predict such behavior. Anxiety about appearance and self-compassion were non-significant predictors associated with engaging in physical exercise. Discussion and Conclusion: This study identified risks of problematic exercising and appearance anxiety among the general population during the COVID-19 lockdown period across all the participating countries with significant gender differences. Such behaviors were positively associated with the unsupervised use of IPEDs, although no interaction between physical exercise and appearance anxiety was observed. Further considerations are needed to explore the impact of socially restrictive measures among vulnerable groups, and the implementation of more targeted responses.

Combination of delirium and coma predicts psychiatric symptoms at twelve months in critically ill patients: A longitudinal cohort study.

PURPOSE: We aimed to determine any associations between delirium and comas during intensive care unit (ICU) stay, and long-term psychiatric symptoms and disability affecting activity of daily living (ADL). MATERIALS AND METHODS: In this prospective observational study, we enrolled critically ill adult patients that were emergently admitted to an ICU. We assessed psychiatric symptoms and disability affecting ADL at three and twelve months after ICU discharge. RESULTS: Among the 81 and the 47 patients that responded to the questionnaires at three and twelve months, 22 (27%) and 13 (28%) patients experienced delirium, respectively. During their ICU stay, 28 (35%) and 21 (45%) had been in comas, respectively. At three and twelve months, 51 (63%) and 23 (49%) of patients experienced composite psychiatric symptoms or disability affecting ADL, respectively. After adjusting predefined confounders, the combination of delirium and comas was an independent risk factor for the presence of composite psychiatric symptoms or disability affecting ADL (adjusted odds ratio [aOR] 3.38; 1.10-10.38 at three months; aOR 8.28; 1.48-46.46 at twelve months). CONCLUSIONS: In critically ill adults, combination of delirium and comas during ICU stay is a predictor of psychiatric symptoms or ADL disability. TRIAL REGISTRATION: UMIN Clinical Trial Registry no. UMIN000023743, September 1, 2016.

Prevalence of post-intensive care syndrome among Japanese intensive care unit patients: a prospective, multicenter, observational J-PICS study.

BACKGROUND: Many studies have compared quality of life of post-intensive care syndrome (PICS) patients with age-matched population-based controls. Many studies on PICS used the 36-item Short Form (SF-36) health survey questionnaire version 2, but lack the data for SF-36 values before and after intensive care unit (ICU) admission. Thus, clinically important changes in the parameters of SF-36 are unknown. Therefore, we determined the frequency of co-occurrence of PICS impairments at 6 months after ICU admission. We also evaluated the changes in SF-36 subscales and interpreted the patients' subjective significance of impairment. METHODS: A prospective, multicenter, observational cohort study was conducted in 16 ICUs across 14 hospitals in Japan. Adult ICU patients expected to receive mechanical ventilation for > 48 h were enrolled, and their 6-month outcome was assessed using the questionnaires. PICS definition was based on the physical status, indicated by the change in SF-36 physical component score (PCS) ≥ 10 points; mental status, indicated by the change in SF-36 mental component score (MCS) ≥ 10 points; and cognitive function, indicated by the worsening of Short-Memory Questionnaire (SMQ) score and SMQ score at 6 months < 40. Multivariate logistic regression model was used to identify the factors associated with PICS occurrence. The patients' subjective significance of physical and mental symptoms was assessed using the 7-scale Global Assessment Rating to evaluate minimal clinically important difference (MCID). RESULTS: Among 192 patients, 48 (25%) died at 6 months. Among the survivors at 6 months, 96 patients responded to the questionnaire; ≥ 1 PICS impairment occurred in 61 (63.5%) patients, and ≥ 2 occurred in 17 (17.8%) patients. Physical, mental, and cognitive impairments occurred in 32.3%, 14.6% and 37.5% patients, respectively. Population with only mandatory education was associated with PICS occurrence (odds ratio: 4.0, 95% CI 1.1-18.8, P = 0.029). The MCID of PCS and MCS scores was 6.5 and 8.0, respectively. CONCLUSIONS: Among the survivors who received mechanical ventilation, 64% had PICS at 6 months; co-occurrence of PICS impairments occurred in 20%. PICS was associated with population with only mandatory education. Future studies elucidating the MCID of SF-36 scores among ICU patients and standardizing the PICS definition are required. Trial registration UMIN000034072.

Comparative characterization of PCDH19 missense and truncating variants in PCDH19-related epilepsy.

Missense and truncating variants in protocadherin 19 (PCDH19) cause PCDH19-related epilepsy. In this study, we aimed to investigate variations in distributional characteristics and the clinical implications of variant type in PCDH19-related epilepsy. We comprehensively collected PCDH19 missense and truncating variants from the literature and by sequencing six exons and intron-exon boundaries of PCDH19 in our cohort. We investigated the distribution of each type of variant using the cumulative distribution function and tested for associations between variant types and phenotypes. The distribution of missense variants in patients was clearly different from that of healthy individuals and was uniform throughout the extracellular cadherin (EC) domain, which consisted of six highly conserved domains. Truncating variants showed two types of distributions: (1) located from EC domain 1 to EC domain 4, and (2) located from EC domain 5 to the cytoplasmic domain. Furthermore, we also found that later onset seizures and milder intellectual disability occurred in patients with truncating variants located from EC domain 5 to the cytoplasmic domain compared with those of patients with other variants. Our findings provide the first evidence of two types of truncating variants in the PCDH19 gene with regard to distribution and the resulting clinical phenotype.