A Systematic Review of Radiation-Related Lymphopenia in Genito-urinary Malignancies.

BACKGROUND: The impact of radiation-related lymphopenia on clinical outcomes has been reported in various solid malignancies such as high grade gliomas, head and neck cancers, thoracic malignancies and gastro-intestinal malignancies but its impact is not clearly known in the context of common genito-urinary (GU) malignancies. METHODOLOGY: To better understand the effect of radiation-associated lymphopenia in prostate and bladder cancer, we undertook this systematic review of clinical studies that have studied radiation-related lymphopenia in GU malignancies. A systematic methodology search of PubMed, Embase, and Cochrane library resulted in 2125 abstracts. Ten studies fulfilled the inclusion criteria which included any prospective, retrospective study or cohort study of prostate, urinary bladder, kidney, ureter, urethra, penile cancer in humans, and radiation should be part of treatment and intent has to be in definitive or adjuvant settings. Finally the study should have data on radiation-related lymphopenia. RESULTS: Four studies reported on the cancer-specific outcomes related to the lymphopenia. The incidence of low lymphocyte counts were documented in all the studies. Three studies analyzed the factors associated with the Lymphocyte depletion. Pooled incidence of severe lymphopenia was 29.25% and mild to moderate lymphopenia was 60.75%. Bone marrow volume receiving 40 Gy was associated with the incidence of lymphopenia. CONCLUSION: One-third of the patients suffer from severe lymphopenia after radiation in prostate and bladder cancer. There are no clear data to support the correlation between severe lymphopenia and disease outcomes. Bone marrow dosimetry can affect the incidence and severity of lymphopenia. There is need of prospective datasets to identify the impact of radiation-related lymphopenia in GU malignancies focusing on long-term side effects, recurrence rates, and overall survival.

Risk and impact of radiation related lymphopenia in lung cancer: A systematic review and meta-analysis.

BACKGROUND: Despite the modern advances in treatment techniques, the survival of locally advanced lung cancer patients continues to remain poor. Circulating lymphocytes have an important role to play in local immune response to RT as well as immune checkpoint inhibitors, and radiation related lymphopenia has been associated with inferior survival in various tumors. METHODS: We undertook this systematic review and meta-analysis to evaluate the literature on risk and impact of lymphopenia in thoracic tumors. A systematic methodology search of the PubMed, Embase and Cochrane library was performed and eligible studies selected based on pre-defined inclusion and exclusion criteria. Review Manager Version 5.4.1 was used for the meta-analysis. RESULTS: Fourteen studies were included in the final systematic review and 10 in the quantitative analysis. Overall mean incidence of severe lymphopenia (absolute lymphocyte count < 500) was 64.24%. The patients with severe lymphopenia were at increased risk of death with a pooled HR of 1.59 (95% CI: 1.40, 1.81, I2 = 17%, P < 0.001) and progression with a pooled HR of 2.1 (95% CI: 1.57, 2.81, I2 = 59%, P < 0.001) compared to patients with no severe lymphopenia. Dosimetric parameters including gross tumor volume, lung V5 and heart V5 were predictive of lymphopenia, while advanced age, lower baseline lymphocyte counts, higher stage and large tumor size were other risk factors. Models predicting estimated radiation dose to lymphocytes were a good surrogate for treatment outcomes. CONCLUSION: Radiation related lymphopenia is associated with increased hazard of progression and death in lung cancer. Minimizing the lung and heart dose, especially in patients with concurrent other risk factors can reduce lymphopenia and potentially improve treatment outcomes in these patients.

Lactobacillus-fermented milk products attenuate bone loss in an experimental rat model of ovariectomy-induced post-menopausal primary osteoporosis.

AIM: In this study, we investigated the anti-osteoporotic effect of two fermented milk products (FMPs) fermented by Lactobacillus plantarum A41 and Lactobacillus fermentum SRK414 on a rat model of ovariectomy-induced post-menopausal primary osteoporosis. METHODS AND RESULTS: The two Lactobacillus FMPs increased the bone volume and bone mineral density (BMD) in ovariectomized (OVX) rats, and normalized the bone biomarkers in the serum. Additionally, they altered the gene expression levels of bone-metabolism-related markers. Furthermore, the two Lactobacillus FMPs downregulated bone-apoptosis-related genes stimulated by ovariectomy. Interestingly, the Lactobacillus FMPs decreased the levels of inflammation markers in the serum, bone, ileum and colon of the rats. Gut bacterial populations were also affected upon FMP treatment due to increase in the abundance of the genus Lactobacillus and Faecalibacterium prausnitzii. CONCLUSIONS: Milk products fermented by L. plantarum A41 and L. fermentum SRK414 can exhibit anti-osteoporotic effects on post-menopausal osteoporosis via regulating the expression of bone-metabolism-related markers. SIGNIFICANCE AND IMPACT OF THE STUDY: The two Lactobacillus FMPs used in the study can be an ideal method that has its potential of treating post-menopausal osteoporosis instead of drug treatments.

Adversity profiles among court-involved youth: Translating system data into trauma-responsive programming.

BACKGROUND: Court-involved youth have high levels of adverse childhood experiences (ACEs), which can impact functioning in adolescence and throughout adulthood. Yet there is limited research to help clinicians translate these histories into trauma-responsive programming guidelines. OBJECTIVE: This manuscript utilizes data that is routinely collected to inform practitioners about how to utilize trauma histories to inform program and practice decisions. METHODS: This study used administrative data with a diverse sample of medium- to high-risk youth on probation (N = 5,378) to examine how ACE clusters, identified through Latent Class Analysis, evinced differential treatment needs across multiple domains. RESULTS: Six identified classes - Low All, Parental Incarceration, Parental Health Problems, High Conflict, High Maltreatment, and High All - were assessed for differences in self-regulation, mental health, substance use, academic functioning, family/social resources, and behavioral problems. Classes varied significantly on all assessed domains, indicating differential needs for effective interventions to interrupt negative trajectories. CONCLUSIONS: Utilizing existing data in a real-world setting and addressing challenges and barriers in real-time can help bring research evidence to practice. In addition to juvenile justice settings, we conclude with discussion of ways that allied community based services in schools, youth programming, and family services can benefit from awareness of these youth adversity profiles.

Semi-automatic segmentation and surface reconstruction of computed tomography images by using rotoscoping and warping techniques.

BACKGROUND: Quick and large-scale segmentation along with three-dimensional (3D) reconstruction is necessary to make precise 3D musculoskeletal models for surface anatomy education, palpation training, medical communication, morphology research, and virtual surgery simulation. However, automatic segmentation of the skin and muscles remain undeveloped. MATERIALS AND METHODS: Therefore, in this study, we developed workflows for semi-automatic segmentation and surface reconstruction, using rotoscoping and warping techniques. RESULTS: The techniques were applied to multi detector computed tomography images, which were optimised to quickly generate surface models of the skin and the anatomical structures underlying the fat tissue. CONCLUSIONS: The workflows developed in this study are expected to enable researchers to create segmented images and optimised surface models from any set of serially sectioned images quickly and conveniently. Moreover, these optimised surface models can easily be modified for further application or educational use.

Longitudinal Associations among Depression, substance Abuse, and Crime: A Test of competing Hypotheses for Driving Mechanisms.

PURPOSE: Crime, depression, and substance abuse, often co-occur. This study examined competing models considering each problem domain individually as a driving mechanism for the other problems to better understand etiology and inform prevention efforts. Gender differences were also examined. METHODS: Data were drawn from the Seattle Social Development Project, a multiethnic and gender-balanced urban panel of 808 participants constituted in 1985. Cross- lagged models examined prospective assessments of early (grades 7 & 8) and late (grades 9-12) adolescent internalizing problems, substance use, and delinquency, as well as measures of depression, substance dependence, and crime at early adulthood (ages 21-24) and later adulthood (ages 27-30). RESULTS: Comparisons of nested models by gender showed (a) continuity in internalizing behaviors/depression, substance use/dependence, and delinquency/crime for both women and men; (b) accounting for continuity, depression did not consistently drive other problems for either women or men; (c) among women, both substance abuse and crime appeared to be important driving mechanisms; and (d) among men, crime emerged as the most pertinent driving mechanism. CONCLUSION: Findings suggest that externalizing problems may be more important driving mechanisms for depression than vice versa. Preventing crime and substance abuse may have the important added benefit of reducing early adult depression.

Suppressive effect of Lactobacillus fermentum Lim2 on Clostridioides difficile 027 toxin production.

Clostridioides difficile is a spore-forming, Gram-positive, anaerobic pathogen that caused gastrointestinal illness. During dysbiosis, overgrowth of C. difficile resulting in higher levels of toxin production. Since Lactobacillus has been commonly used to alleviate gastrointestinal discomfort, this study aimed to investigate the effects of Lactobacillus isolated from kimchi on the quorum-sensing and virulence factors of C. difficile 027. Among the isolated Lactobacillus strains, the acid and bile tolerant L. fermentum Lim2 was only able to reduce C. difficile 027 growth by one log10 CFU per ml. In keeping with this finding, C. difficile 027 growth was unaffected by either untreated or heat-inactivated cell extracts from L. fermentum Lim2. Both untreated and heat-inactivated cell extracts did, however, significantly reduce the autoinducer-2 (AI-2) activity of C. difficile 027, with the most prominent suppression effect (654-fold) being found from 100 mg ml-1 of heat-inactivated cell extract. A gene expression analysis indicated that in the presence of 100 mg ml-1 heat-inactivated cell extract, the quorum-sensing (luxS) and the virulence factors (tcdA, tcdB and tcdE) were significantly suppressed, whereas the negative regulator gene (tcdC) was significantly up-regulated. Taken together, the significant anti-pathogenic effect from L. fermentum Lim2 could potentially be used to treat C. difficile-infections. SIGNIFICANCE AND IMPACT OF THE STUDY: Clostridioides difficile is a Gram-positive pathogenic bacteria that caused gastrointestinal illness via toxic production. The emergence of highly virulence and foodborne C. difficile strains has further increased the incident and severity of C. difficile-infections (CDIs). Numerous studies have reported the immunomodulatory activity of Lactobacillus, a member of healthy gut microbiota, to maintain gastrointestinal health. Here, we successfully isolated L. fermentum Lim2 from kimchi, and identified a promising anti-pathogenic effect against C. difficile 027, from the heat-inactivated L. fermentum cell extract via suppression on the C. difficile 027 quorum-sensing system and toxin production, which could potentially be used to treat and prevent CDIs.

Classifying Changes to Preventive Interventions: Applying Adaptation Taxonomies.

High-quality implementation is important for preventive intervention effectiveness. Although this implies fidelity to a practice model, some adaptation may be inevitable or even advantageous in routine practice settings. In order to organize the study of adaptation and its effect on intervention outcomes, scholars have proposed various adaptation taxonomies. This paper examines how four published taxonomies retrospectively classify adaptations: the Ecological Validity Framework (EVF; Bernal et al. in J Abnorm Child Psychol 23(1):67-82, 1995), the Hybrid Prevention Program Model (HPPM; Castro et al. in Prev Sci 5(1):41-45, 2004. https://doi.org/10.1023/B:PREV.0000013980.12412.cd ), the Moore et al. (J Prim Prev 34(3):147-161, 2013. https://doi.org/10.1007/s10935-013-0303-6 ) taxonomy, and the Stirman et al. (Implement Sci 8:65, 2013. https://doi.org/10.1186/1748-5908-8-65 ) taxonomy. We used these taxonomies to classify teacher-reported adaptations made during the implementation of TOOLBOX™, a social emotional learning program implemented in 11 elementary schools during the 2014-2015 academic year. Post-implementation, 271 teachers and staff responded to an online survey that included questions about adaptation, yielding 98 adaptation descriptions provided by 42 respondents. Four raters used each taxonomy to try to classify these descriptions. We assessed the extent to which raters agreed they could classify the descriptions using each taxonomy (coverage), as well as the extent to which raters agreed on the subcategory they assigned (clarity). Results indicated variance among taxonomies, and tensions between the ideals of coverage and clarity emerged. Further studies of adaptation taxonomies as coding instruments may improve their performance, helping scholars more consistently assess adaptations and their effects on preventive intervention outcomes.

Incarceration history, social network composition, and substance use among homeless youth in Los Angeles.

Background: Homeless youth in the United States have high rates of substance use. Existing research has identified social network composition and street-associated stressors as contributing factors. Incarceration is a highly prevalent stressor for homeless youth. Its effect on youth's social network composition and substance use, however, has been neglected. Aims: This study investigated the direct and indirect associations between incarceration history and substance use (through social networks) among homeless youth in Los Angeles, California. Methods: A sample of 1047 homeless youths were recruited between 2011 and 2013. Computerized self-administrated surveys and social network interviews were conducted to collect youth's sociodemographic characteristics, incarceration history, social network composition, and substance use. Bootstrapping was used to identify the direct and indirect associations between youth's incarceration history and substance use. Results: Incarceration history was positively associated with youth's cannabis, methamphetamine, and injection drug use. The percentage of cannabis-using peers partially mediated the associations between incarceration history and youth's cannabis, cocaine, and heroin use. The percentage of methamphetamine-using peers partially mediated the associations between incarceration history and youth's methamphetamine, cocaine, and injection drug use. The percentage of heroin-using peers partially mediated the association between incarceration history and youth's heroin use. Moreover, the percentage of peers who inject drugs partially mediated the associations between incarceration history and youth's methamphetamine, heroin, and injection drug use. Discussion: Incarceration history should be taken to a more central place in future research and practice with homeless youth in the United States.

MR Imaging for Differentiating Contrast Staining from Hemorrhagic Transformation after Endovascular Thrombectomy in Acute Ischemic Stroke: Phantom and Patient Study.

BACKGROUND AND PURPOSE: Early differentiation of contrast staining from hemorrhagic transformation in patients with acute ischemic stroke who have undergone endovascular treatment is critical in preventing the delayed administration of antiplatelet agents. We aimed to demonstrate the usefulness of an immediate postinterventional DWI protocol including B0 and gradient recalled-echo sequences to discriminate those 2 conditions through phantom and preliminary retrospective patient studies. MATERIALS AND METHODS: On 3T MR imaging, the signal intensities of the phantom models consisting of iodinated contrast agents diluted with normal saline and arterial blood were compared using T1WI, T2WI, and gradient recalled-echo sequences. A total 17 patients (8 with hemorrhagic transformation and 9 with contrast staining; 8 men and 9 women; mean age, 72.00 ± 10.91 years; range, 52-90 years) who underwent mechanical thrombectomy for acute ischemic stroke and showed newly appearing hyperdense lesions on immediate (<24 hours) postinterventional nonenhanced CT scans were included in this study. Immediate postinterventional DWI of patients were compared. RESULTS: In the phantom study, iodinated contrast agents diluted with normal saline showed minimal signal drop, while those diluted with arterial blood demonstrated dark signal intensity in the T2WI and gradient recalled-echo sequences. In the patient study, all hemorrhagic transformations and none of the contrast staining demonstrated dark or low signal (

Sarcopenia is associated with the risk of significant liver fibrosis in metabolically unhealthy subjects with chronic hepatitis B.

BACKGROUND: Sarcopenia is significantly associated with the degree of liver fibrosis. This study investigated the influence of sarcopenia on liver fibrosis in individuals with chronic hepatitis B. METHODS: Data from the Korean National Health and Nutrition Examination Surveys 2008-2011 were analysed. The sarcopenia index (total appendicular skeletal muscle mass [kg]/body mass index [kg/m2 ]) was calculated using dual-energy X-ray absorptiometry. Sarcopenia was defined as the lowest quintile sarcopenia index value (cut-offs: 0.89 for men and 0.58 for women). The fibrotic burden was assessed using the nonalcoholic fatty liver disease fibrosis score and fibrosis-4 index. Significant fibrosis was defined as the highest nonalcoholic fatty liver disease fibrosis score quartile and a fibrosis-4 index ≥2.67. RESULTS: Among the 506 respondents with chronic hepatitis B (258 men and 248 women), the nonalcoholic fatty liver disease fibrosis score and fibrosis-4 index identified sarcopenia and significant fibrosis in 126 (24.9%) and 217 (42.9%), respectively. Sarcopenia was significantly associated with significant fibrosis, regardless of the fibrosis prediction model used (all P < 0.05). When the study population was stratified according to metabolic factors, sarcopenia was specifically associated with an increased risk of significant fibrosis among subgroups with obesity, insulin resistance, metabolic syndrome and liver steatosis (odds ratio 2.37-3.57; all P < 0.05). An independent association between sarcopenia and significant fibrosis was identified after adjusting for other confounders (odds ratio 2.67-3.62 by the nonalcoholic fatty liver disease fibrosis score and 2.04-2.62 by the fibrosis-4 index; all P < 0.05). CONCLUSIONS: Sarcopenia is associated with significant fibrosis in subjects with chronic hepatitis B, specifically those with obesity, insulin resistance, metabolic syndrome and liver steatosis.

Predictors of failure to detect early hepatocellular carcinoma in patients with chronic hepatitis B who received regular surveillance.

BACKGROUND: A proportion of chronic hepatitis B (CHB) patients are diagnosed with advanced hepatocellular carcinoma (HCC) despite regular surveillance. AIMS: To determine predictors for HCC detection failure in CHB patients who underwent regular surveillance. METHODS: CHB patients with well-preserved liver function, who underwent ultrasonography and alpha-foetoprotein (AFP) analysis every 6 months, were enrolled. Cox regression analysis was used to identify predictors for detection failure, defined as HCC initially diagnosed at Barcelona Clinic Liver Cancer (BCLC) stage B or C. RESULTS: Of the 4590 CHB patients (mean age, 52.1 years; men, 61.6%), 169 patients were diagnosed with HCC (3.68%) and 35 (20.7%) HCC patients were initially diagnosed with HCC BCLC stage B or C. The cumulative incidence of HCC detection failure was 0.2% at year 1 and 1.3% at year 5. Multivariate analyses indicated that cirrhosis (hazard ratio [HR], 3.078; 95% CI, 1.389-6.821; P = 0.006), AFP levels ≥9 ng/mL (HR, 5.235; 95% CI, 2.307-11.957; P = 0.010), and diabetes mellitus (HR, 3.336; 95% CI, 1.341-8.296; P = 0.010) were independent predictors of HCC detection failure. Another model that incorporated liver stiffness (LS) values identified LS values ≥11.7 kPa (HR, 11.045; 95% CI, 2.066-59.037; P = 0.005) and AFP levels ≥9 ng/mL (HR, 4.802; 95% CI, 1.613-14.297; P = 0.005) as predictors of detection failure. CONCLUSIONS: In CHB patients undergoing regular surveillance with ultrasonography and alpha-foetoprotein (AFP) analysis every 6 months, the HCC detection failure rate was not high (0.8% per person; 0.1% per test). However, careful attention should be paid in patients with advanced liver fibrosis (clinical cirrhosis or LS value >11.7 kPa), high AFP levels, or diabetes mellitus, who are prone to surveillance failure.

Metabolomics Study for Identification of Potential Biomarkers of Long-term Survival in Kidney Transplantation Recipients.

BACKGROUND: The recent progress and appropriate use of immunosuppressive drugs have considerably improved the short-term survival in kidney transplantation recipients (KTRs). The development of new strategies to improve long-term survival outcome after kidney transplantation is also becoming important. Although current diagnosis of allograft dysfunction relies on serum creatinine concentration and biopsy, they are nonspecific indicators of allograft function. Therefore, noninvasive, sensitive, and specific biomarkers for the prediction of long-term survival are needed. The aim of this study was to discover potential biomarkers for long-term survival in KTRs through the use of liquid chromatography-tandem mass spectrometry. METHODS: We used the metabolic approach to explore the change of metabolites in the serum of KTRs. Twenty-four KTRs with long-term good survival (LGS) and 10 KTRs with chronic antibody-mediated rejection (CAMR) were included in this study. After quantile normalization with chromatographic data, multivariate statistical analysis was performed. We attempted to analyze metabolic profiling with LGS and CAMR groups. RESULTS: The orthogonal partial least-squares discriminant analysis score plot showed a separation between 2 groups in the principal component. In the corresponding loading plot, 344 metabolites responsible for the separation observed in the score plot were identified (variable influence on projection ≥1.0). We then selected 54 metabolites to compare mass with charge by searching a web database, and 11 compounds were identified. CONCLUSIONS: We found metabolites in serum that differ in LGS and CAMR groups. Further studies are needed to figure out potential metabolomic biomarkers to predict long-term survival in KTRs.

The Strengths of Youth in a Public Behavioral Health System: Measurement Choices, Prevalence Rates, and Group Differences.

Youth with severe emotional and behavioral problems receiving services in public behavioral health systems have strengths that are understudied in research and underutilized in practice. This study explores four alternative strategies (individual item scores, the number of "actionable" strengths, subscales, and a total composite) for summarizing the strengths of youth assessed with the Child and Adolescent Needs and Strengths (CANS) in a large, urban, public behavioral health system. The paper examines whether these summarization strategies produce divergent understandings of the prevalence of strengths across gender, age, and racial groups. Analyses suggest that youth enter this system with high levels of strengths. There are few group differences in strengths across the diverse summarization strategies. Though the practice-preferred method of using individual strengths items provides the most interpretable information about strengths, the aggregation strategies may be useful for programs and systems. Implications for policy and practice are discussed.

Protective factor screening for prevention practice: Sensitivity and specificity of the DESSA-Mini.

The Devereux Student Strengths Assessment Mini (DESSA-Mini; Naglieri, LeBuffe, & Shapiro, 2011/2014) was designed to overcome practical obstacles to universal prevention screening. This article seeks to determine whether an entirely strength-based, 8-item screening instrument achieves technical accuracy in routine practice. Data come from a district-wide implementation of a new social emotional learning (SEL) initiative designed to promote students' social-emotional competence. All students, kindergarten through Grade 8, were screened using the DESSA-Mini. A random 5 students per classroom received additional assessment. Concurrent and predictive criterion studies were conducted using the full DESSA as well as administrative records of serious disciplinary infraction. The DESSA-Mini showed excellent internal reliability, exceeding .90. Negligible to small differences were found between scores on the DESSA-Mini screen and the DESSA full assessment. Classification consistency between the DESSA-Mini and the DESSA was high (87%-94%) in routine practice, with sensitivity and specificity estimates exceeding Glascoe's (2005) standards. Finally, predictive validity of the DESSA-Mini was reliable; students screened as having a Need for SEL Instruction at the beginning of the year were 4.5 times more likely to have a record of serious disciplinary infraction at the end of the school year compared with those who were not identified (p < .001). These findings compare quite favorably with other instruments used in schools to screen entire student populations, in cases where such analyses have been conducted, and is consistent with a practice preference of identifying, but not overidentifying, students for accelerated preventative interventions for mental, emotional, and behavioral problems. (PsycINFO Database Record

Tenofovir versus tenofovir plus entecavir for chronic hepatitis B with lamivudine resistance and entecavir resistance.

We compared the viral suppressive efficacy of tenofovir disoproxil fumarate (TDF) mono-rescue therapy (TDF group) and TDF plus entecavir (ETV) combination-rescue therapy (TDF + ETV group) in chronic hepatitis B (CHB) patients with lamivudine resistance and entecavir resistance. One hundred and thirty-three CHB patients with lamivudine and entecavir resistance were investigated. Ninety-six patients were treated with TDF and 37 with TDF + ETV for at least 6 months. We compared the virologic response rate (HBV DNA level <20 IU/mL) between the two groups and identified the predictive factors of treatment outcome. There were no significant differences between the two groups in demographic characteristics. Up to 24 months [median: 18 (range 6-24) months], 85.4% and 89.2% of the TDF group and TDF + ETV group, respectively, achieved a virologic response (P=.068). Only the HBV DNA level at baseline was significantly associated with a virologic response in the multivariate analysis. In a subanalysis of patients with HBV DNA levels ≥4 log (IU/mL) at baseline, a higher proportion of patients in the TDF + ETV group than the TDF group achieved a virologic response (92.9% vs 68.3%; P<.001), while 90% of patients with HBV DNA (IU/mL) levels <4 log in all both TDF and TDF + ETV groups achieved a virologic response. TDF mono-rescue therapy is a reasonable option in patients with lamivudine resistance and entecavir resistance. However, the combination strategy should be considered in patients with high baseline HBV DNA levels.

PCR-reverse blot hybridization assay for fast and accurate identification of causative species in superficial fungal infections.

BACKGROUND: Superficial fungal infections are a very common problem in dermatological clinics. The diagnostic method of fungal culture is time-consuming and has inconsistent sensitivity. Therefore, a practical method for rapid and accurate identification of the species causing superficial fungal infections is needed. AIM: To compare PCR-reverse blot hybridization assay (PCR-REBA) with conventional fungal diagnostic methods so as to determine the reliability of PCR-REBA for the diagnosis and species identification in superficial fungal infections. METHODS: Potassium hydroxide (KOH) preparation, fungal culture, conventional real-time PCR and PCR-REBA were used to assess 83 specimens, and the results from each method were compared. RESULTS: Of the 83 specimens, 44 specimens that were positive by fungal culture had 62.7% agreement with PCR-REBA. Compared with real-time PCR, there was 68.7% agreement with fungal culture, but 91.6% agreement with PCR-REBA. When the comparison was made using the 55 specimens that gave positive results in both KOH preparation and fungal culture, there was 85.5% agreement with real-time PCR for fungal culture, but 94.5% agreement with PCR-REBA. CONCLUSIONS: Compared with KOH preparation or fungal culture, PCR-REBA has higher sensitivity and specificity. Therefore, PCR-REBA could be a useful method in clinical settings because it can identify species quickly and accurately, and can also determine the existence of pathogens.

Examining Protective Factors Against Violence among High-risk Youth: Findings from the Seattle Social Development Project.

PURPOSE: This paper examined proximal and distal effects of protective factors specified in the social development model (SDM) on youth violence among high-risk youth. METHODS: Data come from the Seattle Social Development Project, a longitudinal study of development from childhood into adulthood. A community sample of 808 participants from the Seattle Public School District was surveyed from the 5th grade through adulthood. This paper uses data from participants' adolescent years, ages 10-18. RESULTS: Higher levels of protective factors in early and middle adolescence reduced the odds of violence during late adolescence in the full sample and in two different risk groups (high cumulative risk and low SES). Although risk exposure increased the odds of violence, protective factors in middle adolescence predicted lower odds of violence during late adolescence. Importantly, protective factors had a greater effect in reducing violence among youth exposed to high levels of cumulative risk than among youth exposed to lower levels of cumulative risk. This difference was not observed between youth from higher and lower SES families. CONCLUSION: Protective factors specified in the SDM appear to reduce violence in late adolescence even among youth from low SES families and youth exposed to high levels of cumulative risk.

Childhood Adversity among Court-Involved Youth: Heterogeneous Needs for Prevention and Treatment.

Although experiences of trauma and adversity are highly prevalent among juvenile justice-involved youth, few studies examine the heterogeneity of these histories across individuals. This study seeks to inform practitioners regarding the distinct patterns of adversity among this vulnerable population, using an expanded measure of adverse childhood experiences (ACEs). We employed Latent Class Analysis to test for meaningful subgroups of youth based on histories of childhood adversity. The sample (N=5,378) consisted of youth on probation in a western United States county. The best-fitting model contained six classes, described as: Low All (40.3%), Parental Substance Use and Incarceration (12.0%), Poverty and Parental Health Problems (13.2%), High Family Conflict and SES (15.3%), High Maltreatment and Placements (11.0%), and High All (8.1%). Additional testing revealed significant differences across classes in terms of age, gender, race/ethnicity, and living situations. Results strongly support the need to incorporate a trauma-informed framework for both juvenile justice and community service settings, as well as tailoring interventions to meet heterogeneous needs of court-involved youth. Striking variation in the forms and levels of childhood adversity argue the value of screening for ACEs in conjunction with poverty, and working to interrupt problematic trajectories in adolescence and the transition to adulthood.

Renal denervation for treatment of uncontrolled hypertension in an Asian population: results from the Global SYMPLICITY Registry in South Korea (GSR Korea).

Reports detailing the response of hypertensive patients to renal denervation (RDN) in Asian patients are limited. We evaluated 6- and 12-month outcomes after RDN in an Asian population and compared outcomes to a primarily Caucasian population. The Global SYMPLICITY Registry (GSR) is a prospective, all-comer, worldwide registry that evaluates the safety and effectiveness of RDN and includes the Korean registry substudy (GSR Korea) and a Caucasian subset (GSR Caucasian). Given differences in baseline characteristics among GSR Korea (n=93) as compared with GSR Caucasian (n=169) patients, including lower baseline office systolic blood pressure (SBP), lower body mass index and differences in medications, propensity score adjustment was performed when comparing the change in SBP between subsets. The 6- and 12-month change in SBP in GSR Korea was -19.4±17.2 and -27.2±18.1 mm Hg, respectively (P<0.001 for both vs baseline). GSR Caucasian had a SBP change similar to GSR Korea at 6 months (-20.9±21.4 mm Hg, unadjusted P=0.547, adjusted P=0.998), whereas at 12 months the change was significantly less pronounced (-20.1±23.9 mm Hg, unadjusted P=0.004, adjusted P=0.002). There were no protocol-defined procedure-related adverse events and no chronic adverse events associated with the device in an Asian population. RDN provided a significant reduction in 6- and 12-month office SBP among Asian patients, with a favorable safety profile. The 12-month SBP reduction was larger than that observed in Caucasian patients.