The potential role of breast MRI in evaluation of triple-negative breast cancer and fibroadenoma of less than 3 cm.

Background: The majority of small-sized (<3 cm) triple-negative breast cancer (TNBC) exhibit smooth margins upon palpation and are often oval or rounded masses. Distinguishing these masses preoperatively from fibroadenomas (FAs) would be very meaningful for clinical practice. The aim of our study was to evaluate the magnetic resonance imaging (MRI) appearance of TNBC and differentiate it from FAs. Methods: In this retrospective single-center study, we included 37 patients with TNBCs and 36 patients with FAs who underwent breast MRI. We employed the χ2 test and t-test to compare the differences in morphological features, dynamic contrast-enhanced MRI (DCE-MRI) parameters, and apparent diffusion coefficient (ADC) values between the two groups. Additionally, we constructed non-parametric receiver operating characteristic (ROC) curves using ADC values, with pathological results serving as the gold standard. Results: A total of 37 TNBC lesions and 39 FA lesions were included in the final analysis. TNBCs exhibited more frequent irregular shape, irregular margins, peritumoral edema, fast enhancement in the initial phase, rim enhancement, and time-signal intensity curve (TIC) type III compared to FAs (all P<0.05). Conversely, low-signal segregation in T2-weighted imaging (T2WI) and TIC type I were commonly found in FAs. The mean ADC value of TNBCs was significantly lower than that of FAs [(1.104±0.13)×10-3 vs. (1.613±0.16)×10-3 mm2/s, P<0.05]. The cutoff ADC for differentiating TNBCs from FAs was 1.239×10-3 mm2/s, yielding an area under the curve (AUC) of 0.997, a sensitivity of 94.6%, and a specificity of 100%. Conclusions: The morphological presentation of MRI, internal enhancement features of the mass, TIC curves, and ADC values provide valuable differential diagnostic information for TNBC and FA masses with a maximum diameter of less than 3 cm.

[Pharmacoeconomic evaluation of Shaoma Zhijing Granules in treatment of tic disorders in children].

This study conducted a pharmacoeconomic evaluation of Shaoma Zhijing Granules in the treatment of tic disorder(TD) in children. Firstly, from the perspective of the healthcare system, cost-effectiveness analysis was used to evaluate the economic efficiency of Shaoma Zhijing Granules compared with Changma Xifeng Tablets and Jiuwei Xifeng Granules in the treatment of TD in children. Then, through network Meta-analysis, the overall effectiveness of different regimens was calculated, combined with the total cost of the regimens, to calculate the incremental cost-effectiveness ratio(ICER). Finally, sensitivity analysis was performed to verify the stability of the study results and the credibility of the conclusions. This study included 17 articles, including 9 articles on Chinese patent medicines(3 on Shaoma Zhijing Granules, 2 on Jiuwei Xifeng Granules, and 4 on Changma Xifeng Tablets), for the treatment of TD in children, and 8 articles on Chinese patent medicines combined with conventional western medicines(3 on Shaoma Zhijing Granules, 2 on Jiuwei Xifeng Granules, and 3 on Changma Xifeng Tablets). In the Chinese patent medicine group, the total cost of Shaoma Zhijing Granules for treating TD was CNY 4 410.00, with clinical total effective rate of 77.53%; the total cost of Jiuwei Xifeng Granules for treating TD was CNY 5 192.70, with clinical total effective rate of 82.13%. The ICER of Jiuwei Xifeng Granules vs Shaoma Zhijing Granules was 169.95, higher than the willingness-to-pay(WTP, cost of increasing efficiency by 1% is CNY 85.70). Therefore, Jiuwei Xifeng Granules did not have a cost-effectiveness advantage over Shaoma Zhijing Granules. The total cost of Changma Xifeng Tablets for treating TD was CNY 1 282.50, with clinical total effective rate of 80.60%. The total cost of Changma Xifeng Tablets was lower and clinical total effective rate was higher than that of Shaoma Zhijing Granules. Overall, Shaoma Zhijing Granules did not have a cost-effectiveness advantage. In the Chinese patent medicine combined with conventional western medicine group, the total cost of Shaoma Zhijing Granules for treating TD + conventional western medicines was CNY 6 768.52/6 778.48, with clinical total effective rate of 96.18%. The total cost of Jiuwei Xifeng Granules + conventional western medicines for treating TD was CNY 6 522.56, with clinical total effective rate of 88.30%. The ICER of Shaoma Zhijing Granules + conventional western medicines vs Jiuwei Xifeng Granules + conventional western medicines was 31.20, lower than WTP. Therefore, Shaoma Zhijing Granules + conventional western medicines had a cost-effectiveness advantage over Jiuwei Xifeng Granules + conventional western medicines. The total cost of Changma Xifeng Tablets + conventional western medicines for treating TD was CNY 1 706.12, with clinical total effective rate of 95.39%. The ICER of Shaoma Zhijing Granules + conventional western medicines vs Changma Xifeng Tablets + conventional western medicines was 6 334.06, higher than WTP. Therefore, although Shaoma Zhijing Granules + conventional western medicines had higher clinical total effective rate compared with Changma Xifeng Tablets + conventional western medicines, it did not have a cost-effectiveness advantage. Overall, for different medication regimens(Chinese patent medicines monotherapy or in combination with conventional western medicines), Shaoma Zhijing Granules and Jiuwei Xifeng Granules both had a cost-effectiveness advantage, but compared with Changma Xifeng Tablets, neither had a cost-effectiveness advantage. For Chinese patent medicines in combination with conventional western medicines, clinical total effective rate of Shaoma Zhijing Granules in combination with conventional western medicines for the treatment of TD in children was the highest.

Behavioural Therapy for tic disorders: a comprehensive review of the literature.

INTRODUCTION: Behavioral therapies are recommended as a first-line intervention for Tourette syndrome and persistent motor or phonic tic disorder. AREAS COVERED: In this review, the authors summarize randomized controlled trials on the comprehensive behavioral intervention for tics (CBIT), habit reversal therapy (HRT), and exposure and response prevention (ERP). Studies of face-to-face treatment, treatment by video conferencing, group treatment, and internet delivered treatment were assessed, as well as evidence of treatment predictors, modifiers, and mediators. EXPERT OPINION: There is high-quality evidence for face-to-face one-on-one treatment with CBIT, and data suggesting that one-on-one treatment by videoconference provides similar benefit. Limited data on group treatment with CBIT/HRT suggests inferiority to individual treatment, while internet-based CBIT programs appear more beneficial than wait list or psychoeducation. There is one face-to-face one-on-one treatment comparison of ERP to HRT, suggesting equal benefit. Internet-based ERP with minimal therapist support appears effective, although effect sizes are small. One study using behavioral therapy with ERP or HRT found similar benefit to medical treatment with antipsychotics. Data on predictors, modifiers, and mediators of treatment efficacy are emerging. In summary, behavioral therapies are an important treatment modality for tic disorders. Furthermore, important efforts to improve treatment accessibility are underway.

Description, Implementation, and Efficacy of the Comprehensive Behavioral Intervention for Tics as First-Line Treatment for Tourette and Other Tic Disorders.

Objective: To provide an evidence-based review of the Comprehensive Behavioral Intervention for Tic (CBIT) disorders. Results: For close to a century, behavioral interventions for managing tics associated with Tourette and other tic disorders (TDs) were incorrectly considered ineffective and dangerous by the professional community, due, in large part, to unfounded fears that efforts to suppress tics would lead to a host of negative psychological, and even physical, outcomes (e.g., symptom substitution, tic rebound). Spurred by a growing body of research to the contrary, the Comprehensive Behavioral Treatment for Tics (CBIT) was developed to provide a tolerable and effective nonpharmacological treatment option, alone or in combination with medication, for youth and adults with tics associated with Tourette or other TDs. CBIT combines two evidence-based practices, habit reversal training (HRT) to address the urge-tic relationship and a functional intervention to identify and neutralize tic-related environmental factors. Based on positive findings from two large-scale randomized controlled trials that involved a total of 248 8-69-year olds with Tourette or chronic TD, CBIT has been designated as a first-line treatment, when available, for treating tics by the American Academy of Neurology and the European and Canadian medical academies. Conclusions: CBIT has demonstrated acute and durable efficacy when delivered alone or in combination with medication, in person, or via telehealth, and in the presence or absence of common comorbid conditions. Additional research is needed to develop and test treatment guidelines for the use of CBIT in combination with pharmacologic, neuromodulatory, and other intervention modalities.

Mitochondrial dysfunction in platelets from severe trauma patients - A prospective case-control study.

INTRODUCTION: Trauma-induced coagulopathy (TIC) refers to an abnormal coagulation process, an imbalance between coagulation and fibrinolysis due to several pathological factors, such as haemorrhage and tissue injury. Platelet activation and subsequent clot formation are associated with mitochondrial activity, suggesting a possible role for mitochondria in TIC. Comprehensive studies of mitochondrial dysfunction in platelets from severe trauma patients have not yet been performed. METHODS: In this prospective case-control study, patients with severe trauma (ISS≥16) had venous blood samples taken at arrival to the Emergency Unit of a Level 1 Trauma Centre. Mitochondrial functional measurements (Oxygraph-2k, Oroboros) were performed to determine oxygen consumption in different respiratory states, the H2O2 production and extramitochondrial Ca2+ movements. In addition, standard laboratory and coagulation tests, viscoelastometry (ClotPro) and aggregometry (Multiplate) were performed. Measurements data were compared with age and sex matched healthy control patients. RESULTS: Severe trauma patients (n = 113) with a median age of 38 years (IQR, 20-51), a median ISS of 28 (IQR, 20-48) met our inclusion criteria. Oxidative phosphorylation in platelet mitochondria from severe trauma patients significantly decreased compared to controls (34.7 ± 8.8 pmol/s/mL vs. 48.0 ± 19.7 pmol/s/mL). The mitochondrial H2O2 production significantly increased and greater endogenous Ca2+ release was found in the polytrauma group. Consistent with these results, clotting time (CT) increased while maximum clot firmness (MCF) decreased with the EX-test and FIB-test in severe trauma samples. Multiplate aggregometry showed significantly decreased ADP-test (38 ± 12 AUC vs. 112 ± 14 AUC) and ASPI test (78 ± 22 AUC vs. 84 ± 28 AUC) also tended to decrease in mitochondria of polytrauma patients as compared with controls. Significant strong correlation has been demonstrated between mitochondrial OxPhos and MCF while it was negatively correlated with ISS (R2=0.448, P˂0.05), INR, CT and lactate level of patients. CONCLUSIONS: The present study revealed that severe trauma is associated with platelet mitochondrial dysfunction resulting in reduced ATP synthesis and impaired extramitochondrial Ca2+ movement. These factors are required for platelet activation, recruitment and clot stability likely thus, platelet mitochondrial dysfunction contributes to the development of TIC.

Microstructure, mechanical properties and strengthening mechanism of in-situ synthesized TiC/6061 nanocomposites.

In-situ synthesized 1 wt%, 3 wt% and 5 wt%TiC/6061 nanocomposites were prepared by the reaction using Al-K2TiF6-C as starting materials. Microstructure, mechanical properties and strengthening mechanism of the nanocomposites were investigated. SEM observation illustrates the in-situ synthesized ceramic TiC particles show shape of a polygon and its average size is 60 nm. TEM results show that the interface between the Al matrix and TiC reinforcement is clear and no reaction products can be found. Grain refining can be observed in the composites, as the TiC content increased from 0 wt% to 3 wt%. However, grain coarsening appears in the 5 wt%TiC/6061 composites. As increasing the TiC content from 0 wt% to 5 wt%, the mechanical properties of the composites increase firstly and then decreases. The Vickers hardness, yield strength, tensile strength and elongation of the as-cast 3 wt%TiC/6061 composites achieve the maximum value of 80.7 HV, 135 MPa, 202 MPa and 15.3 %, respectively. Strengthening mechanisms of the TiC/6061 nanocomposites is the micromechanical strengthening mechanisms. As the TiC content increasing, CTE strengthening plays an important role.

Clinical tics and quality of life in children and adolescents with tic disorders: The mediating role of sleep.

BACKGROUND: Sleep conditions are important in children and adolescents with tic disorders. Psychiatric symptoms and tic symptoms themselves can detrimentally affect the quality of life (QOL) in individuals with tic disorders. However, there is currently a lack of explicit research evidence elucidating the relationship between sleep and the QOL in individuals with tic disorders. METHODS: We assessed 150 children/adolescents aged 4-14 years old diagnosed with tic disorders. Participants' tic symptoms were evaluated using the Yale Global Tic Severity Scale (YGTSS), while their sleep conditions were assessed using the Children's Sleep Habits Questionnaire (CSHQ), and quality of life was measured using the Gilles de la Tourette Syndrome-Quality of Life Scale (GTS-QOL), all utilizing standardized measurement instruments. Detailed statistical descriptions, correlation analyses, and mediation analyses of the data were performed. RESULTS: We observed significant correlations among tic symptoms, sleep, and quality of life. Then, we confirmed the mediating role of sleep in the relationship between tic symptoms and quality of life (ß = .591, 95%CI: .252-1.007). We also found that among different sleep variables, particularly bedtime resistance (ß = .088, 95 % CI: .003-.260), played a significant mediating role. CONCLUSIONS: Sleep was found to be a significantly mediator between tic symptoms and quality of life across various domains, especially bedtime resistance played an important mediating role. This indicates that assessment and management of sleep conditions in children/adolescents with tic disorders are important. These findings provide potentially valuable insights into the clinical evaluation of children and adolescents with tic disorders and the potential improvement of their quality of life in the future.

Parent-young person lived experience of sensory dysregulation in children with tic disorders: a qualitative study.

PURPOSE: To understand the breadth of sensory dysregulation on participation in daily tasks for young people with tic disorders, as research identified that sensory dysregulation experiences are broader than the symptoms being assessed. METHODS: Eighteen semi-structured interviews were conducted with 16 families with children (5-16 years) with tic disorders. Interviews ranged from 45 to 120 min and were transcribed verbatim. Data collected from parents and young people were analysed and coded together. Thematic analysis using inductive and open coding methods was implemented using NVivo. RESULTS: The impact of sensory dysregulation on daily life may be understood through the higher-order theme: ''sensory, emotions and tics; it's a ticking time bomb'', and three subthemes: (1) we sacrifice and adapt to get daily activities done in the home, (2) my child's experience of the community environment hinders participation, and (3) sensory preferences impact our entire family. CONCLUSION: Sensory dysregulation experiences impact the entire family's quality of life, yet patient-reported sensory measures do not adequately capture the impact on the family unit and breath of symptoms. A sensory-based measure for children with tics is needed to comprehensively assess sensory dysregulation sensitivities for this population, ensuring patients' needs and effectiveness of therapy can be measured.

This qualitative study provides health professionals with a greater understanding of the sensory dysregulation experiences of children and young people with tic disorders.This study highlights that the sensory dysregulation experiences of children and young people are broader than the symptoms assessed through standardised questionnaires.To comprehensively assess and treat sensory dysregulation in clients with tics, the impact on the family unit needs to be evaluated and understood.When comprehensively assessing sensory dysregulation, understanding the interplay of tics, sensory and emotional dysregulation aids in treatment planning.

Arabidopsis TIC236 contributes to proplastid development and chloroplast biogenesis during embryogenesis.

Plastids are essential, semi-autonomous organelles in plants that carry out a multitude of functions during development. Plastids existing in different subtypes are derived from proplastids progenitors and interconvert in response to environmental and growth cues. Most efforts focus on the differentiation from proplastid to other forms. However, the studies of proplastid development are insufficient and whether proplastid biogenesis affects plant growth is yet to be determined. Arabidopsis TIC236, a translocon component at the inner membrane of the chloroplast envelope, is critical for importing chloroplast-targeted preproteins and chloroplast division. In this study, we uncovered the fundamental influence of proplastid biogenesis on embryo development by exploring the function of TIC236 during embryogenesis. Widespread and strong expression of TIC236 was observed in leaves and embryos. The null mutant tic236 had an embryo-lethal phenotype, with cell division in the mutant embryos delayed starting at the octant stage and arrested at the globular stage. Transmission electron microscopy revealed enlarged proplastids with an aberrant inner structure at the dermatogen and globular stages that ultimately did not differentiate into chloroplasts. Additionally, the fluorescence signal distribution patterns of tic236 embryos carrying the pDR5rev::3xVENUS-N7, pPIN1::PIN1-GFP, pWOX5::GFP, and pSCR::H2B-YFP reporter systems were altered. Together, we provide genetic evidence supporting proplastid biogenesis plays a vital role in embryo development and TIC236 is identified as an indispensable player, ensuring normal proplastid development.

Microstructure and tribological behavior of Al-TiC composite strips fabricated by a multi-step densification method.

This study aims to enhance the tribological properties of automotive applications by examining the effects of TiC content on the microstructure, mechanical properties, and wear behavior. This study investigates the production of Al-TiC composite strips using a novel multi-step densification process combining mechanical alloying and hot rolling with TiC concentrations ranging from 0 to 12 vol%. The novelty of this work lies in its comprehensive approach to developing and analyzing Al-TiC composite strips using a multistep densification method. This study integrates microstructural analysis, mechanical property evaluation, and detailed tribological behavior assessment under different wear loads (5-25 N). A key innovation is the application of the Abbott Firestone method to analyze worn surfaces, providing insights into optimal wear conditions. The study reveals that increasing the TiC content to 12 vol% significantly improves densification, hardness (up to 268.8% increase), and wear resistance (up to 95% improvement at a 5N load). Dry ball-on-flat sliding wear tests at loads of 5-25N demonstrate that TiC particles hindered complete delamination wear in the composite strips. The Abbott Firestone method analysis of worn surfaces indicated an optimal exploitation zone in the Al-6 vol% TiC composite at both low and high wear loads. This comprehensive approach provides valuable insights into optimizing Al-TiC composites for enhanced performance in automotive components that require improved wear resistance.

Evaluating a Trauma-Informed Care Training Program for Mental Health Clinicians.

The aim of this study was to evaluate the interRAI Trauma-Informed Care (TIC) training program based on evidence-informed Collaborative Action Plans. Focus groups and the Attitude Related Trauma-Informed Care (ARTIC) questionnaire addressed clinicians' and mental health professionals' attitudes toward the application of TIC with their child and youth clients. An explanatory sequential design was conducted. In total, 105 clinicians and mental health professionals who participated in a 4-hour, in-person or virtual TIC training, two comprehensive seminars, and 28 trauma-informed training web-based modules completed the ARTIC questionnaire. Researchers conducted seven focus groups with clinicians/participants (N = 23) to discuss the views and effectiveness of the interRAI TIC educational training modules. To quantitatively measure the change of attitudes towards TIC, descriptive statistical analysis was completed using the means and standard deviation of the ARTIC scores at the initial time point, the follow-up time point, and the difference between scores at both time points. Paired sample t-tests were conducted on both the overall score and each of the subscales in each of the three samples (total sample, online subsample, and hybrid subsample). A thematic analysis was conducted to generate qualitative findings from the focus groups. Findings from the quantitative and qualitative analyses suggest that the interRAI TIC training provided clinicians with an improved sense of knowledge and ability to apply trauma-informed care planning with their clients.

Structural insights into the chloroplast protein import in land plants.

Chloroplast proteins are imported via the translocon at the outer chloroplast membrane (TOC)-translocon at the inner chloroplast membrane (TIC) supercomplex, driven by an ATPase motor. The Ycf2-FtsHi complex has been identified as the chloroplast import motor. However, its assembly and cooperation with the TIC complex during preprotein translocation remain unclear. Here, we present the structures of the Ycf2-FtsHi and TIC complexes from Arabidopsis and an ultracomplex formed between them from Pisum. The Ycf2-FtsHi structure reveals a heterohexameric AAA+ ATPase motor module with characteristic features. Four previously uncharacterized components of Ycf2-FtsHi were identified, which aid in complex assembly and anchoring of the motor module at a tilted angle relative to the membrane. When considering the structures of the TIC complex and the TIC-Ycf2-FtsHi ultracomplex together, it becomes evident that the tilted motor module of Ycf2-FtsHi enables its close contact with the TIC complex, thereby facilitating efficient preprotein translocation. Our study provides valuable structural insights into the chloroplast protein import process in land plants.

Volatile oil from Acori graminei Rhizoma affected the synaptic plasticity of rats with tic disorders by modulating dopaminergic and glutamatergic systems.

ETHNOPHARMACOLOGICAL RELEVANCE: Acori graminei Rhizoma is a commonly used traditional Chinese medicine for treating TD, with its main component being calamus volatile oil. Volatile Oil from Acori graminei Rhizoma (VOA)can protect nerve cells and alleviate learning and memory disorders. However, the mechanism of anti-tic of VOA is still unclear. AIM OF THE STUDY: We aimed to explore the effects of Volatile Oil from Acori Tatarinowii Rhizoma (VOA) on striatal dopaminergic and glutamatergic systems and synaptic plasticity of rats with Tic Disorder (TD), as well as its pharmaceutical mechanism against TD. MATERIALS AND METHODS: This study involved 48 (three-week-old) Sprague Dawley (SD) rats, which were randomly divided into two primary groups: Control (8) and TD (40). Rats in the TD group were injected intraperitoneally with 3,3-iminodipropionitrile (IDPN) to construct the TD rat model. They were divided into five subgroups: Model, Tiapride, VOA-high, VOA-medium, and VOA-low (N = 8). After modeling, VOA was administrated to rats in the VOA groups through gavage (once/day for four consecutive weeks), while rats in the blank control and model groups received normal saline of the same volume. The animals' behavioral changes were reflected using the stereotypic and motor behavior scores. After interferences, patterns of striatal neurons and the density of dendritic spines were investigated using H&E and Golgi staining, and the ultrastructure of striatal synapses was examined using Transmission Electron Microscopy (TEM). Furthermore, Ca2+ content was determined using the Ca2+ detector, and Dopamine (DA) and Glutamate (GLU) contents in serum and striatum were detected through ELISA. Finally, DRD1, DRD2, AMPAR1, NMPAR1, DAT, VMAT2, CAMKⅡ, and CREB expression in the striatum was detected using Quantitative real-time PCR (qRT-PCR), Western Blotting (WB) and Immunohistochemical (IHC) methods. RESULTS: Compared to rats in the blank control and model groups, rats in the VOA groups showed lower stereotypic behavior scores. Furthermore, rats in the VOA groups exhibited relieved, neuron damage and increased quantities of neuronal dendrites and dendritic spines Additionally, based on TEM images show that, the VOA groups showed a clear synaptic structure and increased amounts of postsynaptic dense substances and synaptic vesicles. The VOA groups also exhibited reduced Ca2+ contents, and upregulation of DRD1, DRD2, DAT, AMPAR1, and NMPAR1 and downregulation of VMAT-2, CAMKⅡ, and CREB in the striatum. CONCLUSIONS: In summary, VOA could influence synaptic plasticity by tuning the dopaminergic and glutamatergic systems, thus relieving TD.

A study on microstructural, mechanical properties, and optimization of wear behaviour of friction stir processed AZ31/TiC composites using response surface methodology.

The primary objective of this study is to investigate the microstructural, mechanical, and wear behaviour of AZ31/TiC surface composites fabricated through friction stir processing (FSP). TiC particles are reinforced onto the surface of AZ31 magnesium alloy to enhance its mechanical properties for demanding industrial applications. The FSP technique is employed to achieve a uniform dispersion of TiC particles and grain refinement in the surface composite. Microstructural characterization, mechanical testing (hardness and tensile strength), and wear behaviour evaluation under different operating conditions are performed. Response surface methodology (RSM) is utilized to optimize the wear rate by considering the effects of process parameters. The results reveal a significant improvement in hardness (41.3%) and tensile strength (39.1%) of the FSP-TiC composite compared to the base alloy, attributed to the refined grain structure (6-10 µm) and uniform distribution of TiC particles. The proposed regression model accurately predicts the wear rate, with a confirmation test validating an error percentage within ± 4%. Worn surface analysis elucidates the wear mechanisms, such as shallow grooves, delamination, and oxide layer formation, influenced by the applied load, sliding distance, and sliding velocity. The enhanced mechanical properties and wear resistance are attributed to the synergistic effects of grain refinement, particle-accelerated nucleation, the barrier effect of TiC particles, and improved interfacial bonding achieved through FSP. The optimized FSP-TiC composites exhibit potential for applications in industries demanding high strength, hardness, and wear resistance.

Study on the Properties of TiC Coating Deposited by Spark Discharge on the Surface of AlFeCoCrNiCu High-Entropy Alloy.

Titanium carbide (TiC) coatings were prepared on the surface of AlFeCoCrNiCu high-entropy alloy blocks using electro-spark deposition (ESD). The microhardness and corrosion resistance of the TiC coatings prepared under different voltage and capacitance process parameters were studied. The research shows that the maximum microhardness of the TiC coating on sample 4 (working voltage of 20 V, working capacitance of 1000 µF) is 844.98 HV, which is 81.5% higher than the microhardness of the substrate. This is because the deposition energy increases with the increase in voltage, and the adhesion and aggregation between the coating and the substrate are enhanced, increasing the hardness of the coating. It is worth noting that excessive deposition energy can increase surface defects and reduce the microhardness of the coating surface. Electrochemical testing analysis shows that the corrosion current density of the TiC coating is the lowest (9.475 × 10-7 ± 0.06 × 10-7), and the coating impedance is the highest (2.502 × 103 Ω·com2). The absolute phase angle value is the highest (about 72°). The above indicates that the TiC coating prepared with a working voltage of 20 V and a working capacitance of 1000 µF has better microhardness and corrosion resistance.

Performance of a Tic Screening Tool (MOVeIT) in Comparison to Expert Clinician Assessment in a Developmental-Behavioral Pediatrics Clinic Sample.

Youth with intellectual and developmental disabilities typically have higher rates of tics and stereotypies compared to children with otherwise typical development. Differentiating between these two pediatric movement disorders can be challenging due to overlapping clinical features, but is relevant due to distinct treatment modalities. The current study evaluated sensitivity and specificity of a tic screening measure, the Motor or Vocal Inventory of Tics (MOVeIT) in a pediatric sample enriched for stereotypy and tics. Children (n=199, age 2-15 years old) receiving care in a developmental-behavioral pediatrics clinic underwent a gold-standard diagnostic assessment by a tic expert; these evaluations were compared to the MOVeIT. The MOVeIT demonstrated good sensitivity (89.8%) and relatively lower specificity (57.1%) compared to tic expert for detecting tics in the overall sample. Specificity of the MOVeIT to identify tics improved to 75% when excluding children with co-occurring stereotypy. For children with tics and co-occurring stereotypy, sensitivity remained high (91.9%) but specificity was low (39.1%). The area under the curve (AUC) value to detect tics on the MOVeIT compared to the tic expert gold standard was significantly higher for children without stereotypy (AUC=85.7%) than those with stereotypy (AUC=64.3%, p <0.01). Overall, the ability to detect tics was better in those without co-occurring stereotypy symptoms. Further work is needed to establish the utility of the MOVeIT in populations where there is a high likelihood of co-occurring tics and stereotypy and in general population settings. Accurate distinction between tics and stereotypy will guide choices for intervention and anticipatory guidance for families.

Oral aripiprazole in the treatment of tic disorders in China: a cost-effectiveness analysis based on a mapping algorithm derived from a Chinese children and adolescents population.

BACKGROUND: Oral aripiprazole exhibits favorable clinical efficacy and safety in the suppression of tics in children and adolescents with tic disorders. This study aims to evaluate and compare the cost-effectiveness of high-dose and low-dose aripiprazole in children and adolescents with tic disorders from the perspective of the Chinese healthcare system. METHODS: A questionnaire survey was conducted on 146 patients with tic disorders, of whom 144 completed EQ-5D-Y and YGTSS. Four models were built to convert YGTSS onto EQ-5D-Y utility using two mapping algorithms. We constructed a decision tree model containing efficacy and safety to compare the cost-effectiveness of high-dose and low-dose aripiprazole based on our mapping function. RESULTS: The GLM with model 1 (YGTSS total tic scores) was selected as the preferred function in our decision tree model. The base case cost-effectiveness analysis showed that compared to low-dose aripiprazole, high-dose aripiprazole improves effectiveness by 0.001QALYs and increases the overall cost by $197.99, resulting in an ICER of $174339.22 per QALY, which exceeds three times the gross domestic product per capita. Hence, high-dose aripiprazole is not likely to be a cost-effective option for child patients with tic disorders. One-way sensitivity analysis and probabilistic sensitivity analysis showed that these results is robust. CONCLUSION: On the basis of currently available data, low-dose aripiprazole may be a safe, effective, and economical dosage for children and adolescents with tic disorders. LIMITATIONS: The main limitation of our study is the lack of utility directly used for cost-effectiveness analysis. We obtained the utility of patients with tic disorders indirectly by the mapping function. This may introduce some bias and uncertainty. And it is a limitation to use the direct medical costs of Germany in our model. Although we converted it to the equivalent value of China using purchasing power parities, caution should be exercised when interpreting the results of this study.

Trigeminal n eu ra l gia diagnosis - a c ha l lenge - a cros s-se ct ional sur ve y to a ssess the k nowledge and a ttit ud e among t he dentists of S au di A ra bia.

OBJECTIVE: To analyse the knowledge level and attitude of Saudi dentists regarding trigeminal neuralgia. METHODS: The cross-sectional study was conducted from 17/12/ 2020 - 9/2/2021 at Prince Sat t am Bin Abdulaziz University, Al-Kharj, Riyadh Elm University, Riyadh, and Dar Al-Uloom University, Riyadh, Kingdom of Saud i Arabia. The sample comprised dentists and postgraduate dental students from every speciality. Data was collected online using a predesigned self-structured questionnaire consisting of three par ts, assessing knowledge, practice and attitude of the subjects. Data was analysed using SPSS 22. RESULTS: A total of 202 questionnaire about the knowledge level and attitude of Saudi dentists regarding trigeminal neuralgia were completed. The knowledge level was significantly higher in those senior age group compared to the young dentists with respect to the type of pain observed in TN, the unilateral pain of TN, and the abrupt, unexpected and transient nature of TN pain, local anaesthetic, the first-line treatment for TN, and the effect of TN on oral hygiene. CONCLUSIONS: Older and experienced dentists had more knowledge than younger and less experienced ones.

An Observational Longitudinal Study on Seasonal Variations in Tourette Syndrome: Evidence for a Role of Ambient Temperature in Tic Exacerbation.

Tourette syndrome (TS) is a high-incidence neurobehavioral disorder that generally begins in childhood. Several factors play a role in its etiology, including genetic influence and auto-immune activation by streptococcal infections. In general, symptoms subside after the end of adolescence, but, in a significant number of patients, they remain in adulthood. In this study, we evaluated temporal variations in the two core clinical features of TS including tics and obsessive-compulsive disorder (OCD) symptoms. An observational longitudinal study lasting 15 months (2017-2019) was conducted on a cohort of 24 people recruited in Milan (Italy) who were diagnosed with a subtype of TS known as obsessive-compulsive tic disorder. Inclusion criteria included a global score of the Yale global tic severity scale (Y-GTSS) > 50, a Yale-Brown obsessive-compulsive scale (Y-BOCS) global score > 15, and TS onset at least one year prior. Y-GTSS and Y-BOCS data were acquired at six time points, together with local environmental data. Tics, but not OCD symptoms, were found to be more severe in spring and summer compared with winter and autumn (p < 0.001). Changes in tics displayed an appreciable oscillation pattern in the same subject and also a clear synchrony among different subjects, indicating an external orchestrating factor. Ambient temperature showed a significant correlation with Y-GTSS measurements (p < 0.001). We argue that the increase in tics observed during hot seasons can be related to increasing ambient temperature. We believe that our results can shed light on the seasonal dynamics of TS symptomatology and provide clues for preventing their worsening over the year.

Clinical management of children with tic disorder: insights from therapeutic visits in China-a real-world study.

Objective: This retrospective study aims to investigate the treatment of tic disorder (TD) in Dongfang Hospital affiliated with Beijing University of Chinese Medicine, explore its underlying mechanism, and provide valuable insights for future research and clinical management of TD. Methods: The electronic medical records of children with TD, from 2015 to 2021, were extracted from the information system of Dongfang Hospital affiliated with Beijing University of Chinese Medicine. The clinical characteristics of TD, utilization patterns of Chinese herbal medicine and synthetic drugs in prescriptions, as well as their pharmacological effects, were statistically described and categorized. In addition, association rules and network pharmacology were employed to identify core prescriptions (CPs) and elucidate their microscopic molecular mechanisms in treating TD. Results: The age range of the children was from 6 to 11 years, with a higher proportion of male participants than female ones. The average duration of treatment was 6 weeks. Regimen Z for the treatment of TD can be summarized as follows: Chinese herbal medicine [Saposhnikoviae Radix (FangFeng), Puerariae Lobatae Radix (GeGen), Uncariae Ramulus cum Uncis (GouTeng), Acori Tatarinowii Rhizoma (ShiChangPu), Chuanxiong Rhizoma (ChuanXiong)] and vitamins [lysine, inosite, and vitamin B12 oral solution] form the basic treatment, combined with immunomodulators, antibiotics, electrolyte-balancing agents, and antiallergic agents. CPs primarily exerted their effects through the modulation of gene expression (transcription), the immune system, and signal transduction pathways, with interleukin-4 and interleukin-13 pathways being particularly crucial. Among the lysine synthetic drugs used, inosite and vitamin B12 oral solution were the most frequently prescribed. Conclusion: The regimen Z drug treatment holds significant importance in the field, as it exerts its therapeutic effects through a multitude of pathways and intricate interventions. Chinese herbal medicine primarily regulates immune system-related pathways, while synthetic drugs predominantly consist of vitamins.