Managing Multifactorial Deep Vein Thrombosis in an Adolescent: A Complex Case Report.

Introduction: Although rarely diagnosed in the pediatric population, deep vein thrombosis (DVT) is experiencing a growing incidence, while continuously acquiring different nuances due to the widening range of risk factors and lifestyle changes in children and adolescents. Case presentation: A 17-year-old female within four weeks after child delivery was admitted to our clinic due to a six-month history of pain in the left hypochondriac region. After a thorough evaluation, the presence of a benign splenic cyst was revealed, which was later surgically removed. Following the intervention, the patient developed secondary thrombocytosis and bloodstream infection which, together with pre-existing risk factors (obesity, compressive effect of a large cyst, the postpartum period, the presence of a central venous catheter, recent surgery, and post-operative mobilization difficulties) led to the occurrence of extensive DVT, despite anticoagulant prophylaxis and therapy with low-molecular-weight heparin. Conclusions: DVT raises many challenges for the pediatrician, requiring a personalized approach. Although rare, pediatric patients with multiple concomitant high-risk factors should benefit from interdisciplinary care as DVT may not respond to standard therapy in such cases and rapidly become critical. Continual efforts to better understand and treat this condition will contribute to improved outcomes for pediatric patients affected by DVT.

Not Every Dyspepsia Is Related to Helicobacter pylori-A Case of Esophageal Inlet Patch in a Female Teenager.

Helicobacter pylori infection is one of the main causes of dyspepsia, but it is not the only cause. Esophageal inlet patches are areas of heterotopic gastric mucosa within the esophagus and are commonly located in the cervical part of the esophagus. We report the case of a 16-year-old female, previously known to display symptoms of anxiety, who was admitted to our clinic for dyspeptic symptoms lasting for approximately 1 month in spite of the treatment with proton pump inhibitors. The clinical exam revealed only abdominal tenderness in the epigastric area, while routine laboratory tests showed no abnormalities. The upper digestive endoscopy revealed a well-circumscribed salmon-pink-colored oval lesion of approximately 10 mm in the cervical esophagus, along with hyperemia of the gastric mucosa and biliary reflux. The histopathological exam established the diagnosis of esophageal inlet patch with heterotopic antral-type gastric mucosa and also revealed regenerative changes within the gastric mucosa. We continued to treat the patient with proton pump inhibitors, as well as ursodeoxycholic acid, with favorable evolution. Although rare or underdiagnosed, esophageal inlet patches should never be underestimated and all gastroenterologists should be aware of their presence when performing an upper digestive examination in a patient with dyspeptic symptoms.

Investigating risk-taking and executive functioning as predictors of driving performances and habits: a large-scale population study with on-road evaluation.

Introduction: Maladaptive behavior often results from poor decision-making and by extension poor control over decisions. Since maladaptive behavior in driving, such as excessive speed, can lead to dramatic consequences, identifying its causes is of particular concern. The present study investigated how risk-taking and executive functioning are related to driving performance and habits among the general population. Method: Five hundred and eighty-nine participants completed an on-road driving session with a professional driving instructor and a self-reported checklist of difficult driving situations typically avoided. Additionally, participants completed a set of experimental tasks assessing risk-taking tendencies, reactive adaptive mechanisms, and two distinct forms of inhibition: interference control and response inhibition. Results: The results of the present study revealed several significant findings. Firstly, poor driving performance was associated with a high avoidance of challenging driving situations. Secondly, neither form of inhibition studied (interference control or response inhibition) predicted driving performance. Thirdly, while greater involvement in reactive adaptive mechanisms did not predict better on-road performance, it was associated with a reduced tendency to avoid difficult situations. Surprisingly, a higher propensity for risk-taking predicted better on-road performance. Discussion: Overall, these results underline limited links between executive functioning and driving performance while highlighting a potentially more complex relationship between risk-taking tendencies and driving. Executive functioning, however, appears to be linked to driving habits.

Imbalanced weighting of proactive and reactive control as a marker of risk-taking propensity.

According to the dual mechanisms of control (DMC), reactive and proactive control are involved in adjusting behaviors when maladapted to the environment. However, both contextual and inter-individual factors increase the weight of one control mechanism over the other, by influencing their cognitive costs. According to one of the DMC postulates, limited reactive control capacities should be counterbalanced by greater proactive control to ensure control efficiency. Moreover, as the flexible weighting between reactive and proactive control is key for adaptive behaviors, we expected that maladaptive behaviors, such as risk-taking, would be characterized by an absence of such counterbalance. However, to our knowledge, no studies have yet investigated this postulate. In the current study, we analyzed the performances of 176 participants on two reaction time tasks (Simon and Stop Signal tasks) and a risk-taking assessment (Balloon Analog Risk Taking, BART). The post-error slowing in the Simon task was used to reflect the spontaneous individuals' tendency to proactively adjust behaviors after an error. The Stop Signal Reaction Time was used to assess reactive inhibition capacities and the duration of the button press in the BART was used as an index of risk-taking propensity. Results showed that poorer reactive inhibition capacities predicted greater proactive adjustments after an error. Furthermore, the higher the risk-taking propensity, the less reactive inhibition capacities predicted proactive behavioral adjustments. The reported results suggest that higher risk-taking is associated with a smaller weighting of proactive control in response to limited reactive inhibition capacities. These findings highlight the importance of considering the imbalanced weighting of reactive and proactive control in the analysis of risk-taking, and in a broader sense, maladaptive behaviors.

Old and New Aspects of H. pylori-Associated Inflammation and Gastric Cancer.

H. pylori is involved in the development of 80% of gastric cancers and 5.5% of all malignant conditions worldwide. Its persistence within the host's stomach causes chronic inflammation, which is a well-known hallmark of carcinogenesis. A wide range of cytokines was reported to be involved in the initiation and long-term persistence of this local and systemic inflammation. IL-8 was among the first cytokines described to be increased in patients with H. pylori infection. Although, this cytokine was initially identified to exert a chemoattracting effect that represents a trigger for the activation of inflammatory cells within H.-pylori-infected mucosa, more recent studies failed in encountering any association between IL-8 and H. pylori infection. IL-6 is a multifunctional, pleiotropic and multipotent cytokine involved in mediating the interaction between innate and adaptive immunity with a dichotomous role acting as both a proinflammatory and an anti-inflammatory cytokine depending on the signaling pathway. IL-1α functions as a promoter of angiogenesis and vascular endothelial cell proliferation in gastric carcinoma since it is closely related to H.-pylori-induced inflammation in children. IL-1ß is an essential trigger and enhancer of inflammation. The association between a low IL-1ß level and an increased TNF-α level might be considered a risk factor for peptic ulcer disease in the setting of H. pylori infection. IL-10 downregulates both cytotoxic inflammatory responses and cell-mediated immune responses. H. pylori uses the immunosuppressive role of IL-10 to favor its escape from the host's immune system. TGFß is a continuous inflammatory mediator that promotes the adherence of H. pylori to the host's cells and their subsequent colonization. The role of H.-pylori-induced inflammatory responses in the onset of gastric carcinogenesis seems to represent the missing puzzle piece for designing effective preventive and therapeutic strategies in patients with H.-pylori-associated gastric cancer.