Pooledougherty6497

OBJECTIVE To evaluate the short-term and long-term clinical effectiveness and safety of subthalamic nucleus deep brain stimulation (STN-DBS) for medically intractable pediatric isolated dystonia. METHODS Using a longitudinal retrospective design, we assessed the clinical outcomes of nine patients who underwent STN-DBS for treatment-refractory pediatric isolated dystonia one decade ago (mean age at surgery 15.9 ± 4.5 years). The primary clinical outcome used was assessed by retrospective video analyses of patients' dystonia symptoms using the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS). Clinical assessments were performed at baseline, 1-year follow-up (1-yr FU), and 10-year follow-up (10-yr FU). Adverse side effects, including surgery-related, device-related, and stimulation-related effects, were also documented. RESULTS After STN-DBS surgery, the mean improvement in the BFMDRS motor score was 77.1 ± 26.6% at 1-yr FU and 90.4 ± 10.4% at 10-yr FU. Similarly, the mean BFMDRS disability score was improved by 69.5 ± 13.6% at 1-yr FU and by 86.5 ± 13.9% at 10-yr FU. The clinical improvements gained at 10-yr FU were significantly larger than those observed at 1-yr FU. Negative correlations were found between the duration of disease to age at surgery ratio (DD/AS) and the improvements in the BFMDRS motor score and total score at 1-yr FU and 10-yr FU. CONCLUSION To our knowledge, this study provides the first clinical evidence for the short- and long-term effectiveness and safety of STN-DBS for pediatric isolated dystonia. Additionally, putative evidence is provided that earlier STN-DBS intervention in patients with refractory pediatric isolated dystonia may improve short- and long-term clinical outcomes.BACKGROUND Disruptions in neural circuits underlying emotion regulation (ER) may be a mechanism linking child maltreatment with psychopathology. We examined the associations of maltreatment with neural responses during passive viewing of negative emotional stimuli and attempts to modulate emotional responses. We investigated whether the influence of maltreatment on neural activation during ER differed across development and whether alterations in brain function mediated the association between maltreatment and a latent general psychopathology ('p') factor. METHODS Youth aged 8-16 years with (n = 79) and without (n = 72) exposure to maltreatment completed an ER task assessing neural responses during passive viewing of negative and neutral images and effortful attempts to regulate emotional responses to negative stimuli. P-factor scores were defined by a bi-factor model encompassing internalizing and externalizing psychopathology. RESULTS Maltreated youth had greater activation in left amygdala and salience processing regions and reduced activation in multiple regions involved in cognitive control (bilateral superior frontal gyrus, middle frontal gyrus, and dorsal anterior cingulate cortex) when viewing negative v. neutral images than youth without maltreatment exposure. Reduced neural recruitment in cognitive control regions mediated the association of maltreatment with p-factor in whole-brain analysis. Maltreated youth exhibited increasing recruitment with age in ventrolateral prefrontal cortex during reappraisal while control participants exhibited decreasing recruitment with age. Findings were similar after adjusting for co-occurring neglect. CONCLUSIONS Child maltreatment influences the development of regions associated with salience processing and cognitive control during ER in ways that contribute to psychopathology.BACKGROUND The US Census Bureau's County Business Patterns (CBP) series provides a unique opportunity to describe the healthcare sector using a single, national data source. METHODS We analyzed CBP data on business establishments in the healthcare industry for 2000-2016 for all 50 states and the District of Columbia. Setting and facility types were defined using the North American Industry Classification System. selleck chemicals RESULTS In 2016, CBP enumerated 707,634 US healthcare establishments (a 34% increase from 2000); 86.5% were outpatient facilities and services followed by long-term care facilities (12.5%) and acute-care facilities (1.0%). Between 2000 and 2016, traditional facilities such as general medical surgical and surgical hospitals (-0.4%) and skilled nursing facilities (+0.1%) decreased or remained flat, while other long-term care and outpatient providers grew rapidly. CONCLUSION This analysis highlights the steady growth and increased specialization of the US healthcare sector, particularly in long-term care and outpatient settings.There is an urgent need to find alternative feed resources that can further substitute fishmeal in Atlantic salmon diets without compromising health and food quality, in particular during the finishing feeding period when the feed demand is highest and flesh quality effects are most significant. This study investigates efficacy of substituting a isoprotein (35%) and isolipid (35%) low fishmeal diet (FM, 15%) with Antarctic krill meal (KM, 12%) during three-months with growing finishing 2.3±0.3kg salmon (quadruplicate sea cages/diet). Final body weight (3.9±0.4kg) was similar of the dietary groups, but the KM-group had more voluminous body shape, leaner hearts and improved fillet integrity, firmness and colour. Ectopic epithelial cells and focal calcium deposits in intestine were only detected in the FM-group. Transcriptome profiling by microarray of livers showed dietary effects on several immune genes, and a panel of structural genes were upregulated in the KM-group, including cadherin and connexin. Upregulation of genes encoding myosin heavy chain proteins was the main finding in skeletal muscle. Morphology examination by SEM and secondary structure by FTIR revealed more ordered and stable collagen architecture of the KM-group. Free fatty acid composition of skeletal muscle indicated altered metabolism of n-3, n-6 and saturated fatty acids of the KM-group. The results demonstrated that improved health and meat quality in Atlantic salmon fed krill meal were associated with upregulation of immune genes, proteins defining muscle properties and genes involved in cell contacts and adhesion, altered fatty acid metabolism and fat deposition, and improved gut health and collagen structure.