Response to Commentary: The Framework for Systematic Reviews on Psychological Risk Factors for Persistent Somatic Symptoms and Related Syndromes and Disorders (PSY-PSS)

Persistent somatic symptoms (PSS) are common in all fields of medicine. Current classification systems for mental disorders in this field, i.e. Somatic Symptom Disorder (SSD; DSM-5) or Bodily Distress Disorder (BDD; ICD-11), now stress the relevance of psychological features associated with the physical complaints. It is well known that psychological criteria are among the relevant risk factors for the development and/or worsening of persistent physical symptoms, however, the selected diagnostic criteria remain subject to debate. Numerous psychological concepts have been studied and discussed in the scientific field. However, empirical evidence remains scattered, individual factors have not been reviewed systematically, and longitudinal studies to allow for causal inference are scarce. In our framework for systematic reviews on psychological risk factors for persistent somatic symptoms and related syndromes and disorders (PSYPSS) (1), we summarized current knowledge regarding psychological variables relevant to the development and maintenance of persistent somatic symptoms (PSS). The framework provides two lists, one of them with 83 relevant symptoms, syndromes and disorders (list 1) and the other with 120 psychological factors, categorized into 42 subcategories and 7 main categories (list 2). Further, we invited other researchers working in the field of PSS to use and also improve our lists by adding terms and constructs which we might have missed in our initial search. Following up on our invitation, Berens and colleagues (2) rightly pointed out that so far, our list of psychological variables did not contain any factors related to personality functioning and mentalizing, although there is scientific evidence for these concepts from the field of PSS, which the authors convincingly explain in their commentary. By adding these important psychodynamic concepts, the authors helped to improve the PSY-PSS framework

Substance Abuse-Related Self-Stigma in Women with Substance Use Disorder and Comorbid Posttraumatic Stress Disorder

Background: Self-stigma is a result of internalizing negative stereotypes by the affected person. Research on self-stigma in substance use disorders (SUD) is still scarce, especially regarding the role of childhood trauma and subsequent posttraumatic disorders. Objectives: The present study investigated the progressive model of self-stigma in women with SUD and posttraumatic stress disorder (PTSD), and the predictive value of PTSD severity and childhood trauma experiences on self-stigma. Method: In a cross-sectional study with 343 women with SUD and PTSD, we used the Self-Stigma in Alcohol Dependency Scale, the Childhood Trauma Questionnaire (CTQ), the PTSD Symptom Scale Interview (PSS-I), and to control for SUD severity and depression, the Addiction Severity Index Lite and the Beck Depression Inventory-II. Hierarchical regression analyses were conducted for each stage of self-stigma (aware-agree-apply-harm). Results: The interrelated successive stages of self-stigma were largely confirmed. In the regression models, no significant effects of the PSS-I- and the CTQ-scores were observed at any stage of self-stigma. Agreeing with negative stereotypes was solely predicted by younger age, applying these stereotypes to oneself was higher in women with younger age, higher depression and SUD severity, and suffering from the application (harm) was only predicted by depression. Conclusions: The progressive model of self-stigma could be confirmed in women with SUD and PTSD, but PTSD severity and childhood trauma did not directly affect this process. Self-stigma appears to be related to depression in a stronger way than PTSD is related to women with SUD and PTSD

Clinical determinants and neural correlates of presbyphagia in community-dwelling older adults

Background“Presbyphagia” refers to characteristic age-related changes in the complex neuromuscular swallowing mechanism. It has been hypothesized that cumulative impairments in multiple domains affect functional reserve of swallowing with age, but the multifactorial etiology and postulated compensatory strategies of the brain are incompletely understood. This study investigates presbyphagia and its neural correlates, focusing on the clinical determinants associated with adaptive neuroplasticity.Materials and methods64 subjects over 70 years of age free of typical diseases explaining dysphagia received comprehensive workup including flexible endoscopic evaluation of swallowing (FEES), magnetoencephalography (MEG) during swallowing and pharyngeal stimulation, volumetry of swallowing muscles, laboratory analyzes, and assessment of hand-grip-strength, nutritional status, frailty, olfaction, cognition and mental health. Neural MEG activation was compared between participants with and without presbyphagia in FEES, and associated clinical influencing factors were analyzed. Presbyphagia was defined as the presence of oropharyngeal swallowing alterations e.g., penetration, aspiration, pharyngeal residue pooling or premature bolus spillage into the piriform sinus and/or laryngeal vestibule.Results32 of 64 participants showed swallowing alterations, mainly characterized by pharyngeal residue, whereas the airway was rarely compromised. In the MEG analysis, participants with presbyphagia activated an increased cortical sensorimotor network during swallowing. As major clinical determinant, participants with swallowing alterations exhibited reduced pharyngeal sensation. Presbyphagia was an independent predictor of a reduced nutritional status in a linear regression model.ConclusionsSwallowing alterations frequently occur in otherwise healthy older adults and are associated with decreased nutritional status. Increased sensorimotor cortical activation may constitute a compensation attempt to uphold swallowing function due to sensory decline. Further studies are needed to clarify whether the swallowing alterations observed can be considered physiological per se or whether the concept of presbyphagia may need to be extended to a theory with a continuous transition between presbyphagia and dysphagia

A historically controlled, single-arm, multi-centre, prospective trial to evaluate the safety and efficacy of MonoMax® suture material for abdominal wall closure after primary midline laparotomy. ISSAAC-Trial [NCT005725079]

<p>Abstract</p> <p>Background</p> <p>Several randomized controlled trials have compared different suture materials and techniques for abdominal wall closure with respect to the incidence of incisional hernias after midline laparotomy and shown that it remains, irrespective of the methods used, considerably high, ranging from 9% to 20%. The development of improved suture materials which would reduce postoperative complications may help to lower its frequency.</p> <p>Design</p> <p>This is a historically controlled, single-arm, multi-centre, prospective trial to evaluate the safety of MonoMax^®suture material for abdominal wall closure in 150 patients with primary elective midline incisions. INSECT patients who underwent abdominal closure using Monoplus^®and PDS^®will serve as historical control group. The incidences of wound infections and of burst abdomen are defined as composite primary endpoints. Secondary endpoints are the frequency of incisional hernias within one year after operation and safety. To ensure adequate comparability in surgical performance and recruitment, the 4 largest centres of the INSECT-Trial will participate. After hospital discharge, the investigators will examine the enrolled patients again at 30 days and at 12 ± 1 months after surgery.</p> <p>Conclusion</p> <p>This historically controlled, single-arm, multi-centre, prospective ISSAAC trial aims to assess whether the use of an ultra-long-lasting absorbable monofilament suture material is safe and efficient.</p> <p>Trial registration</p> <p>NCT005725079</p

How quick was marine recovery after the end-Triassic mass extinction and what role did anoxia play?

Oxygen restricted conditions were widespread in European shelf seas after the end-Triassic mass extinction event and they are reported to have hindered the recovery of marine benthos. Here we reconstruct the redox history of the Early Jurassic Blue Lias Formation of southwest Britain using pyrite framboid size analysis and compare this with the recovery of bivalves based on field and museum collections. Results suggest widespread dysoxia punctuated by periods of anoxia in the region, with the latter developing frequently in deeper water settings. Despite these harsh conditions, initial benthic recovery occurred rapidly in the British Jurassic, especially in shallowest settings, and shows no relationship with the intensity of dysoxia. A stable diversity was reached by the first recognised ammonite zone after the end-Triassic mass extinction. This contrasts with the deeper-water, more oxygen-poor sections where the diversity increase was still continuing in the earliest Sinemurian Stage, considerably longer than previously reported. Similar recovery rates are seen amongst other groups (brachiopods and ammonites). Oxygen-poor conditions have been suggested to delay recovery after the Permo-Triassic mass extinction, but this is not the case after the end-Triassic crisis. We suggest that this was because the European dysoxia was only a regional phenomenon and there were plenty of well-ventilated regions available to allow an untrammelled bounce back

CA19-9 and apolipoprotein-A2 isoforms as detection markers for pancreatic cancer: a prospective evaluation.

Recently, we identified unique processing patterns of apolipoprotein A2 (ApoA2) in patients with pancreatic cancer. Our study provides a first prospective evaluation of an ApoA2 isoform ("ApoA2-ATQ/AT"), alone and in combination with carbohydrate antigen 19-9 (CA19-9), as an early detection biomarker for pancreatic cancer. We performed ELISA measurements of CA19-9 and ApoA2-ATQ/AT in 156 patients with pancreatic cancer and 217 matched controls within the European EPIC cohort, using plasma samples collected up to 60 months prior to diagnosis. The detection discrimination statistics were calculated for risk scores by strata of lag-time. For CA19-9, in univariate marker analyses, C-statistics to distinguish future pancreatic cancer patients from cancer-free individuals were 0.80 for plasma taken ≤6 months before diagnosis, and 0.71 for >6-18 months; for ApoA2-ATQ/AT, C-statistics were 0.62, and 0.65, respectively. Joint models based on ApoA2-ATQ/AT plus CA19-9 significantly improved discrimination within >6-18 months (C = 0.74 vs. 0.71 for CA19-9 alone, p = 0.022) and ≤ 18 months (C = 0.75 vs. 0.74, p = 0.022). At 98% specificity, and for lag times of ≤6, >6-18 or ≤ 18 months, sensitivities were 57%, 36% and 43% for CA19-9 combined with ApoA2-ATQ/AT, respectively, vs. 50%, 29% and 36% for CA19-9 alone. Compared to CA19-9 alone, the combination of CA19-9 and ApoA2-ATQ/AT may improve detection of pancreatic cancer up to 18 months prior to diagnosis under usual care, and may provide a useful first measure for pancreatic cancer detection prior to imaging

First Nd isotope record of Mediterranean–Atlantic water exchange through the Moroccan Rifian Corridor during the Messinian Salinity Crisis

We present the first neodymium isotope reconstruction of Mediterranean–Atlantic water exchange through the Moroccan (‘Rifian’) Corridor 8–5 Ma. This covers the late Miocene Messinian Salinity Crisis (MSC); a period when progressive tectonic restriction of the Mediterranean–Atlantic seaways resulted in extreme, basin-wide Mediterranean salinity fluctuations. The Rifian Corridor was one of these seaways and until now, relatively poor age constraints existed for the timing of Corridor closure, due to the impact of uplift and erosion on the sedimentary record. The bottom water Nd isotope record from the continuous Bou Regreg Valley succession in northwest Morocco allows us to explore corridor connectivity with the Atlantic. Data from the interior and Mediterranean edge of the Rifian Corridor (respectively, the Taza–Guercif and Melilla basins, northern Morocco) provide new information on corridor shallowing and the provenance of water flowing through the seaway. As a result, we can constrain the age of Rifian Corridor closure to 6.64–6.44 Ma. We also find no evidence of the siphoning of Atlantic waters through the seaway (7.20–6.58 Ma). Our results cannot exclude the possibility that at times during the Messinian Salinity Crisis, Mediterranean Outflow Water reached the Atlantic

A European research agenda for somatic symptom disorders, bodily distress disorders, and functional disorders: Results of an estimate-talk-estimate delphi expert study

Background: Somatic Symptom Disorders (SSD), Bodily Distress Disorders (BDD) and functional disorders (FD) are associated with high medical and societal costs and pose a substantial challenge to the population and health policy of Europe. To meet this challenge, a specific research agenda is needed as one of the cornerstones of sustainable mental health research and health policy for SSD, BDD, and FD in Europe. Aim: To identify the main challenges and research priorities concerning SSD, BDD, and FD from a European perspective. Methods: Delphi study conducted from July 2016 until October 2017 in 3 rounds with 3 workshop meetings and 3 online surveys, involving 75 experts and 21 European countries. EURONET-SOMA and the European Association of Psychosomatic Medicine (EAPM) hosted the meetings. Results: Eight research priorities were identified: (1) Assessment of diagnostic profiles relevant to course and treatment outcome. (2) Development and evaluation of new, effective interventions. (3) Validation studies on questionnaires or semi-structured interviews that assess chronic medical conditions in this context. (4) Research into patients preferences for diagnosis and treatment. (5) Development of new methodologic designs to identify and explore mediators and moderators of clinical course and treatment outcomes (6). Translational research exploring how psychological and somatic symptoms develop from somatic conditions and biological and behavioral pathogenic factors. (7) Development of new, effective interventions to personalize treatment. (8) Implementation studies of treatment interventions in different settings, such as primary care, occupational care, general hospital and specialty mental health settings. The general public and policymakers will benefit from the development of new, effective, personalized interventions for SSD, BDD, and FD, that will be enhanced by translational research, as well as from the outcomes of research into patient involvement, GP-patient communication, consultation-liaison models and implementation. Conclusion: Funding for this research agenda, targeting these challenges in coordinated research networks such as EURONET-SOMA and EAPM, and systematically allocating resources by policymakers to this critical area in mental and physical well-being is urgently needed to improve efficacy and impact for diagnosis and treatment of SSD, BDD, and FD across Europe

Neogene Uplift and Magmatism of Anatolia: Insights from Drainage Analysis and Basaltic Geochemistry

It is generally agreed that mantle dynamics have played a significant role in generating and maintaining the elevated topography of Anatolia during Neogene times. However, there is much debate about the relative importance of subduction zone and asthenospheric processes. Key issues concern onset and cause of regional uplift, thickness of the lithospheric plate, and the presence or absence of temperature and/or compositional anomalies within the convecting mantle. Here, we tackle these interlinked issues by analyzing and modeling two disparate suites of observations. First, a drainage inventory of 1,844 longitudinal river profiles is assembled. This geomorphic database is inverted to calculate the variation of Neogene regional uplift through time and space by minimizing the misfit between observed and calculated river profiles subject to independent calibration. Our results suggest that regional uplift commenced in the east at 20 Ma and propagated westward. Secondly, we have assembled a database of geochemical analyses of basaltic rocks. Two different approaches have been used to quantitatively model this database with a view to determining the depth and degree of asthenospheric melting across Anatolia. Our results suggest that melting occurs at depths as shallow as 60 km in the presence of mantle potential temperatures as high as 1400°C. There is evidence that potential temperatures are higher in the east, consistent with the pattern of sub-plate shear wave velocity anomalies. Our combined results are consistent with isostatic and admittance analyses and suggest that elevated asthenospheric temperatures beneath thinned Anatolian lithosphere have played a first order role in generating and maintaining regional dynamic topography and basaltic magmatism