International cooperation in radiology training: A multipronged approach.

INTRODUCTION: Medical imaging has undergone significant technical advancements in recent years, posing a considerable challenge for radiologists to stay up-to-date with emerging modalities and their applications in daily practice. This challenge is even more daunting in developing countries with limited resources compared to the US and other developed nations with greater economic assets. The collaboration between the United States and other advanced nations with radiological institutions in Latin America has been a significant achievement in the pursuit of new opportunities for continuous medical education. The aim of this study was to evaluate the effectiveness of international collaborations among Spanish-speaking Latin American institutions and radiologists through a survey. MATERIALS AND METHODS: A group of radiologists and institutions from various countries, including the USA, Spain, and Argentina, who have been working together for several years to improve Radiology education across Latin America, were selected. An online survey was conducted. The survey included questions about interest in the activities, participation, and impact of radiologic education during these educational efforts. RESULTS: The survey received responses from 166 participants, all of whom reported knowledge of at least one type of educational activity. The most well-known activity was ALAT Webinars. The primary motivators for participation were the quality of the content and the opportunity to learn new information. Additionally, improving local education in radiology and receiving expert advice on radiology issues were identified as priorities for participation in international collaborations. The Cronbach alpha coefficient was calculated for individual and global Likert questions, resulting in a global score of 0.96. CONCLUSION: The study confirms the significance of a multifaceted approach to address gaps in radiology education. While traditional models have relied on hosting international visitors or sending US teachers abroad, the results suggest that using a variety of methods will have a greater impact than relying on a single technique for those who benefit most from collaborative efforts.

Genetic-based patient stratification in Alzheimer's disease.

Alzheimer's disease (AD) shows a high pathological and symptomatological heterogeneity. To study this heterogeneity, we have developed a patient stratification technique based on one of the most significant risk factors for the development of AD: genetics. We addressed this challenge by including network biology concepts, mapping genetic variants data into a brain-specific protein-protein interaction (PPI) network, and obtaining individualized PPI scores that we then used as input for a clustering technique. We then phenotyped each obtained cluster regarding genetics, sociodemographics, biomarkers, fluorodeoxyglucose-positron emission tomography (FDG-PET) imaging, and neurocognitive assessments. We found three clusters defined mainly by genetic variants found in MAPT, APP, and APOE, considering known variants associated with AD and other neurodegenerative disease genetic architectures. Profiling of these clusters revealed minimal variation in AD symptoms and pathology, suggesting different biological mechanisms may activate the neurodegeneration and pathobiological patterns behind AD and result in similar clinical and pathological presentations, even a shared disease diagnosis. Lastly, our research highlighted MAPT, APP, and APOE as key genes where these genetic distinctions manifest, suggesting them as potential targets for personalized drug development strategies to address each AD subgroup individually.

TCDD and CH223191 Alter T Cell Balance but Fail to Induce Anti-Inflammatory Response in Adult Lupus Mice.

Aryl hydrocarbon receptor (AhR) responds to endogenous and exogenous ligands as a cytosolic receptor, transcription factor, and E3 ubiquitin ligase. Several studies support an anti-inflammatory effect of AhR activation. However, exposure to the AhR agonist 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) during early stages of development results in an autoimmune phenotype and exacerbates lupus. The effects of TCDD on lupus in adults with pre-existing autoimmunity have not been described. We present novel evidence that AhR stimulation by TCDD alters T cell responses but fails to impact lupus-like disease using an adult mouse model. Interestingly, AhR antagonist CH223191 also changed T cell balance in our model. We next developed a conceptual framework for identifying cellular and molecular factors that contribute to physiological outcomes in lupus and created models that describe cytokine dynamics that were fed into a system of differential equations to predict the kinetics of T follicular helper (Tfh) and regulatory T (Treg) cell populations. The model predicted that Tfh cells expanded to larger values following TCDD exposure compared with vehicle and CH223191. Following the initial elevation, both Tfh and Treg cell populations continuously decayed over time. A function based on the ratio of predicted Treg/Tfh cells showed that Treg cells exceed Tfh cells in all groups, with TCDD and CH223191 showing lower Treg/Tfh cell ratios than the vehicle and that the ratio is relatively constant over time. We conclude that AhR ligands did not induce an anti-inflammatory response to attenuate autoimmunity in adult lupus mice. This study challenges the dogma that TCDD supports an immunosuppressive phenotype.

Macular vessel density in the superficial plexus is not a proxy of cerebrovascular damage in non-demented individuals: data from the NORFACE cohort.

INTRODUCTION: Optical coherence tomography angiography (OCT-A) is a novel tool that allows the detection of retinal vascular changes. We investigated the association of macular vessel density (VD) in the superficial plexus assessed by OCT-A with measures of cerebrovascular pathology and atrophy quantified by brain magnetic resonance imaging (MRI) in non-demented individuals. METHODS: Clinical, demographical, OCT-A, and brain MRI data from non-demented research participants were included. We analyzed the association of regional macular VD with brain vascular burden using the Fazekas scale assessed in a logistic regression analysis, and the volume of white matter hyperintensities (WMH) assessed in a multiple linear regression analysis. We also explored the associations of macular VD with hippocampal volume, ventricle volume and Alzheimer disease cortical signature (ADCS) thickness assessed in multiple linear regression analyses. All analyses were adjusted for age, sex, syndromic diagnosis and cardiovascular variables. RESULTS: The study cohort comprised 188 participants: 89 with subjective cognitive decline and 99 with mild cognitive impairment. No significant association of regional macular VD with the Fazekas categories (all, p > 0.111) and WMH volume (all, p > 0.051) were detected. VD in the nasal quadrant was associated to hippocampal volume (p = 0.007), but no other associations of macular VD with brain atrophy measures were detected (all, p > 0.05). DISCUSSION: Retinal vascular measures were not a proxy of cerebrovascular damage in non-demented individuals, while VD in the nasal quadrant was associated with hippocampal atrophy independently of the amyloid status.

Genome-wide association study and polygenic risk scores of retinal thickness across the cognitive continuum: data from the NORFACE cohort.

BACKGROUND: Several studies have reported a relationship between retinal thickness and dementia. Therefore, optical coherence tomography (OCT) has been proposed as an early diagnosis method for Alzheimer's disease (AD). In this study, we performed a genome-wide association study (GWAS) aimed at identifying genes associated with retinal nerve fiber layer (RNFL) and ganglion cell inner plexiform layer (GCIPL) thickness assessed by OCT and exploring the relationships between the spectrum of cognitive decline (including AD and non-AD cases) and retinal thickness. METHODS: RNFL and GCIPL thickness at the macula were determined using two different OCT devices (Triton and Maestro). These determinations were tested for association with common single nucleotide polymorphism (SNPs) using adjusted linear regression models and combined using meta-analysis methods. Polygenic risk scores (PRSs) for retinal thickness and AD were generated. RESULTS: Several genetic loci affecting retinal thickness were identified across the genome in accordance with previous reports. The genetic overlap between retinal thickness and dementia, however, was weak and limited to the GCIPL layer; only those observable with all-type dementia cases were considered. CONCLUSIONS: Our study does not support the existence of a genetic link between dementia and retinal thickness.

Unveiling the sound of the cognitive status: Machine Learning-based speech analysis in the Alzheimer's disease spectrum.

BACKGROUND: Advancement in screening tools accessible to the general population for the early detection of Alzheimer's disease (AD) and prediction of its progression is essential for achieving timely therapeutic interventions and conducting decentralized clinical trials. This study delves into the application of Machine Learning (ML) techniques by leveraging paralinguistic features extracted directly from a brief spontaneous speech (SS) protocol. We aimed to explore the capability of ML techniques to discriminate between different degrees of cognitive impairment based on SS. Furthermore, for the first time, this study investigates the relationship between paralinguistic features from SS and cognitive function within the AD spectrum. METHODS: Physical-acoustic features were extracted from voice recordings of patients evaluated in a memory unit who underwent a SS protocol. We implemented several ML models evaluated via cross-validation to identify individuals without cognitive impairment (subjective cognitive decline, SCD), with mild cognitive impairment (MCI), and with dementia due to AD (ADD). In addition, we established models capable of predicting cognitive domain performance based on a comprehensive neuropsychological battery from Fundació Ace (NBACE) using SS-derived information. RESULTS: The results of this study showed that, based on a paralinguistic analysis of sound, it is possible to identify individuals with ADD (F1 = 0.92) and MCI (F1 = 0.84). Furthermore, our models, based on physical acoustic information, exhibited correlations greater than 0.5 for predicting the cognitive domains of attention, memory, executive functions, language, and visuospatial ability. CONCLUSIONS: In this study, we show the potential of a brief and cost-effective SS protocol in distinguishing between different degrees of cognitive impairment and forecasting performance in cognitive domains commonly affected within the AD spectrum. Our results demonstrate a high correspondence with protocols traditionally used to assess cognitive function. Overall, it opens up novel prospects for developing screening tools and remote disease monitoring.

The Alternative Model of Personality Disorders: Assessment, Convergent and Discriminant Validity, and a Look to the Future.

The Alternative Model of Personality Disorders (AMPD) is a dimensional, empirically based diagnostic system developed to overcome the serious limitations of traditional categories. We review the mounting evidence on its convergent and discriminant validity, with an incursion into the less-studied ICD-11 system. In the literature, the AMPD's Pathological Trait Model (Criterion B) shows excellent convergence with normal personality traits, and it could be useful as an organizing framework for mental disorders. In contrast, Personality Functioning (Criterion A) cannot be distinguished from personality traits, lacks both discriminant and incremental validity, and has a shaky theoretical background. We offer some suggestions with a view to the future. These include removing Criterion A, using the real-life consequences of traits as indicators of severity, delving into the dynamic mechanisms underlying traits, and furthering the integration of currently disengaged psychological paradigms that can shape a sounder clinical science. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 20 is May 2024. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

FACEmemory®, an Innovative Online Platform for Episodic Memory Pre-Screening: Findings from the First 3,000 Participants.

BACKGROUND: The FACEmemory® online platform comprises a complex memory test and sociodemographic, medical, and family questions. This is the first study of a completely self-administered memory test with voice recognition, pre-tested in a memory clinic, sensitive to Alzheimer's disease, using information and communication technologies, and offered freely worldwide. OBJECTIVE: To investigate the demographic and clinical variables associated with the total FACEmemory score, and to identify distinct patterns of memory performance on FACEmemory. METHODS: Data from the first 3,000 subjects who completed the FACEmemory test were analyzed. Descriptive analyses were applied to demographic, FACEmemory, and medical and family variables; t-test and chi-square analyses were used to compare participants with preserved versus impaired performance on FACEmemory (cut-off = 32); multiple linear regression was used to identify variables that modulate FACEmemory performance; and machine learning techniques were applied to identify different memory patterns. RESULTS: Participants had a mean age of 50.57 years and 13.65 years of schooling; 64.07% were women, and 82.10% reported memory complaints with worries. The group with impaired FACEmemory performance (20.40%) was older, had less schooling, and had a higher prevalence of hypertension, diabetes, dyslipidemia, and family history of neurodegenerative disease than the group with preserved performance. Age, schooling, sex, country, and completion of the medical and family history questionnaire were associated with the FACEmemory score. Finally, machine learning techniques identified four patterns of FACEmemory performance: normal, dysexecutive, storage, and completely impaired. CONCLUSIONS: FACEmemory is a promising tool for assessing memory in people with subjective memory complaints and for raising awareness about cognitive decline in the community.

Biomarkers of Alzheimer's disease and neurodegeneration in dried blood spots-A new collection method for remote settings.

BACKGROUND: We aimed to evaluate the precision of Alzheimer's disease (AD) and neurodegeneration biomarker measurements from venous dried plasma spots (DPSv enous) for the diagnosis and monitoring of neurodegenerative diseases in remote settings. METHODS: In a discovery (n = 154) and a validation cohort (n = 115), glial fibrillary acidic protein (GFAP); neurofilament light (NfL); amyloid beta (Aß) 40, Aß42; and phosphorylated tau (p-tau181 and p-tau217) were measured in paired DPSvenous and ethylenediaminetetraacetic acid plasma samples with single-molecule array. In the validation cohort, a subset of participants (n = 99) had cerebrospinal fluid (CSF) biomarkers. RESULTS: All DPSvenous and plasma analytes correlated significantly, except for Aß42. In the validation cohort, DPSvenous GFAP, NfL, p-tau181, and p-tau217 differed between CSF Aß-positive and -negative individuals and were associated with worsening cognition. DISCUSSION: Our data suggest that measuring blood biomarkers related to AD pathology and neurodegeneration from DPSvenous extends the utility of blood-based biomarkers to remote settings with simplified sampling conditions, storage, and logistics. HIGHLIGHTS: A wide array of biomarkers related to Alzheimer's disease (AD) and neurodegeneration were detectable in dried plasma spots (DPSvenous). DPSvenous biomarkers correlated with standard procedures and cognitive status. DPSvenous biomarkers had a good diagnostic accuracy discriminating amyloid status. Our findings show the potential interchangeability of DPSvenous and plasma sampling. DPSvenous may facilitate remote and temperature-independent sampling for AD biomarker measurement. Innovative tools for blood biomarker sampling may help recognizing the earliest changes of AD.

Harnessing acoustic speech parameters to decipher amyloid status in individuals with mild cognitive impairment.

Alzheimer's disease (AD) is a neurodegenerative condition characterized by a gradual decline in cognitive functions. Currently, there are no effective treatments for AD, underscoring the importance of identifying individuals in the preclinical stages of mild cognitive impairment (MCI) to enable early interventions. Among the neuropathological events associated with the onset of the disease is the accumulation of amyloid protein in the brain, which correlates with decreased levels of Aß42 peptide in the cerebrospinal fluid (CSF). Consequently, the development of non-invasive, low-cost, and easy-to-administer proxies for detecting Aß42 positivity in CSF becomes particularly valuable. A promising approach to achieve this is spontaneous speech analysis, which combined with machine learning (ML) techniques, has proven highly useful in AD. In this study, we examined the relationship between amyloid status in CSF and acoustic features derived from the description of the Cookie Theft picture in MCI patients from a memory clinic. The cohort consisted of fifty-two patients with MCI (mean age 73 years, 65% female, and 57% positive amyloid status). Eighty-eight acoustic parameters were extracted from voice recordings using the extended Geneva Minimalistic Acoustic Parameter Set (eGeMAPS), and several ML models were used to classify the amyloid status. Furthermore, interpretability techniques were employed to examine the influence of input variables on the determination of amyloid-positive status. The best model, based on acoustic variables, achieved an accuracy of 75% with an area under the curve (AUC) of 0.79 in the prediction of amyloid status evaluated by bootstrapping and Leave-One-Out Cross Validation (LOOCV), outperforming conventional neuropsychological tests (AUC = 0.66). Our results showed that the automated analysis of voice recordings derived from spontaneous speech tests offers valuable insights into AD biomarkers during the preclinical stages. These findings introduce novel possibilities for the use of digital biomarkers to identify subjects at high risk of developing AD.

Response and resilience of karst subterranean estuary communities to precipitation impacts.

The impact of meteorological phenomena on ecosystem communities of karst subterranean estuaries (KSEs) remains unknown. KSEs are characterized by vertically stratified groundwater separated by a halocline and host endemic aquatic cave-adapted fauna (stygobionts). In October 2015, 8 days of heavy precipitation caused the first recorded mortality event in the KSE. This event was marked by a halocline shift 5 m deeper. The present study aimed to provide insights into resilience of KSEs faunal communities to temporal shifts in temperature and precipitation. Cave water temperature decreased on average 0.0068°C per mm of accumulated precipitation over 4 days, which can add up to, and surpass, the interannual temperature variation in cases of heavy precipitations. Biological surveys (2012-2021) conducted within cave systems El Aerolito and La Quebrada, in Cozumel, indicated that change in community structure was not detected and stygobionts were resilient; however, marine species inhabiting the caves were impacted. Overall, the faunal community at KSEs remains resilient within short-term meteorological phenomena despite shifts of non-stygobionts.

El impacto de fenómenos meteorológicos en las comunidades de los ecosistemas de estuarios subterráneos kársticos (KSE, por sus siglas en inglés) sigue siendo desconocido. Los KSE se caracterizan por aguas subterráneas estratificadas verticalmente separadas por una haloclina, y albergan fauna acuática endémica adaptada a la vida en cuevas (estigobiontes). En octubre de 2015, ocho días de fuertes precipitaciones causaron el primer evento de mortandad registrado en un KSE. Este evento estuvo marcado por un desplazamiento de la haloclina, resultando en una haloclina 5 m más profunda. El presente estudio tuvo como objetivo proveer información sobre la resiliencia de las comunidades faunísticas de los KSE a cambios temporales en la temperatura y la precipitación. La temperatura del agua de la cueva disminuyó en promedio 0.0068°C por mm de precipitación acumulado durante cuatro días, lo cual puede alcanzar, e incluso superar, la variación interanual de la temperatura debido a fuertes precipitaciones. Los estudios biológicos (2012­2021) realizados dentro de los sistemas de cuevas El Aerolito y La Quebrada, en Cozumel, indicaron que no se detectó un cambio en la estructura de la comunidad y que los estigobiontes fueron resilientes, sin embargo, las especies marinas que habitan las cuevas se vieron afectadas. En general, la comunidad de fauna de KSEs se mantiene resiliente a los fenómenos meteorológicos a corto plazo a pesar de los cambios en la fauna no estigobia.

Intermediate risk of choledocholithiasis: are we on the right path?

The risk of choledocholithiasis should be assessed in every patient undergoing cholecystectomy to define the next step. The American Society for Gastrointestinal Endoscopy proposed a stratified predictor scale of choledocholithiasis. Therefore, we aimed to describe our experience managing patients with an intermediate risk of choledocholithiasis according to the American Society for Gastrointestinal Endoscopy guidelines and the actual presence of bile duct stones in magnetic resonance cholangiopancreatography. Methods: A retrospective observational study with a prospective database was conducted. The analysis included sociodemographic data, laboratory values, and imaging. Bivariate, multivariate, and receiver operating characteristic analysis were performed. Results: Three hundred twenty-seven patients had an intermediate risk for choledocholithiasis. Half the patients were at least 65 years old. 24.77% were diagnosed with choledocholithiasis. Bile duct dilation was documented in only 3.06% of cases. Diagnosis of choledocholithiasis is associated with an age odds ratio (OR): 1.87 (P 0.02), alkaline phosphatase OR: 2.44 (P 0.02), and bile duct dilation greater than 6 mm OR: 14.65 (P 0.00). Conclusions: High variability in the accuracy of imaging techniques results in a large number of patients classified as intermediate risk without choledocholithiasis in cholangioresonance. Therefore, enhancing the criteria to define intermediate risk for patients in order to optimize resources is of paramount importance.

Reporte de Pecari tajacu y Procyon lotor con anomalías cromáticas en el Estado de Guerrero, México

Este trabajo documenta el primer registro de anomalías cromáticas en el pecarí de collar (Pecari tajacu) y el tercero en el mapache (Procyon lotor) para México. Los hallazgos se realizaron durante el monitoreo realizado entre el 2009 y el 2021, utilizando cámaras-trampa, principalmente en la ecorregión de la Sierra Madre del Sur del estado de Guerrero, México. Procyon lotor fue registrado entre el 5 de noviembre y el 1 de diciembre de 2019, en vegetación riparia de bosque tropical caducifolio (17°47'35"N, 98°39'59"W, 1134 m de altitud). Mientras que Pecari tajacu se registró el 7 de junio y el 22 de julio del 2021 en una brecha saca cosecha abandonada (17°38'12"N, 100°40'50"W; 1532 m de altitud).

This paper documents the first record of chromatic anomalies in Collared Peccary (Pecari tajacu) and the third in the Raccoon (Procyon lotor) for Mexico. The findings were made during monitoring conducted between 2009 and 2021, using camera traps, primarily in the Sierra Madre del Sur ecoregion of the state of Guerrero, Mexico. Procyon lotor was recorded between November 5th and December 1st, 2019, in riparian vegetation of a deciduous tropical forest (17°47'35"N, 98°39'59"W, 1134 m altitude). Meanwhile, Pecari tajacu was recorded on June 7th and July 22nd, 2021, in an abandoned crop clearing (17°38'12"N, 100°40'50"W; 1532 m altitude).

The evolution of personality disorders: A review of proposals.

Personality disorders (PDs) are currently considered dysfunctions. However, personality differences are older than humanity and are ubiquitous in nature, from insects to higher primates. This suggests that a number of evolutionary mechanisms-other than dysfunctions-may be able to maintain stable behavioral variation in the gene pool. First of all, apparently maladaptive traits may actually improve fitness by enabling better survival or successful mating or reproduction, as exemplified by neuroticism, psychopathy, and narcissism. Furthermore, some PDs may harm important biological goals while facilitating others, or may be globally beneficial or detrimental depending on environmental circumstances or body condition. Alternatively, certain traits may form part of life history strategies: Coordinated suites of morphological, physiological and behavioral characters that optimize fitness through alternative routes and respond to selection as a whole. Still others may be vestigial adaptations that are no longer beneficial in present times. Finally, variation may be adaptative in and by itself, as it reduces competition for finite resources. These and other evolutionary mechanisms are reviewed and illustrated through human and non-human examples. Evolutionary theory is the best-substantiated explanatory framework across the life sciences, and may shed light on the question of why harmful personalities exist at all.

The Synergic Effect of AT(N) Profiles and Depression on the Risk of Conversion to Dementia in Patients with Mild Cognitive Impairment.

Few studies have addressed the impact of the association between Alzheimer's disease (AD) biomarkers and NPSs in the conversion to dementia in patients with mild cognitive impairment (MCI), and no studies have been conducted on the interaction effect of these two risk factors. AT(N) profiles were created using AD-core biomarkers quantified in cerebrospinal fluid (CSF) (normal, brain amyloidosis, suspected non-Alzheimer pathology (SNAP) and prodromal AD). NPSs were assessed using the Neuropsychiatric Inventory Questionnaire (NPI-Q). A total of 500 individuals with MCI were followed-up yearly in a memory unit. Cox regression analysis was used to determine risk of conversion, considering additive and multiplicative interactions between AT(N) profile and NPSs on the conversion to dementia. A total of 224 participants (44.8%) converted to dementia during the 2-year follow-up study. Pathologic AT(N) groups (brain amyloidosis, prodromal AD and SNAP) and the presence of depression and apathy were associated with a higher risk of conversion to dementia. The additive combination of the AT(N) profile with depression exacerbates the risk of conversion to dementia. A synergic effect of prodromal AD profile with depressive symptoms is evidenced, identifying the most exposed individuals to conversion among MCI patients.

Time-calibrated phylogenies reveal mediterranean and pre-mediterranean origin of the thermophilous vegetation of the Canary Islands.

BACKGROUND AND AIMS: The Canary Islands have strong floristic affinities with the Mediterranean Basin. One of the most characteristic and diverse vegetation belts of the archipelago is the thermophilous woodland (between 200 and 900 m.a.s.l.). This thermophilous plant community consists of many non-endemic species shared with the Mediterranean Floristic Region together with Canarian endemic species. Consequently, phytogeographic studies have historically proposed the hypothesis of an origin of the Canarian thermophilous species following the establishment of the summer-dry mediterranean climate in the Mediterranean Basin around 2.8 million years ago. METHODS: Time-calibrated phylogenies for 39 plant groups including Canarian thermophilous species were primarily analysed to infer colonization times. In particular, we used 26 previously published phylogenies together with 13 new time-calibrated phylogenies (including newly generated plastid and nuclear DNA sequence data) to assess whether the time interval between stem and crown ages of Canarian thermophilous lineages postdates 2.8 Ma. For lineages postdating this time threshold, we additionally conducted ancestral area reconstructions to infer the potential source area for colonization. KEY RESULTS: A total of 43 Canarian thermophilous lineages were identified from 39 plant groups. Both mediterranean (16) and pre-mediterranean (9) plant lineages were found. However, we failed to determine the temporal origin for 18 lineages because a stem-crown time interval overlaps with the 2.8-Ma threshold. The spatial origin of thermophilous lineages was also heterogeneous, including ancestral areas from the Mediterranean Basin (nine) and other regions (six). CONCLUSIONS: Our findings reveal an unexpectedly heterogeneous origin of the Canarian thermophilous species in terms of colonization times and mainland source areas. A substantial proportion of the lineages arrived in the Canaries before the summer-dry climate was established in the Mediterranean Basin. The complex temporal and geographic origin of Canarian thermophilous species challenges the view of the Canary Islands (and Madeira) as a subregion within the Mediterranean Floristic Region.

Asparaginase activity monitoring in pediatric acute lymphoblastic leukemia: A cross-sectional nationwide study in Spain.

BACKGROUND: A cross-sectional nationwide study was designed to assess national compliance with international consensus/guidelines of monitoring asparaginase levels in children with acute lymphoblastic leukemia (ALL) treated with asparaginase in routine clinical practice. METHODS: An ad hoc questionnaire was designed and completed by staff physicians from Hemato-Oncology Units throughout Spain. RESULTS: A total of 39 physicians (64% pediatricians) with a mean (SD) age 43.5 (7.9) years and 15.3 (17.6) years of professional activity participated in the study. They accounted for 90% of hospitals in which children with ALL are treated in Spain. A total of 19 participants (48.7%) reported that asparaginase levels were routinely monitored (own center in 2 cases [10.5%], another hospital in 17 cases [89.5%]). Asparaginase was not monitored in 51.3% of the cases, mostly (80%) because unavailability of testing. When asparaginase was monitored, 68% of participants reported that this was done in all asparaginase-treated patients and 84% in all phases of the disease (induction, consolidation, re-induction, maintenance) with a time interval of 7 days for the pegylated form, 48 h for Erwinia asparaginase and 14 days for maintenance with the pegylated form. All participants reported that they modified treatment according to results of testing, with a limit of total depletion of ≥100 IU/L. Levels <100 or 20 IU/L were considered indicative of hypersensitivity by 46% of physicians. CONCLUSION: There is still a gap between what is recommended and what is done in clinical practice, with more than 50% of centers not monitoring the level of asparaginase activity in pediatric ALL. Protocols for asparaginase testing in daily practice should be implemented.

Borderline, where are you? A psychometric approach to the personality domains in the International Classification of Diseases, 11th Revision (ICD-11).

The inclusion of the borderline pattern in the International Classification of Diseases, 11th Revision (ICD-11) dimensional classification of personality disorders (PDs) has caused controversy. Unease about leaving out these clinically challenging patients seems to conflict with the need of an evidence-based and credible diagnostic system. However, the accommodation of borderline within the new diagnostic system has not yet been studied in depth. To this end, we examine in a sample of 1799 general population and clinical subjects the joint structure of the five initial ICD-11 domains and the borderline pattern. Regression and item-level factor analyses reveal that borderline criteria do not form a separate construct and are indissociable from negative affectivity. Furthermore, borderline adds nothing to the remaining domains when it comes to predict PD severity. The borderline pattern appears as largely superfluous and even misguiding, unless their criteria are properly integrated within the structure of personality pathology. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Description of the National Mortality Register of Panama.

Introduction: The National Mortality Register (NMR) of Panama is a key element in demographic analysis and in acquiring an updated picture of population health in Panama. The main objectives of this study are to characterize the NMR and to enumerate its strengths and weaknesses. Methods: We describe the history, processes, and structure of the Vital Statistics Section of the National Institute of Statistics and Census (the curator of the NMR database). In addition, we discuss publication punctuality, underregistration of the data, the proportion of registered deaths certified by medical doctors, and the top 5 causes of death according to the 80 groups of the International Classification of Diseases, Tenth Revision. We also examine works derived from the register's data, from the first publication on its website (2002) until 2019. Results: The NMR procedures were described. The web reports of the NMR were performed with a delay of between 1 to 2 years. The underregistration of deaths in 2002-2019 was 14.7%, and the national yearly proportion of deaths certified by medical doctors was always above 90%. Hard-to-reach areas had higher underregistration proportions and fewer deaths certified by medical doctors. Information extracted from the NMR supports several national and international reports, geographic information systems, and studies. The most common causes of death between 2002 and 2019 were noncommunicable diseases. Conclusions: The NMR is a robust official information system. However, hard-to-reach areas require improvement in terms of the NMR. The NMR is used for publishing official reports, writing studies, and updating reports on the current health status of Panama in a timely fashion following international guidelines.