Trauma, Emotional Regulation, and Coping Styles in Individuals with and without Probable Dissociative Disorders in Hong Kong.

Previous studies showed that dissociation and dissociative disorders (DDs) are prevalent and are associated with considerable individual and social consequences. There are ongoing debates regarding whether dissociation is a response to betrayal trauma across cultures and whether dissociation can be explained by maladaptive coping. Additionally, little is known about the clinical features of individuals with DDs in the Chinese context. This study aimed to investigate the relationship between trauma, emotional regulation, coping, and dissociation. We analyzed baseline data from a randomized controlled trial (N = 101). Participants with dissociative symptoms in Hong Kong completed self-report assessments. Structured interviews were also conducted subsequently. Participants with probable DDs reported more traumatic events (p = .009 to .017) and exhibited significantly higher levels of dysfunctional coping (p < .001) compared to those who reported dissociative symptoms but did not have a DD. Dissociative symptoms were more strongly associated with betrayal trauma than with non-betrayal trauma. Among different emotion regulation and coping strategies, dysfunctional coping was the only significant factor associated with dissociative symptoms (ß = .309, p = .003). Dysfunctional coping was a statistically significant mediator that may explain the relationship between betrayal trauma and dissociative symptoms. Although other mediation paths are also possible and further longitudinal studies are required, our findings highlight the strong link between dysfunctional coping and dissociative symptoms and suggest that coping skills training should be incorporated into interventions for betrayal trauma survivors with dissociative symptoms. Additionally, this study provides evidence for the cross-cultural validity of the betrayal trauma theory. Further studies, however, are required.

TL1A priming induces a multi-cytokine Th9 cell phenotype that promotes robust allergic inflammation in murine models of asthma.

Multi-cytokine-producing Th9 cells secrete IL-9 and type 2 cytokines and mediate mouse and human allergic inflammation. However, the cytokines that promote a multi-cytokine secreting phenotype have not been defined. Tumor necrosis factor superfamily member TL1A signals through its receptor DR3 to increase IL-9. Here we demonstrate that TL1A increases expression of IL-9 and IL-13 co-expressing cells in murine Th9 cell cultures, inducing a multi-cytokine phenotype. Mechanistically, this is linked to histone modifications allowing for increased accessibility at the Il9 and Il13 loci. We further show that TL1A alters the transcription factor network underlying expression of IL-9 and IL-13 in Th9 cells and increases binding of transcription factors to Il9 and Il13 loci. TL1A-priming enhances the pathogenicity of Th9 cells in murine models of allergic airway disease through the increased expression of IL-9 and IL-13. Lastly, in both chronic and memory-recall models of allergic airway disease, blockade of TL1A signaling decreases the multi-cytokine Th9 cell population and attenuates the allergic phenotype. Taken together, these data demonstrate that TL1A promotes the development of multi-cytokine Th9 cells that drive allergic airway diseases and that targeting pathogenic T helper cell-promoting cytokines could be an effective approach for modifying disease.

A prospective study of nightmare disorder among Chinese adults in Hong Kong: Persistence and mental health outcomes.

OBJECTIVES: Previous studies showed that nightmares are prevalent and are associated with negative health outcomes. However, no empirical data is available demonstrating the extent to which nightmare disorder persists over time. Current literature provides a limited understanding of the trajectory and wider mental health outcomes of nightmare disorder. This longitudinal study examined the persistence and mental health outcomes of nightmare disorder. METHODS: A total of 230 Hong Kong Chinese adults completed standardized assessments twice with an interval of about 6 months. RESULTS: Over half (66.7%) of the participants with probable nightmare disorder at baseline remained to meet the DSM-5 criteria for the disorder at follow-up. Participants with probable nightmare disorder at baseline were significantly more likely to screen positive for PTSD (82.1% vs 18.3%) (p < .001) (p < .001), and they reported higher rates of mental health service usage at both timepoints (p = .001 to .003). Baseline nightmare disorder severity was negatively associated with subsequent self-rated mental health (ß = -.151, p = .010) and self-esteem (ß = -.141, p = .009) and it also predicted subsequent PTSD symptoms (ß = .122, p = .012). CONCLUSIONS: This study provides first empirical data showing that nightmare disorder could be persistent over time. Nightmare disorder symptoms are associated not only with PTSD symptoms but also with a broader range of mental health issues. This study points to the public health importance of identifying and managing nightmare disorder symptoms in the community. Additionally, the presence of nightmare disorder symptoms may be a helpful indicator for identifying post-traumatic stress.

The bidirectional relationship between depression and dissociation: A longitudinal investigation.

Depression is a major public health concern. Recent studies suggest that dissociative symptoms are associated with depressive symptoms, and the concept of "dissociative depression" has been proposed. Yet, only cross-sectional evidence is available in the literature. This study examined the bidirectional relationship between dissociative and depressive symptoms through the use of screening tools in a sample of Chinese young adults (N = 340) over four months. Baseline dissociative symptoms predicted depressive symptoms at follow-up (ß = .262, p < .001), but not the other way around (ß = .065, p = .121). Among different dissociative symptom clusters, identity dissociation was the only significant predictor of subsequent depressive symptoms (ß = .177, p < .001). Furthermore, identity dissociation symptoms partially mediated the relationship between childhood trauma and subsequent depressive symptoms. This preliminary study is the first to test the bidirectional relationship between dissociative and depressive symptoms. The results highlight the importance of taking dissociative symptoms into account when preventing and treating depressive symptoms, especially among childhood trauma survivors.

COULD FAMILY WELL-BEING MODERATE THE RELATIONSHIP BETWEEN ADVERSE CHILDHOOD EXPERIENCES AND SOMATOFORM DISSOCIATION? A PRELIMINARY INVESTIGATION.

The impacts of adverse childhood experiences (ACEs) have been well documented. One possible consequence of ACEs is dissociation, which is a major feature of post-traumatic psychopathology and is also associated with considerable impairment and health care costs. Although ACEs are known to be associated with both psychoform and somatoform dissociation, much less is known about the mechanisms behind this relationship. Little is known about whether social and interpersonal factors such as family environments would moderate the relationship between ACEs and somatoform dissociation. This paper discusses the importance of having a positive and healthy family environment in trauma recovery. We then report the findings of a preliminary study in which we examined whether the association between ACEs and somatoform dissociation would be moderated by family well-being in a convenience sample of Hong Kong adults (N = 359). The number of ACEs was positively associated with somatoform dissociative symptoms, but this association was moderated by the level of family well-being. The number of ACEs was associated with somatoform dissociation only when the family well-being scores were low. These moderating effects were medium. The findings point to the potential importance of using family education and intervention programs to prevent and treat trauma-related dissociative symptoms, but further investigation is needed.

Interleukin-9 promotes mast cell progenitor proliferation and CCR2-dependent mast cell migration in allergic airway inflammation.

Allergic asthma is a chronic lung disease characterized by airway hyperresponsiveness and cellular infiltration that is exacerbated by immunoglobulin E-dependent mast cell (MC) activation. Interleukin-9 (IL-9) promotes MC expansion during allergic inflammation but precisely how IL-9 expands tissue MCs and promotes MC function is unclear. In this report, using multiple models of allergic airway inflammation, we show that both mature MCs (mMCs) and MC progenitors (MCp) express IL-9R and respond to IL-9 during allergic inflammation. IL-9 acts on MCp in the bone marrow and lungs to enhance proliferative capacity. Furthermore, IL-9 in the lung stimulates the mobilization of CCR2+ mMC from the bone marrow and recruitment to the allergic lung. Mixed bone marrow chimeras demonstrate that these are intrinsic effects in the MCp and mMC populations. IL-9-producing T cells are both necessary and sufficient to increase MC numbers in the lung in the context of allergic inflammation. Importantly, T cell IL-9-mediated MC expansion is required for the development of antigen-induced and MC-dependent airway hyperreactivity. Collectively, these data demonstrate that T cell IL-9 induces lung MC expansion and migration by direct effects on the proliferation of MCp and the migration of mMC to mediate airway hyperreactivity.

Mouse pulmonary interstitial macrophages mediate the pro-tumorigenic effects of IL-9.

Although IL-9 has potent anti-tumor activity in adoptive cell transfer therapy, some models suggest that it can promote tumor growth. Here, we show that IL-9 signaling is associated with poor outcomes in patients with various forms of lung cancer, and is required for lung tumor growth in multiple mouse models. CD4+ T cell-derived IL-9 promotes the expansion of both CD11c+ and CD11c- interstitial macrophage populations in lung tumor models. Mechanistically, the IL-9/macrophage axis requires arginase 1 (Arg1) to mediate tumor growth. Indeed, adoptive transfer of Arg1+ but not Arg1- lung macrophages to Il9r-/- mice promotes tumor growth. Moreover, targeting IL-9 signaling using macrophage-specific nanoparticles restricts lung tumor growth in mice. Lastly, elevated expression of IL-9R and Arg1 in tumor lesions is associated with poor prognosis in lung cancer patients. Thus, our study suggests the IL-9/macrophage/Arg1 axis is a potential therapeutic target for lung cancer therapy.

Remote work as a new normal? The technology-organization-environment (TOE) context.

The COVID-19 pandemic has established remote work as the new normal. However, the factors that influence the effectiveness of remote work are unexplored. Moreover, the relationships between remote work and job performance and emotional exhaustion are under-investigated. This study addresses these gaps by investigating the factors that influence the effectiveness and outcomes of remote work. The technology-organisation-environment (TOE) framework and the theory of planned behaviour (TPB) are used as a theoretical lens to examine the internal and external factors that affect remote work and work-life balance. An online cross-sectional survey of knowledge workers engaged in remote work in Hong Kong indicates that both external (technological competence, government support) and internal (work flexibility, attitude, perceived behavioural control) factors are significant predictors of successful remote work. Furthermore, remote work is positively associated with job performance but has no association with emotional exhaustion. These findings suggest that to ensure a successful transition to the new normal, governments and organisations should provide technical support to employees engaged in remote work. The theoretical and practical implications of the findings are discussed.

Case of lower limb revascularisation using composite sequential bypass graft with a 'diamond' intermediate anastomosis.

In patients with critical infracrural disease, autologous saphenous vein grafting offers the best reported conduit patency and limb salvage rates but is only feasible in approximately 30% of patients due to the lack of available or suitable vein. In the absence of a suitable length of available vein, various composite grafting techniques have been explored with the aim to improve graft longevity, maximise native vein use and improve overall clinical outcomes, including limb salvage rates. We report a case of a 66-year-old man with critical limb ischaemia and a history of venous disease, where a complex composite sequential bypass graft combining both native vein and synthetic graft, incorporated into a novel intermediate anastomotic technique in a 'diamond' configuration, offered promising results in limb salvage. This case highlights the key steps and advantages in this novel technique.

Devil within: an incidental and rare finding of an extragonandal retroperitoneal germ cell teratoma carcinoid tumour.

Extragonadal germ cell tumours (GCTs) are uncommon neoplasms comprising approximately 2%-5% of all GCTs. Of these, approximately 30%-40% occurs as primary retroperitoneal GCTs. This case report details the presentation, diagnosis and management of a 53-year-old man presenting with an incidental finding of a primary extragonadal retroperitoneal teratoma with carcinoid transformation.

Perforated jejunal diverticulum: a rare case of acute abdomen.

Jejunal pseudo-diverticulosis is a rare acquired herniation of the mucosa and submucosa through weakened areas of the muscularis mucosa of the mesenteric aspect of the bowel. They are asymptomatic in the majority of cases; however, they can present with a wide spectrum of non-specific symptoms such as chronic abdominal discomfort, postprandial flatulence, diarrhoea, malabsorption and steattorhoea. In up to 15% of cases, more serious acute complications may arise such as the development of intestinal obstruction, haemorrhage or as in our case, localized peritonitis secondary to perforation. Perforation carries an overall mortality rate of up to 40% and exploratory laparotomy followed by copious lavage with segmental resection and primary anastomosis remains the mainstay of managing such sequalae of jejunal pseudo-diverticulosis. Our case report highlights the importance of maintaining a high clinical suspicion of a perforated jejunal diverticulum in an elderly patient presenting with an acute abdomen.

Remote preconditioning and cardiac surgery: regrouping after Remote Ischemic Preconditioning for Heart Surgery (RIPHeart) and Effect of Remote Ischemic Preconditioning on Clinical Outcomes in Patients Undergoing Coronary Artery Bypass Surgery (ERICCA).

Remote ischaemic preconditioning (RIPC) is an attractive cardioprotective strategy. Although results from animal studies and phase II study on humans are convincing, it cannot have a role in clinical practice until benefits in clinical outcomes are proven in phase III study. Two phase III studies were recently published [Remote Ischemic Preconditioning for Heart Surgery (RIPHeart) and Effect of Remote Ischemic Preconditioning on Clinical Outcomes in Patients Undergoing Coronary Artery Bypass Surgery (ERICCA)] and this article discusses their design, results and implications.

Chylous ascites post open cholecystectomy after severe pancreatitis.

CONTEXT: Chylous ascites a rare complication post cholecystectomy. There are to our knowledge only 3 reported cases in the literature. We describe a case of chylous ascites post open cholecystectomy in a patient with recent severe pancreatitis. We propose a potential relationship between acute biliary pancreatitis and the development of chylous ascites. CASE REPORT: We present a 37 year old man with a history of severe biliary pancreatitis 10 months prior. He was electively admitted for laparoscopic cholecystectomy. His surgery was converted to open cholecystectomy due to adhesions. A closed, non suction drain was placed intraoperatively draining serosanguinous fluid. Two days post operatively the draining fluid changed to a milky colour fluid with high triglyceride level. Chylous ascites was confirmed clinically with a 24 hour fast. He was treated with total parenteral nutrition. His chylous ascites resolved with conservative management and his drain was removed. CONCLUSION: We describe the diagnosis and management of chylous ascites post cholecystectomy. We propose the hypothesis to the aetiology of this rare condition, based on ours and one previous case, that a history of recent severe acute pancreatitis poses a risk factor in the development of chylous ascites.