Efficacy of differential reinforcement of other behaviors therapy for tic disorder: a meta-analysis

INTRODUCTION

Recently, studies on behavioral tic suppression techniques have gained popularity as opposed to pharmacological alternatives that often have potentially dangerous side effects. Differential Reinforcement of Other Behaviors therapy (DRO) is one such behavioral technique whose efficacy in tic suppression has been experimentally demonstrated albeit in studies with very few patients, and lacking statistical power. Here, we conducted a meta-analysis of these studies to improve their overall power and explore whether DRO intervention is really effective for tic suppression.

MATERIALS AND METHODS

PubMed, Embase, PsycINFO, and Cochrane Library were searched from inception to August 30, 2023. Only original interventional studies that examined the efficacy of DRO for tic suppression were included.

RESULTS

A total of 8 no control interventional studies involving 79 children with tic disorders were recruited. Most of the children had moderate tic severity. The pooled mean Yale Global Tic Severity Scale (YGTSS) score was 24.64 (95% CI: 21.99 - 30.12, p =  < 0.00001, I2 = 87%). In terms of efficacy of the DRO technique for tic suppression, the results showed that DRO was effective in reducing tic frequency among the children. The pooled standardized mean difference (SMD) was -10.25 (95% CI: -14.71 - -5.79, p =  < 0.00001) with I2 = 94%.

CONCLUSION

In conclusion, this study revealed that DRO is potentially an effective tic suppression technique for temporarily managing tic disorder. It also showed that DRO could be employed for both moderate and severe tic disorders. However, the technique bears crucial limitations that limit its implementation outside of experimental settings. More studies are needed to address these limitations and improve its applicability in the real world.

Emulsion-based recovery of a multicomponent petroleum hydrocarbon NAPL using nonionic surfactant formulations

Surfactants can aid subsurface remediation through three primary mechanisms - solubilization, mobilization and/or emulsification. Among these mechanisms, emulsification in porous media is generally not well studied or well understood; particularly in the context of treating sources containing multicomponent NAPL. The objective of this research was to elucidate the processes responsible for recovery of a multicomponent hydrocarbon NAPL when surfactant solutions are introduced within a porous medium to promote the formation of kinetically-stable oil-in-water emulsions. Emulsifier formulations considered here were selected to offer similar performance characteristics while relying on different families of non-ionic surfactants - nonylphenol ethoxylates or alcohol ethoxylates - for emulsification. The families of surfactants have particular environment relevance, as alcohol ethoxylates are often used where replacement of nonylphenol content is necessary. Results from batch and column studies suggest performance of the two formulations was similar. With both, a synergistic combination of emulsification and mobilization led to recovery of a synthetic gasoline NAPL. The relative contribution of solubilization to the recovery was found to be minor. Moreover, the physical processes associated with emulsification and mobilization acted to limit the amount of preferential recovery (or fractionation) of the multicomponent NAPL.

A dynamic susceptibility contrast MRI digital reference object for testing software with leakage correction: Effect of background simulation

PURPOSE

Dynamic susceptibility contrast (DSC)-MRI is a perfusion imaging technique from which useful quantitative imaging biomarkers can be derived. Relative cerebral blood volume (rCBV) is such a biomarker commonly used for evaluating brain tumors. To account for the extravasation of contrast agents in tumors, post-processing leakage correction is often applied to improve rCBV accuracy. Digital reference objects (DRO) are ideal for testing the post-processing software, because the biophysical model used to generate the DRO can be matched to the one that the software uses. This study aims to develop DROs to validate the leakage correction of software using Weisskoff model and to examine the effect of background signal time curves that are required by the model.

METHODS

Three DROs were generated using the Weisskoff model, each composed of nine foreground lesion objects with combinations of different levels of rCBV and contrast leakage parameter (K2). Three types of background were implemented for these DROs: (1) a multi-compartment brain-like background, (2) a sphere background with a constant signal time curve, and (3) a sphere background with signal time curve identical to that of the brain-like DRO's white matter (WM). The DROs were then analyzed with an FDA-cleared software with and without leakage correction. Leakage correction was tested with and without brain segmentation.

RESULTS

Accuracy of leakage correction was able to be verified using the brain-like phantom and the sphere phantom with WM background. The sphere with constant background did not perform well with leakage correction with or without brain segmentation. The DROs were able to verify that for the particular software tested, leakage correction with brain segmentation achieved the lowest error.

CONCLUSIONS

DSC-MRI DROs with biophysical model matched to that of the post-processing software can be well used for the software's validation, provided that the background signals are also properly simulated for generating the reference time curve required by the model. Care needs to be taken to consider the interaction of the design of the DRO with the software's implementation of brain segmentation to extract the reference time curve.

Doctor reported outcomes: Real-world data from a tertiary eye cancer center

Purpose

To provide real-world data on the world-wide-web for patient and doctor awareness.

Methods

From December 2017 to January 2020, consecutive patients with choroidal melanoma (CM), iris ciliary body melanoma (ICM), and ocular surface squamous carcinoma (OSSC) had specific outcomes recorded at each return visit. Each result was anonymized, entered in an online portal, and sent to a unique software program where it was used to create real-world data of number of patients, mean vision, local tumor control, eye salvage, systemic metastases, and length of follow-up for our eye cancer center.

Results

A HIPAA compliant, internet-based software program was developed and linked to public access web page to collect and analyze near-real-time data pertaining to the treatment, vision, life, and follow-up time of patients. During this period, CM radiation plaque tumor control was 99.7%, median vision 20/25 (mean 20/50) and eye salvage 95.8%. ICM tumor control was 99.1% and the median vision 20/20 (mean 20/20). OSSC tumor control was 100% and the most common vision was 20/20 (mean 20/25). Rates of primary enucleation as treatment were 4.2% for CM, 2.8% for ICM, and 0% for OSSC. All patient results were updated by the ophthalmic oncology fellow at each patient visit as to reflect near-real-time outcomes at our center.

Conclusion

Prospective data collection of returning patients was found to be a simple method to reflect patient care outcomes. This method of reporting doctor outcomes offers a measure of transparency for patients and an opportunity to compare results with other clinical practices.

Melatonin inhibits vascular endothelial cell pyroptosis by improving mitochondrial function via up-regulation and demethylation of UQCRC1

Atherosclerosis (AS) is a chronic inflammatory disease that involves cell death and endothelial dysfunction. Melatonin is an endocrine hormone with anti-inflammatory and anti-AS effects. However, the underlying molecular mechanisms for the anti-AS effects of melatonin are unknown. A previous study has shown that pyroptosis plays a detrimental role in the development of AS, therefore, this study was designed to investigate the anti-pyroptotic effects and potential mechanisms of melatonin in atherosclerotic endothelium. Our results show that melatonin attenuated the expression of genes related to pyroptosis, including NLRP3, caspase-1, and IL-1β, in human umbilical vein endothelial cells treated with oxidized low-density lipoprotein. Furthermore, melatonin up-regulated the expression of ten-eleven translocation 2 (TET2), inhibited the methylation of ubiquinol-cytochrome c reductase core protein 1 (UQCRC1), and reduced pyroptosis. The up-regulation of UQCRC1 by melatonin improved mitochondrial function, thereby inhibiting oxidative stress and endothelial cell pyroptosis. Collectively, our results indicate that melatonin prevents endothelial cell pyroptosis by up-regulating TET2 to inhibit the methylation of UQCRC1 and improving mitochondrial function.

Notch1-Nrf2 signaling crosstalk provides myocardial protection by reducing ROS formation

Both the Notch1 and Keap1-Nrf2 signaling pathways have cardioprotective effects, but the role of Notch1-Nrf2 crosstalk in myocardial ischemia-reperfusion injury is unclear. In this study, we established hypoxia-reoxygenation in neonate rat myocardial cells and employed γ-secretase inhibitor and curcumin to inhibit and activate the Notch1 and Keap1-Nrf2 signaling pathways, respectively. We found that the combined action of the Notch1 and Keap1-Nrf2 signaling pathways significantly increased cardiomyocyte viability, inhibited cardiomyocyte apoptosis, reduced the formation of reactive oxygen species, and increased antioxidant activities. In conclusion, these findings suggest that Notch1-Nrf2 crosstalk exerts myocardial protection by reducing the formation of reactive oxygen species.

A comparison of differential reinforcement procedures for treating automatically reinforced behavior

Children diagnosed with autism spectrum disorder (ASD) often exhibit stereotypy, which can be socially stigmatizing, interfere with daily living skills, and affect skill acquisition. We compared differential reinforcement of alternative behavior (DRA) and differential reinforcement of other behavior (DRO) when neither procedure included response blocking or interruption for (a) reducing stereotypy, (b) increasing task engagement, and (c) increasing task completion. DRA contingencies yielded superior outcomes across each measure when evaluated with 3 individuals with autism spectrum disorder.

The Use of Differential Reinforcement of Other Behaviours to Establish Inhibitory Stimulus Control for the Management of Vocal Stereotypy in Children with Autism

OBJECTIVE

This study examined the efficacy of an inhibitory stimulus control procedure (ISCP) for the management of vocal stereotypy in three children with autism.

METHOD

During discrimination training, implemented within a changing criterion design, participants were taught that there were no consequences for vocal stereotypy in the absence of an inhibitory stimulus but that differential reinforcement procedures were in effect in the presence of the stimulus. Functional control of the inhibitory stimulus was subsequently assessed within a reversal design.

RESULTS

Inhibitory stimulus control was established during discrimination training, with participants inhibiting vocal stereotypy for 30 min periods in the presence of the inhibitory stimulus. Reductions in vocal stereotypy were maintained in the presence of the inhibitory stimulus and in the absence of further programmed consequences.

DISCUSSION

This study extends current knowledge by demonstrating the efficacy of ISCPs paired with reinforcement only, and illustrating the functional control of the inhibitory stimulus.

Small hepatitis delta antigen selectively binds to target mRNA in hepatic cells: a potential mechanism by which hepatitis D virus downregulates glutathione S-transferase P1 and induces liver injury and hepatocarcinogenesis

Liver coinfection by hepatitis B virus (HBV) and hepatitis D virus (HDV) can result in a severe form of hepatocellular carcinoma with poor prognosis. Coinfection with HDV and HBV causes more deleterious effects than infection with HBV alone. Clinical research has shown that glutathione S-transferase P1 (GSTP1), a tumor suppressor gene, is typically downregulated in liver samples from hepatitis-infected patients. In the present study, our data indicated that small HDV antigen (s-HDAg) could specifically bind to GSTP1 mRNA and significantly downregulate GSTP1 protein expression. For the human fetal hepatocyte cell line L-02, cells transfected with s-HDAg, along with decreased GSTP1 expression, there was a significant accumulation of reactive oxygen species (ROS) and increased apoptotic ratios. Restoring GSTP1 expression through silencing s-HDAg via RNAi or overexpressing exogenous GSTP1 could largely recover the abnormal cell status. Our results revealed a novel potential mechanism of HDV-induced liver injury and hepatocarcinogenesis: s-HDAg can inhibit GSTP1 expression by directly binding to GSTP1 mRNA, which leads to accumulation of cellular ROS, resulting in high cellular apoptotic ratios and increased selective pressure for malignant transformation. To our knowledge, this is the first study to examine s-HDAg-specific pathogenic mechanisms through potential protein-RNA interactions.

MMS19 localizes to mitochondria and protects the mitochondrial genome from oxidative damage

MMS19 localizes to the cytoplasmic and nuclear compartments involved in transcription and nucleotide excision repair (NER). However, whether MMS19 localizes to mitochondria, where it plays a role in maintaining mitochondrial genome stability, remains unknown. In this study, we provide the first evidence that MMS19 is localized in the inner membrane of mitochondria and participates in mtDNA oxidative damage repair. MMS19 knockdown led to mitochondrial dysfunctions including decreased mtDNA copy number, diminished mtDNA repair capacity, and elevated levels of mtDNA common deletion after oxidative stress. Immunoprecipitation - mass spectrometry analysis identified that MMS19 interacts with ANT2, a protein associated with mitochondrial ATP metabolism. ANT2 knockdown also resulted in a decreased mtDNA repair capacity after oxidative damage. Our findings suggest that MMS19 plays an essential role in maintaining mitochondrial genome stability.

Characterization and fingerprinting of soil and groundwater contamination sources around a fuel distribution station in Galicia (NW Spain)

Soil and groundwater contamination around a fuel distribution station in Tomiño (NW Spain) was evaluated. For this purpose, top and subsoil (up to 6.4 m) and groundwater were sampled around the station, approximately in a 60-m radius. Samples were analysed by HS-SPME-GC-MS to identify and quantify volatile fuel organic compounds (VFOC) (MTBE, ETBE and BTEX) and diesel range organics (DRO). Analysis and fingerprinting data suggested that the contamination of soil and groundwater was provoked by a fuel leak from underground storage tanks. This was reflected by hydrocarbon indices and principal component analysis, which discriminated a direct source of contamination of the subsoil samples around the station. The contaminants probably migrated from tank nearby soils to surrounding soils and leached to groundwater, following a SW direction. Irrigation with contaminated groundwater provoked a severe contamination of topsoils, which were enriched with the lightest components of gasoline and diesel. Fingerprinting also revealed the continuity of the leak, reflected by the presence of volatiles in some samples, which principally appeared in fresh leaks. MTBE was detected in a very high concentration in groundwater samples (up to 690 μg L(-1)), but it was not detected in fresh gasoline. This also evidenced an old source of contamination, probably starting in the mid-1990s, when the use of MTBE in gasoline was regulated.

An analysis of contingency statements in a DRO procedure: A case report

OBJECTIVE

To examine latency to criterion for reduction of challenging behaviour with and without stating a contingency statement immediately prior to a DRO procedure.

METHOD

An ABAC design in which A was baseline, B was used to evaluate the efficacy of a DRO procedure, and C was used to evaluate the efficacy of a DRO procedure with a contingency statement.

RESULTS

The DRO with the contingency statement intervention was associated with a shorter latency to behaviour change than the DRO procedure without the contingency statement.

DISCUSSION

These preliminary findings from this case study highlight the importance of examining the efficiency of behaviour change procedures. Directions for future research are provided.