Body-focused repetitive behaviour disorders (BFRBDs), including trichotillomania (TTM) and skin-picking disorder (SPD), typically emerge during adolescence. These disorders have been conceptualized within emotion regulation models, in which body-focused repetitive behaviours (BFRBs) may function as attempts to regulate aversive emotional states. Although anxiety frequently co-occurs with BFRBDs, its association with BFRB severity is generally modest, highlighting the need to examine affective and regulatory processes. This cross-sectional study examined the associations among social anxiety, shame-proneness, emotion regulation difficulties and BFRB severity using a serial mediation model. Participants were 107 adolescents aged 12-18 years (80.4% female) who met DSM-5 criteria for TTM or SPD and were recruited from a tertiary child and adolescent psychiatry clinic. Diagnoses were established using semi-structured clinical interviews. The analysis controlled for age and sex. Social anxiety was positively correlated with shame, emotion regulation difficulties and BFRB severity (r = 0.28-0.31, all p < 0.01). In the serial model, social anxiety was associated with greater shame, which was associated with greater emotion regulation difficulties; in turn, emotion regulation difficulties were associated with greater BFRB severity. The total indirect effect (B = 0.162, 95% CI [0.038, 0.337]) and the serial indirect effect through both mediators (B = 0.117, 95% CI [0.040, 0.257]) were significant, whereas neither single-mediator indirect effect was significant. The direct association remained significant (B = 0.302, p = 0.022), consistent with partial statistical mediation. These findings support the proposed theory-based model but do not establish temporal or causal ordering.

To compare the skeletal, dentoalveolar, soft-tissue, and treatment-burden effects of skeletal anterior traction (SAT) versus fixed anterior traction (FAT) in growing patients with skeletal Class III malocclusion. PubMed/MEDLINE, Embase, Scopus, Web of Science, and CENTRAL were searched from inception through 15 May 2021, with citation tracking through 30 June 2021. Randomised and non-randomised comparative studies directly evaluating SAT versus FAT in growing Class III patients were eligible. Two reviewers independently screened records, extracted data, and assessed risk of bias with RoB 2 or ROBINS-I as appropriate; certainty was interpreted with GRADE. Random-effects meta-analysis was used for compatible continuous outcomes. The quantitative dataset comprised six comparative studies. In that dataset, SAT was associated with greater maxillary advancement (MD +1.23, 95% CI 0.88 to 1.57), greater intermaxillary sagittal correction (MD +1.38, 95% CI 1.04 to 1.73), less forward mandibular positional change (MD -0.94, 95% CI -1.38 to -0.49), less clockwise mandibular rotation (MD -1.12, 95% CI -1.79 to -0.45), less maxillary-incisor proclination (MD -3.12, 95% CI -4.05 to -2.18), and improved facial convexity (MD +1.42, 95% CI 0.96 to 1.89). Publication-level reconciliation identified two additional pre-2021 direct comparisons already cited in the manuscript and six direct comparative reports published after the original database-search boundary; these were not retrospectively mixed into the retained pooled estimates without a reproducible re-extraction of the original dataset. The retained pooled dataset suggests that SAT shifts early Class III correction toward a more skeletal and less dentoalveolar pattern, but the exact magnitude of the skeletal advantage is uncertain. RCT-only syntheses published subsequently report only small incremental maxillary effects of skeletal anchorage, while the reduction in maxillary-incisor proclination is more consistent. The pooled estimates in this manuscript should therefore be treated as provisional until a complete multi-database update and re-extraction incorporate all eligible direct comparisons.

Time perception is a fundamental aspect of human cognition, influencing motor coordination, decision-making, and planning. Unlike sensory modalities such as vision or hearing, which rely on dedicated sensory organs, the perception of time lacks a specific neural substrate, making it highly dependent on internal physiological and psychological states. Research suggests that physiological arousal plays a crucial role in temporal distortions, with pacemaker-accumulator models proposing that heightened arousal accelerates the internal clock, leading to an overestimation of time. We provide a systematic review of the available literature on the complex relationship between physiological indices of arousal and time distortion. Overall while a relatively consistent association emerged between baseline cardiac autonomic activity and temporal accuracy. When physiological arousal was experimentally manipulated, its relationship with temporal distortion was substantially less consistent. These differences were observed across pain, stress, emotional, and physical-activity paradigms and appeared to vary according to the characteristics of the eliciting stimulus. This pattern highlights the need to distinguish physiological arousal from the other cognitive processes involved and provides a basis for future research investigating also the other potential explanatory factors in the relationship between arousal and time perception.

BackgroundPelvic binders are used in prehospital settings for early stabilization when pelvic fractures are suspected. Although a rapid and cost-effective tool, uncertainties persist regarding their use prior to radiological confirmation of pelvic fracture.MethodsA review of adult patients with a pelvic fracture requiring trauma team activation who were admitted to a tertiary trauma center between 2020 and 2023 was conducted. The radiological studies were reviewed by four consultant orthopedic surgeons and were classified according to whether the application of a pelvic binder would be mechanically favorable, neutral, or potentially unfavorable. The area under the curve (AUC) was calculated to evaluate the ability of specific physiologic and injury-related variables (hypotension, tachycardia, shock index, Injury Severity Score (ISS), Glasgow Coma Scale, and mechanism of injury) to discriminate pelvic fracture morphologies for which pelvic binder application would be favorable.ResultsA total of 298 patients were included in the current investigation. Of these patients, applying a pelvic binder was favorable in 17% of cases (95% CI: 13%-22%, N = 50), would be mechanically neutral in 28% of cases (95% CI: 23%-33%, N = 82), and was potentially unfavorable in 56% of cases (95% CI: 50%-61%, N = 166) (P < .001). All investigated variables demonstrated limited discriminatory ability for identifying patients for whom pelvic binder application was favorable, with most AUCs <0.60. The highest predictive performance was observed for the ISS [AUC (95% CI): 0.65 (0.58-0.73)].ConclusionIn trauma patients with CT-confirmed pelvic ring injuries, readily available prehospital variables such as hemodynamic instability, associated injury patterns, and mechanism of injury appear to be insufficient for reliably identifying patients with a fracture morphology that could be amenable to pelvic binder application.

The Nuss procedure for Pectus Excavatum repair has relied on metallic bars for the past 3 decades. The technical efforts have focused on the improvement of stability and the reduction of the associated risks. However, some challenges still remain, like metal ion release, thoracic wall mechanic behavior, and the need for implant remotion. In other areas of surgery, polyetheretherketone (PEEK), a polymer that allows 3D printing, has shown mechanical properties closer to human bone and excellent biocompatibility, becoming an alternative material for medical implants. Herein, we present the mechanic evaluation of a novel PEEK Pectus Bar (PPB) that was manufactured via fused deposition modeling with 100% infill density. Mechanical validation included quasi-static bending tests, cyclic loading, and finite element analysis (FEA). Dynamic impact simulations replicated anterior-posterior thoracic loading to assess energy absorption capacity. The PPB demonstrated linear mechanical response with experimental-FEA correlation using an elastic modulus of 1500 MPa. Cyclic tests revealed characteristic viscoelastic behavior with energy dissipation stabilization and no progressive structural damage. Dynamic impact simulation yielded energy absorption of 14.55 J, comparable to human ribs under similar loading conditions. The 3D-printed PPB exhibits mechanical behavior aligned with human rib compliance while maintaining structural integrity under physiological and high-rate loading, supporting clinical investigation as an alternative to metallic implants.

Some, but not all, gapmer antisense oligonucleotides (ASOs) delivered into cerebrospinal fluid exhibit fatal subacute toxicity in late-stage prion-infected mice but not in uninfected mice. Here, we performed a battery of in vivo studies demonstrating that the toxicity is compound- and disease- stage-dependent, and not predicted by behavioral or molecular measurements in uninfected animals. A panel of toxic ASOs all elicited a consistent transcriptomic response signature in prion-infected mice, which emerged over the course of 7 days post dose. This signature, driven chiefly by decreased expression of a specific set of astrocyte-expressed genes, was absent in uninfected mice receiving the same ASOs, was absent, less intense, and/or more transient in infected mice receiving tolerated ASOs, and was distinct from the transcriptomic effect of prion disease itself. Our data argue that the toxicity is an interaction between ASO and prion disease at high doses for specific compounds, and does not represent an exacerbation of ASO toxicity nor of prion disease.

BackgroundChildren and young adults diagnosed with a high-grade/relapsed-refractory cancer face a poor prognosis given limited curative options. Recent research has indicated that this population of children and adolescents/young adults (AYAs), alongside their parents, experience elevated stress and poorer health-related quality of life (HRQoL) relative to normative samples. Despite this, minimal research has examined supportive care interventions for these populations. The primary objective of this pilot study was to assess the feasibility (primary outcome) and acceptability of an 8-week mindfulness-based intervention (MBI) in this population.MethodsEligible participants included individuals aged 5-24 years diagnosed with a high-risk cancer characterized by poor prognosis, with an adult caregiver willing to participate in the parallel caregiver arm. A random number generator was used to assign dyads to the MBI (n = 2 dyads) or psychoeducation control group (n = 3 dyads).ResultsFive dyads (N = 10) enrolled in the study, with 3 dyads completing the intervention. All participants completed measures of feasibility and emotional-behavioral wellbeing at baseline and the study completers responded to follow-up measures after the 8-week intervention. Due to low enrollment, the study was discontinued and results are presented descriptively along with recommendations for future interventions with this population.ConclusionsThis pilot trial of an MBI for children with high-risk cancer and their caregivers demonstrated poor feasibility and highlights challenges in providing supportive care to children with high-risk cancer. The barriers and recommendations are provided to inform future research with this underserved population.

To evaluate the effectiveness of a specialist-led structured preventive educational intervention on diabetic foot outcomes in adults at risk of diabetic foot complications.Study designParallel-group randomized controlled trial with an embedded qualitative component.SettingSpecialised diabetic foot unit within a public healthcare setting.ParticipantsAdults with diabetes classified at any ulceration risk level according to the International Working Group on the Diabetic Foot were randomly assigned to the intervention or control group. Forty-two participants completed the 6-month follow-up.InterventionsThe intervention group received a specialist-led structured preventive educational programme comprising two structured group sessions in addition to standard podiatric care. The control group received standard podiatric care alone.ResultsForty-two participants completed the study. No diabetic foot ulceration occurred during the 6-month follow-up. Participants receiving the educational intervention improved disease-related knowledge, preventive self-care behaviours, and foot skin quality. Qualitative findings indicated greater confidence, emotional support, and engagement in preventive self-care.ConclusionsA specialist-led structured preventive educational intervention improved disease-related knowledge, preventive self-care behaviours, and foot skin quality in adults at risk of diabetic foot complications. These findings support the integration of structured education into routine preventive diabetic foot care.

BackgroundTraditional mirror therapy relies on fixed kinematic symmetry, often neglecting the trade-offs between movement accuracy, stability, and muscular effort. This study developed a Multimodal Adaptive Mirror Therapy system featuring a multi-objective controller for personalized gait rehabilitation.ObjectiveTo develop and evaluate a multimodal adaptive mirror therapy system that integrates gait kinematics, postural stability, and muscular activation into a unified multi-objective optimization framework for personalized gait rehabilitation.MethodsTwenty-six subjects underwent asymmetric gait training with unilateral limb restraint to simulate asymmetric gait patterns. The proposed system integrated camera-based gait data, inertial measurement unit (IMU)-based stability metrics, and electromyography (EMG) activation into a unified objective function. Optimization was dynamically adjusted via a weighted harmonic mean of multimodal scores. Normalized mutual information (NMI) was used to quantify dependencies, while interquartile range (IQR) analysis evaluated controller stability.ResultsNMI analysis revealed significant dependencies between all modalities (p < 0.05), with the training parameter showing the strongest correlation with stability (NMI = 0.342). The multimodal controller achieved balanced, near-optimal performance, yielding median scores of 97.81% for stability and 92.44% for gait. Notably, it exhibited the lowest inter-participant variability among all strategies in the stability domain (IQR: 24.80%), compared to substantially wider dispersions observed under unimodal controllers.ConclusionThis study demonstrated that a multimodal, closed-loop control scheme can effectively resolve performance trade-offs in gait training. By transitioning from rigid imitation to dynamic multi-objective optimization, the system provided a robust, intelligent closed-loop platform, establishing a practical foundation for patient-centered robotic rehabilitation.

The relationship between earlier laying and higher breeding success is well-established in avian species. However, a wide distribution of breeding timings is often maintained within a population, and the causes and consequences of this variation require further exploration, particularly as many avian species advance breeding phenology in response to climate change. Using a 16-year dataset combining colony observations and biologging of Manx shearwaters (Puffinus puffinus), we show that earlier laying does not always result in higher breeding success, with later laying becoming less costly in recent years. We additionally report a slight advancement in breeding timing within breeding pairs, despite finding no temporal trends in spring bloom onset. Nonetheless, birds adjusted lay date in response to interannual variation in phytoplankton bloom timing, and years with stronger Celtic Sea blooms exhibited stronger selection for early breeding. Breeding timing was also influenced by repeatable individual differences in migratory behaviour, with birds undertaking generally earlier, shorter migrations to less southerly destinations laying earlier across years. However, lay date was not determined solely by individual behaviour. In this long-lived species with stable pair bonds, the arrival date of the second-returning bird constrained advancement in laying. This study suggests that variation in breeding timing is maintained through the combined effects of fluctuating selection, persistent individual differences, variation in non-breeding duration and pair-level processes.