Pharmacotherapy for Tourette Syndrome.

Tourette syndrome (TS) is associated with dysregulated cortico-striatal-thalamo-cortical neural circuitry, of which the primary implicated neurotransmitters include dopamine, glutamate, and gamma-aminobutyric acid. Pharmacologic intervention for tics should be considered when tics are causing psychological, functional, or physical impairment, and behavioral treatment is either inaccessible or ineffective. Only 3 medications have Food and Drug Administration approval for TS, including 2 typical antipsychotics (pimozide and haloperidol) and 1 atypical antipsychotic (aripiprazole).

Evidence-Based Behavior Therapy for Tourette Syndrome.

This article provides an overview of evidence-based behavior therapy for Tourette syndrome (TS) in children, adolescents, and adults. First, this article describes evidence-based behavioral therapies for TS, examines their efficacy in randomized controlled trials, and identifies extant limitations. Second, based on the identified limitations, this article presents future directions for further research on behavioral therapies for TS.

Evidence-Based Assessment of Tourette Syndrome.

Tourette syndrome and persistent tic disorders (collectively, TS) are impairing childhood-onset neuropsychiatric conditions. Utilizing evidence-based assessments (EBA) is standard for effective and accurate screening, diagnosis, and monitoring of TS. EBAs consist of brief screening instruments, structured/semi-structured clinician-administered interviews, self-report, and parent-report and child-report.

Functional Neuroanatomy of Tics: A Brain Network Perspective.

Tourette syndrome is defined by motor and vocal tics, yet our understanding of the pathophysiology of tics remains limited. Functional MRI (fMRI) can localize brain function related to the clinical phenomenology of tics. Here, we review extant fMRI studies examining brain activity during the premonitory urge, tic release, and tic suppression.

The Role of CBGTC Synaptic Neurotransmission in the Pathophysiology of Tics.

The pathophysiology of tic disorders involves an alteration in the transmission of messages through the cortico-basal ganglia-thalamo-cortical circuit. A major requirement for the passage of a message through this circuit is an intact chemically mediated synaptic neurotransmitter system (ie, neurotransmitters and second messengers). This article reviews the scientific evidence supporting the involvement of a variety of neurotransmitters (ie, dopamine, glutamate, gamma-aminobutyric acid, serotonin, acetylcholine, and the opioid system).

Systematic Literature Review on Public Health Impacts of Persistent Tic Disorders: Health Care Needs and Health Care Use.

This study describes our systematic literature review documenting outcomes associated with persistent tic disorders (PTDs) and summarizes 15 articles comparing health care use between individuals with PTDs and a comparison group without PTDs. Only 2 studies included adults and only one study stratified findings by sociodemographic characteristics, precluding conclusions on health care disparities. Most children with PTDs had access to routine care, similar to children without PTDs, but needed and used more specialty health care, including mental health services, compared to children without PTDs.

Repetitive but Not Interchangeable: Similarities and Differences in the Repetitive Behaviors of Tourette Syndrome, Obsessive-Compulsive Disorder, Tourettic Obsessive-Compulsive Disorder, and Autism Spectrum Disorder.

Repetitive behaviors are the hallmark of many neuropsychiatric disorders, including Tourette syndrome (TS), obsessive-compulsive disorder (OCD), and autism spectrum disorder (ASD). Tics, compulsions, and stereotypies may appear similar and can be difficult to disentangle. This review addresses similarities and differences between these behaviors including clinical presentations, neuroimaging, genetics, and treatment paradigms in order to clarify the relationship between these disorders.

When It's Not Tics: Functional Tic-Like Behaviors.

Functional tic-like behaviors (FTLBs) are a manifestation of functional neurologic disorder that can be mistaken for neurodevelopmental tic disorders like Tourette syndrome. Much information was gained about FTLBs because of an outbreak of FTLBs spreading among adolescents and young adults via social media during the coronavirus disease 2019 pandemic. In comparison to neurodevelopmental tic disorders, FTLBs have an older age of onset, more abrupt symptom onset, and more complex tics as well as other features that would be atypical of Tourette syndrome.

The Pathophysiology of Tics: An Anatomic Review.

The underlying pathophysiology of tics in Tourette syndrome is a topic of major scientific interest. To date, there is an absence of consensus among researchers regarding the precise anatomic location responsible for tics. The goal of this article is to review the current understanding of these brain circuits and data supporting specific anatomic regions.

Mindfulness-Based Interventions for Tourette Syndrome: Current Status and Future Directions.

Mindfulness-based interventions have demonstrated efficacy for a wide range of clinical concerns and populations. Mindfulness-based Intervention for Tics (MBIT) is a recently developed brief, online group intervention for adults with tics. Preliminary evidence suggests that MBIT is feasible, acceptable, and safe.

Genetics of Tourette Syndrome.

This review explores the genetic basis of Tourette syndrome (TS), a complex neuropsychiatric disorder characterized by motor and vocal tics. Family, twin, and molecular genetic studies provide strong evidence for a genetic component in TS, with heritability estimates ranging from 50% to 80%. The genetic architecture of TS is complex, involving both common variants with small effects and rare variants with larger effects.

Perylene diimide based fluorescent sensors for aqueous detection of perfluorooctane sulfonate (PFOS).

Background: Perfluorooctane sulfonate (PFOS), one of the most harmful members of the large group of per- and poly-fluoroalkyl substances (PFAS), is notorious for its environmental persistence, bioaccumulation, and toxic effects, raising serious environmental and health concerns. Developing rapid and sensitive methods to detect PFOS in water is critical for effective monitoring and protection against this hazardous chemical.

Results: In this study, we developed rapid and highly sensitive fluorometric sensors (PDI-2+ , PDI-6+ ) for detecting PFOS.

Severe left-to-right shunting from combined traumatic tricuspid valve rupture and atrial septal defect: bridge to surgical repair using veno-venous ECMO.

Our patient presented to the emergency room following a motor vehicle accident. The traumatic tricuspid valve rupture was diagnosed by transthoracic echocardiogram, and his respiratory status declined rapidly. He was placed on veno-venous extracorporeal membrane oxygenation (VV ECMO) to bridge him to surgical repair.

Minimal methimazole exposure-induced fatal pancytopenia.

This case highlights that refractory pancytopenia leading to death can occur with methimazole treatment even at a very low cumulative dose and after a very short duration of exposure. In addition, the standard treatments to correct the pancytopenia may not be effective and a bone marrow transplant may be required. Current American Thyroid Association guidelines do not recommend routine monitoring of the complete blood count in patients receiving thionamides because of the rapidity of the onset of agranulocytosis and the lack of positive evidence that such monitoring would be useful.

Frozen versus fresh embryo transfer in women with low prognosis for in vitro fertilisation treatment: pragmatic, multicentre, randomised controlled trial.

Objective: To test the hypothesis that a freeze-all strategy would increase the chance of live birth compared with fresh embryo transfer in women with low prognosis for in vitro fertilisation (IVF) treatment.

Design: Pragmatic, multicentre, randomised controlled trial.

Setting: Nine academic fertility centres in China.

Rehabilitation using virtual gaming for Hospital and hOMe-Based training for the Upper limb in acute and subacute Stroke (RHOMBUS II): results of a feasibility randomised controlled trial.

Objective: To investigate the safety, feasibility and acceptability of the Neurofenix platform for upper-limb rehabilitation in acute and subacute stroke.

Design: A feasibility randomised controlled trial with a parallel process evaluation.

Setting: Acute Stroke Unit and participants' homes (London, UK).

Development and validation of a novel risk-predicted model for early sepsis-associated acute kidney injury in critically ill patients: a retrospective cohort study.

Objectives: This study aimed to develop a prediction model for the detection of early sepsis-associated acute kidney injury (SA-AKI), which is defined as AKI diagnosed within 48 hours of a sepsis diagnosis.

Design: A retrospective study design was employed. It is not linked to a clinical trial.

study protocol for a pilot trial of a novel parenting and mental health prevention intervention for migrant mothers with young children at the Mexico-US border.

Introduction: Migrant women in transit face high risk of developing mental health problems such as depression and anxiety, driven by gendered social-structural factors including violence, social isolation, migration uncertainty, limited access to services and gender inequities. Although migrant women who endure such conditions have high need for mental health prevention, few evidence-based interventions are tailored to this population. Moreover, while women and children's mental health are interconnected, few mental health interventions address parenting needs.

Effectiveness of using implementation frameworks to facilitate the implementation of a stroke management guideline in the traditional Chinese medicine hospitals in China: protocol for a factorial randomised controlled trial.

Introduction: Traditional Chinese medicine (TCM) is commonly used alongside Western medicine for stroke management in China. However, there is significant variation in TCM practice, and the utilisation of evidence-based clinical practice guidelines is inadequate. This study aims to evaluate the effectiveness of three popular frameworks-Consolidated Framework for Implementation Research (CFIR), Theoretical Domains Framework (TDF) and Normalization Process Theory (NPT)-in improving implementation outcomes for the integrated TCM and Western medicine clinical practice guideline for stroke management.

Analytical approaches to evaluate risk factors of multimorbidity: a systematic scoping review protocol.

Introduction: Understanding causal risk factors that contribute to the development of multimorbidity is essential for designing and targeting effective preventive strategies. Despite a large body of research in this field, there has been little critical discussion about the appropriateness of the various analytical approaches used. This proposed scoping review aims to summarise and appraise the analytical approaches used in the published literature that evaluated risk factors of multimorbidity and to provide guidance for researchers conducting analyses in this field.

Understanding the impact of racism on surgical outcomes in settler nation-states USA and Canada: a protocol for a systematic review and meta-analysis.

Introduction: To improve surgical quality and safety, health systems must prioritise equitable care for surgical patients. Racialised patients experience worse postoperative outcomes when compared with non-racialised surgical patients in settler colonial nation-states. Identifying preventable adverse outcomes for equity-deserving patient populations is an important starting point to begin to address these gaps in care.

Efficacy of the Foodbot Factory digital curriculum-based nutrition education intervention in improving children's nutrition knowledge, attitudes and behaviours in elementary school classrooms: protocol for a cluster randomised controlled trial.

Introduction: Schools are an important setting for supporting children's development of food literacy, but minimal research has assessed which strategies are most suitable for school nutrition education. The Foodbot Factory intervention, consisting of serious game (ie, a digital game designed for education) and curriculum-based lesson plans, was developed to support teachers and children ages 8-12 with nutrition education. Pilot data have demonstrated that Foodbot Factory can significantly improve children's nutrition knowledge, but it has not yet been evaluated in classrooms.

Barriers and facilitators to global access to life-saving skills training: an international cross-sectional survey.

Introduction: Emergency care begins in the community, who are often the first on the scene. Where emergency care systems are nascent or absent, bystanders represent the only prehospital emergency care that victims might receive. It is important to equip bystanders through life-saving skills training (LST).