Background: When traumatic events and losses intersect in the form of traumatic loss, these events can trigger both posttraumatic stress disorder and pathological grief.Objective: This systematic review investigates which characteristics differentiate between the development of the respective disorders or are associated with comorbidity.Method: A systematic literature search using Medline, PubMed, APA PsycInfo and Web of Science yielded 46 studies which met the inclusion criteria. In these studies, PTSD was assessed using 17 and pathological grief using 16 different validated instruments. In the quality assessment, 12 studies were classified as average, 30 as above average, and 4 as excellent. The investigated risk factors were categorized into 19 superordinate clusters and processed using narrative synthesis.Results: The relationship to the deceased, mental health issues, and religious beliefs seem to be associated specifically with pathological grief symptoms compared to PTSD symptoms. Social support and social emotions emerged as significant correlates and potential risk factors for both PTSD and pathological grief. Included studies had mainly cross-sectional designs.Conclusions: Differentiating factors between pathological grief and PTSD appear to exist. The results should be considered within the limitations of the heterogeneity of the included studies and the research field. There is a lack of studies (1) using a longitudinal study design, (2) starting data collection early following the traumatic loss, (3) using standardized, up-to-date measurement instruments and (4) including comorbidity in their analyses. Further research is urgently needed for more accurate (acute) screenings, prognoses, and interventions following traumatic loss.
When traumatic events and losses intersect in the form of traumatic loss, these events can trigger both posttraumatic stress disorder and pathological grief. This systematic review investigates which characteristics can differentiate between the development of the respective disorders or are associated with comorbidity.The relationship to the deceased, mental health issues, and religious beliefs seem to be specific characteristics for predicting pathological grief. Social support and social emotions were frequently reported as significant correlates of both PTSD and pathological grief.The studies to date have been very heterogeneous and mainly cross-sectional. Further research considering both disorders after traumatic loss in longitudinal study designs is urgently indicated for better (acute) screenings, prognoses, and interventions.

Bereavement is a commonly experienced grief event; however, bereavement can also trigger a number of psychological consequences, such as prolonged grief disorder (PGD). At present, the differences in prolonged grief disorder symptoms (PGD symptoms) among various individuals and how those symptoms relate to cognitive variables are unclear. In the present study, 817 Chinese college students with bereavement experience were selected as participants. Based on the evaluation results of their irrational beliefs, bereavement-related irrational beliefs, basic world assumptions, and PGD symptoms, an individual-centered latent profile analysis was used to divide a group with PGD symptoms into several subgroups and comprehensively examine the relationships between these subgroups and cognitive variables. (1) The severity of PGD symptoms among Chinese college students can be categorized into three subgroups: mild, moderate, and severe. (2) Cognitive variables such as irrational beliefs and basic world assumptions were all found to correlate with the severity of PGD symptoms; bereavement-related irrational beliefs was the variable with the largest correlation. However, for the first time, this study found that different dimensions of basic world assumptions had different directions of correlation, based on the severity of the PGD symptoms. Justice, control, randomness, and self-control had significantly positive correlations. Conversely, benevolence of the world, benevolence of people, and worthiness of the self had significantly negative correlations. These results have important reference value for cognitive behavioral therapy (CBT) treatment and interventions for PGD issues in Chinese college students.

Primary graft dysfunction (PGD) is a common complication after lung transplantation. A plethora of contributing factors are known and assessment of donor lung function prior to organ retrieval is mandatory for determination of lung quality. Specialized centers increasingly perform ex vivo lung perfusion (EVLP) to further assess lung functionality and improve and extend lung preservation with the aim to increase lung utilization. EVLP can be performed following different protocols. The impact of the individual EVLP parameters on PGD development, organ function and postoperative outcome remains to be fully investigated. The variables relate to the engineering and function of the respective perfusion devices, such as the type of pump used, functional, like ventilation modes or physiological (e.g. perfusion solutions). This review reflects on the individual technical and fluid components relevant to EVLP and their respective impact on inflammatory response and outcome. We discuss key components of EVLP protocols and options for further improvement of EVLP in regard to PGD. This review offers an overview of available options for centers establishing an EVLP program and for researchers looking for ways to adapt existing protocols.

Advanced heart failure (AdvHF) can only be treated definitively by heart transplantation (HTx), yet problems such right ventricle dysfunction (RVD), rejection, cardiac allograft vasculopathy (CAV), and primary graft dysfunction (PGD) are linked to a poor prognosis. As a result, numerous biomarkers have been investigated in an effort to identify and prevent certain diseases sooner. We looked at both established biomarkers, such as NT-proBNP, hs-troponins, and pro-inflammatory cytokines, and newer ones, such as extracellular vesicles (EVs), donor specific antibodies (DSA), gene expression profile (GEP), donor-derived cell free DNA (dd-cfDNA), microRNA (miRNA), and soluble suppression of tumorigenicity 2 (sST2). These biomarkers are typically linked to complications from HTX. We also highlight the relationships between each biomarker and one or more problems, as well as their applicability in routine clinical practice.

Shidu parents refer to the couple who have lost their only child and have not given birth or adopted another child in China. The number of Shidu parents is increasing annually. The aim of this research was to examine the mediating role of anxiety and the moderating role of social support between perceived stress and prolonged grief disorder (PGD) among Chinese Shidu parents.
A cross-sectional study was carried out with 505 participants who completed a questionnaire including the Prolonged Grief Questionnair-3 (PG-13), the Perceived Stress Scale-10 (PSS-10), the Self-Rating Anxiety Scale (SAS) and the Duke-UNC Functional Social Support Questionnaire (FSSQ). SPSS PROCESS macro was employed to examine the mediating role of anxiety and the moderating role of social support.
The mediation analysis showed anxiety partially mediated the link between perceived stress and PGD, and the proportion of mediation of anxiety was 39.22%. The moderated mediation analysis revealed the second stage of mediating effects of anxiety on the link between perceived stress and PGD was moderated by social support. Specifically, compared with Shidu parents with higher social support, the association between anxiety and PGD was closer for those with lower social support.
The moderated mediation model can broaden our understanding of how and when perceived stress, anxiety and social support work together to affect PGD. The interventions aimed at improving mental health of Chinese Shidu parents need to work on reducing stress and enhancing social support.

The pentose phosphate pathway (PPP) is an important mechanism by which tumour cells resist stressful environments and maintain malignant proliferation. However, the mechanism by which the PPP regulates these processes in colorectal cancer (CRC) remains elusive.
Closely related PPP genes were obtained from the TCGA and GEO databases. The effect of ATP13A2 on CRC cell proliferation was evaluated by performing in vitro assays. The connection between the PPP and ATP13A2 was explored by assessing proliferation and antioxidative stress. The molecular mechanism by which ATP13A2 regulates the PPP was investigated using chromatin immunoprecipitation and dual luciferase experiments. The clinical therapeutic potential of ATP13A2 was explored using patient-derived xenograft (PDX), patient-derived organoid (PDO) and AOM/DSS models.
We identified ATP13A2 as a novel PPP-related gene. ATP13A2 deficiency inhibited CRC growth and PPP activity, as manifested by a decrease in the levels of PPP products and an increase in reactive oxygen species levels, whereas ATP13A2 overexpression induced the opposite effect. Mechanistically, ATP13A2 regulated the PPP mainly by affecting phosphogluconate dehydrogenase (PGD) mRNA expression. Subsequent studies showed that ATP13A2 overexpression promoted TFEB nuclear localization by inhibiting the phosphorylation of TFEB, thereby enhancing the transcription of PGD and ultimately affecting the activity of the PPP. Finally, ATP13A2 knockdown inhibited CRC growth in PDO and PDX models. ATP13A2- /- mice had a lower CRC growth capacity than ATP13A2+/+ in the AOM/DSS model.Our findings revealed that ATP13A2 overexpression-driven dephosphorylation of TFEB promotes PPP activation by increasing PGD transcription, suggesting that ATP13A2 may serve as a potential target for CRC therapy.

Adversarial training, especially projected gradient descent (PGD), has proven to be a successful approach for improving robustness against adversarial attacks. After adversarial training, gradients of models with respect to their inputs have a preferential direction. However, the direction of alignment is not mathematically well established, making it difficult to evaluate quantitatively. We propose a novel definition of this direction as the direction of the vector pointing toward the closest point of the support of the closest inaccurate class in decision space. To evaluate the alignment with this direction after adversarial training, we apply a metric that uses generative adversarial networks to produce the smallest residual needed to change the class present in the image. We show that PGD-trained models have a higher alignment than the baseline according to our definition, that our metric presents higher alignment values than a competing metric formulation, and that enforcing this alignment increases the robustness of models.

Retinoblatoma is now the pediatric cancer with the highest cure rate. More than any other ocular malignancy the approach to this cancer has changed dramatically in the past 10 years. Most of the things taught to the majority of all Ophthalmology residents is out of date. Because few Ophthalmologists deal with retinoblastoma they are not aware of these seismic changes so this summary of my Curtin lectures outlines some of the major changes all Ophthalmologists should be familiar with.

Covid-19 has posed a serious threat to the existence of the human race. Early detection of the virus is vital to effectively containing the virus and treating the patients. Profound testing methods such as the Real-time reverse transcription-polymerase chain reaction (RT-PCR) test and the Rapid Antigen Test (RAT) are being used for detection, but they have their limitations. The need for early detection has led researchers to explore other testing techniques. Deep Neural Network (DNN) models have shown high potential in medical image classification and various models have been built by researchers which exhibit high accuracy for the task of Covid-19 detection using chest X-ray images. However, it is proven that DNNs are inherently susceptible to adversarial inputs, which can compromise the results of the models. In this paper, the adversarial robustness of such Covid-19 classifiers is evaluated by performing common adversarial attacks, which include the Fast Gradient Sign Method (FGSM) and Projected Gradient Descent (PGD). Using these attacks, it is found that the accuracy of the models for Covid-19 samples decreases drastically. In the medical domain, adversarial training is the most widely explored technique to defend against adversarial attacks. However, using this technique requires replacing the original model and retraining it by including adversarial samples. Another defensive technique, High-Level Representation Guided Denoiser (HGD), overcomes this limitation by employing an adversarial filter which is also transferable across models. Moreover, the HGD architecture, being suitable for high-resolution images, makes it a good candidate for medical image applications. In this paper, the HGD architecture has been evaluated as a potential defensive technique for the task of medical image analysis. Experiments carried out show an increased accuracy of up to 82% in the white box setting. However, in the black box setting, the defense completely fails to defend against adversarial samples.

Chinese shidu parents (bereaved parents over the age of 49 who have lost their only child) are potentially at a high risk of prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD) and insomnia.
The current study aimed to estimate three network models in 310 shidu parents who met the ICD-11 criteria for PGD: (1) a PGD network to identify central symptoms; (2) a comorbidity network to explore bridge symptoms between PGD and PTSD; (3) a comorbidity network to examine the associations between PGD and insomnia symptoms.
The R-packages bootnet, qgraph and networktools were used to investigate the structure of network models and centrality indices of symptoms. In addition, robustness and significance analyses for the edge weights and the order of centrality were performed.
Emotional pain and numbness emerged as the most central symptoms in the PGD network. In the PGD-PTSD comorbidity network, the highest bridge strength symptoms were inability to trust others (PGD) and feeling upset (PTSD). Inability to trust others (PGD), avoidance (PGD), and impairment of life quality (insomnia) were possible bridge symptoms connecting PGD and insomnia.
Reducing emotional pain and numbness may be a viable target in PGD interventions for shidu parents. Additionally, findings suggest that future studies could examine the role of inability to trust others and avoidance in PGD comorbidities.
• Emotional pain and numbness were the most influential symptoms in shidu parents with PGD. The role of PGD symptoms of inability to trust others and avoidance in the comorbidities of PGD with PTSD and insomnia might be worthy of further study.
Antecedentes: Los padres chinos shidu (padres en duelo mayores de 49 años que han perdido a su único hijo) tienen un alto riesgo potencial de presentar trastorno de duelo prolongado (TDP), trastorno de estrés postraumático (TEPT) e insomnio. Objetivo: El presente estudio tuvo como objetivo estimar tres modelos de redes en 310 padres shidu que cumplieron con los criterios CIE-11 para TDP: (1) una red TDP para identificar síntomas centrales; (2) una red de comorbilidad para explorar los síntomas puente entre TDP y TEPT; (3) una red de comorbilidad para examinar las asociaciones entre el TDP y síntomas del insomnio. Métodos: Se utilizaron los paquetes R bootnet, qgraph y networktools para investigar la estructura de los modelos de redes y los índices de centralidad de los síntomas. Además, se realizaron análisis de robustez y significancia para los pesos de borde y el orden de centralidad. Resultados: El dolor y el embotamiento emocional surgieron como los síntomas más centrales en la red TDP. En la red de comorbilidad TDP-TEPT, los síntomas fuerza de puente más altos fueron la incapacidad para confiar en los demás (TDP) y sentirse molesto (TEPT). La incapacidad para confiar en los demás (TDP), la evitación (TDP) y el deterioro de la calidad de vida (insomnio) fueron posibles síntomas puente que conectan el TDP y el insomnio. Conclusiones: Reducir el dolor y el embotamiento emocional puede ser un objetivo viable en las intervenciones de TDP para padres shidu. Además, los hallazgos sugieren que los estudios futuros podrían examinar el papel de la incapacidad para confiar en los demás y la evitación en las comorbilidades del TDP.
背景: 失独父母(49岁以上失去独生子女的父母)患有延长哀伤障碍(PGD)、创伤后应激障碍(PTSD)和失眠的风险较高。 目的: 在310名符合PGD诊断标准的失独父母中探讨三个网络模型：(1)确定PGD网络模型的中心症状；(2)探索PGD与PTSD的共病网络模型的桥症状；(3)探索PGD与失眠共病网络模型的桥症状。 方: 法 采用R程序包bootnet、qgraph和networktools估计网络模型的结构和症状的中心性。此外，还对边缘权重和中心性顺序进行了稳健性和显着性分析。 结果: 情感痛苦和麻木是PGD网络中最中心的症状。在PGD-PTSD共病网络中，中心性程度最高的桥症状是难以信任他人(PGD))和情感痛苦(PTSD)。难以信任他人(PGD)、回避(PGD)和生活质量受损(失眠)可能是连接PGD和失眠的桥症状。 结论: 减轻情感痛苦和麻木可能是对失独父母的哀伤干预的一个可行目标。此外，本研究结果提示，未来的研究可以探讨难以信任他人和回避在PGD共病中的作用。.