BACKGROUND: Congenital portosystemic shunt (CPSS) is a vascular malformation in which portal blood drains toward the systemic circulation, leading to pulmonary hypertension.
METHODS: A 10-year-old patient was brought for evaluation because of dyspnea on exertion. Echocardiography revealed a pulmonary hypertension of 75 mmHg, and multi-slice CT angiography revealed the presence of a CPSS. Closure was finally implemented using a muscular ventricular septal defect device. Follow-up of the patient revealed a gradual decline in pulmonary hypertension.
CONCLUSIONS: CPSS is an overlooked cause of reversible pulmonary hypertension (PH). Closure of such lesions and reversal pulmonary hypertension are possible via catheterization. The preferred device type depends largely on the intervening team. Plugs are the first choice for interventional radiologists, while ventricular and atrial septal occluder devices and duct occluders are preferred by pediatric cardiologists.

Vibrio parahaemolyticus, the leading cause of seafood-associated gastroenteritis, has a strong capacity to form biofilms on surfaces, which is strictly regulated by the CpsS-CpsR-CpsQ regulatory cascade. OpaR, a master regulator of quorum sensing, is a global regulator that controls multiple cellular pathways including biofilm formation and virulence. QsvR is an AraC-type regulator that works coordinately with OpaR to control biofilm formation and virulence gene expression of V. parahaemolyticus. QsvR and OpaR activate cpsQ transcription. OpaR also activates cpsR transcription, but lacks the detailed regulatory mechanisms. Furthermore, it is still unknown whether QsvR regulates cpsR transcription, as well as whether QsvR and OpaR regulate cpsS transcription. In this study, the results of quantitative real-time PCR and LacZ fusion assays demonstrated that deletion of qsvR and/or opaR significantly decreased the expression levels of cpsS and cpsR compared to the wild-type strain. However, the results of two-plasmid lacZ reporter and electrophoretic mobility-shift assays showed that both QsvR and OpaR were unable to bind the regulatory DNA regions of cpsS and cpsR. Therefore, transcription of cpsS and cpsR was coordinately and indirectly activated by QsvR and OpaR. This work enriched our knowledge on the regulatory network of biofilm formation in V. parahaemolyticus.

BACKGROUND: Chronic pain after spinal surgery (CPSS), formerly known as failed back surgery syndrome, encompasses a variety of highly incapacitating chronic pain syndromes emerging after spinal surgery. The intractability of CPSS makes objective parameters that could aid classification and treatment essential. In this study, we investigated the use of cerebral diffusion-weighted magnetic resonance imaging.
METHODS: Cerebral 3T diffusion-weighted (DW-) MRI data from adult CPSS patients were assessed and compared with those of healthy controls matched by age and gender. Only imaging data without relevant artefacts or significant pathologies were included. Apparent diffusion coefficient (ADC) maps were calculated from the b0 and b1000 values using nonlinear regression. After skull stripping and affine registration of all imaging data, ADC values for fifteen anatomical regions were calculated and analyzed with independent samples T-tests.
RESULTS: A total of 32 subjects were included (sixteen CPSS patients and sixteen controls). The mean ADC value of the spinothalamic tract was found to be significantly higher in CPSS patients compared with in healthy controls (p = 0.013). The other anatomical regions did not show statistically different ADC values between the two groups.
CONCLUSIONS: Our results suggest that patients suffering from CPSS are subject to microstructural changes, predominantly within the cerebral spinothalamic tract. Additional research could possibly lead to imaging biomarkers derived from ADC values in CPSS patients.

This research examined factors influencing levels of secondary traumatic stress (STS) in non-offending caregivers (NOCs) of children with histories of sexual or physical abuse. These factors included the nature of the abuse, NOCs\' relationships with the initiators of the abuse, children\'s ages and genders, NOCs\' trauma histories, and the elapsed time between children\'s disclosures of abuse and their trauma assessments. As a secondary objective, this research examined the interactions between children\'s self-reports of their own posttraumatic stress disorder (PTSD) symptomatology, NOCs\' estimates of their children\'s PTSD symptomatology, and NOCs\' self-reports of their own STS symptomatology. Participants from a clinical sample (N = 300, children = 150, NOCs = 150; child age M = 9.89, SD = 4.08; NOC age M = 37.87, SD = 9.23) completed structured intake interviews, the PTSD Checklist for the DSM-5 (PCL-5) and the Child PTSD Symptom Scale (CPSS; Child-Report and NOC-Report). Analytic strategies included point-biserial correlation coefficient calculations, linear regression analyses, and Analyses of Covariance (ANCOVAs). NOCs\' levels of STS were impacted by their relationships with the initiators of the abuse and their own trauma histories. NOCs\' self-reported STS symptomatology mirrored their estimates of their children\'s PTSD symptomatology. The discrepancy scores between children\'s self-reports of their PTSD symptomatology and NOCs\' estimates of children\'s PTSD symptomatology were impacted by children\'s ages and genders. Clinical practitioners should note the importance of examining children\'s PTSD symptomatology and NOCs\' STS symptomatology concurrently when making recommendations for trauma-informed evidence-based treatments.

OBJECTIVE: Screening scales are recommended to assist field-based triage of acute stroke patients to designated stroke centers. Cincinnati prehospital stroke scale (CPSS) is a commonly used prehospital stroke screening tool and has been validated to identify large vessel occlusion (LVO). This study addresses the impact of county-based CPSS implementation to triage suspected LVO patients to a comprehensive stroke center (CSC).
METHODS: Dekalb County in Atlanta, Georgia, implemented CPSS-based protocol with score of 3 and last seen normal time < 24 h mandating transfer to the nearest CSC if the added bypass time was <15 min. Frequency of stroke codes, LVO, IV-tPA use, and thrombectomy treatment were compared six months before and after protocol change (November 1, 2020).
RESULTS: During the study period, 907 stroke patients presented to the CSC by EMS, including 289 (32%) with CPSS score 3. There was an increase in monthly ischemic stroke volume (pre-16 ± 2 vs.19 ± 3 p = 0.03), LVO (pre-4.3 ± 1.7 vs. post-7.0 ± 2.4; p = 0.03), EVT (pre-15% vs. post-30%; p = 0.001), without significant increase in stroke mimic volume or delay in mean time from last seen normal to IV-tPA (pre-165 ± 66, post-158 ± 49 min; p = 0.35). CPSS score 3 was associated with increased likelihood of LVO diagnosis (OR 8.5, 95% CI 5.0-14.4; p = 0.001) and decreased the likelihood of stroke mimics (OR 0.66, 95% CI 0.50-0.88; p = 0.004).
CONCLUSIONS: CPSS is a quick, easy to implement, and reliable prehospital severity scale for EMS to triage LVO to CSC without delaying IV-tPA treatment or significantly increasing stroke mimics.

Phenotypically identified Candida parapsilosis is actually a complex of 3 member species named Candida parapsilosis sensu stricto (CPSS), Candida orthopsilosis (CO), and Candida metapsilosis (CM), which can be identified only by molecular methods and automated methods such as MALDI-TOF mass spectrometry (MS). This study was undertaken to evaluate the VITEK MS, which uses the principle of MALDI-TOF MS for the identification of member species of C. parapsilosis complex (CPC).
In this cross-sectional study, 126 presumptively identified and stocked isolates of CPC were included. Definite identification to species level was done by VITEK MS and PCR as the gold standard method. Clinico-demographic characters and risk factors were analyzed. Antifungal susceptibility testing was performed for fluconazole and voriconazole.
Twelve isolates were not identified as CPC either by VITEK MS or PCR and hence were excluded from the analysis. Out of 114 CPC isolates, 89 (78.1%), 18 (15.8%), and 7 (6.1%) isolates were identified as CPSS, CO, and CM, respectively, by VITEK MS. PCR identified 84 (79.2%), 15 (14.2%), and 7 (6.6%) isolates as CPSS, CO, and CM, respectively. However, PCR did not detect 8 isolates of CPSS detected by VITEK MS. VITEK MS showed 95.3% agreement in species identification and showed a kappa coefficient of 0.87, which is almost perfect agreement. Predominant isolations of all 3 species were from blood. Resistance was observed more in CPSS for both the azoles.
MALDI-TOF MS can be used as a rapid, reliable, cost-effective method to identify the species of CPC.

Összefoglaló. Bevezetés: A stroke-betegek ellátásában arra kell törekedni, hogy a tünetek jelentkezését követően minél előbb a szakmai centrumba kerüljön a beteg. Célkitűzés: Kutatásunkban a terápiás időablak tarthatósága céljából vizsgáltuk, hogy mely tényezők bírnak hatással a prehospitális ellátás időtartamaira. Módszer: Keresztmetszeti, kvantitatív kutatásunkhoz az adatgyűjtést két magyarországi város mentőállomásán, orvosi kompetenciával rendelkező (eset-, rohamkocsi) és orvosi kompetenciával nem rendelkező (mentőgépkocsi) mentőegység szintjén végeztük 2017-es adatok feldolgozásával olyan betegek körében, akiknek a mentőegység általi iránydiagnózisa stroke volt (n = 220). Vizsgáltuk, hogy a mentőegységek által elvégzett vizsgálatok, a tapasztalt tünetek, a terápiás időablakon belüliség miként befolyásolta a prehospitális időket. Az adatfeldolgozást SPSS 26.0 statisztikai programmal végeztük. Az elemzéshez leíró statisztikát, χ2-próbát, F-próbát és T-próbát alkalmaztunk. Eredmények: Megállapítottuk, hogy az alkalmazott score-rendszer vizsgálati elemei közül, ha aphasia volt észlelhető a betegnél, úgy szignifikánsan meghosszabbodott a helyszínen töltött idő (p = 0,003). A gyors ABCDE-betegvizsgálat D-lépésében kötelező a betegnél a vércukorszintmérés, ugyanakkor ez mintánk 25,45%-ában elmaradt. A helyszíni műszeres vércukorszintmérés hatással van a prehospitális késés alakulására az orvosi kompetencia nélküli egységek vonatkozásában (p<0,001). Következtetés: A helyszínen töltött idő az emelt szintű mentőegységek esetében hosszabb, mint az alacsonyabb szintű egységeknél. Következtetésként levonhatjuk, hogy a motoros vagy szenzoros aphasia nem befolyásolja a terápiát, pusztán a stroke-diagnózis valószínűségét növelő egyik tünet, így a helyszíni idő emiatti megnyúlása mindenképpen kerülendő, amire javasolt a továbbképzések alkalmával is felhívni az ellátók figyelmét. Az orvosi kompetencia nélküli egységek esetében beavatkozást igényel a műszeres vércukormérés időrabló hatásának csökkentése, hiszen látható, hogy az orvosi kompetenciával rendelkező egységeknél ez a vizsgálat nem jelenik meg mint késést okozó tényező. Orv Hetil. 2022; 163(7): 279-287.

When treating stroke patients, the aim should be to get the patient to a specialist stroke centre as soon as possible.
In our study, in order to be able to stay within the therapeutic window, we investigated which variables affect the time period of prehospital treatment.
For our cross-sectional quantitative study, we gathered data from two ambulance stations in Hungary, comparing the competence of physician and non-physician units. We processed information from 2017 regarding patients whose initial diagnosis was stroke (n = 220). We examined how investigations by the ambulance unit, symptoms experienced and therapeutic time window have affected prehospital times. As for the statistic software, we used SPSS 26.0. The analysis was conducted by performing χ2 test, F-test and T-test.
We identified that if the aphasia component of the used score system was positive, the on-scene time increased significantly (p = 0.003). In the D section of the rapid ABCDE assessment, it is mandatory to measure the blood glucose level of the patient, however, in our sample it was omitted in 25.45% of the cases. We identified that on-site blood glucose measurement has an effect on prehospital delay for non-physician units (p<0.001).
We found that the on-scene time is longer for physician units than for non-physician units. We concluded that motor or sensory aphasia does not affect the therapy, it is just one of the symptoms that can increase the likelihood of stroke diagnosis, therefore prolonging time for assessing aphasia in the field should be avoided. Moreover, it is recommended to make care providers aware of this during training sessions. Improvements are required in non-physician units to reduce the time consumed by blood glucose measurement, as it has been shown that within physician units this test does not appear to be a delay-causing factor. Orv Hetil. 2022; 163(7): 279-287.

BACKGROUND: Congenital portosystemic shunts (CPSS) are rare vascular malformations and can be classified into extrahepatic and intrahepatic shunts. Extrahepatic CPSS, also termed Abernethy malformations are associated with severe long-term complications including portopulmonary hypertension, liver atrophy, hyperammoniemia and hepatic encephalopathy. We report a hitherto undescribed variant of Abernethy malformation requiring an innovative approach for interventional treatment.
METHODS: We describe a 31-year-old patient following surgical repair of atrioventricular septal defect at the age of 6 years. In the long-term follow-up he showed persistent pulmonary hypertension which deteriorated despite dual pulmonary vasodilative treatment. When he developed arterial desaturation and symptomatic hyperammoniemia detailed reassessment revealed as underlying cause a hitherto undescribed variant of Abernethy malformation connecting the portal vein with the right lower pulmonary vein. Following interdisciplinary discussions we opted for an interventional approach. Since the malformation was un-accessible to interventional closure via antegrade venous or retrograde arterial access, a transhepatic percutaneous puncture of the portal vein was performed. Temporary balloon occlusion of the malformation revealed only a slight increase in portal venous pressure. Interventional occlusion of the large vascular connection was achieved via this transhepatic approach by successive implantation of two large vascular occluding devices. The postinterventional course was unremarkable and both ammonia levels and arterial saturation normalized at follow-up of 12 months.
CONCLUSIONS: Portal vein anomalies should be included in the differential diagnoses of pulmonary hypertension or pulmonary arterio-venous malformations. Based on careful assessment of the anatomy and testing of portal vein hemodynamics interventional therapy of complex Abernethy malformations can be performed successfully in specialized centers.

In recent years, there has been a large increase in the number of youth and families emigrating from Central America to the United States to escape extreme violence and crime victimization. As a result, the rate of trauma-exposure and trauma-related distress among this population is alarmingly high and necessitates representation of this population in psychological research, particularly related to trauma symptom measurement. The broad aim of the current study was to examine the psychometric performance of caregiver-reported data on one such instrument intended to measure youth trauma symptoms. Specifically, we sought to document the psychometric performance of the Child PTSD Symptoms Scale (CPSS) with recently immigrated Spanish-Speaking youth and caregivers from Central America by examining the convergent, divergent, and concurrent validity of the caregiver-report form. Overall, the measure showed psychometric promise as it broadly demonstrated adequate concurrent and convergent. Results also suggested that further research is needed to better understand how to reduce the comorbidity that is often depicted in caregiver reports, which can lead to poor discriminant validity. Regardless, current findings suggest the appropriateness of incorporating caregiver reports of youth trauma in Spanish-speaking, recently immigrated youth.

Background and purposes: Stroke severity scales may expedite prehospital large vessel occlusion (LVO) stroke detection, but few are validated for paramedic use. We evaluated the feasibility of introducing the Cincinnati Stroke Triage Assessment Tool (C-STAT) in the field and its capacity to detect LVO stroke.Methods: We performed a prospective paramedic-based study assessing C-STAT in the field on patients currently redirected to two comprehensive stroke centers (CSC), based on a Cincinnati Prehospital Stroke Scale (CPSS) score of 3/3. C-STAT was administered by on-site paramedics with telephone guidance from trained centralized clinical support paramedics.Results: Between October 2018 and November 2019, C-STAT scores were obtained in 188/218 (86.2%) patients, among which 118/188 (62.8%) were positive. Paramedics reported performing the C-STAT in less than 5 minutes on 170/188 (90.4%) patients and noted no difficulties administering the scale in 151/188 (80.3%). A positive C-STAT identified 51/68 (75%) LVO strokes in the cohort, demonstrating a 43% (95% CI: 38%-48%) positive and 76% (95% CI: 66%-83%) negative predictive value for LVO stroke diagnosis. In a cohort of 100 patients with CPSS 3/3, requiring a positive C-STAT for redirection would decrease CSC patient volume by 37 but miss 9 of 36 LVO strokes.Conclusion: Prehospital administration of the C-STAT was feasible, using a model of minimal paramedic training and real-time telephone guidance. A protocol based on both a CPSS 3/3 and a positive C-STAT would decrease CSC redirected patient volume by one-third but would miss one-quarter of LVO strokes when compared to a CPSS-based protocol.