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A drug delivery system with sustainable controlled drug release can improve the quality of life of a patient by reducing the side-effects and better absorption of the drug locally. However, the main disadvantageous of this delivery model is the burst release of the drug, which can result in severe health problem, such as toxicity. Here in this study, a new coaxial microfiber has been developed with encapsulated anti-inflammatory drug, ibuprofen, inside the core structure of the coaxial fibre. The core consisting of polyethylene oxide (PEO) carrying the drug was covered with the polylactic acid (PLA)/PEO and shell to prevent the burst release of the drug and provide sustainable release over a prolonged time. The release profiles showed that the burst release was reduced from 20% in control scaffold, core only, to 5% in core-shell structure after 6 hrs. The higher percentage of PLA in the shell composition provides a slower release of ibuprofen, due to the slower degradation of PLA in comparison with PEO. The result indicates the developed structure can be a potential system for the localized release of the various drug system, which leads to a more sustainable and controlled release of the drug over the more extended period and deliver a better outcome along with side-effect prevention.
This rejoinder proposes how the five trait domain qualifiers of the ICD-11 personality disorder classification may capture personality dynamics, while also being feasible in various clinical settings. It is highlighted that the simple coding of one to five trait qualifiers may serve as a basic step in the process that leads to a clinical management plan; for clinicians with more resources, a second step may involve taking advantage of the 25 detailed DSM-5 AMPD subfacets for a more fine-grained case-formulation and treatment planning. Moreover, the ICD-11 trait domain qualifiers seem to take personality dynamics into account, which is exemplified by how different trait domain combinations may involve different situational and motivational trait domain expressions that demand different treatment implications.
The DSM-5 Alternative Model of Personality Disorders (AMPD) and the ICD-11 Classification of Personality Disorders allow clinicians to describe trait domains that contribute to the unique expression of personality dysfunction. Both diagnostic systems deliniate trait domain features of negative affectivity, detachment, antagonism/dissociality, disinhibition, and anankastia/compulsivity, which may inform clinicians about how to manage treatment. This chapter specifically describes how the DSM-5 and ICD-11 trait domains may be useful for establishing a favorable treatment alliance, doing therapeutic assessment, increasing the patient’s self-knowledge, providing psychoeducation, planning realistic treatment goals, and matching therapy to the patient’s personality. A key message of this chapter is that practitioners should not treat traits per se but the maladaptive expressions of traits.
This study examines the relative importance of local institutions and external finance on small business investment. Utilising the institutional theory, we argue that local institutions and external finance have heterogeneous effects on firm investment. More importantly, they may interact and moderate each other. Analysing a set of 1.3 million observations of small businesses operating in Vietnam (2006–2016) obtained from the Annual Enterprise Survey data from the Vietnam Statistics Office, we find that local institutional settings and external finance are important determinants of firm investment. Moreover, local institutions are able to moderate the effects of external finance on firm investment. As such, this study asserts that conventional models cannot discern whether institutions or external finance are more important to firm investment. Rather, the relative importance of institutions and external finance should be investigated from the perspective of their interaction.
Mechanisms contributing to the development and maintenance of obesity remain to be elucidated especially regarding the interaction between appetite regulating hormones and mesolimbic reward circuits. Leptin was recently suggested to attenuate dopamine release in mesolimbic reward pathways. We now test the functional relevance assessing whether leptin plasma concentration affects the BOLD-response following the presentation of food cues.
21 obese and 23 normal weight subjects were investigated. Visual food cues and neutral stimuli were presented in a block design during fMRI. Blood-samples were collected immediately prior to the scan to assess plasma leptin concentration. Using linear regression analyses, the association between BOLD response to food cues and the body mass index (BMI) as well as plasma leptin concentration was examined.
Food-cues elicited activation of large cortical and subcortical networks, whereas only in obese patients food cues activated the left ventral and right dorsal striatum. Mean plasma concentration of leptin was significantly increased in obese subjects compared to normal weight controls. We found a significant positive correlation between the food cue-induced BOLD signal change in the ventral striatum and leptin plasma concentration. Furthermore, ventral and dorsal striatum BOLD response to food cues was significantly positive associated with the body mass index (BMI).
These findings suggest a physiological role of the satiety factor leptin in modulating responsivity of reward pathways towards food cues. Altered homeostatic feedback regulation of the mesolimbic brain reward circuit might explain the inability of obese patients to adapt their food intake according to physiologically needs.
Compulsive buying behavior (CBB) is receiving increasing consideration in both consumer and psychiatric-epidemiological research, yet empirical evidence on treatment interventions is scarce and mostly from small homogeneous clinical samples.
To estimate the short-term effectiveness of a standardized, individual cognitive behavioral therapy intervention (CBT) in a sample of n = 97 treatment-seeking patients diagnosed with CBB, and to identify the most relevant predictors of therapy outcome.
The intervention consisted of 12 individual CBT weekly sessions, lasting approximately 45 minutes each. Data on patients’ personality traits, psychopathology, sociodemographic factors, and compulsive buying behavior were used in our analysis.
The risk (cumulative incidence) of poor adherence to the CBT program was 27.8%. The presence of relapses during the CBT program was 47.4% and the dropout rate was 46.4%. Significant predictors of poor therapy adherence were being male, high levels of depression and obsessive-compulsive symptoms, low anxiety levels, high persistence, high harm avoidance and low self-transcendence.
Cognitive behavioral models show promise in treating CBB, however future interventions for CBB should be designed via a multidimensional approach in which patients’ sex, comorbid symptom levels and the personality-trait profiles play a central role.
The development and maintenance of an alcohol addiction is a complex interaction between genetic and environmental factors. Genetic effects seem to contribute substantially to the risk of developing an addiction, but also to its course and patients’ responses to different treatments. Recent studies identified associations between polymorphisms in the genes of glutamate and μ-opioid receptors and addiction risk. Those receptors are of special interest, because they are targets of therapeutic agents, such as acamprosate and topiramate.
Objectives and aims
Several studies were conducted, in order to further determine the effects of genetic polymorphisms in glutamate and opioid receptor genes on addictive behavior, neural response to alcohol cues and relapse risk.
Genetic effects were investigated in samples of alcohol-dependent patients using functional imaging techniques, neuropsychological tests and follow-up investigation after standard clinical treatment. Data on clinical parameters, neuronal response to alcohol cues, functional neuronal connectivity and relapse risk were collected and analyzed.
Results demonstrate effects of genetic polymorphisms in glutamate and opioid receptors on neuronal response to alcohol cues in frontal and mesolimbic brain areas, subjective craving and time to first relapse. Current findings will be discussed in the light of existing evidence on the contribution of genetic effects to treatment outcome and patient stratification.
The investigation of genetic risk factors and mechanisms by which they affect addiction related phenotypes seems to be a promising tool to identify molecular treatment targets and predictors for successful treatment strategies.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Borderline Personality Disorder (BPD) is a highly prevalent diagnosis in mental health care and includes a heterogeneous constellation of symptoms. As the field of personality disorder (PD) research moves to emphasize dimensional traits in its operationalization, it is important to determine how the alternative DSM-5 Section III personality trait dimensions differentiates such features in BPD patients versus comparison groups. To date, no study has attempted such validation.
The current study examined the utility of the DSM-5 trait dimensions in differentiating patients with the categorical DSM-IV/5 diagnosis of BPD (n = 101) from systematically matched samples of other PD patients (n = 101) and healthy controls (n = 101). This was investigated using one-way ANOVA and multinomial logistic regression analyses.
Results indicated that Emotional Lability, Risk Taking, and Suspiciousness uniquely differentiated BPD patients from other PD patients, whereas Emotional Lability, Depressivity, and Suspiciousness uniquely differentiated BPD patients from healthy controls.
Emotional Lability is in particular a key BPD feature of the proposed Section III model, whereas Suspiciousness also augments essential BPD features. Provided that these findings are replicated cross-culturally in forthcoming research, a more parsimonious traits operationalization of BPD features is warranted.
The use of medicinal zinc oxide (ZnO) must be phased out by 2022, thus prompting an urgent need for alternative strategies to prevent diarrhoea in weaner piglets. The objectives of this study were to assess the impact on weaner piglet performance, diarrhoea incidence and gut development, when (1) dietary ZnO supplementation was substituted by alternative commercial products based on macroalgae, specific probiotics or synbiotics, or (2) dietary ZnO inclusion was reduced from 2500 to 1500 ppm. A total of 4680 DLY piglets (DanBred, Herlev, Denmark), weaned around 35 days of age, were randomly assigned according to sex and BW to six different dietary treatment groups. A basal diet was supplemented with no ZnO (NC = negative control), 2500 ppm ZnO (PC = positive control), 1500 ppm ZnO (RDZ = reduced dose of ZnO) or commercial macroalgae (OceanFeed™ Swine = OFS), probiotic Miya-Gold or synbiotic GærPlus products. The piglets entered and exited the weaner unit at ~7.0 and 30 kg BW, respectively. In-feed ZnO was provided the first 10 days post-weaning, while the alternative supplements were fed throughout the weaner period. As expected, the average daily feed intake, average daily weight gain (ADG), feed conversion ratio (FCR) and diarrhoea incidence were improved in the PC compared to NC group (P < 0.05) during phase 1 consistent with improved indices of villi development observed in subgroups of piglets sacrificed 11 days post-weaning. Reduction of ZnO to 1500 ppm lowered ADG (P < 0.05) and slightly increased incidence of diarrhoea during the first 10 days after weaning (but not later) without affecting FCR. None of the three alternative dietary additives, including a 10-fold increased dose of GærPlus than recommended, improved piglet performance, gut health and gut development above that of NC piglets. The OFS piglets sacrificed 11 days after weaning had significantly lower weights of hindgut tissue and contents compared to the PC group, consistent with antimicrobial activity of the product, which was detected from anaerobic in vitro fermentation. In conclusion, dietary ZnO supplementation during the first 10 days post-weaning may be reduced from 2500 to 1500 ppm without major negative implications for weaner piglet performance and health in herds under a high management level. However, none of the alternative dietary supplements were able to improve piglet performance or gut health, when ZnO was omitted from the diet.
DSM-5 proposed a new operational system by using the number of fulfilled criteria as an indicator of gambling disorder severity. This method has proven to be controversial among researchers and clinicians alike, due to the lack of studies indicating whether severity, as measured by these criteria, is clinically relevant in terms of treatment outcome. Additionally, numerous studies have highlighted the associations between gambling disorder and impulsivity, though few have examined the impact of impulsivity on long-term treatment outcomes.
In this study, we aimed to assess the predictive value of DSM-5 severity levels on response to cognitive-behavioral therapy (CBT) in a sample of male adults seeking treatment for gambling disorder (n = 398). Furthermore, we explored longitudinal predictors of CBT treatment response at a follow-up, considering UPPS-P impulsivity traits.
Our study failed to identify differences in treatment outcomes between patients categorized by DSM-5 severity levels. Higher baseline scores in negative urgency predicted relapse during CBT treatment, and higher levels of sensation seeking were predictive of drop-out from short-term treatment, as well as of drop-out at 24-months.
These noteworthy findings raise questions regarding the clinical utility of DSM-5 severity categories and lend support to the implementation of dimensional approaches for gambling disorder.
Impulsivity and cognitive distortions are hallmarks of gambling disorder (GD) but it remains unclear how they contribute to clinical phenotypes. This study aimed to (1) compare impulsive traits and gambling-related distortions in strategic versus non-strategic gamblers and online versus offline gamblers; (2) examine the longitudinal association between impulsivity/cognitive distortions and treatment retention and relapse.
Participants seeking treatment for GD (n = 245) were assessed for gambling modality (clinical interview), impulsive traits (Urgency, Premeditation, Perseverance and Sensation Seeking [UPPS] scale) and cognitive distortions (Gambling Related Cognitions Scale) at treatment onset, and for retention and relapse (as indicated by the clinical team) at the end of treatment. Treatment consisted of 12-week standardized cognitive behavioral therapy, conducted in a public specialized clinic within a general public hospital.
Strategic gamblers had higher lack of perseverance and gambling-related expectancies and illusion of control than non-strategic gamblers, and online gamblers had generally higher distortions but similar impulsivity to offline gamblers. Lack of perseverance predicted treatment dropout, whereas negative urgency and distortions of inability to stop gambling and interpretative bias predicted number of relapses during treatment.
Individuals with online and strategic GD phenotypes have heightened gambling related biases associated with premature treatment cessation and relapse. Findings suggest that these GD phenotypes may need tailored treatment approaches to reduce specific distortions and impulsive facets.