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Abstract Background Hyperchloremic metabolic acidosis that develops during the treatment of diabetic ketoacidosis is usually attributed to the chloride content of resuscitation fluids. We explored an alternative explanation, namely that fluid-induced plasma volume expansion alters the absolute differences in the concentrations of sodium and chloride (the Na–Cl gap) enough to affect the acid–base balance. We analyzed data from a prospective single-center cohort study of 14 patients treated for diabetic ketoacidosis. All patients received 1 L of 0.9% saline over 30 min on two consecutive days. Blood gases were sampled before and after the infusions. Results The initial plasma volume was estimated to be 25 ± 13% (mean ± SD) below normal on admission to the intensive care unit. At that time, most patients had an increased actual Na–Cl gap, which counteracts acidosis. However, the correction of the plasma volume deficit revealed that these patients would have had a decreased Na–Cl gap upon admission if they had been normovolemic at that time; the estimated “virtual Na–Cl gap” of 29 ± 5 mmol/L was significantly lower than the uncorrected value, which was 39 ± 5 mmol/L (P

Abstract Background Previous research on the relationship between social media use and well-being in adolescents has yielded inconsistent results. We addressed this issue by examining the association between various digital media activities, including a new and differentiated measure of social media use, and well-being (internalizing symptoms) in adolescent boys and girls. Method The sample was drawn from the four cross-sectional surveys from the Öckerö project (2016–2019) in eight municipalities in southern Sweden, consisting of 3957 adolescents in year 7 of compulsory education, aged 12–13. We measured the following digital media activities: playing games and three different activities of social media use (chatting, online sociability, and self-presentation). Our outcome measure was internalizing symptoms. Hypotheses were tested with linear regression analysis. Results Social media use and playing games were positively associated with internalizing symptoms. The effect of social media use was conditional on gender, indicating that social media use was only associated with internalizing symptoms for girls. Of the social media activities, only chatting and self-presentation (posting information about themselves) were positively associated with internalizing symptoms. Self-presentation was associated with internalizing symptoms only for girls. Conclusion Our study shows the importance of research going beyond studying the time spent on social media to examine how different kinds of social media activities are associated with well-being. Consistent with research in psychology, our results suggest that young girls posting information about themselves (i.e. self-presentation) might be especially vulnerable to display internalizing symptoms.

Abstract Background Several studies have examined the effect of community interventions on youth alcohol consumption, and the results have often been mixed. The aim of this study is to evaluate the effectiveness of a community intervention known as the Öckerö Method on adolescent alcohol consumption and perceived parental attitudes towards adolescent drinking. Method The study is based on a quasi-experimental design, using matched controls. Self-report studies were conducted among adolescents in grades 7–9 of compulsory education in four control and four intervention communities in the south of Sweden in 2016–2018. Baseline measures were collected in autumn 2016 before the intervention was implemented in the intervention communities. Outcomes were the adolescents’ alcohol consumption, past-year drunkenness, past-month drunkenness and perceived parental attitudes towards alcohol. Results Estimating Difference-in-Difference models using Linear Probability Models, we found no empirical evidence that the intervention has any effect on adolescents’ drinking habits, or on their perceptions of their parents’ attitudes towards adolescent drinking. Conclusion This is the first evaluation of this method, and we found no evidence that the intervention had any effect on the level of either young people’s alcohol consumption or their past-year or past-month drunkenness, nor on their parents’ perceived attitudes toward adolescent drinking. A further improvement would be to employ a follow-up period that is longer than the three-year period employed in this study. Trial registration ISRCTN registry: Study ID: 51635778 , 31th March 2021 (Retrospectively registered).

Abstract Background Early treatment of severe hyperglycemia involves large shifts of body fluids that entail a risk of hemodynamic instability. We studied the feasibility of applying a new electrolyte equation that estimates the degree of volume depletion and the distribution of infused 0.9% saline in this setting. Methods The new equation was applied to plasma and urinary concentrations of sodium and chloride measured before and 30 min after a 30-min infusion of 1 L of 0.9% saline on two consecutive days in 14 patients with severe hyperglycemia (mean age 50 years). The extracellular fluid (ECF) volume was also estimated based on the volume dilution kinetics of chloride. Results On day 1, the baseline ECF volume amounted to 11.5 L. The saline infusion expanded the ECF space by 160 mL and the intracellular fluid space by 375 mL. On day 2, the ECF volume was 15.5 L, and twice as much of the infused fluid remained in the ECF space. The chloride dilution kinetics yielded baseline ECF volumes of 11.6 and 15.2 L on day 1 and day 2, respectively. No net uptake of glucose to the cells occurred during the two 1-h measurement periods despite insulin administration in the intervening time period. Conclusions The electrolyte equation was feasible to apply in a group of hyperglycemic patients. The ECF space was 3 L smaller than expected on admission but normal on the second day. Almost half of the infused fluid was distributed intracellularly.

Objectives This study examines the associations between ten family structure types and delinquency, including four groups of symmetrical and asymmetrical living arrangements. We also adjust for attachment to parents and parental monitoring. Methods Data are drawn from four cross-sectional surveys conducted between 2016 and 2019 in southern Sweden. The sample consists of 3,838 adolescents, aged 14–15. Negative binomial models were used to calculate the associations between family structure and delinquency. Results The results show that those living in single-father, single-mother, father-stepmother, mother-stepfather families report significantly more delinquency than adolescents living with both their parents. Adolescents living in “symmetrical” family arrangements, i.e. both parents are single or have a new partner, reported lower levels of delinquency, whereas adolescents living in “asymmetrical” family arrangements, i.e. where either the mother or the father, but not both, have a new partner, reported higher levels of delinquency. Most of the associations between family structure and delinquency decline when adjusted for attachment to parents and parental monitoring. Discussion This study shows that it is important to move on to the use of more detailed categorisations of family structure in relation to delinquency. We need to increase our knowledge about the group of adolescents that moves between parents and especially about the different constellations of asymmetrical and symmetrical living arrangements.

ObjectivesThis study examines the associations between ten family structure types and delinquency, including four groups of symmetrical and asymmetrical living arrangements. We also adjust for attachment to parents and parental monitoring.MethodsData are drawn from four cross-sectional surveys conducted between 2016 and 2019 in southern Sweden. The sample consists of 3,838 adolescents, aged 14-15. Negative binomial models were used to calculate the associations between family structure and delinquency.ResultsThe results show that those living in single-father, single-mother, father-stepmother, mother-stepfather families report significantly more delinquency than adolescents living with both their parents. Adolescents living in "symmetrical" family arrangements, i.e. both parents are single or have a new partner, reported lower levels of delinquency, whereas adolescents living in "asymmetrical" family arrangements, i.e. where either the mother or the father, but not both, have a new partner, reported higher levels of delinquency. Most of the associations between family structure and delinquency decline when adjusted for attachment to parents and parental monitoring.DiscussionThis study shows that it is important to move on to the use of more detailed categorisations of family structure in relation to delinquency. We need to increase our knowledge about the group of adolescents that moves between parents and especially about the different constellations of asymmetrical and symmetrical living arrangements.

Background: Acute lower limb ischemia with a motor deficit (Rutherford IIb) needs urgent revascularization to avoid major amputation and mortality. It is unclear whether immediate revascularization without performing CT angiography (CTA) prior to revascularization in Rutherford IIb acute lower limb ischemia (ALI) is associated with better outcomes.Methods: Retrospective observational study of Rutherford IIb ALI patients treated between 2006 and 2018. A propensity score adjusted analysis was performed to compare outcomes after the performance of CTA examination or not.Results: Among 681 patients, 260 had Rutherford IIb ALI. CTA prior to revascularization was performed in 131 (50.4%) and increased (p < 0.001) throughout the study period. Open vascular and endovascular surgery was first performed in 147 (56.5%) and 113 (43.5%) patients, respectively. The proportion of endovascular treatment increased while the open vascular surgery decreased during the study period (p = 0.031). In the propensity score adjusted analysis, the performance of CTA was associated with decreased risk of combined major amputation /mortality (odds ratio 0.52, 95% confidence interval 0.27–0.99; p = 0.046) at 1 year.Conclusion: Performance of CTA was associated with a higher amputation-free survival in revascularized patients with Rutherford IIb ALI. CTA seem to provide guidance in selecting the most appropriate candidates for revascularization and choice of technique.

Here we have improved an existing mouse model of prostate cancer based on prostate-specific deletion of Pten and Trp53 by incorporating a Cre-activatable luciferase reporter. By coupling the deletion of those genes to the activation of a luciferase reporter, we were able to monitor tumor burden non-invasively over time. We show that, consistent with previous reports, deletion of both Pten and Trp53 on a C57BL/6 background accelerates tumor growth and results in both the loss of androgen receptor expression and castrate resistant tumors as compared with loss of Pten alone. Loss of Trp53 results in the development of sarcomatoid histology and the expression of markers of epithelial-to-mesenchymal transition Zeb1 and vimentin, with kinetics and penetrance dependent on whether one or both alleles of Trp53 were deleted. Homozygous deletion of Trp53 and Pten resulted in uniformly lethal disease by 25 weeks. While we were able to detect locally invasive disease in the peritoneal cavity in aggressive tumors from the double knockout mice, we were unable to detect lymphatic or hematogenous metastatic disease in lymph nodes or at distant sites.

Contextual research on delinquency is primarily based on the idea that residential areas provide a major ecological setting that (indirectly) shapes observed differences in delinquency. Just like neighborhoods, schools differ in terms of their level of structural characteristics such as the concentration of immigrant children and children from disrupted families. Such characteristics may also shape delinquency. The present study aims to test the relationship between structural characteristics of schools and child antisocial behavior, using a sample of elementary school children ( N = 779, aged 10-12 years in the urban context of Ghent, Belgium). This study found that the concentration of children from disrupted families has an independent effect on child delinquency, independent of social bonds, moral cognitions, and moral emotions. The contextual effect is fully mediated by exposure to peer delinquency.