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Aim Methods Results Conclusion The aim of the third Asia‐Pacific Advanced Prostate Cancer Consensus Conference (APAC APCCC 2023) was to discuss the application in the Asia‐Pacific (APAC) region of consensus statements from the 4th Advanced Prostate Cancer Consensus Conference (APCCC 2022).The one‐day meeting in July 2023 brought together 27 experts from 14 APAC countries. The meeting covered five topics: (1) Intermediate‐ and high‐risk and locally advanced prostate cancer; (2) Management of newly diagnosed metastatic hormone‐sensitive prostate cancer; (3) Management of non‐metastatic castration‐resistant prostate cancer; (4) Homologous recombination repair mutation testing; (5) Management of metastatic castration‐resistant prostate cancer. Pre‐ and post‐symposium polling gathered APAC‐specific responses to APCCC consensus questions and insights on current practices and challenges in the APAC region.APAC APCCC highlights APAC‐specific considerations in an evolving landscape of diagnostic technologies and treatment innovations for advanced prostate cancer. While new technologies are available in the region, cost and reimbursement continue to influence practice significantly. Individual patient considerations, including the impact of chemophobia on Asian patients, also influence decision‐making.The use of next‐generation imaging, genetic testing, and new treatment combinations is increasing the complexity and duration of prostate cancer management. Familiarity with new diagnostic and treatment options is growing in the APAC region. Insights highlight the continued importance of a multidisciplinary approach that includes nuclear medicine, genetic counseling, and quality‐of‐life expertise. The APAC APCCC meeting provides an important opportunity to share practice and identify APAC‐specific issues and considerations in areas of low evidence where clinical experience is growing. [ABSTRACT FROM AUTHOR]

In 2022, a national study titled The DUHEI (Drug Use in Higher Educationin Ireland) was conducted to determine the prevalence and problem of drug use among students in institutes of higher education. The findings of the DUHEI revealed that drug use is prevalent among college students in Ireland, with over half reporting they use or hadused drugs in the past.The study also uncovered a subpopulation of students who have recovered from a previous problem with drug or alcohol use in thepast, known as students in recovery. These students were identifiedas a unique and vulnerable population in need of specific support on college campuses. The authors of the report recommend the establishment of collegiate recovery programs in institutes of higher education in Ireland to support these students in active recovery from addiction. Collegiate recovery programs are well established in the U.S and are emerging in the UK and Canada. This perspective article echoes, and extends upon the DUHEI recommendationto implement CRPs in Ireland, by highlighting the evidence base which demonstrates the efficacy of collegiate recovery programs. Itis important that Irish colleges and Universities follow international best practice by establishing collegiate recovery program. [ABSTRACT FROM AUTHOR]

To define the effect of symptom duration on outcomes in people undergoing surgery for idiopathic full-thickness macular holes (iFTMHs) by means of an individual participant data (IPD) study of randomized controlled trials (RCTs). The outcomes assessed were primary iFTMH closure and postoperative best-corrected visual acuity (BCVA). Idiopathic full-thickness macular holes are visually disabling with a prevalence of up to 0.5%. Untreated BCVA is typically reduced to 20/200. Surgery can close holes and improve vision. Symptom duration is thought to affect outcomes with surgery, but the effect is unclear. A systematic review identified eligible RCTs that included adults with iFTMH undergoing vitrectomy with gas tamponade in which symptom duration, primary iFTMH closure, and postoperative BCVA were recorded. Bibliographic databases were searched for articles published between 2000 and 2020. Individual participant data were requested from eligible studies. Twenty eligible RCTs were identified. Data were requested from all studies and obtained from 12, representing 940 eyes in total. Median symptom duration was 6 months (interquartile range, 3–10). Primary closure was achieved in 81.5% of eyes. There was a linear relationship between predicted probability of closure and symptom duration. Multilevel logistic regression showed each additional month of duration was associated with 0.965 times lower odds of closure (95% confidence interval [CI], 0.935–0.996, P = 0.026). Internal limiting membrane (ILM) peeling, ILM flap use, better preoperative BCVA, face-down positioning, and smaller iFTMH size were associated with increased odds of primary closure. Median postoperative BCVA in eyes achieving primary closure was 0.48 logarithm of the minimum angle of resolution (logMAR) (20/60). Multilevel logistic regression showed for eyes achieving primary iFTMH closure, each additional month of symptom duration was associated with worsening BCVA by 0.008 logMAR units (95% CI, 0.005–0.011, P < 0.001) (i.e., ∼1 Early Treatment Diabetic Retinopathy Study letter loss per 2 months). ILM flaps, intraocular tamponade using long-acting gas, better preoperative BCVA, smaller iFTMH size, and phakic status were also associated with improved postoperative BCVA. Symptom duration was independently associated with both anatomic and visual outcomes in persons undergoing surgery for iFTMH. Time to surgery should be minimized and care pathways designed to enable this. [ABSTRACT FROM AUTHOR]

Background: Salmonella is an important zoonotic pathogen and is one of the main causes of foodborne outbreaks and infections in the European Union. Pigs are a significant reservoir and are frequently subclinical carriers of this organism. Salmonella can be shed in the faeces allowing infection to spread to other pigs, the environment, transport vehicles, lairages and other areas. Inadvertent spillage of gut contents during the slaughter process also leads to contamination. A pig Salmonella control programme has operated in Ireland since 2002 but many local surveys and an EUMS baseline survey in 2008 continued to indicate high levels of the organism in the pig sector. The objectives of this study were to generate updated information on the prevalence of Salmonella spp, in slaughter pigs and carcasses in Irish abattoirs. Five pigs from each of 164 herds were randomly sampled over a 14-week period during 2016. One sample from each of the five pigs of; caecal content, ileo-caecal lymph nodes and carcass swabs (pre-chill) were collected. The five caeca and lymph node samples from each herd were processed as one pool of caecal samples and one pool of lymph node samples, respectively, while the five carcass swabs were tested as individual samples. All isolates were characterised by serotyping and antimicrobial susceptibility. Results: In total, 235 Salmonella spp. were isolated from 820 individual carcass swabs, 164 pooled lymph nodes and 164 caecal contents. Salmonella spp. were isolated from 54.3% of the caecal contents and from 31.7% of the ileocaecal lymph node sample pools. A total of 11.5% of carcass-swab samples yielded Salmonella spp. S. Typhimurium 4,[5],12:i:1,2 or its monophasic variant 4,[5],12:i:-: predominated among isolates from all positive samples; accounting for 73% of lymph nodes, 68% of caecal contents and 56% of carcass swab isolates. S. London and S. Derby were the next most common isolated serotypes. Conclusions: These results confirm continuing high levels of Salmonella in fattening pigs in Ireland although reductions in carcass contamination compared to previous surveys were noted. A high prevalence of Salmonella in lymph nodes suggests that it remains a significant problem pre slaughter and a challenge to abattoirs in adhering to process hygiene requirements. The high prevalence of monophasic S. Typhimurim 4,[5],12:i:-: is of serious concern. Therefore, it is important to identify contributing factors in the dissemination of this pathogen in the pork industry in order to minimise the risk of human salmonellosis cases. [ABSTRACT FROM AUTHOR]

Aim: The second Asia‐Pacific Advanced Prostate Cancer Consensus Conference (APAC APCCC 2020) gathered insights into the real‐world application in the Asia‐Pacific (APAC) region of consensus statements from the 3rd Advanced Prostate Cancer Consensus Conference (APCCC 2019). Methods: The 4‐h our virtual meeting in October 2020 brought together 26 experts from 14 APAC countries to discuss APCCC 2019 recommendations. Presentations were prerecorded and viewed prior to the meeting. A postmeeting survey gathered views on current practice. Results: The meeting and survey highlighted several developments since APAC APCCC 2018. Increased access and use in the region of PSMA PET/CT imaging is providing additional diagnostic and staging information for advanced prostate cancer and influencing local and systemic therapy choices. Awareness of oligometastatic disease, although not clearly defined, is increasing. Novel androgen receptor pathway antagonists are expanding treatment options. Cost and access to contemporary treatments and technologies continue to be a significant factor influencing therapeutic decisions in the region. With treatment options increasing, multidisciplinary treatment planning, shared decision making, and informed choice remain critical. A discussion on the COVID‐19 pandemic highlighted challenges for diagnosis, treatment, and clinical trials and new service delivery models that will continue beyond the pandemic. Conclusion: APAC‐specific prostate cancer research and data are important to ensure that treatment guidelines and recommendations reflect local populations and resources. Facilitated approaches to collaboration across the region such as that achieved through APAC APCCC meetings continue to be a valuable mechanism to ensure the relevance of consensus guidelines within the region. [ABSTRACT FROM AUTHOR]

Purpose: Albinism defines a group of genetic diseases which result from disordered melanin biosynthesis. Proliferative diabetic retinopathy (PDR) results from poorly controlled type 1 or 2 diabetes mellitus (DM) and can lead to blindness due to progressive neovascularisation. However, the treatment of PDR in patients with ocular/oculocutaneous albinism may be more challenging. In this study, we compared a group of patients with albinism and PDR, to a group with albinism and diabetes mellitus but no PDR, to examine the long-term implications. Methods: Retrospective observational study included all patients with ocular albinism (OA) or oculocutaneous albinism (OCA) and DM who presented at a single specialist centre. Participants were allocated into either group 1 (eyes with PDR) or group 2 (all eyes without PDR). Statistical analysis was performed using SPSS V26.0. Between-group differences were investigated. Results: Outcome data was available for 5 eyes from 3 participants in group 1 and 26 eyes from 13 participants in group 2. Despite interventions, a large and significant difference in vision at follow-up was observed between group 1 and group 2 (mean change in visual acuity: 1.11 (± 1.00) versus − 0.15 (± 0.46), respectively; p = < 0.0001). Conclusion: PDR is associated with poor long-term prognosis despite interventions for patients with albinism. Those without PDR appear to maintain stable vision. Alternative treatments for PDR and its complications may be required in this population. Measures to prevent the development of diabetic eye disease and progression towards PDR should be employed at an early stage. [ABSTRACT FROM AUTHOR]

Globally, 43 million people are living with HIV, 90% in developing countries. Increasing life expectancy with combination antiretroviral therapy (cART) results in chronic complications, including HIV-associated neurocognitive disorders (HAND) and eye diseases. HAND screening is currently challenging. Our aim was to evaluate clinical utility of retinopathy as a screening measure of HAND in older cART-treated individuals in Tanzania and feasibility of smartphone-based retinal screening in this low-resource setting. A cross-sectional systematic sample aged ≥ 50-years attending routine HIV follow-up in Tanzania were comprehensively assessed for HAND by American Academy of Neurology criteria and received ophthalmic assessment including smartphone-based retinal imaging. HAND and ophthalmic assessments were independent and blinded. Diagnostic accuracy was evaluated by AUROC curves. Of 129 individuals assessed, 69.8% were visually impaired. Thirteen had retinopathy. HAND prevalence was 66.7%. Retinopathy was significantly associated with HAND but HIV-disease factors (CD4, viral load) were not. Diagnostic accuracy of retinopathy for HAND was poor (AUROC 0.545-0.617) but specificity and positive predictive value were high. We conclude that ocular pathology and HAND appear highly prevalent in this low-resource setting. Although retinal screening cannot be used alone identify HAND, prioritization of individuals with abnormal retinal screening is a potential strategy in low-resource settings. [ABSTRACT FROM AUTHOR]

Introduction: The preferred diagnostic pathway for patients presenting with non‐massive haemoptysis and normal or benign computer tomography (CT) radiological findings is unclear. The common approach is to investigate with both CT and bronchoscopy, irrespective of patient‐specific factors. The value of performing fibreoptic bronchoscopy (FOB) in patients with non‐massive haemoptysis and clear or benign CT findings remains undetermined. We aimed to investigate its value using a large retrospective case series. Material and Methods: A retrospective review of 4376 FOBs performed in Northumbria Healthcare NHS Foundation Trust from January 2012 to December 2019 for patients presenting with haemoptysis and clear or benign CT findings. Statistical analysis was performed to describe patient‐specific variables, clinical characteristics, pathological findings and subsequent management decisions. Results: A total of 4376 FOBs were performed during the study period, 275 were indicated to investigate non‐massive haemoptysis. Two hundred and fifty‐nine patients underwent a CT scan (158 before and 101 after FOB); 16 never had a CT because the treating physician did not feel it was necessary. About 258 CT scans showed normal anatomy. All patients underwent FOB; 192 showed normal findings. Bronchoscopic findings did not alter clinical management in 274 patients. One patient was referred to the ear, nose and throat department following the identification of polypoid vocal cord lesion which, following thorough investigation, was confirmed as benign. Conclusion: FOB provides minimal value for identifying lung malignancies in patients with non‐massive haemoptysis and a clear or benign CT scan irrespective of patient‐specific risk factors. Cost savings would be associated if physicians altered practice accordingly. [ABSTRACT FROM AUTHOR]

Aim: To identify the predictors of poor outcome and need for surgical management in paediatric patients with periorbital cellulitis. To assess the adherence to local guidelines in the management of periorbital cellulitis.Methods: Retrospective descriptive analysis of clinical, laboratory and radiological characteristics of 175 paediatric periorbital cellulitis presentations at a UK teaching hospital over a 10-year period. Regression investigated correlations for continuous and categorical variables.Results: A total of 175 paediatric presentations were diagnosed as periorbital infections over the 10-year period. Of these, 139 had pre-septal cellulitis, 27 had a subperiosteal abscess, 6 had an orbital cellulitis, 1 had an orbital abscess, 1 a cavernous sinus thrombosis and 1 an extradural abscess. Median age at presentation was 5 years (range: 1 month-17 years). In total, 169 (97%) cases received systemic antimicrobial treatment. Cross-sectional imaging occurred in 30% of cases and 18% required surgical intervention. Increasing C-reactive protein was associated with greater risk of post-septal disease and requiring surgery. The best predictors of post-septal disease in the multivariate analysis (R2 = 0.49, P = ≤0.001) were ophthalmoplegia (P = 0.009), proptosis (P = 0.016) and pain on eye movement (P = 0.046). Proptosis was the single most significant predictor of surgical management (R2 = 0.53, P = <0.001).Conclusion: Multidisciplinary involvement and early medical management can improve outcomes for most patients. Those who deteriorate despite medical management should be considered for prompt imaging and surgical management to avoid serious life-threatening or sight-threatening complications. [ABSTRACT FROM AUTHOR]

Background: ENT disease prevalence, risk factors and treatment vary between developed and developing countries. Health provision, particularly disease prevention strategies and surgery, in developing countries is poor, manifesting as a high frequency of common and preventable diseases. Healthcare systems in developing countries are unsustainable, and the technological advances that provide ENT surgery with novel diagnostic and treatment opportunities are inaccessible. Conclusion: A multifaceted approach is essential to improve the care of patients with ENT diseases in developing countries. Public health efforts must focus on educating the local community, reducing high-risk behaviours and decreasing the frequency of preventable diseases. Governments must be pressured to prioritise the funding of long-term, sustainable efforts with effective disease prevention strategies. Providing local healthcare professionals with high-quality ENT training so that self-sustaining and low-cost care can be delivered, mainly in a primary care setting, is key. [ABSTRACT FROM AUTHOR]

Introduction: Haemorrhage is a frequent complication of radiation cystitis leading to emergency presentations in patients with prior pelvic radiation therapy. Standard initial patient management strategies involve resuscitation, bladder washout with clot evacuation and continuous bladder irrigation. Beyond this, definitive surgical treatment is associated with significant morbidity and mortality. Alternative less invasive management options for non‐emergent haemorrhagic cystitis include systemic medical therapies, hyperbaric oxygen (HBO), intravesical therapies and laser ablation. However, evidence to support and compare treatment for haemorrhagic radiation cystitis is limited. Methods: Herein, a literature search pertaining to the current management of haemorrhagic cystitis was conducted. Results: In total, 23 studies were included in this review with 2 studies reviewing systemic therapy, 7 studies evaluating HBO therapy, 10 studies investigating a variety of intravesical therapies and the remaining 4 were relating to ablative therapies. Across these studies, the patient groups were heterogenous with small numbers and variable follow up periods. Conclusion: With evaluation of existing literature, this narrative review also provides a stepwise clinical algorithm to aid the urologist in treating patients presenting with complications associated with radiation cystitis. [ABSTRACT FROM AUTHOR]

Objective: The Asia Pacific Advanced Prostate Cancer Consensus Conference (APAC APCCC 2018) brought together 20 experts from 15 APAC countries to discuss the real‐world application of consensus statements from the second APCCC held in St Gallen in 2017 (APCCC 2017). Findings: Differences in genetics, environment, lifestyle, diet and culture are all likely to influence the management of advanced prostate cancer in the APAC region when compared with the rest of the world. When considering the strong APCCC 2017 recommendation for the use of upfront docetaxel in metastatic castration‐naïve prostate cancer, the panel noted possible increased toxicity in Asian men receiving docetaxel, which would affect this recommendation in the APAC region. Although androgen receptor‐targeting agents appear to be well tolerated in Asian men with metastatic castration‐resistant prostate cancer, access to these drugs is very limited for financial reasons across the region. The meeting highlighted that cost and access to contemporary treatments and technologies are key factors influencing therapeutic decision‐making in the APAC region. Whilst lower cost/older treatments and technologies may be an option, issues of culture and patient or physician preference mean, these may not always be acceptable. Although generic products can reduce cost in some countries, costs may still be prohibitive for lower‐income patients or communities. The panellists noted the opportunity for a coordinated approach across the APAC region to address issues of access and cost. Developments in technologies and treatments are presenting new opportunities for the diagnosis and treatment of advanced prostate cancer. Differences in genetics and epidemiology affect the side‐effect profiles of some drugs and influence prescribing. Conclusions: As the field continues to evolve, collaboration across the APAC region will be important to facilitate relevant research and collection and appraisal of data relevant to APAC populations. In the meantime, the APAC APCCC 2018 meeting highlighted the critical importance of a multidisciplinary team‐based approach to treatment planning and care, delivery of best‐practice care by clinicians with appropriate expertise, and the importance of patient information and support for informed patient choice. [ABSTRACT FROM AUTHOR]

Background: Accurate staging of patients with prostate cancer (PCa) is important for therapeutic decision‐making. Relapse after surgery or radiotherapy of curative intent is not uncommon and, in part, represents a failure of staging with current diagnostic imaging techniques to detect disease spread. Prostate‐specific membrane antigen (PSMA) positron‐emission tomography (PET)/computed tomography (CT) is a new whole‐body scanning technique that enables visualization of PCa with high contrast. The hypotheses of this study are that: (i) PSMA‐PET/CT has improved diagnostic performance compared with conventional imaging; (ii) PSMA‐PET/CT should be used as a first‐line diagnostic test for staging; (iii) the improved diagnostic performance of PSMA‐PET/CT will result in significant management impact; and (iv) there are economic benefits if PSMA‐PET/CT is incorporated into the management algorithm. Objectives and Methods: The proPSMA trial is a prospective, multicentre study in which patients with untreated high‐risk PCa will be randomized to gallium‐68‐PSMA‐11 PET/CT or conventional imaging, consisting of CT of the abdomen/pelvis and bone scintigraphy with single‐photon emission CT/CT. Patients eligible for inclusion are those with newly diagnosed PCa with select high‐risk features, defined as International Society of Urological Pathology grade group ≥3 (primary Gleason grade 4, or any Gleason grade 5), prostate‐specific antigen level ≥20 ng/mL or clinical stage ≥T3. Patients with negative, equivocal or oligometastatic disease on first line‐imaging will cross over to receive the other imaging arm. The primary objective is to compare the accuracy of PSMA‐PET/CT with that of conventional imaging for detecting nodal or distant metastatic disease. Histopathological, imaging and clinical follow‐up at 6 months will define the primary endpoint according to a predefined scoring system. Secondary objectives include comparing management impact, the number of equivocal studies, the incremental value of second‐line imaging in patients who cross over, the cost of each imaging strategy, radiation exposure, inter‐observer agreement and safety of PSMA‐PET/CT. Longer‐term follow‐up will also assess the prognostic value of a negative PSMA‐PET/CT. Outcome and Significance: This trial will provide data to establish whether PSMA‐PET/CT should replace conventional imaging in the primary staging of select high‐risk localized PCa, or whether it should be used to provide incremental diagnostic information in selected cases. [ABSTRACT FROM AUTHOR]

As the value of nuclear medicine increases in PCa, it may be necessary to expand the nuclear medicine presence and also invite medical physicists and nuclear medicine technologists to the MDT meeting. Cold Kit for Prostate-Specific Membrane Antigen (PSMA) PET imaging: Phase 1 study of (68)Ga-Tris(Hydroxypyridinone)-PSMA PET/CT in patients with prostate cancer. [Extracted from the article]

Background Fine motor skill impairments are common in autism spectrum disorder (ASD), significantly affecting quality of life. Sensory inputs reaching the primary motor cortex (M1) from the somatosensory cortex (S1) are likely involved in fine motor skill and specifically motor learning. However, the role of these connections has not been directly investigated in humans. This study aimed to investigate, for the first time, the role of the S1-M1 connections in healthy subjects in vivo and whether microstructural alterations are associated with motor impairment in ASD. Methods Sixty right-handed neurotypical adult men aged 18 to 45 years, and 60 right-handed age- and sex-matched subjects diagnosed with ASD underwent fine motor skill assessment and scanning with diffusion tensor imaging (DTI). The streamlines of the hand region connecting S1-M1 of the motor-sensory homunculus were virtually dissected using TrackVis, and diffusion properties were extracted. The face/tongue region connections were used as control tracts. Results The ASD group displayed lower motor performances and altered DTI measurements of the hand-region connection. Behavioral performance correlated with hand-region DTI measures in both groups, but not with the face/tongue connections, indicating anatomical specificity. There was a left-hemisphere association of motor ability in the control group and an atypical rightward shift in the ASD group. Conclusions These findings suggest that direct interaction between S1 and M1 may contribute to the human ability to precisely interact with and manipulate the environment. Because electrophysiological evidence indicates that these connections may underpin long-term potentiation in M1, our findings may lead to novel therapeutic treatments for motor skill disorders. [ABSTRACT FROM AUTHOR]

The Gleason score is one of a number of factors used in staging patients diagnosed with prostate cancer and in determining the treatment path such patients will ultimately follow. However, discrepancies in the Gleason scores obtained through biopsy compared with the final pathological staging of specimens following radical prostatectomy are not uncommon. Incorrect Gleason scoring can potentially influence treatment decisions and therefore, it is imperative that research is undertaken to elucidate factors that may be able to predict whether a patient's Gleason score might need to be reconsidered. A literature review was undertaken in late 2014 to highlight some of these factors that require further investigation. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objective To assess the online and social media presence of all practising Australian and New Zealand urologists. Subjects and Methods In July 2014, all active members of the Urological Society of Australia and New Zealand ( USANZ) were identified. A comprehensive search of Google and each social media platform (Facebook, Twitter, LinkedIn and YouTube) was undertaken for each urologist to identify any private websites or social media profiles. Results Of the 435 urologists currently practising in Australia and New Zealand, 305 (70.1%) have an easily identifiable social media account. LinkedIn (51.3%) is the most commonly used form of social media followed by Twitter (33.3%) and private Facebook (30.1%) accounts. About half (49.8%) have a private business website. The average number of social media accounts per urologist is 1.42 and 16 urologists (3.7%) have an account with all searched social media platforms. Over half of those with a Twitter account (55.9%) follow a dedicated urology journal club and have a median (range) number of 'followers' of 12 (1-2 862). Social media users had a median (range) of 2 (0-8 717) 'tweets' on Twitter, 2 (1-45) LinkedIn posts and 1 (1-14) YouTube video. Conclusion This study represents a unique dataset not relying on selection or recall bias but using data freely available to patients and colleagues to gauge social media presence of urologists. Most Australian and New Zealand urologists have a readily identifiable online and social media presence, with widespread and consistent use across both countries. [ABSTRACT FROM AUTHOR]

The article offers information regarding androgen biosynthesis inhibition for treatment of high-risk hormone-natıve prostate cancer. It mentions information on STAMPEDE which is a multi-arm randomized controlled trials (RCT) being conducted in the Great Britain and Switzerland to assess novel therapeutic agents in conjunction with androgen deprivation therapy (ADT). It presents information on addition of abiraterone acetate (AA) in RCT.

We have made little recent progress developing effective new treatments for neuropsychiatric and neurodevelopmental disorders. Novel molecular mechanisms have been identified, but have not translated into the clinic. We suggest an alternative: combinations of treatments targeting different aspects of final common pathways in biologically defined clinical subgroups. This will require integrated translational neuroscience and international public-private partnerships. [ABSTRACT FROM AUTHOR]

Over the past decade, human neuroimaging studies have provided invaluable insights into the neural substrates that underlie autism spectrum disorder (ASD). Although observations from multiple neuroimaging approaches converge in suggesting that changes in brain structure, functioning and connectivity are associated with ASD, the neurobiology of this disorder is complex, and considerable aetiological and phenotypic heterogeneity exists among individuals on the autism spectrum. Characterization of the neurobiological alterations that underlie ASD and development of novel pharmacotherapies for ASD, therefore, requires multidisciplinary collaboration. Consequently, pressure is growing to combine neuroimaging data with information provided by other disciplines to translate research findings into clinically useful biomarkers. So far, however, neuroimaging studies in patients with ASD have mainly been conducted in isolation, and the low specificity of neuroimaging measures has hindered the development of biomarkers that could aid clinical trials and/or facilitate patient identification. Novel approaches to acquiring and analysing data on brain characteristics are currently being developed to overcome these inherent limitations, and to integrate neuroimaging into translational research. Here, we discuss promising new studies of cortical pathology in patients with ASD, and outline how the novel insights thereby obtained could inform diagnosis and treatment of ASD in the future. [ABSTRACT FROM AUTHOR]

Purpose - Autism spectrum disorder (ASD) has been studied as a neurodevelopmental disorder since Leo Kanner's early observations of abnormal head circumference in autistic children. In the past few years, there has been much progress made in elucidating the anatomical and functional abnormalities in ASD. This paper aims to summarise the extant research.Design/methodology/approach - This paper provides a summary of relevant research findings in the neuroimaging of autism for the past 12 month period. Papers were identified using the Medline search terms: autism; ASD (functional); magnetic resonance imaging (MRI); neuroimaging; diffusion tensor imaging (DTI); and endophenotype.Findings - Relatively recent techniques such as functional MRI and DTI have furthered the initial work derived from early histological and structural imaging studies. Even newer techniques, such as DTI tractography and support vector machine analysis, and other computer-based learning methods have allowed us to move beyond regional variations in grey and white matter volume and study ASD as a disorder of connectivity, and of regional cerebral function and neural circuitry. Brain regions and neural circuits that are implicated in the core symptoms of ASD (deficits in social reciprocity, language and communication, and restricted and stereotyped interests) have been repeatedly shown to be abnormal in those individuals.Originality/value - This paper aims to provide a background for clinicians to the current research and focuses on developments in the field of neuroimaging of ASD from the past year, which have generated further insights into the neurobiology of ASD. [ABSTRACT FROM AUTHOR]

OBJECTIVE∙To systematically review the current literature concerning perioperative, functional and oncological outcomes reported after open and minimally invasive prostate cancer surgery specifically from institutions within Australasia. MATERIALS AND METHODS∙Four electronic databases were searched to identify studies reporting outcome after open and minimally invasive prostate cancer surgery. Studies were sought using the search term 'radical prostatectomy'.∙In all, 11 378 articles were retrieved. For the purpose of this review, data were only extracted from studies reporting Australasian experience.∙A total of 28 studies met final inclusion criteria. RESULTS∙Overall, the data are limited by the low methodological quality of available studies.∙Only two comparative studies evaluating open radical prostatectomy (ORP) and robotic-assisted laparoscopic RP (RALP) were identified, both non-randomized.∙The mean blood loss, catheterization time and hospital stay was shorter after RALP than with ORP. In contrast, mean operative procedure time was significantly longer for RALP.∙Overall adverse event rates were similar for the different surgical approaches although the rate of bladder neck stricture was significantly higher after open RP.∙Incorporation of patient outcomes achieved by surgeons still within their learning curve resulted in a trend towards higher positive surgical margin rates and lower continence scores after RALP. However, there was equivalence once the surgeons' learning curve was overcome. Given the limited follow-up for RALP and laparoscopic RP (14.7 and 6 months vs 43.8 months for ORP) and the lack of data concerning erectile function status, comparison of biochemical failure and potency was not possible. CONCLUSIONS∙Few comparative data are available from Australasia concerning open and minimally invasive prostate cancer surgery.∙While perioperative outcomes appear to favour minimally invasive approaches, further comparative assessment of functional and long-term oncological efficacy for the different surgical approaches is required to better define the role of minimally invasive approaches. [ABSTRACT FROM AUTHOR]

Abstract: There is increasing evidence that children with autism spectrum disorder (ASD) have differences in brain growth trajectory. However, the neurobiological basis of ASD in adults is poorly understood. We report evidence that brain anatomy and aging in people with ASD is significantly different as compared to controls—so that in adulthood they no longer have a significantly larger overall brain volume, but they do have anatomical and functional abnormalities in frontal lobe, basal ganglia and the limbic system. Further we present preliminary evidence that females have significantly greater abnormalities in brain than males to express the same symptom severity of ASD (i.e. the female brain is “protective” against developing ASD). Also we present preliminary evidence that, in adults, clinical services for autism in the United Kingdom are experiencing very significantly increased demand; but that just over 50% of people seeking a diagnosis from one expert service do not have ASD. This consumes very significant health care resources, and so we need to identify new cost-effective methods to aid current diagnostic practice. We present initial evidence offering proof of concept that brain anatomy can be used to accurately distinguish adults with autism from healthy controls, and from some other neurodevelopmental disorders (ADHD). Hence further studies are required to determine if sMRI can become an aid to current diagnostic practice in young adults with ASD. Lastly we report evidence that differences in serotonin, glutamate and GABA may partially explain neuroanatomical and neurofunctional abnormalities in people with ASD, and that genetic influences on brain maturation vary across the lifespan (with 5-HT transporter polymorphisms having significant modulatory effects in children but not adults). [Copyright &y& Elsevier]

A nascent theory of near division is presented, from which an efficient quantization algorithm for rhythm intervals is derived. Based on a number theoretic analysis of the uniqueness and convergence of this first algorithm, a generalized algorithm is presented. An empirical study of the algorithm's performance reveals a readily computable criterion within which the perceived ratio may reliably be produced on real performance data. Distribution properties are shown to be reasonable for computation. [ABSTRACT FROM AUTHOR]

Abstract: Context: Robot-assisted laparoscopic radical prostatectomy (RALP) using the da Vinci Surgical System (Intuitive Surgical, Sunnyvale, CA, USA) is now in widespread use for the management of localised prostate cancer (PCa). Many reports of the safety and efficacy of this procedure have been published. However, there are few specific reports of the limitations and complications of RALP. Objective: The primary purpose of this review is to ascertain the downsides of RALP by focusing on complications and limitations of this approach. Evidence acquisition: A Medline search of the English-language literature was performed to identify all papers published since 2001 relating to RALP. Papers providing data on technical failures, complications, learning curve, or other downsides of RALP were considered. Of 412 papers identified, 68 were selected for review based on their relevance to the objective of this paper. Evidence synthesis: RALP has the following principal downsides: (1) device failure occurs in 0.2–0.4% of cases; (2) assessment of functional outcome is unsatisfactory because of nonstandardised assessment techniques; (3) overall complication rates of RALP are low, although higher rates are noted when complications are reported using a standardised system; (4) long-term oncologic data and data on high-risk PCa are limited; (5) a steep learning curve exists, and although acceptable operative times can be achieved in <20 cases, positive surgical margin (PSM) rates may require experience with >80 cases before a plateau is achieved; (6) robotic assistance does not reduce the difficulty associated with obese patients and those with large prostates, middle lobes, or previous surgery, in whom outcomes are less satisfactory than in patients without such factors; (7) economic barriers prevent uniform dissemination of robotic technology. Conclusions: Many of the downsides of RALP identified in this paper can be addressed with longer-term data and more widespread adoption of standardised reporting measures. The significant learning curve should not be understated, and the expense of this technology continues to restrict access for many patients. [Copyright &y& Elsevier]

A complex form of aggression, commonly expanded as 'aggressive challenging behaviour', is reported in one in four adults with intellectual disability and is often treated with antipsychotics, mood stabilizers and antidepressants. Psychological treatments, including anger and behavioural management, person-centred planning and manipulation of the environment (nidotherapy), have also been used when available but to a lesser extent. In this article, the evidence for efficacy for each intervention is examined, with data from randomized controlled trials given primacy. Very little evidence, based on limited data, can be found for the interventions of anger and behavioural management and also for the atypical antipsychotic drug, risperidone; the data available on these interventions come primarily from studies conducted in children in whom the behaviour is part of the autistic spectrum. Antipsychotic drugs, particularly the atypical group, have been the most commonly used interventions in recent years, but a recent independent randomized trial showed no benefits for either risperidone or haloperidol compared with placebo, with some evidence of a better response to placebo than either active drug in the reduction of aggression. In the light of this uncertainty, the clinician must return to the task of collecting a careful history and mental state examination, including awareness of the setting in which the behaviour is shown, which will help with diagnosis and appropriate intervention. The choice of intervention should not be a casual one and is not likely to be chosen well if the clinician relies only on standard guidelines. The paucity of randomized trial evidence is preventing progress in the treatment of persistent aggressive behaviour. On present evidence, the use of drug treatment should be much more sparing and reserved for those patients who are putting themselves and others at particular risk as a consequence of their behaviour; such treatment should be regarded as temporary and as adjunctive to other forms of management. There is an urgent need for larger, randomized studies of psychological interventions, which at present appear to have a higher benefit-risk ratio than drug treatment but that also have a poor evidence base. More care should be taken to avoid the term 'aggressive challenging behaviour' being used as a portmanteau diagnostic pseudonym when it merely represents a diverse oppositional repertoire of many aetiologies. [ABSTRACT FROM AUTHOR]

Neuroimaging studies of Turner syndrome can advance our understanding of the X chromosome in brain development, and the modulatory influence of endocrine factors. There is increasing evidence from neuroimaging studies that TX individuals have significant differences in the anatomy, function, and metabolism of a number of brain regions; including the parietal lobe; cerebellum, amygdala, hippocampus; and basal ganglia; and perhaps differences in “connectivity” between frontal and parieto-occipital regions. Finally, there is preliminary evidence that genomic imprinting, sex hormones and growth hormone have significant modulatory effects on brain maturation in TS. © 2009 Wiley-Liss, Inc. Dev Disabil Res Rev 2009;15:279–283. [ABSTRACT FROM AUTHOR]

OBJECTIVE To report on the short-term functional and oncological results, from one institution, of high-intensity focused ultrasound (HIFU) for treating localized prostate cancer. PATIENTS AND METHODS Over a 3-year period, 43 patients with localized prostate cancer were scheduled for HIFU in the primary (31) and salvage (12) settings using a second-generation AblathermTM device (EDAP, Lyon, France). Oncological failure was defined by several criteria, including biochemical failure (assessed using both the Phoenix definition of the nadir + 2 ng/mL) and the current Food and Drug Administration (FDA) trial endpoint of a prostate-specific antigen (PSA) level of ≥0.5 ng/mL, or starting salvage therapy, or the presence of cancer on biopsy after treatment. RESULTS Three patients had their procedures abandoned due to technical limitations/rectal wall thickness. The mean PSA levels in the primary and salvage groups were 9.2 and 5.1 ng/mL, respectively. The mean HIFU treatment time in the primary and salvage groups was 71.1 and 63.3 min, respectively. Using the Phoenix definition of biochemical failure, HIFU treatment failed in 13 patients in the primary group (46%) and five in the salvage group. Using the FDA trial endpoint, HIFU failed in 21 patients in the primary group (75%) and eight in the salvage group. One man died from metastatic prostate cancer 18 months after salvage HIFU. There were two urethral strictures in the primary (7%) and one in the salvage treatment group. There were two prostato-rectal fistulae in the salvage HIFU group. CONCLUSIONS HIFU is proposed to be a minimally invasive low-morbidity ablative treatment for localized prostate cancer, and with good efficacy. The present limited series is unable to support these claims. There were significant rates of complications and oncological failure in both the primary and salvage setting. As a result we have suspended our programme pending further evidence of its safety and efficacy. [ABSTRACT FROM AUTHOR]

Abstract: Background: Robotic-assisted laparoscopic radical prostatectomy (RALP) using the da Vinci® surgical system (Intuitive Surgical, Sunnyvale, CA) is increasingly used for the management of localised prostate cancer. Objective: We report the operative details and short-term oncological and functional outcome of the first 400 RALPs performed at our unit. Design, setting and participants: From December 2003 to August 2006, 400 consecutive patients underwent RALP at our institution. A prospective database was established to record the relevant details of all RALP cases. Surgical procedure: A six port transperitoneal approach using a 4-arm da Vinci® system was used to perform RALP. This database was reviewed to establish the operative details and oncological and functional outcome of all patients with a minimum of 12 months follow-up. Measurements: Perioperative characteristics and outcomes are reported. Functional outcome was assessed using continence and erectile function questionnaires. Biochemical recurrence (prostate-specific antigen (PSA) ≥0.2ng/mL) is used as a surrogate for cancer control. Results and limitations: The mean age±standard deviation (SD) was 60.2±6 years. Median PSA level was 7.0 (interquartile range (IQR) 5.3–9.6) ng/mL. The mean operating time±SD was 186±49 mins. The complication rate was 15.75% comprising Clavien grade I-II and Clavien grade III complications in 10.5% and 5.25% of patients respectively. The overall positive surgical margin rate was 19.2% with T2 and T3 positive margin rates of 9.6% and 42.3% respectively. The biochemical recurrence-free survival was 86.6% at a median follow-up of 22 (IQR=15–30) months. At 12 months follow-up, 91.4% of patients were pad-free or used a security liner. Of those men previously potent (defined as Sexual Health Inventory for Men [SHIM] score ≥21) who underwent nerve-sparing RALP, 62% were potent at 12 months. Conclusions: The safety and feasibility of RALP has already been established. Our initial experience with this procedure shows promising short-term outcomes. [Copyright &y& Elsevier]

The article provides information on anterior retraction of the prostate during robotic-assisted laparoscopic radical prostatectomy (LRP) for prostate cancer. Among several techniques for anterior retraction of the prostate, it is said that the percutaneous insertion of a suture through the eye of the catheter proved to be an effective and efficient procedure during robot-assisted LRP. Photographs which demonstrate how the techniques is conducted are provided.

The article discusses targeted local therapy in oligometastatic prostate cancer. Topics discussed include prostate cancer, tumor biology and mechanism of metastasis evolution, and ablation of oligometastases. Also being discussed are androgen deprivation therapy (ADT), and castrate-resistant prostate cancer (CRPC).

There is increasing patient and surgeon interest in robotic-assisted surgery, particularly with the proliferation of da Vinci surgical systems (Intuitive Surgical, Sunnyvale, CA, USA) throughout the world. There is much debate over the usefulness and cost-effectiveness of these systems. The currently available robotic surgical technology is described. Published data relating to the da Vinci system are reviewed and the current status of surgical robotics within Australia and New Zealand is assessed. The first da Vinci system in Australia and New Zealand was installed in 2003. Four systems had been installed by 2006 and seven systems are currently in use. Most of these are based in private hospitals. Technical advantages of this system include 3-D vision, enhanced dexterity and improved ergonomics when compared with standard laparoscopic surgery. Most procedures currently carried out are urological, with cardiac, gynaecological and general surgeons also using this system. The number of patients undergoing robotic-assisted surgery in Australia and New Zealand has increased fivefold in the past 4 years. The most common procedure carried out is robotic-assisted laparoscopic radical prostatectomy. Published data suggest that robotic-assisted surgery is feasible and safe although the installation and recurring costs remain high. There is increasing acceptance of robotic-assisted surgery, especially for urological procedures. The da Vinci surgical system is becoming more widely available in Australia and New Zealand. Other surgical specialties will probably use this technology. Significant costs are associated with robotic technology and it is not yet widely available to public patients. [ABSTRACT FROM AUTHOR]

Abstract: Background: The use of robotic technology for laparoscopic prostatectomy is now well established. The same cannot yet be said of robotic-assisted laparoscopic radical cystectomy (RARC), which is performed in just a few centres worldwide. Objective: We present our technique and experience of this procedure using the da Vinci surgical system. Design, setting, and participants: From 2004 to 2007, 23 patients underwent RARC and urinary diversion at our institution. Surgical procedure: We report the development of our technique for RARC, which involves posterior dissection, lateral pedicle control, anterior dissection, and lymphadenectomy prior to either ileal conduit urinary diversion or Studer pouch reconstruction performed extracorporeally. Measurements: Demographic and perioperative data were recorded prospectively. Oncologic and functional outcomes were assessed at 3- to 6-mo intervals. Results and limitations: To date, 23 patients have undergone this procedure at our institution. Of those, 19 had ileal loop urinary diversion and 4 were suitable for Studer pouch reconstruction. Mean total operative time plus or minus (±) standard deviation (SD) was 397±83.8min. Mean blood loss ±SD was 278±229ml with one patient requiring a blood transfusion. Surgical margins were clear in all patients with a median ±SD of 16±8.9 lymph nodes retrieved. The complication rate was 26%. At a mean follow-up ±SD of 17±13 (range 4–40) mo, one patient had died of metastatic disease and one other is alive with metastases. The remaining 21 patients are alive without recurrence. Conclusions: RARC remains a procedure in evolution in the small number of centres carrying out this type of surgery. Our initial experience confirms that it is feasible with acceptable morbidity and good short-term oncologic results. [Copyright &y& Elsevier]

Objectives: To assess outcomes after hand-assisted laparoscopic nephrectomy (HALN) for renal cell cancer tumor thrombus confined to the renal vein and to compare outcomes with published series in this setting. Methods: Thirteen patients underwent HALN for radiologic T3b disease (tumor thrombus confined to the renal vein on preoperative computed tomography) under the care of three surgeons at two centers between 1997 and 2006. Results: Median patient age was 69 years. Median duration of surgery was 176 minutes. Median blood loss was 250 mL. Median postoperative stay was 3 days. Two patients were converted to open surgery: 1 owing to unsuspected invasion of the subdiaphragmatic vena cava requiring vascular clamping with direct excision and suture, and 1 for control of bleeding. No patients suffered major morbidity associated with surgery, and there was one minor complication (aside from blood transfusion in 5 patients). After 2.7 years median follow-up, 3 of the 12 patients with pT3bN0 disease had metastases, but there were no local recurrences. Conclusions: These data demonstrate that HALN for renal cell cancer with tumor thrombus limited to the renal vein is feasible. Our outcomes compare favorably to published data on open surgical radical nephrectomy in this setting, and HALN should be considered in centers with experience with this technique. [Copyright &y& Elsevier]

The article discusses the efficiency of robotically assisted laparoscopic pyeloplasty. It has been outlined that open and laparoscopic procedures have been used to manage PUJ obstruction. However, dismembered pyeloplasty via the laparoscopic approach remains a challenging procedure to those without considerable laparoscopic experience.

The article explores the role of robotic technology in laparoscopic radical prostatectomy (LRP). It defines a surgical robot, its uses and functions. It describes the various robotic technology for use in surgery including the Automated Endoscopic System for Optimum Positioning and daVinci™ robot from Intuitive Surgical Inc., and EndoAssist™ from Armstrong Healthcare Ltd. The advantages and disadvantages of robotic technology in LRP are also discussed.

Objective: Laparoscopic reconstructive urology is undergoing rapid change. We review the current status of laparoscopic reconstructive urology, with particular respect to pyeloplasty and reconstructive ureteric surgery. Methods: An extensive Medline search of reconstructive laparoscopic procedures was undertaken. The initial reports and large series reports of a range of procedures was examined and summarised. The most commonly practised procedure within this remit is laparoscopic pyeloplasty. Several series of over 100 patients have been published. Success rates average over 90% for laparoscopic pyeloplasty with a low complication rate. Much less common laparoscopic reconstructive urological procedures include ureteric re-implantation, Boari flap, urinary diversion and transuretero-ureterostomy. The results of these are encouraging. Conclusions: Laparoscopic pyeloplasty may be safely performed by either the transperitoneal or retroperitoneal routes with excellent results. It should be considered the "gold standard" for the management of UPJ obstruction, especially in those patients with significant hydronephrosis, renal impairment or a crossing vessel. Laparoscopic ureteric reimplantation, Boari flap, urinary diversion and transuretero-ureterostomy have been performed by experienced laparoscopic urologists with encouraging results. [ABSTRACT FROM AUTHOR]

Focuses on the effects of hormone replacement therapy on cerebral blood flow, glucose metabolism, and neurotransmitter systems as suggested by recent imaging studies. Designs used to investigate the effects of hormones on brain function in postmenopausal women; Results of cross-sectional or interventional studies; Limitations of the approaches; Effects of aging on the brain; Description of cross-sectional and intervention studies; Features of longitudinal studies; Suggestions for further studies.

Forgiveness, a construct common to religiousness/spirituality and positive psychology, and resentment are thought to be critical factors in addiction and recovery therefrom. Although empirical evidence is accumulating to support forgiveness as an important factor in addiction recovery, very little work has empirically examined the role of resentment in addiction recovery, including the role of the forgiveness – resentment interface. The association of forgiveness with addiction recovery-related outcomes, as mediated by resentment, in the context of substance (mis)use was examined in two cross-sectional studies among undergraduate college students from three institutions, in this IRB-approved study. Self-forgiveness was consistently associated – both directly and indirectly through resentment – with less psychological distress and less vulnerability to use substances in the context of both alcohol (mis)use and drug (mis)use. Other-forgiveness was similarly associated, but less frequently. Empirical evidence is beginning to emerge to support the long-held anecdotal assumptions regarding the importance of forgiveness and resentment to addiction recovery, with implications for interventions and approaches to treatment for those struggling with substance (mis)use. [ABSTRACT FROM AUTHOR]

Face-processing timing differences may underlie visual social attention differences between autistic and non-autistic people, and males and females. This study investigates the timing of the effects of neurotype and sex on face-processing, and their dependence on age. We analysed EEG data during upright and inverted photographs of faces from 492 participants from the Longitudinal European Autism Project (141 neurotypical males, 76 neurotypical females, 202 autistic males, 73 autistic females; age 6–30 years). We detected timings of sex/diagnosis effects on event-related potential amplitudes at the posterior–temporal channel P8 with Bootstrapped Cluster-based Permutation Analysis and conducted Growth Curve Analysis (GCA) to investigate the timecourse and dependence on age of neural signals. The periods of influence of neurotype and sex overlapped but differed in onset (respectively, 260 and 310 ms post-stimulus), with sex effects lasting longer. GCA revealed a smaller and later amplitude peak in autistic female children compared to non-autistic female children; this difference decreased in adolescence and was not significant in adulthood. No age-dependent neurotype difference was significant in males. These findings indicate that sex and neurotype influence longer latency face processing and implicates cognitive rather than perceptual processing. Sex may have more overarching effects than neurotype on configural face processing. [ABSTRACT FROM AUTHOR]

Clinical trials of pharmacological candidates targeting the core features of autism have largely failed. This is despite evidence linking differences in multiple neurochemical systems to brain function in autism. While this has in part been explained by the heterogeneity of the autistic population, the field has largely relied upon association studies to link brain chemistry to function. The only way to directly establish that a neurotransmitter or neuromodulator is involved in a candidate brain function is to change it and observe a shift in that function. This experimental approach dominates preclinical neuroscience, but not human studies. There is little direct experimental evidence describing how neurochemical systems modulate information processing in the living human brain. Thus, our understanding of how neurochemical differences contribute to neurodiversity is limited, impeding our ability to translate findings from animal studies into humans. Here, we introduce our 'shiftability' paradigm, an approach to bridge the translational gap in autism research. We provide an overview of the guiding principles and methodologies we use to directly test the hypothesis that neurochemical systems function differently in autistic and non‐autistic individuals. [ABSTRACT FROM AUTHOR]

Autistic individuals experience higher rates of externalising and internalising symptoms that may vary with environmental factors. However, there is limited research on variation across settings that may highlight common factors with globally generalisable effects. Data were taken from two cohorts: a multinational European sample (n = 764; 453 autistic; 311 non-autistic; 6–30 years), and a South African sample (n = 100 non-autistic; 3–11 years). An exploratory factor analysis aggregated clinical (Verbal Comprehension and Perceptual Index), adaptive traits (Vineland Adaptive Behaviour Scale) and socio-economic variables (parental employment and education, home and family characteristics) in each cohort separately. With regression, we investigated the effect of these factors and autistic traits on internalising and externalising scores (measured with the Strengths and Difficulties Questionnaire). Cohorts showed similar four-factor structures (Person Characteristics, Family System, Parental and Material Resources). The 'Family System' factor captured family size and maternal factors and was associated with lower internalising and externalising symptoms in both cohorts. In the European cohort, high autistic traits reduced this effect; the opposite was found in the South Africa cohort. Our exploratory findings from two separate analyses represent consistent evidence that Family System is associated with internalising and externalising symptoms, with a context-specific impact in persons with high autism traits. Autistic individuals are more likely than non-autistic individuals to experience a mental health condition in their lifetime, and this includes externalising and internalising symptoms. We know very little about how different environments and family conditions impact these symptoms for autistic individuals. Improving our understanding of these relationships is important so that we can identify individuals who may be in greater need of support. In this article, we seek to improve our understanding of how environmental and family conditions impact externalising and internalising symptoms in autistic and non-autistic people. To do this, we conducted analyses with two cohorts in very different settings – in Europe and South Africa – to ensure our findings are globally representative. We used advanced statistical methods to establish environmental and family conditions that were similar to each other, and which could be combined into specific 'factors'. We found that four similar 'factors' could be identified in the two cohorts. These were distinguished by personal characteristics and environmental conditions of individuals, and were named Person Characteristics, Family System, Parental and Material Resources. Interestingly, just 'Family System' was associated with internalising and externalising symptoms, and this was the same in both cohorts. We also found that having high traits of autism impacted this relationship between Family System and mental health conditions with opposite directions in the two settings. These results show that characteristics in the Family System are associated with internalising and externalising symptoms, and autistic persons are particularly impacted, reinforcing the notion that family stressors are important to consider when implementing policy and practice related to improving the mental health of autistic people. [ABSTRACT FROM AUTHOR]