Association of maternal arsenic exposure with birth size: A systematic review and meta-analysis

ObjectivesChronic exposure to arsenic during pregnancy or early life continues to be a major global health problem worldwide, affecting hundreds of millions of people. However, its effects on birth size are uncertain. The aim of this study is to summarized the association between maternal arsenic exposure and birth size.MethodsA comprehensive literature search was conducted on the maternal arsenic exposure and birth size (birth weight, birth length, head circumference and chest circumference) through databases (PubMed, Qvid Medline, Web of Science, Cochrane and EMBASE), the last search was in March 2019. Heterogeneity was testes by using the Q statistic and stratifying for epidemiological factors. The possibility of publication bias was assessed through Begg’s test.ResultsA total of 12 studies provided sufficient data were included. Meta-analysis revealed that maternal arsenic exposure was associated with the decrease of birth weight (β = −25.0 g; 95% CI: −41.0, −9.0) and head circumference (β = −0.12 cm; 95% CI: −0.24, −0.01) in random-effect model, birth length (β = −0.12 cm; 95% CI: −0.17, −0.07) in fixed-effect model, no significant reduction was suggested in chest circumference (β = −0.74 cm; 95% CI: −1.78, 0.3). In addition, we found that the birth weight decreased stronger in women living in the Americas, or appling the exposure marker of urine.ConclusionsMaternal arsenic exposure is associated with the decrease of the birth weight, length and head circumference. Millions of people are still exposured to high-level arsenic, therefore, high quality epidemiologic studies that involve large samples are necessary to determine the precise relationships between maternal arsenic exposure with birth size. And that effective mitigation measures are also need to prevent arsenic exposure in women of reproductive age.     

Endogenous Deficiency of Brain-Derived Neurotrophic Factor Induces the Downregulation of Tryptophan Hydroxylase-2 Expression in Raphe Nuclei of Rapid Ejaculator Rats

BackgroundPremature ejaculation (PE) is one of the most common ejaculatory disorders. Recent studies have suggested a close relationship between the serotonin (5-hydroxytryptamine [5-HT]) system and brain-derived neurotrophic factor (BDNF), raising the question of whether BDNF plays a role in ejaculation regulation. To our knowledge, no previous studies have explored BDNF level of the central nervous system in ejaculatory disorders. At the same time, the interaction of central BDNF and 5-HT systems has not been undertaken in ejaculation regulation field.AimThe aim of this study was to investigate the interaction between BDNF and 5-HT levels in raphe nuclei which contains the serotonergic neurons in a rat animal model with different ejaculatory behavior.MethodsEighteen male rats were selected and classified as “sluggish,” “normal,” and “rapid” ejaculators on the basis of ejaculation frequency during copulatory behavioral testing. BDNF and 5-HT levels were determined by enzyme-linked immunosorbent assay (ELISA). Real-Time Quantitative PCR and Western blot analyses were used to measure the mRNA level of Tryptophan Hydroxylase-2 (TPH2) gene and the expression of TPH2 protein (the rate-limiting enzyme in central 5-HT synthesis) in raphe nuclei, respectively.OutcomesMale rat sexual behavior, the levels of BDNF and 5-HT in raphe nuclei of rats with different ejaculatory behavior, the mRNA level of gene encoding TPH2 and the expression of TPH2 protein in raphe nuclei.ResultsThe primary finding of our study was that BDNF concentration was significantly decreased in raphe nuclei of rapid ejaculators. There was a strong positive correlation between the levels of BDNF and 5-HT (r = 0.944, P < .001). Further results showed that decreased TPH2 gene expression accompanied by TPH2 protein was shown in rapid ejaculators with lower BDNF level.Clinical ImplicationsWith refinement of current knowledge, BDNF may eventually serve as a promising biomarker in patients with PE.Strengths & LimitationsThere are no previous studies examining the interaction of the brain BDNF and 5-HT in ejaculation regulation field. The main limitation is the limited sample size.ConclusionBDNF may act via increasing the synthesis of central 5-HT in the process of ejaculation regulation. Our results suggest lack of endogenous BDNF induces the downregulation of TPH2 gene expression and the decrease of 5-HT synthesis in raphe nuclei of rapid ejaculator rats. Huang Y, Peng D, Geng H, et al. Endogenous Deficiency of Brain-Derived Neurotrophic Factor Induces the Downregulation of Tryptophan Hydroxylase-2 Expression in Raphe Nuclei of Rapid Ejaculator Rats. J Sex Med 2021;18:1491–1499.     

Problems in the application of the Addiction Severity Index (ASI) in rural substance abuse services

The aim of this research was to test the utility of the Addiction Severity Index (ASI) in a rural community substance abuse outpatient treatment center and to predict future alcohol and drug problems based on ASI information. Substance abuse counselors used the ASI to assess the problems of 89 adult clients at intake, and research staff assessed drug use outcomes 3 months later. There were significant improvements between intake and follow-up on the scores on the alcohol, drug, legal, and family sections of the ASI. Scores on the alcohol abuse, drug abuse, and medical sections of the ASI predicted some of the variance (16%) in drug and alcohol use outcomes, but psychiatric, medical, legal, and employment problems were not significant predictors. There was some difficulty in obtaining adequate reliability in counselors' severity ratings for alcohol problems. The relationship of counselors' severity ratings to the more objective composite scores varied substantially by subsection of the ASI. The improvements in alcohol and drug use indices appeared to be more related to subjective appraisals of problems related to use rather than due to changes in drug-using behavior. Implications of these findings and recommendations for further research using the ASI are discussed.     

2018版加拿大儿科学会《儿童青少年注意缺陷多动障碍诊疗指南》解读

注意缺陷多动障碍（ADHD）是儿童期常见的慢性神经发育障碍,已经成为全球共同的公共卫生问题,世界各学术组织先后发表了相关的诊治指南。随着近几年研究的不断深入,其临床指南也得到了不断更新。2018年10月24日,加拿大儿科学会（CPS）精神卫生和发育障碍委员会牵头制定了《儿童青少年注意缺陷多动障碍诊疗指南》,指南总结了目前ADHD所有的临床证据,并制定了ADHD治疗标准,以便更好地为临床医师提供循证医学的治疗策略。本研究旨在对该指南的重点内容进行解读,同时与《2018 NICE指南：注意缺陷多动障碍的诊断和管理（NG.87）》以及我国目前相关的指南进行比较。     

ORIGINAL RESEARCH–EPIDEMIOLOGY: Selective Serotonin Reuptake Inhibitor-Induced Sexual Dysfunction

IntroductionSexual dysfunctions are often present in subjects with mood disturbances; however. antidepressants can induce per se sexual dysfunctions.AimTo explore the relationship between the use of selective serotonin reuptake inhibitors (SSRIs), non-SSRIs antidepressants and benzodiazepines (BDZ), hormonal parameters, and reported sexual dysfunction (as assessed by the Structured Interview on Erectile Dysfunction [SIEDY]) in male subjects with comparable psychopathological symptoms (as assessed by the Middlesex Hospital Questionnaire [MHQ] a self-reported test for the screening of mental disorders in a non-psychiatric setting).MethodsA consecutive series of 2,040 (mean age 51 ± 13 years) male patients with sexual dysfunction was studied.Main Outcome MeasuresSeveral hormonal and biochemical parameters were investigated, along with SIEDY and the MHQ.ResultsHigher prolactin was observed only in patients using SSRIs, whereas no other hormonal difference was found after adjustment for confounders. Use of SSRIs was associated with a twofold risk for patient hypoactive sexual desire and with a higher impairment of reported erectile function. However, no difference in penile blood flow was observed. A very high risk (sevenfold) for delayed ejaculation (DE) was observed in SSRI users. Interestingly, the association with the mild, but not severe, form of DE was observed also in subjects using non-SSRI antidepressants (3.35 [1.48–7.59]; P < 0.005). Different life stressors and relational parameters were also associated with SSRI use. SSRI users reported less enjoyment with masturbation and decreased partner desire and climax. Conversely, a lack of significant association was observed among BDZ or non-SSRI antidepressant users and all the aforementioned life-stressors and relational parameters.ConclusionsSSRIs can negatively affect all the steps of the male sexual response cycle (desire–arousal–excitement–orgasm). SSRI-associated sexual dysfunction has a deleterious effect on both auto- and couple-erotic performances. Conversely, other antidepressants and BDZ are less often associated with sexual impairment. Corona G, Ricca V, Bandini E, Mannucci E, Lotti F, Boddi V, Rastrelli G, Sforza A, Faravelli C, Forti G, and Maggi M. Selective serotonin reuptake inhibitor-induced sexual dysfunction. J Sex Med 2009;6:1259–1269.     

Alcohol and adolescents: Knowledge,attitudes, and behavior

Students (n = 3017) from the 6th, 8th, 10th, and 12th grades in six school districts throughout Georgia and South Carolina completed a questionnaire to determine their knowledge, attitudes, and behavior regarding alcohol use. Results suggest that knowledge, attitudes, and behavior are significantly correlated. Two distinct attitudes were discovered: acceptable use of alcohol and unacceptable uses of alochol, and these interacted with knowledge and behavior in different ways. Students who reported school as their major source of information about alcohol were more knowledgeable and had the most conservative attitudes toward unacceptable use of alcohol (p < 0.001). White students scored higher on the knowledge test and had more liberal attitudes than minority students (p < 0.001). Females were more conservative than males (p < 0.001), and older students had more liberal attitudes (p < 0.001). Our results suggest that efforts to educate youth about alcohol should incorporate acceptable uses as well as the negative aspects of drinking.     

In utero and postnatal programing of dehydroepiandrosterone sulfate (DHEAS) in young adult women

Fetal adrenal-derived OH-DHEAS is the primary precursor for maternal estriol, an abundant, human, placental estrogen. We measured maternal pregnancy estriol as a marker of fetal adrenal function + placenta capacity to synthesize estriol. We hypothesized that maternal estriol is directly correlated with the adrenal hormone, DHEAS, in young adult women. We tested this hypothesis in a subset of women in the Child Health and Development Studies (351 of 470 eligible). 176 of these had serum samples collected at ages 27–30 for DHEAS assays, archived maternal pregnancy serum for estriol assays, and childhood growth data. In regression analyses, both maternal estriol and accelerated growth in middle childhood were independently, directly associated with DHEAS (+19% for quartile 4 versus quartile 1 of estriol, 95%CI=+ 2%, +36% and +12% for quartile 4 versus quartile 1 for middle childhood growth, 95%CI= +3%, +21%). Adrenal function may be programmed in utero and middle childhood with long-term consequences.     

中成药治疗儿童注意缺陷多动障碍疗效和安全性的系统评价

目的 系统评价中成药治疗儿童注意缺陷多动障碍的疗效和安全性。方法 检索中国知网、万方数据库、维普网、中国生物医学文献服务系统、PubMed、Cochrane Library、PsycINFO、Embase中所有关于中成药治疗儿童注意缺陷多动障碍的随机对照试验。根据预先设定的标准由两名研究者独立筛选，使用Review Manager 5.3软件进行纳入研究的偏倚风险评估和Meta分析。结果 最终23项研究共2 314个对象被纳入数据分析，未发现中成药与安慰剂比较的研究。中成药组与哌甲酯组的总有效率比较，差异无统计学意义（RR=1.06，95% CI为0.99～1.13，P=0.08），但中成药组的不良反应总发生率低于哌甲酯组，差异有统计学意义（RR=0.14，95% CI为0.08～0.24，P<0.000 01）。中成药联合哌甲酯组总有效率高于哌甲酯组，差异有统计学意义（RR=1.17，95% CI为1.07～1.29，P=0.000 5）；两组不良反应总发生率的差异无统计学意义（RR=0.53，95% CI为0.24～1.17，P=0.11）。结论 中成药治疗儿童注意缺陷多动障碍疗效良好且不良反应少，但仍需要设计更合理的高质量随机对照研究，尤其是与安慰剂对照的研究来证实。