Lithium treatment of chronic hair pulling

Ten patients with chronic hair pulling received trials of lithium carbonate of 2 to 14 months' duration. Eight patients demonstrated decreased hair pulling and mild to marked hair regrowth. Three responders experienced increased hair pulling subsequent to discontinuation of lithium treatment. Lithium's effect on hair pulling may be related to its observed benefits in treating aggressivity, impulsivity, and mood instability.     

Real world experience with teriflunomide in multiple sclerosis: the TER-Italy study

Journal of Neurology - To identify baseline factors associated with disease activity in patients with relapsing–remitting multiple sclerosis (RRMS) under teriflunomide treatment. This was an...     

An integrated components preventive intervention for aggressive elementary school children: the early risers program

The Early Risers prevention program aims to alter the developmental trajectory of children with early onset aggressive behavior. The program features 4 CORE components: (a) an annual 6-week summer school program, (b) a teacher consultation and student mentoring program, (c) child social skills groups, and (d) parent education and skills-training groups, all delivered in tandem with a FLEX family support program individually tailored to address the unique needs of families. At baseline, the mean age of the sample was 6.6 years. Following 2 years of intervention, program children showed significant improvement relative to controls in academic achievement and school behaviors. Change on behavioral self-regulation was moderated by level of child aggression, with intervention effects found for only the most severely aggressive children. Parents with high program attendance rates showed improvement in discipline methods.     

Sexual Behaviors in Autism: Problems of Definition and Management

Surveys of sexual behavior in autism suggest a variety of behavioral expression. However, the course of sexual development in autism is unplotted, leaving questions about the normalcy of specific behaviors. Even less is known about deviations of sexual development and the incidence of paraphilias in this population. We explore the problems of definition of sexual behaviors and describe a case report that highlights the difficulties of management. An application of a testosterone-suppressing medication and its effect on sexual behavior are reported. After failure of behavioral and educational programs, leuprolide, an injectable antiandrogen, resulted in suppression of behaviors and retention of the participants' community placement. Follow-up for almost 3 years shows no abnormal physical effects. Dosage has been tapered over that period to a low but effective dose. Directions for research are discussed.     

The Roles of Reelin, Bcl2, and Serotonin in Cerebellar Pathology in Autism

This review describes involvement of serotonin, Reelin, and Bcl2 in cerebellar pathology in autism. The literature regarding neurochemical, neuropathologic, and imaging aspects of autistic pathology as related to cerebellum is discussed. Where appropriate, relevant animal data are also presented to explain the impact of environmental and genetic influences on development of autism.     

Growth hormone response to L-Dopa and clonidine in autistic children

Studies have shown abnormal pituitary hormone responses to neuroendocrine agonists in autistic subjects. Two probes (clonidine and L-Dopa) were used to investigate neuroendocrine responses through changes in growth hormone levels. Seven medication-free autistic subjects (ages 6.6 to 19.1) were evaluated and compared to 14 normal controls. Growth hormone was collected at 30-min intervals during the entire study. Clonidine was administered first (dose: 0.15 mgm ² ), and samples were collected for 180 min. L-Dopa was then administered (dose: 250 mg for subjects <70 lb and 500 mg for subjects >70 lb), and samples were collected for 120 min. There was no difference in the amplitude of the clonidine or L-Dopa peak growth hormone responses in the control versus the autistic subjects. In the autistic subjects, the L-Dopa-stimulated growth hormone peak was delayed and the clonidine growth hormone peak was premature. A statistical difference with the control subjects was found when consideration was given to both the premature response of growth hormone to clonidine and the delayed response to L-Dopa (p=.01, Fisher's Exact Test). These findings suggest possible abnormalities of both dopaminergic and noradrenergic neurotransmission in subjects with autism.The authors thank Dorothee Aeppli for statistical consultation, Mary Bennett for clerical assistance, Lois Laitinen for secretarial support, and the Twin Cities Society for Autistic Children for access to patient recruitment. This study was supported in part by a grant from the Alex Kunin Foundation.     

Adolescent survivors of massive childhood trauma in Cambodia: Life events and current symptoms

Cambodian adolescents who survived massive trauma as children were studied to examine the relation of current trauma symptoms to sex, age, trauma exposure, and other current symptoms. Exposure to traumatic life events was expected to be very high, to relate to age and to other symptoms of current psychological functioning. Questionnaires assessed traumatic life events, post-traumatic stress disorder (PTSD) and other psychiatric symptoms, and current functioning. Results document high levels of stress exposure and current trauma symptoms. Based on self-reports of PTSD symptoms, 37% of the subjects were estimated to fulfill DSM-III-R criteria for PTSD. Trauma symptoms were correlated with exposure (r=.31), although not with symptoms of depressed mood, anxiety, or dissociation. Age was related to high levels of recollected trauma exposure (r=.56). Further studies are needed to identify factors associated with better outcomes and to plot the differential course of PTSD symptom clusters over time.     

One-step osteochondral repair with cartilage fragments in a composite scaffold

Purpose

This study proposes a single-step therapeutic approach for osteochondral defects using autologous cartilage fragments loaded onto a scaffold composed of a hyaluronic acid (HA) derivative, human fibrin glue (FG) and autologous platelet-rich-plasma (PRP), in a rabbit model. The aim is to demonstrate the in vitro outgrowth of chondrocytes from cartilage fragments and the in vivo formation of a functional repair tissue.

Methods

In vitro: minced articular cartilage was loaded onto two different types of scaffold (paste or membrane) according to two different HA preparations (injectable HA-derivative or HA-derivative felt). In vivo: trochlear osteochondral defects were created in 50 adult rabbits, which were then assigned to 5 different treatment groups: cartilage fragments loaded onto membrane scaffolds with FG (Group 1) or without FG (Group 2); membrane scaffolds alone with FG (Group 3) or without FG (Group 4); empty defects (Group 5). Membrane scaffolds were used “in vivo” for simpler preparation and better adhesive properties. Repair processes were evaluated histologically and by immunohistochemistry at 1, 3, and 6 months.

Results

An in vitro time-dependent cell outgrowth from cartilage fragments was observed with both types of scaffolds. At 6 months, in vivo, cartilage fragment-loaded scaffolds induced significantly better repair tissue than the scaffold alone using histological scoring. Repair in Group 2 was superior to that in any of the control groups (p < 0.05).

Conclusion

Autologous cartilage fragments loaded onto an HA felt/FG/PRP-scaffold provided an efficient cell source, and allowed for an improvement of the repair process of ostechondral defects in a rabbit model. Human FG, however, hampered the rabbit healing process. These results may have clinical relevance as they show the potential of a novel one-stage repair technique for osteochondral defects.