跖腱膜炎与功能性腓肠肌挛缩关系的临床观察

目的 研究跖腱膜炎与腓肠肌挛缩的关系.方法 对2010年9月～2010年1 1月足踝外科门诊收治的20人跖腱膜炎患者和31人正常足进行对比研究.结果 29足跖腱膜炎中16例(55.2％)合并腓肠肌挛缩.62正常足中 11例(17.7％)合并腓肠肌挛缩.结论 跖腱膜炎与腓肠肌挛缩关系密切,跖腱膜炎的患者多伴有腓肠肌挛缩.     

全内侧深入路造腔内镜技术在难治性跖筋膜炎治疗中的应用

目的:探讨全内侧深入路造腔内镜技术治疗难治性跖筋膜炎的可行性及其临床疗效。方法:回顾性研究。纳入徐州市中心医院2018年5月—2020年5月采用全内侧深入路造腔内镜技术治疗的28例30足难治性跖筋膜炎患者的临床资料。其中,男13例13足,女15例17足;年龄22～57（40±11）岁。症状持续时间8～24（17.0±4...     

The effects of unilateral medial arch support stimulation on plantar pressure and center of pressure adjustment in young gymnasts

The purpose of this study was to examine the contribution of tactile afferents from the medial arch of the foot on postural control. The center of pressure (CoP) position and right/left plantar pressure distributions of 13 gymnasts, with and without a medial arch support, were recorded by a force platform coupled with a baropedometry analysis. Stimulation of the subject's plantar sole was accomplished using a 3 mm thick medial arch insert. Right arch stimulation induced an ipsilateral increase of plantar pressure and a contralateral displacement of the CoP to the left. Left arch support also resulted in an ipsilateral increase in plantar pressure and displacement of the CoP to the right. Stimulation of the plantar arch may induce a perception that the body's center of mass has shifted toward the stimulated foot. To maintain stability, individuals may then shift their CoP in the opposite direction. This response may involve compensatory muscle activation strategies to adjust posture. Clinicians may apply these results in their use of foot orthoses to address postural anomalies in patients.     

无症状扁平足与正常足的足底压力和足弓形态对比研究

目的　通过与正常足青年女性对比分析得出无症状扁平足足底压力和足弓形态的特征。 方法　利用Zebris足底压力测量仪对正常足组（12例）和扁平足组（12例）进行直立状态和行走状态下的足底压力测试,并拍摄其负重位和非负重位的侧位X线片进行足弓形态测量,测量数据进行统计学分析。 结果 双足直立时,扁平足组与正常足组的足底压力差异无显著意义（P>0.05）;单足直立时,扁平足组的前足负重比例增大;步行时,扁平足组与正常足组足底压力中心运动轨迹有明显区别。扁平足组负重位与非负重位的足弓形态各参数有显著差异（P<0.05）,而且扁平足组负重位与正常足组负重位的足弓形态有显著差异（P<0.05）。 结论 无症状扁平足单足直立和行走状态的足底压力和足弓形态与正常足相比有明显区别,为评价、诊断和预防无症状扁平足提供定量化数据。     

足弓第2与第5跖列的肌骨系有限元模型及其临床意义

目的：建立足部内侧纵弓第2跖列与外侧纵弓第5跖列的肌骨系统有限元模型,为研究跖骨应力性骨折与相关足痛症提供生物力学工具。方法：采用中国虚拟人“女性1号”CT图像和MRI图像;应用非线性有限元方法进行生物力学分析。结果：构建了包含皮质骨、松质骨、软骨、韧带、足底腱膜、肌腱、固有肌、脂肪垫、骨髓腔与骨髓窦等10种组织的第2、第5跖列的有限元模型。足弓直立时,最大von Mises应力／应变位于第2、第5跖骨骨干与基底。各种足底软组织中,足底腱膜承担着最大张拉应力,其次为足底长韧带,足底固有肌张拉应力最小。结论：有限元预测的应力应变为研究跖骨应力性骨折,足底腱膜炎引起的慢性跟骨痛,以及足弓塌陷的发生机制提供了生物力学依据。     

足内缘动脉弓为蒂的足内侧岛状皮瓣应用解剖

目的　为足内侧岛状皮瓣修复足底外侧皮肤缺损提供解剖学依据。   方法　35侧成年尸体足标本,经动脉灌注红色乳胶,在手术显微镜下(×10)解剖观测母展肌上缘动脉弓与足底内侧动脉深支内侧支吻合的位置、外径及长度。  结果  　母展肌上缘动脉弓与足底内侧动脉深支内侧支在内侧楔骨内侧有一较恒定的吻合,并把这一吻合支暂命名为足内缘动脉弓。形成足内缘动脉弓占82.8%（29侧）,吻合处外径为(0.65±0.21)mm,长度为（2.63±0.71）mm;未发现吻合动脉弓占17.2%（6侧）。  结论　以足内缘动脉弓为蒂的足内侧岛状皮瓣可以修复足底外侧皮肤缺损。     

Dynamics of longitudinal arch support in relation to walking speed: contribution of the plantar aponeurosis

The plantar aponeurosis (PA), in spanning the whole length of the plantar aspect of the foot, is clearly identified as one of the key structures that is likely to affect compliance and stability of the longitudinal arch. A recent study performed in our laboratory showed that tension/elongation in the PA can be predicted from the kinematics of the segments to which the PA is attached. In the present investigation, stereophotogrammetry and inverse kinematics were employed to shed light on the mechanics of the longitudinal arch and its main passive stabilizer, the PA, in relation to walking speed. When compared with a neutral unloaded position, the medial longitudinal arch underwent greater collapse during the weight‐acceptance phase of stance at higher walking speed (0.1°±1.9° in slow walking; 0.9°±2.6° in fast walking; P = 0.0368). During late stance the arch was higher (3.4°±3.1° in slow walking; 2.8°±2.7° in fast walking; P = 0.0227) and the metatarsophalangeal joints more dorsiflexed (e.g. at the first metatarsophalangeal joint, 52°±5° in slow walking; 64°±4° in fast walking; P < 0.001) during fast walking. Early‐stance tension in the PA increased with speed, whereas maximum tension during late stance did not seem to be significantly affected by walking speed. Although, on the one hand, these results give evidence for the existence of a pre‐heel‐strike, speed‐dependent, arch‐stiffening mechanism, on the other hand they suggest that augmentation of arch height in late stance is enhanced by higher forces exerted by the intrinsic muscles on the plantar aspect of the foot when walking at faster speeds.     

Motion characteristics of the medial and lateral longitudinal arch during landing

This study determined sagittal plane motion of the medial longitudinal arch (MLA) and lateral longitudinal arch (LLA) as well as the kinematics of the arch during landing. IRB-approved informed consent was obtained from 10 healthy male subjects (23.4 ± 3.4 years old) who performed single leg landings from a height of 10 cm with their knee extended. The subjects were then asked to stop and balance after each landing. Each trial was recorded using cineangiography. Images were obtained at a rate of 60 Hz using a radiation exposure equivalent to 200 mA (1 ms) with an intensity of 50 kV. Simultaneous ground reaction forces were measured using a force plate. The data were analyzed using a template method. Sagittal motion was defined as the change in the angle and the translational motion of the arch. A paired t test was performed to determine the differences in the measured values between the MLA and the LLA. The magnitude of the arch angle increased with time for 80–100 ms in all subjects. The magnitude of the arch angle for the LLA was significantly larger than that for the MLA. Regarding translational motion, the motion of the MLA was larger than that of the LLA. It was clear that each longitudinal arch had a different deformation pattern in absorbing the impact on landing. The MLA had a small angular change and a moderate degree of translational motion. Conversely, the motion of the LLA was mainly an angular change with a small translational motion.     

Extent and level of fascial involvement in 100 cases with nodular fasciitis

Summary Nodular fasciitis (NF) shows a cellular proliferation which leads to widening of the fascia. Frequently unilateral or more often bilateral disruption of the fascia, with an infiltrative pattern is present. Subcutaneous fascia and surrounding fat are involved. Superficially the cellular proliferation may extend into dermal connective tissue. Deeper muscular tissue may be involved, with transitional forms or purely intramuscular changes, compatible with proliferative myositis. Proliferative myositis is considered to be a deep-seated variant of NF with muscular involvement. Intramuscular myxoma may be thought of as an intramuscular and mucoid variant of NF. A bilateral infiltrative pattern was most frequently found at all levels; in cases with muscular involvement it was always present.

---

Zusammenfassung Die Beurteilung der Ausdehnung und des topographischen Niveaus der FascienverÄnderungen bei 100 FÄllen mit nodulÄrer Fasciitis ergab z.T. nur intrafasciale Zellproliferation mit spindeliger Auftreibung der Fascie. HÄufiger fand sich jedoch einseitig von der Fascie ausgehendes infiltratives Wachstum, am hÄufigsten eine vollstÄndige Unterbrechung der ursprünglichen Fascienstruktur mit beidseitiger Infiltration der Umgebung.Die nodulÄre Fasciitis befiel nicht nur die subcutane Fascie und das umgebende Fettgewebe. VerÄnderungen der oberflÄchlichen Fascie führen zu einer Mitbeteiligung der Cutis. Bei tief gelegener nodulÄrer Fasciitis greifen die VerÄnderungen auf die Muskulatur über. Es finden sich entweder übergangsformen zur proliferativen Myositis bei Befall der supramuskulÄren Fascie oder bei rein intramuskulÄren VerÄnderungen das typische Bild des proliferativen Myositis, die demnach als tiefsitzende Variante der nodulÄren Fasciitis mit Muskelbeteiligung aufgefa\t werden kann. IntramuskulÄre Myxome, die ebenfalls z.T. übergangsformen zur typischen nodulÄren Fasciitis erkennen lie\en, scheinen eine intramuskulÄre mucoide Variante der nodulÄren Fasciitis darzustellen.Insgesamt fand sich am hÄufigsten eine bilaterale Infiltration in allen Lagen der nodulÄren Fasciitis. In FÄllen mit Muskelbeteiligung fand sich ausschlie\lich eine Zellproliferation mit Zerstörungen der Fascie und bilateraler Infiltration der Umgebung.

     

趾足底固有动脉趾端动脉弓及其分支的显微解剖

目的　解剖观测趾足底固有动脉趾端动脉弓及其分支的解剖学特点。 方法　选取新鲜成人足标本8只,分别经足背动脉灌注红色乳胶,对第2趾趾足底固有动脉进行显微解剖,观察趾足底固有动脉弓的出现概率,位置及其口径,趾端动脉弓发出的弓上动脉的起始部位,走行方向,分支数目及血管口径情况。 结果　第2趾趾足底固有动脉趾端动脉弓恒定,动脉弓的外径为0.5~0.8 mm,平均外径为0.64 mm,动脉弓距趾端的距离为9.5~13.0 mm,平均为11.1 mm。动脉弓上发出5支恒定的分支,即趾端弓上动脉,我们将其命名为第1~5支趾端弓上动脉（由胫侧至腓侧）。 结论 第2趾趾端动脉弓及其发出的弓上动脉解剖恒定,可以采用弓上动脉为蒂的微型轴型皮瓣改善第2足趾再造后外形。     

Proliferative fasciitis of the forearm: Case report with immunohistochemical, ultrastructural and DNA ploidy studies and a review of the literature

A case of prollferative fasclitis arising In the left forearm of a 56-year-old man was examined. The lesion was preceded by blunt trauma, measured 1.5 times 1.3 times 1.0 cm, was poorly circumscribed and appeared white to light gray on the cut surface. Light microscopic examinations revealed that spindle cells and giant cells with one or two nuclei and abundant basophllic cytoplasm ware arranged without any organized patterns In collagenous stroma. Ultrastructurally, well-developed rough endoplasmic reticulum separated by varying amounts of fine to course fibrillar materials was detected in the giant cells. Only vimentin lmmunoreactivity was detected In both spindle and gtant cells. The Ki-67 labeling Index of spindle cells was 35% but that of giant cells was less than 5%, and this reflects the quiescent or slow-growing features of these giant cells in proliferative fasclitis. DNA content of the calls, which was examined by Image cytometry, demonstrated diploidy In both spindle (DNA Index = 1.01) and glant (DNA Index = 1.09) calls.     

Clinical significance of musculoskeletal finite element model of the second and the fifth foot ray with metatarsal cavities and calcaneal sinus

Aim

The aim of this study was to establish musculoskeletal finite element (FE) model of the second and the fifth foot ray accounting for metatarsal cavities and calcaneal sinus. The model was then used to predict the effects of metatarsal cavities and calcaneal sinus on internal stresses/strains of plantar longitudinal arches.

Materials and methods

The geometry of foot bones and soft tissues were constructed by CT and MRI images of Virtual Chinese Human “female No. 1”. Two types of nonlinear FE models of sagittal foot rays were developed with or without metatarsal cavities and calcaneal sinus using ANSYS © software package. The sagittal trabecular architecture of metatarsals and calcaneus were obtained by cutting, defatting and bleaching fresh foot specimen of a cadaver.

Results

The model proposed was able to describe the isostatic stress flows in sagittal planes of plantar longitudinal arches. The size of metatarsal cavity or calcaneal sinus could affect stress/strain distributions on metatarsals and calcaneus, but had almost no effects on stress/strain of other foot bones and plantar soft tissues. During balance standing, the maximum von Mises stresses were predicted at the shaft and the basis of metatarsals, while the maximum strains of bony regions were found around metatarsal cavities. Among plantar soft tissues, relative high tensions were burdened by plantar fascia, followed by long plantar ligament. The minimum tensions occurred in plantar intrinsic muscles.

Conclusions

The study shows that the tension/compression stress flows are geometrically similar with the tension/compression trabecular architectures in sagittal sections of metatarsal and calcaneus. The FE predictions of stress/strain concentration on metatarsals and fascia are useful in enhancing biomechanical knowledge on metatarsal stress fractures and plantar fasciitis.

     

肠内外营养联合负压封闭引流治疗会阴部坏死性筋膜炎的疗效观察

目的 探讨肠内外营养联合负压封闭引流治疗会阴部坏死性筋膜炎的疗效.方法 选择2016年1月至2019年6月黑龙江省医院烧伤科收治的30例会阴部坏死性筋膜炎患者,按随机数字表法分为实验组(n = 15)和对照组(n = 15).创面治疗方案均采取手术清创、持续负压封闭引流、创面基底床准备充分时植皮或皮瓣修复创面.实验组术...     

Incidence and significance of 22q11.2 hemizygosity in patients with interrupted aortic arch

Interruption of the aortic arch (IAA) is a severe malformation of the heart with known association to DiGeorge syndrome (DGS) and 22q11.2 hemizygosity. The aim of this study was to establish incidence and significance of 22q11.2 hemizygosity in an unbiased sample of patients with IAA. All 15 children with IAA who were referred to our hospital in a 3-year period were tested by chromosome and fluorescence in situ hybridization (FISH) analysis with the probes D22S75, Tuple1, and cHKAD26 and by a set of 10 simple tandem repeat polymorphic (STRP) markers. In nine of 11 children with IAA type B, 22q11.2 hemizygosity was demonstrated by FISH and STRP analysis, but in none of the four children with type A. In all but one child, deletion size was ∼3 Mb. The girl with the smaller deletion of ∼1.5 Mb differed because of an Ullrich-Turner syndrome-like phenotype and severe T-cell defect. Additionally, in one patient with phenotypic signs of DGS, a small deletion distal to the known DGS region containing the marker D22S308 was suspected by STRP analysis. One deletion was shown to be inherited from a healthy father and one IAA type A recurred in a sib. T-cell anomalies were evident in eight of the nine children with classical deletion, five of whom suffered also from hypoparathyroidism. With respect to cause and clinical course, IAA type A and B were shown to represent different entities. This study showed that variable symptoms of 22q11.2 hemizygosity may cluster. Am. J. Med. Genet. 78:322–331, 1998. © 1998 Wiley-Liss, Inc.     

Prevalence and association of somatic symptoms in patients with Major Depressive Disorder

BACKGROUND: Painful and non-painful somatic symptoms are often reported in patients with depressive disorder. The proper identification of depression-relevant somatic symptoms is important for the accurate diagnosis of depression, development of treatment strategies and measurement of outcome. The objective of this study was to characterize the relationship between somatic symptoms and depression in patients diagnosed with Major Depressive Disorder (MDD), using data from randomized drug trials carried out by a pharmaceutical company. METHODS: Pooled 'blinded' data from 2191 patients enrolled in randomized, multicenter, double-blind placebo-controlled studies for the treatment of MDD were analyzed. Somatic symptoms were assessed using the Somatic Symptoms Inventory (SSI) and the Hamilton Depression Rating Scale (HAMD) was used to assess symptoms of depression. RESULTS: The most common somatic symptom reported by patients with MDD was 'feeling fatigued, weak, or tired all over', with 78% of patients reporting 'moderate' levels or above. This was followed by 'feeling that not in as good physical health as most of your friends' (59%), 'not feeling well most of the time in the past few years' (54%), and 'feeling weak in parts of body' (45%). 'Headache' was the most common pain-related symptom with 43% reporting 'moderate' or above. Pearson's product-moment correlations revealed that somatic symptoms generally increased as a function of overall depressive (r=0.43), with 'feeling fatigued, weak, or tired all over' (r=0.50), 'feeling that not in as good physical health as most of your friends' (r=0.42), 'feeling weak in parts of body' (r=0.41), 'heavy feeling in arms and legs' (r=0.34), 'not feeling well most of the time in the past few years' (r=0.32), and 'headache' (r=0.31) showing the strongest correlation with overall HAMD scores. Non-parametric item response analyses showed that many somatic symptoms demonstrate good relationship between item response and the overall severity of depression. In particular, 'feeling fatigued, weak, or tired all over' exhibited good discriminative properties across the full range of severity for depression. LIMITATIONS: The analysis utilized data from a 'restricted' patient population in drug trials sponsored by a pharmaceutical company. CONCLUSIONS: These results demonstrate a high prevalence and association of somatic symptoms in patients with MDD, including feelings of fatigue, physical malaise and pain-related symptoms, which could be potentially useful in the assessment of depression and in the evaluation of treatment strategies.     

Anomalous origin of the brachiocephalic vessels with right aortic arch and contralateral subclavian steal syndrome

Summary Anomalies of origin of the brachiocephalic vessels are uncommon. The authors report a new case of such an abnormality revealed by a subclavian steal syndrome. The angiographic study showed a right aortic arch with hypoplasia of the origin of the left subclavian a., which arose from the descending aorta, and a collateral cervical circulation derived from the left vertebral a. and the right subclavian a.

---

Anomalies d'origine des vaisseaux cervicaux à destinée encéphalique avec dextro-position de l'arc aortique et syndrome subclavier controlatéral

Résumé Les auteurs rapportent le cas d'une jeune femme ayant une symptomatologie évoquant un syndrome subclavier. Les différents examens vasculaires (Doppler, angiographie) ont montrés une anomalie d'origine des vaisseaux cervicaux à destinée encéphalique avec un arc aortique à droite par rapport à la trachée, une hypoplasie du segment proximal de l'a. subclavière gauche qui nait de l'aorte thoracique descendante et prise en charge du segment artériel distal par une circulation collatérale cervicale développée à partir des branches musculaires issues de l'a. vertébrale.

     

Biomechanical characterization of ascending aortic aneurysm with concomitant bicuspid aortic valve and bovine aortic arch

Studies have shown that patients harboring bicuspid aortic valve (BAV) or bovine aortic arch (BAA) are more likely than the general population to develop ascending aortic aneurysm (AsAA). A thorough quantification of the AsAA tissue properties for these patient groups may offer insights into the underlying mechanisms of AsAA development. Thus, the objective of this study was to investigate and compare the mechanical and microstructural properties of aortic tissues from AsAA patients with and without concomitant BAV or BAA. AsAA (n = 20), BAV (n = 20) and BAA (n = 15) human tissues were obtained from patients who underwent elective AsAA surgery. Planar biaxial and uniaxial failure tests were used to characterize the mechanical and failure properties of the tissues, respectively. Histological analysis was performed to detect medial degenerative characteristics of aortic aneurysm. Individual layer thickness and composition were quantified for each patient group. The circumferential stress–strain response of the BAV samples was stiffer than both AsAA (p = 0.473) and BAA (p = 0.152) tissues at a low load. The BAV samples were nearly isotropic, while AsAA and BAA samples were anisotropic. The areal strain of BAV samples was significantly less than that of AsAA (p = 0.041) and BAA (p = 0.004) samples at a low load. The BAA samples were similar to the AsAA samples in both mechanical and failure properties. On the microstructural level, all samples displayed moderate medial degeneration, characterized by elastin fragmentation, cell loss, mucoid accumulation and fibrosis. The ultimate tensile strength of BAV and BAA sampleswere also found to decrease with age. Overall, the BAV samples were stiffer than both AsAA and BAA samples, and the BAA samples were similar to the AsAA samples. The BAV samples were thinnest, with less elastin than AsAA and BAA samples, which may be attributed to the loss of extensibility of these tissues at a low load. No apparent difference in failure mechanics among the tissue groups suggests that each of the patient groups may have a similar risk of rupture.     

正常人与青少年特发性脊柱侧凸患者椎弓根磁共振对比

目的:应用MRI成像技术对正常人与青少年特发性脊柱侧凸(AIS)患者椎弓根的不对称性进行对比分析,评价AIS患者是否表现出一致的形态学特点。方法:分析8位正常人的76个椎弓根和10例AIS早期患者的80个椎弓根的MRI成像。测定并比较正常人和AIS早期患者椎弓根不对称的程度和方向。结果:正常人表现出椎弓长度的不对称,左侧椎弓根和椎板长度较长,差异无统计学意义。AIS患者也表现出不对称,两者相比后者的不对称性更明显并有统计学意义。AIS患者的这种椎弓根不对称在侧凸凸侧和凹侧之间没有一致的分布。结论:研究AIS椎骨形态学的标准应该重新考虑,AIS椎骨形态不对称的类型依赖于特定的病因。     

Shape variation of the neural arch in the thoracic and lumbar spine: characterization and relationship with the vertebral body shape

Quantifying the human vertebral geometry is important for accurate medical procedures. We aimed to characterize the neural arch (NA) shape at T1-L5. All T1-L5 dry vertebrae (N = 4,080) of 240 individuals were measured and analyzed by age, gender, and ethnicity. A 3D digitizer was used to measure the dimensions of the spinous (SP) and transverse (TP) processes, vertebral canal (VC), laminae, and isthmus. Most parameters were independent of age and ethnicity, yet greater in males than in females. Isthmus length increases from T1 (9.8 mm) to T12 (19.87 mm) and decreases from T12 to L5 (9.68 mm) with right > left in the thorax and oppositely in the lumbar region. The SP is longer than its thickness both decreasing in the upper thorax (by ca. 4mm), increasing in the lower thoracic and upper lumbar vertebrae (by 7 mm for length and ca. 14.5 mm for thickness) and decreasing again along the lower lumbar vertebrae (both by 8 mm). The TP length decreases at T1-T12 (by 13 mm) and increases at L1-L5 with left > right at T1-L5 (P < 0.003). The laminar length decreases from T1 (8.72 mm) through T5 (4.76 mm) and increases toward L5 (8.4 mm) with right > left at T1-L5 (P < 0.003). The VC is oval-shaped at T1 and T11-L5 (width > length), rounded-shape at T2 and T10 (width = length), and inverted oval-shaped at T3-T9 (length > width). In conclusion, the NA is systematically asymmetrical and dynamic in shape along the thoracic and lumbar spine. The inter-relationship with the vertebral body and articular facets is discussed.     

Concurrent and longitudinal associations of basal and diurnal cortisol with mental health symptoms in early adolescence

Recent biosocial theories postulate that both biological risk and the social context influence the development of mental health problems [Boyce and Ellis (2005) Development and Psychopathology, 17(2), 271-301]. Guided by this framework, we examined whether basal cortisol and its diurnal rhythm were associated with mental health symptoms in early adolescence. Because cross-sectional and longitudinal investigations sometimes reveal different cortisol-mental health associations, we examined the association both concurrently and longitudinally when children transition to middle school, a time which entails a major change in social context from single to multiple teachers, classrooms, and sets of classmates. Salivary cortisol was measured three times a day (waking, afternoon, and bedtime) across 3 days when adolescents were 5th graders. Mental health was measured when adolescents were in 5th and 7th grades, just before and after the transition to middle school. To deal with the substantial comorbidity of internalizing and externalizing symptoms at this developmental stage, mental health measures distinguished overall symptom severity from the preponderance of internalizing versus externalizing symptoms (i.e., directionality). A three-level Hierarchical Linear Model was used to extract basal cortisol and its diurnal rhythm separate from the day-to-day and within-the-day fluctuations in cortisol in response to daily experiences. Results were specific to symptom severity, suggesting that cortisol is a nonspecific risk factor for mental health symptoms in young adolescents. At 5th grade, low basal cortisol was associated with concurrent symptom severity. However, longitudinally, it was adolescents with high cortisol at 5th grade who were at risk for increasing mental health symptoms by 7th grade. Flat diurnal rhythms in 5th grade were related to levels of symptom severity at both 5th and 7th grades. Considering the change in social context, as defined by the transition to middle school, helped resolve seemingly inconsistent evidence that both hypo- and hyper-arousal were associated with mental health symptoms in early adolescence.