Elevated repetitive behaviors are associated with lower diurnal salivary cortisol levels in autism spectrum disorder

Previously, we reported a subgroup of children with autism spectrum disorders (ASD) had consistently high rates of repetitive behaviors (RBs) with abnormal sensory sensitivity. Given evidence of lower cortisol levels in response to stress and associated sensory sensitivity in the ASD population, this pilot study evaluates whether the presence of RBs reflects an underlying pathophysiology related to cortisol regulation. Diurnal salivary cortisol from 21 children with ASD and high versus low occurrence RBs were collected at four time points over three consecutive days. Although a typical decline in salivary cortisol was observed, participants in the high RB group showed 36% lower diurnal salivary cortisol than the low RB group. Age, IQ, RB type, and sleep quality were unrelated to observed differences. These findings suggest that RBs may serve to mitigate distress or that the glucocorticoid system has been down regulated in association with prolonged distress in this sample population.     

Women lose patella cartilage at a faster rate than men: A 4.5-year cohort study of subjects with knee OA

Objectives

Patellofemoral knee osteoarthritis (OA) is a common disease, and a significant cause of knee pain, however few data have examined longitudinal change at the patellofemoral joint. The aim of this study was to examine factors affecting change in patella cartilage over a longer time period than previously examined.

Study design

Longitudinal study of 77 subjects (58% female) with knee OA underwent magnetic resonance imaging (MRI), with a repeat MRI of the same knee obtained approximately 4.5 years later.

Main outcome measures

Annual change in patella cartilage volume, and annual percentage change over 4.5 years.

Results

After adjusting for age, gender, BMI and patella bone volume at baseline, cartilage change was observed at the rate of 2.5% (95% confidence interval, 2.0, 3.0) per annum over 4.5 years. Cartilage was lost at a higher rate in women compared to men after accounting for age, BMI or bone volume at baseline (3.3% vs. 1.4%, respectively, p = 0.03). Increased patella bone volume was associated with increased patella cartilage loss (p = 0.02). No measures of radiographic severity of disease affected change in cartilage volume.

Conclusions

The increased rate of cartilage loss in women may contribute to the increased prevalence of disease, although the underlying mechanism requires further study. Increased patella bone volume was also associated with increased patella cartilage loss. Whether this is due to biomechanical factors will need to be determined.     

Electrical impedance in the lower limbs of patients with Duchenne muscular dystrophy: A preliminary study

Electrical impedances were measured, at a range of frequencies from 2 to 200 kHz, in the lower limbs of nine patients with Duchenne muscular dystrophy and 12 normal subjects. The specific admittance was calculated from the impedance, based on the assumption that the shape of the part of the limb measured is a truncated cone. Curve-fitting to the admittance locus on the complex plane gave the intracellular and extracellular resistances and the membrane capacitance. The intracellular resistance was higher and the membrane capacitance was lower in the patients than in the normal subjects. The membrane capacitance in the normal subjects increased with age. In the patients, the membrane capacitance decreased, and the intracellular resistance increased with the stage of disability, which was assessed by a physician. These experimental results agree well with the theoretical explanation, which uses simplified spherical models to represent living tissue.     

Women have Relatively Larger Brains than Men: A Comment on the Misuse of General Linear Models in the Study of Sexual Dimorphism

General linear models (GLM) have become such universal tools of statistical inference, that their applicability to a particular data set is rarely questioned. These models are designed to minimize residuals along the y‐axis, while assuming that the predictor (x‐axis) is free of statistical noise (ordinary least square regression, OLS). However, in practice, this assumption is often violated, which can lead to erroneous conclusions, particularly when two predictors are correlated with each other. This is best illustrated by two examples from the study of allometry, which have received great interest: (1) the question of whether men or women have relatively larger brains after accounting for body size differences, and (2) whether men indeed have shorter index fingers relative to ring fingers (digit ratio) than women. In depth analysis of these examples clearly shows that GLMs produce spurious sexual dimorphism in body shape where there is none (e.g. relative brain size). Likewise, they may fail to detect existing sexual dimorphisms in which the larger sex has the lower trait values (e.g. digit ratio) and, conversely, tend to exaggerate sexual dimorphism in which the larger sex has the relatively larger trait value (e.g. most sexually selected traits). These artifacts can be avoided with reduced major axis regression (RMA), which simultaneously minimizes residuals along both the x and the y‐axis. Alternatively, in cases where isometry can be established there are no objections against and good reasons for the continued use of ratios as a simple means of correcting for size differences. Anat Rec, 2011. © 2011 Wiley‐Liss, Inc.     

Relations of plasma acth and cortisol levels with the distribution and function of peripheral blood cells in response to a behavioral challenge in breast cancer: An empirical exploration by means of statistical modeling

This study explores by means of statistical modeling the relations between adrenocorticotrophin hormone (ACTH) and Cortisol levels and distribution and function of peripheral blood cells in response to an acute stressor consisting of a standardized speech task in breast cancer patients with axillary lymphnode metastases and distant metastases. As a control group age-matched women participated in this study. The preliminary findings show that the effect of ACTH on imrrmnoreacrivity is related to the health of the donor. In node-positive breast cancer patients and healthy women, ACTH has a modest positive effect on T lymphocyte percentages and on pokeweedinduced proliferation at baseline and in response to the speech task. In contrast, in breast cancer patients with distant metastases ACTH has a negative effect on T lymphocyte percentages and function at baseline and in response to the stressor. Interestingly, neither ACTH nor Cortisol levels were related to natural killer (NK) cell percentages and natural killer cell activity (NKCA). In addition, it appeared that Cortisol had a positive effect on CD3 cell percentages when the health of the donor was taken into account. This effect was most distinct on CD3 cells measured at baseline. If replicated on a larger scale, these findings may indicate that the hypothalamic pituitary adrenal axis plays a role in the adaptation of the host defenses in reaction to acute stress, particularly those involving T lymphocytes. Moreover, these findings may suggest that the health of the donor may be an important effect modification factor in the relations between neuroendocrines and immunoreacttvity.     

No difference in long-term outcomes between men and women undergoing medial fixed-bearing cemented unicompartmental knee arthroplasty: A retrospective cohort study with minimum 10-year follow up

BackgroundSome studies have suggested that women have poorer short-term outcomes after unicompartmental knee arthroplasty (UKA) due to a higher incidence of implant overhang. This study aimed to compare patient-reported outcome measures (PROMs) between men and women after UKA at a minimum follow-up of 10 years.MethodsPatients who underwent medial fixed-bearing UKA by two arthroplasty surgeons were identified from an institutional joint registry. Men and women were matched for age, body mass index, Charlson Comorbidity Index, American Society of Anesthesiologists class, range-of-motion and baseline PROMs using propensity scores. PROMs were compared at 2 and 10 years. Patients also completed a satisfaction questionnaire during these visits. Radiographic outliers were defined as > 2 mm of overhang.ResultsA total of 128 patients were included. There was no difference in complications, length of stay or readmissions. Women had poorer Knee Society functional scores, Short-Form 36 physical and mental component scores (SF-36 MCS) at 2 years. No difference in PROMs was found at 10 years, except for poorer SF-36 MCS in women (P = 0.041). At 10 years, 96% of women and 92% of men were satisfied (P = 0.243). Fifteen-year survivorship free from any revision was 96% in each group. There were more medial-tibial outliers in women (9%) compared with men (5%) (P = 0.018). However, no association between outliers and outcomes or survivorship was found on multivariate analyses.ConclusionThere was no difference in clinical outcomes between men and women undergoing UKA at a minimum follow-up of 10 years. While women had a higher incidence of medial tibial overhang, this was not associated with long-term outcomes or survivorship.     

Smoking policies in the home have less influence on cigarettes per day and nicotine dependence level among African American than White smokers: A cross-sectional analysis

BackgroundAfrican American smokers suffer disproportionately from tobacco-related disease caused, in part, by lower rates of smoking cessation. We examined whether smoke-free home policies and delay discounting were differentially associated with cigarettes smoked per day (CPD) and nicotine dependence (ND) among African Americans and Whites.MethodsSecondary data analysis was conducted using data from 65 African American (n = 40) and White (n = 25) smokers who completed measures of CPD, ND, tobacco craving, stress, depression, home smoking policy, and delay discounting.ResultsA significant interaction was found between race and home smoking policy on CPD (B = −11.21, p = 0.002) and ND (B = −3.42, p = 0.004). Smoke-free policies in the home were associated with fewer CPD and lower ND levels among Whites, but not among African Americans. Whites who allowed smoking in their homes had significantly greater mean CPD and higher mean ND than their counterparts who did not allow smoking in the home. Among African American smokers, there were no differences in CPD and ND among those who allowed smoking in their home versus those who did not.ConclusionsThe findings extend the scientific literature by suggesting that a malleable environmental factor (home smoking policy) commonly associated with cessation among Whites does not have the same influence on cessation among African American.     

PTSD and its treatment in people with intellectual disabilities: A review of the literature

Although there is evidence to suggest that people with intellectual disabilities (ID) are likely to suffer from Post-Traumatic Stress Disorder (PTSD), reviews of the evidence base, and the potential consequences of this contention are absent. The purpose of this article is to present a comprehensive account of the literature on prevalence, assessment, and treatment of PTSD in people with ID. Some support was found for the notion that people with ID have a predisposition to the development of PTSD. Differences in comparison with the general population may consist of the expression of symptoms, and the interpretation of distressing experiences, as the manifestation of possible PTSD seems to vary with the level of ID. Since reliable and valid instruments for assessing PTSD in this population are completely lacking, there are no prevalence data on PTSD among people with ID. Nine articles involve treatment of PTSD in people with ID. Interventions reported involve those aimed to establish environmental change, the use of medication and psychological treatments (i.e., cognitive behavioral therapy, EMDR and psychodynamic based treatments). Case reports suggest positive treatment effects for various treatment methods. Development of diagnostic instruments for assessment of PTSD symptomatology in this population is required, as it could facilitate further research on its prevalence and treatment.     

Reduced levels of hepcidin associated with lower ferritin concentration and increased number of previous donations in periodic blood donors: A pilot study

BackgroundHepcidin is one of the major negative regulators of iron balance. Periodic blood donors are highly susceptible to iron deficiency. Our goal was to evaluate the possible association between serum hepcidin levels and iron homeostasis parameters in periodic blood donors.Materials and MethodsWe enrolled a total of n = 39 periodic healthy blood donors (n = 24 M and n = 15 F). A solid phase enzyme-linked immunosorbent assay (ELISA) was performed to measure endogenous hepcidin-25 levels in serum biospecimens collected from each study participant. Statistical analysis evaluated possible associations between hepcidin levels and ferritin, transferrin, total iron binding capacity (TIBC), unsaturated iron binding capacity (UIBC), transferrin saturation (TSAT), and number of previous donations.ResultsReduced serum hepcidin levels significantly correlated with lower ferritin concentration (r = 0.56, IC 95%: 0.51–0.60, p < 0.01). A multiple linear regression analysis showed that hepcidin levels were independently and negatively correlated with ferritin (p < 0.01). In addition, the number of previous blood donations was significantly associated with reduced hepcidin levels, independently of the other covariates (p < 0.01).ConclusionReduced serum hepcidin levels were significantly associated with reduced levels of ferritin and with increased number of previous donations suggesting its possible clinical role as non-invasive “point-of-care” in predicting iron deficiency among periodic blood donors.     

Three‐dimensional demonstration of the lymphatic system in the lower extremities with multi‐detector‐row computed tomography: A study in a cadaver model

Sentinel lymph node biopsy (SLNB) has had a great impact on the staging and treatment of cancer. The purpose of this study was to study the lymphatic anatomy of the lower extremities by constructing three‐dimensional images using multi‐detector‐row computed tomography (MDCT). To select appropriate contrast media for MDCT lymphatic imaging in a cadaver, we tested four kinds of contrast media by injecting them into fresh swine kidneys. After the suitable contrast medium was selected, 10 lower extremities from 5 fresh cadavers were studied. After injection of the contrast medium, each lower extremity was scanned with high‐spatial‐resolution MDCT. The zinc oxide mixture was found to be the most appropriate contrast formula for MDCT imaging of cadaver lymphatics in terms of CT value and no extravasation. The high‐resolution MDCT imaging revealed two different superficial lymphatic pathways in the legs. One lymphatic pathway accompanying the great saphenous vein had a constant course and was connected to the superficial inguinal lymph nodes. However, another pathway, along the small saphenous vein, was variable. Some of the deep lymphatic vessels bypassed the inguinal lymph nodes. Using a new protocol, we were able to construct three‐dimensional images of the lower extremity lymphatics in a cadaver model. MDCT imaging provided novel information about two different superficial lymphatic pathways in the lower extremities. Clin. Anat., 2013. © 2013 Wiley Periodicals, Inc.