A plea for caution: violent video games, the Supreme Court, and the role of science

On November 2, 2010, the US Supreme Court heard arguments in the case of Schwarzenegger v Entertainment Merchants Association, with a ruling expected in 2011. This case addressed whether states have the right to restrict freedom of speech by limiting the sale of violent video games to minors. To date, 8 states have tried to pass legislation to this effect, with all attempts being found unconstitutional by lower courts. In large part, the Supreme Court's decision will be determined by its review and interpretation of the medical and social science literature addressing the effects of violent video games on children. Those on both sides of the violent video game debate claim that the scientific literature supports their opinions. Some involved in the debate have proclaimed that the debate is scientifically settled and that only people holding personal interests and biases oppose these "established truths." We review the historical similarities found in the 1950s comic book debate and studies identified from a PubMed search of the term violent video games showing both the harmful and beneficial effects of these video games. We define factors that physicians need to consider when reading and stating opinions about this literature. Opinions from past court rulings are discussed to provide insight into how judges may approach the application of these social science studies to the current legal issue. Although on the surface the case of Schwarzenegger v Entertainment Merchants Association pertains only to the restriction of violent video games, it may establish principles about how medical and public health testimony can affect fundamental constitutional rights and how much and on what basis the courts will defer to legislators' reliance on unsettled science.     

Best practice guidelines on surgical response in disasters and humanitarian emergencies: report of the 2011 Humanitarian Action Summit Working Group on Surgical Issues within the Humanitarian Space

The provision of surgery within humanitarian crises is complex, requiring coordination and cooperation among all stakeholders. During the 2011 Humanitarian Action Summit best practice guidelines were proposed to provide greater accountability and standardization in surgical humanitarian relief efforts. Surgical humanitarian relief planning should occur early and include team selection and preparation, appropriate disaster-specific anticipatory planning, needs assessment, and an awareness of local resources and limitations of cross-cultural project management. Accurate medical record keeping and timely follow-up is important for a transient surgical population. Integration with local health systems is essential and will help facilitate longer term surgical health system strengthening.     

Interaction of allergy history and antibodies to specific varicella‐zoster virus proteins on glioma risk

Glioma is the most common cancer of the central nervous system but with few confirmed risk factors. It has been inversely associated with chicken pox, shingles and seroreactivity to varicella virus (VZV), as well as to allergies and allergy‐associated IgE. The role of antibody reactivity against individual VZV antigens has not been assessed. Ten VZV‐related proteins, selected for high immunogenicity or known function, were synthesized and used as targets for antibody measurements in the sera of 143 glioma cases and 131 healthy controls selected from the San Francisco Bay Area Adult Glioma Study. Glioma cases exhibited significantly reduced seroreactivity compared to controls for six antigens, including proteins IE63 [odds ratio (OR) = 0.26, 95% confidence interval (CI): 0.12–0.58, comparing lowest quartile to highest) and the VZV‐unique protein ORF2p (OR = 0.44, 95% CI: 0.21–0.96, lowest quartile to highest). When stratifying the study population into those with low and high self‐reported allergy history, VZV protein seroreactivity was only associated inversely with glioma among individuals self‐reporting more than two allergies. The data provide insight into both allergy and VZV effects on glioma: strong anti‐VZV reactions in highly allergic individuals are associated with reduced occurrence of glioma. This result suggests a role for specificity in the anti‐VZV immunity in brain tumor suppression for both individual VZV antigens and in the fine‐tuning of the immune response by allergy. Anti‐VZV reactions may also be a biomarker of effective CNS immunosurveillance owing to the tropism of the virus.     

Pregnancy and glial brain tumors

Background

Improvements in brain tumor treatments have led to an increase in the number of young women with brain tumors who are now considering pregnancy. The aim of this study is to evaluate the influence of pregnancy on brain tumor biology.

Methods

In this institutional review board-approved retrospective study, we searched the institution''s database for patients with glial brain tumors who were pregnant at the time of diagnosis or became pregnant during the course of their illness. We identified 34 such patients and reviewed their charts to determine each patient''s clinical course and pregnancy outcome.

Results

Fifteen patients were diagnosed with a primary brain tumor during pregnancy: 3 with glioblastomas, 6 with grade III gliomas, and 6 with grade II gliomas. Pregnancy was terminated in only 2 of these patients, and the remainder delivered healthy babies. Twenty-three patients became pregnant after diagnosis (4 patients were pregnant at diagnosis and again after diagnosis). Of the patients who became pregnant after diagnosis, the 5 with grade I tumors had stable disease during and after pregnancy. However, of the 18 patients with grade II or III gliomas, 8 (44%) had confirmed tumor progression during pregnancy or within 8 weeks of delivery.

Conclusions

In contrast to grade I gliomas, the tumor biology of grades II and III gliomas may be altered during pregnancy, leading to an increased risk of tumor progression. These findings support the need for increased tumor surveillance and patient counseling and for additional data collection to further refine these results.     

Ultra high-risk PFA ependymoma is characterized by loss of chromosome 6q

BackgroundWithin PF-EPN-A, 1q gain is a marker of poor prognosis, however, it is unclear if within PF-EPN-A additional cytogenetic events exist which can refine risk stratification.MethodsFive independent non-overlapping cohorts of PF-EPN-A were analyzed applying genome-wide methylation arrays for chromosomal and clinical variables predictive of survival.ResultsAcross all cohorts, 663 PF-EPN-A were identified. The most common broad copy number event was 1q gain (18.9%), followed by 6q loss (8.6%), 9p gain (6.5%), and 22q loss (6.8%). Within 1q gain tumors, there was significant enrichment for 6q loss (17.7%), 10q loss (16.9%), and 16q loss (15.3%). The 5-year progression-free survival (PFS) was strikingly worse in those patients with 6q loss, with a 5-year PFS of 50% (95% CI 45%-55%) for balanced tumors, compared with 32% (95% CI 24%-44%) for 1q gain only, 7.3% (95% CI 2.0%-27%) for 6q loss only and 0 for both 1q gain and 6q loss (P = 1.65 × 10⁻¹³). After accounting for treatment, 6q loss remained the most significant independent predictor of survival in PF-EPN-A but is not in PF-EPN-B. Distant relapses were more common in 1q gain irrespective of 6q loss. RNA sequencing comparing 6q loss to 6q balanced PF-EPN-A suggests that 6q loss forms a biologically distinct group.ConclusionsWe have identified an ultra high-risk PF-EPN-A ependymoma subgroup, which can be reliably ascertained using cytogenetic markers in routine clinical use. A change in treatment paradigm is urgently needed for this particular subset of PF-EPN-A where novel therapies should be prioritized for upfront therapy.     

Attention-Deficit/Hyperactivity Disorder Genomics: Update for Clinicians

Attention deficit, hyperactivity disorder (ADHD) is familial and highly heritable. Several candidate genes involved in neurotransmission have been identified, however these confer minimal risk, suggesting that for the most part, ADHD is not caused by single common genetic variants. Advances in genotyping enabling investigation at the level of the genome have led to the discovery of rare structural variants suggesting that ADHD is a genomic disorder, with potentially thousands of variants, and common neuronal pathways disrupted by numerous rare variants resulting in similar ADHD phenotypes. Heritability studies in humans also indicate the importance of epigenetic factors, and animal studies are deciphering some of the processes that confer risk during gestation and throughout the post-natal period. These and future discoveries will lead to improved diagnosis, individualized treatment, cures, and prevention. These advances also highlight ethical and legal issues requiring management and interpretation of genetic data and ensuring privacy and protection from misuse.     

Findings From the Pittsburgh Youth Study: Cognitive Impulsivity and Intelligence as Predictors of the Age–Crime Curve

ObjectiveThis article first summarizes key research findings from the Pittsburgh Youth Study from 1987 to the present, and focuses on delinquency in 1,517 young men who have been followed up from late childhood into their 20s. Second, the article addresses how indicators of self-control prospectively predict later offending, and whether the prediction shows individual difference in the age–crime curve, particularly the up-slope, peak, and down-slope of that curve.MethodLongitudinal analyses were conducted on a sample of boys in the middle sample of the Pittsburgh Youth Study (n = 422), whose cognitive impulsivity and intelligence were assessed at about age 12 years. Criminal records on the sample were until age 28.ResultsThe results show that cognitive impulsivity and intelligence, measured between ages 12 and 13 by means of psychometric tests, predicted the age–crime curve. The age–arrest curve was substantially higher in boys with high cognitive impulsivity and in boys with low IQ. However, there was a significant interaction between cognitive impulsivity and intelligence. For boys with high IQ, cognitive impulsivity was associated with a greater escalation in the prevalence of offending during early adolescence, followed by a more rapid decline in offending as boys entered early adulthood with a slight subsequent increase in criminal offending then occurring late 20. In contrast, there was no evidence that cognitive impulsivity independently influenced criminal offending at any developmental period for boys with low IQ.ConclusionsThe results are discussed in terms of interventions to reduce individuals' delinquency from childhood through early adulthood and lower the age–crime curve for populations. However, the association was complex because it was moderated by both age and intelligence.