Religion as a means to assure paternity

The sacred texts of five world religions (Buddhism, Christianity, Hinduism, Islam, and Judaism) use similar belief systems to set limits on sexual behavior. We propose that this similarity is a shared cultural solution to a biological problem: namely male uncertainty over the paternity of offspring. Furthermore, we propose the hypothesis that religious practices that more strongly regulate female sexuality should be more successful at promoting paternity certainty. Using genetic data on 1,706 father-son pairs, we tested this hypothesis in a traditional African population in which multiple religions (Islam, Christianity, and indigenous) coexist in the same families and villages. We show that the indigenous religion enables males to achieve a significantly (P = 0.019) lower probability of cuckoldry (1.3% versus 2.9%) by enforcing the honest signaling of menstruation, but that all three religions share tenets aimed at the avoidance of extrapair copulation. Our findings provide evidence for high paternity certainty in a traditional African population, and they shed light on the reproductive agendas that underlie religious patriarchy.     

Sudden unexpected death in epilepsy in lamotrigine randomized‐controlled trials

Purpose: Nonrandomized studies of the relationship of antiepileptic drugs (AEDs) with sudden unexpected death in epilepsy (SUDEP) may be susceptible to confounding by tonic–clonic seizure frequency, polypharmacy, and other potential risk factors for SUDEP. We evaluated the risk of SUDEP with lamotrigine (LTG) compared to active comparators and placebo in randomized controlled clinical trials conducted by GlaxoSmithKline (GSK) between 1984 and 2009. Methods: Among 7,774 subjects in 42 randomized clinical trials, there were 39 all‐cause deaths. Ten deaths occurred >2 weeks after discontinuation of study medication and were excluded. Narrative summaries of deaths were independently reviewed by three clinical experts (TT, LH, DF), who were blinded to randomized treatment arm. The risk of definite or probable SUDEP was compared between treatment arms for each trial type (placebo‐controlled, active‐comparator, crossover), using exact statistical methods. Key Findings: Of 29 on‐treatment deaths, eight were definite/probable SUDEP, four were possible SUDEP, and 17 were non‐SUDEP. The overall, unadjusted rate of definite/probable SUDEP for LTG was 2.2 events per 1,000‐patient years (95% confidence interval [95% CI] 0.70–5.4). The odds ratios (OR) for on‐treatment, definite/probable SUDEP in LTG arms relative to comparator arms, adjusted for length of exposure and trial, were the following: placebo‐controlled, OR 0.22 (95% CI 0.00–3.14; p = 0.26); active‐comparator, OR 2.18 (95% CI 0.17–117; p = 0.89); and placebo‐controlled cross‐over, OR 1.08 (95% CI 0.00–42.2; p = 1.0). Significance: There was no statistically significant difference in rate of SUDEP between LTG and comparator groups. However, the CIs were wide and a clinically important effect cannot be excluded.     

Role of Ultrasound in Managing Rheumatoid Arthritis

Ultrasound (US) is a valid and reliable imaging tool for evaluation of joint and tendon inflammation as well as cartilage and erosions in patients with rheumatoid arthritis (RA). Synovitis is usually scored semiquantitatively for both gray scale synovitis and power Doppler activity, and use of an atlas for US scoring has shown excellent reliability. Several scores are shown to be responsive to medical treatment, but the optimal joint/tendon score is to be explored. Doppler activity may be quantified by use of pixel counts and flow may be examined by use of resistive index. US-guided injections are better tolerated and have increased efficacy, as compared with palpation guidance, and should thus be included in rheumatologic practice. Different methods such as three-dimensional US, contrast-enhanced US and fusion imaging methods are all possible US approaches that may be used in treatment of RA patients in the future.     

The effect of summer vacation on bilingual preschoolers' language development

The purpose of the investigation was to examine the developmental trajectories of bilingual preschoolers' comprehension of Spanish and English and to determine whether a lengthy summer vacation impacted children's development during the preschool years. Participants included 83 bilingual children who were followed over a 2‐year period during which time children attended a federally funded preschool programme for children from low‐income homes living in the US. Children were divided into two groups based on whether their scores on receptive language measures increased or decreased during their first year of Head Start. Results revealed that children whose scores increased experienced positive growth in their language comprehension in Spanish and English over the 2‐year period, whereas children whose scores decreased during the first year continued to experience a negative developmental trajectory in their second year. Additionally, it was found that a lengthy summer vacation had a differential effect on children's development. Summer vacation had a negative effect on the developmental trajectories of children who experienced gains in their comprehension of English and Spanish and a positive impact on children whose scores declined during the school year. Clinical implications suggest that children may require differential support during the school year and summer vacation depending upon their developmental trajectories during the first year in preschool.     

Left atrial appendage occlusion with the Amulet device: to tug or not to tug?

Journal of Interventional Cardiac Electrophysiology - Left atrial appendage occlusion (LAAO) involves a “tug test,” in which implanters pull on the device delivery cable to ensure...     

Correction to: Left atrial appendage occlusion with the Amulet device: to tug or not to tug?

Journal of Interventional Cardiac Electrophysiology - For Fig. 4, an internal working draft of the image depicting the device placed in the heart was erroneously provided during the...     

Comparison of Longitudinal and Apical Foetal Speckle Tracking Echocardiography Using Tissue Motion Annular Displacement and Segmental Longitudinal Strain

The aim of our prospective pilot study with exploratory analysis was to compare longitudinal and apical foetal speckle tracking echocardiography (STE) using tissue motion annular displacement (TMAD) and segmental longitudinal strain (SLS). We compared two different STE quantification tools in a longitudinal and apical four-chamber view in 57 normal foetuses between 20 and 40 wk of gestation. Myocardial mechanical dyssynchrony and strain were assessed using offline quantification software (QLab Version 10.3, Philips Medical Systems, Andover, MA, USA). We compared the dyssynchrony measurements with TMAD and SLS in longitudinal and apical four-chamber views. Furthermore, we examined the segmental strain values of both ventricles with SLS and compared the differences between longitudinal and apical measurements. Dyssynchrony measurements with TMAD and SLS and strain measurements with SLS were feasible in all cases. In the apical view, the dyssynchrony measurements with TMAD were systematically greater than those achieved with SLS (p < 0.001). For the longitudinal view, no differences were observed between tools (p?=?0.153). The application of SLS provided similar results for dyssynchrony in both views (intra-class correlation coefficient [ICC]?=?0.281, p?=?0.623), but the strain measurements in the left and right ventricles differed significantly between views (ICC?=?–0.082, p?=?0.011, and ICC?=?–0.061, p?=?0.024, respectively). For TMAD, we found large differences in the dyssynchrony values between longitudinal and apical assessment (ICC?=?–0.060, p?=?0.03). Furthermore, TMAD exhibited reduced accuracy in the system's automatic tracking algorithm, limiting the data quality. The dyssynchrony assessment is affected less by the foetal position in SLS than in TMAD. The strain readings in SLS varied depending on the view in which they were assessed. The application of TMAD cannot be recommended for foetal STE.     

A solitary chest wall metastasis from unknown primary hepatocellular carcinoma

We report a 61-year-old male smoker who was admitted to our hospital for treatment of a moderately growing tumour on the right anterolateral chest wall causing chest pain during coughing. Chest computed tomography and magnetic resonance imaging showed a 55 x 50 mm inhomogeneous mass around the 4th rib but not penetrating the subcutis and lung. Neither a preoperative technetium scintigraphy nor a needle biopsy revealed the primary nature of the tumour. The patient was treated with en bloc resection and partial resection of the adjacent 3rd and 4th rib. The frozen section diagnosis confirmed a metastasis from a primary hepatocellular carcinoma.