The interacting role of media violence exposure and aggressive-disruptive behavior in adolescent brain activation during an emotional Stroop task

Only recently have investigations of the relationship between media violence exposure (MVE) and aggressive behavior focused on brain functioning. In this study, we examined the relationship between brain activation and history of media violence exposure in adolescents, using functional magnetic resonance imaging (fMRI). Samples of adolescents with no psychiatric diagnosis or with disruptive behavior disorder (DBD) with aggression were compared to investigate whether the association of MVE history and brain activation is moderated by aggressive behavior/personality. Twenty-two adolescents with a history of aggressive behavior and diagnosis of either conduct disorder or oppositional-defiant disorder (DBD sample) and 22 controls completed an emotional Stroop task during fMRI. Primary imaging results indicated that controls with a history of low MVE demonstrated greater activity in the right inferior frontal gyrus and rostral anterior cingulate during the violent word condition. In contrast, in adolescents with DBD, those with high MVE exhibited decreased activation in the right amygdala, compared with those with low MVE. These findings are consistent with research demonstrating the importance of fronto-limbic structures for processing emotional stimuli, and with research suggesting that media violence may affect individuals in different ways depending on the presence of aggressive traits.     

Sniff nasal inspiratory pressure and sleep disordered breathing in childhood neuromuscular disorders

The ease of sniff nasal inspiratory pressure testing may extend application of respiratory muscle assessment to younger and cognitively-impaired children. We sought to quantify sniff nasal inspiratory pressure in childhood neuromuscular disorders, and to correlate this measure with conventional pulmonary function tests and overnight polysomnography. Thirty children (mean 9.7 ± 3.8 years, range 4.3-16.5 years) with diagnosed neuromuscular disorders (Duchenne muscular dystrophy, spinal muscular atrophy, Becker muscular dystrophy, congenital myopathy, facioscapulohumeral muscular dystrophy, myotonic dystrophy, multi-minicore disease) underwent assessment. Thirty-seven percent displayed cognitive impairment. Those with neuromuscular disorders were then compared with 32 volunteer age- and gender-matched controls (mean 10.9 ± 2.9 years, range 6.6-17.2 years) with normal respiratory function. Twenty-three children with neuromuscular disorders also underwent overnight polysomnography. Children with neuromuscular disorders demonstrated significantly impaired sniff nasal inspiratory pressure, maximal inspiratory pressure, FEV(1) and FVC (p<0.05). A positive correlation was identified between daytime sniff nasal inspiratory pressure and maximal inspiratory pressure (r=0.58), FEV(1) (r=0.55) and FVC (r=0.46), though not with polysomnography variables (respiratory disturbance index, nadir SpO(2), peak CO(2)). Moderate prevalence of nocturnal hypoxia was observed, and 32% of children demonstrated sleep disordered breathing. Sniff nasal inspiratory pressure assessment was well tolerated, representing a promising surrogate measure for assessment of respiratory function in childhood neuromuscular disorders.     

From depersonalization to hallucination

Henri Ey suggested that all hallucinations occur against the background of depersonalization, which is an alteration in experience that people find hard to describe, where the subject feels a strangeness pervading the world and her/his own body, emotions and thoughts. Embracing Ey's proposal, this paper draws a comparison between depersonalization in hallucinations and depersonalization in some delusional states (especially the Capgras and the Cotard syndromes), which by the most recent models used in cognitive neuroscience is considered to be a disruption in so-called 'affective familiarity'. Sensory information regarding the world is divided into the 'overt pathway' of perceptual inputs and the 'covert pathway' of 'atmospheric cues'. In hallucinating subjects, we suggest that a breakdown of the grasping of atmospheric qualities in the environment triggers a compensatory process consisting of the production of hypotheses that make sense of the world perceived. Finally, we report on a case that illustrates our proposal.     

Mutations in EDARADD account for a small proportion of hypohidrotic ectodermal dysplasia cases

Background Hypohidrotic ectodermal dysplasia (HED) is characterized by abnormal development of the eccrine sweat glands, hair and teeth. The X‐linked form of the disease, caused by mutations in the EDA gene, represents the majority of HED cases. Autosomal dominant and recessive forms occasionally occur and result from mutations in at least two other genes: EDAR and EDARADD. EDARADD interacts with the TAB2/TRAF6/TAK1 complex, which is necessary for NF‐κB activation by EDAR. Objectives To determine frequency of EDARADD, TRAF6, TAB2 and TAK1 mutations in HED. Materials and methods We have screened 28 familial or sporadic HED cases with no mutations in the EDA and EDAR genes for EDARADD, TRAF6, TAB2 and TAK1 mutations. Results We identified one EDARADD 6‐bp homozygous in‐frame deletion (c.402‐407del, p.Thr135‐Val136del) in a patient born to consanguineous parents. Functional studies showed that the p.Thr135‐Val136del impaired the EDAR–EDARADD interaction and then severely inhibited NF‐κB activity. In the remaining 27 patients, we failed to find causative mutations in EDARADD, or in TRAF6, TAB2 or TAK1. Conclusions Our study demonstrates that EDARADD mutations are not a frequent cause of HED, while mutations in TRAF6, TAB2 and TAK1 may not be implicated in this disease.     

Caesarean section at term: the relationship between neonatal respiratory morbidity and microviscosity in amniotic fluid

Objectives

The incidence of neonatal respiratory morbidity following an elective caesarean section is 2–3 times higher than after a vaginal delivery. The microviscosity of surfactant phospholipids, as measured with fluorescence polarisation, is linked with the functional characteristics of fetal surfactant and thus fetal lung maturity, but so far this point has received little attention in new-borns at term. The aim of the study is to evaluate the correlation between neonatal respiratory morbidity and amniotic microviscosity (Fluorescence Polarisation Index) in women undergoing caesarean section after 37 weeks’ gestation.

Study design

The files of 136 women who had undergone amniotic microviscosity studies during elective caesarean deliveries at term were anonymised. Amniotic fluid immaturity (AFI) was defined as a Fluorescence Polarisation Index higher than 0.335.

Results

Respiratory morbidity was observed in 10 babies (7.3%) and was independently associated with AFI (OR: 6.11 [95% CI, 1.20–31.1] with p = 0.029) and maternal body mass index (OR: 1.12 [95% CI, 1.02–1.22] with p = 0.019). Gestational age at the time of caesarean delivery was inversely associated with AFI (odds ratio, 0.46 [95% confidence interval, 0.29–0.71], p < 0.001), especially before 39 weeks, and female gender was associated with an increased risk (odds ratio, 3.29 [95% confidence interval, 1.48–7.31], p = 0.004).

Conclusions

AFI assessed by amniotic microviscosity was significantly associated with respiratory morbidity and independently correlated with shorter gestational age especially before 39 weeks. This finding provides a physiological rationale for recommending delaying elective caesarean section delivery until 39 weeks of gestation to decrease the risk for respiratory morbidity.     

Direct vs. standard method of insertion of an intrauterine contraceptive device: insertion pain and outcomes at 6 months

Abstract

Objectives: The direct method is a procedure designed to cause less pain during insertion of an intrauterine contraceptive device (IUCD). It was first reported in 2005 and differs from the standard method of insertion recommended by IUCD manufacturers. In France, the direct method is well known and used by experienced practitioners, but it has never been evaluated against the standard method of insertion. The aim of the study was therefore to compare the direct method with the standard method in terms of pain experienced during insertion and the side effects and satisfaction rates over 6 months.

Methods: A prospective observational study was conducted in France between June and December 2016 to compare the direct and standard methods of IUCD insertion.

Results: The study included 535 women: 281 in the direct method group (DM group) and 254 in the standard method group (SM group). Women in the DM group reported less pain. This difference was assessed by multilevel multivariate analysis (?8.3?mm, 95% confidence interval (CI) ?14.3, ?2.3). There was no difference in the occurrence of infection (1.4% vs. 2.8%; p?=?.366) and 6-month continuation rates (89.4% vs. 89.2%; p?=?.936). Satisfaction rates at 6 months were higher in the DM group (93.6% vs. 87.4%; p?=?.019).

Conclusions: The results of the study suggest that the direct method of IUCD insertion is associated with less pain and does not increase the risk of adverse effects. Widespread adoption of the direct method could improve women’s comfort and lead to a higher uptake of the IUCD as a form of contraception.     

Successful Medical Treatment of Glans Ischemia after Voluntary Buprenorphine Injection

IntroductionThe diverted use of synthetic opioid buprenorphine by drug addicts can be responsible for serious ischemic and infectious complications, particularly in the case of intravenous injection.AimWe present a case of serious glans ischemia after buprenorphine injection directly into the deep dorsal vein of the penis. Analysis using new medical imaging techniques and treatments is detailed below.MethodsA 26‐year‐old male drug addict presented with glans pain 4 days after self‐injection of buprenorphine into the deep dorsal vein of the penis. The patient was apyretic and presented a urethral discharge. His glans was blue without discoloration on digital pressure. Additionally, his biologic and serologic tests were normal while bacteriology showed the presence of Enterobacter cloacae urethritis.ResultsAfter 48 hours of intravenous antibiotic treatment without improvement, a specific medical treatment using enoxaparin and ilomedin was initiated, with the assumption that there was an ischemic complication. Laser speckle contrast imaging allowed confirmation of the presence of distal penis ischemia and provided an accurate mapping of the ischemic zone. A 28‐day treatment combining antibiotics, subcutaneous heparin at curative dose, antiplatelet drug, ilomedin, and hyperbaric oxygen therapy resulted in clinical improvement of the lesions with no functional complications.ConclusionsTo date, no consensus exists on the proper diagnostic and treatment approach to severe glans ischemia due to buprenorphine injection into the deep dorsal vein of the penis. The results of laser speckle contrast imaging were of real interest during the process of diagnosis. In addition, the combination of ilomedin with hyperbaric oxygen therapy and anticoagulant and antiplatelet drugs appeared to be an effective therapy. Brecheteau F, Grison P, Abraham P, Lebdai S, Kemgang S, Souday V, Nedelcu C, Culty T, Larré S, Azzouzi AR, and Bigot P. Successful medical treatment of glans ischemia after voluntary buprenorphine injection. J Sex Med 2013;10:2866–2870.     

Phase 1/2 pilot study of methotrexate-laurocapram topical gel for the treatment of patients with early-stage mycosis fungoides

OBJECTIVES: To assess the safety and tolerability of a topical gel formulation combining methotrexate and laurocapram and to obtain preliminary information on the therapeutic potential of methotrexate-laurocapram in patients with early-stage mycosis fungoides (stage IA or IB). DESIGN: An open-label, phase 1/2 pilot study. SETTING: Two academic referral centers. PATIENTS: Ten patients 18 years or older with histologically confirmed stage IA or IB mycosis fungoides.Intervention The gel formulation of methotrexate-laurocapram was applied to the total body surface, excluding genital, perianal areas, nipples, face, and skin under the breasts, on an every-other-day basis for 24 consecutive weeks. MAIN OUTCOME MEASURES: The safety of methotrexate-laurocapram was assessed in this study by reviewing adverse events and laboratory data. Efficacy outcomes included changes in lesion condition and severity assessments, reduction in area of sample lesions, and the investigator's global evaluation. RESULTS: Adverse events consisted of skin reactions of mild severity. No clinically significant laboratory abnormalities were observed. Based on the investigator's global evaluation at the end of the treatment phase (week 24), 7 (78%) of 9 patients demonstrated a slight-to-moderate response to treatment with methotrexate-laurocapram. Statistical significance (P =.049) was reached for induration and pruritus, a trend (P =.10) was observed for erythema, and no change was found for scaling (P =.37). CONCLUSIONS: These findings indicate that the topical administration of methotrexate-laurocapram is safe and in general well tolerated. This treatment may represent a new therapeutic potential for patients with mycosis fungoides.     

Regionally selective atrophy of subcortical structures in prodromal HD as revealed by statistical shape analysis

Huntington disease (HD) is a neurodegenerative disorder that involves preferential atrophy in the striatal complex and related subcortical nuclei. In this article, which is based on a dataset extracted from the PREDICT‐HD study, we use statistical shape analysis with deformation markers obtained through “Large Deformation Diffeomorphic Metric Mapping” of cortical surfaces to highlight specific atrophy patterns in the caudate, putamen, and globus pallidus, at different prodromal stages of the disease. On the basis of the relation to cortico‐basal ganglia circuitry, we propose that statistical shape analysis, along with other structural and functional imaging studies, may help expand our understanding of the brain circuitry affected and other aspects of the neurobiology of HD, and also guide the most effective strategies for intervention. Hum Brain Mapp 35:792–809, 2014. © 2012 Wiley Periodicals, Inc.