Psychiatric disorders and left-handedness in children living in an urban environment

The objective of this study was to conduct an analysis of left-handed children treated in an urban mental health clinic to investigate the frequency and severity of psychiatric disorders compared to right-handed peers. Data on handedness, diagnoses, hospitalizations and severity of mental disorders were collected on 692 consecutive children, 4–18 years old (M = 10.1, SD = 3.2), referred for psychiatric evaluation. Left-handed children were 18.2% of patients in the study, a rate significantly higher than left-hand dominance in the USA (p < .05). Compared to children with right-handedness, logistic regression analysis yielded 31% [odds ratio (OR) = 1.31, 95% confidence interval (CI): 1.15–1.50] higher odds of having more psychiatric diagnosis, 70% (OR = 1.70, 95% CI: 1.10–2.62) increased odds of anxiety, 53% (OR = 1.53, 95% CI: 1.03–2.27) increased odds of depression and 78% (OR = 1.78, 95% CI: 1.21–2.62) increased odds of oppositional defiant disorder for children who were left-handed. Left-handed children had increased odds of being prescribed antipsychotic and anxiolytic medication uses, 53% and 86% increased odds, respectively, and 66% (OR = 1.66, 95% CI: 1.08–2.55) increased odds of psychiatric hospitalizations. Left-handedness was a phenotypic risk factor for psychiatric disorders and increased severity of psychiatric disorders.     

Characterisation of cannabinoid 1 receptor expression in the perikarya, and peripheral and spinal processes of primary sensory neurons

The cannabinoid 1 (CB1) receptor is expressed by a sub-population of primary sensory neurons. However, data on the neurochemical identity of the CB1 receptor-expressing cells, and CB1 receptor expression by the peripheral and central terminals of these neurons are inconsistent and limited. We characterised CB1 receptor expression in dorsal root ganglia (DRG) and spinal cord at the lumbar 4–5 level, as well as in the urinary bladder and glabrous skin of the hindpaw. About 1/3 of DRG neurons exhibited immunopositivity for the CB1 receptor, the majority of which showed positivity for the nociceptive markers calcitonin gene-related peptide (CGRP) or/and Griffonia (bandeiraea) simplicifolia IB4 isolectin-binding. Virtually all CB1 receptor-immunostained fibres showed immunopositivity for CGRP in the skin, while very few did in the urinary bladder. No CB1 receptor-immunopositive nerve fibres were IB4 positive in either peripheral tissue. Spinal laminae I and II-outer showed the highest density of CB1 receptor-immunopositive punctae, the majority of which showed positivity for CGRP or/and IB4 binding. These data indicate that a major sub-population of nociceptive primary sensory neurons expresses CB1 receptors that are transported to both peripheral and central terminals of these cells. Therefore, the present data suggest that manipulation of endogenous CB1 receptor agonist levels in these areas may significantly reduce nociceptive input into the spinal cord.     

Merkel Cell Carcinoma: 30-Year Experience from a Single Institution

Background

Merkel cell carcinoma (MCC) is a rare cutaneous malignancy. Few single-institution series have been reported.

Methods

Review of MCC patients treated at our institution between 1980 and 2010. Patient, tumor, and treatment variables were analyzed to determine MCC-specific outcomes.

Results

We identified 161 patients with MCC. There was a 2.5-fold increase in cases over the last decade. Median length of follow-up was 36 months. Stage at diagnosis was I in 35 %, II in 21 %, IIIa in 12 %, IIIb in 23 %, and IV in 9 %. The 5-year MCC-specific survival rates were 87, 63, 42, and 0 % for stages I, II, III, and IV, respectively. Death from the disease occurred in 10 % of patients with T1 and in 50 % with larger lesions. One-third of patients presented with nodal disease. Sentinel lymph node biopsy (SLNB) identified micrometastases in 9 out of 27 (33 %) early-stage patients. Recurrence developed in 56 % of SLNB-positive and 39 % of SLNB-negative patients. Half of patients recurred after a median time of 9 months. Proportions of first recurrence location were distant (52 %), nodal (27 %), and local (21 %). Adjuvant treatments did not improve recurrence or survival rates. One-third of patients died of the disease.

Conclusions

SLNB identifies micrometastasis in one-third of early-stage patients. Negative SLNB may predict for improved but not necessarily favorable outcome. Initial tumor size and clinical nodal disease predict for poor outcome. High recurrence rates warrant the development of more effective adjuvant therapies, and better markers of recurrence and treatment response for MCC are needed.     

Effects of neurological damage on production of formulaic language

Early studies reported preserved formulaic language in left hemisphere damaged subjects and reduced incidence of formulaic expressions in the conversational speech of stroke patients with right hemispheric damage. Clinical observations suggest a possible role also of subcortical nuclei. This study examined formulaic language in the spontaneous speech of stroke patients with left, right, or subcortical damage. Four subjects were interviewed and their speech samples compared to normal speakers. Raters classified formulaic expressions as speech formulae, fillers, sentence stems, and proper nouns. Results demonstrated that brain damage affected novel and formulaic language competence differently, with a significantly smaller proportion of formulaic expressions in subjects with right or subcortical damage compared to left hemisphere damaged or healthy speakers. These findings converge with previous studies that support the proposal of a right hemisphere/subcortical circuit in the management of formulaic expressions, based on a dual‐process model of language incorporating novel and formulaic language use.     

Social Factors Associated with Non-initiation and Cessation of Predominant Breastfeeding in a Mother–Child Cohort in Spain

Objective The aim of the study was to identify factors associated with non-initiation and cessation of predominant breastfeeding (PBF) in a mother–child cohort from Spain. Materials and Methods The analysis included 2195 mother-infant from birth to 14 months post- delivery recruited between 2004 and 2008. Maternal characteristics were collected during the pregnancy. Lactation data were obtained at 6 and 14 months after delivery. PBF was defined as intake of breast milk plus liquids like juices or water. The PBF cessation was calculated using the date that women started PBF and the date that she reported to start giving infant formula and/or food. The relationship between maternal variables and PBF initiation and cessation was modeled using logistic and Cox proportional hazards regression analysis. Results The prevalence of PBF at hospital discharge was 85.3, 53.4% at 3 months, 46.1% at 4 months and 7.2% at 6 month. Only two women continued PBF at 12 months and none at 14 months. The initiating of PBF was associated with higher levels of maternal education, being a first-time mother and worked in a non-manual occupation. Higher level of physical activity, not smoking and having a healthy BMI, were also positively associated with PBF initiation. PBF cessation was higher in young, obese women, who had had complications during the pregnancy, and who had lower levels of education and smoked. The employment status of women, in week 32 of pregnancy and also in month 14 post-delivery, determined likelihood of PBF cessation. Conclusions Healthier habits and education positively influenced PBF initiation and duration. Decrease in PBF duration rates in Spain can be interpreted in part as a consequence of women returning to work.     

Comparison of sonographic appearance of normal and postradiotherapy parotid glands: a preliminary study

This study was undertaken to evaluate and compare the grey-scale and Doppler sonographic features of postradiotherapy (RT) and normal parotid glands. A total of 10 patients with previous head and neck RT and with different degrees of xerostomia were included. Another 10 healthy subjects, who are age and gender-matched with the 10 patients, were also recruited. Grey-scale and Doppler ultrasound examinations of parotid glands were performed on both the patients and healthy subjects. The parotid glands were assessed for their size, echogenicity, echotexture, conspicuity of intraparotid ducts, blood flow velocity and vascular resistance. Results showed that post-RT parotid glands tended to be smaller than normal parotid glands with a significant difference in the transverse dimension (p < 0.05). Normal parotid glands appeared homogeneous, hyperechoic relative to the adjacent muscles and had marginally seen intraparotid ducts. Post-RT parotid glands were heterogeneous, isoechoic (50%) or hypoechoic (50%) relative to the adjacent muscles, and the intraparotid ducts were either marginally (50%) or obviously (50%) seen on ultrasound. The PSV, RI and PI of normal parotid glands were significantly higher than that of post-RT parotid glands (p < 0.05). However, the difference in EDV between normal and post-RT parotid glands was not significant (p > 0.05). In conclusion, ultrasound is useful in assessing parotid glands. To avoid image misinterpretation, post-RT changes in the sonographic appearance of parotid glands should be considered in examining patients with previous head and neck RT.