Threat-Related Selective Attention Predicts Treatment Success in Childhood Anxiety Disorders

ObjectiveThe present study examined whether threat-related selective attention was predictive of treatment success in children with anxiety disorders and whether age moderated this association. Specific components of selective attention were examined in treatment responders and nonresponders.MethodParticipants consisted of 131 children with anxiety disorders (aged 8–16 years), who received standardized cognitive-behavioral therapy. At pretreatment, a pictorial dot-probe task was administered to assess selective attention. Both at pretreatment and posttreatment, diagnostic status of the children was evaluated with a semistructured clinical interview (the Anxiety Disorders Interview Schedule for Children).ResultsSelective attention for severely threatening pictures at pretreatment assessment was predictive of treatment success. Examination of the specific components of selective attention revealed that nonresponders showed difficulties to disengage their attention away from severe threat. Treatment responders showed a tendency not to engage their attention toward severe threat. Age was not associated with selective attention and treatment success.ConclusionsThreat-related selective attention is a significant predictor of treatment success in children with anxiety disorders. Clinically anxious children with difficulties disengaging their attention away from severe threat profit less from cognitive-behavioral therapy. For these children, additional training focused on learning to disengage attention away from anxiety-arousing stimuli may be beneficial.     

Removal of an oral squamous cell carcinoma including parts of osseointegrated implants in the marginal mandibulectomy. A case report

Purpose

The incidence of oral squamous cell carcinomas (OSCC) arising around dental implants will increase because of the rising popularity of dental implants. In this case, a novel surgical treatment of an OSCC in the vicinity of endosseous implants is reported.

Materials and methods

In a 69-year-old woman, a recurrent OSCC (cT₂N₀M₀) developed in the floor of the mouth extending to the attached keratinized peri-implant mucosa of both interforaminal-placed dental implants. Radiographically, no bone invasion could be observed.

Results

To radically remove the tumor, a marginal mandibulectomy was performed including the cranial parts of both dental implants by cutting them into two parts. Three years after tumor resection and one year after reimplantation, the patient is disease free and has a good oral function.

Conclusions

In case of an OSCC, traditional bone and soft margins for oncologic safety are 1.0 cm. If a dental implant is present within this safety zone, on condition, there is no massive bone invasion, and the original mandible has sufficient vertical height; a marginal mandibulectomy including part of the implants can be considered.     

The EEG response to pyridoxine-IV neither identifies nor excludes pyridoxine-dependent epilepsy

Purpose: Pyridoxine‐dependent epilepsy (PDE) is characterized by therapy‐resistant seizures (TRS) responding to intravenous (IV) pyridoxine. PDE can be identified by increased urinary alpha‐aminoadipic semialdehyde (α‐AASA) concentrations and mutations in the ALDH7A1 (antiquitin) gene. Prompt recognition of PDE is important for treatment and prognosis of seizures. We aimed to determine whether immediate electroencephalography (EEG) alterations by pyridoxine‐IV can identify PDE in neonates with TRS. Methods: In 10 neonates with TRS, we compared online EEG alterations by pyridoxine‐IV between PDE (n = 6) and non‐PDE (n = 4). EEG segments were visually and digitally analyzed for average background amplitude and total power and relative power (background activity magnitude per frequency band and contribution of the frequency band to the spectrum). Results: In 3 of 10 neonates with TRS (2 of 6 PDE and 1 of 4 non‐PDE neonates), pyridoxine‐IV caused flattening of the EEG amplitude and attenuation of epileptic activity. Quantitative EEG alterations by pyridoxine‐IV consisted of (1) decreased central amplitude, p < 0.05 [PDE: median ?30% (range ?78% to ?3%); non‐PDE: ?20% (range ?45% to ?12%)]; (2) unaltered relative power; (3) decreased total power, p < 0.05 [PDE: ?31% (?77% to ?1%); ?27% (?73% to ?13%); ?35% (?56% to ?8%) and non‐PDE: ?16% (?43% to ?5%); ?28% (?29% to ?17%); ?26% (?54% to ?8%), in delta‐, theta‐ and beta‐frequency bands, respectively]; and (4) similar EEG responses in PDE and non‐PDE. Discussion: In neonates with TRS, pyridoxine‐IV induces nonspecific EEG responses that neither identify nor exclude PDE. These data suggest that neonates with TRS should receive pyridoxine until PDE is fully excluded by metabolic and/or DNA analysis.     

An intriguing "silent" mutation and a founder effect in antiquitin (ALDH7A1)

Recently, alpha-aminoadipic semialdehyde (alpha-AASA) dehydrogenase deficiency was shown to cause pyridoxine-dependent epilepsy in a considerable number of patients. alpha-AASA dehydrogenase deficiency is an autosomal recessive disorder characterized by a neonatal-onset epileptic encephalopathy in which seizures are resistant to antiepileptic drugs but respond immediately to the administration of pyridoxine (OMIM 266100). Increased plasma and urinary levels of alpha-AASA are associated with pathogenic mutations in the alpha-AASA dehydrogenase (ALDH7A1/antiquitin) gene. Here, we report an intriguing "silent" mutation in ALDH7A1, a novel missense mutation and a founder mutation in a Dutch cohort (10 patients) with alpha-AASA dehydrogenase deficiency.     

Viscosity gradient within the mucus layer determines the mucosal barrier function and the spatial organization of the intestinal microbiota

BACKGROUND: Migration is an important virulence factor for intestinal bacteria. However, the role of bacterial mobility in the penetration of viscous mucus and their spatial organization within the colon is relatively unknown. METHODS: Movements of fecal bacteria were assessed in gels of varying agarose concentrations and were compared with patterns of bacterial distribution observed in colons from conventional and Enterobacter cloacae-monoassociated mice. Bacteria were visualized using fluorescence in situ hybridization. RESULTS: Long curly bacteria moved best in moderate viscosity gels, short rods and cocci preferred a low viscous environment, whereas high viscosity immobilized all bacterial groups. The spatial distribution of bacteria in the murine colon was also shape- and not taxonomy-dependent, indicating the existence of vertical (surface to lumen) and longitudinal (proximal to distal colon) viscosity gradients within the mucus layer. Our results suggest that mucus viscosity is low in goblet cells, at the crypt basis and close to the intestinal lumen, whereas sites adjacent to the columnar epithelium have a high mucus viscosity. The mucus viscosity increased progressively toward the distal colon, separating bacteria selectively in the proximal colon and completely in the distal colon. CONCLUSIONS: The site-specific regulation of mucus secretion and dehydration make the mucus layer firm and impenetrable for bacteria in regions close to the intestinal mucosa but loose and lubricating in regions adjacent to the luminal contents. Selective control of mucus secretion and dehydration may prove to be a key factor in the management of chronic diseases in which intestinal pathogens are involved.