Gastric emptying and gastric myoelectrical activity in patients with diabetic gastroparesis: effect of long-term domperidone treatment

We measured gastric emptying and gastric myoelectrical activity with solid-phase gastric-emptying tests and cutaneously recorded electrogastrograms (EGGs), respectively, in six insulin-dependent diabetic patients with nausea and vomiting who did not respond to standard treatments. Baseline solid phase gastric emptying was markedly delayed (78 +/- 8% retained at 120 min) and EGG recordings revealed gastric dysrhythmias; tachygastria (4-9 cpm signals) in one patient, 1- to 2-cpm waves in two patients, and flatline patterns in three patients. No patient had a normal 3-cpm EGG pattern. After 6 months of domperidone treatment, mean upper gastrointestinal symptoms scores decreased from 17.8 to 3.7 (p less than 0.01), and normal 3-cpm EGG frequencies were recorded from each of the six patients. The mean percentage of meal retained at 120 min decreased but did not improve significantly. Thus, establishment of normal 3-cpm gastric myoelectric activity and resolution of dysrhythmias, not normalization of emptying rates, was associated with improvement in upper gastrointestinal symptoms in these diabetic patients.     

Evidence of Cognitive Biases for Maximizing Indirect Fitness in Samoan Fa’afafine

The kin selection hypothesis posits that male androphilia (i.e., sexual attraction to males), although detrimental to reproduction (i.e., direct fitness), has persisted and evolved because androphilic males compensate by increasing their indirect fitness via increased investment in kin. In previous studies, Samoan androphilic males (known locally as fa’afafine) reported elevated avuncular (i.e., uncle-like) tendencies compared to Samoan gynephilic (i.e., sexually attracted to females) men. Their avuncular tendencies were also greater than the materteral (i.e., aunt-like) tendencies of androphilic women. The present study examined whether the avuncular cognition of fa’afafine was enhanced for maximizing indirect fitness. To do so, it examined whether fa’afafine had a stronger propensity than Samoan gynephilic men and androphilic women to invest in kin categories that would result in more reliable and substantive increases in indirect fitness (i.e., young, female kin) in hypothetical investment scenarios. In a forced-choice paradigm, although all individuals showed some degree of bias to invest in adaptive kin categories during non-frivolous investment contexts in which the consequences of investment were relatively non-trivial, fa’afafine showed greater adherence to the predicted pattern. In addition, shifting the context from frivolous investments, in which the consequences of investment were relatively trivial, to non-frivolous investments prompted fa’afafine to exhibit an enhanced preference, relative to Samoan gynephilic men and androphilic women, to invest in adaptive kin categories. These findings were consistent with the kin selection hypothesis and suggest that, although all individuals exhibit cognitive biases for increasing indirect fitness, the avuncular cognition of androphilic males has undergone selective enhancement to maximize the accrual of indirect fitness via kin-directed altruism.     

The relationship between fraternal birth order and childhood sex-atypical behavior among the Istmo Zapotec muxes

Research on male androphilia (i.e., sexual attraction towards adult males) consistently finds that androphilic males tend to have more older biological brothers than males who are gynephilic (i.e., sexually attracted to adult females). This fraternal birth order effect (FBOE) has been well replicated among androphilic males who present publically in a male-typical (cisgender) and a female-typical (transgender) manner. There is some evidence that the FBOE is more pronounced among transgender androphilic males. However, no studies have directly compared both forms of male androphilia within the same culture. This study tested the FBOE, and its association with childhood sex-atypical behavior (CSAB), among the Istmo Zapotec of Oaxaca, Mexico, where both forms of male androphilia are referred to as a third gender, muxes. Our results indicated that both cisgender muxe nguiiu (n = 124) and transgender muxe gunaa (n = 120) were more likely to be later born among brothers than gynephilic men (n = 194). However, the number of older brothers did not differentiate between transgender and cisgender muxes, nor did it predict CSAB among muxes. These findings replicate the FBOE among both cisgender and transgender muxes but show no evidence that it is more pronounced among transgender androphilic males.     

Prediction of cardiac mortality after myocardial infarction: the role of maximal treadmill stress echocardiography.

Patients frequently undergo low-level exercise treadmill testing after acute myocardial infarction (MI) and, in the absence of inducible ischemia, a maximal test several weeks later. This study examines 203 patients who had 2-dimensional echocardiography before and after a maximal Bruce protocol exercise treadmill test performed 4 to 6 weeks after MI. The subjects were followed for a mean of 43 months (range 1 to 77 months). Predictors of cardiac mortality by multivariate or univariate analysis included an ejection fraction < or =40%, diabetes, age > or=70 years, and ischemia by exercise echocardiography but not by electrocardiography. Therefore, standard electrocardiographic monitoring during exercise treadmill testing 6 weeks after MI fails to predict cardiac mortality. The addition of pre-exercise and post-exercise treadmill stress echocardiography to readily available clinical parameters identifies those patients at greatest risk for cardiac death (resting ejection fraction < or=40%) and detects residual exercise-induced ischemia that may be of additional prognostic value.     

Problematic Methods in the Assessment of Scholarly Productivity in Clinical PhD Programs

We review the methods in the ranking of clinical psychology doctoral programs provided by Stewart, Roberts, and Roy (2007). Using our own program as an example, we identify several areas of concern (e.g., authorship credits, criteria applied, faculty attrition). The inaccuracies identified for our program ranking, in combination with methodological concerns highlighted by previous commentaries, suggest that the validity of the rankings can be called into question.     

Antiestrogen therapy is active in selected ovarian cancer cases: the use of letrozole in estrogen receptor-positive patients.

PURPOSE: To evaluate the efficacy of the aromatase inhibitor letrozole in preselected estrogen receptor (ER)-positive relapsed epithelial ovarian cancer patients and to identify markers that predict endocrine-sensitive disease. EXPERIMENTAL DESIGN: This was a phase II study of letrozole 2.5 mg daily until clinical or marker evidence of disease progression in previously treated ER-positive ovarian cancer patients with a rising CA125 that had progressed according to Rustin's criteria. The primary end point was response according to CA125 and response evaluation criteria in solid tumors (RECIST) criteria. Marker expression was measured by semiquantitative immunohistochemistry in sections from the primary tumor. RESULTS: Of 42 patients evaluable for CA125 response, 7 (17%) had a response (decrease of >50%), and 11 (26%) patients had not progressed (doubling of CA125) following 6 months on treatment. The median time taken to achieve the CA125 nadir was 13 weeks (range 10-36). Of 33 patients evaluable for radiological response, 3 (9%) had a partial remission, and 14 (42%) had stable disease at 12 weeks. Eleven patients (26%) had a PFS of >6 months. Subgroup analysis according to ER revealed CA125 response rates of 0% (immunoscore, 150-199), 12% (200-249), and 33% (250-300); P = 0.028, chi(2) for trend. Expression levels of HER2, insulin-like growth factor binding protein 5, trefoil factor 1, and vimentin were associated with CA125 changes on treatment. CONCLUSIONS: This is the first study of a hormonal agent in a preselected group of ER-positive ovarian cancer patients. A signature of predictive markers, including low HER2 expression, predicts response.     

Nasal dermoids: the significance of a midline punctum

Nasal dermoids are rare and their diagnosis is often delayed until complications occur. Signs such as a midline nasal punctum may be noted at birth but the significance of this finding frequently passes unrecognised. The cases are reported of two patients which illustrate the typical presentation of these lesions and their subsequent management is discussed.     

Population studies of leukocyte-reactive antinuclear antibody and HLA antigens

Summary The prevalence of serum leukocyte-reactive antinuclear antibody (LR-ANA) was determined in 31 patients with ankylosing spondylitis (AS), their age-and gender-matched normal controls, and two tribes of 340 West Coast Canadian Indians (Bella Coolas and Haidas). At a serum dilution of 1:10, the prevalence of LR-ANA in AS and controls was 45% and 7%, respectively. At 1:20 dilution, the prevalence was 23% in AS, 0% in controls, 29% in Bella Coolas and 27% in Haidas. No concordance was found among LR-ANA, HLA-B27 and CREG-B7, and nine HLA-A and seven HLA-B antigens in the Indian tribes. These studies confirm an increased prevalence of LR-ANA in AS and AS kindreds. but the latter association appears to be independent of HLA antigens.