Differences in the right inferior longitudinal fasciculus but no general disruption of white matter tracts in children with autism spectrum disorder

One of the most widely cited features of the neural phenotype of autism is reduced “integrity” of long-range white matter tracts, a claim based primarily on diffusion imaging studies. However, many prior studies have small sample sizes and/or fail to address differences in data quality between those with autism spectrum disorder (ASD) and typical participants, and there is little consensus on which tracts are affected. To overcome these problems, we scanned a large sample of children with autism (n = 52) and typically developing children (n = 73). Data quality was variable, and worse in the ASD group, with some scans unusable because of head motion artifacts. When we follow standard data analysis practices (i.e., without matching head motion between groups), we replicate the finding of lower fractional anisotropy (FA) in multiple white matter tracts. However, when we carefully match data quality between groups, all these effects disappear except in one tract, the right inferior longitudinal fasciculus (ILF). Additional analyses showed the expected developmental increases in the FA of fiber tracts within ASD and typical groups individually, demonstrating that we had sufficient statistical power to detect known group differences. Our data challenge the widely claimed general disruption of white matter tracts in autism, instead implicating only one tract, the right ILF, in the ASD phenotype.What is the key difference in the brains of individuals with autism that accounts for the distinctive cognitive profile of this disorder? One of the most widely claimed brain signatures of autism spectrum disorder (ASD), reported in dozens of papers that used diffusion-weighted imaging (DWI), is reduced integrity of long-range fiber tracts (1). This finding has been taken as evidence that autism is fundamentally a “disconnection” syndrome, in which the core cognitive deficits result from reduced integration of information at the neural and cognitive levels (2–5). For example, it has been argued that the characteristic deficits in social cognition and language arise because these functions require rapid integration of information across spatially distant brain areas (3, 6, 7), which would likely be affected if major white matter tracts are compromised.Evidence for a general reduction in the “integrity”^* of white matter in autism has come primarily from diffusion imaging studies that report reduced directionality of the diffusion of water molecules, or fractional anisotropy (FA), and increased speed of diffusion, or mean diffusivity (MD) of many major fiber bundles. However, the literature reveals little actual agreement on the existence and direction of group differences in diffusion parameters (reviewed in ref. 1). White-matter differences have been reported in various brain regions in positive and negative directions. Possible reasons for these inconsistent findings include small sample sizes [mean of ∼20 in each group, with 40% of studies scanning 15 or fewer participants with ASD (1)], the heterogeneity of ASD itself, variations across studies in the age of the cohort tested, and the type of DTI analysis performed. Another potential problem that few diffusion studies of autism address or even mention is data quality. Indeed, to our knowledge, only two studies (9, 10) report quantitative analyses of the amount of motion in their DWI data. Group differences in head motion could be a serious confounding factor, given that head motion is likely to be greater in children with autism, and group differences in head motion can lead artifactually to just the effects most often reported: reduced FA in white matter tracts in ASD (11).To address these concerns, we scanned a relatively large sample of children with and without ASD, and evaluated data quality from each participant by visual inspection of the data and quantification of head motion (11). We then excluded scans that did not reach our data quality criterion, and matched the remaining participants across groups for data quality. These data were used to determine whether people with autism do in fact show widespread differences in the known white matter tracts in ASD. We further tested the specific hypothesis that individuals with ASD show changes in one particular tract, the inferior longitudinal fasciculus (ILF), a white matter tract important for face recognition (12, 13), a mental function selectively disrupted in ASD (ref. 14; but see ref. 15).     

The relationship between therapist-client interpersonal compatibility,sex of therapist,and therapeutic outcome

Explored the relationship between therapist-client interpersonal compatibility, sex of therapist, and psychotherapeutic outcome. The research sample consisted of 48 therapist-client dyads. The therapists were all graduate students enrolled in an individual therapy practicum, while the client sample was composed of 48 undergraduate females (mean age 19.3 years). The interpersonal compatibility of the dyads was determined from the FIRO-B results for each of the members' using a modification of Schutz's (1966) original mathematical schema. Therapy outcome was determined from pretherapy and posttherapy testing with the Tennessee Self Concept Scale and Mooney Problem Check List. A 3 × 2 research design with one concomitant variable (pretest) was used and data were analyzed using an analysis of covariance procedure. Results suggested that among this sample the sex of therapist did not have a significant differential effect. There was also a consistent lack of intetration effects between dyadic compatibility and sex of therapist. However, significant differences in therapeutic outcome across the levels of compatibility were observed.     

Vesiculobullous Hailey-Hailey disease: Successful treatment with oral retinoids

A 56-year-old male presented with a pruritic, generalized vesiculobullous eruption. His past history revealed classical symptoms of limited Hailey-Hailey disease for 34 years. Clinically, vesicles, bullae and occasional pustules were present and multiple biopsies confirmed this to be an unusual presentation of Hailey-Hailey disease. Various therapeutic modalities including topical and oral antibiotics, oral prednisone and dapsone failed to achieve sustained remission. Treatment with lowdose oral etretinate (25 mg daily) produced marked clinical improvement with complete suppression of new vesicle formation after 6 weeks.     

Laterality differences in quantitative and qualitative Hooper performance.

The Hooper Visual Organization Test (HVOT) is a measure of visuospatial processing commonly employed in neuropsychological assessment. Despite the well-documented relationship between visuospatial abilities and right hemisphere function, the literature has not supported a right hemisphere association with HVOT performance. The current study was conducted to examine laterality differences in HVOT performance. Sixty-seven geriatric stroke patients (44 right CVAs, 23 left CVAs) were administered the HVOT and the Mini-Mental State Exam (MMS). Results revealed significant differences between CVA groups for total score, with right CVA patients performing more poorly. Qualitative error analyses revealed highest frequencies for part responses and don't know/no response errors. Between-group differences were seen for part and unformed/unassociated errors (higher right CVA rates), and language-based errors (higher left CVA rates). Findings are consistent with theories of brain lateralization and suggest that whereas HVOT performance predominantly involves right hemisphere functions, left hemisphere dysfunction may also lead to impaired performance, and the two can be discriminated by qualitative analysis of errors.     

自体骨髓干细胞移植治疗失代偿期肝硬化

选择36例失代偿期肝硬化患者,年龄37～59岁,患者在无菌条件下,从髂后上棘抽取骨髓100～200mL,在体外分离纯化骨髓干细胞后,局部麻醉下经股动脉插管经肝动脉将分离的骨髓干细胞移植于肝脏。自移植后12周,25例(69.4%)患者谷丙转氨酶逐渐降低,由平均(2788.56±357.90)nkat/L降至(1077.05±440.25)nkat/L;22例(61.1%)患者总胆红素逐渐下降,由平均(151.47±25.77)μmol/L降至(69.93±18.86)μmol/L;27例(75%)患者白蛋白逐渐升高,由平均(25.17±11.79)g/L升至(30.87±12.17)g/L。在干细胞移植后凝血酶原活动度逐渐上升,由术前平均(25.89±12.67)%上升至术后12周的(50.39±19.38)%,患者凝血机制明显改善。移植后大多数患者身体状况有明显的改善;移植后12周腹水减轻的19例(52.7%),食欲改善的28例(77.7%),体力好转20例(58.3%),腹胀减轻17例(47.2%),36例干细胞移植患者未出现严重并发症。