A prospective randomized study of pregnancy rates following intrauterine and intracervical insemination using frozen donor sperm

Cryopreserved sperm have lowered fertility when compared with fresh sperm in artificial insemination by donor programs. The purpose of this study was to compare pregnancy rates following intrauterine insemination (IUI) and intracervical insemination (ICI) with cryopreserved sperm in a prospective trial using the patient as her own control. A total of 154 patients were randomized into alternating treatment cycles and underwent 238 cycles of IUI and 229 cycles of ICI. The pregnancy rate per treatment cycle was 9.7% following IUI and 3.9% following ICI. Treatment outcome was influenced by patient age, ovulatory status, and endometriosis. Pregnancy success correlated well with the post-thaw survival of sperm and the number of motile cells inseminated. In spite of having normal semen parameters, some donors were found to have markedly reduced sperm fecundity. We conclude that IUI with cryopreserved sperm can be an effective treatment for couples with infertility, genetic indications, or other reasons.     

Motor unit number estimation in the evaluation of focal conduction block

Temporal dispersion and phase cancellation limit the utility of amplitude reduction in compound muscle action potential (CMAP) as a measure of focal conduction block but may not affect motor unit number estimation (MUNE). Hence, MUNE offers the potential of a specific measure of conduction block. We investigated the role of MUNE in 11 patients with ulnar neuropathy and conduction block at the elbow and also in 8 normal subjects. MUNE failed to detect motor unit dropout in the patient group because reduced values for surface-recorded motor unit potentials (SMUPs) were obtained at proximal locations, suggesting that focal compression selectively damages larger motor axons, an hypothesis that has support from animal studies. We conclude that, because MUNE is affected by the physiological characteristics of functional axons surviving the underlying pathological process, the utility of MUNE is limited to diseases in which the expected pathology affects motor axons uniformly.     

Mental rotation in unipolar major depression

Mental rotation (MR) performance may be used as an index of mental slowing or bradyphrenia, and may reflect, in particular, speed of motor preparation. MR was employed with a sample of both melancholic (n=8) and non-melancholic (n=9) unipolar depressed patients and healthy controls (n=10) to determine if motor slowing associated with depression might be reflected in slowed motor preparation (as reflected in slope of the MR function) independent of actual motor slowing (overall response time). Both melancholic and non-melancholic patients showed a generalised slowing relative to controls, perhaps reflecting bradykinesia and akinesia. This effect was significantly greater in the melancholic group than in the non-melancholic group. Relative to both the controls and the non-melancholic groups, the melancholic patients showed a progressive slowing with increasing angle of orientation indicating a specific slowing of MR. This deficit suggests a role of slowed motor planning in the psychomotor retardation of patients with melancholic depression.     

Local-global processing in Alzheimer's disease: an examination of interference, inhibition and priming

Impairments of memory, praxis, gnosis, language and executive functioning are well documented in Alzheimer's disease (AD). Functions, such as attention, however, have only recently been systematically investigated. We used Navon-type stimuli (large "global" digits composed of smaller "local" digits) to assess 12 AD participants' plus age-matched controls' ability to focus and alter the scale of their spatial attention. In the first experiment, participants responded to either the global or local characters within a block, ignoring characters at the other spatial scale. Healthy young adults (n=12) demonstrated the normal 'global precedence' effect on this task. In contrast, participants with AD and their age-matched controls were significantly faster on the local task than on the global task, suggesting in these groups a 'local precedence' effect. This consisted of both a local advantage and a local-on-global interference effect. In a second experiment, participants searched for designated targets which occurred unpredictably at either the local or global spatial scale. Participants with AD were significantly slower and more error-prone than older controls. In addition, participants with AD showed a greater cost in reaction time (RT) when required to switch spatial scales on consecutive trials, compared to no switch responses at the same spatial scale on consecutive trials. Thus, AD may impair the ability to process global figures, due perhaps to involvement of posterior parietal areas. Further, participants with AD were poor at inhibiting irrelevant stimuli and at inhibiting attentional allocation to an irrelevant spatial scale, which may relate to prefrontal pathology.     

Brief Report: Random Number Generation in Autism

This study explored the ability of individuals with autism to generate a unique series of digits. Fourteen low-functioning individuals with autism, 14 intellectually disabled individuals, and 14 postgraduate university students generated a series of pseudo-random digits. Individuals with autism were more likely to repeat previous digits than were either of the control groups. The normal control group, however, was less likely to attempt cycling through all digits before repeating. Accordingly, low-functioning individuals with autism may exhibit a shortfall in response inhibition. This finding supports the executive dysfunction theory of autism.     

The spectrum of HIV-related disease in rural Central Thailand

To determine the spectrum of HIV-related illnesses presenting to a rural primary and secondary healthcare facility in Central Thailand, a cross-sectional study was conducted. Routinely collected data were extracted from outpatient medical notes for all adult HIV-infected new attenders of the Manorom Christian Hospital Infectious Disease Clinic. Data concerning inpatient admissions of HIV-infected individuals were collected from ward admission books and discharge summaries. Complete data were available for 229 outpatients, 70% of whom were men. The median age at presentation was 31 years for men and 30 years for women. The majority of the outpatients were married (69%) and infected heterosexually (91%). The commonest conditions requiring admission were cryptococcal meningitis (15%), bacterial pneumonia (12%), extrapulmonary tuberculosis (12%), Pneumocystis carinii pneumonia (7%), cerebral toxoplasmosis (4%) and pulmonary tuberculosis (3%). Of the patients presenting for the first time, 32% had AIDS-defining illnesses. Presentations with some conditions, such as tuberculosis and septicemia, were fewer than expected. The common opportunistic infections among HIV-infected adults in this rural region are treatable and preventable. Most patients present with advanced disease and earlier diagnosis, through improved access to voluntary counseling and testing, would enable them to receive appropriate preventive therapies and antiretrovirals as they becomes available. The high prevalence of cryptococcal disease suggests that prophylactic anti-fungal therapy may be of value in this area. Septicemia and tuberculosis may be under-diagnosed, highlighting the need for improved diagnostic laboratory facilities or treatment based upon validated clinical algorithms. Community care and palliative care services for HIV-infected individuals will increasingly be required in this region.     

Non-invasive measurement of organ density in a rat simulated microgravity model

BACKGROUND: Spaceflight has caused serious concerns to the health and well-being of astronauts, both while in space and post-mission on Earth. The deleterious health effects due to microgravity are not well understood and though these effects may be caused by multiple factors, fluid shifts within the body may play a major role. HYPOTHESIS: We believe that 45 degrees C HDT will cause significant changes in organ density as measured by spiral computed tomography in a 1-h experimental time period. METHODS: There were 20 male Fischer 344 rats that were randomly selected to be in an experimental or control group. The experimental group (n = 12) was subjected to a 45 degrees head down tilt microgravity exposure (45 degrees HDT) for 1 h, and the control group (n = 8) remained in the prone position for the same amount of time. At the end of 1 h, the density of the brain, lungs, heart, liver, and left and right kidneys were measured using spiral computed tomography (SCT) while the rats remained in their experimental positions. RESULTS: With the exception of the right kidney, we demonstrated that there was a significant change (p < 0.05) in the densities of all tested organs in the 45 degrees HDT group when compared with the control group. The brain showed the largest percent increase at 45.6% while the lungs showed the least amount of change at 8.7%. CONCLUSIONS: We conclude there are significant increases in organ density, as measured by SCT, in male 45 degrees HDT rats compared with prone controls.     

Integrating Cognitive-Behavioral Psychotherapy for Persons with Schizophrenia into a Psychiatric Rehabilitation Program: Results of a Three Year Trial

Emerging models of cognitive-behavioral treatment (CBT) offer promising new intervention strategies in the psychotherapy of schizophrenia. These models, however, have not been integrated into community support programs and evaluated in comparison to standard community treatments. This study examined differences in outcomes of clients who received long-term day treatment program services (DTP) compared to clients who received individual CBT that was included as part of their DTP treatment. Twenty-four clients were randomly assigned to DTP treatment or CBT/DTP treatment. Data on standardized measures of psychosocial functioning, symptomatology and rehospitalizations were collected over the course of three years of treatment. Analysis of variance with repeated measures was conducted to evaluate the effects of type of treatment (CBT/DTP and DTP) and time (dependent variable scores taken at the end of treatment years one, two and three) on the three outcome variables. Results indicate significant improvement for the CBT/DTP group compared to the DTP group in the patterns of change over time for psychosocial functioning and symptomology. In addition to this significant group/time interaction the time factor was also significant for both variables. For rehospitalizations the time factor was significant and the group/time factor was nonsignificant. Implications for service delivery to persons with schizophrenia and suggestions for future research are discussed.     

Cognitive deficits associated with a recently reported familial neurodegenerative disease: familial encephalopathy with neuroserpin inclusion bodies

BACKGROUND: We recently discovered an autosomal dominant disease causing a progressive dementia. The disease is caused by a point mutation in the gene coding for the serine protease inhibitor (ie, serpin) neuroserpin. The mutation results in an unstable neuroserpin protein that readily aggregates into intraneuronal inclusions that we identify as Collins bodies. The bodies are distributed throughout the cerebral hemispheres but are significantly more numerous in the cortex and the substantia nigra. We have named the disease familial encephalopathy with neuroserpin inclusion bodies (FENIB). OBJECTIVES: To describe the cognitive and neurophysiological changes exhibited by individuals with FENIB and to correlate the phenotypic expression of the disease with the neuropathological findings. DESIGN: Multiple case studies using neuropsychological assessment, electroencephalography (EEG), magnetic resonance imaging (MRI), and single-photon emission computed tomographic (SPECT) studies of family members were performed. Using these measures, we also compared family members in whom the mutation is present with family members in whom the mutation was absent to control for nonspecific familial factors. SUBJECTS: Nine individuals (5 women, aged 31-64 years; 4 men, aged 43-67 years) from 2 generations of family members related to the first reliably identified individual with symptoms of this disease. Symptoms, by self-report and reports of other family members, ranged from asymptomatic to severe dementia. Six of the 9 individuals carried the disease mutation. RESULTS: All subjects with the mutation demonstrated some cognitive changes, with the greatest demonstrated by subjects older than 40 years. The changes included restricted attention, concentration, and response regulation functions, reduced controlled oral fluency (word-list generation), and restricted visuospatial organization. In general, recall memory was not as affected as other cognitive domains. The most severely affected subject demonstrated global dementia with prominent frontal lobe features. Findings on SPECT showed anomalies limited to frontal areas in the less affected subjects and more global, patchy areas of hypoperfusion in the more severely affected subjects. The 3 oldest and most affected subjects demonstrated slowing on EEG findings. The MRI findings were noncontributory except in the 2 most severe cases, which showed global cortical atrophy. CONCLUSIONS: Cognitive changes in mildly to moderately affected subjects were characterized by deficits in frontal and frontal-subcortical area-dependent processes. Continued progressive deterioration of cerebral functions with relative sparing of recall memory suggests a unique dementia associated with this disease.