Improved detection of amyloid in fat pad aspiration: an evaluation of Congo red stain by fluorescent microscopy

Amyloid fat pad aspiration specimens for cases with a clinical suspicion of amyloid typically are stained with Congo red and examined by brightfield microscopy. Congophilia with apple-green birefringence by polarization microscopy (PM) is considered diagnostic for amyloid. Examination of Congo red-stained slides by fluorescent microscopy (FM) is considered by some to be a more sensitive detection method. In this study, we assessed the utility of this technique in cytopathology archival slides from abdominal fat pad aspirations previously stained with Congo red dye. Seventy-eight cases of abdominal fat pad aspirations collected during the last 5 yr and stained with the Congo red procedure were obtained from archival files. Additionally, 20 adipose tissue material slides prepared from the surgical pathology specimens were examined as controls. One representative smear was examined in each case using FM equipped with rhodamine excitation/absorption (540/570 nm) filters. Relevant clinical information was obtained in all cases. Twelve cases (15.4%) of the 78 fat pad aspiration cases were reported originally as positive by Congo red stain using polarization and apple-green birefringence as diagnostic criteria. On review, four cases were deemed unsatisfactory. By FM examination 29 of the 74 (39.2%) cases were reclassified as positive for amyloid. The results were confirmed by immunohistochemical stain for amyloid P protein and electron microscopy. A number of similar distinct fluorescence and immunohistochemical patterns were recognized in the positive cases. Minimally weak fluorescence in the adipose tissue was observed in the control cases. The use of FM in Congo red-stained fat pad smears can improve the detection of amyloid in cytology preparations.     

Grandparental genotyping enhances exome variant interpretation

Trio exome sequencing is a powerful tool in the molecular investigation of monogenic disorders and provides an incremental diagnostic yield over proband‐only sequencing, mainly due to the rapid identification of de novo disease‐causing variants. However, heterozygous variants inherited from unaffected parents may be inadvertently dismissed, although multiple explanations are available for such scenarios including mosaicism in the parent, incomplete penetrance, imprinting, or skewed X‐inactivation. We report three probands, in which a pathogenic or likely pathogenic variant was identified upon exome sequencing, yet was inherited from an unaffected parent. Segregation of the variants (in NOTCH1, PHF6, and SOX10) in the grandparent generation revealed that the variant was de novo in each case. Additionally, one proband had skewed X‐inactivation. We discuss the possible genetic mechanism in each case, and urge caution in data interpretation of exome sequencing data. We illustrate the utility of expanding segregation studies to the grandparent generation and demonstrate the impact on exome interpretation strategies, by showing that objective genotype data can overcome subjective parental report of lack of symptoms.     

Immunization with cholinergic cell bodies induces histopathological changes in rat brains

We have previously shown that sera from patients with Alzheimer’s disease (AD) contain antibodies to the cell bodies (perikarya; PK) of purely cholinergicTorpedo neurons, and that repeated immunization of rats with this neuronal preparation for over a year induces learning and memory impairments. In the present study, we examined the brain morphology of cholinergic PK immunized rats relative to controls. Immunohistochemical studies of the brains of these rats revealed the accumulation of IgG in specific areas, such as, the hippocampus. Parallel histochemical studies demonstrated significant changes in the hippocampus, and in white matter areas. They included large vacuoles and necrotic nuclei in the granular layer of the dentate gyrus, tangle-like appearance in some pyramidal neurons of the hippocampus, and vacuolar degeneration accompanied by oligodendroglia hypertrophy in white matter tracts, such as, the corpus callosum and fimbria. In contrast, immunization withTorpedo cholinergic nerve terminals, that has no cognitive effects on the rat, also did not induce brain morphological changes. These findings suggest that the learning and memory deficits induced by immunizing rats with cholinergic PK are related to the observed brain morphological changes, and support the hypothesis that the antibodies to cholinergic neurons found in the sera of AD patients may play a role in neuronal degeneration in this disease.     

Stigmatization, self-esteem, and coping among the adolescent children of lesbian mothers

Purpose: To examine perceived stigma, coping, disclosure, and self-esteem among adolescents with lesbian mothers.

Method: Interviews were conducted with 76 adolescents ages 11–18 years. Standardized measures of self-esteem and coping skills were used. A measure of stigma was adapted for this study and a measure of disclosure was developed. The relationship between perceived stigma and self-esteem was examined. General coping skills and level of disclosure about the adolescents’ mothers’ sexual orientation were assessed as potential moderators of the relationship between perceived stigma and self-esteem.

Results: Adolescents who perceived more stigma had lower self-esteem in five of seven self-esteem areas, compared to those who perceived less stigma. In addition, coping skills moderated the effect of stigma on self-esteem in three self-esteem areas. However, only one subtype of coping skills, that of decision-making coping, was found to moderate the relationship of perceived stigma and self-esteem in such a way that adolescents using more decision-making coping had higher self-esteem in the face of high perceived stigma. For social support coping, in the face of high perceived stigma, the adolescents with more effective coping skills had lower self-esteem. In the face of high perceived stigma, adolescents who disclosed more about their mother’s sexual orientation had higher self-esteem in the subscale of close friendship than those who disclosed less.

Conclusions: Results suggest that stigma is related to self-esteem among the adolescent children of lesbian mothers. The results indicate that this relationship is moderated by coping skills. These results have implications for intervention and prevention of stigmatization by the establishment of effective coping skills as well as through educational efforts to eradicate stigmatizing attitudes.     

Is obesity a risk factor for psychopathology among adolescents?

BACKGROUND: Although several studies have documented the existence of psychopathology in obese adolescents, disagreement remains regarding the extent and nature of this psychopathology. The aim of the present study was to explore the type and frequency of psychopathology in a clinical as well as a non-clinical sample of obese adolescents, and in a normal weight control group. METHODS: The study sample consisted of a clinical study group of 30 obese adolescents, a non-clinical obese group of 30 obese adolescents, and a control group of 30 normal weight adolescents. Psychological assessment was performed using a non-structured psychiatric interview, the Child Behavior Checklist (CBCL), Children Depression Inventory (CDI), Rosenberg Self-esteem scale (SES) and the Eating Attitude Test (EAT). RESULTS: More than half of the clinical obese adolescents (16/30) had a DSM-IV diagnosis, often involving major depressive disorder (n = 10). The mean scores of anxiety-depression, social problems, social withdrawal and total problem in the CBCL scale of the clinical obese group were significantly higher than the non-clinical obese group and the normal weight control group. The mean total scores of the SES and the CDI of the clinical obese group were higher than the normal weight control group. The mean total score of EAT of the clinical obese group was significantly higher than the normal weight control group, and the mean score of EAT of the non-clinical obese group was significantly higher than the normal weight control group. CONCLUSIONS: The results support previously published reports which show a higher ratio of psychopathology (depression, behavioral problems, low-esteem) among clinical obese adolescents than among non-clinical obese adolescents. Findings provided evidence for a psychosocial at-risk population in a subgroup of obese adolescents.     

Diagnostic uncertainty and recall bias in chronic low back pain

Patients’ beliefs about the origin of their pain and their cognitive processing of pain-related information have both been shown to be associated with poorer prognosis in low back pain (LBP), but the relationship between specific beliefs and specific cognitive processes is not known. The aim of this study was to examine the relationship between diagnostic uncertainty and recall bias in 2 groups of chronic LBP patients, those who were certain about their diagnosis and those who believed that their pain was due to an undiagnosed problem. Patients (N = 68) endorsed and subsequently recalled pain, illness, depression, and neutral stimuli. They also provided measures of pain, diagnostic status, mood, and disability. Both groups exhibited a recall bias for pain stimuli, but only the group with diagnostic uncertainty also displayed a recall bias for illness-related stimuli. This bias remained after controlling for depression and disability. Sensitivity analyses using grouping by diagnosis/explanation received supported these findings. Higher levels of depression and disability were found in the group with diagnostic uncertainty, but levels of pain intensity did not differ between the groups. Although the methodology does not provide information on causality, the results provide evidence for a relationship between diagnostic uncertainty and recall bias for negative health-related stimuli in chronic LBP patients.     

Adolescents on the Front Line: Exposure to Shelling Via Television and the Parental Role

Objectives: Research suggests that exposure to traumatic content via television inadvertently increases posttraumatic stress symptoms (PTSS) as well as psychological distress, especially among adolescent viewers. The aim of the current study was to assess the effect of news consumption on PTSS and general distress among adolescents who live in a war area, as well as to examine the role of parents as intermediaries of news broadcasting. Method: A total of 65 adolescents who live in a war zone filled out the Child Post Traumatic Stress Reaction Index, the Brief Symptoms Inventory, and a scale measuring the level of real-life exposure, news broadcast consumption, and parents as intermediaries of news broadcasting. Results: A main effect for real-life exposure on both PTSS and general distress was revealed. Interestingly, a three-way interaction between real-life exposure, television exposure, and parents as intermediators was found for general distress. Only under low real-life exposure did parents as intermediaries buffer the effect of television exposure on general distress. Conclusions: Parental intermediation of news broadcasting of traumatic events, especially in situations of continuous, real-life exposure, is essential.