Impaired recognition of fear in a Chinese man with bilateral cingulate and unilateral amygdala damage

LJM, a 41-year-old schizophrenic Chinese man with bilateral anterior cingulate gyrus (Brodmann's area 24) lesions and also a small lesion in right amygdala after an operation, was compared with normal as well as brain-damaged and schizophrenic controls in identification of morphed facial expressions of six basic emotions. In repeated administrations of the test for recognition of facial emotions, over a 1- year period, LJM performed significantly worse for expressions of fear compared with the three groups of controls. Recognition of other emotions was not significantly different from that of the controls, except that his recognition of disgust during the first session (but not in two subsequent sessions) was worse than normal and brain-damaged controls but not worse than schizophrenic controls. The dissociation between recognition of fear and other emotions supported the view that the brain has separable networks for processing different emotions, and that the right amygdala as well as the anterior part of bilateral cingulate gyrus are possible substrates involved in the special network for perception of fear. The results from the various groups of Chinese subjects indicate that they perceive emotions in a categorical manner, and that the six basic emotions are likely to be cross-cultural universals.     

Major threats to childbirth in developing countries

Biological, psychological or social elements may constitute a threat to childbirth. In developing countries, major threats to childbirth mainly caused by restricted health service budgets may be overcome by the introduction of appropriate screening tests, implementation of evidence-based medicine protocols, and a primary health-care approach to maternity services.     

Ethical and Practical Considerations for Collecting Research-Related Data from Commercially Sexually Exploited Children

This article presents seven challenges of collecting primary (i.e., firsthand) data from commercially sexually exploited children (CSEC). We drew on our research team's experience collecting longitudinal data from 28 CSEC survivors with a 12-month follow-up period. We used both face-to-face and electronic group brainstorming methods to nominate a list of research-related challenges. The two main themes that were identified were challenges that can limit data quality and concerns about the impact of research on participants, researchers, and others. The three challenges related to data quality are (1) the age of the research participants; (2) questions about obtaining informed consent from parents or guardians; and (3) the over-interrogation of CSEC youth. The four challenges related to concerns about the impact of research were (4) concerns that research participation may further exploit youth; (5) staying in the role of researcher and refraining from providing advocacy; (6) secondary trauma and burnout experienced by research staff; and (7) the additional burden that research and data collection may place on the advocates and direct service providers. Because the process of collecting data from CSEC youth can be complicated, and rife with ethical and practical challenges, we have relayed our experiences with seven specific research-related challenges in order to stimulate discourse and further progress in the field.     

Diagnosis of tuberculous meningitis: clinical and laboratory parameters.

BACKGROUND: Confirming the clinical suspicion of tuberculous meningitis (TBM) has always been problematic. Whilst smear and culture positivity are diagnostic, these tests have low sensitivity. The polymerase chain reaction (PCR) assay has given variable results. AIM: This study attempted to improve the diagnostic yield by: (a) increasing the cerebrospinal fluid (CSF) volumes; (b) testing the yield from three specimens of CSF assumed to represent lumbar, cervico-thoracic cord, and base of brain CSF samples; (c) undertaking PCR assays using multiple primer sets; and (d) using real-time PCR. METHOD: Patients suspected of having cranial or spinal meningeal tuberculosis were entered into the study. Three aliquots of CSF were subjected to smear, culture, and conventional and real-time PCR. Three sets of primers - IS6110, MPB64, and PT8/9 - were used. Patients were retrospectively classified into four categories: 'definite TB' (culture positive), 'probable TB' (clinical and other tests suggestive of TB), 'not TB', and 'uncertain diagnosis'. RESULTS: A total of 68 patients were studied. There were 20 patients classified as definite TB, 24 probable TB, 17 not TB, and seven uncertain diagnosis. Forty-eight of 57 (84.2%) patients tested were HIV seropositive. The IS6110 PCR was positive in 27 patients which included 18/20 culture positive cases, six in the probable TB group, and three in the not TB group. The MPB64 and PT8/9 primers did not increase the yield. Real-time PCR was positive in seven additional patients. Combining the definite and probable TB, the sensitivity of all PCR assays was 70.5% (31/44) and specificity 87.5% (21/24). CONCLUSION: Targeting multiple sites of the TB genome using conventional PCR did not increase the number of positive cases. Real-time PCR was more sensitive. However, all the current techniques are still too insensitive to confidently exclude the diagnosis on laboratory grounds.     

Impairment of recognition of disgust in Chinese with Huntington's or Wilson's disease

The selective involvement of the basal ganglia in recognition of the facial expression of disgust was investigated by examining a group of six symptomatic Huntington's disease patients and 32 Wilson's disease patients in China. Morphed photographs of facial expressions covering happiness-surprise-fear-sadness-disgust-anger were used and the patients were asked to label each photo. Other measures assessed basic cognitive functions and perception of non-emotion facial information, such as perception of gender, age, gaze direction, and recognition of unfamiliar as well as famous people. There was dissociation between the perception of emotions and other facial information, and between impairment of recognition of disgust and other emotions. The basal ganglia are the overlapping substrate involved in both Huntington's and Wilson's disease, although each has its own other lesions. The differentially severe impairment of recognition of disgust in the Chinese Huntington's disease and Wilson's disease patients strengthens the view that basal ganglia are selectively involved in processing the emotion of disgust.     

Talking while performing a task: a better attentional performance in patients with closed head injury?

This study explored the potentially beneficial effect of explicit verbalization on the attentional performance in patients with closed head injury (CHI) in both distracting and nondistracting environments. Ten patients with CHI and 10 normal controls were recruited. The findings indicated that in the absence of distractors, the two groups did not differ significantly on the total actual time of off-task behaviour. When distractors were present, the patients performed worse than their controls; whereas verbalization tended to reduce total actual time of off-task behaviour in patients more than normal controls (z=1.965, p=.049), the controls were at ceiling under the verbalization condition. Although the findings must be considered tentative because of this ceiling effect and the small sample sizes, our results do suggest that patients with CHI benefit more from self-instructional cues in a complex and distracting environment.     

Ipratropium bromide delivered by metered-dose aerosol to infant wheezers

Two methods of administration of ipratropium bromide (Atrovent; Boehringer Ingelheim) to wheezing children less than 25 months of age were compared: (i) the conventional nebulisation (15 children); and (ii) a metered-dose aerosol plus spacer and mask (MDA group, 17 children). The drug induced a significant and similar fall in respiratory rate in both groups. Transcutaneous carbon dioxide pressure was also reduced significantly but was more marked in the MDA group. This increase in alveolar ventilation was similar in those less than 12 months as in older children; in those with recurrent or with first time wheezing; and in those with radiological evidence of pneumonia. Clinical assessment of bronchospasm and recession was recorded as improved in over 80% of both groups. The MDA delivery of ipratropium bromide was as effective as nebulisation and was more convenient, since it required less time and equipment. It was also well accepted by the small patients.     

Wilson病患者的厌恶情绪加工障碍

目的　探讨Wilson病 (WD)患者是否出现选择性厌恶情绪认知障碍 ,以进一步验证基底节参与情绪加工的假说。方法　测试 32例WD患者 (WD组 )和 2 0名健康人 (对照组 )对 30张含有 6种基本情绪 (喜、惊、怕、悲、厌和怒 )面孔照片的辨认能力。结果　与对照组比较 ,WD组对厌 [(9.1± 4 .7)分 ,P <0 .0 0 1 ) ] ,怒和怕 [(1 4 .9± 4 .3)分 ;(1 2 .8± 3 .6)分 ,P均 <0 .0 5]情绪面孔的辨别有障碍 ,而相对于怕和怒 ,厌的认知障碍更为明显。结论　WD组表现为相对选择性的厌恶加工障碍     

A synthetic vascular conduit (expanded PTFE) for hemodialysis access--a preliminary report

The short term follow up of the thirteen PTFE synthetic grafts placed in eleven patients for chronic hemodialysis is reported. PTFE graft appears to be a satisfactory alternative to a bovine graft for use as a subcutaneous arteriovenous conduit for hemodialysis. Its resistance to local infection is noteworthy.