Pattern and source of secretion of relaxin in the reproductive cycle of the spotted hyena (Crocuta crocuta)

Female spotted hyenas are highly masculinized at birth and have no external vagina. Copulation with males and birth of young are accomplished through the central urogenital canal of the clitoris. This unusual adaptation requires remarkable changes in the elasticity of the connective tissues of the clitoris, without which neither copulation nor birth would be possible. We hypothesized that relaxin, a hormone that increases the extensibility of the connective tissues of the uterus and cervix of many other mammalian species, plays a role in the clitoral changes observed in hyenas. Serum relaxin was determined by specific RIA. Relaxin was not detected in serum of males, pubertal or nonpregnant adult females, or ovariectomized females. Immunoactive relaxin was detected in serum of juveniles at the time of initial growth of the urogenital meatus. High concentrations of immunoactive relaxin appeared in the serum of pregnant hyenas in the 2 wk preceding parturition. Immunoassays of extracts of hyena tissues and serum obtained from uterine and ovarian veins indicated that the placenta was the predominant source of relaxin, with possible ovarian contributions. Circulating relaxin decreased promptly following cesarean section near term. We conclude that relaxin secretion coincides with changes in extensibility of clitoral connective tissues 1) during growth of the clitoris in juveniles and 2) near the time of parturition in adults.

Standardized assessment of concussion in football players

The recent formulation of guidelines for the management of concussion in sports adopted by the American Academy of Neurology specifically calls for the development of a standardized, systematic sideline evaluation for the immediate assessment of concussion in athletes. The present study involved the preliminary investigation of the feasibility and clinical validity of a standardized version of a brief sideline examination complied in accordance with these guidelines. This examination, intended for use by athletic trainers, was administered by three trainers to 141 nonconcussed high school football players at three separate schools. All players suspected of suffering a concussion (N = 6) during the fall 1995 season were also tested immediately following their injury. The examination was easily administered and scored. The concussed players as a group scored significantly below the nonconcussed controls and below their own baseline (pre-injury) performance, despite their all having been considered by the trainers to have suffered mild, grade 1 concussions. Although preliminary, these data suggest that a standardized sideline examination of this type can be useful in detecting concussion and determining fitness to return to play.

Hypertension education: an important and neglected part of the diabetes education curriculum?

This review highlights the important role of hypertension education in reducing the impact of hypertension on the development and progression of diabetes-related complications. Hypertension is commonly associated with diabetes mellitus and can significantly affect the progression of the complications of diabetes. Lifestyle changes similar to those recommended for diabetes management can result in a lowering of blood pressure and can be maintained on a long-term basis to benefit patients with diabetes and mild hypertension. Recently, a team approach in a hypertension clinic model similar to the team approach for diabetes treatment was shown to be effective in diabetes management. Increased awareness of hypertension education may contribute greatly to reducing the complications of diabetes. Hypertension education should be an important component of the diabetes education curriculum.

The free running athletic screening test as a screening test for exercise-induced asthma in high school

As part of a multicenter study envisioned by the American College of Allergy Sports Committee to screen for exercise-induced asthma, 303 high school students, freshman and sophomore gym classes, completed a questionnaire concerning exercise-related asthma, chronic asthma, and atopy. The study group included 124 females (41%) and 179 males (59%) with an average and median age of 15 years and a range of 13-17 years, and included 99% Caucasian and 1% nonCaucasian students, all attending the same parochial high school. After obtaining informed consent, 112 (37%) agreed to a free running test with initial challenge on an outdoor cinder track during April-June 1995. All challenges were conducted between 8:00 A.M. and noon with relative-humidity 59% and average temperature 15 degrees C. The challenge consisted of 7 minutes of continuous running on the cinder track with a doubling of pulse rate to 160/min during the run. Peak expiratory flows were taken at baseline, 0, 5, and 10 minutes postexercise. Twenty nine of 112 (26%) of the students were initially assessed as positive challenges, defined as a 15% decline in peak flow following exercise on the first challenge. However, four students self-recovered; thus 25 of 112 (22%) were qualified as true positives. Of these 25, 20 (80%) agreed to be reexercised. Fourteen of 20 (70%) were positive, yielding a prevalence rate of 14/112 (12.5%). Sixteen of these 20 (80%) were then exercised a third time using spirometry pre- and postexercise. Eight were positive, yielding a prevalence rate of 8/112 (7%). The questionnaire correlated significantly with the challenge, particularly when read by section (p = 0.000001) rather than globally positive or negative (p = 0.00008), with a specificity of 64%, sensitivity of 94%, positive predictive value of 44%, and negative predictive value of 97%. In summary, inexpensive and familiar free-running tests can be a useful screening test to confirm the questionnaire which is sensitive (94%) in ruling in, but has low specificity (64%) in ruling out, exercise-induced asthma.

Auditory working memory and Wisconsin Card Sorting Test performance in schizophrenia

BACKGROUND

Impaired Wisconsin Card Sorting Test (WCST) performance has been one critical piece of evidence suggesting frontal lobe dysfunction in schizophrenia. However, the specific cognitive processes underlying impaired performance have not been identified. Impaired WCST performance in schizophrenia might in part reflect a fundamental working memory deficit.

METHODS

We examined the performance of 30 normal subjects and 36 patients with schizophrenia on a neuropsychological battery including a novel measure of working memory-letter-number (LN) span.

RESULTS

Patients with schizophrenia were impaired on LN span performance, which was also highly correlated with WCST performance (r = 0.74). Between-group WCST differences were eliminated when we covaried LN span. Regression analyses suggested that LN span performance predicted the WCST category achieved score, whereas measures of set shifting, verbal fluency, and attention were predictive of perseveration.

CONCLUSION

Working memory may be a critical determinant of one aspect of WCST performance in schizophrenia.

Visuospatial working memory in patients with schizophrenia

Recent investigations have documented abnormalities in working memory related processes in schizophrenics on tasks assessing the central executive component of this cognitive model. This preliminary study investigated the function of another component of the working memory system, the visuospatial scratch pad in schizophrenia. The "scratch pad's" passive visual store--responsible for the temporary retention of visual material--was assessed via a computerized spatial delayed response task, whereas its active spatial rehearsal subsystem--specialized for retaining the temporal properties--was explored through visual block span. To assess elemental visual spatial abilities we used the Judgment of Line Orientation test. Thirty-two schizophrenics and 27 controls were tested. Although we discovered the basic perceptual abilities of patients to be intact, we determined that whenever memory was necessitated on spatial tasks, patients demonstrated marked deficits. This pattern of cognitive dysfunction is consistent with impairments in a neural network involving prefrontal and/or posterior brain regions in schizophrenia.

Utility of clinical trial batteries in the measurement of Alzheimer's and Huntington's dementia

Tests used as outcome measures in clinical trials of antidementia agents are not typically employed as part of diagnostic evaluations, and little information exists as to the sensitivity of these tests in terms of either differentiating demented patients from normal individuals or in distinguishing dementias of various types and etiologies. Sensitivity to mild dementia and sensitivity to impairment of various neuropsychological domains are, however, prerequisites for valid use of an instrument as an outcome measure in this context. The present study was undertaken to directly compare six different tests (three traditional psychometric tests and three clinical trial batteries) in terms of their sensitivity to detect and distinguish between mild dementia in patients with either Alzheimer's disease (n = 15) or Huntington's disease (n = 15), when compared to normal controls (n = 15). Tests included the Mattis Dementia Rating Scale, the Mini-Mental State Examination, the Wechsler Memory Scale-Revised, the Alzheimer's Disease Assessment Scale-Cognitive Subscale, the Computerized Drug Research (CDR) Cognitive Assessment System, and the Repeatable Battery for the Assessment of Dementia (RBAD). All of the tests were roughly equivalent in terms of their ability to discriminate normal subjects from mildly demented patients. Only the CDR and RBAD, however, were able to reliably discriminate between the two patient groups. The results are discussed in terms of the applicability of these tests as outcome measures for clinical trials in dementing disorders.

Neuropsychological characterization and detection of subclinical hepatic encephalopathy

OBJECTIVE

To elucidate the nature of the neuropsychological deficits associated with subclinical hepatic encephalopathy.

DESIGN

Prospective study comparing the performance of patients with liver disease and carefully matched normal controls on a short but comprehensive neuropsychological test battery.

SETTING

A university medical center.

PARTICIPANTS

Twenty patients with cirrhosis (10 alcoholic and 10 nonalcoholic) and 20 controls carefully matched on the basis of age, sex, education, and alcohol history.

RESULTS

The cirrhotic patients exhibited relatively selective deficits in complex attentional and fine motor skills, with preservation of general intellectual ability, memory, language and visuospatial perception.

CONCLUSIONS

This pattern of neuropsychological deficits suggests a subcortical pathophysiology, possibly reflecting involvement of the basal ganglia. These neuropsychological findings are consistent with recent neuroradiological, electrophysiological, and neurophysiological research implicating basal ganglia involvement in cirrhosis.

Latex hypersensitivity in a horse farmer

Latex immediate hypersensitivity has been documented in 28% to 67% of spina bifida patients, 2.6%-16.9% of health care workers and at least 1% of the general population. Additionally, it has been confirmed in food-sensitive individuals sensitive to cross-reacting foods such as chestnut, avocado, banana, and passion fruits. Recently it has been observed even in low risk populations that are defined by absence of the conventional risk factors of atopy and exposure. We report the first documented case of latex allergy in a horse farmer who had the joint factors of atopy and exposure. This case exemplifies the paramount importance of screening all patients with a careful history first and appropriate testing for latex allergy when possible.

Isolating the mnemonic component in spatial delayed response: a controlled PET 15O-labeled water regional cerebral blood flow study in normal humans

In this study we attempted to elucidate the neural network involved in maintaining spatial information over short delays by means of the PET 15O-labeled water method for measuring regional cerebral blood flow. To isolate the mnemonic component of delayed response processing we designed a control task isomorphic to the experimental task (in which the subject remembered the location of four targets in an array over a 7 s delay) and controlled for spatial encoding. Fourteen normal subjects participated in the study. Regional cerebral blood flow (rCBF) data were analyzed using statistical parametric mapping, a data-driven approach which canvasses the whole brain for significantly activated pixels in the experimental vis-à-vis the control task, and a hypothesis driven region of interest approach involving comparisons of control and experimental conditions using normalized rCBF data. We found convergent evidence for a spatially distinct but functionally related network in which dorsolateral prefrontal cortex and extrastriate occipital cortex were activated by the experimental task vis-à-vis the control task, as well as evidence for superior parietal and supplementary motor area cortical activation. These findings suggest that anterior components of the network may be involved in mnemonic rehearsal functions, while posterior components may store critical perceptual attributes of the memoranda.

Lipoprotein profiles and glucose tolerance in lean and obese chimpanzees

We compared serum lipid profiles and glucose tolerance of obese and lean chimpanzees maintained on a 10.9% fat diet. Seven of 14 obese and 6 of 17 lean chimpanzees were hypercholesterolemic (low density lipoprotein cholesterol > 160 mg/dl), three obese and three lean animals had total cholesterol/high density lipoprotein cholesterol ratios of 5.9-10.7, and two obese and one lean chimpanzee had abnormal glucose tolerance. Useful numbers of captive chimpanzees thus exhibit metabolic abnormalities without recourse to high fat diets and could serve as surrogates in studies of human metabolic diseases.

The functional neuroanatomy of Tourette's syndrome: an FDG-PET Study. II: Relationships between regional cerebral metabolism and associated behavioral and cognitive features of the illness

We analyzed F-18 fluoro-deoxyglucose PET scans carried out in 18 drug-free patients with Tourette's syndrome (TS) in order to evaluate relationships between cerebral metabolism and complex cognitive and behavioural features commonly associated with this disorder. These features (obsessions and compulsions, impulsivity, coprolalia, self-injurious behavior, echophenomena, depression, and measures of attentional and visuospatial dysfunction) were associated with significant increases in metabolic activity in the orbitofrontal cortices. Similar increases, although less robust, were observed in the putamen and, in the case of attentional and visuospatial measures, in the inferior portions of the insula. On the other hand, behavioral and cognitive features were not associated with metabolic rates in other subcortical (midbrain, ventral striatum), paralimbic (parahippocampal gyrus), or sensorimotor regions (supplementary motor area, lateral premotor or Rolandic cortices), in which metabolism had, in some cases more robustly, distinguished these TS patients from controls (Braun et al., 1993). These results suggest that a subset of regions in which metabolic activity appears to be associated with the diagnosis of TS per se, may be explicitly associated with the emergence of complex behavioral and cognitive features of the illness. This is most conspicuous in the orbitofrontal cortices, and it is consistent with the observation that these features resemble the elements of a behavioral syndrome typically seen in patients with lesions of the orbitofrontal cortex.

Patterns of relaxin and steroids in the reproductive cycle of the common marmoset (Callithrix jacchus): effects of prostaglandin F2 alpha on relaxin and progesterone secretion during pregnancy

We measured the concentrations of relaxin (Rlx), progesterone, and estradiol-17 beta in serum samples obtained twice or three times weekly from marmosets during the estrous cycle and pregnancy. The cyclic patterns and concentrations of progesterone and estradiol-17 beta were similar to those reported by previous investigators. Rlx was not detected in individual serum samples ( < 0.62-1.25 ng/ml) obtained from nonpregnant marmosets. However, pooling of luteal serum from all animals permitted assay of much larger volumes of serum (0.4 ml vs. 0.1 ml), and a concentration of about 1 ng/ml was detected. Rlx was first detected in serum in the second or third week of the 21-wk marmoset pregnancy, rose to a peak during Weeks 10-14, and then declined slowly as the time of parturition approached. The pattern of Rlx was unlike that observed during pregnancy in Old World monkeys, chimpanzees, or women, and resembled, instead, that seen in rodents, carnivores, and equids. Progesterone and estradiol-17 beta likewise increased throughout pregnancy, and their patterns were similar to those previously described for marmosets by other investigators. The concentrations of the steroids and Rlx in serum of pregnant marmosets was 10-fold or more higher than those found in Old World monkeys, baboons, chimpanzees, or women. Spontaneous abortions in two of the marmosets were accompanied by precipitous falls in serum levels of progesterone, estradiol-17 beta, and Rlx. Following s.c. injection of the luteolytic agent prostaglandin F2 alpha (PGF2 alpha) into two marmosets at midpregnancy, serum progesterone and Rlx fell to low levels. These animals received a progestin, 17 alpha-ethyl-19-nortesterone, to preclude abortion. Serum progesterone rose again, but serum Rlx remained low for the duration of pregnancy.(ABSTRACT TRUNCATED AT 250 WORDS)

Memory and intelligence in lateralized temporal lobe epilepsy and schizophrenia

Recent neuroimaging studies of patients with schizophrenia have suggested structural and functional abnormalities of mesial temporal lobe structures. We compared the intelligence and memory test performance of 70 patients with schizophrenia and 72 patients with focal, lateralized temporal lobe epilepsy (30 left, 42 right temporal lobe) in order to examine the adequacy of a temporal lobe model of schizophrenic cognitive deficits. The groups did not differ in age, education, or Full Scale IQ. The right temporal lobe group had better overall memory performance than either the left temporal or schizophrenic patients. Unlike the schizophrenic patients, the memory impairment of the left temporal group was most evident with verbal materials and was amplified by delayed testing. Both epilepsy groups had better visual memory than the schizophrenic group. The clear differences in performance pattern between groups suggests that lateralized temporal lobe dysfunction does not by itself provide an adequate model of schizophrenic cognitive impairment.

Physiological activation of a cortical network during performance of the Wisconsin Card Sorting Test: a positron emission tomography study

To determine the neural circuitry engaged by performance of the Wisconsin Card Sorting Test (WCST), a neuropsychological test traditionally considered to be sensitive to prefrontal lesions, regional cerebral blood flow was measured with oxygen-15 water and positron emission tomography (PET) while young normal subjects performed the test as well as while they performed a specially designed sensorimotor control task. To consider which of the various cognitive operations and other experiential phenomena involved in the WCST PET scan are critical for the pattern of physiological activation and to focus on the working memory component of the test, repeat WCST scans were also performed on nine of the subjects after instruction on the test and practice to criteria. We confirmed that performance of the WCST engages the frontal cortex and also produces activation of a complex network of regions consistently including the inferior parietal lobule but also involving the visual association and inferior temporal cortices as well as portions of the cerebellum. The WCST activation in the dorsolateral prefrontal cortex (DLPFC) remained significant even after training and practice on the test, suggesting that working memory may be largely responsible for the physiological response in DLPFC during the WCST and, conversely, that the DLPFC plays a major role in modulating working memory.

Wechsler adult intelligence scale-revised in the evaluation of anterior temporal lobectomy candidates

We wished to (a) determine the ability of the Wechsler Adult Intelligence Scale-Revised (WAIS-R) to discriminate between patients with epilepsy of left or right temporal lobe (LTLE, RTLE) origin and (b) examine the ability of Kaufman's (1990) WAIS-R short forms to estimate actual Full-Scale IQ (FSIQ). We administered the WAIS-R to 215 nonretarded, left hemisphere dominant patients with invasively verified epilepsy of unilateral TL origin without lesions demonstrated by magnetic resonance imaging (MRI) (excluding mesial temporal sclerosis, MTS). LTLE (n = 106) and RTLE (n = 109) groups were compared on the WAIS-R subtests and summary IQ scores. Verbal-Performance IQ (VIQ-PIQ) discrepancies of various magnitudes, and Verbal Comprehension (VC) and Perceptual Organization (PO) scores derived by factor analysis. The LTLE group scored significantly lower on the Vocabulary subtest, and none of the other indexes reliably distinguished LTLE from RTLE patients. The Kaufman 2, 3, and 4 subtest short forms were significant predictors of FSIQ, with the 4 subtest short form having the highest correlation and lowest error of estimate.

Implicit memory in Alzheimer's disease

While patients with Huntington's disease (HD) and Korsakoff's syndrome (KS) demonstrate "preserved" performance on implicit word-stem completion tasks, patients with Alzheimer's disease (AD) are typically found to be impaired. It has been hypothesized that AD patients do poorly as a result of degenerative changes in posterior cortical association areas thought to mediate performance on this type of implicit memory task, and that the relative sparing of these areas in KS and HD results in their "preserved" performance. The present study was undertaken to examine the implicit memory performance of AD patients on this task after equating their explicit performance to that of normal controls by manipulating the number of encoding exposures. When this was accomplished, the implicit memory performance of AD patients was equivalent to that of controls. The results are discussed within the context of a critical review of the evidence for the existence of separable neural systems in mediating implicit and explicit memory.

Coadministration of fluvoxamine increases serum concentrations of haloperidol

Four patients with chronic schizophrenia were treated with a combination of fluvoxamine, haloperidol, and benztropine. The combination significantly impaired performance on tests of delayed recall memory and attentional function. Haloperidol concentrations in serum were monitored in three patients and were robustly elevated by fluvoxamine.

Electroencephalographic abnormalities in monozygotic twins with Tourette's syndrome

The association of attentional, neuropsychological, and behavioural abnormalities with Tourette's syndrome (TS) suggests that the abnormal function of the disorder extends beyond the motor circuits of the basal ganglia. To explore this possibility we studied, with conventional 18-channel electroencephalography, monozygotic twins ranging from 8 to 26 years of age, where at least one member of the twin pair suffered from TS. In nine out of the 11 twin pairs that differed in clinical severity of the tic disorder, the twin with the more severe course of illness had a significantly more abnormal electroencephalogram (EEG) by qualitative visual analysis. Most of the differences were due to excessive frontocentral theta activity, suggesting dysfunction outside the basal ganglia. There was also a significant relationship between a lower global neuropsychological testing score and a worse overall EEG. In eight of nine twin sets with different global neuropsychological testing scores, the twin with the lower score had a worse EEG. A similar relationship was found between birth weight and overall EEG quality. In the nine sets that differed in birth weight, the twin with a lower birth weight had a worse EEG in seven of the sets. The EEG findings are unlikely to be unlikely to be a medication effect because the same result was seen in the six twin pairs who had been medication-free for at least six months before entry into the study. The origin of this slowing may relate to the interaction between environmental insults to the central nervous system and the genetic component of TS, an interaction producing damage to the cortex, thalamus, or both.

Schizophrenia and temporal lobe epilepsy. A neuropsychological analysis

BACKGROUND

Recent neuroimaging studies have reported structural abnormalities of mesial temporal lobe structures in schizophrenia. This study compared the neuropsychological performance of patients with schizophrenia with patients with either left or right temporal lobe epilepsy to determine if lateralized, developmental temporal lobe dysfunction provides a model of the cognitive impairments observed in schizophrenia.

METHODS

A total 66 patients with schizophrenia and 101 patients with medically intractable focal temporal lobe epilepsy (48 left temporal, 53 right temporal) received a comprehensive neuropsychological battery.

RESULTS

The three groups did not differ on age, years of education, or Full-Scale IQ. However, clear differences were noted in performance profiles. Patients with schizophrenia scored significantly higher than either epilepsy group on a measure of word reading thought to reflect premorbid competence. Patients with schizophrenia demonstrated greater attentional impairment and motor slowing than either epilepsy group. The patients with schizophrenia had superior semantic knowledge and verbal memory compared with the left temporal lobe group. On the Wisconsin Card Sorting Test the patients with schizophrenia obtained significantly fewer categories than either temporal lobe group, but were not significantly more perseverative.

CONCLUSIONS

Data suggest lateralized temporal lobe dysfunction does not provide an adequate model of the cognitive impairments seen in schizophrenia. The disorders seem to follow different developmental paths: In early-onset epilepsy, the acquisition of cognitive skills and academic knowledge is compromised, while in schizophrenia cognitive functions are lost. Extratemporal pathologic features, most likely of the frontal lobe, are implicated in the cognitive dysfunction of schizophrenia.