Emotional functioning in eating disorders: attentional bias, emotion recognition and emotion regulation

BACKGROUND

Interpersonal processes, anxiety and emotion regulation difficulties form a key part of conceptual models of eating disorders (EDs), such as anorexia nervosa (AN) and bulimia nervosa (BN), but the experimental findings to support this are limited.

METHOD

The Reading the Mind in the Eyes task, the Difficulties in Emotion Regulation Scale (DERS) and a computerized pictorial (angry and neutral faces) Stroop task were administered to 190 women [50 with AN, 50 with BN and 90 healthy controls (HCs)].

RESULTS

Those with an ED showed attentional biases to faces in general (medium effect), but specifically to angry faces over neutral faces (large effect) compared to HCs. The ED group also reported significantly higher emotion regulation difficulties (large effect) than HCs. There was a small difference between the ED and HC groups for the emotion recognition task (small-medium effect), particularly in the restricting AN (RAN) group. Depression and attentional bias to faces significantly predicted emotion regulation difficulties in a regression model.

CONCLUSIONS

The data provide support for conceptualizations of EDs that emphasize the role of emotional functioning in the development and maintenance of EDs. Further research will concentrate on exploring whether these findings are state or trait features of EDs.

Treatment patterns of docetaxel and paclitaxel in patients with early-stage breast cancer in a community oncology center

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Background: Docetaxel and paclitaxel have been widely used in treating breast cancer (BC). This study aimed to describe real-world treatment patterns of two taxanes in early-stage BC. Methods: Georgia Oncology Specialist Database (GOSD) was used and contained chemotherapy, medical and pharmacy claims, and lab results for nearly 170,000 patients with various types of cancer (2003–2008). Patients with stage I-III BC receiving doxirubicin-cyclophosphamide-taxane (ACT) were identified, and their pre-taxane and on-taxane periods (from first to last dose of docetaxel/paclitaxel) were examined. Number of cycles was compared using Student's t-test. Taxane dose schedule and the use of other chemotherapy in pre- and on-taxane periods were compared using Chi-Square test. A similar analysis was replicated using Pharmetrics database (2003–2008) in BC patients on ACT regimen with prior mastectomy. Results: In GOSD, 79 docetaxel (7.9%, 58.2%, 34.2% in stage I, II, III, respectively) and 139 paclitaxel (10.8%, 64.7%, 25.5% in stage I, II, III, respectively) patients were identified. Compared with paclitaxel, docetaxel patients completed more cycles (4.9 vs. 3.9, p < 0.001), were less frequently on weekly schedule, and more frequently on every-two-week (Q2w) or every-three-week (Q3W) schedules (2.5% vs. 15.2%, 27.9% vs. 62.6%, and 41.8% vs. 0%; p < 0.001). 22.8% of docetaxel patients received AC followed by docetaxel (AC>T) and 77.22% received ACT concurrently, while 100% of paclitaxel patients were on AC>T regimen. In Pharmetrics data, compared with paclitaxel (n = 211), docetaxel patients (n = 96) completed more cycles (11.3 vs. 4.6, p < 0.001), were less frequently on weekly, while more frequently on Q2W and Q3W schedules (3.1 vs. 9.5%, 9.4% vs. 62.6%, and 59.4% vs. 4.7%; p < 0.001). While 97.6% of paclitaxel patients were on AC>T regimen, AC>T and ACT regimens were evenly split among docetaxel patients (49% vs. 51%). Conclusions: Docetaxel and paclitaxel have different treatment patterns in real-world clinical practice. The patterns in a community oncology center appear to be consistent with national data. A potential limitation of this study is that the potential selection bias may not be fully adjusted.

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Genetic ancestries in northwest Cambodia

A survey of the genetic ancestry of 125 Cambodian children resident in Siem Reap province was undertaken, based on eight Y-chromosome binary polymorphisms and sequencing of the mtDNA HV1 region. The data indicated a largely East Asian paternal ancestry and a local Southeast Asian maternal ancestry. The presence of Y-chromosomes P* and R1al* was suggestive of a small but significant Indo-European male ancestral component, which probably reflects the history of Indian, and later European, influences on Cambodia.

Personality characteristics in obesity and relationship with successful weight loss

OBJECTIVE

Personality influences lifestyle behaviors. Therefore, certain personality traits could contribute to obesity and the response to behaviorally based weight loss therapy.

PURPOSE

The aims of this study were to test the hypothesis that personality characteristics differ between lean and obese persons in the community, obese persons in the community and obese persons seeking weight loss therapy by enrolling in a comprehensive weight loss program, and in obese persons who were successful and unsuccessful in achieving behavioral therapy-induced weight loss.

METHODS

The Temperament and Character Inventory was administered to 264 lean (body mass index (BMI) <25 kg/m(2)) and 56 obese (BMI> or =35 kg/m(2)) subjects from the St Louis community and 183 obese patients (BMI=44+/-10 kg/m(2)) enrolled in the Washington University Weight Management Program (WUWMP), which involved weekly group behavioral therapy and diet education sessions for 22 weeks.

RESULTS

Compared with lean subjects, obese subjects in the community scored higher in novelty seeking (19.7+/-5.9 vs 16.2+/-6.0, P<0.05), lower in Persistence (4.1+/-1.8 vs 4.8+/-1.7, P<0.05) and lower in self-directedness (32.1+/-7.6 vs 34.3+/-6.6, P<0.05.) Patients enrolled in the WUWMP scored higher than obese persons in the general population in both Reward Dependence (17.1+/-4.2 vs 15.7+/-4.3, P<0.05) and cooperativeness (36.9+/-5.4 vs 34.5+/-6.2, P<0.05). Patients who were successful in losing weight (>10% weight loss) after 22 weeks of behavioral therapy scored lower in novelty seeking than those who were unsuccessful in losing weight (<5% weight loss) (17.6+/-5.9 vs 20.2+/-5.9, P<0.05).

DISCUSSION

These results suggest that personality traits differ between lean and obese persons, and between obese persons who enroll and who do not enroll in a comprehensive weight management program. Moreover, high scores in novelty seeking are associated with decreased success in achieving behavioral therapy-induced weight loss.

Organ specificity in the circadian control of plant gene expression

Of the many plant genes whose expressions are controlled by the circadian clock, one of the phosphoenolpyruvate carboxylase kinase genes in soya bean (Glycine max) exhibits the unusual property that its control is organ-specific--it is under circadian control in leaves but not in roots. Preliminary experiments suggest that the same is true for at least one gene in Arabidopsis thaliana. It will be important to define the extent and function of this phenomenon and the underlying mechanism.

Referrals for cataract surgery: variations between different geographic areas within a Welsh Health Authority

AIM

The aim of the study was to identify variations in cataract presentation within three different eye units in a single health authority and to identify any correlation between cataract presentation and social deprivation indices. We also compared our patient profile and results with the UK National Cataract Audit Statistics.

METHODS

It was a prospective multicentre questionnaire-based project involving three hospitals: Cardiff Eye Unit--University Hospital of Wales (UHW), Royal Glamorgan Hospital--Llantristant (RGH), and Prince Charles Hospital--Merthyr Tydfil (PCH). Demographic, clinical, and socioeconomic data were collected in patients undergoing cataract surgery. Patients were also asked to fill in the questionnaire based on Berth-Petersen Visual Function Index (VF-14) indicating difficulty in performing daily living activities.

RESULTS

A total of 112 patients were recruited in the study. Demographics were similar to National Cataract Audit. However, the percentage of patients with poor visual acuity (less than 6/60) at the time of surgery was greater at all the three hospitals compared to the national statistics. Among the three hospitals at South Wales, PCH had the lowest visual acuity in both listed and fellow eye and the lowest VF-index. Both the outpatient and surgery waiting times were longest at PCH. The population at PCH also visited their optician least frequently.

CONCLUSION

Our results show significant variation in cataract presentation between the three eye units within a single Health Authority. These variations correlate well with social deprivation indices and poor use of Optometric services. Local policies are needed to redress these inequalities and raise public and professional awareness of causes of poor sight in the elderly population.

Retrosternal displacement after physeal fracture of the medial clavicle in children

Retrosternal displacement of the medial aspect of the clavicle after physeal fracture is rare. We treated six patients with this injury between 1995 and 1998, all as an emergency in order to avoid complications associated with compression of adjacent mediastinal structures. Attempted closed reduction was undertaken, but all required open reduction and internal fixation using a wire suture. There were no associated complications. Five were reviewed clinically and radiologically at a minimum of one year after operation. All had regained full use of the affected arm without pain and had resumed their preinjury level of activity including sports. Follow-up radiographs showed union in the anatomical position in all patients. We recommend attempted closed reduction in the operating room, followed, if necessary, by open reduction. Internal fixation after open reduction gives stable fixation with minimal morbidity.

Retrosternal displacement after physeal fracture of the medial clavicle in children treatment by open reduction and internal fixation

Retrosternal displacement of the medial aspect of the clavicle after physeal fracture is rare. We treated six patients with this injury between 1995 and 1998, all as an emergency in order to avoid complications associated with compression of adjacent mediastinal structures. Attempted closed reduction was undertaken, but all required open reduction and internal fixation using a wire suture. There were no associated complications. Five were reviewed clinically and radiologically at a minimum of one year after operation. All had regained full use of the affected arm without pain and had resumed their preinjury level of activity including sports. Follow-up radiographs showed union in the anatomical position in all patients. We recommend attempted closed reduction in the operating room, followed, if necessary, by open reduction. Internal fixation after open reduction gives stable fixation with minimal morbidity.

Consanguinity and early mortality in the Muslim populations of India and Pakistan

Empirical information from studies conducted in Pakistan has indicated a high level of offspring mortality that can be attributed to parental consanguinity even when non-biological variables are controlled. However, with the exception of some small and geographically restricted studies, few comparable data are available on the influence of inbreeding in child survival among the Muslim population of India, which numbers between 100 and 120 million. The present study compares deaths during the first 5 years of life among the offspring of first cousin (F = 0.0625) and non-consanguineous unions (F = 0), using data collected in the 1992-1993 Indian National Family Health Survey (NFHS) and the 1990-1991 Pakistan Demographic and Health Survey (PDHS). The focus was on determinants of mortality in live-born children to age 5 years. In both countries, bivariate analyses indicated that mortality was significantly increased in the offspring of first cousin unions during the neonatal and post-neonatal, total infant, and under-5 year periods. The findings were confirmed by multivariate regression, which incorporated control for a range of biological and demographic factors.

Chordal cutting: a new therapeutic approach for ischemic mitral regurgitation

BACKGROUND

Mitral regurgitation (MR) conveys adverse prognosis in ischemic heart disease. Because such MR is related to increased leaflet tethering by displaced attachments to the papillary muscles (PMs), it is incompletely treated by annular reduction. We therefore addressed the hypothesis that such MR can be reduced by cutting a limited number of critically positioned chordae to the leaflet base that most restrict closure but are not required to prevent prolapse. This was tested in 8 mitral valves: a porcine in vitro pilot with PM displacement and 7 sheep with acute inferobasal infarcts studied in vivo with three-dimensional (3D) echo to quantify MR in relation to 3D valve geometry.

METHODS AND RESULTS

In all 8 valves, PM displacement restricted leaflet closure, with anterior leaflet angulation at the basal chord insertion, and mild-to-moderate MR. Cutting the 2 central basal chordae reversed this without prolapse. In vivo, MR increased from 0.8+/-0.2 to 7.1+/-0.5 mL/beat after infarction and then decreased to 0.9+/-0.1 mL/beat with chordal cutting (P<0.0001); this paralleled changes in the 3D leaflet area required to cover the orifice as dictated by chordal tethering (r(2)=0.76).

CONCLUSIONS

Cutting a minimum number of basal chordae can improve coaptation and reduce ischemic MR. Such an approach also suggests the potential for future minimally invasive implementation.

Paradoxic decrease in ischemic mitral regurgitation with papillary muscle dysfunction: insights from three-dimensional and contrast echocardiography with strain rate measurement

BACKGROUND

Ischemic mitral regurgitation (MR) was first ascribed to papillary muscle (PM) contractile dysfunction. Current theories include apical leaflet tethering caused by left ventricular (LV) distortion, but PM dysfunction is still postulated and commonly diagnosed. PM contraction, however, parallels apical tethering, suggesting the hypothesis that PM contractile dysfunction can actually diminish MR due to ischemic distortion of the inferior base alone.

METHODS AND RESULTS

We therefore occluded the proximal circumflex circulation in 7 sheep while maintaining PM perfusion, confirmed by contrast echocardiography. By 3D echocardiography, we measured the tethering distance between the ischemic medial PM tip and anterior annulus and LV ejection volume to give MR (by subtracting flowmeter LV outflow). In 6 sheep without initial MR, inferior ischemia alone produced PM tip retraction with restricted leaflet closure and mild-to-moderate MR (regurgitant fraction, 25.2+/-2.8%). Adding PM ischemia consistently decreased MR and tethering distance (5.2+/-0.3 to 1.4+/-0.3 mL; +3.8+/-0.5 mm to -2.2+/-0.7 mm axially relative to baseline; P<0.001) as PM strain rate decreased from +0.78+/-0.07 per second (contraction) to -0.42+/-0.06 per second (elongation, P<0.001) and leaflet tenting decreased. In one sheep, prolapse and MR resolved with inferior ischemia and recurred with PM ischemia.

CONCLUSIONS

PM contractile dysfunction can paradoxically decrease MR from inferobasal ischemia by reducing leaflet tethering to improve coaptation. This emphasizes the role of geometric factors in ischemic MR mechanism and potential therapy.

Electromyography and computed tomography scan-guided fine needle aspiration biopsy of discrete extraocular muscle metastases

Discrete or isolated metastasis to the extraocular muscles without an accompanying intraconal or extraconal mass is rare. Although it is estimated that 5% of orbital metastasis involves extraocular muscles only, to our knowledge there are no reports of discrete extraocular muscle involvement from renal cell carcinoma. With discrete extraocular muscle involvement, accurate localization within the infiltrated region of the muscle is of paramount importance in achieving a safe and positive biopsy. We describe a case with discrete extraocular muscle metastasis from a renal cell carcinoma, where a novel technique of FNAB (fine needle aspiration biopsy) of the medial rectus was undertaken, with EMG (electromyography) control and CT (computerized tomography) scan guidance.

Cognitive therapy, nutritional therapy and their combination in the treatment of bulimia nervosa

BACKGROUND

This study compared the effectiveness of cognitive therapy (CT), nutritional therapy (NT), the combination of cognitive and nutritional therapy (CNT), against a control condition of support group (SG) in the treatment of bulimia nervosa.

METHODS

One hundred female out-patients who fulfilled DSM-III-R criteria for bulimia nervosa were randomized to the four treatment groups. NT and CT were designed to cover different areas with minimal overlap, and CNT provided all of the features of both of these treatments. The control condition was conducted in a group self-help format. Each of the treatments lasted 14 weeks.

RESULTS

All three active treatments as well as SG produced significant decreases in binge/vomit episodes. Intent-to-treat analysis found CNT and CT to be significantly more effective than SG in retaining subjects in treatment and completion of study, as well as in producing greater improvements in dysfunctional attitudes and self-control. CNT was superior to SG in achieving abstinence from bulimic behaviour. NT was superior to SG only in increase of self-control. Logistic regression found that the cognitive component, whether given alone or in conjunction with NT, and higher pre-treatment self-control scores were significant predictors for both completion of study and abstinence.

CONCLUSION

CT (either alone, or in combination with nutritional therapy) remains the treatment of choice for bulimia nervosa. A treatment escalation approach should be tested for the treatment of bulimia with the more intensive and less widely available CT (with or without nutritional counselling) offered after patients have failed the less intensive and more widely available support group treatment.

Mental retardation in pediatric candidates for epilepsy surgery: the role of early seizure onset

PURPOSE

We sought to determine whether early age at seizure onset is a risk factor for mental retardation, independent of etiology. Assessment of risk for mental retardation with continued uncontrolled seizures plays a role in considerations of timing for epilepsy surgery. Previous studies have indicated that onset of seizures in the first years of life may be a risk factor for mental retardation, but the etiologies of the epilepsies were not included in the analyses.

METHODS

Intellectual function was assessed at ages 2-20 years during presurgical evaluation in 100 patients with intractable epilepsy due to focal lesions limited to part of one lobe of the brain. Mental retardation (MR) was defined as Full-Scale Intelligence Quotient (FSIQ) < or =70. The age at seizure onset and the seizure frequency were obtained retrospectively.

RESULTS

Younger ages at seizure onset were associated with lower FSIQ scores, and mean FSIQ was also significantly lower for patients with onset of epilepsy at < or =24 months of age (74.0 +/- 21.5) versus that in patients with onset of epilepsy later in life (87.8 +/- 18.8; p = 0.005). The frequency of patients with MR was significantly higher for patients with seizure onset at < or =24 months of age (15 of 33, 46%) than for patients with seizure onset later in life (eight of 67, 12%; p < 0.001). This difference persisted within etiologic subgroups. For patients with focal malformation of cortical development, MR was seen in eight (50%) of 16 patients with seizure onset at < or =24 months versus two (10%) of 20 patients with seizure onset at >24 months (p < 0.001); for patients with tumor, MR was seen in four (50%) of eight patients with seizure onset at < or =24 months versus four (13%) of 30 patients with seizure onset at >24 months (p = 0.003); and for patients with hippocampal sclerosis, MR was seen in two (28%) of seven patients with seizure onset at < or =24 months versus none of 30 patients with seizure onset at >24 months (NS). Within the subgroup with daily seizures, MR was present in 13 (65%) of 20 patients with seizure onset at < or =24 months versus five (17%) of 29 patients with seizure onset later in life (p = 0.001).

CONCLUSIONS

These results indicate that onset of intractable epilepsy within the first 24 months of life is a significant risk factor for MR, especially if seizures occur daily. The risk based on early age at seizure onset appeared independent of etiology and persisted within subgroups of patients with focal malformation of cortical development, tumor, or hippocampal sclerosis. Prospective studies will be important to clarify whether early surgical intervention may reduce the risk for subsequent MR in carefully selected infants.