Associations between executive function and attention abilities and language and social communication skills in young autistic children

LAY ABSTRACT

Executive functioning describes a set of cognitive processes that affect thinking and behavior. Past research has shown that autistic individuals often have delays in the acquisition of executive function abilities. Our study explored how differences in executive function and attention abilities relate to social abilities and communication/language in 180 young autistic children. Data were gathered via caregiver report (questionnaires/interviews) and an assessment of vocabulary skills. The ability to sustain attention to a dynamic video was measured via eye tracking. We found that children with higher levels of executive function skills demonstrated lower levels of social pragmatic problems, a measure of having difficulties in social contexts. Furthermore, children who were able to sustain their attention longer to the video displayed higher levels of expressive language. Our results emphasize the importance of executive function and attention skills across multiple areas of functioning in autistic children, in particular those that involve language and social communication.

Gastrointestinal problems are associated with increased repetitive behaviors but not social communication difficulties in young children with autism spectrum disorders

LAY ABSTRACT

Individuals with autism spectrum disorder are more likely than typically developing individuals to experience a range of gastrointestinal abnormalities, including chronic diarrhea, constipation, food sensitivities, and abdominal pain. These gastrointestinal symptoms have been associated with higher levels of irritability and aggressive behavior, but less is known about their relationship with core autism spectrum disorder symptoms. We investigated the relationship between autism spectrum disorder symptom severity and gastrointestinal symptoms while accounting for three associated behavioral symptom domains (Irritability, Aggressiveness, and Specific Fears), in a sample of 176 children (140 males and 36 females) ages 2-7 years old with autism spectrum disorder. A large majority (93.2%) of the sample had at least one reported gastrointestinal symptom, and most (88.1%) participants had more than one gastrointestinal symptom. Various types of gastrointestinal symptoms were reported; the most common symptoms reported were constipation, food limits, gas/bloating, and stomach pain. After accounting for each associated behavioral symptom domain, repetitive behaviors and stereotypies were significantly associated with gastrointestinal symptom severity. Increased severity of autism spectrum disorder symptoms was correlated with increased gastrointestinal symptom severity. Social and communication difficulties were not significantly associated with gastrointestinal symptom severity after accounting for associated behavioral symptoms. Our findings replicate a previously described association between irritability and aggression and gastrointestinal symptoms. Furthermore, we found that repetitive behaviors, but not social or communication symptoms, are associated with gastrointestinal symptom severity, even after accounting for associated behavioral symptoms. This suggests that gastrointestinal symptoms may exacerbate repetitive behaviors, or vice versa, independent from other associated behavioral symptoms.

A Phase II Randomized Clinical Trial of the Safety and Efficacy of Intravenous Umbilical Cord Blood Infusion for Treatment of Children with Autism Spectrum Disorder

OBJECTIVE

To evaluate whether umbilical cord blood (CB) infusion is safe and associated with improved social and communication abilities in children with autism spectrum disorder (ASD).

STUDY DESIGN

This prospective, randomized, placebo-controlled, double-blind study included 180 children with ASD, aged 2-7 years, who received a single intravenous autologous (n = 56) or allogeneic (n = 63) CB infusion vs placebo (n = 61) and were evaluated at 6 months postinfusion.

RESULTS

CB infusion was safe and well tolerated. Analysis of the entire sample showed no evidence that CB was associated with improvements in the primary outcome, social communication (Vineland Adaptive Behavior Scales-3 [VABS-3] Socialization Domain), or the secondary outcomes, autism symptoms (Pervasive Developmental Disorder Behavior Inventory) and vocabulary (Expressive One-Word Picture Vocabulary Test). There was also no overall evidence of differential effects by type of CB infused. In a subanalysis of children without intellectual disability (ID), allogeneic, but not autologous, CB was associated with improvement in a larger percentage of children on the clinician-rated Clinical Global Impression-Improvement scale, but the OR for improvement was not significant. Children without ID treated with CB showed significant improvements in communication skills (VABS-3 Communication Domain), and exploratory measures including attention to toys and sustained attention (eye-tracking) and increased alpha and beta electroencephalographic power.

CONCLUSIONS

Overall, a single infusion of CB was not associated with improved socialization skills or reduced autism symptoms. More research is warranted to determine whether CB infusion is an effective treatment for some children with ASD.

Prevalence and risk factor assessment of Tropheryma whipplei in a rural community in Gabon: a community-based cross-sectional study

Tropheryma whipplei is the causative agent of Whipple's disease and has been detected in stools of asymptomatic carriers. Colonization has been associated with precarious hygienic conditions. There is a lack of knowledge about the epidemiology and transmission characteristics on a population level, so the aim of this study was to determine the overall and age-specific prevalence of T. whipplei and to identify risk factors for colonization. This molecular epidemiological survey was designed as a cross-sectional study in a rural community in Central African Gabon and inhabitants of the entire community were invited to participate. Overall prevalence assessed by real-time PCR and sequencing was 19.6% (95% CI 16-23.2%, n=91) in 465 stool samples provided by the study participants. Younger age groups showed a significantly higher prevalence of T. whipplei colonization ranging from 40.0% (95% CI 27.8-52.2) among the 0-4 year olds to 36.4% (95% CI 26.1-46.6) among children aged 5-10 years. Prevalence decreased in older age groups (p<0.001) from 12.6% (95% CI 5.8-19.4%; 11-20 years) to 9.7% (95% CI 5.7-13.6) among those older than 20. Risk factor analysis revealed young age, male sex, and number of people sharing a bed as factors associated with an increased risk for T. whipplei carriage. These results demonstrate that T. whipplei carriage is highly prevalent in this part of Africa. The high prevalence in early life and the analysis of risk factors suggest that transmission may peak during childhood facilitated through close person-to-person contacts.

Evaluation of poly(styrene-4-sulfonate) as a preventive agent for conception and sexually transmitted diseases

A commercial preparation of a sodium polystyrene sulfonate (designated as N-PSS; its molecular weight is 500000 daltons) was tested as an inhibitor of sperm function and as a preventive agent for conception and the transmission of sexually transmitted diseases. The polymer is an irreversible inhibitor of hyaluronidase and acrosin; its IC50 values are 5.7 microg/mL and 0.5 microg/mL, for hyaluronidase and acrosin, respectively. N-PSS is also a stimulus of human sperm acrosomal loss. It produces maximal acrosomal loss at 2.5 microg/mL. Contraception in rabbits is nearly complete when rabbit spermatozoa are pretreated with 0.5 mg/mL of N-PSS before artificial insemination; however, N-PSS does not immobilize spermatozoa at concentrations as high as 50 mg/mL. N-PSS has broad spectrum antiviral and antibacterial activities. Infection by human immunodeficiency virus and herpes simplex virus are inhibited by N-PSS; 3-log reductions are produced by 7 microg/mL and 3 microg/mL, respectively. N-PSS is active against Chlamydia trachomatis and Neisseria gonorrhoeae. At 1 mg/mL, N-PSS inhibits chlamydial infectivity by more than 90%. N-PSS produces a 3-log reduction in gonococcal growth at 15 microg/mL. In contrast, N-PSS (5 mg/mL) does not affect the growth of Lactobacillus (normal component of the vaginal flora). N-PSS can be classified as a noncytotoxic contraceptive antimicrobial agent. These properties justify bringing a polystyrene sulfonate into clinical trials for its evaluation as a preventive agent for conception and several sexually transmitted diseases.

[Isovolemic hemodilution--an adjuvant treatment principle in patients with chronic cor pulmonale caused by chronic obstructive lung disease]

On the basis of 10 patients with chronic cor pulmonale due to chronic obstructive lung disease and secondary polyglobulia in a clinical and experimental study could be made evident that by limited isovolaemic haemodilution (haematocrit value of 0.58 +/- 0.03 reduced to 0.36 +/- 0.01) are to be expected a decrease of the total pulmonary-arterial resistance, a reduction of the mean pulmonary arterial pressure, an increase of the partial O2-pressure as well as an increase of the heart index. Analogically to this as a consequence of the improved rheologic conditions a clear involution of the clinical signs of a heart insufficiency developed. Complications were not observed. The technique of the limited haemodilution should find a broader use in the medical practice, taking into consideration the isovolaemia as adjuvant treatment principle for patients with the indication mentioned.

Purity of commercial non-certified European samples of Pyronin Y

The purity of six European non-certified samples of Pyronin Y was compared with that of two American samples certified by the Biological Stain Commission. The methods used were spectrophotometry and a Methyl Green-Pyronin staining test (both as applied by the Biological Stain Commission), thin layer chromatography, mass spectrometry, determination of pH, and content of some electrolytes. It was found that none of the European batches of Pyronin Y passed the complete test as prescribed by the Biological Stain Commission. Their dye content was uniformly low (between 5 and 19%). Furthermore, thin layer chromatography and mass spectrometry revealed that two of the dye samples contained no Pyronin Y or only traces. It is concluded that assessment of an unknown sample of a dye labelled Pyronin Y should be initiated with thin layer chromatography. The pH and content of electrolytes in an aqueous solution of the dye should also be determined in order to obtain reproducible staining results. Finally, the value of the work performed by the Biological Stain Commission is underlined, although more sophisticated methods are necessary for testing the purity of dyestuffs.

[About the clinical picture of pulmonary heart disease with special regard to correlations between pulmonary function and pulmonary hemodynamics (author's transl)]

After introducing heart catheterization especially the right heart catheterization according to Grandjean the direct measurement of right ventricular as well as pulmonary artery pressure has been made possible in a relatively simple manner. Thereby the diagnosis cor pulmonale chronicum can be secured or omitted respectively with high confidence. In this regard the exercise--induced increase in pulmonary artery pressure has evident importance especially in case of clinical uncertainty. But because the right heart catheterization is not available in each patient suffering from a pulmonary disease distinct parameters (PaO2, FEV1, pulmonary residual volume, ECG, heart rate) can be used for recognition of the not yet decompensated state of the pulmonary heart disease considering the clinical situation as well as the correlation calculations pointed out by us. With increasing number of implicated functional parameters the security of diagnosis raises.

[Ergometric investigations with pressure measurements in the pulmonary arteria for judgment of the severity of the disease in patients suffering from left heart diseases (author's transl)]

Pressure measurements in the pulmonary artery were performed on 34 patients by intracardiac floating catheter during rest and under ergometer load of 51 Watt (corresponding to an oxygen consumption of 750 ml/min). 15 of the patients were suffering from myocardial infarction 4--6 weeks after admission, 12 from chronic coronary heart disease respectively angina pectoris and 7 from affection of the aortic valve. The pressure during rest ranged within the norm. Under load the patients suffering from myocardial infarction and coronary heart disease showed two forms of reaction: 1. moderate ascent of pressure up to 40 torr systolic and 15--18 torr diastolic (mean pressure 25--28 torr). 2. distinct ascent of pressure up to 50--60 torr systolic and 25--30 torr diastolic (mean pressure 36--42 torr). Evidence of latent pulmonary hypertension was irrespective of classification as myocardial infarction with or without complications. That demands regarding of central hemodynamics for the further course of rehabilitation more than hitherto.

[Hemodynamics in chronic cor pulmonale during exercise (author's transl)]

1. In patients with chronic cor pulmonale there is a regression dependence between the amount of exercise-induced increase in pulmonary arterial pressure and the level of resting value. 2. Hemodynamics during exercise are influenced by the patient's position in a certain degree. 3. The exercise-induced increase in pulmonary arterial pressure in chronic cor pulmonale is not influenced by the patient's age. 4. The time course of pressure fall during recovery depends on the amount of pressure increase during exercise, it depends less evidently on the level of the resting values. 5. Tachycardia is not a compulsory symptom of chronic cor pulmonale.

[71. Float catheter and pulmonary work load hypertension in mitral valve defects and cor pulmonale]

In patients with mitral valvular defects as well as with chronic cor pulmonale there exists an ascertained relation between the pulmonary-arterial pressure in rest and the increase of blood pressure under easy physical load. Patients with high initial value or strong increase of blood pressure reveal a retarded return of the blood pressure of the pulmonary artery to the initial value.

[Mechanics of breathing and exertion dyspnea in silicosis (author's transl)]

Mechanics of breathing as studied in patients with different stages of silicosis in rest and during exercise show the following: dynamic compliance and work against elastic and viscous resistances could not be found to be decisive indices of exertion dyspnea. Evidence of exertion dyspnea could only be achieved by means of the ration VT/PT (VT equals tidal volume, PT equals tidal esophageal pressure). Exertion dyspnea was observed at less than 0,081 VT per cm H20 PT. In accordance with Campbell and Howell, dyspnea is seen as an inappropriateness between ventilation and pressure needed.