The Effects of Microaggressions on Depression in Young Adults of Color: Investigating the Impact of Traumatic Event Exposures and Trauma Reactions

Microaggressions are a common way that individuals experience racism in the United States. The current study examined the extent to which microaggressions contribute to mental health difficulties, namely trauma reactions and depression, after controlling for other traumatic event exposures. We sought to address gaps in the literature by quantitatively assessing the associations among microaggressions, posttraumatic stress symptoms, and depression symptoms. Participants were 140 young adults of color (68.8% female) who were recruited online. Linear regression analyses evidenced that microaggressions were uniquely associated with depression symptoms, B = 0.27, after controlling for lifetime traumatic event exposures, with this association partially mediated by trauma reactions, B = 0.49. These results suggest that microaggressions are a clinically relevant factor in understanding mental health problems reported by Black, Indigenous, and People of Color in the United States and warrant analysis, assessment, and intervention through a trauma lens.

Predictors of Non-Alcoholic Liver Disease in Ethnically Diverse Overweight Children and Adolescents

OBJECTIVES

To study the relationship between Non-Alcoholic Fatty Liver Disease (NAFLD) and sleep, Physical Activity (PA), and screen-time habits/behaviors among a multiethnic sample of overweight children/adolescents.

METHODS

A retrospective medical chart review (6/2013-7/2014) identified 209 patients (7-21 years old) who were overweight/obese (BMI > 85th% for age/sex). A follow-up telephone survey was completed among 130 of these patients' parents to obtain information on sleep, screen-time, PA habits, and socio-demographics. NAFLD was defined as ALT and/or AST levels above the age/sexadjusted cutoff value in the absence of medications or associated medical conditions. Logistic regression models were fitted to identify predictors of NAFLD by adjusting age, sex, heritage, and income.

RESULTS

Over a third (34%) of the sample (N=130, 55% males, 74% Hispanic) had NAFLD. Compared to non-Hispanics, Central American heritage subjects were over three times as likely to have NAFLD compared to non-Hispanics (OR=3.90, 95% CI, 1.23-12.37) after adjusting for socioeconomics and lifestyle habits. Subjects with low PA levels were at increased risk for NAFLD (aOR=4.52, 95% CI, 1.21-16.82) compared to their more active counterparts. Lower income families were over twice as likely to have NAFLD as higher income families (OR = 2.57, 0.95-6.96).

CONCLUSIONS

Families residing from a Central American heritage are at significant risk for NAFLD versus their ethnic group counterparts. Identifying specific groups and risks for pediatric-onset NAFLD can inform and improve clinical practice and public health initiatives, especially as patient populations become more ethnically diverse across the nation.

Sour Grapes, Sweet Lemons, and the Anticipatory Rationalization of the Status Quo

Integrating theories of cognitive dissonance, system justification, and dynamic thought systems, the authors hypothesized that people would engage in anticipatory rationalization of sociopolitical outcomes for which they were not responsible. In two studies, the authors found that people adjusted their judgments of the desirability of a future event to make them congruent with its perceived likelihood, but only when the event triggered motivational involvement. In Study 1, a political survey administered to 288 Democrats, Republicans, and nonpartisans prior to the Bush-Gore presidential election manipulated the perceived likelihood that each candidate would win and measured the subjective desirability of each outcome. In Study 2, 203 undergraduate students rated the desirability of a large or small tuition increase or decrease that was low, medium, or high in likelihood. Under conditions evoking high motivational involvement, unfavorable as well as favorable outcomes were judged to be more desirable as their perceived likelihood increased.

Hemodynamic Interaction Between a Daily Dosed Phosphodiesterase 5 Inhibitor, Tadalafil, and the α-Adrenergic Blockers, Doxazosin and Tamsulosin, in Middle-Aged Healthy Male Subjects

The hemodynamic interaction between tadalafil (5 mg/d) and doxazosin or tamsulosin was investigated in 2 randomized, double-blind, crossover phase 1 studies. Healthy men (n = 45) received tadalafil or placebo for 28 days and increasing doses of doxazosin (1, 2, and 4 mg/d) for the last 21 days of treatment. In the second study, participants (n = 39) received tadalafil or placebo for 14 days and tamsulosin (0.4 mg/d) for the last 7 days of treatment. Similar mean maximum postbaseline changes in standing systolic blood pressure were observed in subjects given tadalafil or placebo with 4 mg of doxazosin (-0.5 mm Hg; 95% confidence interval, -4 to 3.1 mm Hg) or with tamsulosin (0.9 mm Hg; 95% confidence interval, -1.4 to 3.2 mm Hg). Standing systolic blood pressure less than 85 mm Hg (blood pressure outlier) occurred in 1 subject treated with 4 mg of doxazosin plus tadalafil but was not reported in subjects treated with tamsulosin and tadalafil. Three subjects experienced moderate hypotensive events lasting less than 2 hours, 2 with syncope (after tadalafil alone or with 4 mg of doxazosin) and 1 without (after 4 mg of doxazosin with placebo). The incidence of hypotension was low in healthy men given increasing doses of doxazosin with chronically dosed tadalafil or placebo. Administration of tadalafil with tamsulosin was well tolerated in healthy men.

Efficacy and safety of exenatide administered before the two largest daily meals of Latin American patients with type 2 diabetes

OBJECTIVE

To evaluate whether exenatide administered before breakfast and dinner (BD) or before lunch and dinner (LD) provided similar glycemic control in Latin American patients with type 2 diabetes mellitus (T2DM) who consume a small breakfast.

METHODS

In this open-label, 2-arm study, patients taking metformin, sulfonylureas, and/or thiazolidinediones were randomized to exenatide before BD or before LD (5-mug exenatide for 4 weeks, then 10-microg exenatide for 8 weeks). Treatment assignment was determined by a computer-generated random sequence using an interactive response system. Patients were eligible for study inclusion if they consumed <15% of their total caloric intake at breakfast. The primary endpoint was HbA(1c) change from baseline to endpoint. Secondary endpoints included fasting serum glucose (FSG) level, 7-point SMBG profile, and safety. Clinicaltrials.gov Identifier: NCT00359879.

RESULTS

377 participants (55% female, age 54 +/- 10 years, weight 82 +/- 15 kg, BMI 31 +/- 4 kg/m(2), HbA(1c) 8.4 +/- 0.9%; mean +/- SD) from Brazil and Mexico were randomized to study treatment. HbA(1c) reduction with exenatide administration before BD was non-inferior to administration before LD (mean difference between (LD-BD) treatments: 0.14%; 95% CI -0.04 to 0.32%, p=0.120). Both treatments resulted in statistically significant HbA(1c) reductions at endpoint (BD -1.2% and LD -1.1%, respectively, p<0.001). In Brazil, the non-inferiority criteria were met for HbA(1c) reduction between treatment arms (-0.12%; CI -0.37 to 0.13%, p=0.344), whereas in Mexico, there was a difference favoring exenatide administration before BD (0.41%; CI 0.16 to 0.66%, p=0.002). At endpoint, there were no statistical significant differences between the BD and LD arms in mean change in FSG (0.50 mmol/L; CI -0.02 to 1.02 mmol/L, p=0.058) and daily mean change in SMBG (0.19 mmol/L; CI -0.17 to 0.54 mmol/L, p=0.295). The rates of symptomatic hypoglycemia (5.2 events/patient-year vs. 6.1 events/patient-year) and nausea (23% vs. 25%), were similar between the BD and LD arms, respectively. A limitation of the study design was that caloric intake of patients and meal times were not monitored.

CONCLUSIONS

In T2DM patients who consume a small breakfast, exenatide administration before breakfast or lunch resulted in significant improvement in glycemic control.

Correlation of vibratory quantitative sensory testing and nerve conduction studies in patients with diabetes

Monitoring the course of diabetic peripheral neuropathy (DPN) remains a challenge. Besides clinical examination, nerve conduction studies (NCS) and quantitative sensory testing (QST) are the most commonly used methods for evaluating peripheral nerve function in clinical trials and population studies. In this study the correlation between vibratory QST and NCS was determined. Patients (N = 227) with diabetes mellitus participated in this multicenter, single-visit, cross-sectional study. QST of vibration measured with the CASE IV system was compared with a composite score of peroneal motor and tibial motor NCS and with individual attributes of peroneal, tibial, and sural nerves. The correlation between QST and composite score of NCS was 0.234 (Pearson correlation coefficient, P = 0.001). The correlations between QST and individual attributes of NCS ranged from 0.189 to 0.480 (Pearson correlation coefficients, P < 0.001). The low to moderate correlation between QST and NCS suggests that these tests cannot replace each other but are complementary.

Dynamic left ventricular outflow tract obstruction secondary to catecholamine excess in a normal ventricle

Hypertrophic cardiomyopathy (HCM) is the most common cause of left ventricular outflow tract (LVOT) obstruction. The LVOT obstruction is a consequence of the asymmetric septal hypertrophy and the mitral systolic anterior motion (SAM), causing both of them a dynamic gradient in LVOT. LVOT obstruction has been observed also in other conditions like hypertensive hypertrophy, dehydration, sepsis, vasodilatation, excessive sympathetic stimulation, pericardial tamponade, and after mitral valve repair and aortic valve replacement for aortic stenosis. We report in this document the case of two patients who developed a significant gradient at LVOT in the context of amine treatment during their admission into the intensive unit care. In both, cases there were no gradient, significant hypertrophy or SAM at baseline cardiac evaluation. We have met only one case reported in the literature matching those conditions. In order to treat this type of patients properly, it is essential to take in consideration this pathology.

Assimilation for Affiliation and Contrast for Control: Complementary Self-Construals

People have knowledge about relationships (i.e., relational schemas) that is based on their experiences. Because most people have experience with complementary behavior (interaction partners behaving similarly in terms of affiliation but oppositely in terms of control), they expect complementary behavior in their relationships. Like other beliefs about relationships, expectations of complementarity affect self-construal. The authors provide evidence for complementary self-construal; people assimilate to relevant relationship partners on the affiliation dimension and contrast on the control dimension. Consistent with the proposed role of relationship knowledge in these effects, complementary self-construal was moderated by the familiarity of the target, whether people focused on their relationship with or the appearance of the target, and whether the context was relevant for the interpersonal dimension.

Smiling and relative status in news photographs

To test the hypothesis that lower social status is associated with more smiling, the authors used newspaper photographs and their associated news stories as the basis for scoring the smiling and relative social status of the 2 individuals in each photograph. Independent raters judged smiling and 5 dimensions of relative status for 496 individuals in 248 newspaper photographs. There was no relation between status and smiling, although status and smiling were both related to other variables such as gender, age, and story valence. These findings add to a growing body of evidence that there is no generalized relation between smiling and status.

Collagen fiber orientation as quantified by small angle light scattering in wounds treated with transforming growth factor-beta2 and its neutalizing antibody

The purpose of this study was determine quantitative differences in collagen fiber orientation in a wound healing model in the presence of transforming growth factor-beta2 and anti-transforming growth factor-beta2,3 antibody. Full-thickness wounds were made in the paravertebral area of two young pigs. Wounds were treated once, topically, with either transforming growth factor-beta2 or anti-transforming growth factor-beta2 antibody, or with methylcellulose gel. Control wounds were left untreated. Tissue biopsies were obtained from each wound on days 7, 14 and 46 post wounding. Tissue sections were stained with hematoxylin and eosin, and collagen fiber preferred orientation was quantified using small angle light scattering. Our results indicated that wounds treated with transforming growth factor-beta2 and anti-transforming growth factor-beta2,3 antibody had a significantly higher degree of orientation of collagen fibers than normal unwounded skin on days 7, 14 and 46 (p < 0.001). Transforming growth factor-beta2- treated wounds had a higher degree of orientation of collagen fibers than control wounds on days 7 and 14 (p < 0.001), and control wounds displayed a higher degree of orientation than wounds treated with anti-transforming growth factor-beta2,3 and normal unwounded skin at all time points (p < 0.001). These results suggest that differences in the dermal collagen degree of orientation correlate with scarring, and show that small angle light scattering can be used quantitatively to assess differences in the collagen fiber architecture of dermal wounds.

Actinomycosis of the thigh presenting as a soft-tissue neoplasm

A 14-year-old boy presented with a mass measuring 6 cm x 9 cm, proximal to the patella on the anterior aspect of the knee. Magnetic resonance imaging revealed a 6 x 8 x 4 cm smoothly marginated slightly heterogeneous ellipsoidal mass which displaced musculature, the adjacent cutaneous fat and the quadriceps tendon. At surgery, the mass was noted not to penetrate the superficial surface of the quadriceps tendon and was full of slimy fluid. Histological examination revealed multiple basophilic lobulated granules with homogeneous centres and eosinophilic peripheral clubbed projections. The organisms grown anaerobically were identified as Actinomyces species. The anatomical site of the lesion is very unusual for actinomycosis and the exact route of infection in this patient remains unclear.

Transitory T-lymphoblastic leukemoid reaction in a neonate with Down syndrome

A transient leukemoid reaction in a neonate with Down syndrome is reported. The blastic proliferation was identified as T lymphoblastic in an early stage of maturation (prethymocytes) using morphological, cytochemical, and immunological methods. A spontaneous complete remission occurred in 8 weeks. No additional cytogenetic alterations were found, except for those concerning chromosome 21. Other cases reported in the literature reveal that cytogenetic studies may be useful to distinguish these transient leukemic reactions from true leukemias in newborns with Down syndrome. The in vitro growth pattern of peripheral blood and bone marrow may also be useful for this purpose.