The risk of depressive symptoms in offspring exposed to prenatal alcohol and tobacco use: evidence from a population-based longitudinal study

Introduction

Evidence from epidemiological studies indicated that intrauterine exposure to alcohol and tobacco is linked with a number of adverse outcomes in offspring. However, few studies have linked prenatal alcohol and tobacco exposures to offspring depressive symptoms with mixed results.

Objectives

The objective of this study was to examine the link between maternal prenatal alcohol and tobacco exposures and depressive symptoms in offspring.

Methods

Using data from the Raine Study, a prospective multigenerational observational study, we examined the associations between maternal prenatal alcohol and tobacco use and the risk of depressive symptoms in offspring at age 17 years (N=1168). Depressive symptoms in offspring were measured using the Beck Depression Inventory for Youth. Log-binomial regression was used to estimate relative risk (RR) for associations between exposures and outcome. To better investigate the role of potential confounders, risk factors were sequentially added as adjustment variables in separate models.

Results

After adjustment for potential confounders, depressive symptoms in offspring remained related to maternal alcohol use of six or more standard drinks per week during the first trimester of pregnancy [RR 1.59 (95% CI: 1.11-2.26)]. Further, the risk of depressive symptoms was 50% higher for offspring exposed to prenatal tobacco use when compared to non-exposed. The Associations did not appear to be mediated by the effects of prenatal alcohol and tobacco use on adverse pregnancy outcomes.

Conclusions

Early screening and prevention of these exposures could possibly reduce depressive symptoms in offspring. Moreover, future examinations such as Mendelian Randomization that allow a stronger causal inference is warranted.

Disclosure

No significant relationships.

The risk of anxiety symptoms in young adult offspring of parents with mental health problems: Findings from the raine study

Introduction

Previous research has suggested that offspring of parents with mental health problems, including depression and anxiety, are at an increased risk of developing anxiety disorders. Few studies have investigated this relationship in young adults.

Objectives

To investigate the risk of anxiety symptoms in young adult offspring of parents with mental health problems

Methods

We used data from the 1989-1991 cohort of the Western Australian Pregnancy (Raine) Study, which is a multi-generational birth cohort study following mothers and their offspring from pregnancy to 28 years of age. The Depression, Anxiety, and Stress Scale (DASS) was used to assess maternal anxiety and depression whereas a self-reported questionnaire was used to assess paternal emotional problems. Anxiety symptoms among offspring at age 20 were measured by using the short form of the Depression, Anxiety, and Stress Scale (DASS 21). A multivariable negative binomial regression model was used to quantify the associations.

Results

After adjustment, maternal anxiety [RR 1.60 (95% CI 1.11-2.32)] and paternal emotional problems [RR 1.32 (95%CI 1.03-1.68)] were associated with an increased risk of anxiety in offspring at age 20 years. Conversely, maternal depressive symptoms [RR 1.04 (95%CI 0.84-1.32)] were not associated with an increased risk of anxiety in offspring.

Conclusions

The present study suggests that maternal anxiety and paternal emotional problems were associated with an increased risk of anxiety in young adult offspring. However, maternal depressive symptoms were not associated with an increased risk of anxiety in the offspring. The findings suggest the potential for targeted screening and intervention of anxiety problems in the offspring.

Disclosure

No significant relationships.

Depression, chronic pain, and high-impact chronic pain among cancer survivors

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Background: The majority of the 17 million individuals living with a cancer diagnosis in the United States have experienced pain, either from the disease itself or from its treatment. Pain negatively impacts psychosocial quality of life and is associated with poorer overall outcome. However, the impact of pain on daily living differ among cancer survivors, and there is a paucity of research on chronic pain, especially high-impact chronic pain (HICP) in this growing population. We estimated the prevalence of chronic pain, and HICP among cancer survivors, and described the association between depression and these outcomes. Methods: This study used data from the 2015-2017 National Health Interview Survey. Outcomes of interest were chronic pain, defined as pain on most days or every day in the past six months, and HICP, defined as chronic pain that limited life or work activities on most days or every day during the past six months. Weighted, adjusted multivariable logistic regressions estimated association between depression and chronic pain and HICP among cancer survivors, while controlling for age, gender, marital status, education, employment, health insurance, smoking status, number of doctor’s visit, general health, and comorbidities. Results: Among 49,326 survey respondents, 11.7% (n = 5,335) had a cancer diagnosis. An estimated 43.6% of cancer survivors reported chronic pain; and 19.2% reported HICP. We found an association between depression and both chronic pain and HICP in unadjusted analyses. In the adjusted models, cancer survivors depressed within the last month had more than double the odds of reporting both chronic pain (aOR = 2.32; 95% CI 1.75, 3.07) and HICP (aOR = 2.12; 95% CI 1.50, 3.01). Other factors associated with both chronic pain and HICP among cancer survivors included being a current smoker (aORchronic pain = 1.63; 95% CI 1.14, 2.34; aORHICP = 1.83; 95% CI 1.18, 2.84) and being unemployed (aORchronic pain = 1.44; 95% CI 1.10,1.90; aORHICP = 3.10; 95% CI: 2.00−4.81). Cancer survivors with ≥2 comorbidities also had 55% increased odds of reporting chronic pain (aOR = 1.55; 95% CI 1.17,2.04) compared with those without comorbidities. Conclusions: Over 40% of cancer survivors may have a history of chronic pain, and survivors reporting being depressed are significantly more likely to report both chronic pain and HICP. The association between depression and pain in cancer survivors calls for personalized management of chronic pain, especially in cancer survivors with a history of depression.

The risk of attention deficit hyperactivity disorder symptoms in the adolescent offspring of mothers with anxiety and depressive symptoms. Findings from the raine study

Introduction

While there exist some studies that explored the association between maternal anxiety and depressive symptoms and the risk of attention-deficit/hyperactivity disorder (ADHD) in early and late childhood, studies exploring the risk in late adolescence are however lacking.

Objectives

This is the first study that aimed to investigate the association between maternal anxiety, depressive, as well as comorbid anxiety and depressive symptoms, and the risk of ADHD symptoms in late adolescence.

Methods

We used data from the Raine Study, a birth cohort in Western Australia. The Depression, Anxiety, and Stress Scale (DASS) was used to assess maternal depressive and anxiety symptoms when the child was aged 10. Whereas, the DSM-oriented scales of the child behavior checklist (CBCL) was used to assess ADHD symptoms offspring in adolescents aged 17. Log-binomial regression model was used to explore the associations.

Results

After adjusting for relevant covariates, we found an increased risk of ADHD symptoms in the adolescent children of mothers with anxiety [RR 2.84 (95%CI 1.18-6.83)] as well as comorbid anxiety and depressive symptoms [RR 5.60 (95%CI 3.02-10.37)]. No association was seen with maternal depressive symptoms.

Conclusions

This study suggested that adolescent offspring of mothers with anxiety as well as comorbid anxiety and depressive symptoms had an increased risk of ADHD symptoms. Early detection and management for ADHD symptoms in children of mothers with anxiety and comorbid anxiety and depressive symptoms are needed.

Disclosure

No significant relationships.

Cultivating emergency physician behavioral empathy to improve emergency department care for pain and prescription opioid misuse

Clinical empathy is the ability to understand the patient's experience, communicate that understanding, and act on it. There is evidence that patient and physician benefits are associated with more empathic communications. These include higher patient and physician satisfaction, improved quality of life, and decreased professional burnout for physicians, as well as increased patient compliance with care plans. Empathy appears to decline during medical school, residency training, and early professional emergency medicine practice; however, brief training has the potential to improve behavioral measures of empathy. Improvements in emergency department physician empathy seems especially important in managing patients at elevated risk for opioid-related harm. We describe our conceptual approach to identifying and designing a practice improvement curriculum aimed to cultivate and improve behavioral empathy among practicing emergency physicians. Emergent themes from our preliminary study of interviews, focus groups, and workshops were identified and analyzed for feasibility, sensitivity to change, and potential impact. A conceptual intervention will address the following key categories: patient stigmatization, identification of problematic pain-subtypes, empathic communication skills, interactions with family and friends, and techniques to manage inappropriate patient requests. The primary outcomes will be the changes in behavioral empathy associated with training. An assessment battery was chosen to measure physician psychosocial beliefs, attitudes and behavior, communication skills, and burnout magnitude. Additional outcomes will include opioid prescribing practice, naloxone prescribing, and referrals to addiction treatment. A pilot study will allow an estimation of the intervention impact to help finalize a curriculum suitable for web-based national implementation.

How to Teach Medical Students About Pain and Dementia: E-Learning, Experiential Learning, or Both?

OBJECTIVE

Pain management in persons with mild to moderate dementia poses unique challenges because of altered pain modulation and the tendency of some individuals to perseverate. We aimed to test the impact of an e-learning module about pain in communicative people with dementia on third-year medical students who had or had not completed an experiential geriatrics course.

DESIGN

Analysis of pre- to postlearning changes and comparison of the same across the student group.

SETTING

University of Pittsburgh School of Medicine and Saint Louis University School of Medicine.

SUBJECTS

One hundred four University of Pittsburgh and 57 Saint Louis University medical students.

METHODS

University of Pittsburgh students were randomized to view either the pain and dementia module or a control module on pain during a five-day geriatrics course. Saint Louis University students were asked to complete either of the two modules without the context of a geriatrics course. A 10-item multiple choice knowledge test and three-item attitudes and confidence questionnaires were administered before viewing the module and up to seven days later.

RESULTS

Knowledge increase was significantly greater among students who viewed the dementia module while participating in the geriatrics course than among students who viewed the module without engaging in the course (P < 0.001). The modules did not improve attitudes in any group, while student confidence improved in all groups.

CONCLUSIONS

Medical students exposed to e-learning or experiential learning demonstrated improved confidence in evaluating and managing pain in patients with dementia. Those exposed to both educational methods also significantly improved their knowledge.

The Professionalism and Integrity in Research Program: Description and Preliminary Outcomes

Violations of rules and regulations in research can cause significant problems for human participants, animal subjects, data integrity, institutions, and investigators. The Professionalism and Integrity in Research Program (PI Program) provides remediation training that addresses the root causes of violations of rules and regulations in research. Through assessments, a three-day workshop, and follow-up coaching calls, the PI Program teaches evidence-based decision-making strategies designed to help researchers to compensate for bias, uncertainty, and work-related stress, and foster the skills needed to oversee research projects in today's complex regulatory environments. Across its first three years (2013-2015), the program trained 39 researchers from 24 different institutions in the United States. Participant evaluations of the program's faculty and workshop content were highly positive (4.7-4.8 and 4.5-4.6, respectively, on a 5-point scale). Preliminary program outcome assessment using validated measures of professional decision making and cognitive distortions in a pre- and postworkshop design indicated significant improvements. A follow-up survey of participants found statistically significant increases in a variety of target behaviors, including training research staff members to foster compliance and research quality, using standard operating procedures to support compliance and research integrity, performing self-audits of research operations, reducing job stressors, actively overseeing the work of the research team, and seeking help when experiencing uncertainty. Assessment of the PI Program was conducted with modest sample sizes, yet evaluation, outcome assessment, and self-reported survey data provided statistically significant evidence of effectiveness in achieving program goals.

Antithrombin alfa in hereditary antithrombin deficient patients: A phase 3 study of prophylactic intravenous administration in high risk situations

During surgery and childbirth, patients with hereditary antithrombin (AT) deficiency are at high risk for thrombosis,and heparin prophylaxis may not be sufficiently efficacious. In these patients, exogenous AT may be used in association with heparin. A recombinant human AT (generic name: antithrombin alfa) has been developed. This multi-center study assessed the efficacy and safety of prophylactic intravenous administration of antithrombin alfa to hereditaryAT deficient patients in high risk situations, including elective surgery, childbirth, or cesarean section. Antithrombin alfa was administered prior to and during the high risk period for restoration and maintenance of AT activity at 100% of normal. Heparin, low-molecular-weight heparin, and/or vitamin K antagonists were used according to standard of care. The primary efficacy endpoint was the incidence of acute deep vein thrombosis (DVT) from baseline up to day 30 post dosing as assessed by independent central review of duplex ultrasonograms and/or venograms. Safety was assessed based on adverse events (AEs) and laboratory evaluations. Five surgical and nine obstetrical hereditary AT deficiency patients received antithrombin alfa for a mean period of seven days.No clinically overt DVT occurred. Central review of ultrasonograms identified signs of acute DVT in two out of 13 evaluable patients. No antithrombin alfa-related AEs were reported. No patient developed anti-antithrombin alfa antibodies. In conclusion, this study suggests that antithrombin alfa is a safe and effective alternative to human plasma-derived AT for treating hereditary AT deficiency patients at high risk for thromboembolic events.

Increased prevalence of hypertension in haemophilia patients

An increased prevalence of hypertension is reported in haemophilia patients, but data from large, unbiased studies are lacking. The aim of our study was to cross-sectionally assess the prevalence of hypertension in a large cohort of 701 haemophilia patients. Blood pressure (BP) measurements performed in 386 Dutch and 315 UK haemophilia patients aged 30 years or older were analysed and compared with the general age-matched male population. Mean values of up to three BP measurements were used when available. Hypertension was defined as BP over 140/90 mmHg and/or the use of antihypertensive medication. A total of 49% of patients had severe haemophilia. Mean age was 49.8 years. The prevalence of hypertension was significantly higher in haemophilia patients (49%, 95% confidence interval [CI] 45–53) than in the general population (40%, 95% CI 37–43). The prevalence of hypertension was higher in patients with severe haemophilia than in those with non-severe disease, but similar across haemophilia types and in Dutch and UK patients. Multiple BP measurements were available for 70%.The prevalence of hypertension was similar in patients with multiple BP measurements and the complete cohort. Hypertension was not significantly associated with renal function, a history of renal bleeding or with infection with hepatitis C or HIV, but it was associated with overweight/obesity and age. In conclusion, the prevalence of hypertension is higher in haemophilia patients than in the general population. The cause of this increased prevalence is unknown. Blood pressure measurements should be part of standard care in haemophilia patients aged 30 years or older.

Advanced magnetic resonance imaging and neuropsychological assessment for detecting brain injury in a prospective cohort of university amateur boxers

BACKGROUND/AIM

The safety of amateur and professional boxing is a contentious issue. We hypothesised that advanced magnetic resonance imaging and neuropsychological testing could provide evidence of acute and early brain injury in amateur boxers.

METHODS

We recruited 30 participants from a university amateur boxing club in a prospective cohort study. Magnetic resonance imaging (MRI) and neuropsychological testing was performed at three time points: prior to starting training; within 48 h following a first major competition to detect acute brain injury; and one year follow-up. A single MRI acquisition was made from control participants. Imaging analysis included cortical thickness measurements with Advanced Normalization Tools (ANTS) and FreeSurfer, voxel based morphometry (VBM), and Tract Based Spatial Statistics (TBSS). A computerized battery of neuropsychological tests was performed assessing attention, learning, memory and impulsivity.

RESULTS

During the study period, one boxer developed seizures controlled with medication while another developed a chronic subdural hematoma requiring neurosurgical drainage. A total of 10 boxers contributed data at to the longitudinal assessment protocol. Reasons for withdrawal were: logistics (10), stopping boxing (7), withdrawal of consent (2), and development of a chronic subdural hematoma (1). No significant changes were detected using VBM, TBSS, cortical thickness measured with FreeSurfer or ANTS, either cross-sectionally at baseline, or longitudinally. Neuropsychological assessment of boxers found attention/concentration improved over time while planning and problem solving ability latency decreased after a bout but recovered after one year.

CONCLUSION

While this neuroimaging and neuropsychological assessment protocol could not detect any evidence of brain injury, one boxer developed seizures and another developed a chronic sub-dural haematoma.

Effects of naltrexone are influenced by childhood adversity during negative emotional processing in addiction recovery

Naltrexone is an opioid receptor antagonist used in the management of alcohol dependence. Although the endogenous opioid system has been implicated in emotion regulation, the effects of mu-opioid receptor blockade on brain systems underlying negative emotional processing are not clear in addiction. Individuals meeting criteria for alcohol dependence alone (n=18, alcohol) and in combination with cocaine and/or opioid dependence (n=21, alcohol/drugs) and healthy individuals without a history of alcohol or drug dependence (n=21) were recruited. Participants were alcohol and drug abstinent before entered into this double-blind, placebo-controlled, randomized, crossover study. Functional magnetic resonance imaging was used to investigate brain response while viewing aversive and neutral images relative to baseline on 50 mg of naltrexone and placebo. We found that naltrexone modulated task-related activation in the medial prefrontal cortex and functional connectivity between the anterior cingulate cortex and the hippocampus as a function of childhood adversity (for aversive versus neutral images) in all groups. Furthermore, there was a group-by-treatment-by-condition interaction in the right amygdala, which was mainly driven by a normalization of response for aversive relative to neutral images under naltrexone in the alcohol/drugs group. We conclude that early childhood adversity is one environmental factor that influences pharmacological response to naltrexone. Pharmacotherapy with naltrexone may also have some ameliorative effects on negative emotional processing in combined alcohol and drug dependence, possibly due to alterations in endogenous opioid transmission or the kappa-opioid receptor antagonist actions of naltrexone.

Developmental white matter microstructure in autism phenotype and corresponding endophenotype during adolescence

During adolescence, white matter microstructure undergoes an important stage of development. It is hypothesized that the alterations of brain connectivity that have a key role in autism spectrum conditions (ASCs) may interact with the development of white matter microstructure. This interaction may be present beyond the phenotype of autism in siblings of individuals with ASC, who are 10 to 20 times more likely to develop certain forms of ASC. We use diffusion tensor imaging to examine how white matter microstructure measurements correlate with age in typically developing individuals, and how this correlation differs in n=43 adolescents with ASC and their n=38 siblings. Correlations observed in n=40 typically developing individuals match developmental changes noted in previous longitudinal studies. In comparison, individuals with ASC display weaker negative correlation between age and mean diffusivity in a broad area centred in the right superior longitudinal fasciculus. These differences may be caused either by increased heterogeneity in ASC or by temporal alterations in the group's developmental pattern. Siblings of individuals with ASC also show diminished negative correlation between age and one component of mean diffusivity-second diffusion eigenvalue-in the right superior longitudinal fasciculus. As the observed differences match for location and correlation directionality in our comparison of typically developing individuals to those with ASC and their siblings, we propose that these alterations constitute a part of the endophenotype of autism.

Development of DEMQOL-U and DEMQOL-PROXY-U: generation of preference-based indices from DEMQOL and DEMQOL-PROXY for use in economic evaluation

BACKGROUND

Dementia is one of the most common and serious disorders in later life and the economic and personal cost of caring for people with dementia is immense. There is a need to be able to evaluate interventions in dementia using cost-effectiveness analyses, but the generic preference-based measures typically used to measure effectiveness do not work well in dementia. Existing dementia-specific measures can effectively measure health-related quality of life but in their current form cannot be used directly to inform cost-effectiveness analysis using quality-adjusted life-years as the measure of effectiveness.

OBJECTIVES

The aim was to develop two brief health-state classifications, one from DEMQOL and one from DEMQOL-Proxy, to generate health states amenable to valuation. These classification systems consisted of items taken from DEMQOL and DEMQOL-Proxy so they can be derived from any study that has used these instruments.

DATA SOURCES

In the first stage of the study we used a large, clinically representative sample aggregated from two sources: a sample of patients and carers attending a memory service in south London and a sample of patients and carers from other community services in south London. This included 644 people with a diagnosis of mild/moderate dementia and 689 carers of those with mild/moderate dementia. For the valuation study, the general population sample of 600 respondents was drawn to be representative of the UK general population. Households were sampled in urban and rural areas in northern England and balanced to the UK population according to geodemographic profiles. In the patient/carer valuation study we interviewed a sample of 71 people with mild dementia and 71 family carers drawn from a memory service in south London. Finally, the instruments derived were applied to data from the HTA-SADD (Study of Antidepressants for Depression in Dementia) trial.

REVIEW METHODS

This was a complex multiphase study with four linked phases: phase 1 - derivation of the health-state classification system; phase 2 - general population valuation survey and modelling to produce values for every health state; phase 3 - patient/carer valuation survey; and phase 4 - application of measures to trial data.

RESULTS

All four phases were successful and this report details this development process leading to the first condition-specific preference-based measures in dementia, an important new development in this field.

LIMITATIONS

The first limitation relates to the lack of an external data set to validate the DEMQOL-U and DEMQOL-Proxy-U classification systems. Throughout the development process we have made decisions about which methodology to use. There are other valid techniques that could be used and it is possible to criticise the choices that we have made. It is also possible that the use of a mild to moderate dementia sample has resulted in classification systems that do not fully reflect the challenges of severe dementia.

CONCLUSION

The results presented are sufficiently encouraging to recommend that the DEMQOL instruments be used alongside a generic measure such as the European Quality of Life-5 Dimensions (EQ-5D) in future studies of interventions in dementia as there was evidence that they can be more sensitive for patients at the milder end of disease and some limited evidence that the person with dementia measure may be able to reflect deterioration.

FUNDING

The National Institute for Health Research Health Technology Assessment programme.

Adenomyoepithelioma of the breast; a case report and literature review

A case of adenomyoepithelioma of the breast is presented in order to illustrate some of the difficulties in achieving a pathological diagnosis of this lesion. Given the emerging evidence for adenomyoepithelioma to develop into malignancy, it is imperative that the histopathological features of this lesion are well described and recognized.

The effects of cigarette consumption on the Sternberg visual memory search paradigm

AIM

To examine the performance of non-smokers (n = 24), light smokers (n = 22, mean 6.5 cigarettes per day) and heavy smokers (n = 19, mean 23 cigarettes per day) on the Sternberg memory search task.

DESIGN

A repeated-measures, counterbalanced design was used with one between-subject factor, status (heavy, light or non-smoker) and two within-subject factors, condition (12 hours abstinence or ad libitum smoking) x time (pre- or post-cigarette).

FINDINGS

Heavy smokers in the pre-cigarette abstinent session had significantly slower reaction times, movement times and higher intercepts (a measure of factors contributing to performance other than rate of memory scan) than non-smokers. After smoking these differences were removed.

CONCLUSIONS

This suggests that rather than improving performance smoking ameliorates a deficit in certain measures of the Sternberg task produced by abstinence. Under ad libitum conditions improvements in performance were attributed to practice. Across all within-subject conditions, there were no significant main effects of smoking status, and this result was consistent with the lack of relationship between measures of saliva continine and expired air carbon monoxide and performance. These data do not support the view that non-abstinent smokers differ from non-smokers in the performance of the Sternberg memory search procedure.

Third time lucky--an unusual suicide

We present the case of a 39-year-old male who died with three significant and separate shotgun wounds. During the investigation, the possibility of murder was considered, but reconstruction of the case and post-mortem findings led to a coronial conclusion that the death was a suicide, accounted for by the type of weapon used and the stamina of the deceased.

Nerve-dependent factors regulating transcript levels of glycogen phosphorylase in skeletal muscle

1. Muscle glycogen phosphorylase (MGP), the rate-limiting enzyme for glycogen metabolism in skeletal muscle, is neurally regulated. Steady-state transcript levels of the skeletal muscle isozyme of MGP decrease significantly following muscle denervation and after prolonged muscle inactivity with an intact motor nerve. These data suggest that muscle activity has an important influence on MGP gene expression. The evidence to this point, however, does not preclude the possibility that MGP is also regulated by motor neuron-derived trophic factors. This study attempts to distinguish between regulation provided by nerve-evoked muscle contractile activity and that provided by the delivery of neurotrophic factors. 2. Steady-state MGP transcript levels were determined in rat tibialis anterior (TA) muscles following controlled interventions aimed at separating the contributions of contractile activity from axonally transported trophic factors. The innervated TA was rendered inactive by daily epineural injections of tetrodotoxin (TTX) into the sciatic nerve. Sustained inhibition of axonal transport was accomplished by applying one of three different concentrations of the antimicrotubule agent, vinblastine (VIN), to the proximal sciatic nerve for 1 hr. The axonal transport of acetylcholinesterase (AChE) was assessed 7, 14, and 28 days after the single application of VIN. 3. MGP transcript levels normalized to total RNA were reduced by 67% in rat TA, 7 days after nerve section. Daily injection of 2 microg TTX into the sciatic nerve for 7 days eliminated muscle contractile activity and reduced MGP transcript levels by 60%. 4. A single, 1-hr application of 0.10% (w/v) VIN to the sciatic nerve reduced axonal transport but did not alter MGP transcript levels in the associated TA, 7 days after treatment. Application of 0.10% VIN to the sciatic nerve also did not affect IA sensory or motor nerve conduction velocities or TA contractile function. 5. Treatment of the sciatic nerve with 0.40% (w/v) VIN for 1 hr reduced axonal transport and decreased MGP transcript levels by 50% within 7 days, but also reduced sensory and motor nerve conduction velocities and depressed TA contractile function. 6. Myogenin, a member of a family of regulatory factors shown to influence the transcription of many muscle genes, including MGP, was used as a molecular marker for muscle inactivity. Myogenin transcript levels were increased following denervation and after treatment with TTX or 0.40% VIN but not after treatment with 0.10% VIN. 7. The results suggest that MGP transcript levels in TA are regulated predominantly by muscle activity, rather than by the delivery of neurotrophic factors. Intrinsic myogenic factors, however, also play a role in MGP expression, since denervation did not reduce MGP transcript levels below 30% of control TA. The dominant influence of activity in the regulation of MGP contrasts with the proposed regulation of oxidative enzyme expression, which appears to depend on both activity and trophic factor influences.

Chondroblastoma--an unusual site in a young patient

We report a case of primary chondroblastoma presenting as a submucosal lump on the nasal bridge of a 15-year-old female. The lesion was curetted and the patient remains well after one year follow-up. This case report describes a primary chondroblastoma arising in an unusual site and in an unusual age group.

Botulinum-induced muscle paralysis alters metabolic gene expression and fatigue recovery

We evaluated the physiological, histochemical, and biochemical consequences of inhibiting contractile activity in rat skeletal muscles with botulinum toxin A (BTX). Contractile activity was entirely eliminated 12-18 h after a single, focal, intramuscular injection of BTX into the rat tibialis anterior muscle (TA). Neuromuscular transmission remained completely inhibited for 10-12 days, then slowly recovered. BTX-treated muscles exhibited a lower resistance to both high- and low-frequency fatigue at 7 and 14 days after injection, but contractile force recovered more rapidly in treated TA after fatigue. Treated TA showed a twofold increase in the activity of the triglyceride hydrolase enzyme lipoprotein lipase (LPL) and a comparable increase in the relative abundance of LPL steady-state mRNA. In contrast, there was a 28% reduction in protein levels of the muscle isozyme of glycogen phosphorylase (MGP) and a 70% decrease in relative MGP transcript levels. Similar changes in relative transcript levels of LPL and MGP were observed in the predominantly fast-twitch extensor digitorum longus after BTX injection, but relative LPL and MGP mRNA levels were not altered in predominantly slow-twitch soleus. Histochemical evidence indicated that fast-twitch glycolytic fibers had increased lipid content. These biochemical alterations were reversed 120 days after BTX treatment despite persistent atrophy.

A subgroup of human VH3 germline genes that encode a high-avidity synovial rheumatoid factor

We have previously derived and identified a highly avid monoclonal IgM rheumatoid factor (mRF), C6, from unstimulated rheumatoid synovial cells (RSC). At the time, the closet VH germline gene, VH26, demonstrated only 88% homology with C6. To identify the germline counterpart of C6, genomic DNA from the same rheumatoid arthritis (RA) patient from whom C6 was derived was used in the polymerase chain reaction (PCR). Four of the six closely related germline genes that we sequenced had exonic regions that were identical with the VH region of C6 cDNA. These six germline sequences differed in their intronic regions, suggesting that they were distinct, but closely related genomic sequences. To further evaluate the extent of these related genes we identified nine additional germline genes having VH-encoding exons that were 86-97% identical to the C6 cDNA sequence. Furthermore, we examined the polymorphic nature of the C6 VH gene using single strand conformation polymorphism (SSCP), and identified two peaks, confirming the existence of highly homologous genes. The sequence and polymorphism data suggest that: (1) the VH region of the high avidity mRF C6 was derived from an unmutated germline gene; (2) C6 was encoded by a VH gene belonging to a set of homologous genes within the larger VH3 family; and (3) in addition to somatic rearrangements of B-cell genes and antigen-driven somatic mutation, gene duplication and conversion events of germline genes could be important in generating diversity and polyclonality among high-affinity pathogenic autoantibodies.

Reduced glycolytic metabolism in regenerated fast-twitch skeletal muscle

Freely grafted rat extensor digitorum longus (EDL) muscles were subjected to low-frequency stimulation in an anaerobic environment to determine whether regenerating fast-twitch muscles regain normal glycolytic metabolic capacity. Regenerating muscles were tested at 28, 42, and 76 days after the graft procedure. Stabilized grafts (76 days) produced approximately 60% of the lactate generated by intact, control EDL subjected to the same stimulus paradigm and developed half the estimated increase in H+. The grafts exhibited the same relative decline in force after 5 min of anaerobic stimulation as control EDL but maintained relatively constant levels of ATP while consuming phosphocreatine. This study indicates that regenerating fast-twitch skeletal muscle has a reduced ability to initiate glycolytic activity during exercise. The data also indicate that a small population of regenerating fast-twitch fibers express the slow isoform of myosin heavy chain (beta-MHC) with maximum expression occurring at 56 days postsurgery.

Stiff-man syndrome: a GABAergic autoimmune disorder with autoantigenic heterogeneity

Autoantibodies that reacted with cell bodies and axon terminals of gamma-aminobutyric acid (GABA)ergic neurons were present in the serum and cerebrospinal fluid in a patient with stiff-man syndrome with type I diabetes. Immunoblot experiments using this patient's serum and cerebrospinal fluid did not corroborate an earlier observation that these autoantibodies are directed against the GABAergic cytosolic enzyme, L-glutamic acid decarboxylase. While L-glutamic acid decarboxylase autoantibodies may be associated with this syndrome, they do not appear to be easily demonstrated.

Strontium is required for statolith development and thus normal swimming behaviour of hatchling cephalopods

When cephalopod eggs were incubated in artificial sea water it was found that they sometimes resulted in hatchlings with defects of the statocyst suprastructure, leading to the severe behavioural defect of uncontrolled swimming. Experiments in defined media (seven basic salts mixed in deionized water) with seven species of cephalopods demonstrated clearly that there is 100% normal development of the aragonite statoliths when strontium levels were 8 mg l-1. Conversely, statoliths did not develop when strontium was absent. In cuttlefish, the growth of the cuttlebone was also affected adversely when strontium was absent. In mariculture production tanks, supplementing commercial artificial sea water with strontium to normal levels of 8 mg l-1 almost eliminated the occurrence of abnormal hatchlings. Circumstantial evidence indicates that there is a critical window in development during which strontium is required for normal development. The role of strontium in biomineralization during embryogenesis is unknown, but it appears to be important in the Mollusca.

Effects of sleep disruption on cognitive performance and mood in medical house officers

Twelve medical house officers were tested on a battery of memory, concentration, and work related tasks after three conditions: a night spent off duty; a night spent on call; and a night spent admitting emergency cases. Short term recall, but not digit span, concentration, or work related abilities, was impaired after a night of emergency admissions. A night spent on call had no effect on cognitive performance. Self reported mood scores showed that house officers were more deactivated (indicating a lack of vigour and drive) after nights of emergency admissions but not after nights on call. Significant between subject differences were found for five of the eight cognitive tests. Though loss of sleep and long hours of work have an effect on memory and mood, the individual differences among doctors are the main source of the variance in performance of tasks.

A comparison of low back pain patients in the United States and New Zealand: psychosocial and economic factors affecting severity of disability

One hundred and ninety-eight patients suffering from chronic low back pain seen at the University of Virginia (U.S.) Pain Center and 117 similar patients seen at the Auckland Hospital, Auckland, New Zealand (N.Z.) Pain Clinic completed a self-report questionnaire prior to beginning comparable outpatient treatment programs. Approximately 55% of the sample from each country returned a follow-up questionnaire 1 year later. Analyses of the results indicated that despite nearly similar between-country reports of pain frequency and intensity, the U.S. patients, both at pre- and post-testing, reported greater emotional and behavioral disruption as a correlate of their pain. U.S. patients consistently used more medication, experienced more disphoric mood states, and were more hampered in social-sexual, recreational, and vocational functioning. Patients from both countries demonstrated a nearly equal degree of pre- to post-improvement; however, the relative initial differences favoring the New Zealanders remained constant across both questionnaire administrations. At the onset of treatment, 49% of the U.S. sample and only 17% of the N.Z. patients were receiving pain-related financial compensation. At follow-up, patients from both countries receiving pretreatment compensation were less likely to report a return to full activity, although the relationship appeared more pronounced in U.S. patients. Seemingly, compared to the U.S., the N.Z. compensation-disability system is used less, or for shorter durations of time, resulting in less severe life-style disruption than appears to be the case in the U.S.

A comparison of health locus of control beliefs in low-back patients from the U.S. and New Zealand

In order to study differences in health control attitudes between chronic low-back patients from the U.S. and New Zealand, the Health Locus of Control (HLC) was administered to 284 consecutive admissions to pain clinics in those countries: 96 patients seen at the Auckland (New Zealand) Pain Clinic and 188 seen at the University of Virginia (U.S.) Pain Clinic. The HLC is an 11-item instrument [23] that assesses general control over health matters. Principal component factor analyses indicated 3 distinct subscales for the low back patients: (a) personal health control, (b) external health control, and (c) control by powerful others (physicians). HLC responses were analyzed with univariate analyses of variance using subscale scores as dependent measures and country and sex as independent variables. New Zealanders rated themselves as less dependent on physicians' orders (F (1,280)=3.92, P less than 0.05), and women were seen as having less personal control over their pain conditions than men (F (1,280)=6.29, P less than 0.02). The differences related to sex and country are discussed within a social learning framework. Suggestions are made for future cross-cultural research, especially related to issues of dependency on others for health control and outcomes in the treatment of chronic pain.

A general method for the purification of restriction enzymes

An abbreviated procedure has been developed for the purification of restriction endonucleases. This procedure uses chromatography on phosphocellulose and hydroxylapatite and results in enzymes of sufficient purity to permit their use in the sequencing, molecular cloning, and physical mapping of DNA.

Pneumococcal antigen in pneumonia. A post-mortem study with the histological and bacteriological findings

Pneumococcal capsular antigens can be detected in lung tissue by counter-current immunoelectrophoresis even when, following antibiotics, post-mortem bacterilogy suggests that Escherichia coli has replaced pneumococci. The results suggest that antipneumococcal therapy would benefit at least 55% of patients critically ill with lung infection and that the potentially toxic drugs directed at coliform bacteria may be unnecessary.