Uraemic toxins and cardiovascular disease across the chronic kidney disease spectrum: an observational study

BACKGROUND AND AIMS

There is a growing body of evidence supporting the nephrovascular toxicity of indoxyl sulphate (IS) and p-cresyl sulphate (PCS). Nonetheless, a comprehensive description of how these toxins accumulate over the course of chronic kidney disease (CKD) is lacking.

METHODS AND RESULTS

This cross-sectional observational study included a convenience sample of 327 participants with kidney function categorised as normal, non-dialysis CKD and end-stage kidney disease (ESKD). Participants underwent measurements of serum total and free IS and PCS and assessment of cardiovascular history and structure (carotid intima-media thickness [cIMT, a measure of arterial stiffness]), and endothelial function (brachial artery reactivity [flow-mediated dilation (BAR-FMD); glyceryl trinitrate (BAR-GTN)]). Across the CKD spectrum there was a significant increase in both total and free IS and PCS and their free fractions, with the highest levels observed in the ESKD population. Within each CKD stage, concentrations of PCS, total and free, were significantly greater than IS (all p < 0.01). Both IS and PCS, free and total, were correlated with BAR-GTN (ranging from r = -0.33 to -0.44) and cIMT (r = 0.19 to 0.21), even after adjusting for traditional risk factors (all p < 0.01). Further, all toxins were independently associated with the presence of cardiovascular disease (all p < 0.02).

CONCLUSION

More advanced stages of CKD are associated with progressive increases in total and free serum IS and PCS, as well as increases in their free fractions. Total and free serum IS and PCS were independently associated with structural and functional markers of cardiovascular disease. Studies of therapeutic interventions targeting these uraemic toxins are warranted.

Paternal and maternal depressed mood during the transition to parenthood

BACKGROUND

The course of postnatal depression was examined in first-time mothers and fathers with emphasis on the role of personality and parental relationships as risk factors.

METHOD

157 couples were assessed at four points: antenatally and at 6, 12 and 52 weeks postnatally. Various measures of mood and personality were administered at each of these assessment points.

RESULTS

Examination of the factors associated with depressed mood suggested that a woman's relationship with her own mother was important in the early postpartum stage, and also her level of interpersonal sensitivity and neuroticism. For the father, his relationship with either his mother or father and his level of neuroticism were associated with his mood level early on. By the end of the first year couple morbidity increased, with rates of distress being at their highest for both parents, and factors associated with depressed mood being linked to partner relationship variables, at least for mothers. At most time points, antenatal mood and partner relationship were significant predictor variables for the postnatal mood of both mothers and fathers.

LIMITATIONS

The sample had a relatively high level of education and this should be taken into account when considering the generalisation of findings to less educated populations. At the time of conducting this study, the Edinburgh Postnatal Depression Scale (EPDS) had only been validated for use in the first few months postpartum, and thus we used another scale to measure the mother's mood at the other assessment points (the Beck Depression Inventory). Current research would suggest that the EPDS is valid both antenatally and at other times in the first year postpartum.

CONCLUSION

Whilst there was some consistency for mothers and fathers in the variables that predict their postpartum adjustment, these being antenatal mood and partner relationship, there is also evidence that adjustment to parenthood was related to different variables at different times. Early adjustment was related to the couple's relationship with their own parents, as well as their own personality. Later adjustment was related to the couple's functioning and relationship.

Nonverbal communication and play correlates of language development in autistic children

The aim of this study was to determine the social and cognitive correlates of language acquisition in autistic children. Functional and symbolic play skills were shown to be associated with language abilities in a sample of young autistic children (mean CA 54.5 months), thereby replicating previous findings. Certain types of nonverbal communication skills were also shown to be significant correlates of language development in this group of autistic children. These involved the ability to use gestures to coordinate visual attention between social partners with respect to objects or events. The play and nonverbal communication variables were not significantly correlated, suggesting that these variables reflect independent psychological factors associated with language development in young autistic children.

Psychological predictors of survival in cancer patients undergoing radiation therapy

In a prospective study to identify psychological factors affecting survival in cancer patients receiving radiation therapy, 101 consecutive patients were evaluated for anxiety, depression, and perception of the seriousness of the condition. In 3 years, the survivors were compared to the nonsurvivors. The survivors had significantly higher mean trait anxiety (p less than 0.05) than the nonsurvivors. State anxiety and depression scores also tended to be higher in the survivors (p less than 0.01). Self-assessment of the seriousness of their disease did not differentiate the two groups. The nonsurvivors had significantly more pain (p less than 0.05). Within the nonsurvivor group, survival time was negatively correlated with state anxiety (p less than 0.01), trait anxiety (p less than 0.02), and depression (p less than 0.01). In the nonsurvivors, women rated their condition to be significantly more serious than men (p less than 0.01). Female nonsurvivors tended to rate their condition to be more serious than female survivors (p less than 0.1), while male nonsurvivors rated their condition to be significantly less serious than male survivors (p less than 0.01). Only among female nonsurvivors did the seriousness rating correlate significantly with anxiety (p less than 0.01). The sex differences confirm our previous finding that men may tend to cope with cancer with more massive denial than women. We hypothesize that patients with higher anxiety and depression in the nonsurvivor group had a massive defensive failure, while those who had high anxiety levels in the survivor group had been more realistic about their disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Social interactions of autistic, mentally retarded and normal children and their caregivers

The social interactions of young autistic children and their caregivers were contrasted to interactions involving normal and mentally retarded controls. The autistic children displayed a much lower frequency of attention sharing behaviors, such as pointing to or showing objects. Alternatively, the autistic children directed as much looking, vocalizing and proximity behaviors toward their caregivers as did the other groups. Thus, although the autistic children did not show a clear lack of responsiveness to their caregivers, they did display a significant deficit in indicating behaviors during child-caregiver interaction.

Defining the social deficits of autism: the contribution of non-verbal communication measures

Young autistic children were compared to normal and control samples on measures of non-verbal communication skills and object play skills. Deficits in non-verbal indicating behaviors best discriminated the children diagnosed as autistic from the other groups. Although the autistic children also exhibited deficits in object play behavior, these deficits did not add appreciably to the discriminant function based on the non-verbal communication behaviors. These results suggest that a deficit in the development of non-verbal indicating behaviors is a significant characteristic of young children who receive the diagnosis of autism.

Skin testing and erythrocyte sedimentation rate in women undergoing breast biopsy

The purpose of this study was to determine the utility of skin testing and erythrocyte sedimentation rate (ESR) as measures of immune function in a population undergoing stress. Eight women were tested one week prior to breast biopsy and six were retested at least four weeks later. All biopsies were negative for malignancy. Control subjects were also tested four weeks apart. ESR values were elevated with stress but the magnitude of this effect was small. There were no differences between groups in skin test responses. Skin testing and ESR may have limited usefulness in the study of immune function in populations under stress.

Intranasal cocaine: dose relationships of psychological effects and plasma levels

We compared the psychological effects of three doses of intranasal cocaine hydrochloride (.2, .75, and 1.5 mg/kg) with cocaine plasma concentrations in four volunteers. Intranasal lidocaine hydrochloride (.2 mg/kg) was used as a topically active placebo. Peak "high" ratings were related to both dose and peak plasma concentrations. At a given plasma concentration, "high" ratings were greater when plasma levels were increasing than when they were decreasing. This indicates that acute tolerance by tachphylaxis occurred after single doses. The cocaine "high" was a pleasant feeling but was without distinctive sensations. The dramatic effects of intranasal cocaine on the street may be related to larger or repeated doses as well as the setting.

Sensorimotor skills and language comprehension in autistic children

The objectives of this study were to examine the level of sensorimotor concepts of young autistic children and to relate these concepts to language comprehension. A sample of 16 autistic children with a mean mental age of 24.8 months was administered a standardized scale of sensorimotor intelligence and of receptive language. The autistic children demonstrated surprisingly sophisticated sensorimotor skills, particularly object permanence. While their initial performance was inferior to that of normal controls matched on mental age, particularly in their use of objects in combination, the difference between groups diminished on the second test administration. On the receptive language measure, the autistic children were less able to identify words correctly. The sensorimotor behavior of autistic children who demonstrated language comprehension did not differ from those who showed no language comprehension, except that the former group tended to use an object as an instrument somewhat more frequently. The fact that the autistic children were so impaired in language even with fairly good sensorimotor skills suggests that these skills, particularly object permanence, play a minor role in their language acquisition.

Denial and helplessness in cancer patients undergoing radiation therapy: sex differences and implications for prognosis

One hundred consecutive outpatients undergoing radiation therapy were prospectively studied using the Locus of Control Inventory designed by Rotter and a questionnaire covering various aspects of diagnosis, implications of disease, and details of therapy. The Locus of Control Inventory, which measures a person's belief that life's important events are controlled by personal effort (internality) as opposed to factors outside of one's control (externality), revealed a significant difference between men and women in this study. Although women were similar to the general healthy population, men expressed a greater sense of control as their radiation therapy progressed. Men were also more likely to characterize their illness as not very serious and to deny knowledge of their correct diagnoses or details of their treatment. With survival determined at two years following the study, it was found that living and deceased women had initially rated the seriousness of their illnesses appropriately, while deceased men had rated their illnesses as significantly less serious than women or surviving men. It is concluded that sexual differences in coping mechanisms may be accentuated by malignancy and men may actively deny their diagnosis and its implications. This amount of denial and sense of personal control in the face of a potentially fatal illness may indicate a need for more supportive clinical intervention for the radiation therapy patient.

Oral cocaine: plasma concentrations and central effects

Cocaine (2.0 milligrams per kilogram) given by the oral route is at least as effective as the same dose given intranasally. Cocaine is not detected in the plasma until 30 minutes after oral administration, but peak plasma concentrations are similar after both routes. The subjective "highs" in man are greater after oral than after intranasal administration.

Borderline hypertensives volunteering for follow-up and biofeedback. A preliminary study: locus of control characteristics

We compared the locus of control scores of the following groups: (1) 19 male borderline hypertensives volunteering for biofeedback treatment; (2) 100 consecutive males who were screened for hypertension; (3) 30 male cancer patients receiving radiation therapy, and (4) the normative data from college students. The biofeedback volunteer group was significantly more internal in locus of control as compared to all other groups. The locus of control of the borderline hypertensives within the screened population did not differ from the normotensives, but the screened population as a whole had a relatively internal locus of control. Our findings imply that the 'internals' may be more attracted to self-control treatments like biofeedback, and data generated from this particular population may have limited generalizability, especially in regard to 'externals'.