Brachytherapy-on-Chip: A Microfluidic Setup for In Vitro Interrogation of Hypoxic Spheroids

PURPOSE/OBJECTIVE(S)

Despite evidence of its advantages in many cancers, brachytherapy (BT) remains clinically underused and understudied in the pre-clinical setting due to a lack of versatile RT-compatible in vitro tools that can emulate the tumor microenvironment and radiobiology of various cancers. Microfluidic devices use conventional cell culture methods in 3D-tumor models, are radiocompatible and can integrate radiobioassays. However, they are seldom used in pre-clinical BT research. This project engineered the first microfluidic tool for in vitro testing of BT, with applications in translational radiobiology.

MATERIALS/METHODS

PDMS microfluidic chips were engineered to grow and culture concentric rows of hypoxic spheroids, and to allow the insertion of a clinical iodine-125 BT seed at the center of the device. FaDu (hypopharyngeal squamous cell carcinoma), SK-LMS-1 (leiomyosarcoma) and HCT116 (colorectal carcinoma) cell lines were selected for their clinical relevance and ability to form spheroids. Presence of hypoxia in spheroids was assessed by immunofluorescence (IF) staining for hypoxic protein CAIX. On-chip dose distribution was calculated using clinical TG-43 parameters and compared to EBT-XD radiographic film. Target dose criteria was fixed at 8 Gy in the center of the first row of spheroids. Treatment response was quantified by DNA damages (γH2AX IF, comet assay) and cell survival (clonogenic assay). Response of hypoxic and normoxic regions of spheroids will be compared in IF.

RESULTS

A total of 15 spheroids that are 750µm or larger can be cultured in our device, arranged as 5 rows of 3 spread from 1.5mm to 7.5mm away from a central iodine-125 seed. 48h after cell seeding, hypoxic cores were observed in spheroids derived from FaDu (50 ± 4% of cross-section, N = 3) and SK-LMS-1 (46 ± 4% of cross-section, N = 3) cells, results are pending for HCT116. TG-43 formula predicts that the center of each row receives 8 Gy, 2.6 Gy, 1.2 Gy, 0.7 Gy and 0.4 Gy respectively. Radiographic film analysis confirms on-chip TG-43 calculated doses (N = 5, R2 = 0.999). Similarly, tail moment from comet assays follows predicted dose trends (n>60, N = 3). There was no statistical difference between 8 Gy BT and 8 Gy GammaCell (8 Gy BT vs 8 Gy GammaCell, p = 0.8758), with a statistical difference between 8 Gy BT (8 Gy BT vs 2.6 Gy BT,1.2 Gy BT,0.7 Gy BT,0.4 Gy BT,0 Gy, p < 0.0001), 2.6 Gy BT (2.6 Gy BT vs 1.2 Gy BT,0.7 Gy BT,0.4 Gy BT,0 Gy, p < 0.05) or 8 Gy GammaCell (8 Gy GammaCell vs 2.6 Gy BT,1.2 Gy BT,0.7 Gy BT,0.4 Gy BT,0 Gy, p < 0.0001) and other lower BT doses.

CONCLUSION

For the first time, brachytherapy can be easily integrated on-chip and its effects evaluated on relevant 3D-tumor models. Our system allows simultaneous quantification of BT efficacy on normoxic and hypoxic cells treated at various doses. On-chip combination of BT with antitumor drug will be explored in future work. We hope this device will serve as further proof of the potential of BT/RT-on-chip systems for better drug development, treatment planification and theranostics.

Emotional and behavioral problems in Japanese preschool children with subthreshold autistic traits: findings from a community-based sample

BACKGROUND

Recently, there has been a growing recognition that autistic traits exist along a continuum beyond diagnostic categories and that even subclinical symptoms may be associated with an increased risk for the psychosocial well-being and mental health of children. However, as yet, there has been little research on whether preschool children with autism spectrum disorder (ASD) symptoms, who do not meet the diagnostic criteria for ASD, are more likely to experience difficulties. To address this deficit this study examined whether young children with subthreshold autistic traits have an increased risk for emotional/behavioral difficulties.

METHODS

Data were analyzed from 1057 Japanese preschool children aged 5-years old collected during the first wave of the Tama Children's Survey (TCS) cohort study. Parent-reported autistic traits were assessed with the Social Responsiveness Scale (SRS), while they provided information on their child's emotional/behavioral problems using the Strengths and Difficulties Questionnaire (SDQ). Logistic regression analysis was used to examine associations.

RESULTS

Preschool children with mild-to-moderate autistic traits, corresponding to subclinical autism were significantly more likely to score above the clinical thresholds for emotional/behavioral problems compared to children with fewer autistic traits. Follow-up diagnostic assessments and analyses of 72 children from the cohort confirmed these findings and showed that these children with subthreshold autistic traits also had a significantly lower intelligence quotient (IQ) as measured by the Wechsler Preschool and Primary Scale of Intelligence (WPPSI).

CONCLUSIONS

Although subthreshold autistic traits are difficult to define due to the sometimes vague border between typical and atypical development, there may be a large number of preschool children with subthreshold autistic traits, who may have an increased risk for a variety of different emotional/behavioral difficulties as well as lower cognitive functioning.

Training types associated with knowledge and experience in public health workers

BACKGROUND

Training non-specialist workers in mental healthcare improves knowledge, attitude, confidence, and recognition of mental illnesses. However, still little information is available on which type of mental health training is important in the improvement of these capacities.

METHODS

We studied web-based survey data of 495 public health workers to examine training types associated with knowledge and experience in supporting individuals with mental illness. Multivariable logistic regression analysis was conducted to evaluate the association between a lack of knowledge and experience (outcome) and mental health training (exposure). We fitted three regression models. Model 1 evaluated unadjusted associations. Model 2 adjusted for age and sex. Model 3 adjusted for age, sex, years of experience, mental health full-time worker status, and community population. Bias-corrected and accelerated bootstrap confidence intervals (CIs) were used.

RESULTS

For all training types, the association between a lack of knowledge and experience and mental health training attenuated as the model developed. In Model 3, a lack of knowledge and experience was significantly associated with training in specific illness (OR, 0.54; 95% CI, 0.32-0.93) and screening and assessment (OR, 0.63; 95% CI, 0.39-0.99). Non-significant results were produced for training in counseling, psychosocial support, collaborative work, and law and regulation in Model 3.

CONCLUSIONS

We believe that the present study provides meaningful information that training in specific illness and screening and assessment may lead to knowledge and experience of public health workers. Further studies should employ a longitudinal design and validated measurements.

Changes in self-efficacy in Japanese school-age children with and without high autistic traits after the Universal Unified Prevention Program: a single-group pilot study

BACKGROUND

Research has shown the efficacy of school-based programs for mental health problems in children. However, few studies have focused on the strengths of children, such as resilience, which is essential in preventing mental health problems. Moreover, no research has investigated the effect of a universal school-based program on children with increased autistic traits in mainstream classes. We examined the changes in children's self-efficacy, social skills, and general mental health after the implementation of a newly developed universal program, the Universal Unified Prevention Program for Diverse Disorders (Up2-D2), and whether similar changes occurred in children with and without higher autistic traits.

METHODS

To assess possible changes associated with the program, questionnaires were collected from 396 children (207 boys and 189 girls) aged 9-12 years old before (T1), immediately after (T2), and three months after (T3) the implementation of the program.

RESULTS

Results from a linear mixed-effects model showed a significant increase in children's self-efficacy at T2 (adjusted difference 0.49, 95% CI 0.03-0.94; p < 0.05) and T3 (0.78, 95% CI 0.32-1.23; p < 0.001). There were also significant positive changes in social skills and general mental health. Similar changes were observed in children with high autistic traits. Autistic traits at T1 did not contribute to the degree of change in self-efficacy.

CONCLUSIONS

Our pilot study suggests that a universal program has the potential to promote positive attitudes and mental health in both at-risk and not-at-risk children.

Practical applications of brief screening questionnaires for autism spectrum disorder in a psychiatry outpatient setting

OBJECTIVES

This study was designed to examine the diagnostic performance of the social and communication disorders checklist (SCDC) and strength and difficulties questionnaire (SDQ) to detect autism spectrum conditions (ASC), along with the social responsiveness scale-second edition (SRS-2) as reference, in a psychiatry outpatient setting.

METHODS

We translated the SCDC into Japanese since its Japanese version was unavailable. We examined its test-retest reliability as well as the internal consistency reliability and diagnostic performance of the three questionnaires among 41 Japanese psychiatric outpatients, using the best-estimate diagnosis of ASC based on the diagnostic interview for social and communication disorders, as a gold standard.

RESULTS

The test-retest reliability was high for the SCDC. Although the internal consistency reliability was high for the SCDC and SRS-2, that was low for the prosocial and peer problem subscales of the SDQ. The performance of the SCDC, SDQ, and SRS-2 to detect ASC was moderate: the area under the ROC curve of 0.78, 0.78, and 0.84, respectively.

CONCLUSIONS

Although questionnaires to detect ASC, including the three examined, generally have only moderate performance in this setting, these can be successfully applied to high-risk populations such as psychiatry outpatients, when multi-level rather than dichotomous likelihood ratios are used.

Attention-deficit/hyperactivity disorder symptoms and sleep problems in preschool children: the role of autistic traits

BACKGROUND

Sleep problems are elevated in children with attention-deficit/hyperactivity disorder (ADHD). However, until now there has been comparatively little research on the role of autistic traits in this association. The current study examined the association between ADHD symptoms and sleep problems in Japanese preschool children and whether autistic traits might also be important for this relationship.

METHODS

Data were analyzed from 1053 children (average age 64.14 months, range 58-71; 50.3% male) that were drawn from the Tama Children's Survey (TCS). Parent-reported information was obtained on ADHD symptoms using the Strengths and Difficulties Questionnaire (SDQ) and autistic traits with the Social Responsiveness Scale Second Edition (SRS-2). Parents also provided information on three different categories of sleep problems experienced by their children - parasomnias, sleep disordered breathing and awakening/daytime problems. Ordinal logistic regression analysis was used to examine the associations.

RESULTS

In analyses adjusted for sociodemographic factors, the mother's mental health and child's emotional problems, compared to children with no ADHD symptoms or autistic traits, children with only ADHD symptoms had significantly increased odds for only one of 11 individual sleep problems - waking in a negative mood. In contrast, children with comorbid ADHD symptoms and autistic traits had elevated odds for five sleep problems with odds ratios ranging from 2.10 (takes time to become alert in the morning) to 3.46 (excessive body movement while sleeping).

CONCLUSIONS

Sleep problems may be especially elevated in children with comorbid ADHD symptoms and autistic traits.

Attention-deficit/hyperactivity disorder and physical multimorbidity: A population-based study

Background:

There has been little research on the association of attention-deficit/hyperactivity disorder (ADHD) with co-occurring physical diseases. The aim of this study was to examine the association between possible ADHD and physical multimorbidity (i.e. = 2 physical diseases) among adults in the English general population.

Methods:

Data were analyzed from 7274 individuals aged = 18 years that came from the Adult Psychiatric Morbidity Survey 2007. ADHD symptoms were assessed with the Adult Self-Report Scale (ASRS) Screener. Information was also obtained on 20 self-reported doctor/other health professional diagnosed physical health conditions present in the past 12 months. Multivariable logistic regression and mediation analyses were conducted to assess the associations.

Results:

There was a monotonic relation between the number of physical diseases and possible ADHD (ASRS score = 14). Compared to those with no diseases, individuals with = 5 diseases had over 3 times higher odds for possible ADHD (odds ratio [OR]: 3.30, 95% confidence interval [CI]: 2.48–4.37). This association was observed in all age groups. Stressful life events (% mediated 10.3–24.3%), disordered eating (6.8%), depression (12.8%), and anxiety (24.8%) were significant mediators in the association between possible ADHD and physical multimorbidity.

Conclusion:

Adults that screen positive for ADHD are at an increased risk for multimorbidity and several factors are important in this association. As many adults with ADHD remain undiagnosed, the results of this study highlight the importance of detecting adult ADHD as it may confer an increased risk for poorer health outcomes, including physical multimorbidity.

Developing the universal unified prevention program for diverse disorders for school-aged children

BACKGROUND

Psychological problems during childhood and adolescence are highly prevalent, frequently comorbid, and incur severe social burden. A school-based universal prevention approach is one avenue to address these issues.

OBJECTIVE

The first aim of this study was the development of a novel, transdiagnostic cognitive-behavioral universal prevention program: The Universal Unified Prevention Program for Diverse Disorders (Up2-D2). The second aim of this study was to examine the acceptability and fidelity of the Up2-D2.

METHODS

Classroom teachers who attended a 1-day workshop implemented the Up2-D2 independently as a part of their regular curricula. To assess the acceptability of the Up2-D2, 213 children (111 boys and 102 girls) aged 9-12 years completed questionnaires about their enjoyment, comprehension, attainment, applicability, and self-efficacy after completing Lessons 1-12. For fidelity, research assistants independently evaluated audio files that were randomly selected and assigned (27.3%).

RESULTS

Our preliminary evaluation revealed the program was highly enjoyable, clear, and applicable for students. In addition, self-efficacy demonstrated a trend of gradually increasing over the 12 sessions. The total fidelity observed in the two schools was sufficient (76.2%), given the length of the teacher training.

CONCLUSIONS

The results of this study supported the theory that the Up2-D2 could be feasible in real-world school settings when classroom teachers implement the program. We discussed current research and practical issues of using universal prevention to address mental health problems in school, based on implementation science for user-centered design.

Relationship of the Acoustic Startle Response and Its Modulation to Adaptive and Maladaptive Behaviors in Typically Developing Children and Those With Autism Spectrum Disorders: A Pilot Study

Background: Autism spectrum disorder (ASD) is associated with persistent impairments in adaptive functioning across multiple domains of daily life. Thus, investigation of the biological background of both adaptive and maladaptive behaviors may shed light on developing effective interventions for improving social adaptation in ASD. In this study, we examined the relationship between adaptive/maladaptive behaviors and the acoustic startle response (ASR) and its modulation, which are promising neurophysiological markers for ASD translational research.

Method: We investigated the ASR and its modulation in 11 children with ASD and 18 with typical development (TD), analyzing the relationship between startle measures and adaptive/maladaptive behaviors assessed with the Vineland Adaptive Behavior Scales (VABS) Second Edition.

Results: Peak-ASR latency was negatively correlated with the VABS total score and socialization domain score of adaptive behaviors, while the ASR magnitude for relatively weak stimuli of 75–85 dB was positively correlated with VABS maladaptive behavior scores. Prepulse inhibition (PPI) at the prepulse intensity of 70–75 dB was also correlated with VABS maladaptive behavior. However, these relationships did not remain significant after adjustment for multiple comparisons.

Conclusions: Our results indicate that the prolonged peak-ASR latency of ASD children might be associated with impairment in the developmental level of adaptive behavior, and that the greater ASR magnitude to relatively weak acoustic stimuli and smaller PPI of ASD children might increase the risk of maladaptive behavior. Future studies that have larger sample sizes will be important for further elucidating the neurophysiological factors that underpin adaptive as well as maladaptive behaviors in ASD.

The orbitofrontal cortex modulates parenting stress in the maternal brain

Many mothers are adaptive, deploying successful coping strategies that mitigate the deleterious effects of parenting stress on caregiving, nevertheless, the neural mechanisms underlying these adaptive responses remain unclear. We utilized functional magnetic resonance imaging to investigate brain activity in 28 healthy mothers of typically developing, 2-to-3-year-old children in response to the feeding behavior of their own children versus that of other children. We then examined the correlation between maternal brain activation and subjective feelings of parenting stress. Brain regions associated with maternal motivation including the orbitofrontal cortex (OFC), ventral pallidum, periaqueductal gray (PAG), dorsal raphe nucleus (DRN), and anterior insular cortex (AIC)—as well as those associated with the recognition of one’s own child’s state (e.g., cerebellum)—exhibited significant activation in response to their own children. While mothers with higher activation in the OFC showed less parenting stress related to one’s sense of competence in the parental role, mothers with higher co-activation of the OFC with both of the AIC and PAG/DRN, and with the cerebellum showed less parenting stress caused by child characteristics. Our findings suggest that well-balanced maternal brain mechanisms integrated by the OFC may provide effective adaptive responses in daily parenting scenarios.

Negatively Skewed Locomotor Activity Is Related to Autistic Traits and Behavioral Problems in Typically Developing Children and Those With Autism Spectrum Disorders

An important objective for researchers and clinicians is to gain a better understanding of the factors that underlie autism spectrum disorders (ASDs). It is possible that investigating objective and quantitative behavioral phenotypes and their relationship to clinical characteristics, such as autistic traits and other emotional/behavioral problems, might facilitate this process. Given this, in the current study we examined the link between locomotor dynamics and clinical characteristics, including autistic traits and emotional/behavioral problems, in children with ASD (n = 14) and typically developing (TD) children (n = 13). A watch-type actigraph was used to continuously measure locomotor activity which was assessed in terms of mean activity levels and the skewness of activity. Parents assessed quantitative autistic traits using the Japanese version of the Social Responsiveness Scale (SRS) and emotional and behavioral problems using the Japanese version of the Strengths and Difficulties Questionnaire (SDQ). Results showed that among all children, all-day activity was more negatively skewed, suggesting sporadic large all-day "troughs" in activity and was significantly correlated with the SRS social awareness subscale score (ρ = -0.446, p = 0.038). In addition, the more negatively skewed daytime locomotor activity was associated with the SDQ Hyperactivity Inattention subscale score (ρ = -0.493, p = 0.020). The results of this study indicate that investigating locomotor dynamics may provide one way to increase understanding of the neurophysiological mechanisms underlying the clinical characteristics of ASD.

Prevalence of childhood obstructive sleep apnea syndrome and its role in daytime sleepiness

Objectives

To investigate childhood obstructive sleep apnea syndrome (OSAS) and its role in daytime sleepiness among school-age children.

Methods

A questionnaire survey was conducted with 25,211 children aged 6–15 (mean, 10.39) years attending 148 elementary and 71 middle schools in 10 prefectures across Japan and their parents. Questions concerned 4 sleep habit items (bedtime, sleep onset latency, wake time after sleep onset, wake-up time) and 4 sleep disorder items (loud snoring, snorts/gasps, breathing pauses, seems very sleepy in the daytime). Total sleep time (TST) was calculated with sleep habits. Severe possible OSAS (p-OSAS) was defined as having loud snoring, snorts and gasps, or breathing pauses “frequently” (≥ 5 times per week), and mild p-OSAS was rated as having any of these “sometimes” (2–4 times per week). Severe daytime sleepiness was defined as seeming very sleepy “frequently” and mild daytime sleepiness as seeming very sleepy “sometimes”.

Results

Mean prevalence of mild to severe p-OSAS and severe p-OSAS in children across all grade levels was 9.5% and 1.6%, respectively. p-OSAS was particularly prevalent in children at lower elementary levels, decreasing with advancing grade levels. Prevalence of mild and severe daytime sleepiness was 6.1% and 0.9%, respectively, among all children (7.0%). Prevalence of daytime sleepiness increased with advancing grade levels, particularly in middle-school level. Average TST was 8.4 ± 2.2 h in both elementary and middle-school levels, and decreased as grades advanced, particularly in middle-school levels. Multivariate logistic regression analysis showed that middle-school level, TST < 8 h, and p-OSAS were independent factors for daytime sleepiness. Strong correlations were found between severe daytime sleepiness and severe p-OSAS or TST < 6 h, and between daytime sleepiness and loud snoring or breathing pauses.

Conclusion

p-OSAS may be an independent factor influencing daytime sleepiness in school-age children. Loud snoring and breathing pauses could be clinical markers for children with severe daytime sleepiness.

Relationship between Autistic Spectrum Trait and Regional Cerebral Blood Flow in Healthy Male Subjects

OBJECTIVE

Autistic spectrum traits are postulated to lie on a continuum that extends between individuals with autism and individuals with typical development. The present study was carried out to investigate functional and network abnormalities associated with autistic spectrum trait in healthy male subjects.

METHODS

Subjects were 41 healthy male subjects who underwent the social responsiveness scale-adult (SRS-A) and magnetic resonance imaging.

RESULTS

There was significant positive correlation between the total score of SRS-A and the regional cerebral blood flow (CBF) in posterior cingulate cortex (PCC). Also, there were changes in functional network such as in cingulate corti, insula and fusiform cortex. Further, we also found the significant difference of functional networks between the healthy male subjects with high or low autistic spectrum trait, and these points were congruent with the previous perceptions derived from autistic-spectrum disorders.

CONCLUSION

These findings suggest a biological basis for the autistic spectrum trait and may be useful for the imaging marker of autism symptomatology.

Attention-deficit/hyperactivity disorder symptoms and suicidal behavior in adult psychiatric outpatients

AIM

We aimed to examine the association between attention-deficit/hyperactivity disorder (ADHD) symptoms and suicidal behavior in psychiatric outpatients and whether this association differs among patients with different psychiatric disorders.

METHODS

Cross-sectional data came from the Japan Prevalence Study of Adult ADHD at Psychiatric Outpatient Care, which included psychiatric outpatients aged 18-65 years recruited from one university hospital and three general psychiatric outpatient clinics in Kitakyushu City, Fukuoka, Japan from April 2014 to January 2015 (N = 864). The Adult ADHD Self-Report Scale (ASRS) Screener was used to collect information on ADHD symptoms. Reports of current and lifetime suicidal behavior were also obtained. A multivariable Poisson regression analysis was used to examine the association between ADHD symptoms and suicidal behavior.

RESULTS

After adjusting for covariates there was a strong association between possible ADHD (ASRS ≥14) and suicidal behavior with prevalence ratios ranging from 1.17 (lifetime suicidal ideation) to 1.59 (lifetime suicide attempt) and 2.36 (current suicidal ideation). When ASRS strata were used, there was a dose-response association between increasing ADHD symptoms and suicidal ideation and suicide attempts. Analyses of individual ICD-10 psychiatric disorders showed that associations varied across disorders and that for anxiety disorder, ADHD symptoms were significantly linked to all forms of suicidal behavior.

CONCLUSION

ADHD symptom severity is associated with an increased risk for suicidal behavior in general psychiatric outpatients. As ADHD symptoms are common among adult psychiatric outpatients, detecting and treating ADHD in this population may be important for preventing suicidal behavior.

Acoustic startle response and its modulation in schizophrenia and autism spectrum disorder in Asian subjects

The acoustic startle response (ASR) and its modulation, including prepulse inhibition (PPI), are considered to be promising neurophysiological indices for translational research in psychiatry. Impairment of the PPI has been reported in several psychiatric disorders, but particularly in schizophrenia, where PPI is considered to be a candidate endophenotype of the disorder. Although the profiles of the ASR differ between races, recent studies of single ethnicity samples in Asia were in accord with a number of studies from Western countries, in reporting that patients with schizophrenia exhibit impaired PPI. The PPI of the ASR is known to develop before 8years of age, and PPI impairment has only been reported in adults (not children) with autism spectrum disorder (ASD), which involves atypical features that are present from early development. Recent Asian studies of children with ASD suggest that comprehensive investigation of the ASR and its modulation, including the startle response to weak startle stimuli, peak startle latency, and PPI, may contribute to an understanding of the impairment of the neural circuitry in children with ASD and its comorbid behavioral problems. In this review, we review recent findings on the ASR and its modulation from Asian countries, and discuss its potential use for studying sensorimotor gating and its relationship to schizophrenia and ASD. In conclusion, the ASR and its modulation can provide a well-established global neurophysiological index for translational research in psychiatric disorders. Future studies investigating the development of sensorimotor gating in early development may contribute to prevention of psychiatric disorders.

Development of a new screening tool for neuromotor development in children aged two - the neuromotor 5 min exam 2-year-old version (N5E2)

OBJECTIVE

As a new screening tool for neuromotor development in children aged two, we developed the Neuromotor 5 min Exam 2-year-old version (N5E2), which can be easily administered by pediatricians or primary care physicians. In this study, as an initial attempt to examine the utility of the N5E2, the inter-rater reliability on scoring for the individual items in this scale was assessed.

METHODS

The participants of the study were 29 children (aged 1-5 years, mean age = 2.79) diagnosed with a variety of neuromotor/developmental disorders/high-risk conditions. Inter-rater reliability was examined on the following 11 items in the N5E2: (1) Retrieving a rolling ball, (2) Gait, (3) Toe-walking, (4) Asymmetries of posture and/or movement, (5) Age at unsupported walking, (6) Speaking in two-word understandable sentences, (7) Hypotonus, (8) Hypertonus, (9) Eye movement, (10) Vision problem, (11) Hearing problem. The items were administered to children by two pediatricians with different expertise and clinical experience, separately.

RESULTS

The results showed that among the eleven items in the N5E2 examined, a high level of agreement (κ ≥ 0.60) was found on 4 items, and a moderate level of agreement (0.40 ≤ κ < 0.60) was found on 5 items. The level of agreement somewhat improved after the dichotomization of the score; using this format, a high level of rater agreement (κ ≥ 0.60) was found on 6 out of 11 items. The analyses also revealed high inter-rater reliability on the sum score of the 11 items (r = 0.84).

CONCLUSIONS

The results suggest the possibility that this brief screening tool could be feasible in settings where clinicians' experience varies, based on its inter-rater reliability on individual items between the clinicians with different expertise and amount of clinical experiences.

Meta-analyses of individual versus group interventions for pre-school children with autism spectrum disorder (ASD)

There is little evidence regarding the effects of individual and group intervention for children with autism spectrum disorder (ASD) on important outcomes. We performed meta-analyses using a random effects model to investigate the effectiveness of the individual and group intervention studies and to compare the effectiveness of these two types if possible. The main analysis which excluded studies at a high risk of bias (Analysis I) included 14 randomised controlled trials targeting children with ASD≤6 years of age (594 children). The results suggested that both individual and group interventions showed significant effects compared to the control condition on "reciprocity of social interaction towards others" (standard mean difference[SMD] [95%confidence interval{CI}] = 0.59[0.25, 0.93], p = 0.16; 0.45[0.02, 0.88], p = 0.39, respectively). Only individual interventions showed significant effects compared to the control condition on "parental synchrony" (SMD [95%CI] = 0.99 [0.70, 1.29], p<0.01). Our results showed no significant differences between individual and group interventions in effects on "autism general symptoms" (no study available for group intervention), "developmental quotient" (no study available for group intervention), "expressive language" (p = 0.56), "receptive language" (p = 0.29), "reciprocity of social interaction towards others" (p = 0.62), or "adaptive behaviour" (p = 0.43). We also performed sensitivity analyses including studies that had been excluded due to being at a high risk of potential bias (Analysis II). The results suggested that "reciprocity of social interactions towards others" showed significant effects for individual intervention compared to the control condition (0.50[0.31,0.69], p<0.001) but not for group intervention (0.23[-0.33, 0.78], p = 0.42). Individual intervention also showed significant effects on "parental synchrony" (0.98[0.30,1.66], p = 0.005) in the sensitivity analysis. The results also suggested no significant difference on all the outcomes between the individual and group interventions. We also reanalysed the data using cluster-robust standard errors as sensitivity analyses (Analysis III). Analysis III showed no significant effects in the intervention condition compared to the control condition on all the outcomes for both individual and group interventions. When Analysis II was reanalysed using cluster-robust standard errors (Analysis IV), individual interventions showed significant effects compared to the control condition on "reciprocity of social interaction towards others" and "parental synchrony" (mean estimate[95%CI], robust standard error, p = 0.50[0.20, 0.81], 0.13, 0.006; and 1.06[0.08, 2.05], 0.42, 0.04, respectively), and none of the outcomes showed significant effects under the intervention condition compared to the control condition for group interventions. The discrepancies in the results between the main analysis (Analysis I) and the sensitivity analyses (Analyses II, III, and IV) may be due to the small number of included studies. Since the outcome of "reciprocity of social interaction towards others" can be a dependent variable that is usually measured in a context-bound setting with the child's parent, we cannot conclude that individual interventions for pre-school children with ASD have significant effects on generalised skills for engaging in reciprocal interactions with others, even if the interventions have significant effects on the outcome. However, the outcomes of "reciprocity of social interaction towards others" may be promising targets for both individual and group interventions involving pre-school children with ASD. "Parental synchrony" may also be a promising target for individual interventions.

TRIAL REGISTRATION

(CRD42011001349).

Relationship between physiological and parent-observed auditory over-responsiveness in children with typical development and those with autism spectrum disorders

The objective of this study was to investigate relationships between caregiver-reported sensory processing abnormalities, and the physiological index of auditory over-responsiveness evaluated using acoustic startle response measures, in children with autism spectrum disorders and typical development. Mean acoustic startle response magnitudes in response to 65-105 dB stimuli, in increments of 10 dB, were analyzed in children with autism spectrum disorders and with typical development. Average peak startle latency was also examined. We examined the relationship of these acoustic startle response measures to parent-reported behavioral sensory processing patterns in everyday situations, assessed using the Sensory Profile for all participants. Low-threshold scores on the Sensory Profile auditory section were related to acoustic startle response magnitudes at 75 and 85 dB, but not to the lower intensities of 65 dB. The peak startle latency and acoustic startle response magnitudes at low-stimuli intensities of 65 and 75 dB were significantly related to the low-threshold quadrants (sensory sensitivity and sensation avoiding) scores and to the high-threshold quadrant of sensation seeking. Our results suggest that physiological assessment provides further information regarding auditory over-responsiveness to less-intense stimuli and its relationship to caregiver-observed sensory processing abnormalities in everyday situations.

Acoustic Hyper-Reactivity and Negatively Skewed Locomotor Activity in Children With Autism Spectrum Disorders: An Exploratory Study

Investigation of objective and quantitative behavioral phenotypes along with neurobiological endophenotypes might lead to increased knowledge of the mechanisms that underlie autism spectrum disorders (ASD). Here, we investigated the association between locomotor dynamics and characteristics of the acoustic startle response (ASR) and its modulation in ASD (n = 14) and typically developing (TD, n = 13) children. The ASR was recorded in response to acoustic stimuli in increments of 10 dB (65-105 dB SPL). We calculated the average ASR magnitude for each stimulus intensity and peak-ASR latency. Locomotor activity was continuously measured with a watch-type actigraph. We examined statistics of locomotor activity, such as mean activity levels and the skewness of activity. Children with ASD had a significantly greater ASR magnitude in response to a weak acoustic stimulus, which reflects acoustic hyper-reactivity. The skewness of all-day activity was significantly more negative in children with ASD than those with TD. Skewness of daytime activity was also more negative, although only of borderline statistical significance. For all children, the higher mean and more negatively skewed daytime activity, reflecting hyperactivity that was associated with sporadic large daytime "troughs," was significantly correlated with acoustic hyper-reactivity. The more negatively skewed locomotor activity occurring in the daytime was also associated with impaired sensorimotor gating, examined as prepulse inhibition at a prepulse intensity of 70 dB. This comprehensive investigation of locomotor dynamics and the ASR extends our understanding of the neurophysiology that underlies ASD.

A systematic review and meta-analysis of comprehensive interventions for pre-school children with autism spectrum disorder (ASD)

BACKGROUND

There has an increasing number of published trials on psychosocial intervention programmes for pre-school children with autism spectrum disorder (ASD). To achieve better quality of unbiased evidence for the effectiveness of ASD interventions, it is necessary to conduct a comprehensive review that covers studies with adequate quality standards, such as randomised controlled trials (RCTs), and different types of intervention In this study, we categorize interventions for ASD as behavioural, social-communication focused, and multimodal developmental based on Howlin's classification of early interventions for children with ASD. The aim of this study was to compare these three models and investigate the strengths and weaknesses of each type of intervention and to identify the approaches that contribute to a successful outcome for children with autism.

METHODS

We performed a systematic review and meta-analysis. We included RCTs targeting children with ASD 6 years old or younger. A random effects model was used to present the effect estimate for the outcomes. This study also performed combined meta-analyses of all the three models to investigate the overall effectiveness of the intervention programmes.

RESULTS

32 randomized controlled studies were found to be eligible for inclusion. The synthesized data included 594 children from 14 RCTs. There was no statistically significant difference in the effects on autism general symptoms between the social-communication-focused model and the multimodal developmental model (p = 0.83). The results suggest that there is evidence of an effect on 'reciprocity of social interaction towards others' (standard mean difference [95% confidential interval] = 0.53[0.29,0.78], p<0.01) and 'parental synchrony' (SMD = 0.99[0.70,1.29], p<0.01).

CONCLUSION

The small number of studies included in the present study limited the ability to make inferences when comparing the three models and investigating the strengths and weaknesses of each type of intervention with respect to important outcomes. Since the outcome of 'reciprocity of social interaction towards others' could be a dependent variable that might be context-bound to interactions with the child's parent, we cannot conclude the interventions for pre-school children with ASD have significant effects on a generalized skill to engage in reciprocal interactions with others. However, the outcomes of 'reciprocity of social interaction towards others' and 'parental synchrony' may be promising targets for interventions involving pre-school children with ASD.

TRIAL REGISTRATION

Prospero CRD42011001349.

Alpha band event-related desynchronization underlying social situational context processing during irony comprehension: A magnetoencephalography source localization study

Irony comprehension requires integration of social contextual information. Previous studies have investigated temporal aspects of irony processing and its neural substrates using psychological/electroencephalogram or functional magnetic resonance imaging methods, but have not clarified the temporospatial neural mechanisms of irony comprehension. Therefore, we used magnetoencephalography to investigate the neural generators of alpha-band (8-13Hz) event-related desynchronization (ERD) occurring from 600 to 900ms following the onset of a critical sentence at which social situational contexts activated ironic representation. We found that the right anterior temporal lobe, which is involved in processing social knowledge and evaluating others' intentions, exhibited stronger alpha ERD following an ironic statement than following a literal statement. We also found that alpha power in the left anterior temporal lobe correlated with the participants' communication abilities. These results elucidate the temporospatial neural mechanisms of language comprehension in social contexts, including non-literal processing.

Association Between Autistic Traits in Preschool Children and Later Emotional/Behavioral Outcomes

Although children with a greater number of autistic traits are likely to have other mental health problems, research on the association between earlier autistic traits in preschool children and later emotional/behavioral outcomes is scarce. Using data from 189 Japanese community-based children, this study examined whether autistic traits at age 5 were related to emotional/behavioral outcomes at age 7. The results showed that prior autistic traits were subsequently associated with all emotional/behavioral domains. After controlling for baseline emotional/behavioral scores autistic traits continued to predict later emotional symptoms and peer problems. This study highlights that in addition to clinical ASD, it is also important to focus on subthreshold autistic traits in preschool children for better subsequent emotional/behavioral outcomes.

Assessment of Autistic Traits in Children Aged 2 to 4½ Years With the Preschool Version of the Social Responsiveness Scale (SRS-P): Findings from Japan

The recent development and use of autism measures for the general population has led to a growing body of evidence which suggests that autistic traits are distributed along a continuum. However, as most existing autism measures were designed for use in children older than age 4, to date, little is known about the autistic continuum in children younger than age 4. As autistic symptoms are evident in the first few years, to address this research gap, the current study tested the preschool version of the Social Responsiveness Scale (SRS‐P) in children aged 2 to 4½ years in clinical (N = 74, average age 40 months, 26–51 months) and community settings (N = 357, average age 39 months, 25–50 months) in Japan. Using information obtained from different raters (mothers, other caregivers, and teachers) it was found that the scale demonstrated a good degree of internal consistency, inter‐rater reliability and test‐retest reliability, and a satisfactory degree of convergent validity for the clinical sample when compared with scores from diagnostic “gold standard” autism measures. Receiver operating characteristic analyses and the group comparisons also showed that the SRS‐P total score discriminated well between children with autism spectrum disorder (ASD) and those without ASD. Importantly, this scale could identify autistic symptoms or traits distributed continually across the child population at this age irrespective of the presence of an ASD diagnosis. These findings suggest that the SRS‐P might be a sensitive instrument for case identification including subthreshold ASD, as well as a potentially useful research tool for exploring ASD endophenotypes. Autism Res 2017, 10: 852–865. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.

Attention-deficit/hyperactivity disorder symptoms and loneliness among adults in the general population

BACKGROUND

Research on the association between adult attention-deficit/hyperactivity disorder (ADHD) and loneliness is scarce even though factors which have been previously linked to loneliness, such as divorce and poorer mental health may be more prevalent among adults with ADHD. This study investigated the relation between ADHD symptoms/symptom severity and loneliness in the general adult population.

METHODS

Data from the Adult Psychiatric Morbidity Survey 2007 (N=7403, aged ≥16years) were analyzed. ADHD symptoms and common mental disorders (CMDs) were assessed with the Adult ADHD Self-Report Scale (ASRS) Screener and the Clinical Interview Schedule Revised, respectively. Loneliness was measured with a question from the Social Functioning Questionnaire. Multivariable logistic regression analysis was used to examine the associations.

RESULTS

In the fully adjusted model, an ASRS score ≥14 was strongly associated with loneliness (OR=2.48 95%CI=1.83-3.36). ADHD symptom severity was related to loneliness in a dose-response fashion. Over one-third of the association between ADHD symptoms and loneliness was explained by CMDs.

CONCLUSIONS

Adults with more ADHD symptoms are at an increased risk of feeling lonely. Future research should determine how ADHD symptoms are linked to loneliness and if loneliness is affecting well-being.

Examining cross-cultural differences in autism spectrum disorder: A multinational comparison from Greece, Italy, Japan, Poland, and the United States

Autism spectrum disorder (ASD) is characterized by social and communication impairments as well as restricted, repetitive behavior patterns. Despite the fact that ASD is reported worldwide, very little research exists examining ASD characteristics on a multinational scale. Cross-cultural comparisons are especially important for ASD, since cultural differences may impact the perception of symptoms. Identifying behaviors that are similarly reported as problematic across cultures as well as identifying behaviors in which there is cultural variation could aid in the development and refinement of more universally effective measures. The present study sought to examine similarities and differences in caregiver endorsement of symptom severity through scores on the Baby Infant Screen for Children with aUtIsm Traits (BISCUIT). The BISCUIT was utilized to examine ASD core symptomology in 250 toddlers diagnosed with ASD from Greece, Italy, Japan, Poland, and the United States. Significant differences in overall ASD symptom severity and endorsement were found between multinational groups. Implications of the results are discussed.

ADHD symptoms and pain among adults in England

Prior research has produced conflicting findings on the association between attention-deficit/hyperactivity disorder (ADHD) and pain, while studies among community-dwelling adults are lacking. This study examined the association between ADHD symptoms and pain in the general adult population, and the extent to which this association is influenced by comorbid common mental disorders (CMDs). Data came from the 2007 Adult Psychiatric Morbidity Survey which included a representative sample of the English adult household population aged ≥16 years (N=7403). The Adult ADHD Self-Report Scale (ASRS) Screener was used to obtain information on ADHD symptoms, while pain was assessed by the degree to which it interfered with work activity in the previous month. The Clinical Interview Schedule Revised (CIS-R) was used to evaluate six categories of CMDs. In a binary logistic regression analysis adjusted for socio-demographic factors and physical health conditions, an ADHD symptom score ≥14 was strongly associated with extreme pain (odds ratio [OR]: 3.15, 95% confidence interval [CI]: 2.09-4.74). The OR was attenuated greatly after further adjustment for CMDs (OR: 1.64, 95% CI: 1.05-2.58) but remained statistically significant. Adults with ADHD symptoms have higher odds for experiencing pain. CMDs are influential in this association but do not fully explain it.

Current viewpoints on DSM-5 in Japan

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published in 2013, and its official Japanese version was published in 2014. The Japanese Government uses classifications from the 10th revision of the I nternational C lassification of D iseases (ICD-10) to categorize disorders and determine treatment fees. However, since the publication of the DSM-III, the use of the DSM system has become prevalent in research and educational settings in Japan. In addition to traditional psychiatry, both the ICD and the DSM are taught by many Japanese medical schools, and virtually all clinical research and trials refer to the DSM to define targeted disorders. Amid the current backdrop in which the reputation of the DSM-5 is being established, the editorial board of P sychiatry and C linical N eurosciences has asked Japanese experts across 12 specialties to examine the structure of the DSM-5, including the following categories: Neurodevelopmental Disorders, Schizophrenia Spectrum Disorders, Major Depression, Bipolar Disorders, Obsessive-Compulsive Disorders, Somatic Symptom Disorder, Eating Disorders, Substance-Related and Addictive Disorders, Gender Dysphoria, and Neurocognitive Disorders. Although opinions were only obtained from these selected experts, we believe that we have succeeded, to a certain extent, in presenting views that are representative of each specialty.

Attention-deficit/hyperactivity disorder symptoms and suicide ideation and attempts: Findings from the Adult Psychiatric Morbidity Survey 2007

BACKGROUND

Adults with attention-deficit/hyperactivity disorder (ADHD) may have an increased risk of engaging in suicidal behavior. This study examined this association in the general adult population where there has been little research.

METHODS

Data came from the Adult Psychiatric Morbidity Survey 2007. This was a representative sample of the English adult household population aged ≥16 years (N=7403). The Adult ADHD Self-Report Scale (ASRS) was used to obtain information on ADHD symptoms. The Clinical Interview Schedule Revised (CIS-R) was used to assess six forms of common mental disorder (CMD). Information was also obtained on the lifetime and past 12-month occurrence of suicide ideation and attempts. Logistic regression analysis was used to examine these associations.

RESULTS

After adjusting for comorbid disorders, adults with more ADHD symptoms had significantly higher odds for suicidal behavior. When a single cut-off point was used to classify ADHD (ASRS score ≥14), odds ratios ranged from 1.62 (lifetime suicide attempt) to 2.43 (past 12-month suicide ideation). When ADHD symptoms were categorized by strata (I: a score of 0-9; II: 10-13; III: 14-17; IV: 18-24), compared to adults in stratum I, those in stratum IV had odds ratios ranging from 2.16 (lifetime suicide ideation) to 3.68 (past 12-month suicide attempt).

LIMITATIONS

ADHD and suicide data came from self-reports which may have been affected by socially desirable responding.

CONCLUSIONS

ADHD symptoms were linked to suicidal behavior after controlling for comorbid conditions. Health care professionals should be alerted to the increased suicide risk among adults with ADHD symptoms.

Autistic-like traits in adult patients with mood disorders and schizophrenia

Autism spectrum disorder often co-occurs with other psychiatric disorders. Although a high prevalence of autistic-like traits/symptoms has been identified in the pediatric psychiatric population of normal intelligence, there are no reports from adult psychiatric population. This study examined whether there is a greater prevalence of autistic-like traits/symptoms in patients with adult-onset psychiatric disorders such as major depressive disorder (MDD), bipolar disorder, or schizophrenia, and whether such an association is independent of symptom severity. The subjects were 290 adults of normal intelligence between 25 and 59 years of age (MDD, n=125; bipolar disorder, n=56; schizophrenia, n=44; healthy controls, n=65). Autistic-like traits/symptoms were measured using the Social Responsiveness Scale for Adults. Symptom severity was measured using the Positive and Negative Symptoms Scale, the Hamilton Depression Rating Scale, and/or the Young Mania Rating Scale. Almost half of the clinical subjects, except those with remitted MDD, exhibited autistic-like traits/symptoms at levels typical for sub-threshold or threshold autism spectrum disorder. Furthermore, the proportion of psychiatric patients that demonstrated high autistic-like traits/symptoms was significantly greater than that of healthy controls, and not different between that of remitted or unremitted subjects with bipolar disorder or schizophrenia. On the other hand, remitted subjects with MDD did not differ from healthy controls with regard to the prevalence or degree of high autistic-like traits/symptoms. A substantial proportion of adults with bipolar disorder and schizophrenia showed high autistic-like traits/symptoms independent of symptom severity, suggesting a shared pathophysiology among autism spectrum disorder and these psychiatric disorders. Conversely, autistic-like traits among subjects with MDD were associated with the depressive symptom severity. These findings suggest the importance of evaluating autistic-like traits/symptoms underlying adult-onset psychiatric disorders for the best-suited treatment. Further studies with a prospective design and larger samples are needed.

Brief report: large individual variation in outcomes of autistic children receiving low-intensity behavioral interventions in community settings

BACKGROUND

Despite widespread awareness of the necessity of early intervention for children with autism spectrum disorders (ASDs), evidence is still limited, in part, due to the complex nature of ASDs. This exploratory study aimed to examine the change across time in young children with autism and their mothers, who received less intensive early interventions with and without applied behavior analysis (ABA) methods in community settings in Japan.

METHODS

Eighteen children with autism (mean age: 45.7 months; range: 28-64 months) received ABA-based treatment (a median of 3.5 hours per week; an interquartile range of 2-5.6 hours per week) and/or eclectic treatment-as-usual (TAU) (a median of 3.1 hours per week; an interquartile range of 2-5.6 hours per week). Children's outcomes were the severity of autistic symptoms, cognitive functioning, internalizing and externalizing behavior after 6 months (a median of 192 days; an interquartile range of 178-206 days). In addition, maternal parenting stress at 6-month follow-up, and maternal depression at 1.5-year follow-up (a median of 512 days; an interquartile range of 358-545 days) were also examined.

RESULTS

Large individual variations were observed for a broad range of children's and mothers' outcomes. Neither ABA nor TAU hours per week were significantly associated with an improvement in core autistic symptoms. A significant improvement was observed only for internalizing problems, irrespective of the type, intensity or monthly cost of treatment received. Higher ABA cost per month (a median of 1,188 USD; an interquartile range of 538-1,888 USD) was associated with less improvement in language-social DQ (a median of 9; an interquartile range of -6.75-23.75).

CONCLUSIONS

To determine an optimal program for each child with ASD in areas with poor ASD resources, further controlled studies are needed that assess a broad range of predictive and outcome variables focusing on both individual characteristics and treatment components.

Association between delayed bedtime and sleep-related problems among community-dwelling 2-year-old children in Japan

Background

Although delayed sleep timing causes many socio-psycho-biological problems such as sleep loss, excessive daytime sleepiness, obesity, and impaired daytime neurocognitive performance in adults, there are insufficient data showing the clinical significance of a ‘night owl lifestyle’ in early life. This study examined the association between habitual delayed bedtime and sleep-related problems among community-dwelling 2-year-old children in Japan.

Methods

Parents/caregivers of 708 community-dwelling 2-year-old children in Nishitokyo City, Tokyo, participated in the study. The participants answered a questionnaire to evaluate their child’s sleep habits and sleep-related problems for the past 1 month.

Results

Of the 425 children for whom complete data were collected, 90 (21.2%) went to bed at 22:00 or later. Children with delayed bedtime showed significantly more irregular bedtime, delayed wake time, shorter total sleep time, and difficulty in initiating and terminating sleep. Although this relationship indicated the presence of sleep debt in children with delayed bedtime, sleep onset latency did not differ between children with earlier bedtime and those with delayed bedtime. Rather, delayed bedtime was significantly associated with bedtime resistance and problems in the morning even when adjusting for nighttime and daytime sleep time.

Conclusions

Even in 2-year-old children, delayed bedtime was associated with various sleep-related problems. The causal factors may include diminished homeostatic sleep drive due to prolonged daytime nap as well as diurnal preference (morning or night type) regulated by the biological clock.

Verification of the utility of the social responsiveness scale for adults in non-clinical and clinical adult populations in Japan

BACKGROUND

Recently great attention has been paid to the still unmet clinical needs of most adults with autism spectrum disorder (ASD) who live in the community, an increasing number of whom visit psychiatric clinics to seek accurate diagnosis and treatment of concurrent psychiatric symptoms. However, different from the case of children diagnosed with ASD in childhood, it is difficult in adults to identify the ASD symptoms underlying psychopathology and to differentiate ASD from other psychiatric disorders in general psychiatric practice. This study aimed to verify the utility of the Social Responsiveness Scale-Adult version (SRS-A), a quantitative measure for identifying ASD symptoms, in non-clinical and clinical adult populations in Japan.

METHODS

The total sample aged 19 to 59 years consisted of a non-clinical population (n =592) and clinical population with and without ASD (n =142). We examined score distributions of the Japanese version of the scale, and the effects of gender, age, and rater on the distribution. We analyzed factor structure and internal consistency in the non-clinical normative sample, and analyzed convergent, divergent, and discriminative validities in the clinical sample. We applied receiver operator characteristic (ROC) analysis to determine optimal cutoff scores discriminating the ASD clinical population from the non-ASD clinical population.

RESULTS

The score distributed continuously, which replicated findings in children. For non-clinical adults, except in men aged 19 to 24 years, we found no or few gender, age, or rater effects. Both single- and two-factor models were supported for adults. Total SRS-A scores demonstrated high internal consistency and capably discriminated adults with ASD from those with non-ASD psychiatric disorders such as major depressive disorder, schizophrenia, and bipolar disorder with an overlap across diagnoses. Moderate to high correlations of the SRS-A with other-rated ASD measures indicated sufficient convergent validity. Based on the ROC analysis, we recommend cutoff points by gender for use in clinical settings.

CONCLUSION

This study provides additional supportive evidence that the Japanese version SRS-A can reliably and validly measure ASD symptoms in non-clinical and clinical adult populations, and thus can serve as a useful tool for ASD research as well as for secondary screening in Japanese adults.

Molecular Cloning and Sequencing of the Extracellular Pectate Lyase II Gene fromErwinia carotovoraEr

Erwinia carotovora Er produces three extra-cellular pectate lyases (PL I, II, and III). The gene for pectate lyase II (pelII) of E. carotovora Er was cloned and expressed both in Escherichia coli and E. carotovora Er. Localization experiments in E. coli showed that PL II was exclusively in the cytoplasmic space, while PL II was excreted into the culture medium. The complete nucleotides of the pelII gene were sequenced and found to include one open reading frame of 1122 bp coding for a protein of 374 amino acid residues. From comparison of the N-terminal amino acid sequence between the purified PL II and the deduced protein from the nucleotide sequence we reached the conclusion that the mature protein is composed of 352 amino acids with a calculated molecular weight of 38,169 and is preceded by a typical signal sequence of 22 amino acid residues. PL II had 90.1% and 82.9% homologies with PL I and PL III in amino acid sequence, respectively.

Hyperreactivity to weak acoustic stimuli and prolonged acoustic startle latency in children with autism spectrum disorders

BACKGROUND

People with autism spectrum disorders (ASD) are known to have enhanced auditory perception, however, acoustic startle response to weak stimuli has not been well documented in this population. The objectives of this study are to evaluate the basic profile of acoustic startle response, including peak startle latency and startle magnitude to weaker stimuli, in children with ASD and typical development (TD), and to evaluate their relationship to ASD characteristics.

METHODS

We investigated acoustic startle response with weak and strong acoustic stimuli in 12 children with ASD and 28 children with TD, analyzing the relationship between startle measures and quantitative autistic traits assessed with the Social Responsiveness Scale (SRS). The electromyographic activity of the left orbicularis oculi muscle to acoustic stimuli of 65 to 115 dB sound pressure level (SPL), in increments of 5 dB, was measured to evaluate acoustic startle response. The average eyeblink magnitude for each acoustic stimuli intensity and the average peak startle latency of acoustic startle response were evaluated.

RESULTS

The magnitude of the acoustic startle response to weak stimuli (85 dB or smaller) was greater in children with ASD. The peak startle latency was also prolonged in individuals with ASD. The average magnitude of the acoustic startle response for stimulus intensities greater than 85 dB was not significantly larger in the ASD group compared with the controls. Both greater startle magnitude in response to weak stimuli (particularly at 85 dB) and prolonged peak startle latency were significantly associated with total scores, as well as several subscales of the SRS in the whole sample. We also found a significant relationship between scores on the social cognition subscale of the SRS and the average magnitude of the acoustic startle response for stimulus intensities of 80 and 85 dB in the TD group.

CONCLUSIONS

Children with ASD exhibited larger startle magnitude to weak stimuli and prolonged peak startle latency. These startle indices were related to several characteristics of ASD. A comprehensive investigation of acoustic startle response, including the magnitude of startle responses to weak stimuli and peak startle latency, might further our understanding of the neurophysiological impairments underlying ASD.

Mitigation of sociocommunicational deficits of autism through oxytocin-induced recovery of medial prefrontal activity: a randomized trial

IMPORTANCE

Sociocommunicational deficits make it difficult for individuals with autism spectrum disorders (ASD) to understand communication content with conflicting verbal and nonverbal information. Despite growing prospects for oxytocin as a therapeutic agent for ASD, no direct neurobiological evidence exists for oxytocin's beneficial effects on this core symptom of ASD. This is slowing clinical application of the neuropeptide.

OBJECTIVE

To directly examine whether oxytocin has beneficial effects on the sociocommunicational deficits of ASD using both behavioral and neural measures.

DESIGN, SETTING, AND PARTICIPANTS

At the University of Tokyo Hospital, we conducted a randomized, double-blind, placebo-controlled, within-subject-crossover, single-site experimental trial in which intranasal oxytocin and placebo were administered. A total of 40 highly functioning men with ASD participated and were randomized in the trial.

INTERVENTIONS

Single-dose intranasal administration of oxytocin (24 IU) and placebo.

MAIN OUTCOMES AND MEASURES

Using functional magnetic resonance imaging, we examined effects of oxytocin on behavioral neural responses of the participants to a social psychological task. In our previous case-control study using the same psychological task, when making decisions about social information with conflicting verbal and nonverbal contents, participants with ASD made judgments based on nonverbal contents less frequently with longer time and could not induce enough activation in the medial prefrontal cortex. Therefore, our main outcomes and measures were the frequency of the nonverbal information-based judgments (NVJs), the response time for NVJs, and brain activity of the medial prefrontal cortex during NVJs.

RESULTS

Intranasal oxytocin enabled the participants to make NVJs more frequently (P = .03) with shorter response time (P = .02). During the mitigated behavior, oxytocin increased the originally diminished brain activity in the medial prefrontal cortex (P < .001). Moreover, oxytocin enhanced functional coordination in the area (P < .001), and the magnitude of these neural effects was predictive of the behavioral effects (P ≤ .01).

CONCLUSIONS AND RELEVANCE

These findings provide the first neurobiological evidence for oxytocin's beneficial effects on sociocommunicational deficits of ASD and give us the initial account for neurobiological mechanisms underlying any beneficial effects of the neuropeptide.

TRIAL REGISTRATION

umin.ac.jp/ctr Identifier: UMIN000002241 and UMIN000004393.

Evaluation of chromID strepto B as a screening media for Streptococcus agalactiae

Background

Streptococcus agalactiae (Group B Streptococcus, GBS), a leading cause of sepsis and meningitis in infants, can be transmitted vertically from mother to infant during passage through the birth canal. Detection of GBS colonization in perinatal women is a major strategy for the prevention of postpartum neonatal disease. The U.S. Centers for Disease Control and Prevention recommends that all women undergo vaginal-rectal screening for GBS colonization at 35-37 weeks of gestation. ChromID Strepto B (STRB) is a chromogenic GBS screening media on which GBS colonies appear pink or red, while other bacteria are either inhibited or form colonies in other colors. In this study, we compared STRB with a conventional GBS detection method using 5% sheep blood agar (BA) followed by a selective enrichment broth.

Methods

Anovaginal swabs were collected from 1425 women during weeks 35 to 37 of their pregnancies. The swabs were used to inoculate both STRB and BA plates after enrichment with selective Todd Hewitt Broth (THB). A GBS latex agglutination test was used to confirm the identity of isolates from each plate.

Results

GBS was recovered from 319 (22.4%) samples with one or both media: 318 on STRB compared to 299 using BA. One false negative was observed on STRB, and 20 false negatives were observed on BA. In addition, non-hemolytic GBS was recovered from 19 (6.0%) samples using STRB.

Conclusions

STRB offers effectiveness and convenience over BA for GBS screening in clinical laboratories. STRB produces fewer false negatives, has a higher detection rate and uses a simple color screen that is ideal for technician-level applications. We recommend STRB as the media of choice for GBS screening.