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Background: Obesity in adults without Down syndrome is associated with an adverse metabolic profile including high prevalence of pre‐diabetes and diabetes, high levels of insulin, non‐high‐density lipoprotein (HDL) cholesterol, leptin and high‐sensitivity C‐reactive protein (hsCRP) and low levels of HDL and adiponectin. We examined whether obesity in middle‐aged adults with Down syndrome is also related to an adverse metabolic profile. Methods: This cross‐sectional study included 143 adults with Down syndrome, with a mean age of 55.7 ± 5.7 years and 52.5% women. Body mass index (BMI) was classified as underweight (BMI < 18.5 kg/m2), normal (BMI 18.5–24.9 kg/m2), overweight (BMI 25–29.9 kg/m2) and obese (BMI ≥ 30 kg/m2). Diabetes was ascertained by history or by haemoglobin A1c (HbA1c) as normal glucose tolerance (HbA1c < 5.7%), pre‐diabetes (HbA1c 5.7–6.4%) and diabetes (HbA1c ≥ 6.5%). We measured non‐fasting lipids, hsCRP, insulin, adiponectin and leptin. Results: The majority of the sample had an overweight (46.9%) or obesity (27.3%) status. However, there was a relatively low prevalence of pre‐diabetes (9.8%) and diabetes (6.9%). Overweight and obesity status were not associated with lower HDL and adiponectin and higher insulin, non‐HDL cholesterol and hsCRP as expected in adults without Down syndrome. However, overweight and obesity were strongly associated with higher leptin (P < 0.001). Conclusions: The only metabolic correlate of obesity in middle‐aged adults with Down syndrome was high leptin levels. Our findings are limited by non‐fasting laboratory tests but suggest that middle‐aged adults with Down syndrome do not have the adverse metabolic profile related to obesity found in adults without Down syndrome. [ABSTRACT FROM AUTHOR]

Abstract: Objective: We examined whether motivation and treatment credibility predicted alliance in a 10‐session cognitive behavioral treatment delivered in community clinics for youth anxiety disorders. Method: Ninety‐one clinic‐referred youths (meanage = 11.4 years, standard deviation = 2.1, range 8–15 years, 49.5% boys) with anxiety disorders‐rated treatment motivation at pretreatment and perceived treatment credibility after session 1. Youths and therapists (YT) rated alliance after session 3 (early) and session 7 (late). Hierarchical linear models were applied to examine whether motivation and treatment credibility predicted YT early alliance, YT alliance change, and YT alliance agreement. Results: Motivation predicted high early YT alliance, but not YT alliance change or alliance agreement. Youth‐rated treatment credibility predicted high early youth alliance and high YT positive alliance change, but not early therapist alliance or alliance agreement. Conclusion: Conclusion Efforts to enhance youth motivation and treatment credibility early in treatment could facilitate the formation of a strong YT alliance. [ABSTRACT FROM AUTHOR]

This article presents the results of a case series to assess the feasibility, acceptability, and clinical promise of transcranial Direct Current Stimulation (tDCS) as an augmentation strategy in clinic referred adolescents. Attention Bias Modification Treatment (ABMT) is a computer-based attention-training protocol designed to reduce rapidly deployed attention orienting to threat and thereby reduce anxiety symptom severity. Studies of ABMT reveal overall small to medium effect sizes. Advances in the neural underpinnings of attention to threat and attention-training protocols suggest the potential of tDCS of the dorsolateral prefrontal cortex (dlPFC) as a novel augmentation strategy to enhance ABMT’s efficacy (ABMT + tDCS). However, tDCS has never been tested in a sample of adolescents with anxiety disorders. Six adolescents with a primary anxiety disorder completed all four ABMT + tDCS sessions. Adverse effects were mild and transient. Adolescents and parents independently reported fair to excellent levels of satisfaction. Impairment ratings of the primary anxiety disorder significantly decreased. Further, electrophysiological data recorded via electroencephalography (EEG) suggested decreases in neural resources allocated to threat. These findings support the feasibility, acceptability, and clinical promise of tDCS as an augmentation strategy in adolescents with anxiety disorders, and provide the impetus for further investigation using randomized controlled designs in larger samples.

CYP17 and CYP19 are involved in the peripheral synthesis of estrogens, and polymorphisms in CYP17 and CYP19 have been associated with increased risk of estrogen-related disorders. Women with Down syndrome (DS) have early onset and high risk for Alzheimer's disease (AD). We conducted a prospective community-based cohort study to examine the relationship between SNPs in CYP17 and CYP19 and cumulative incidence of AD, hormone levels and sex hormone binding globulin in women with DS. Two hundred and thirty-five women with DS, 31 to 67 years of age and nondemented at initial examination, were assessed for cognitive and functional abilities, behavioral/psychiatric conditions, and health status at 14-20 month intervals over five assessment cycles. We genotyped these individuals for single-nucleotide polymorphisms (SNPs) in CYP17 and CYP19. Four SNPs in CYP17 were associated with a two and one half-fold increased risk of AD, independent of APOE genotype. Four SNPs in CYP19 were associated with a two-fold increased risk of AD, although three were significant only in those without an APOE ε4 allele. Further, carrying high risk alleles in both CYP17 and CYP19 was associated with an almost four-fold increased risk of AD (OR = 3.8, 95% CI, 1.6-9.5) and elevated sex hormone binding globulin in postmenopausal women. The main effect of the CYP17 and CYP19 variants was to decrease the age at onset. These findings suggest that genes contributing to estrogen bioavailability influence risk of AD in women with DS. [ABSTRACT FROM AUTHOR]

Background: Genetic variants that affect estrogen activity may influence the risk of Alzheimer's disease (AD). Two tightly linked polymorphisms (PvuII and XbaI) in the first intron of estrogen receptor 1 (ESR1), the gene for ER-alpha, have been reported to influence estrogen receptor expression and may influence the risk of AD. Methods: We examined the relation of polymorphisms in ESR1 to the risk of AD in women with Down syndrome. The subjects (181 women with DS, 41-78 years of age) were followed at 14- to 18-month intervals. Information from cognitive assessments, caregiver interviews, medical record reviews and neurological examinations was used to classify dementia. Genomic DNA was genotyped for 5 single-nucleotide polymorphisms in the upstream region and the first exon/intron of the ESR1 gene. Their association with dementia risk was evaluated, adjusting for covariates. Results: Women with at least 1 copy of the C allele at rs2234693 (PvuII) and those homozygous for the C allele at rs2077647 had an almost 3-fold increase in the risk of AD, compared with women without the C allele. The increased risks were independent of the apolipoprotein E genotype. Conclusion: These findings support a role for estrogen receptor activity in the development of AD in women with Down syndrome. [ABSTRACT FROM AUTHOR]

This study examined the role of anxiety sensitivity (the fear of anxiety symptoms because such symptoms are believed to have harmful consequences), anxiety, and depression in older adults and their relation to hypochondriacal concerns and medical illnesses. The sample included 53 clinic-referred (M age = 78.8 years), and 53 non-clinic referred (M age = 70.9 years) older adults. It was examined whether (1) anxiety sensitivity was elevated in the clinic-referred group relative to the non-referred group, (2) symptoms of anxiety, anxiety sensitivity and depression were related to number of medical illnesses and/or to hypochondriacal concerns, and (3) anxiety sensitivity was a better predictor of hypochondriacal concerns relative to depression or trait anxiety. The results indicated that anxiety sensitivity was significantly elevated in the clinic-referred group relative to the non-clinic referred group, was negatively associated with history of medical illnesses, was strongly associated with hypochondriacal concerns, and was a better predictor of hypochondriacal concerns than depression and trait anxiety. The findings are discussed in terms of problems facing older adults as they relate to the constructs of anxiety sensitivity and hypochondriacal concerns. [ABSTRACT FROM AUTHOR]

To date, when using the Milwaukee classification for sphincter of Oddi dysfunction (SOD), one cannot accurately classify patients with marginal elevations in laboratory tests; ie, < 1.5 x the upper limit of normal (ULN). Since subsequent treatment may depend on how they are classified, we sought to determine whether these patients should be considered as type II or type III. Between January 1993 and October 1996, 113 consecutive patients (82 females and 31 males; ages 12-87 years) without prior sphincterotomy were referred to consider a diagnosis of SOD type II or III. SOD II patients had pancreaticobiliary-type pain and laboratory elevations >1.5 x ULN or dilated ducts, while SOD III patients had pain only. Hybrid patients had pain and marginal laboratory elevations <1.5 x ULN, with normal duct diameters. Drainage times, frequency, duration, and propagation were not assessed. Sphincter of Oddi manometry (SOM) was performed in each case, and the frequency of abnormal biliary and/or pancreatic basal sphincter pressure was compared, with respect to type II, III, and hybrid SOD. Successful SOM was obtained in 113/114 patients: Abnormal basal sphincter pressure was found in 65, 89, and 43% of type II, hybrid, and type III SOD, respectively. We found no statistical difference between type II and hybrid patients. In contrast, there was statistical difference between types II and III patients and between type III and hybrid patients. In conclusion, there was no significant difference in the frequency of elevated basal sphincter pressure in SOD type II versus hybrid, and thus they should be considered as one group. [ABSTRACT FROM AUTHOR]

This study examined worry and the parameters of worry that may be associated with clinical anxiety in a sample of 119 children and adolescents referred to a childhood anxiety disorders specialty clinic. Using an interviewing procedure, results indicated that the types of worries reported by the children were similar to those reported in previous studies of nonreferred community children. Also similar to previous community studies were findings showing moderate but significant correlations between different indices of worry (i.e., number, intensity, and frequency of the worries) and children's scores on self-rating scales of anxiety. Results further indicated that worry contributed additional variance beyond that of anxiety in predicting fear. In addition, intensity differentiated clinic children's worries from nonreferred children's. Intensity and number of worries differentiated subsamples of children within the clinic-referred sample (i.e., children with overanxious disorder or generalized anxiety disorder and children with simple phobia). The importance of examining children's worries to further understand anxiety and its disorders in youth is discussed. [ABSTRACT FROM AUTHOR]

Focuses on the issues related to pediatrics and perinatal in the U.S. Improvement of fluid retention; Use of saline solution; Treatment of traumatic and burn shock.

Unrelated donor marrow transplantation is associated with an increased incidence of graft-versus-host disease (GVHD) compared with sibling donor transplants. Forty-one patients undergoing unrelated donor transplants were treated with a GVHD prophylaxis regimen that consisted of continuous infusion cyclosporine from day -1 to 100 days post transplant along with nifedipine, glucocorticoids and short-course methotrexate. The regimen was well-tolerated in this cohort with mostly high risk disease. Fifty-one percent of patients developed acute GVHD, which was grade III–IV in 22% of patients. Six of 22 patients at risk for chronic GVHD developed extensive chronic GVHD, five of whom were adults. In patients <18 years of age, there was a >40% chance of 2 year disease-free survival. Use of continuous infusion cyclosporine with nifedipine as an immunosuppressant and protectant against cyclosporine-induced toxicities in unrelated donor transplants is well-tolerated, and results in acute GVHD incidence favorable to that reported with bolus cyclosporine. [ABSTRACT FROM AUTHOR]

Jaundice in hepatocellular carcinoma (HCC) can be due to biliary obstruction. Endoscopic retrograde cholangiopancreatography (ERCP) can be both diagnostic and therapeutic. Biliary stenting can relieve jaundice and allow further chemotherapy, but at additional expense and potential morbidity. We sought to determine whether CT scan or ultrasound (US) could identify which patients with HCC and jaundice would benefit from endoscopic stenting. We retrospectively analyzed 26 patients with HCC and jaundice who underwent ERCP after CT or US. We compared biliary dilation on CT or US with the dominant biliary stricture seen on ERCP, and with response to biliary stenting. Eleven of 26 patients had dominant biliary stricture on ERCP; 11 underwent stenting. Six of 11 (55%) stented patients had a significant decline in bilirubin; three became eligible for further chemotherapy. All six responders to stenting had biliary dilation on prior CT or US. Procedure-related complications occurred in 1/11 (9%) who underwent stent placement. In conclusion, in selected patients, stenting can safely relieve jaundice and allow subsequent chemotherapy. CT or US accurately predicted lesions that responded to stenting. ERCP and stenting provided no benefit in the absence of biliary dilation on CT or US. [ABSTRACT FROM AUTHOR]

Eight adult male stutterers with Down's syndrome (DS) were compared with a matched group of fluent speakers with DS on verbal and manual motor production tasks at two levels of complexity. The simpler tasks involved diadochokinetic rate (syllable repetition) and finger tapping; the more complex tasks involved the imitation of sentences and placing pegs in the grooved pegboard. On both verbal and manual tasks, stutterers were faster on the simpler but slower on the more complex tasks than were the fluent speakers. The findings suggest that stutterers with DS have a different motor organization than fluent speakers with DS. [ABSTRACT FROM AUTHOR]

The relationship between speech dysfluency and manual lateralization was studied in 31 adults with Down's syndrome. Analysis of speech samples from videotapes indicated that frequency of dysfluency ranged from normal to very severe; 42% of the subjects were stutterers. Manual lateralization was measured by the demonstrated use of five objects (pencil, comb, toothbrush, ball and scissors); 61% of the subjects had a clear right-hand preference, 13% a left-hand preference, and the remaining subjects (39%) were mixed-handed. Increased dysfluency was associated with increased non-right-handedness, and this finding could not be explained by reference to either generalized linguistic or intellectual deficits. Results suggest individual variation in the speech motor control system in adults with Down's syndrome which may be associated with anomalous cerebral dominance. [ABSTRACT FROM AUTHOR]

Until about thirty years ago, the extent of disclosure about and consent-seeking for medical interventions was influenced by a beneficence model of professional behaviour. Informed consent shifted attention to a duty to respect the autonomy of patients. The new requirement arrived on the American scene in two separate contexts: for daily practice in 1957, and for clinical study in 1966. A confusing double standard has been established. 'Daily consent' is reviewed, if at all, only in retrospect. Doctors are merely exhorted to obtain informed consent; they often minimise uncertainties about 'best' treatment and they feel duty-bound to provide patients with an unequivocal recommendation for action. 'Study consent' in a clinical trial is reviewed prospectively, and doctors are compelled by regulation to point out that there is insufficient evidence to make a rational choice between two compared treatments. It has been impossible to devise informed consent practices that satisfy, in full, the competing moral imperatives of respect for autonomy, concern for beneficence with emphasis on the value of health, and a vigil for justice. A way must be found to experiment with various discretionary approaches that would strike a realistic balance among competing interests. [ABSTRACT FROM PUBLISHER]

Discusses Alzheimer's disease (AD) in old age and its consequences for affected adults with mental retardation. Clinical characteristics of AD; Significance of differential diagnosis; Literature review of AD neuropathology in groups of mentally retarded adults without Down's syndrome.

Mildly and moderately mentally retarded adults, who live in the community, were examined for global changes in mental status and specific changes in auditory and visual memory over a period of 3-5 years. Twenty-eight subjects with Down's syndrome (DS) between the ages of 27 and 55 years were compared to 18 subjects without DS who were of similar IQ and age. The evaluation of mental status consisted of testing orientation to person, place and time, object naming, visuomotor coordination, and concentration. Auditory memory was tested with an adapted version of the Buschke Memory test. Visual memory testing consisted of matching shapes which were presented simultaneously and after delays of 0, 5 and 10s on a computer-controlled screen. No changes were found in test scores between an initial testing and follow-up testing up to 5 years later, indicating that ageing processes were not having a major impact in the cognitive functioning of these subjects. Furthermore, there was no indication of any generalized decline in performance suggestive of early symptoms of dementia among the older subjects with DS. [ABSTRACT FROM AUTHOR]

Investigated the psychometric properties of the Social Anxiety Scale for children-Revised (SASC-R) as well as relations between social anxiety and children's social and emotional functioning. Participants were a clinic sample of children, ages 6-11 with anxiety disorders (N = 154) who completed the SASC-R. For a subset of these children, parent ratings of social skills, and self-ratings of perceived competence and peer interactions were also obtained. Factor analysis of the SASC-R supported the original three-factor solution and internal consistencies were in the acceptable range. Among children with simple phobia, scores on the SASC-R differentiated those with and without a comorbid social-based anxiety disorder. Social anxiety was also associated with impairments in social and emotional functioning. Specifically, highly socially anxious children reported low levels of social acceptance and global self-esteem and more negative peer interactions. Girls with high levels of social anxiety were also rated by parents as having poor social skills, particularly in the areas of assertive and responsible social behavior. [ABSTRACT FROM AUTHOR]

A recent settlement of a trademark dispute between various importers and marketers of rooibos tea and Virginia Burke-Watkins and her company Burke International of Dallas, Texas, provides a persuasive illustration of the importance of the trademark selection process and the pitfalls of attempting to proprietize the recognized common name for an herb in inter-national commerce. Burke International and its principal owner, Ms. Virginia Burke Watkins, acquired the trademark 'rooibos' from Forever Young Ltd., a company in South Africa that had registered the mark in 1994 with the United States Patent and Trademark Office (USPTO) in connection with, among other things, herbal teas. In June 2005, after losing a lawsuit with Republic of Teal and after mounting legal costs and several additional pending lawsuits, Burke Watkins agreed to voluntarily surrender her rights to the trademark. [ABSTRACT FROM AUTHOR]

Comments on the mass resuscitation of people who have stopped breathing during the 1953 polio epidemic in Denmark. Postponement of death by the practice of artificial ventilation; Reduction of the adverse symptoms by varying the rate of bag compression; Use of technology to develop effective respirators.

Medicine pays almost exclusive homage to the shock of the new. We place a constant emphasis on novelty. We trumpet the most recent discoveries and give far too little attention to the concepts underlying our accumulated knowledge. Ours is an era of the instantaneous and immediate fact, a time when traditions are dissolving and the perceived need for a dialogue with the past is all but invisible. Richard Horton1. [ABSTRACT FROM AUTHOR]