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Functional neurological disorder (FND) is a common and disabling disorder, often misunderstood by clinicians. Although viewed sceptically by some, FND is a diagnosis that can be made accurately, based on positive clinical signs, with clinical features that have remained stable for over 100 years. Despite some progress in the last decade, people with FND continue to suffer subtle and overt forms of discrimination by clinicians, researchers and the public. There is abundant evidence that disorders perceived as primarily affecting women are neglected in healthcare and medical research, and the course of FND mirrors this neglect. We outline the reasons why FND is a feminist issue, incorporating historical and contemporary clinical, research and social perspectives. We call for parity for FND in medical education, research and clinical service development so that people affected by FND can receive the care they need.

Functional Neurological Symptom Disorder (FNSD) and Autistic Spectrum Disorders (ASD) are both complex and incompletely understood conditions. This review investigates the literature for evidence of associa- tion between them.A literature search produced nine Resultsthree case reports and six epidemiological studies. The case reports describe the conditions co-occurring, providing anecdotal evidence of an association. Nimmo- Smith and Lever reported 2.5-fold and three-fold higher prevalence of ‘somatoform disorders’ in ASD samples compared to the general population (Lever 2016; Nimmo-Smith 2020). Jester and Schendel published studies which both suggest higher rates of functional symptoms in ASD patients, are limited by methodological issues (Jester 2016; Schendel 2019). Only the study by Roy reported no difference; 8% prevalence compared to 7.5% (Roy 2015). McWilliams et al reported a case series showing a much higher rate of ASDs in 59 young people with non-epileptic seizures; 16.9%, compared to 1.3–1.5% in the general population (McWilliam 2019).The range of terminology and methodology used makes integrating the results difficult, but overall there is evidence of an association between ASD and FNSD. Potential mechanisms linking the two such as emotional dysregulation and alexithymia are highlighted, as well as brain regions including the amygdala and anterior cingulate cortex (ACC).jacob.john.roelofs@gmail.com

Two basalts with compositions relevant to the crusts of Mars and Earth were synthesized at igneous temperatures and held at 650°C for 21 to 257 days under quartz‐fayalite‐magnetite fO2buffer conditions. The run products are germane to slowly cooled igneous intrusions, which might be a significant volumetric fraction of the Martian crust and carriers of magnetic anomalies in the Southern Highlands. Both basalts acquired intense thermoremanent magnetizations and intense but easily demagnetized anhysteretic remanent magnetizations carried by homogeneous multidomain titanomagnetite. Hypothetical intrusions on Mars composed of these materials would be capable of acquiring intense remanences sufficient to generate the observed anomalies. However, the remanence would be easily demagnetized by impact events after the cessation of the Mars geodynamo. Coercivity enhancement by pressure or formation of single domain regions via exsolution within the multidomain grains is necessary for long‐term retention of a remanence carried exclusively by multidomain titanomagnetite grains. Fe‐rich basalts are viable carriers of Mars magnetic anomaliesFe‐rich basalts containing multidomain Fe‐Ti oxides acquire intense NRM and ARMNRM preservation requires pressure effects or exsolution to increase coercivity

A systematic study of the Raman spectra of the titanomagnetite solid-solution series (Fe3-xTixO4) for x = ~0.0, 0.2, 0.4, and 0.6 has been conducted. The samples showed combinations of five previously predicted Raman peaks at ~190, 310, 460, 540, and 670 cm-1that correspond to vibrational modes with T2g(1), Eg, T2g(3), T2g(2), and A1g, respectively. The calibration of Raman spectra for titanomagnetite with known values of Ti concentrations reveals a strong dependence of relative intensity for the T2g(2) and T2g(3) modes on Ti concentration. The most prominent feature is the appearance and increase in the relative intensity of a T2g(3) peak above x = ~0.2. On the other hand, the Raman peak for the T2g(2) mode gradually diminishes as Ti increases and nearly disappears at x = ~0.6. Combining the two relative intensities potentially provides a sensitive indicator of Ti content. The technique was applied to study titanomagnetite in grains from Hana Volcanics and melatroctolite from Rhode Island.

Infections of the thyroid are quite rare but may be life threatening. Thyroid abscess resulting from acute suppurative thyroiditis is a rare clinical entity. The infection may engage one or both lobes, and abscess formation may not be evident until late in the course of the disease. We report a case of a woman who presented with acute thyroiditis and eventually developed thyroid abscess. The causal organism was found to be Brucella melitensis. Antibiotic treatment and removal of the abscess led to an uneventful recovery.

IntroductionFunctional Neurological Disorder (FND) is common and can lead to multiple emergency department (ED) presentations and unnecessary investigation. Early identification and intervention have been shown to reduce health care costs and re-presentation to acute services by more than 50%1.We created a pilot model to provide early access to a multi-disciplinary FND team for patients assessed by the ED-embedded neurology team (Stroke or Neurology SDEC pathway) to have a new diagnosis of FND. The MDT provided patients with individualised information about FND, pathway navigation, and shown self-management tools.MethodsWe reviewed data for all patients seen to date by the pilot service.ResultsSince commencement in November 2021, nine patients have been seen by the MDT. All patients were seen within two weeks by a neurophysiotherapist and neuropsychiatrist with neurology support.6 were female and median age was 41 years. All presented with limb weakness and/or sensory distur- bance. 7 reported prior anxiety or depression. 6 had psychiatric factors, including Emotionally Unstable Personality Disorder and health anxiety. Follow up, 2 of the 9 patients so far demonstrated reduced health anxiety and increased confidence.ConclusionAn acute FND pathway can provide timely intervention and reduce symptoms for new presentations with FND.1. Stepped care for functional neurological disorder, A new approach to improving outcomes for a common neurological problem in Scotland. Report and Recommendations, NHS Improvement, February 2012

IntroductionWhilst higher rates of alexithymia have previously been reported in FNSD, little is known about the prevalence of autistic traits in adults with FNSD. We aim to:Report on the prevalence of autistic traits in an outpatient group of adults diagnosed with FNSD using the Autism Spectrum Quotient (AQ-10)Report on the prevalence of alexithymia using the Toronto Alexithymia Scale (TAS-20)Report on differences in symptom severity of psychiatric comorbidity between those scoring <6 or ≥6 on the AQ-10, and those with or without alexithymiaMethodOut of 105 consecutive patients reviewed in an outpatient FNSD program, 91 completed self-report assessments for autistic traits, alexithymia, generalised anxiety, depression, social phobia, somatic symptom severity, attention deficit hyperactivity disorder (ADHD) and dyslexia. Patients were grouped by AQ-10 scores of <6 or ≥6 and compared for significant differences in tested variables using a Mann-Whitney U test. Kruskal-Wallis H tested differences in alexithymia status. Simple effects were tested using pairwise comparisons.Results40% screened positive on the AQ-10 (scoring ≥6), and 40% screen positive for alexithymia. When comparing those scoring < or ≥6 on the AQ-10, those with the higher number of autistic traits scored significantly higher on scales of alexithymia, depression, generalised anxiety, social phobia,ADHD, and dyslexia. Positive alexithymia status was significantly associated with a higher number of autistic traits as well symptoms of generalised anxiety, depression, somatic symptoms severity, social phobia and dyslexia.ConclusionWhilst higher rates of neurodevelopmental disorders have previously been reported in FNSD, we report new evidence for a high proportion of autistic traits and further evidence of a high prevalence of alexithymia in a group of adults with FNSD.1–10Mechanistic insights are limited however autistic traits may be associated with FNSD due to altered sensitivity to sensory data, as well as cognitive or affective biases, or increased susceptibility to panic. There may be an additional contribution from psychosocial stressors. Clinically, the AQ-10 and TAS-20 may be important tools in the management of FNSD, and a higher prevalence of autistic traits may highlight a need for specialised communication styles in the MDT.11This builds on research exploring the relationship between autistic traits, alexithymia and FNSD. Previous research suggests that alexithymia and altered interoceptive awareness may be modifying factors in the relationship between autistic traits and FNSD,12and further research is required to clarify the nature of these relationships.ReferencesDemartini B, Nisticò V, Goeta D, Tedesco R, Giordano B, Faggioli R, et al. Clinical overlap between functional neurological disorders and autism spectrum disorders: A preliminary study. Journal of the Neurological Sciences2021 Oct;429:117648.Freedman et al. Psychogenic nonepileptic events in pediatric patients with autism.Hatta K, Hosozawa M, Tanaka K, Shimizu T. Exploring traits of autism and their impact on functional disability in children with somatic symptom disorder. Journal of Autism and Developmental Disorders2019 Feb 15;49(2):729–37.Jester KA, Londino DL, Hayman J. 2.68 examining the occurrence of conversion disorder diagnoses and asd among adolescents and young adults in the emergency department. Journal of the American Academy of Child & Adolescent Psychiatry [Internet]. 2019 Oct 1 [cited 2022 Feb 7];58(10):S193. Available from: http://www.jaacap.org/article/S089085671931617X/fulltextMcWilliams A, Reilly C, Gupta J, Hadji-Michael M, Srinivasan R, Heyman I. Autism spectrum disorder in children and young people with non-epileptic seizures. Seizure2019 Dec 1;73:51–5.Miersch et al. A retrospective study of 131 patients with psychogenic non-epileptic seizures (PNES)- Comorbid diagnoses and outcome after inpatient treatment.Nimmo-Smith V, Heuvelman H, Dalman C, Lundberg M, Idring S, Carpenter P, etal. Anxiety disorders in adults with autism spectrum disorder: a population-based study. Journal of Autism and Developmental Disorders. 2020 Jan 1;50(1):308–18.Pun P, Frater J, Broughton M, Dob R, Lehn A. Psychological profiles and clinical clusters of patients diagnosed with functional neurological disorder. Frontiers in Neurology2020 Oct 15;11.Zdankiewicz-Scigała E, Scigała D, Sikora J, Kwaterniak W, Longobardi C. Relationship between interoceptive sensibility and somatoform disorders in adults with autism spectrum traits. The mediating role of alexithymia and emotional dysregulation. PLoS ONE. 2021 Aug 1;16(8 August).Demartini B, Petrochilos P, Ricciardi L, Price G, Edwards MJ, Joyce E. The role of alexithymia in the development of functional motor symptoms (conversion disorder). Journal of Neurology, Neurosurgery & Psychiatry [Internet]. 2014 Oct 1 [cited 2022 Feb 8];85(10):1132–7. Available from: https://jnnp.bmj.com/content/85/10/1132Cooper M, Gale K, Langley K, Broughton T, Massey TH, Hall NJ, et al. Neurological consultation with an autistic patient. Practical Neurology [Internet]. 2021 Oct 8 [cited 2022 Jan 14];practneurol-2020-002856. Available from: https://pn.bmj.com/content/early/2021/10/07/practneurol-2020-002856Shah P, Hall R, Catmur C, Bird G. Alexithymia, not autism, is associated with impaired interoception. Cortex2016 Aug 1;81:215–20.

In recent years, there has been a revival of interest in the contribution of ancient Greek writers to economic thought. The present paper argues that the Hellenic contributions on private ownership of property and atomistic behaviour, division of labour, free foreign trade, value, money, interest, as well as the efficient and effective estate management, leading to wealth creation and growth, compare favourably with our present views on these matters. While their analysis of economic issues has been part of ethics and politics and has lacked an autonomous and systematic treatment of the subject, nevertheless, their teachings have influenced subsequent thinkers, including Adam Smith and in particular Karl Marx, and have been very relevant in the development of economics.

A previously transfused female patient, known to have a platelet defect, was transfused with platelets prior to surgery. After the 18th unit she felt unwell, developed fever, rigor, became nauseous, and vomited. Her blood pressure decreased from 140/90 to 80/50mm Hg. Passive transfer of donor granulocytes or red cell antibodies were excluded as a cause. Therefore, a serum sample from the patient was investigated for the presence of antibodies to human leukocyte antigens (HLA) using a standard National Institutes of Health (NIH) lymphocytotoxicity test, but antibodies were not detected. However, an extended incubation cytotoxicity test demonstrated the presence of an anti-HLA-A2, and indirect immunofluorescence flow cytometry showed the presence of an IgG1 antibody reacting with 50 percent of cells in a random pool of lymphocytes. One week later, multispecific HLA antibodies were detectable by both NIH and extended incubation cytotoxicity tests. Flow cytometry showed a 16-fold increase in the amount of IgG antibodies and the appearance of an IgM component. Such clinically important HLA antibodies can be detected by extended incubation cytotoxicity and flow cytometric assays prior to becoming reactive in a standard NIH cytotoxicity technique.

A family is described showing the association of juvenile diabetes mellitus, optic atrophy, and mild perceptive deafness inherited in an autosomal recessive manner. It is pointed out that concomitant diabetes insipidus has predominantly involved females suffering from this association.

We report the case of a 38-year-old woman who had pulmonary actinomycosis that involved the pleura and the pectoral muscles. The patient was initially treated with intravenous ceftriaxone once a day on an outpatient basis. After 3 weeks of treatment, a computed tomogram showed resolution of the initial findings. This result suggests that ceftriaxone may be an effective and convenient therapeutic agent for the initial parenteral treatment of actinomycosis.