Maternal autoantibodies are associated with abnormal brain enlargement in a subgroup of children with autism spectrum disorder

Autism spectrum disorder (ASD) is very heterogeneous and multiple subtypes and etiologies likely exist. The maternal immune system has been implicated in the pathogenesis of some forms of ASD. Previous studies have identified the presence of specific maternal IgG autoantibodies with reactivity to fetal brain proteins at 37 and 73kDa in up to 12% of mothers of children with ASD. The current study evaluates the presence of these autoantibodies in an independent cohort of mothers of 181 preschool-aged male children (131 ASD, 50 typically developing (TD) controls). We also investigated whether ASD children born to mothers with these autism-specific maternal IgG autoantibodies exhibit a distinct neural phenotype by evaluating total brain volume using structural magnetic resonance imaging (MRI). Of the 131 ASD children, 10 (7.6%) were born to mothers with the 37/73kDa IgG autoantibodies (ASD-IgG). The mothers of the remaining ASD children and all TD controls were negative for these paired autoantibodies. While both ASD groups exhibited abnormal brain enlargement that is commonly observed in this age range, the ASD-IgG group exhibited a more extreme 12.1% abnormal brain enlargement relative to the TD controls. In contrast, the remaining ASD children exhibited a smaller 4.4% abnormal brain enlargement relative to TD controls. Lobar and tissue type analyses revealed that the frontal lobe is selectively enlarged in the ASD-IgG group and that both gray and white matter are similarly affected. These results suggest that maternal autoantibodies associated with autism spectrum disorder may impact brain development leading to abnormal enlargement.

Control of Rheological Behaviour with Oppositely Charged Polyelectrolyte Surfactant Mixtures

Mixtures of the cationic, cellulose based polyelectrolyte JR 400 and the anionic surfactant sodium dodecylbenzene sulfonate (LAS) have been used to control the rheological behaviour of aqueous solutions. Around charge equilibrium precipitation takes place, but both for the surfactant-rich and the polymer-rich side homogeneous solutions are formed. In these monophasic regions the rheology depends strongly on the mixing ratio between the two components and highly viscous systems can be obtained on the polyelectrolyte rich side upon the addition of relatively small amounts of surfactant. Here the viscosity increases by more than four orders of magnitude before reaching the phase boundary of precipitation. Small-angle neutron scattering (SANS) showed the formation of an interconnected network of rodlike aggregates composed of a polyelectrolyte/surfactant complex, which explains the observed high viscosity due to the high degree of interconnection by the polyelectrolyte.

Nonlinear behavior of nematic platelet dispersions in shear flow

Dispersions of platelets in the nematic phase are submitted to large amplitude oscillatory shear flow and probed by high temporal resolution small angle x-ray scattering. The response displays rich dynamic and structural behavior. Under small amplitude deformations we observe an elastic response, while structurally symmetry is broken: a preferential direction of deformation is selected which induces off-plane orientation of the platelets. We associate the elastic responses with the tilting director of the platelets towards the flow direction at all strain amplitudes. At large strain amplitudes there is a yielding transition between elastic and plastic deformation, accompanied by a flipping of the director. At intermediate strain amplitudes the director has a rich dynamic behavior, illustrating the complex motion of platelets in shear flow. These observations are confirmed by steady-shear flow reversal experiments, which underline the unique character of sheared nematic platelet dispersions.

Is there a need for early post-operative x-rays in primary total knee replacements? Experience of a centre in the UK

INTRODUCTION

Early post-operative x-rays are often taken in total knee replacements (TKRs). Patient mobilisation may be delayed until these x-rays are obtained and this may prolong discharge. The aim of this study was to assess the value of such early x-rays and whether they influenced the early post-operative management of these patients.

METHODS

A total of 624 consecutive TKRs performed at the Blackpool Victoria Hospital over a 34-month period were evaluated. Plain anteroposterior and lateral x-rays were examined.

RESULTS

Two patients were found to have significant abnormalities: an undisplaced periprosthetic tibial fracture and a partial inferior pole patellar avulsion. Neither of these required further treatment or influenced mobility. No other complications were noted that changed routine post-operative management.

CONCLUSIONS

These results question the need for immediate x-rays in primary TKRs.

Increased rate of amygdala growth in children aged 2 to 4 years with autism spectrum disorders: a longitudinal study

CONTEXT

Precocious amygdala enlargement is commonly observed in young children with autism. However, the age at which abnormal amygdala enlargement begins and the relative growth trajectories of the amygdala and total brain remain unclear.

OBJECTIVE

To determine whether the rate of amygdala growth is abnormal and disproportionate to total brain growth in very young children with autism spectrum disorders (ASDs).

DESIGN

Longitudinal structural magnetic resonance imaging study.

SETTING

Neuroimaging and diagnostic assessments were performed at an academic medical center. Participants were recruited from the community.

PARTICIPANTS

Baseline scans were acquired in 132 boys (85 with ASD and 47 control subjects with typical development [TD]; mean age, 37 months). Longitudinal magnetic resonance images were acquired in 70 participants (45 with ASD and 25 TD controls) 1 year later.

MAIN OUTCOME MEASURE

Amygdala volumes and total cerebral volumes (TCVs) were evaluated at both time points, and 1-year growth rates were calculated.

RESULTS

The amygdala was larger in children with ASD at both time points, but the magnitude of enlargement was greater at time 2. The TCV was also enlarged in the children with ASD by the same magnitude at both time points. When we controlled for TCV, amygdala enlargement remained significant at both time points. The rate of amygdala growth during this 1-year interval was faster in children with ASD than in TD controls. The rate of TCV growth did not differ between groups. Post hoc exploratory analyses revealed 3 patterns of amygdala and TCV growth rates in the ASD group.

CONCLUSIONS

Disproportionate amygdala enlargement is present by 37 months of age in ASD. The amygdala continues to grow at an increased rate, but substantial heterogeneity exists in amygdala and TCV growth patterns. Future studies aimed at clinical characterization of different growth patterns could have implications for choice and outcomes of treatment and behavioral therapy.

Alcohol misuse in patients with psoriasis: identification and relationship to disease severity and psychological distress

BACKGROUND

Moderate to severe psoriasis is associated with increased alcohol intake and excessive mortality from alcohol-related causes. Alcohol biomarkers provide an objective measure of alcohol consumption. Carbohydrate-deficient transferrin (CDT) is the single most sensitive and specific alcohol biomarker.

OBJECTIVES

To assess alcohol consumption in a cohort of patients with moderate to severe psoriasis using standard alcohol screening questionnaires and biomarkers. We investigated whether there was an association between alcohol intake, anxiety, depression and disease severity.

METHODS

Consecutive patients with chronic plaque psoriasis were recruited and completed a range of anonymized assessments. Psoriasis severity, anxiety and depression, and the impact of psoriasis on quality of life were assessed. Alcohol screening questionnaires were administered. Blood specimens were taken and γ-glutamyltransferase (γGT) and CDT were measured.

RESULTS

A total of 135 patients completed the study. Using validated questionnaires, between 22% and 32% had difficulties with alcohol. Seven per cent had CDT > 1·6% indicating a heavy alcohol intake. The Alcohol Use Disorders Identification Test (AUDIT) questionnaire was superior to other validated questionnaires in detecting alcohol misuse. There were no significant associations between measures of excessive alcohol consumption and disease severity. Excessive alcohol intake as measured by the CAGE questionnaire was associated with increased depression (P = 0·001) but other measures of alcohol excess did not correlate with psychological distress. Men had significantly more difficulties with alcohol than women (P < 0·001).

CONCLUSION

Alcohol misuse is common in patients with moderate to severe psoriasis. Screening with the AUDIT questionnaire and CDT may allow the identification of patients who are misusing alcohol and allow appropriate intervention.