Does the Relationship between Age and Brain Structure Differ in Youth with Conduct Disorder?

Conduct disorder (CD) is characterised by persistent antisocial and aggressive behaviour and typically emerges in childhood or adolescence. Although several authors have proposed that CD is a neurodevelopmental disorder, very little evidence is available about brain development in this condition. Structural brain alterations have been observed in CD, and some indirect evidence for delayed brain maturation has been reported. However, no detailed analysis of age-related changes in brain structure in youth with CD has been conducted. Using cross-sectional MRI data, this study aimed to explore differences in brain maturation in youth with CD versus healthy controls to provide further understanding of the neurodevelopmental processes underlying CD. 291 CD cases (153 males) and 379 healthy controls (160 males) aged 9-18 years (Mage = 14.4) were selected from the European multisite FemNAT-CD study. Structural MRI scans were analysed using surface-based morphometry followed by application of the ENIGMA quality control protocols. An atlas-based approach was used to investigate group differences and test for group-by-age and group-by-age-by-sex interactions in cortical thickness, surface area and subcortical volumes. Relative to healthy controls, the CD group showed lower surface area across frontal, temporal and parietal regions as well as lower total surface area. No significant group-by-age or group-by-age-by-sex interactions were observed on any brain structure measure. These findings suggest that CD is associated with lower surface area across multiple cortical regions, but do not support the idea that CD is associated with delayed brain maturation, at least within the age bracket considered here.

Standardizing the influenza neuraminidase inhibition assay among United States public health laboratories conducting virological surveillance

BACKGROUND

Monitoring influenza virus susceptibility to neuraminidase (NA) inhibitors (NAIs) is vital for detecting drug-resistant variants, and is primarily assessed using NA inhibition (NI) assays, supplemented by NA sequence analysis. However, differences in NI testing methodologies between surveillance laboratories results in variability of 50% inhibitory concentration (IC50) values, which impacts data sharing, reporting and interpretation. In 2011, the Centers for Disease Control and Prevention (CDC), in collaboration with the Association for Public Health Laboratories (APHL) spearheaded efforts to standardize fluorescence-based NI assay testing in the United States (U.S.), with the goal of achieving consistency of IC50 data.

METHODS

For the standardization process, three participating state public health laboratories (PHLs), designated as National Surveillance Reference Centers for Influenza (NSRC-Is), assessed the NAI susceptibility of the 2011-12 CDC reference virus panel using stepwise procedures, with support from the CDC reference laboratory. Next, the NSRC-Is assessed the NAI susceptibility of season 2011-12 U.S. influenza surveillance isolates (n = 940), with a large subset (n = 742) tested in parallel by CDC. Subsequently, U.S. influenza surveillance isolates (n = 9629) circulating during the next three influenza seasons (2012-15), were independently tested by the three NSRC-Is (n = 7331) and CDC (n = 2298).

RESULTS

The NI assay IC50s generated by respective NSRC-Is using viruses and drugs prepared by CDC were similar to those obtained with viruses and drugs prepared in-house, and were uniform between laboratories. IC50s for U.S. surveillance isolates tested during four consecutive influenza seasons (2011-15) were consistent from season to season, within and between laboratories.

CONCLUSION

These results show that the NI assay is robust enough to be standardized, marking the first time IC50 data have been normalized across multiple laboratories, and used for U.S. national NAI susceptibility surveillance.

Phaeochromocytoma in pregnancy

The Royal Women's Hospital, Melbourne, is a tertiary referral hospital with over 7,000 deliveries per year. We report 3 cases of phaeochromocytoma in pregnancy at the hospital in the 20-year period since 1976. The first case was unsuspected and resulted in a maternal death. The subsequent 2 cases were diagnosed antenatally with successful outcomes for both mother and baby. The 3 cases demonstrate the importance of an early antenatal diagnosis and the special management problems of phaeochromocytoma in pregnancy. The diagnosis of phaeochromocytoma should be considered in any pregnant women with severe hypertension, particularly if presenting before 20 weeks' gestation, labile, or associated with sweating, palpitations or headaches.

Cardiopulmonary arrest in pregnancy: successful resuscitation of mother and infant following immediate caesarean section in labour ward

Our patient experienced cardiopulmonary arrest secondary to profound hypotension and was unable to be resuscitated with external cardiac massage and assisted ventilation. This case demonstrates the need for continued vigilance by medical and nursing staff when epidural anaesthesia is being established. Resuscitation equipment should be available in the labour ward as cardiopulmonary resuscitation and immediate Caesarean section can be lifesaving in the event of a cardiopulmonary arrest.

Intraoperative patient-controlled analgesia: an alternative to physician administration during outpatient monitored anesthesia care

Outpatients undergoing minor diagnostic and therapeutic procedures associated with intermittent discomfort are frequently given bolus injections of intravenous opioid analgesics. In a group of 80 healthy women undergoing vaginal ovum pickup procedures, we evaluated patient-controlled administration of alfentanil using a patient-controlled analgesia device (with a lockout interval of 3 min) as an alternative to conventional physician-controlled administration. The two alfentanil administration techniques were equally effective in providing intraoperative analgesia. The average alfentanil dosage requirements were 1.49 +/- 0.50 and 1.46 +/- 0.55 micrograms.kg-1.min-1 (mean +/- SD) in the physician- and patient-controlled groups, respectively. The incidence of postoperative nausea was the same in both treatment groups (8%). Even with the mandatory lockout interval, intraoperative patient-controlled administration of alfentanil was comparable to physician-controlled administration with respect to patient comfort and satisfaction during vaginal ovum pickup procedures.

Hexosaminidase A activity and amyotrophic lateral sclerosis

Abnormalities of GM2 ganglioside metabolism owing to hexosaminidase A (Hex A) deficiency have been associated with ALS phenotypes. The clinical features described in these ALS patients with Hex A deficiency include early onset, positive family history, and/or long disease duration. In an attempt to determine prospectively the incidence of Hex A deficiency within an ALS population, the records of The Mount Sinai Medical Center ALS Clinic were reviewed to select those patients with "atypical" ALS (total N = 52), i.e. onset before age 35, positive family history, and/or disease duration greater than 90 months. The control group (total N = 50), "typical" ALS patients, did not fulfill any of these historical criteria. Hex A activity determined in isolated peripheral blood leukocytes was normal in all typical ALS patients (mean 67.3%). Hex A deficiency was not found in any atypical ALS patients. Thus, Hex A deficiency apparently is an unusual etiology of typical or atypical ALS but is of medical and genetic importance in individual families.