Rate of head growth decelerates and symptoms worsen in the second year of life in autism.

BACKGROUND: Longitudinal studies of head circumference growth in infants later diagnosed with autism are needed to understand the accelerated head growth in this disorder. METHODS: We analyzed longitudinal head circumference data from birth to 3 years in 28 children later diagnosed with autism spectrum disorder on the basis of individual growth curve analyses using hierarchical linear models. RESULTS: Head circumference Z scores relative to norms significantly increased in the autism sample from birth to 12 months, but this pattern did not persist beyond 12 months. Rather, the rate of change in head circumference from 12 to 36 months was not different from the normative sample. CONCLUSIONS: These results suggest that a period of exceptionally rapid head growth occurs during the first year of life in autism; after 12 months of age, the rate of head circumference growth decelerates relative to the rate during the first year of life. Studies of behavioral development in infants later diagnosed with autism suggest that the period of acceleration of head growth precedes and overlaps with the onset of behavioral symptoms, and the period of deceleration coincides with a period of worsening of symptoms in the second year of life.

Rate of head circumference growth as a function of autism diagnosis and history of autistic regression.

Several reports indicate that autism spectrum disorder is associated with increased rate of head growth in early childhood. Increased rate of growth may index aberrant processes during early development, may precede the onset of symptoms, and may predict severity of the disease course. We examined rate of change in occipitofrontal circumference measurements (abstracted from medical records) in 28 boys with autism spectrum disorder and in 8 boys with developmental delay without autism from birth to age 36 months. Only children who had more than 3 occipitofrontal circumference measurements available during this age period were included. All data were converted to z scores based on the Centers for Disease Control and Prevention norms. Rate of growth from birth to age 36 months was statistically significantly higher for the autism spectrum disorder group than the developmental delay group, with children with autism spectrum disorder showing a statistically significant increase in occipitofrontal circumference relative to norms between 7 and 10 months; this group difference in rate of growth was more robust when height was used as a covariate. Rate of growth was not found to be different for children with autism spectrum disorder whose parents reported a history of loss of skills (regression) vs those whose parents reported early onset of autism symptoms. Findings from this study suggest that the aberrant growth is present in the first year of life and precedes the onset and diagnosis in children with autism spectrum disorder with and without a history of autistic regression.

Sex Differences and Bone Metastases of Breast, Lung, and Prostate Cancers: Do Bone Homing Cancers Favor Feminized Bone Marrow?

Sex-associated differences in bone metastasis formation from breast, lung, and prostate cancer exist in clinical studies, but have not been systematically reviewed. Differences in the bone marrow niche can be attributed to sexual dimorphism, to genetic variations that affect sex hormone levels, or to the direct effects of sex hormones, natural or exogenously delivered. This review describes the present understanding of sex-associated and sex hormone level differences in the marrow niche and in formation of bone metastasis during the transition of these three cancers from treatable disease to an often untreatable, lethal metastatic one. Our purpose is to provide insight into some underlying molecular mechanisms for hormonal influence in bone metastasis formation, and to the potential influence of sexual dimorphism, genetic differences affecting sex assignment, and sex hormone level differences on the bone niche and its favorability for metastasis formation. We reviewed publications in PubMed and EMBASE, including full length manuscripts, case reports, and clinical studies of relevance to our topic. We focused on bone metastasis formation in breast, lung, and prostate cancer because all three commonly present with bone metastases. Several clear observations emerged. For breast cancer bone metastasis formation, estrogen receptor (ER) signaling pathways indicate a role for ER beta (ERß). Estrogen influences the bone microenvironment, creating and conditioning a favorable niche for colonization and breast cancer progression. For lung cancer, studies support the hypothesis that females have a more favorable bone microenvironment for metastasis formation. For prostate cancer, a decrease in the relative androgen to estrogen balance or a "feminization" of bone marrow favors bone metastasis formation, with a potentially important role for ERß that may be similar to that in breast cancer. Long-term estrogen administration or androgen blockade in males may feminize the bone marrow niche to one more favorable for bone metastases in prostate cancer. Administration of androgens in females, especially combined with mastectomy, may reduce risk of developing bone metastatic breast cancer. We conclude that it should be considered that females, those with female-leaning genetic variations, or hormonal states that feminize the bone marrow, may offer favorable sites for bone metastases.

Safety and Efficacy of Mobility Interventions in Patients with Femoral Catheters in the ICU: A Prospective Observational Study.

INTRODUCTION: There are limited data describing mobility interventions provided to patients with femoral catheters. The purpose of this study was to examine the incidence of femoral catheter related adverse effects during physical therapy (PT) sessions in a cardiovascular intensive care unit (ICU). METHODS: This was a prospective, observational study and included patients with at least one femoral catheter. Data were collected after each PT session. RESULTS: There were 77 subjects with a total of 92 femoral catheters (50 arterial, 15 central venous, and 27 dialysis) treated. A total of 210 separate PT sessions occurred with 630 mobility activities including sitting on side of bed, standing at the bedside, transfers to stretcher chair or regular chair, and walking. There were no catheter related mechanical or thrombotic complications during any of the PT sessions. CONCLUSIONS: Physical therapy sessions, including standing and walking were feasible and safe in cardiovascular ICU patients with femoral catheters who met the criteria for mobility interventions. The results from this study support the hypothesis that early mobilization in patients with femoral catheters is important to minimize functional decline and provide evidence that the presence of femoral catheters alone should not be a reason to limit progressive mobility interventions.

Sensory processing, problem behavior, adaptive behavior, and cognition in preschool children with autism spectrum disorders.

OBJECTIVE. This retrospective study explored sensory processing characteristics in preschool-age children with autism spectrum disorders (ASD); the relationships between sensory processing and problem behavior, adaptive behavior, and cognitive function; and the differences in sensory processing between two subgroups (autism and pervasive developmental disorder-not otherwise specified). METHOD. Study measures included the Short Sensory Profile (SSP), Aberrant Behavior Checklist-Community, Vineland Adaptive Behavior Scales, and Mullen Scales of Early Learning. RESULTS. Most of the children with ASD had sensory processing challenges, and a significant relationship was found between SSP total scores and problem behavior scores; however, no significant relationships were found between SSP total scores and adaptive behavior and cognitive functioning. Although all the children had low Vineland scores, approximately one-quarter of the children had typical SSP scores. No significant differences in SSP scores were found between the subgroups. CONCLUSION. The findings highlight the importance of comprehensive evaluations for children with ASD.