Predictors of Weight Restoration in a Day-Treatment Program that Supports Family-Based Treatment for Adolescents with Anorexia Nervosa.

Family-Based Treatment (FBT) is considered a first-line treatment for adolescents with eating disorders. The traditional outpatient model of FBT may not, however, be appropriate for adolescents requiring more intensive treatment due to severe medical complications or insufficient progress in traditional outpatient FBT. In response, efforts have been made to incorporate FBT into higher levels of care, such as day-treatment programs (DTPs), for families who need additional support. Little is known about the factors that predict weight restoration for DTPs intended to support FBT. The current study examined the ability of specific adolescent and caregiver variables to predict weight restoration at discharge for adolescents with anorexia nervosa (AN) enrolled in a skills-based DTP that supports FBT. Participants were 87 adolescents diagnosed with AN and their caregivers (N = 74). Body Mass Index (BMI) at baseline, percentage of Expected Body Weight (%EBW) gain within the first 4 weeks, and caregiver empowerment level at baseline were found to significantly predict weight restoration. Higher BMI at baseline and higher %EBW gained in the first 4 weeks of treatment were predictive of weight restoration, whereas lower caregiver empowerment at baseline was predictive of weight restoration. Additionally, the rate of weight gain is reported for this DTP grounded in FBT philosophy.

Elevated plasma norepinephrine inhibits insulin secretion, but adrenergic blockade reveals enhanced ß-cell responsiveness in an ovine model of placental insufficiency at 0.7 of gestation.

In pregnancies complicated by placental insufficiency (PI), fetal hypoglycemia and hypoxemia progressively worsen during the third trimester, which increases circulating norepinephrine (NE). Pharmacological adrenergic blockade (ADR-block) at 0.9 gestation revealed that NE inhibits insulin secretion and enhanced ß-cell responsiveness in fetuses with PI-induced intrauterine growth restriction (IUGR). NE concentrations in PI fetuses at 0.7 gestation were threefold greater compared with age-matched controls, but the levels were similar to near-term controls. Therefore, our objective was to determine whether elevations in plasma NE concentrations inhibit insulin secretion and produce compensatory ß-cell responsiveness in PI fetuses at 0.7 gestation. Fetal insulin was measured under basal, glucose-stimulated insulin secretion (GSIS) and glucose-potentiated arginine-stimulated insulin secretion (GPAIS) conditions in the absence and presence of an ADR-block. Placental weights were 38% lower (P < 0.05) in PI fetus than in controls, but fetal weights were not different. PI fetuses had lower (P < 0.05) basal blood oxygen content, plasma glucose, insulin-like growth factor-1 and insulin concentrations and greater plasma NE concentrations (891 ± 211 v. 292 ± 65 pg/ml; P < 0.05) than controls. GSIS was lower in PI fetuses than in controls (0.34 ± 0.03 v. 1.08 ± 0.06 ng/ml; P < 0.05). ADR-block increased GSIS in PI fetuses (1.19 ± 0.11 ng/ml; P < 0.05) but decreased GSIS in controls (0.86 ± 0.02 ng/ml; P < 0.05). Similarly, GPAIS was 44% lower (P < 0.05) in PI fetuses than in controls, and ADR-block increased (P < 0.05) GPAIS in PI fetuses but not in controls. Insulin content per islet was not different between treatments. We conclude that elevations in fetal plasma NE suppress insulin concentrations, and that compensatory ß-cell stimulus-secretion responsiveness is present before IUGR.

Effectiveness and feasibility of a cognitive-behavioral group intervention for body image disturbance in women with eating disorders.

OBJECTIVE: The present study investigated the effectiveness and feasibility of a cognitive-behavioral group intervention for the treatment of body image disturbance in women with eating disorders. METHOD: The study used a multiple-baseline design and enrolled 38 participants with a range of eating disorders. The intervention targeted attitudinal and behavioral components of body image disturbance using psychoeducation, self-monitoring, systematic desensitization, and cognitive restructuring. Primary outcomes included multidimensional body image assessment (effectiveness) and treatment adherence and satisfaction (feasibility). RESULTS: Participants undergoing manualized group treatment reported significantly less body image disturbance than participants randomized to a waitlist control condition. However, differences disappeared after both groups had been through intervention. Participants also reported less depression and eating disorder pathology from baseline to posttreatment, however this difference was not considered statistically significant. Feasibility outcomes suggest the intervention was well received and highly acceptable to participants. CONCLUSIONS: Findings emphasize the importance of adding an evidence-based body image component to standard eating disorder treatment.

Cognitive set-shifting in anorexia nervosa.

OBJECTIVE: Adult anorexia nervosa (AN) is associated with inefficient cognitive flexibility and set-shifting. Whether such inefficiencies also characterize adolescent AN is an important area of research. METHOD: Adolescents with AN and matched controls were administered a computerized task that required initial learning of an explicit rule using corrective feedback and learning of a new rule after a set number of trials. Adult patients with AN and controls were also examined. RESULTS: Adolescents with AN did not differ from matched controls with respect to set-shifting cost (decrease in performance after rule change), whereas adults with AN had significantly greater set-shifting cost compared with controls. DISCUSSION: This study suggests that set-shifting inefficiencies may not be a vulnerability factor for AN development in adolescents with AN, but might become an important aspect of the disorder at later age, and could point towards developmental neurobiologic brain changes that could affect AN at different ages.

Microsatellites behaving badly: empirical evaluation of genotyping errors and subsequent impacts on population studies.

Microsatellites are useful tools for ecological studies because they can be used to discern population structure, dispersal patterns and genetic relationships among individuals. However, they can also yield inaccurate genotypes that, in turn, bias results, promote biological misinterpretations, and create repercussions for population management and conservation programs. We used empirical data from a large-scale microsatellite DNA study of white-tailed deer (Odocoileus virginianus) to identify sources of genotyping error, evaluate corrective measures, and provide recommendations to prevent bias in population studies. We detected unreported mutations that led to erroneous genotypes in five of 13 previously evaluated microsatellites. Of the five problematic markers, two contained mutations that resulted in null alleles, and three contained mutations that resulted in imperfect repeats. These five microsatellites had error rates that were four times greater on average than those observed in the remaining eight. Methodological corrections, such as primer redesign, reduced errors up to 5-fold in two problematic loci, although analytical corrections (computational adjustment for errors) were unable to fully prevent bias and, consequently, measures of genetic differentiation and kinship were negatively impacted. Our results demonstrate the importance of error evaluation during all stages of population studies, and emphasize the need to standardize procedures for microsatellite analyses. This study facilitates the application of microsatellite technology in population studies by examining common sources of genotyping error, identifying unreported problems with microsatellites, and offering solutions to prevent error and bias in population studies.

Trisomic pregnancy and elevated FSH: implications for the oocyte pool hypothesis.

BACKGROUND: Some studies, but not all, support the hypothesis that trisomy frequency is related to the size of the oocyte pool, with the risk increased for women with fewer oocytes (older ovarian age). We tested this hypothesis by comparing hormonal indicators of ovarian age among women who had trisomic pregnancy losses with indicators among women with non-trisomic losses or chromosomally normal births. The three primary indicators of advanced ovarian age were low level of anti-Müllerian hormone (AMH), high level of follicle-stimulating hormone (FSH) and low level of inhibin B. METHODS: The analysis drew on data from two hospital-based case-control studies. Data were analyzed separately and the evidence from the two sites was combined. We compared 159 women with trisomic pregnancy losses to three comparison groups: 60 women with other chromosomally abnormal losses, 79 women with chromosomally normal losses and 344 women with live births (LBs) age-matched to women with losses. We analyzed the hormone measures as continuous and as categorical variables. All analyses adjust for age in single years, day of blood draw, interval in storage and site. RESULTS: AMH and inhibin B did not differ between women with trisomic losses and any of the three comparison groups. Mean ln(FSH) was 0.137 units (95% confidence interval (CI): 0.055, 0.219) higher for trisomy cases compared with LB controls; it was also higher, though not significantly so, for trisomy cases compared with women with other chromosomally abnormal losses or chromosomally normal losses. The adjusted odds ratio in relation to high FSH (≥ 10 mIU/ml) was significantly increased for trisomy cases versus LB controls (adjusted odds ratio (OR): 3.8, 95% CI: 1.6, 8.9). CONCLUSIONS: The association of trisomy with elevated FSH is compatible with the oocyte pool hypothesis, whereas the absence of an association with AMH is not. Alternative interpretations are considered, including the possibility that elevated FSH may disrupt meiotic processes or allow recruitment of abnormal follicles.

Ultrasound-guided fallopian tube cannulation using Albunex.

OBJECTIVE: To test the role of transcervical fallopian tube catheterization under ultrasound (US) guidance using an ultrasound contrast agent. DESIGN: Catheterization was performed under US guidance in a patient with bilateral proximal tubal obstruction. SETTING: This study is a case report. PATIENT(S): Proximal tubal obstruction had been diagnosed on previous roentgenogram hysterosalpingography. INTERVENTION(S): Salpingography and tubal cannulation. MAIN OUTCOME MEASURE(S): Tubal patency was assessed using Albunex (Mallinckrodt Medical, St. Louis, MO) enhanced US. RESULT(S): Transvaginal catheterization was successful in achieving tubal patency. CONCLUSION(S): This catheterization technique should be investigated for possible use in the treatment of proximally obstructed tubes.

A comparison of pain tolerance during X-ray hysterosalpingography and sonohysterosalpingography. Albunex Study Group.

The objective of this study was to determine patient perception of the level of discomfort during sonohysterosalpingography (sono-HSG) compared with standard X-ray hysterosalpingography (HSG). This was a prospective, operator-blinded, multicenter study using both numerical ranking and a visual analog scale to quantify discomfort. Sono-HSG utilizing Albunex was associated with a significantly lower mean intensity of pain than the instillation of X-ray contrast media. Sono-HSG is an alternative to X-ray HSG in the evaluation of the uterus and fallopian tubes and compares favorably with respect to patient discomfort.

Ovarian activity during follicular-phase down regulation in in vitro fertilization is associated with advanced maternal age and a high recurrence rate in subsequent cycles.

PURPOSE: Previous reports have suggested that the ovarian response to leuprolide acetate is predictive of in vitro fertilization pregnancy rates. This study evaluated the outcome of in vitro fertilization cycles complicated by elevated estradiol levels during leuprolide acetate down regulation and the outcome of subsequent cycles in the same patients. METHODS: Two hundred fifty-two in vitro fertilization cycles were initiated utilizing leuprolide acetate down regulation beginning on cycle day 1. RESULTS: Seventy-four of these cycles had an elevated estradiol level at the time of the baseline scan (28%). This group of patients had a higher maternal age, a higher cycle cancellation rate (27.5 vs 16.3%), and a high rate of recurrence on subsequent cycles (63%). CONCLUSIONS: The pregnancy rate per retrieval was equivalent in the two groups. This suggests that patients with advanced maternal age or a history of failure to suppress in a previous cycle may benefit from alternate regimens of superovulation.

Estrogens and Parkinson's disease.

There is substantial evidence that estrogens modulate the activity of dopamine in the extrapyramidal system. However, there is conflicting data as to the exact mechanism of estrogen's effects. The majority of clinical reports support an antidopaminergic effect of estrogens on Parkinsonian symptoms. Generally, Parkinsonism worsens with estrogen therapy. We report a case of improvement in Parkinsonian symptoms in a premenopausal patient when placed on leuprolide acetate. The pharmacologic menopause induced by leuprolide acetate leads to a hypoestrogenic state. We hypothesize that the decrease in estrogen improves Parkinson's disease symptoms via the relief of its antidopaminergic effects on the nigrostriatal pathway.

Current concepts in estrogen replacement therapy in the menopause.

OBJECTIVE: To provide a review of the risks and benefits of hormonal replacement therapy in the menopause, including new therapeutic regimens and modes of delivery. DESIGN: A review of the literature to identify published studies was accomplished using a computerized bibliographical search (Medline). RESULTS: Replacement therapy is effective in treating symptoms of estrogen deficiency and in lowering the risk of osteoporosis and cardiovascular disease. The daily administration of an estrogen and progestin eliminates the withdrawal bleed and increases patient compliance. This continuous form of therapy also consistently suppresses the endometrium, decreasing the risk of hyperplasia. More studies investigating the effect of continuous therapy on the lipid profile and cardiovascular disease are needed. CONCLUSIONS: New therapeutic regimens and modes of delivery decrease risk and increase patient acceptance of hormonal replacement therapy.

Gonadotropin-releasing hormone and chorionic gonadotropin gene expression in human placental development.

Control of human chorionic gonadotropin (hCG) synthesis during pregnancy is poorly understood, although in vitro data suggest a role for placental gonadotropin releasing hormone (GnRH) in its regulation. To study GnRH regulation during placental development, placental tissue of different gestational ages was analyzed for GnRH and beta hCG mRNA content. cRNA probes to exonic/intronic sequences of GnRH and beta hCG transcripts were constructed and used to perform solution hybridization/nuclease protection and in situ hybridization assays. The levels of GnRH mRNA were approximately 0.1-1% of that of beta hCG mRNA, in agreement with its suggested paracrine, rather than endocrine, role. While beta hCG mRNA content decreased significantly from first trimester to term (643 to 21.6 pg/microgram RNA), there was no significant change in GnRH mRNA (0.179 to 0.155 pg/microgram RNA). While beta hCG mRNA was localized almost exclusively in syncytiotrophoblasts, GnRH mRNA was present in all cell types of the placenta, including the stroma. In the course of performing sense-strand controls in the in situ hybridization, we noted that the placenta appeared to express more antisense GnRH than sense GnRH mRNA, again, in all cell types. Solution hybridization/nuclease protection analysis with exon 1 and exon 3 probes confirmed this observation, showing that there is two to three times more antisense GnRH RNA than sense GnRH mRNA. These studies suggest that GnRH gene expression and its role in regulating hCG production in human placenta is complex and does not fit a simple model for paracrine regulation of hCG.

Alternate regimens for ovulation induction in polycystic ovarian disease.

The patient with PCOD remains a challenge to the reproductive endocrinologist. Although successful induction of ovulation can often be achieved using standard therapeutic regimens of CC or hMG, too often this group of anovulatory patients fails to respond as expected. Over the past 10 to 15 years, alternate approaches to ovulation induction have been investigated with encouraging results. Whereas no one method is productive in all patients, these varied regimens offer us a number of options in dealing with this difficult clinical problem.

Arrested puberty associated with a Sertoli-Leydig cell tumor.

Androgen-producing ovarian tumors are rarely recognized as a cause of delayed or arrested puberty, despite their frequent association with secondary amenorrhea in the older patient. A case is discussed of a Sertoli-Leydig cell tumor in an 18-year-old girl resulting in arrest of breast development and primary amenorrhea.