Autism with intellectual disability is associated with increased levels of maternal cytokines and chemokines during gestation.

Immune abnormalities have been described in some individuals with autism spectrum disorders (ASDs) as well as their family members. However, few studies have directly investigated the role of prenatal cytokine and chemokine profiles on neurodevelopmental outcomes in humans. In the current study, we characterized mid-gestational serum profiles of 22 cytokines and chemokines in mothers of children with ASD (N=415), developmental delay (DD) without ASD (N=188), and general population (GP) controls (N=428) using a bead-based multiplex technology. The ASD group was further divided into those with intellectual disabilities (developmental/cognitive and adaptive composite score<70) (ASD+ID, N=184) and those without (composite score⩾70) (ASD-noID, N=201). Levels of cytokines and chemokines were compared between groups using multivariate logistic regression analyses, adjusting for maternal age, ethnicity, birth country and weight, as well as infant gender, birth year and birth month. Mothers of children with ASD+ID had significantly elevated mid-gestational levels of numerous cytokines and chemokines, such as granulocyte macrophage colony-stimulating factor, interferon-γ, interleukin-1α (IL-1α) and IL-6, compared with mothers of children with either ASD-noID, those with DD, or GP controls. Conversely, mothers of children with either ASD-noID or with DD had significantly lower levels of the chemokines IL-8 and monocyte chemotactic protein-1 compared with mothers of GP controls. This observed immunologic distinction between mothers of children with ASD+ID from mothers of children with ASD-noID or DD suggests that the intellectual disability associated with ASD might be etiologically distinct from DD without ASD. These findings contribute to the ongoing efforts toward identification of early biological markers specific to subphenotypes of ASD.

Maternal mid-pregnancy C-reactive protein and risk of autism spectrum disorders: the early markers for autism study.

Maternal pregnancy levels of the inflammatory marker C-reactive protein (CRP) has been previously associated with autism spectrum disorder (ASD) in the offspring. We conducted a population-based nested case-control study with 500 children with ASD, 235 with developmental delay (DD) and 580 general population (GP) controls to further investigate whether elevated CRP during pregnancy increases the risk of ASD. Maternal CRP concentration was measured in archived serum collected during 15-19 weeks of pregnancy and genome-wide single-nucleotide polymorphism (SNP) data were generated. The levels of CRP were compared between ASD vs GP and DD vs GP. The genetic associations with CRP were assessed via linear regression. Maternal CRP levels in mid-pregnancy were lower in mothers of ASD compared with controls. The maternal CRP levels in the upper third and fourth quartiles were associated with a 45 and 44% decreased risk of ASD, respectively. Two SNPs at the CRP locus showed strong association with CRP levels but they were not associated with ASD. No difference was found between maternal CRP levels of DD and controls. The reasons for the lower levels of CRP in mothers of ASD are not known with certainty but may be related to alterations in the immune response to infectious agents. The biological mechanisms underlying this association remain to be clarified.

[Toxocarosis in dogs - important aspects for the veterinary practice]. / Die Toxokarose des Hundes - wichtige Aspekte für die tierärztliche Praxis.

The zoonotic roundworm Toxocara canis is considered one of the most common gastrointestinal helminths in dogs in Europe. Infection occurs via embryonated eggs from the environment or the ingestion of paratenic hosts. Pups become infected via intrauterine or lactogenic transmission of larvae from the bitch. Prenatal infection results in major consequences because the infected neonates shed large amounts of T. canis eggs into the environment due to a lack of immunocompetence and the resulting inability to fight the infection. After oral ingestion of the eggs, larvae hatch in the small intestine and penetrate the mucosal intestinal wall. Depending on the immune status and the route of infection, either tracheal or somatic migration occurs. Clinical symptoms of Toxocara infections in pups include gastrointestinal symptoms like the typical pot belly or rachitic symptoms. High worm loads might even result in ruptures of the intestine with the consequence of lethal peritonitis. The infection in humans as paratenic host may lead to the clinical pattern of larva migrans visceralis, larva migrans ocularis, neurotoxocarosis or the so called "covert" toxocarosis. Based on the zoonotic potential, information concerning the biology of the parasite and the necessity of anthelmintic treatment to effectively control T. canis in dogs should be provided for the pet owner. This may lead to better parasite control and decreased environmental contamination.

Association of a MET genetic variant with autism-associated maternal autoantibodies to fetal brain proteins and cytokine expression.

The contribution of peripheral immunity to autism spectrum disorders (ASDs) risk is debated and poorly understood. Some mothers of children with ASD have autoantibodies that react to fetal brain proteins, raising the possibility that a subset of ASD cases may be associated with a maternal antibody response during gestation. The mechanism by which the maternal immune system breaks tolerance has not been addressed. We hypothesized that the mechanism may involve decreased expression of the MET receptor tyrosine kinase, an ASD risk gene that also serves as a key negative regulator of immune responsiveness. In a sample of 365 mothers, including 202 mothers of children with ASD, the functional MET promoter variant rs1858830 C allele was strongly associated with the presence of an ASD-specific 37+73-kDa band pattern of maternal autoantibodies to fetal brain proteins (P=0.003). To determine the mechanism of this genetic association, we measured MET protein and cytokine production in freshly prepared peripheral blood mononuclear cells from 76 mothers of ASD and typically developing children. The MET rs1858830 C allele was significantly associated with MET protein expression (P=0.025). Moreover, decreased expression of the regulatory cytokine IL-10 was associated with both the MET gene C allele (P=0.001) and reduced MET protein levels (P=0.002). These results indicate genetic distinction among mothers who produce ASD-associated antibodies to fetal brain proteins, and suggest a potential mechanism for how a genetically determined decrease in MET protein production may lead to a reduction in immune regulation.

Cluster clinics for migrant Hispanic farmworkers with diabetes: perceptions, successes, and challenges.

INTRODUCTION: Diabetes is a chronic disease that requires individuals to schedule multiple office visits with a multidisciplinary team to learn how to successfully manage and delay the progression of complications. To respond to the health-care and educational needs of Hispanic migrant farmworkers who travel to Minnesota and North Dakota, the Migrant Health Service Inc diabetes program coordinator implemented evening cluster clinics. The purpose of this research project was to describe Hispanic migrant farmworkers' perceptions of the services provided to them at 37 multidisciplinary cluster clinics designed to serve this rural population diagnosed with diabetes. METHODS: This descriptive research employed a questionnaire and individual interviews. Both quantitative and qualitative data were obtained from cluster clinic clients. Quantitative data consisted of the numbers and percentages of clients providing various responses to questionnaire items. The qualitative data consisted of the verbal responses of clients to two open-ended questionnaire items and to an interview protocol. RESULTS: The main findings of the project indicated that 75-88% of the clients rated the services provided at the 37 cluster clinics as 'excellent'; an additional 21-25% rated them as 'good.' More than 85% of the clients indicated either that 'nothing should be changed' (59%) or that 'everything was fine' (26%). These ratings and content analysis of the interview data revealed that the clients perceived they had received quality services at these cluster clinics. The authors also discuss six characteristics that they believed contributed to the successful delivery of health care and education through cluster clinics. These characteristics include: (1) provision of both direct and referral services for this underserved population; (2) comprehensive delivery of services in a single setting; (3) collaborative delivery of services; (4) access-driven delivery of services; (5) delivery of culturally-sensitive and linguistically-appropriate services; and (6) evidence-based service delivery. CONCLUSIONS: Cluster clinics are an effective way to improve health-care services, education, and counseling for the under-served or unserved Hispanic migrant population diagnosed with diabetes. The authors conclude with four primary challenges to the implementation of these cluster clinics which include: (1) locating and preparing facilities; (2) recruiting health-care providers for the clinics; (3) achieving effective, appropriate communication with clients; and (4) securing funding.

["Pre-warming" - how can perioperative hypothermia be avoided?]. / "Pre-warming" - Einführung in ein Verfahren zur Vermeidung der perioperativen Hypothermie.

Perioperative hypothermia is a well known problem in general and neuroaxial anaesthesia. Some years ago effective therapeutic means as e. g. forced air systems and infusion heaters were introduced into clinical routine. If these systems are used intraoperatively only, hypothermia is solely treated symptomatically. Pathophysiologic cause of perioperative hypothermia mainly is an initial drop of core-temperature due to redistribution of heat-energy. On this basis Camus and Sessler introduced pre-warming. Patients are warmed with forced-air systems prior to induction of anaesthesia. Thus the drop in core-temperature caused by redistribution is minimized. Pre-warming is a simple, effective and cheap way to reduce perioperative hypothermia. This article gives a short overview on pathophysiology of perioperative hypothermia. Published clinical experiences are discussed and practical guidelines for everyday-use given.

[Recombinant factor VIIa (NovoSeven). A review of current and possible future indications]. / Rekombinanter Faktor VIIa (NovoSeven). Ein Uberblick über aktuelle und mögliche zukünftige Indikationen.

Recombinant activated coagulation factor VII (rFVIIa, NovoSeven) was originally developed for the treatment of bleeding complications in haemophilia patients with allo-antibodies (inhibitors) against exogenous factor VIII or IX. In 1988, rFVIIa was used successfully in such patients for the first time. Subsequently, the efficacy and safety of rFVIIa in haemophilia patients with inhibitors has been proven in several prospective trials. A large number of case reports and results from initial clinical trials suggest that rFVIIa may also be effective in the prevention and treatment of bleeding in patients under oral anticoagulation, with liver diseases, and in patients without any pre-existing haemorrhagic diathesis. However, further clinical studies will be necessary to specify the future potential of rFVIIa.

American nursing students experience shock during a short-term international program.

When individuals plan to travel internationally, they frequently assume that they will have an enjoyable and memorable experience. But for some, the effects of culture shock may negatively impact their travels and memories. The purpose of this study was to describe culture shock as reported by student nurses who took part in an international short-term program. A phenomenological approach was utilized to elicit the essence of meaning attached to the experience. Eight student nurses in an upper Midwestern university, participated in this international experience. It was concluded that all of the student nurses experienced culture shock to a varying degree and they had varying perceptions of their experiences.

Transcultural healthcare: a phenomenological study of an educational experience.

This phenomenological study was undertaken for the purpose of describing the meaning of transcultural health care. A phenomenological approach was utilized to elicit the essence of meaning attached to the experience. Students in an upper midwestern university, enrolled in a transcultural health care course participated in the educational experience presented in this paper. While the course was multidisciplinary in nature, nursing represented the majority. The purpose was to identify and describe students' perception and definition of culture at the beginning and end of the course and to utilize an inductive process to formulate a descriptive structure depicting the meaning of transcultural health care. It was concluded that students' perception and definition of culture changed via the transformational process influenced by the passage of time and by the particular experiences students were exposed to.

The moderating effect of self-esteem in reaction to voice: converging evidence from five studies.

It has been posited that high self-esteem persons (high SEs) are more confident than low self-esteem persons (low SEs) of their capability to provide meaningful input in a decision process. If this is so, then high SEs should be more influenced by their perceived level of voice, relative to low SEs. Survey data from 4 field studies showed that voice was more positively related to various dependent variables among high SEs than low SEs. In Study 5, the authors experimentally manipulated voice as well as participants' beliefs about their capability to provide meaningful input. As expected, voice had a greater impact on the reactions of participants who were led to believe that they were more capable of providing meaningful input. Theoretical implications are discussed.

Neonatal intensive care nurse stressors: an American study.

The purpose of this study was to determine the frequency of selected stressors and the level of associated stress experienced by neonatal intensive care unit (NICU) nurses in the USA, and to identify their responses/coping mechanisms. The research instrument consisted of demographic data (education, location of practice, age, years in practice, gender) and a modification of the Stress Audit tool developed by Popoff and Funkhouser (1975). Participants were randomly chosen from health-care units located in the upper Midwest of the USA. Fifty-nine nurses (35%) responded to the postal survey. In terms of scale items, floating out of the unit (ability to staff other units when necessary) was the most stressful item and routine procedures the least stressful item. From a subscale perspective, knowledge was the least stressful and management the most. Subscale scores did not differ by marital status, number of years of practice as a registered nurse, or years of practice in NICU. Coping with stress was best facilitated by discussion with coworkers. Consistency of care, inservice education, mental health days (time off for stress relief, paid or unpaid) and staff support groups were reported as helpful in coping with job-related stress.

Cognitive bias in procedural justice: formation and implications of illusory correlations in perceived intergroup fairness.

Illusory correlations in procedural justice were investigated in 2 experiments. After receiving information describing the fair and unfair treatment of 2 groups' members by police, participants judged the fairness of each group's treatment. Illusory correlations formed in both experiments, resulting in erroneous associations between the smaller group and the infrequent type of treatment. In Experiment 2, participants made harsher guilt judgements of members of the group perceived as receiving relatively favorable treatment. Mediational evidence suggests that differences in guilt judgments reflected attempts to compensate for perceived injustice, creating real differences in group treatment. The benefit of incorporating cognitive biases in models of procedural justice is discussed.

Dying babies and associated stress in NICU nurses.

Death is a reality in the neonatal intensive care setting. This adds to the job stress nurses experience. Although the literature is replete with topics on death and dying, few of these articles are empirically based. The purpose of this study was to determine the stress associated with taking care of babies who die in NICU settings. The responses/coping mechanisms of NICU nurses were also identified. Fifty-nine nurses in an upper mid-western state participated in this study. Nurses reported feelings of helplessness and intense sorrow when a baby dies. As a result, they experienced the physio-emotional responses of chronic fatigue, decreased interest in exercise, irritability, and being overcritical. The greatest help in coping with grieving came through discussion with coworkers, a chaplain, the patient's family, and the nurse's own family. For some, attending the funeral or memorial services also helped. Implications for practice include fostering planned discussion sessions and continued education to improve counseling skills related to bereavement.

Parental stressors in a pediatric intensive care unit.

Parents experience a variety of stressors when their child is hospitalized in an intensive care unit. Thirty-two parents (10 males and 22 females) of children in the pediatric intensive care unit of a children's hospital were surveyed using a revised version of the Carter and Miles (1983) Parental Stressor Scale: Pediatric ICU (PSS:PICU) and one open-ended question to identify their most significant stressors. Some findings agreed with those from previous studies; other results differed. Differences in some areas in fathers' and mothers' perceptions were noted. Two concerns reported were the differences of doctors' opinions regarding the child's care and parents not being able to continually stay with their child.

[Effect of acarbose on carbohydrate and lipid metabolism in type II diabetes with secondary failure]. / Zur Wirkung von Acarbose auf den Kohlenhydrat- und Fettstoffwechsel bei sekundärversagendem Typ-II-Diabetes.

The effect of the glucosidase inhibitor acarbose on carbohydrate and lipid metabolism was studied in 9 older hospitalized diabetics with secondary failure. In a single blind cross-over study of three weeks the patients received glibenclamide in a dose of 15 mg/day associated with acarbose in a daily dose of 3 X 100 mg or placebo for two periods. Acarbose reduced both the postprandial blood glucose profils and urinary glucose levels significantly. However neither morning fasting glucose concentration nor cholesterin or triglyceride levels were lowered by the drug. The other biochemical and haematological findings were not influenced by the substance. Some patients complained of flatulence or meteorism, but this side-effect was tolerated with the demand to continue the study.

[Comparative studies of the effect of mithramycin and calcitonin on small intestine and pancreas function in the rat]. / Vergleichende Untersuchungen zur Wirkung von Mithramycin und Calcitonin auf die Fünndarm- und Pankreasfunktion der Ratte.

The effects of synthetic salmon calcitonin (Calcitonin R-Sandoz) at a dose of 10 IU/kg BW and Mithramycin (Mithramycin R-Pfizer) at a dose of 35 micrograms/kg BW on the absorption of calcium was evaluated in normocalcenic fasted rats by investigating both the pancreatic function and the intestinal absorption of xylose. During 2 h observation calcitonin induced a fall in serum calcium concentration of 6 % (p = n.s.). As compared with controls, the renal elimination of xylose is diminished in calcitonin treated animals by 49% (p less than 0,1), whilst in mithramycin treated animals no change is observed. Serum insulin level was not influenced by calcitonin, but it was stimulated about 70% (p less than 0,05) by mithramycin. Blood glucose concentration is decreased only by 14 mg % (calcitonin) and 18 mg % mithramycin) (p = n.s.). Both drugs do change neither urinary volume nor serum alpha-Amylase. It is concluded that the sites of action of mithramycin differ from those of calcitonin.

[Diabetic autonomic neuropathy of the heart and its treatment with thioctic acid]. / Die diabetische autonome Neuropathie des Herzens und ihre Behandlung mit Thioctsäure.

The therapeutic effect of thioctic acid was studied in two groups of patients with peripheral diabetic neuropathy (N = 34 and 27, resp.), who had no evidence of cardiovascular or respiratory insufficiency. The immediate heart-rate response to standing up was measured in the first group of diabetics and in nondiabetic controls (N = 33). Each subject lay quietly for three minutes, then stood up (within five seconds) and remained motionless for one minute. A continuous ECG was recorded from one minute before to one minute after standing. For the Valsalva manoeuvre, the diabetics of the second group were asked to blow a column of mercury up to a height of 40 mm Hg for 10 seconds. The patients were treated with thioctic acid in daily oral doses of 3 X 150 mg for 21 days. No changes of heart rate were found in 80% (standing up) and 59% (Valsalva) resp., in the diabetics with peripheral neuropathy. However, non-diabetic controls of the same age group had likewise no changes of heart rate response in 19 and 5%, respectively. Treatment with thioctic acid did not alter the heart rate response to standing up or Valsalva manoeuvre of the diabetics with peripheral neuropathy.