Effect of midazolam in autism spectrum disorder: A retrospective observational analysis.

BACKGROUND: While midazolam is commonly used as premedication for uncooperative patients, its effects are difficult to predict in patients with autism spectrum disorder for whom abnormalities in gamma-aminobutyric acid have been reported. This study aimed to investigate the influence of autism spectrum disorder on the effect of midazolam when used as premedication. METHODS: This retrospective observational study was performed between April 2017 and August 2018. Before inducing general anesthesia with sevoflurane for dental treatment, 390 uncooperative patients received premedication with midazolam. Ordinal logistic regression analysis was performed with the Observer's Assessment of Alertness/Sedation score 30 min after premedication as the objective variable. Age, sex, American Society of Anesthesiologists physical status class, premedication route, dose per body weight, presence of specific disorders (autism spectrum disorder, intellectual disability, epilepsy, cerebral palsy, and other psychiatric disorders), and regular benzodiazepine or non-benzodiazepine psychotropic administration were included as explanatory variables. Kendall's rank correlation coefficient was used to assess the correlation between the Observer's Assessment of Alertness/Sedation score and cooperation level (1, obvious negative response; 2, negative response; 3, positive reaction; 4, obvious positive reaction) during admission and inhalation induction. All data were extracted from anesthesia and medical records. RESULTS: Age (odds ratio 1.437 [95% confidence interval (CI) 1.213-1.708], P < .001), autism spectrum disorder (1.318 [1.079-1.612], P = .007), benzodiazepine medication (0.574 [0.396-0.827], P = .002), and intramuscular route (1.478 [1.137-1.924], P = .004) were significantly associated with the Observer's Assessment of Alertness/Sedation score, while the score was negatively associated with cooperation levels during admission (τ = -0.714, P < .001) and inhalation induction (τ = -0.606, P < .001). CONCLUSIONS: Patients with autism spectrum disorder may be susceptible to premedication with midazolam; however, regular benzodiazepine administration may reduce the effect.

Trigeminal nervous system sensitization by infraorbital nerve injury enhances responses in a migraine model.

Background Although the peripheral and central sensitizations of trigeminal nervous system may be one of the important factors of migraine, the precise mechanism is not fully understood. In this study, we examined the influence of the sensitization of the second division of the trigeminal nerve (V2) by chronic constriction injury (CCI) of the infraorbital nerve (ION) on migraine headache, using the capsaicin-induced migraine model. Methods Male Sprague-Dawley rats were assigned to four groups: (a) sham surgery and topical-dural vehicle application (Sham + Vehicle) group, (b) CCI-ION and topical-dural vehicle application (CCI-ION + Vehicle) group, (c) sham surgery and topical-dural capsaicin application (Sham + Capsaicin) group, (d) CCI-ION and topical-dural capsaicin application (CCI-ION + Capsaicin) group. Behavioral testing and immunohistochemical staining were performed. Results In the behavioral test, the Sham + Capsaicin group showed significantly longer duration of immobilization and shorter duration of exploration compared with the Sham + Vehicle group, which is similar to clinical features of migraine patients. Moreover, CCI-ION enhanced these effects in the CCI-ION + Capsaicin group. Immunohistochemical staining for phospho-extracellular signal-related kinase (pERK) in the trigeminal ganglion (TG) containing first and second divisions of the trigeminal nerve and the trigeminocervical complex (TCC) revealed that pERK expression was significantly increased in the CCI-ION + Capsaicin group compared with the other groups. However, comparing between effects of the peripheral and central sensitizations (in the TG and TCC), from our results, peripheral sensitization would play a much less or not significant role. Conclusions These data demonstrate that the sensitization of V2 could influence the activation and the sensitization of the first division of the trigeminal nerve in the TCC, subsequently exacerbating pain sensation and pain-related behaviors. We have shown for the first time that the existence of the central sensitization of V2 can be an exacerbating factor for migraine related nociceptive thresholds/activation.

[Choice based on plausible reasons].

This study tested the prediction that preferences induced by hidden factors would be justified and even accelerated by other factors that seem to be plausible determinants as causes but, in fact, do not have any influence on the preferences. Participants were repeatedly exposed to a variety of product logos of detergents and then asked to choose one from a pair of detergents with different logos. For half of the participants, information on product quality was available at choice; for the other half, only logos were available. The participants showed a tendency to prefer detergents with the logos that were more frequently exhibited, and this tendency was stronger when information was available about the product quality. The participants seemed to believe that they based their decisions on the relative superiority of quality between the pairs as well as their logos. Provided with convincing, but incorrect, reasons to make a choice, the participants were encouraged to select the detergents whose attractiveness had actually been manipulated by exposing the participants to their logos.

Culture and egocentric perceptions of fairness in conflict and negotiation.

In this article, the authors advanced a cultural view of judgment biases in conflict and negotiation. The authors predicted that disputants' self-serving biases of fairness would be more prevalent in individualistic cultures, such as the United States, in which the self is served by focusing on one's positive attributes to "stand out" and be better than others, yet would be attenuated in collectivistic cultures, such as Japan, where the self is served by focusing on one's negative characteristics to "blend in" (S. J. Heine, D. R. Lehman, H. R. Markus, & S. Kitayama, 1999). Four studies that used different methodologies (free recall, scenarios, and a laboratory experiment) supported this notion. Implications for the science and practice of negotiation are discussed.

Anesthetic effects on susceptibility to cortical spreading depression.

Cortical spreading depression (CSD) is a transient neuronal and glial depolarization and disruption of membrane ionic gradients that propagates slowly across the cerebral cortex. Recent clinical and experimental evidence has implicated CSD in the pathophysiology of migraines and neuronal injury states. In the current study, we examined the influence of four different anesthetics (propofol, dexmedetomidine, isoflurane, pentobarbital) on CSD susceptibility in a KCl application animal model. We found that isoflurane and dexmedetomidine suppressed CSD frequency, and tended to reduce the CSD propagation speed. Our data suggest that these anesthetics may be therapeutically beneficial in preventing CSD in diverse neuronal injury states.

Differences between tight and loose cultures: a 33-nation study.

With data from 33 nations, we illustrate the differences between cultures that are tight (have many strong norms and a low tolerance of deviant behavior) versus loose (have weak social norms and a high tolerance of deviant behavior). Tightness-looseness is part of a complex, loosely integrated multilevel system that comprises distal ecological and historical threats (e.g., high population density, resource scarcity, a history of territorial conflict, and disease and environmental threats), broad versus narrow socialization in societal institutions (e.g., autocracy, media regulations), the strength of everyday recurring situations, and micro-level psychological affordances (e.g., prevention self-guides, high regulatory strength, need for structure). This research advances knowledge that can foster cross-cultural understanding in a world of increasing global interdependence and has implications for modeling cultural change.