Effects of a 12-month moderate weight loss intervention on insulin sensitivity and inflammation status in nondiabetic overweight and obese subjects.

Weight loss intervention is the principal non-pharmacological method for prevention and treatment of type 2 diabetes. However, little is known whether it influences insulin sensitivity directly or via its anti-inflammatory effect. The aim of this study was to assess the independent role of changes in inflammation status and weight loss on insulin sensitivity in this population.Overweight and obese nondiabetic participants without co-morbidities underwent a one-year weight loss intervention focused on caloric restriction and behavioral support. Markers of inflammation, body composition, anthropometric para-meters, and insulin sensitivity were recorded at baseline, 6, and 12 months. Insulin sensitivity was assessed with frequently sampled intravenous glucose tolerance test and Minimal Model. Twenty-eight participants (F: 15, M: 13, age 39±5 years, BMI 33.2±4.6 kg/m(2)) completed the study, achieving 9.4±6.9% weight loss, which was predominantly fat mass (7.7±5.6 kg, p<0.0001). Dietary intervention resulted in significant decrease in leptin, leptin-to-adiponectin ratio, hs-CRP, and IL-6 (all p<0.02), and improvement in HOMA-IR and Insulin Sensitivity Index (SI) (both p<0.001). In response to weight loss IL-1ß, IL-2, leptin, and resistin were significantly associated with insulin, sensitivity, whereas sICAM-1 had only marginal additive effect. Moderate weight loss in otherwise healthy overweight and obese individuals resulted in an improvement in insulin sensitivity and in the overall inflammation state; the latter played only a minimal independent role in modulating insulin sensitivity.

Early adolescent outcome of attention-deficit hyperactivity disorder in a Chinese population: 5-year follow-up study.

OBJECTIVE: To examine early adolescent outcome of attention-deficit hyperactivity disorder in local Chinese children. DESIGN: Cohort study. SETTING: A university teaching hospital in Hong Kong. PARTICIPANTS: A cohort of Chinese children with attention-deficit hyperactivity disorder diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders (4th edition) who attended a day hospital between January 1998 and December 2003. MAIN OUTCOME MEASURES: Data on psychopathology, academic attainment, delinquency, substance use, and other psychosocial functioning collected from multiple informants and official records. Performances of subjects were compared with a group of community controls. RESULTS: A total of 150 children with attention-deficit hyperactivity disorder were reassessed 6 years after initial intake assessment (mean age, 14 years; follow-up rate, 86%). Compared with the controls, their externalising and internalising disturbances were 4 and 1.5 times more common, respectively. Adolescents with attention-deficit hyperactivity disorder were more likely to smoke cigarettes and use illicit drugs. Their academic attainment was below age norms with more than one fourth repeating grades; 7% of them had been arrested by the police compared with none of the controls. They faced more difficulties in the family environment and social problem-solving. There were discrepancies between parent and patient reports about their attention-deficit hyperactivity disorder symptoms, and officially recorded youth reports of delinquency. CONCLUSION: Local Chinese children with attention-deficit hyperactivity disorder are at significant risk of multiple forms of adolescent maladjustment. Their outcome profile is similar to that reported in the West.

White matter fractional anisotrophy differences and correlates of diagnostic symptoms in autism.

BACKGROUND: Individuals with autism have impairments in 3 domains: communication, social interaction and repetitive behaviours. Our previous work suggested early structural and connectivity abnormalities in prefrontal-striato-temporal-cerebellar networks but it is not clear how these are linked to diagnostic indices. METHOD: Children with autism (IQ > 70) aged 6 to 14 years old and matched typically developing controls were studied using diffusion tensor imaging. Voxel-based methods were used to compare fractional anisotrophy (FA) measures in each group and to correlate FA measures in the autism group with the diagnostic phenotype described by the Autism Diagnostic Interview - Revised (ADI-R) algorithm for ICD-10. RESULTS: After controlling for the effects of age and white matter volume, we found that FA in the autism group was significantly lower than controls in bilateral prefrontal and temporal regions, especially in the right ventral temporal lobe adjacent to the fusiform gyrus. FA was greater in autism in the right inferior frontal gyrus and left occipital lobe. We observed a tight correlation between lower FA and higher ADI-R diagnostic algorithm scores across white matter tracts extending from these focal regions of group difference. Communication and social reciprocity impairments correlated with lower FA throughout fronto-striato-temporal pathways. Repetitive behaviours correlated with white matter indices in more posterior brain pathways, including splenium of the corpus callosum and cerebellum. CONCLUSIONS: Our data support the position that diagnostic symptoms of autism are associated with a core disruption of white matter development.

A case-control study of 92 cases of in-patient suicides.

BACKGROUND: A significant number of patients committed suicide while receiving in-patient treatment in psychiatric hospitals. Most previous studies on psychiatric in-patient suicides were conducted in the West. This study aimed to describe the characteristics and identify risk factors of suicides occurring during psychiatric in-patient care in Hong Kong. METHOD: The case record data of suicide cases (Coroner's verdicts of suicides and undetermined deaths) from all public psychiatric hospitals in the entire region within a 3 years' period (N=93) were compared with matched controls. RESULTS: In-patient suicide rate was 269/100,000 admissions. Majority had schizophrenia. Suicide usually occurred after the first month of admission, during leave, and by jump from heights. There were little case-control differences in treatment received. Multiple conditional logistic regression found 5 risk factors: previous history of deliberate self-harm (OR=4.60, 95% CI=1.57-13.5); admitted because of suicidal behaviour (OR=3.92, 95% CI=1.3-11.9); depressive symptoms at time of suicide (OR=8.53, 95% CI=1.4-52); away without leave at anytime during index admission (OR=17, 95% CI=1.76-163); and extrapyramidal side effects/akathisia at time of suicide (OR=10.8, 95% CI=1.75-66.7). LIMITATIONS: Retrospective case record review depended on non-standardized and variable quality of case notes entry. Matching for hospitals in this study would make the comparison between hospitals impossible. Although this is the second largest case-control study of psychiatric in-patient suicide, the estimated power suggested subtle risk factors would be missed. CONCLUSION: Majority of in-patient suicides occurred at a time of perceived low risk. A high sensitivity to the risk of suicide and vigorous treatment of depressive symptoms were indicated. The care processes during the index admission could bear strong influences on the risk of in-patient suicides.

Parent management training in a Chinese population: application and outcome.

OBJECTIVE: To examine the applicability and outcome of parent management training in a group of Chinese children referred for aggressive and defiant behaviors. METHOD: Twenty-five children (aged 4-10 years) were assigned to a standardized 8 to 12 sessions of parent management training. Trained child and adolescent psychiatric nurses conducted the treatment. Measures taken at pretreatment, posttreatment, and 4-month follow-up period included the Child Behavior Checklist, direct observation of parent-child interactions, and a parent perception inventory. RESULTS: Significant therapeutic gains occurred in parent-child interactions, externalizing behaviors, and parents' perception of their parenting behaviors. These were maintained at 4-month follow-up. Fifty-two percent of cases improved to a level below clinical cutoffs. Poor parent-child interactions had stronger correlation with externalizing disturbances than internalizing disturbances. The changes in parent-child interactions had low correlation with the changes in the symptom profiles. CONCLUSIONS: The data provide preliminary evidence for the efficacy of parent management training for Chinese children with conduct problems. The rationale for its success and modifications to improve its cultural sensitivity are discussed.

Extensibility characteristics of human cheek--visco-elastic properties.

Using a hydraulic bellows system mounted on a maxillary partial denture, continuous force-displacement data were taken in an edentulous area in the maxillary bicuspid-molar region on ten adults. Both loading and unloading force-displacement curves showed three segments. Two visco-elastic properties - hysteresis and relaxation - were consistently evident. The maximum difference in force-magnitude of the hysteresis loop was 1.02 g. A pre-conditioning phenomenon of the cheek tissue, evidence by a reduction of the area of the hysteresis loop, was observed in a series of repeated runs. The significance of the study was that: (1) in some individuals, the cheek could be displaced, by expansion of the molars, up to 1 mm into a second stable position; and (2) the relaxation phenomenon suggests a limited adjustive capacity in cheek stiffness.

A re-examination of seasonal variation in suicides in Australia and New Zealand.

BACKGROUND: To examine the seasonality of suicides in Australia and New Zealand during the period 1981 to 1993. METHODS: A chi-square test and a harmonic analysis were used to detect the seasonality of the suicide data. RESULTS: The reduced amplitude and a smaller proportion of variance accounted for by seasonality suggested the seasonal effect on suicide is greatly diminished. The absence of biseasonal distribution of female suicides was also consistently found in the two countries. The finding was contrary to the reported results in seventies in many Western countries. CONCLUSIONS: The change in living condition, roles of males and females and communication pattern resulted in the reduction of climatic and environment effect in the seasonality of suicides were suggested. LIMITATIONS: The results would be better if a longer series of suicide date were available.

Comparison of child psychiatric patients in hospital and community clinics in Hong Kong.

This is a prospective study comparing a consecutive sample of child psychiatric patients at a community child mental health clinic (N = 56) and hospital clinic (N = 42) in Hong Kong. The subjects and their parents were studied with standardized questionnaires and semistructured interviews at their first visits to the clinics. A review of the treatment received was conducted 15 months later. Across settings, subjects were similar in sociodemographic profile, degree of social adversity, number of preceding life events, duration of chief complaints, maternal psychopathology, parental explanatory models of the child's problems, and expectations in treatment. Community clinic attenders had more disruptive behavioral problems, received shorter treatment, and less inpatient care than hospital clinic attenders. Subjects in both settings had very similar previous help-seeking behaviors. The findings suggested that the community clinic attracted disturbed children of similar backgrounds. The community child mental health clinic appeared to be a viable alternative in providing psychiatric care to children in Hong Kong.

Physical properties of human lips: experimental and theoretical analysis.

The lip stiffness characteristics in the vertical plane of a white population sample, aged 18-26, were studied. The physical properties of the lip system were analyzed and a mathematical model was derived to approximate this system. The instrumentation consisted of a force-transducer bar, a head holder and a three-directional micrometer adjustment. Four specific contact areas were used. Individual lower lip is stiffer than upper lip and the corresponding male lip is stiffer than the female lip. The force-displacement relationship approximates a linear function at small displacements (less than 1 mm) and is a second order function at larger displacements. A mechanical T-spring model approximates the system to an accuracy of about 96%.

Establishing the constructs of childhood behavioral disturbances in a Chinese population: a questionnaire study.

The behavioral problems of Chinese children were examined in a questionnaire study of a representative sample of 3,069 seven-year-old Chinese schoolboys in Hong Kong using Rutter's questionnaires for completion by parents and teachers. Separate robust dimensions of hyperactivity, antisocial, and neurotic behaviors were evident. The correlations among different dimensions were similar to those reported in the West. Short-term longitudinal analysis suggested that these dimensions were stable over time and that antisocial behaviors might develop in hyperactive children. The finding highlights the necessity of differentiating the hyperactive domain from the antisocial one. A significant source effect was found in all three dimensions. Chinese schoolboys had nearly two times the level of questionnaire-rated hyperactivity compared with school boys in the West; but it is premature to conclude that hyperactivity is more common in Chinese schoolboys in Hong Kong. Cross-cultural differences in adults' expectations and tolerance remain a plausible explanation.

T-cell lymphoma presenting as acute mastoiditis with a facial palsy.

Isolated T-cell lymphomas affecting only the mastoid are extremely rare. Presentation with oto-neurological signs prior to systemic involvement of a lymphoproliferative disease is also unusual. This is the youngest reported patient with a peripheral T-cell lymphoma with disease isolated only in the mastoid who presented with acute mastoiditis and a complete seventh cranial nerve palsy.

Triiodothyronine augmentation for the treatment of depression in substance misusers unresponsive to tricyclic antidepressants.

We report on two substance misusers with depression resistant to tricyclic antidepressant treatment who responded to triiodothyronine augmentation. The management of resistant depression, augmentation strategies with particular reference to triiodothyronine, and the possible mechanism of action of triiodothyronine are discussed.

The prevention of youth suicide: research and services.

In parallel with the escalating concern about youth suicides in the 1970s in the West, came an increase in suicide prevention efforts. The production of research data in the past 20 years enables us to evaluate the rationale and effectiveness of these suicide prevention programmes. Effective prevention programmes for youth suicide depend on our knowledge of the scope of the problem, factors associated with its occurrence, and an evaluation of the existing prevention strategies. The aim of this article is to review the main body of knowledge on the prevalence of and risk factors for youth suicide (both completed and attempted suicides) and use these to assess various prevention programmes.

Suicides in general hospitals in Hong Kong: retrospective study.

OBJECTIVE: To describe the characteristics of suicidal patients and their suicidal acts occurring in general wards. DESIGN: Retrospective study. SETTING: All general public hospitals in Hong Kong. PATIENTS: Survey data based on hospital records of patients who died of suicide or who attempted suicide in general wards between 2000 and 2002 were studied. MAIN OUTCOME MEASURES: Demographic information, medical history, and circumstances of the suicidal acts. RESULTS: Twenty-six hospitals reported a total of 166 suicidal acts, which included 34 completed suicides, corresponding to 9.46 attempted suicides and 1.93 completed suicides per 100 000 admissions. Most suicidal acts occurred in medical wards. Patients were, on average, in their mid-50s, predominantly male, and had been admitted because of physical problems. Fewer than 20% were admitted because of attempted suicide. A significant proportion of suicide attempters used potentially lethal suicide methods in the wards. Wide ranges of objects were used in the suicidal acts. Completed suicides tended to occur after midnight and in the ward toilet. Patients who went missing and then committed suicide acts did so in the first few hours of leaving the hospital. The timing of suicidal acts varied greatly with the reasons of admission. CONCLUSION: Prevention efforts in general wards are unlikely to be effective if they simply focus on patients admitted for attempted suicide, or on the restriction of suicide means. For patients admitted to general wards because of attempted suicide, the risk is highest just after admission; hence, these patients have to be monitored closely. A high degree of alertness to the possibility of depression and suicidal risk among general ward patients is required.

Malignant peripheral nerve sheath tumour of the spinal accessory nerve.

A 50-year-old man presented with a left-sided neck mass. Clinical examination revealed a large fluctuant 7 cm x 7 cm mass in the left posterior triangle. Magnetic resonance imaging (MRI) revealed an encapsulated soft tissue lesion. He underwent exploration of the neck and a 14 cm by 8 cm mass enfolding the accessory nerve was identified and completely excised. Histological examination of the surgical specimen showed features in keeping with a malignant peripheral nerve sheath tumour (MPNST). We present the clinical and pathological features of this condition.

Does cognitive function influence alaryngeal speech rehabilitation?

BACKGROUND: We sought to define the cognitive domains that influence valved speech rehabilitation. METHODS: Sixteen laryngectomees with primary tracheoesophageal punctures were randomly recruited from one head and neck unit. They were assessed by a consultant neuropsychologist and a speech therapist. Speech therapy time was determined from speech therapy notes. RESULTS: The Digit Symbol Substitution Test, assessing learning speed and processing speed, correlated significantly with speech therapy time in the first (p = .002) and third (p = .014) postoperative years, respectively. Categorical fluency assessment correlated positively with speech therapy time in the first year (p = .009). Learning speed (p = .007) and categorical fluency (p = .041) correlated positively with the fall in speech therapy input between the first and third year after laryngectomy. CONCLUSIONS: Learning speed, processing speed, and categorical fluency strongly influence alaryngeal speech rehabilitation. This study highlights the potential for pre-laryngectomy cognitive assessment to help plan alaryngeal speech rehabilitation. This has significant resource implications.