Greater muscle damage in athletes with ACTN3 R577X (RS1815739) gene polymorphism after an ultra-endurance race: a pilot study.

In this study, we aimed to investigate the influence of ACTN3 R577X gene polymorphism on muscle damage responses in athletes competing in an ultra-endurance race. Twenty moderate to well-trained ultra-runners who had entered in an official 37.1 km adventure race (22.1 km mountain biking, 10.9 km trekking, 4.1 km water trekking, 30 m rope course, and orienteering) volunteered for the study. Blood samples were collected for genotyping and analysis of muscle protein levels before and after the race. Percentage changes (pre- to post-race) of serum myoglobin [XX = 5,377% vs. RX/RR = 1,666%; P = 0.005, effect size (ES) = 1.73], creatine kinase (XX = 836.5% vs. RX/RR = 455%; P = 0.04, ES = 1.29), lactate dehydrogenase (XX = 82% vs. RX/RR = 65%; P = 0.002, ES = 1.61), and aspartate aminotransferase (XX = 148% vs. RX/RR = 75%; P = 0.02, ES = 1.77) were significantly greater for XX than RX/RR genotypes. ES analysis confirmed a large magnitude of muscle damage in XX genotype ultra-runners. Therefore, athletes with the ACTN3 577XX genotype experienced more muscle damage after an adventure race. This suggests that ultra-runners with alpha-actinin-3 deficiency may be more susceptible to rhabdomyolysis and associated health complications during ultra-endurance competitions.

Weight gain, thermic effect of glucose and resting metabolic rate during recovery from anorexia nervosa.

Rate of weight gain, together with metabolic rate before and after a glucose meal, were studied in a group of 15 female anorexia nervosa patients as their weight was being restored to normal levels. The previously obese anoretic patients gained weight more rapidly, on the same food intake, than those who were of normal weight before their illness began. The increase in metabolic rate (as treatment progressed) was less in the previously obese patients, who also showed a tendency for the metabolic rate to increase less after a glucose meal than the patients with no history of obesity. The thermic effect of glucose was greater in patients with anorexia nervosa than in a comparable control group of six female students.

Personality, body weight and ultimate outcome in anorexia nervosa.

The Eysenck Personality Inventory, a highly standardized self-rating questionnaire, allows 2 measures of psychosocial functioning on independent scales entitled "emotionally" and "extroversion/introversion." A population of severely ill, low body weight anorectics revealed a high degree of "introversion" and variable amounts of "emotionality" on these measures. Low amounts of "emotionality" were associated with abnormally high "lie" scores. Following restoration of body weight to full matched population mean levels within an intensive treatment program, significant changes occurred on these measures--increased extroversion scores, decreased emotionality and lie scores. However, possibly qualitative changes had occurred in the state of emotionality since high levels were now related to good clinical outcome many years later. The nature of this phenomenon is discussed.

Factors affecting prognosis in male anorexics.

Twenty-seven male anorexics have been followed up over 2-20 yr (mean 8 yr) and their outcome assessed. This has been compared with outcome in female patients with similar pictures at presentation (Burns and Crisp, 1984). Features of the family and personal history and clinical aspects of the disease at presentation were compared with outcome and a number found to be significantly associated with it. Poor relationship with parents during childhood and the absence of normal adolescent sexual behavior and fantasy premorbidly were strongly predictive of a poor outcome. Long duration of illness, previous treatment and greater weight loss during illness were also associated with poor outcome, although no specific dietary behaviour was predictive. The remarkable similarity in outcome pattern between the male and female prompts re-evaluation of some theories of the nature of the role of sexual conflicts in anorexia nervosa.

Symbolic functioning in anorexia nervosa.

This study examined 20 patients with anorexia nervosa using a projective test with a quantitative scoring system (the SAT9), and an indirect measure of symbolic function (the interoceptive awareness subscale of the EDI). The findings support the clinical observation that patients with anorexia nervosa are often arrested developmentally, and are without the ability to deal adequately with the anxieties created by the process of maturation. The results of this study have significance for the psychotherapy techniques used in the treatment of these patients.

Family structure and birth order of patients with anorexia nervosa.

A retrospective case-notes study of 252 patients was undertaken, to focus on their birth order, and other aspects of their sibships. There is little evidence of a relationship to birth order using an established measure (Slater, 1962). Previous researchers have found a preponderance of female siblings in the families of patients with anorexia nervosa. We have not found this, neither is our sample characterised by older or younger siblings of any one sex. This is true for both female and male anorexics. These results are discussed in terms of experimental and family theories concerning the development of anorexia nervosa.

Dexamethasone suppression and energy balance: a study of anorexic patients.

The performance of the dexamethasone suppression test (DST) was investigated in 45 female anorexic out-patients (cross-sectional study) and in nine female anorexic in-patients (longitudinal study). DST non-suppression was strongly associated with negative energy balance (low body weight and low Ponderal Index) but there was no significant association with the presence of affective or neurotic disturbance in these patients. These findings cast doubt on the value of the DST in the management of depressive illness.

Why do some anorexics steal? Personal, social and illness factors.

There is a recognised association between anorexia nervosa and stealing. Anorexics who steal are usually also bulimic. However, not all bulimic anorexics steal. The question of why some do and others do not is explored with respect to features of the illness and personal and social variables. Bulimic anorexics who stole differed from their non-stealing counterparts in older age at presentation and in terms of greater sexual activity. These and other findings are discussed with reference to clinical understanding and aetiological theories of other aberrant behavior displayed by the adolescent female.

Cerebral hemisphere function and migraine.

An hypothesis that migraine is the experience of a protective vascular response to cerebral information overload has been explored to a limited extent by examining the association between laterality of the attack and verbal and spatial performances under standard symptom-free conditions. The study was restricted to individuals with unilateral symptoms always presenting on the same side. It emerged that those with classical migraine do not always have prodromata referable to the same side as the pain. Indeed, in the present study, prodromata were almost exclusively referable to the left (dominant) cerebral hemisphere. A subgroup of those with speech disturbances as a feature of the prodromal symptoms was also found to have relatively impaired language abilities on routine testing. It is this finding that lends some support to the hypothesis. The findings also invite the refining proposition that information overload, as defined in the hypothesis, is almost always borne by the dominant (verbal) hemisphere in our species. Such overload might concurrently or sequentially also overtax a suggested limited right hemisphere language capacity, in terms of the hypothesis, accounting for the right-sided pain sometimes presenting in these cases. Otherwise, pain appears to be predominantly left-sided or midline. Perhaps the frequency of this particular syndrome is an indictment of the limitations of language as a basis for communication, as well as reflecting the possibility that most of our stressful transactions and their cerebral processing use a verbal substrate. The results also reveal the need for agreement on rules for classification of laterality in migraine.

Symptoms without signs in outpatients attending ophthalmology clinics.

Ophthalmic outpatients without physical signs have been shown, as a group, to be significantly more anxious and depressed than a control group. They also have a higher incidence of somatic complaints of a kind commonly made by patients with psychiatric 'disorder'. There was a higher incidence of past psychiatric history in the proband group, and they also gave a greater subjective assessment of recent conscious life stress.

Laterality of migraine and reported affect. The relevance of an hypothesis concerning the nature of migraine.

The few right-handed female subjects with exclusively left-sided classical migraine drawn from an epidemiological study have been found to be characterized by very low levels of anxiety and depression. This finding is examined in relation to the theory that migraine is a cerebral hemisphere response, ultimately vascular, to 'information overload' and that such specificity may be an indication of relatively high and selective hemisphere capacity and activity, left-sided in the above instance. There is also experimental evidence from elsewhere that unfettered or predominant left hemisphere activity is associated with reduction in depressive affect in normal subjects. This, then may be the basis of the present finding.

Sexual abuse as a factor in anorexia nervosa: evidence from two separate case series.

Evidence of a link between reported sexual abuse and specific eating behaviours was considered in 100 anorexic women. The women were assessed as part of case series from two separate clinics. There was a strong association between reported unwanted sexual experiences and purging behaviours (vomiting and/or abusing laxatives). Anorexics who did not purge had lower reported rates of abuse. The pattern and prevalence rate of reported abuse were similar in the two clinics, suggesting that the association was not a product of a specific method of eliciting disclosure. Implications for treatment and possible causal mechanisms behind this relationship are discussed.

The relationship between nocturnal motility and the enuresis alarm device.

The mode of action of the enuresis alarm is not clear. Earlier work suggested that the wire mesh itself may alter sleep and in this way affect nocturnal enuresis. Seven healthy males have been studied within a two-period cross-over design in which their nocturnal motility, on and off an enuresis wire mesh, was recorded using a motility bed. There were no order, treatment or day effects in any of the variables studied. However, the mean hourly motility for each subject averaged over the three nights shows a substantial trend towards increased motility on the mesh. This lends some support to the hypothesis and merits further study.

Sociopsychological factors in chronic pelvic pain: a review.

Chronic pelvic pain is a common gynecological problem. There has long been an assumption that social and psychological factors play a part in its genesis in a significant subgroup, but their precise role remains unclear. More recently, childhood sexual abuse has been implicated as a specific risk factor. For this review, PSYCHLIT and MEDLINE searches for relevant publications were supplemented by tracing back through the latter's related reference lists. One hundred thirty-one references directly concerning pelvic pain were identified with varying emphasis on social and psychological aspects. A further 449 references were in related fields. Forty-three were considered to be helpful in directly exploring the link between chronic pelvic pain and sociopsychological factors and 22 of these reported specific studies directly relevant. In common with other research into chronic pain conditions, it appears unhelpful to separate this type of pain into "psychogenic" and "organic" categories. Clear case definition is essential. The specificity of childhood sexual abuse as a risk factor is unclear. It may be helpful to consider clearly defined subgroups with the condition in future studies. An example of such a subgroup with pelvic venous congestion is discussed.

Sociopsychological factors in women with chronic pelvic pain with and without pelvic venous congestion.

Social and psychological factors have long been proposed as being of importance in a sizeable subgroup of women complaining of unexplained chronic pelvic pain (CPP). The aim of this study was to examine this in two subgroups of CPP patients, thereby eliminating pain alone as the determining variable. Consecutive attenders at a clinic for CPP were assessed on a range of somatic, historical, social, and psychological variables using detailed interviews and questionnaires. They were subsequently allocated to one of two groups, based on the presence or absence of pelvic venous congestion (PVC). Significant associations emerged between some social arrangements, paternal parenting, and patterns of hostility in the group with pelvic venous congestion. The groups also differed in patterns of family illness, and the congested group tended to report more childhood sexual abuse (CSA). Clear case definition in CPP is important. In the subgroup with pelvic venous congestion early social experience may play an important role. Father-daughter relationships may be particularly relevant. Hostility patterns may influence the development of the condition. CSA does not appear to play a specific role in all unexplained CPP cases, but may have relevance for the subgroup with pelvic venous congestion.

Interviewing for sexual abuse: reliability and effect of interviewer gender.

An interview to detect histories of sexual abuse was administered to consecutive attenders at a gynecology clinic on two occasions, on one occasion by a male interviewer and on the other by a female interviewer. Fifty-six subjects were assessed, and at least partial agreement was found in 70% between the two interviews. Approximately one-third of incidents were reported at only one of the interviews, with gender of interviewer making little apparent difference to this. Contrary to expectation, subjects appeared more forthcoming at the first interview. Reasons for this are discussed. Interviews for sexual abuse must be carried out in an appropriate context, and simple routine screening questions may not be appropriate. Selection of interviewers on the basis of gender alone may not be helpful.

Undergraduate training for communication in medical practice.

Communication is a major aspect of medical practice in such areas as the consultation, counselling, team work, management duties, health education and teaching. Many communication skills essential to the clinical consultation are different from those used in everyday life. They require an understanding of the doctor/patient relationship and of the self as well as of others. They also require a subserving repertoire of specific behavioural skills. The present paper sets out to emphasize this pervasive importance of communication skills in medical practice and to suggest some educational goals and objectives for those skills of particular relevance to the consultation. It describes one attempt to pursue these within the author's own school despite the piecemeal nature of such teaching. In Britain great emphasis is placed on the importance of clinical skills and this is reflected in the priority given to them in the final professional examination, and yet their communication aspects are rarely well defined within the curriculum or directly assessed. The author advocates the teaching and assessment of communication skills as a continuous process throughout undergraduate and postgraduate medical education for clinical practice.

Sleep and the enuresis alarm device.

The effect on sleep of the wire-mesh element within the `buzzer and pad' enuresis alarm device was studied using healthy adult volunteers in a single or double crossover design. Polygraphic recording revealed a reduction in the number of shifts between sleep stages, and in the time spent in wakefulness, movement and stage 1, on the nights when the mesh was in the bed. This effect may be responsible for preventing some of the enuretic episodes which would otherwise have occurred at such times.

Sleepwalking, night terrors, and consciousness.

OBJECTIVE: To determine some personality and psychoneurotic characteristics of adults who have the sleepwalking-night terrors syndrome. DESIGN: Prospective assessment of two groups of consecutive patients with a firm diagnosis of either of two specific sleep disorders as established clinically and by polysomnography. SETTING: Outpatient sleep disorders clinic and sleep laboratory in a tertiary referral centre. PATIENTS: 12 Patients referred consecutively to the clinic in whom a diagnosis of sleepwalking (six) or night terrors (six) was confirmed. MAIN OUTCOME MEASURES: Psychological characteristics as measured at the time of clinical assessment by means of the Eysenck personality questionnaire, the hostility and direction of hostility questionnaire, and the Crown-Crisp experiential index. RESULTS: Both groups scored exceptionally highly on the hysteria scale of the Crown-Crisp experiential index and the night terrors group also scored highly on the anxiety scale. The patients with sleepwalking also scored highly on a measure of externally directed hostility. CONCLUSIONS: The physiological and psychological features identified in these patients, possibly reflecting different expressions of a constitutional cerebral characteristic, may be explored in terms of hysterical dissociation. The findings contribute to the debate concerning the nature of sleepwalking, in particular with and without the forensic aspects.