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.

Test-retest reliability and criterion validity of the Chinese version of CBCL, TRF, and YSR.

BACKGROUND: Psychometric properties of the Chinese version of CBCL, TRF, and YSR were understudied. This study aimed at examining their test-retest reliability and criterion validity. METHODS: Three Chinese community and clinic samples were recruited in Hong Kong. The parents, teachers, and youths respectively completed the CBCL, TRF, and YSR. RESULTS: The Chinese CBCL, TRF, and YSR were test-retest reliable and valid. However, there was score/case attenuation at retest. CBCL and TRF appeared to screen externalizing and ADHD problems better, while YSR screened internalizing problems better. CONCLUSIONS: Clinicians should be cautious about score/case attenuation at retest while using CBCL, TRF, and YSR to chart patients' progress. They should also recognize their different strengths in screening various disorders.

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.

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.

Dopamine receptor D4 (DRD4) gene in Han Chinese children with attention-deficit/hyperactivity disorder (ADHD): increased prevalence of the 2-repeat allele.

There is an increased prevalence of the 7-repeat (7R) allele of the dopamine receptor D4 (DRD4) gene in attention-deficit/hyperactivity disorder (ADHD). However, the population prevalence of the 7R allele varies considerably across ethnicity and is very low in Asians. To test whether this 7R allele/ADHD association still held in a Chinese clinical sample, 32 Han Chinese children with a confirmed ADHD diagnosis and normal IQ who were methylphenidate-responders were genotyped. None of them had a DRD4 7R allele. Instead, we observed a significantly increased prevalence of the 2-repeat (2R) allele in this clinical sample (33%) compared to ethnically-matched controls (20%) (chi(2)(1d.f.) = 5.90, P = 0.015). This approximately 1.65-fold increase of the 2R allele in our probands is close to the observed increase of the 7R allele in European-ancestry ADHD children. Recent genetic studies have indicated that the 2R allele in Asians is likely derived from the 7R allele. Further, available biochemical data indicate that both the 2R and 7R protein have blunted responses to dopamine compared to the 4R protein. Based on these results, we propose that the observed increased prevalence of the 2R allele in our Han Chinese ADHD probands is still consistent with the 7R allele hypothesis of ADHD in European-ancestry children. Recent studies have suggested that any variant from the conserved ancestral 4R allele might potentially alter biochemistry/phenotype. We hypothesize that an increased frequency of any non-4R allele may define the association of the DRD4 gene with ADHD that holds across ethnicity. The present findings, however, obtained with a small ADHD sample size, should be replicated.

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.

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.

Development and inter-rater reliability of a standardized verbal instruction manual for the Chinese Geriatric Depression Scale-short form.

The Geriatric Depression Scale (GDS) is a common screening tool for elderly depression in Hong Kong. This study aimed at (1) developing a standardized manual for the verbal administration and scoring of the GDS-SF, and (2) comparing the inter-rater reliability between the standardized and non-standardized verbal administration of GDS-SF. Two studies were reported. In Study 1, the process of developing the manual was described. In Study 2, we compared the inter-rater reliabilities of GDS-SF scores using the standardized verbal instructions and the traditional non-standardized administration. Results of Study 2 indicated that the standardized procedure in verbal administration and scoring improved the inter-rater reliabilities of GDS-SF.

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.

Congenital anosmia.

We present two cases demonstrating congenital anosmia. In both cases, magnetic resonance imaging (MRI) has served to highlight an interesting clinical oddity. To date, there has only been one study of the use of MRI in the assessment of patients with congenital anosmia who do not have Kallmann's syndrome.

The mental health of the peers of suicide completers and attempters.

This study examined the prevalence and risk of psychiatric disturbances and suicidal behaviours among the peers of suicide attempters and completers. The subjects were selected from high schools with and without history of student suicides in the past 3 years. The psychiatric disturbances (as measured by the YSR and CBCL), suicidal behaviours, drug use, and a wide range of potential risk factors were measured. About a quarter of the peers of suicide completers and attempters were probable psychiatric cases and 15-21% of them reported suicidal acts. The increased risk of psychiatric disturbances and suicidal behaviours were still evident after controlling for age, sex, and potential risk factors. The presence of psychiatric disturbances could not wholly account for the increased odds of suicidal behaviours. Peers of suicide attempters carried a higher risk than peers of suicide completers. The close friends of suicide completers were particularly at risk of internalising problems, whereas the close friends of suicide attempters were at high risk of externalising problems. The peers of suicide completers and attempters represent a high-risk group for psychiatric disturbances and suicidal behaviours. The specific association of different types of psychiatric disturbances in the peers of suicide completers and attempters suggested that different risk mechanisms might be in operation within these peer groups.

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.

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.

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.