Dysphagia in Parkinson's Disease Improves with Vocal Augmentation.

While voice-related disorders in Parkinson's disease (PD) are commonly discussed in the literature, dysphagia in PD is less widely published. Vocal fold augmentation, including injection laryngoplasty (IL), is a well-established treatment for glottal insufficiency (Cates et al. in Otolaryngol Head Neck Surg 155(3):454-457, 2016). This study aimed to observe the effects of IL in PD patients with vocal bowing, with or without therapy, on glottic closure and patient-reported dysphagia outcomes. The study design was based on retrospectively collected database and cohort-case series. PD patients selected for retrospective review over a 2-year period were referred and evaluated in the Voice, Swallowing, and Airway multidisciplinary clinic by speech language pathologist and laryngologist, and were undergoing IL. Charts were reviewed for age, gender, Body Mass Index (BMI), onset of PD, and Movement Disorders Society-Unified Parkinson's Disease Rating Scale Part 3 (MDS-UPDRS) scoring. We compared pre/postoperatively (> 1 < 3 months) using validated patient-reported outcome tools: Reflux Symptom Index (RSI), Glottal Function Index (GFI), Eating Assessment Tool-10 (EAT), and stroboscopic examinations. The study included 14 patients undergoing 22 IL or 1.6 IL/patient: mean age 70 years (63-80), 100% male, and BMI 25.9 ± 4.3 (mean ± SD). MDS-UPDRS scoring 33 ± 20 (moderate severity), with time between PD diagnosis and IL 8 ± 10 years. All patients had pre- and post-stroboscopic examinations; however, only 4:14 underwent formal swallowing evaluation. Overall, 14 IL patients improved on patient-reported measures (ΔRSI = 4; ΔGFI = 3; ΔEAT = 4). Based on the findings of the study, we conclude that PD is a progressive neurodegenerative condition with dysphagia. The presented pilot data suggest that IL may be considered as a beneficial adjunct for PD patients with glottal insufficiency. LEVEL OF EVIDENCE: 4.

Investigating non-attendance at colposcopy clinic.

We investigated non-attendance at colposcopy clinic. This was a retrospective case-control study conducted to find out any specific characteristics for women who failed to attend their appointment at colposcopy during a 3-month period, in comparison to attenders. The incidence of non-attendance was 23.7%. Younger age, smoking, occurrence of pregnancy, previous history of termination of pregnancy, anxiety and follow-up appointments were more common in non-attenders.

Neurologic function among termiticide applicators exposed to chlorpyrifos.

Chlorpyrifos is a moderately toxic organophosphate pesticide. Houses and lawns in the United States receive a total of approximately 20 million annual chlorpyrifos treatments, and 82% of U.S. adults have detectable levels of a chlorpyrifos metabolite (3,5, 6-trichloro-2-pyridinol; TCP) in the urine. The U.S. Environmental Protection Agency has estimated that there are 5,000 yearly reported cases of accidental chlorpyrifos poisoning, and approximately one-fourth of these cases exhibit symptoms. Organophosphates affect the nervous system, but there are few epidemiologic data on chlorpyrifos neurotoxicity. We studied neurologic function in 191 current and former termiticide applicators who had an average of 2.4 years applying chlorpyrifos and 2.5 years applying other pesticides, and we compared them to 189 nonexposed controls. The average urinary TCP level for 65 recently exposed applicators was 629.5 microg/L, as compared to 4.5 microg/L for the general U.S. population. The exposed group did not differ significantly from the nonexposed group for any test in the clinical examination. Few significant differences were found in nerve conduction velocity, arm/hand tremor, vibrotactile sensitivity, vision, smell, visual/motor skills, or neurobehavioral skills. The exposed group did not perform as well as the nonexposed group in pegboard turning tests and some postural sway tests. The exposed subjects also reported significantly more symptoms, including memory problems, emotional states, fatigue, and loss of muscle strength; our more quantitative tests may not have been adequate to detect these symptoms. Eight men who reported past chlorpyrifos poisoning had a pattern of low performance on a number of tests, which is consistent with prior reports of chronic effects of organophosphate poisoning. Overall, the lack of exposure effects on the clinical examination was reassuring. The findings for self-reported symptoms raise some concern, as does the finding of low performance for those reporting prior poisoning. Although this was a relatively large study based on a well-defined target population, the workers we studied may not be representative of all exposed workers, and caution should be exercised in generalizing our results.

Ozone. The good, the bad, and the ugly.

Sensitive individuals are at risk of adverse health effects from exposure to even modest levels of ozone. Such individuals are likely to develop respiratory symptoms and are more likely to be hospitalized when exposed to ozone at currently accepted levels. A review of scientific documents regarding the health effects of ozone has led the DHHS to agree with the EPA that the primary ambient air standard for ozone should be changed from 0.12 ppm (1-hour average) to 0.08 ppm (8-hour average). Achieving the proposed 0.08 ppm standard should decrease physician visits, hospitalization, and use of respiratory medications. In addition, because very susceptible healthy individuals may experience adverse health effects of the current standard, it is clear that the current standard provides little or no margin of safety, particularly for sensitive individuals. In order to avoid exposure to unhealthy levels of ozone, people should take precautions to minimize exposure from 2:00 to 6:00 pm on days when ozone levels are high. This is especially so for children, adults who are active outdoors, those with respiratory disease such as asthma, and people with unusual susceptibility to ozone.

Delayed luteo-placental shift of progesterone production in IVF pregnancy.

OBJECTIVE: To observe absolute and relative levels of progesterone, 17 alpha-hydroxyprogesterone (17-OHP) and human chorionic gonadotrophin (hCG) in in vitro fertilization (IVF) pregnancies after withdrawal of luteal support. METHOD: Single blood samples were obtained from 41 pregnant women following IVF treatment and 43 normal pregnant women at various weeks gestation within the first trimester. Progesterone, 17-OHP and hCG were measured by immunoassay. RESULTS: Serum levels of progesterone, but not of hCG, in IVF pregnancies were significantly greater than in normal pregnancies up to 8 weeks post-conception, despite discontinuing luteal support 2 weeks after conception. The ratio of progesterone to 17-OHP, a predominantly ovarian product, in normal pregnancies rose between 4 and 9 weeks but did not change over the same period in IVF pregnancies. CONCLUSION: The luteal contribution to maternal serum levels of progesterone is much higher in IVF pregnancies compared with normal pregnancies. This is sustained throughout the first trimester without the need for luteal support and obscures the placental contribution of progesterone for much longer than in normal pregnancies. Progesterone or hCG supplements may therefore be unnecessary in IVF pregnancy.

Effects of co-trimoxazole, erythromycin, amoxycillin, tetracycline and chloroquine on sperm function in vitro.

This in-vitro study was designed to investigate the effects of commonly prescribed antibiotics on sperm movement characteristics, viability and the ability of spermatozoa to undergo the acrosome reaction. Spermatozoa were obtained by swim-up from normozoospermic semen and cultured for 24 h with increasing concentrations of co-trimoxazole, erythromycin, amoxycillin, tetracycline and chloroquine. Tetracycline at concentrations as low as 2.5 microg/ml led to a significant dose-dependent inhibition in percent rapid-moving spermatozoa, mean path velocity (VAP), straight-line velocity (VSL) and curvilinear velocity (VCL), but at 50 microg/ml tetracycline all spermatozoa were static. Erythromycin had significant effects on rapid movement, VAP, VSL and VCL only at concentrations >100 microg/ml. In contrast, percent rapid-moving spermatozoa was significantly enhanced at low concentrations of chloroquine (5 microg/ml), but significantly inhibited by higher concentrations. Co-trimoxazole did not adversely affect percent rapid-moving spermatozoa below 500 microg/ml, at which concentration movement was decreased by 34%. The mean lateral head displacement (ALH) was significantly enhanced by 5 microg/ml co-trimoxazole and reduced at 1 mg/ml erythromycin. The effects of these drugs were mostly irreversible. Amoxycillin had no effect on sperm movement characteristics over the dose range used, though it inhibited viability at high doses. Viability was significantly reduced at concentrations of all drugs which affect rapid sperm movement; these concentrations of drugs did not appear to affect the ability of spermatozoa to undergo the acrosome reaction. The results from this study, when combined with known effects on spermatogenesis, should facilitate the choice of drugs for the treatment of both genitourinary and unrelated infections in men who are attempting to conceive.

Memory, repression, and child sexual abuse: forensic implications for the mental health professional.

Childhood sexual abuse is prevalent in our society today. Over the last 30 years, mental health professionals have become increasingly involved in the assessment and treatment of adults who were sexually abused as children. The emergence of the phenomenon of recovered memories has divided both families and mental health professionals. The current debate over repressed memory as well as the prominent theories in this area are discussed. Recent legal developments of repressed memory litigation are discussed along with examples of legal cases that are most relevant to mental health professionals today.

A bridge to intracytoplasmic sperm injection--high insemination concentrations benefit patients who have a reduced chance of fertilization with standard in-vitro fertilization.

This study was carried out to determine whether high insemination concentrations (HIC) could improve fertilization and pregnancy rates in patients who had either previously demonstrated poor fertilization rates in vitro using standard protocols (Group 1) or in whom a reduced chance of fertilization was indicated at semen assessment prior to in-vitro fertilization (IVF) (Groups 2 and 3). Forty nine patients were recruited for the study. Standard IVF was carried out in 1 ml volumes using 10(5) spermatozoa/ml. HIC treatment involved co-culture of spermatozoa and oocytes in microdroplets with insemination concentrations increased 10-50 fold higher than standard IVF. Fertilization and pregnancy rates were compared between standard IVF and HIC in individual patients either in consecutive cycles (Group 1) or using sibling oocytes in the same cycle (Group 2). Group 3 patients were treated with HIC for their first treatment cycle. HIC significantly improved the fertilization rate compared with standard IVF for Groups 1 (59.7 +/- 10.7 versus 19.6 +/- 5.4% respectively) and 2 (54.9 +/- 8.5 versus 34.0 +/- 8.5% respectively). HIC increased the pregnancy rate from 0% with standard IVF to 20% per embryo transfer in Group 1 patients. A single pregnancy derived from the transfer of HIC and IVF embryos occurred in Group 2. The fertilization rate (47.2 +/- 7.6%) and pregnancy rate (31.3% per embryo transfer) for Group 3 patients was higher than predicted. There was no increase in the rate of polyploidy with HIC. Provided there are sufficient numbers of motile spermatozoa, HIC may be offered as an initial form of treatment, thus permitting referral of only the poorest responders for intracytoplasmic sperm injection (ICSI).

The relationship of attention deficit hyperactivity disorder and conduct disorder to juvenile delinquency: legal implications.

Attention deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) are both disorders of childhood and adolescence that all too frequently extend into adulthood. But just what is the relationship between these two disorders? This study explores the overlap between these two disorders as they relate to juvenile delinquency; both are significant risk factors for the development of antisocial behavior. But there is more significance to the presence or absence of ADHD or CD in later antisocial behavior. Higher levels of defiant and/or aggressive behavior lead to antisocial acts as compared with lower levels of defiance and antisocial acts. Boys diagnosed with ADHD have higher felony rates than normal control boys, yet ADHD is not nearly as strong a predictor of offending behavior as is CD in study subjects. The presence of both CD and ADHD contributes to illegal behavior, and it is likely that early intervention in both disorders will reduce the prevalence of antisocial behavior.

Serum is more effective than albumin in promoting human embryo development and implantation.

OBJECTIVE: To compare the effects of serum with those of Albuminar-5 (Armour Pharmaceutical Co., Eastbourne, Sussex, United Kingdom) as medium supplements to Earl's balanced salt solution (EBSS) for IVF and subsequent embryo development. DESIGN: A retrospective study. Gametes and embryos from 318 patients were cultured in the presence of serum (group 1). Gametes and embryos from 130 patients were cultured in the presence of Albuminar-5 (group 2). Embryos obtained from IVF were replaced into the uterus within 48 hours after insemination. Surplus bipronucleate embryos were cultured up to 14 days with either serum or Albuminar-5. SETTING: Two tertiary referral fertility clinics; university teaching hospital. PATIENTS: Four hundred forty-eight patients with a wide spectrum of causes of subfertility, ranging in age from 24 to 43 years. MAIN OUTCOME MEASURES: Fertilization rate, pregnancy rate (PR), implantation rate, and surplus embryo development in vitro. RESULTS: The PR for group 1 patients was higher than that of group 2 (27.0% versus 15.4%, respectively). Although fertilization rates were identical in the two groups, cumulative embryo scores and implantation rates were significantly higher in group 1. There was no difference between the groups in age distribution, types of ovarian stimulation, numbers of patients with day 1 or day 2 transfers, or luteal phase support. Of 31 embryos cultured with serum, 54.8% reached the fully expanded blastocyst stage and 25.8% hatched. Of 19 embryos cultured with Albuminar-5, only 5.3% reached the fully expanded blastocyst stage and none hatched. CONCLUSIONS: The results suggest that, under certain conditions, serum supplementation yields better results than protein supplementation alone. The latter may be suitable only in conjunction with additional components.

Lack of evidence for a circadian rhythm of IGFBP-1 in the mother and fetus during labour.

OBJECTIVE: To determine whether the circadian rhythm of circulating levels of insulin-like growth factor binding protein-1 (IGFBP-1) is evident at the time of delivery. DESIGN: Prospective observational study in six pregnant women and cross-sectional study in 65 women at the time of delivery. SUBJECTS: Six pregnant women sampled over a period of 24 hours, 23 women sampled at the time of elective caesarean section, and 42 women sampled at the time of vaginal delivery. RESULTS: In the women sampled serially over a 24 hour period there was an obvious circadian rhythm of IGFBP-1 with a peak between 01.00 and 09.00 hours. In the women sampled at the time of delivery there was no evidence for any relationship between the time of delivery and maternal or fetal levels of IGFBP-1. CONCLUSIONS: The circadian rhythm of IGFBP-1 is not observed in women in labour. Therefore, the time of day is not an important confounding variable in studies on IGFBP-1 levels at the time of normal delivery.

Oestrogen and progesterone receptors in endometriosis: heterogeneity of different sites.

The expression of receptors for the ovarian steroid hormones oestrogen and progesterone was studied immunohistochemically using monoclonal antibodies in samples of endometriosis and endometrium in 22 patients. In nine patients samples of endometriosis from more than one site were studied. There was marked heterogeneity in expression of receptors in endometriosis, both when comparing lesions with the corresponding endometrium and also between samples of endometriosis collected from different sites within the same patient. It was suggested that local environmental factors related to the site, depth and degree of fibrosis of the lesions determine the amount of steroid hormone stimulation reaching the lesions and account for the observed difference between endometriosis and endometrium and between endometriosis lesions of different sites.

Munchausen syndrome by proxy in false allegations of child sexual abuse: legal implications.

A review of the literature regarding Munchausen syndrome by proxy in relation to allegations of child sexual abuse is presented. Problems in the diagnosis of Munchausen syndrome by proxy in these cases can be the result of a failure to consider that the allegations may be false, legal issues surrounding the child's testimony, and other biases in professional and legal attitudes towards allegations of sexual abuse. A proposal for a more stringent standard of care is made. Treatment of Munchausen syndrome by proxy is best effected by case management, with the person who made the diagnosis managing the case throughout the treatment. This person should act as liaison to relay information between all the parties involved.

An epidemiological study of attention-deficit hyperactivity disorder and major depression in a male prison population.

One hundred two inmates were interviewed and tested to determine epidemiological rates of attention-deficit hyperactivity disorder (ADHD) and depression in an adult male prison population. The Beck Depression Inventory, Hamilton Rating Scale, and four measures to assess childhood and adult ADHD were completed. The two disorders were diagnosed independently. Diagnosable ADHD was found to occur in 25.5 percent of the inmates, and major depression occurred in 25.5 percent of the inmates. A significant relationship between ADHD and depression was found to exist (p < .001). Having identified a major mental health problem in the prison population, implications include a need for further diagnosis and treatment of these disorders within a prison setting. The relationship between depression and ADHD also needs further examination.

Child sexual abuse examinations: proposed guidelines for a standard of care.

A review of the literature regarding child sexual abuse examinations is presented and a proposal for a more objective and stringent standard of care is made. Current limitations in sexual abuse examinations include examiner bias, faulty procedures or diagnostic materials, and varied or conflicting roles of the judicial, social service, and mental health systems. Examiners in such cases should have adequate and specific training, be a neutral party appointed by the court, record the proceedings, and have access not only to the alleged victim, but also to the accused and to other parties during the examination.

The effects on in-vitro fertilization of autoantibodies to spermatozoa in subfertile men.

Thirty-six infertile couples underwent treatment by in-vitro fertilization. In 16 couples (group 1) the male partner was positive for antisperm antibodies measured by direct mixed antiglobulin reaction, direct immunobead test, and serum and/or seminal plasma tray agglutination test. In 20 couples (group 2) the men had no such antibodies. Men with poor sperm motility were excluded. The female partners had no antisperm antibodies, and in the controls (group 2) infertility was due to a known female factor. The fertilization rate in couples without antisperm antibodies (group 2) was 72.7% compared to 50.5% when the men had antibodies. However, the pregnancy rate per embryo transfer was not significantly different in the two groups (46.1% in group 1, 33.3% in group 2). This indicates that antisperm antibodies in the male interfere with sperm--egg fusion and subsequent fertilization but once fertilization has occurred, the pregnancy rate remains the same.

Memory processes in children: implications for investigations of alleged child sexual abuse.

Allegations of child sexual abuse naturally raise the ire of the populace at large, as well as the fears and apprehensions of those who may be falsely accused as perpetrators. Within this emotionally charged and litigious climate, the memory functions of children have become a matter of acute interest for those professionals involved in the ensuing investigations and legal proceedings. This is especially true, given that the child witness, approaching a court of law, is likely to encounter numerous circumstances that will invite memory distortion. These circumstances include interviews by concerned adults and protective service workers, as well as cross-examination by a defense attorney. Well-intentioned efforts may be replete with leading questions or subtle inferences that may distort episodic memory. The present paper will discuss developmental aspects of long-term memory functions in children, events, and cognitive processes that may contribute to memory distortion, and recommendations for improving procedures related to the investigations of alleged child sexual abuse.

Comparison of mixed antiglobulin reaction and direct immunobead test for detection of sperm-bound antibodies in subfertile males.

OBJECTIVE: To compare two methods of detection of surface bound antibodies on spermatozoa from subfertile males. DESIGN: Prospective comparison of direct mixed antiglobulin reaction (MAR) for immunoglobulin (Ig)G with direct immunobead test (IgG and IgA) applied to spermatozoa from male partners of infertile couples. Circulating unbound antibody measured by tray agglutination test in serum and seminal plasma in a representative proportion. SETTING: Seminology laboratory. PATIENTS: One hundred nine male partners of infertile couples. RESULTS: Highly significant correlation between direct MAR (IgG) and direct immunobed test (IgG) and between both of these tests and serum unbound antibody measured by tray agglutination test. Highly significant correlation between direct immunobead test (IgA) and seminal plasma unbound antibody measured by tray agglutination test, but no correlation with MAR (IgG). CONCLUSIONS: Mixed antiglobulin reaction (IgG) is a cheap, quick, and sensitive screening test, but immunobead test (IgA) provides useful additional information on class of antibody on spermatozoa that may be clinically more important.

The plethysmograph: a review of recent literature.

There is much research to support the claim that the penile plethysmograph is a reliable and valid method of objectively measuring and assessing the erectile response in male sex offenders. The authors have reviewed some of the most recent literature dealing with this subject. The conclusion is that although the penile plethysmograph is the best objective measure of male sexual arousal and can be useful in the assessment and treatment of sex offenders, caution must be exercised because of the limitations. The limitations include using the plethysmograph as a predictive test, the lack of standards for administration and interpretation, the lack standardized norms, and the susceptibility to controlling results. Despite these limitations, the plethysmograph is often used as the single most important source of predictive data in some court rooms, boards of pardons, and for prison inmate classification systems. The plethysmograph is most effective in predictive situations when it is used in conjunction with multiple data source.