One-Year Follow-Up Diagnostic Stability of Autism Spectrum Disorder Diagnosis in a Clinical Sample of Children and Toddlers.

Some studies show that the diagnosis of Autism Spectrum Disorder could be considered reliable and stable in children aged 18 to 24 months. Nevertheless, the diagnostic stability of early ASD diagnosis has not yet been fully demonstrated. This observational study examines the one-year diagnostic stability of autism spectrum disorder diagnosis in a clinical sample of 147 children diagnosed between 18 and 48 months of age. The ADOS-2 scores were used in order to stratify children in three levels of symptom severity: Autism (AD; comparison score 5-7), Autism Spectrum Disorder (ASD; comparison score 3-4), and Sub-Threshold Symptoms; (STS; comparison score 1-2). Results: Overall, the largest part of children and toddlers diagnosed with autism spectrum disorder between 18 and 48 months continued to show autistic symptoms at one-year follow-up evaluation. Nevertheless, a significant percentage of children with higher ADOS severity scores exhibited a reduction of symptom severity and, therefore, moved towards a milder severity class one year later. Conversely, the number of subjects of the STS group meaningfully increased. Therefore, at one-year follow-up a statistically significant (χ2(2) = 181.46, p < 0.0001) percentage of subjects (25.2% of the total) who had received a categorical diagnosis of Autistic Disorder or Autism Spectrum Disorder in baseline no longer met the criteria for a categorical diagnosis. Furthermore, children who no longer met the criteria for autism spectrum disorder continue to show delays in one or more neurodevelopmental areas, possibly related to the emergence of other neurodevelopmental/neuropsychiatric disorders. Overall, the comprehensive results of the study account for a high sensibility but a moderate stability of ASD early diagnosis.

Lowering of elevated ambulatory blood pressure by HMG-CoA reductase inhibitors.

Controversial results were reported as to a possible blood pressure-lowering effect of statins. This may relate to methodological limitations (blood pressure measuring techniques) or to putative different effects of statins in different biologic conditions (cholesterol or blood pressure levels, age, etc). Patients with cholesterol>200 mg/dL and no previous statin treatment underwent 24-hour ambulatory blood pressure (ABP) monitoring and were classified as normotensives or hypertensives according to their ABP. They were randomized to statin (n=51, simvastatin or pravastatin, 10-20 mg/d; atorvastatin, 5-10 mg/d) or control treatment (n=23, soy lecithin, 20 g/d) for 2 months, after which ABP assessment was repeated. No consistent treatment-related reduction in ABP was observed in lecithin-treated patients (either hypertensives or normotensives) or in statin-treated normotensive patients (-0.7+/-5.1/-1.0+/-4.6 mm Hg, both P=ns). In contrast, statin-treated hypertensive patients showed lower systolic and diastolic blood pressure (-5.7+/-5.8/-3.5+/-3.9 mm Hg, both P<0.001), the effect was entirely accounted for by reduced daytime values with no change in nighttime values, and it was unrelated to the concomitant statin-induced cholesterol reduction. Statins moderately but significantly lower blood pressure in patients with high (but not with normal) ABP; the effect is confined to the daytime period and is unrelated to the extent of the cholesterol lowering.

Effects of slow, controlled breathing on baroreceptor control of heart rate and blood pressure in healthy men.

BACKGROUND: Slow, controlled breathing has been shown by cross-spectral techniques to potentiate arterial baroreflex control of heart rate. However, crucial aspects of the effects of slow breathing on the arterial baroreflex remain unsettled, namely whether the major function of the arterial baroreflex (i.e. the control of blood pressure) is also potentiated and whether baroreflex function is differentially modulated according to the age of the individual. OBJECTIVE: To examine the bradycardic and depressor responses to selective carotid baroreceptor stimulation by the neck chamber technique (-15 and -30 mmHg neck suction) and the cross-spectral R-R interval/systolic blood pressure relationship (alpha index). METHODS: In 24 resting, supine healthy male volunteers (aged 19-66 years, mean +/-SEM 37.5 +/- 3.19 years), blood pressure (Finapres), R-R interval (electrocardiogram) and ventilation (impedance) were recorded continuously. Both assessments were performed during spontaneous breathing and during 6 cycles/min controlled ventilation in random order. RESULTS: The depressor and bradycardic responses to neck suction were significantly larger during slow breathing than in spontaneous breathing (+32 and +85%, respectively; both P < 0.01). The alpha index was also significantly larger during slow breathing (+62%; P < 0.01). Even after the volunteers were divided into older (> 50 years, n = 9) and younger (< 30 years, n = 9) groups, the baroreflex potentiation related to slow breathing was clearcut and significant for both the depressor (+46 and +24% older and younger volunteers; both P < 0.01) and the bradycardic (+130 and +73% older and younger volunteers; both P < 0.01) responses. When the assessment was made by computing the cross-spectral alpha index, a marked potentiation related to slow breathing was observed in younger volunteers (+99%; P < 0.01), whereas in older volunteers only a trend to an enhancement (by 32%; P < 0.055) was observed. CONCLUSIONS: Slow controlled breathing is associated with potentiation of both the depressor and the cardio-inhibitory components of the arterial baroreflex, the potentiation being largely similar regardless of the age of the individual.