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At least 613 records · Page 34Linked to original sources
PubMed2007

Inhibitory control in children with autism spectrum disorder.

Impairments in executive abilities such as cognitive flexibility have been identified in individuals with autism spectrum disorder (ASD). It remains unclear, however, whether such individuals also experience impairments in another executive ability: inhibitory control. In the present study, we administered three inhibitory tasks to 18 children with ASD, 23 siblings of children with ASD, and 25 typically developing children. After controlling for individual differences in age, overall IQ, and processing speed, children with ASD demonstrated impaired performance on two of the three inhibitory tasks. Results suggest that children with ASD experience circumscribed deficits in some but not all aspects of inhibitory control. More generally, the findings underscore the importance of using multiple measures to assess a putative single cognitive ability.

Adolescent↗
PubMed2007

Response to joint attention in toddlers at risk for autism spectrum disorder: a prospective study.

Response to joint attention (RJA) is impaired in preschoolers with autism spectrum disorder (ASD) and is pivotal to social and communication development. Response to joint attention was examined at 14 and 24 months in 51 children at high risk for autism (siblings of children with autism). Outcome groups at age 3 years included ASD (n = 16), broader autism phenotype (n = 8), and non-broader autism phenotype (n = 27). The ASD group made minimal improvement in RJA between 14 and 24 months, but stability of RJA across tasks increased for all three groups. Significantly, lower RJA was observed for the ASD group at 24 months. Response to joint attention performance at 14 months predicted ASD outcome. Response to joint attention is an important screening and early intervention target.

Attention↗
PubMed2006

Early social and emotional communication in the infant siblings of children with autism spectrum disorders: an examination of the broad phenotype.

Infants with older siblings with Autism Spectrum Disorders (ASD-sibs) are at risk for socioemotional difficulties. ASD-sibs were compared to infants with typically developing older siblings (TD-sibs) using the face-to-face/still-face (FFSF) at 6 months and the Early Social Communication Scale (ESCS) at 8, 10, 12, 15, and/or 18 months. ASD-sibs smiled for a lower proportion of the FFSF than TD-sibs and lacked emotional continuity between episodes. With respect to TD-sibs, ASD-sibs engaged in lower rates of initiating joint attention at 15 months, lower rates of higher-level behavioral requests at 12 months, and responded to fewer joint attention bids at 18 months. The results suggest subtle, inconsistent, but multi-faceted deficits in emotional expression and referential communication in infants at-risk for ASDs.

Adolescent↗
PubMed2006

Effects of different attentional cues on responding to joint attention in younger siblings of children with autism spectrum disorders.

We compared responding to joint attention (RJA) in younger siblings of children with ASD (SIBS-ASD; n = 46) and younger siblings of children developing typically (SIBS-TD; n = 35). Children were tested between 12 and 23 months of age in a situation in which an experimenter directed the child's attention to one of 8 targets. Each child responded to 10 different combinations of verbal and nonverbal cues containing varying levels of attention-specifying information. SIBS-ASD had significantly lower overall RJA scores than SIBS-TD. Moderately redundant cues were most difficult for SIBS-ASD relative to SIBS-TD; adding a point to moderately redundant cues improved RJA for SIBS-ASD, bringing them to a level of RJA commensurate with SIBS-TD.

Attention↗
PubMed2026

ADAM10's combined influence on the diagnostic usefulness of IL 22, IL 10, IL-17 A, and IL-17D in autism spectrum disorders: Predicted role on gut leakiness as co-morbidity.

Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder with increasing global prevalence but a lack of reliable diagnostic biomarkers. Emerging evidence suggests that immune dysregulation, gut-brain axis dysfunction, and increased intestinal permeability play key roles in ASD pathophysiology. This study investigated the combined diagnostic value of ADAM10 and cytokines (IL-10, IL-22, IL-17 A, and IL-17D). Multivariable logistic regression produces an improved ROC curve that improves diagnostic accuracy over individual markers by combining numerous predictors into a single risk score (linear predictor). The technique, which frequently raises individual marker AUCs, entails modelling a binary result, calculating the probability, and visualizing ROC based on the projected probabilities. In this case-control study, plasma levels of ADAM10, IL-10, IL-22, IL-17 A, and IL-17D were measured in 37 male children with ASD and 37 age-matched controls. Group comparisons, correlation analyses, and receiver operating characteristic (ROC) curve analyses, including combined ROC models, were performed. ADAM10, IL-22, and IL-17 A levels were significantly reduced in children with ASD compared to controls, whereas IL-10 and IL-17D showed no significant differences. ADAM10, IL-17 A, and IL-22 demonstrated good diagnostic performance, with AUC values of 0.886, 0.855, and 0.812, respectively. In contrast, IL-10 and IL-17D showed poor discriminatory ability, with AUC values of 0.524 and 0.599, respectively. Combined ROC analysis markedly improved diagnostic accuracy, with all panels including ADAM10 achieving AUC values above 0.90, and some reaching as high as 0.988, with high sensitivity and specificity. The combination of ADAM10 with selected cytokines significantly enhances diagnostic performance compared to individual markers, supporting a link between immune dysregulation, barrier dysfunction, and gut permeability in ASD.

Humans↗
PubMed1983

Spontaneous closure of secundum atrial septal defect in infants and young children.

The records of 264 pediatric patients with uncomplicated ostium secundum atrial septal defect (ASD) were reviewed. Eighty-seven patients were younger than age 4 years at the time of cardiac catheterization. Subnormal weight gain, frequent pneumonia, cyanosis or tachypnea were present in 26 patients (30%). Of the 36 infants at catheterization, 17 (48%) had the previously described symptoms, including 12 (33%) who had congestive heart failure. Eight of the 36 infants were found to have closed their defect at a subsequent catheterization. Six of 18 patients who underwent cardiac catheterization between 1 and 2 years of age also had spontaneously closed their ASD at subsequent study. Statistical analysis of hemodynamic data revealed no difference (except a smaller shunt size) between ASDs that closed and those that did not in patients who were less than 4 years at initial catheterization. Analysis of hemodynamic data revealed no statistical differences between groups of patients with an ASD who were younger than and those older than 4 years at time of diagnostic study. Patients with ASDs that closed were significantly different from patients with atrial level shunting thought to be secondary to a valve-incompetent foramen ovale with respect to age at initial study (11 versus 2 months, p less than 0.001), mean left atrial pressure (7.7 versus 12.3 mm Hg, p less than 0.02) and difference between mean right and left atrial pressures (1.0 versus 4.2 mm Hg, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Angiocardiography↗
PubMed1985

Pre- and postoperative electrophysiologic assessment of children with secundum atrial septal defect.

Sinus node (SN) and atrioventricular node (AVN) dysfunction after repair of atrial septal defect (ASD) may be caused by inherent nodal abnormalities and not related to altered hemodynamics. To assess the preoperative prevalence and postoperative persistence of nodal dysfunction, 21 consecutive children, mean age 5.4 years, underwent electrophysiologic evaluations before ASD repair. Preoperative SN recovery time was prolonged in 11 patients and was associated with abnormal AVN response to rapid atrial pacing in 5. There were no significant differences in age, hemodynamic values or shunt size between children with normal and those with abnormal nodal function. Atrial and AVN refractory periods were normal. The ASD was repaired in 9 children with SN dysfunction. Electrophysiologic studies performed 4 to 16 months after surgical correction showed improvement in all electrophysiologic values. However, SN function remained abnormal. Significant decreases were observed in atrial (p less than 0.05) and AVN (p less than 0.05) refractory periods, with increased atrial conduction velocity (p less than 0.01) and AVN Wenckebach response to atrial pacing (p less than 0.01). ASD repair improved nodal and atrial muscle electrophysiologic function, theoretically by relieving stress on atrial impulse propagation. SN and AVN dysfunction may persist as an inherent part of the ASD complex.

Adolescent↗
PubMed1985

Transatrial septal velocity measurement by Doppler echocardiography in atrial septal defect: correlation with Qp:Qs ratio.

Right atrial velocities measured perpendicular to the atrial septum by Doppler echocardiography in patients with atrial septal defects (ASD) have a discernible morphology that may bear a relation to shunt magnitude. The integral of the right atrial Doppler waveform was compared with shunt magnitude measured at cardiac catheterization or nuclear shunt scan in 17 ASD patients. For control subjects, the mean right atrial velocity was 15 +/- 4 cm/s (+/- standard deviation) and that for ASD patients was 41 +/- 11 cm/s (p less than 0.001). Doppler pulmonary-to-systemic flow ratio (Qp:Qs) correlated with catheterization Qp:Qs ratio (n = 9, r = 0.85, SEE = 0.27) and with nuclear Qp:Qs ratios (n = 8, r = 0.60, SEE = 0.51). Mean transatrial septal velocity in ASD patients correlated with catheterization Qp:Qs ratio (n = 9, r = 0.8, SEE = 6.0) and with simultaneous Doppler Qp:Qs ratio (n = 16, r = 0.89, SEE = 4.9, y = 16.2 +/- 8.3). Although Qp:Qs ratio can be approximated by measuring pulmonary and systemic flow by Doppler echocardiography in many ASD patients, this newly described method allows estimation of Qp:Qs ratio. It is useful when these more conventional measurements cannot be performed because of turbulence or when inadequate imaging prevents Doppler pulmonary to systemic flow measurement.

Adolescent↗
PubMed1985

Detection of intracardiac shunt flow in atrial septal defect using a real-time two-dimensional color-coded Doppler flow imaging system and comparison with contrast two-dimensional echocardiography.

To evaluate the noninvasive detection of shunt flow using a newly developed real-time 2-dimensional color-coded Doppler flow imaging system (D-2DE), 20 patients were examined, including 10 with secundum atrial septal defect (ASD) and 10 control subjects. These results were compared with contrast 2-dimensional echocardiography (C-2DE). Doppler 2DE displayed the blood flow toward the transducer as red and the blood flow away from the transducer as blue in 8 shades, each shade adding green according to the degree of variance in Doppler frequency. In the patients with ASD, D-2DE clearly visualized left-to-right shunt flow in 7 of 10 patients. In 5 of these 7 patients, C-2DE showed a negative contrast effect in the same area of the right atrium. Thus, D-2DE increased the sensitivity over C-2DE for detecting left-to-right shunt flow (from 50% to 70%). However, the specificity was slightly less in D-2DE (90%) than C-2DE (100%). Doppler 2DE could not visualize right-to-left shunt flow in all patients with ASD, though C-2DE showed a positive contrast effect in the left-sided heart in 9 of 10 patients with ASD. Thus, D-2DE is clinically useful for detecting left-to-right shunt flow in patients with ASD.

Adolescent↗
PubMed1990

Transesophageal echocardiographic guidance of transcatheter closure of atrial septal defect.

Transcatheter closure of atrial septal defect (ASD) was accomplished in 10 of 11 patients aged 13 months to 46 years (weight range 11 to 77 kg). Transesophageal echocardiography (TEE) was used simultaneously with fluoroscopic imaging in 4 of these patients aged 4.5 to 46 years (weight range 19 to 77 kg). TEE was used to ascertain defect size, position and number of defects and to ascertain appropriate seating of the defect occluder within the atrial defect. In 2 patients TEE-assisted transcatheter ASD closure was accomplished after previous attempts at transcatheter ASD closure, unaided by TEE, had been unsuccessful. The only unsuccessful ASD closure procedure occurred in the smallest patient in the series (an 11-kg 13-month-old), a child who was too small to undergo TEE using our 11-mm diameter endoscopic probe. The concomitant use of TEE with fluoroscopic imaging provides information that is unique and complementary and may improve the efficacy and safety of the transcatheter technique for ASD closure. The recent availability of a 7-mm diameter TEE probe will extend the use of TEE into the infant age group and may decrease the discomfort and potential morbidity of TEE in older patients.

Cardiac Catheterization↗
PubMed1995

Photoaffinity labeling of cottonseed microsomal N-acylphosphatidylethanolamine synthase protein with a substrate analogue, 12-[(4-azidosalicyl)amino]dodecanoic acid.

N-Acylphosphatidylethanolamine (NAPE), an unusual acylated derivative of phosphatidylethanolamine (PE), is synthesized from free fatty acids and PE in cotton seedlings (Chapman and Moore (1993) Plant Physiol. 102(3), 761-769). Here we use a photoreactive dodecanoic acid analogue, [12-(4-azidosalicy)amino]dodecanoic acid (ASD), and its 125I-labeled derivative to identify a protein subunit which corresponds to this cottonseed NAPE synthase activity. Dodecylmaltoside (DDM)-solubilized microsomal NAPE synthase enzyme was irreversibly and progressively inactivated by adding increasing concentrations of ASD and illuminating with UV254 light. Protection from this photoinactivation was afforded by the natural substrate, palmitic acid. In low light, microsomal NAPE synthase utilized ASD as a substrate to synthesize NAPE; palmitic acid competed for this activity. NAPE synthase activity was measured directly in gel slices following nondenaturing PAGE of DDM-solubilized microsomal membrane proteins. Two-dimensional electrophoresis (nondenaturing PAGE, followed by SDS-PAGE) of photoaffinity-labeled, DDM-solubilized microsomal proteins revealed a 64 kDa polypeptide that was associated with the active NAPE synthase enzyme. Also, a 64 kDa protein was photoaffinity labeled in all NAPE synthase isozyme fractions isolated by preparative isoelectric focusing; photoaffinity labeling of this 64 kDa polypeptide was diminished in the presence of exogenously supplied palmitic acid. Collectively, our results demonstrate that ASD specifically interacts with NAPE synthase in a manner analogous to its fatty acid substrate and indicate that a 64 kDa polypeptide is a component of cottonseed microsomal NAPE synthase. ASD will be a useful molecular probe in future studies aimed at understanding the physiological role of this NAPE synthase enzyme in membranes of plant cells.

Acyltransferases↗
PubMed1996

Antecedents and consequences of acute stress disorder among motor vehicle accident victims.

The aim of this study was to examine differences between motor vehicle accident (MVA) victims diagnosed retrospectively with Acute Stress Disorder (ASD) and subsequent Post-Traumatic Stress Disorder (PTSD), and MVA victims with only PTSD. A total of 14 ASD subjects and 28 PTSD subjects (matched on age and on sex) were compared on subjects' levels of functioning and symptom severity at three time-points: pre-MVA, 1-4 months post-MVA (initial assessment), and 6 months post initial assessment. Fourteen non-MVA subjects were included as controls in the analyses for pre-MVA differences and presence of psychopathology at time of initial assessment. ASDs had higher rates of previous mood disorders (other than major depression), previous AXIS-I disorders, and previous AXIS-II disorders than did PTSDs. No differences existed between the groups at 6-month follow-up. These results provide clinically useful information regarding characteristics that predispose people to develop ASD in the aftermath of a trauma. Previous research with trauma victims has demonstrated dissociative symptoms to be associated with higher PTSD symptom severity and longer symptom duration, but our follow-up results suggest that ASD, which is characterized by dissociative symptomatology, is not indicative of poorer outcome in MVA victims.

Accidents, Traffic↗
PubMed2004

Five-year clinical and echocardiographic evaluation of the Das AngelWings atrial septal occluder.

BACKGROUND: The late outcome of patients treated with atrial septal occluder devices remains incompletely defined. The purpose of this study was to assess the late outcome (range 4-7 years postprocedure) of patients in whom the Das AngelWings septal occluder device was implanted in the atrial septum. We report the clinical and echocardiographic outcome, at an average of 5 years following the procedure, of patients treated with the Das AngelWings device used to close either a secundum atrial septal defect (ASD) or a patent foramen ovale (PFO). METHODS: Thirty-two patients underwent successful percutaneous closure of an atrial septal closure, patent foramen ovale, or fenestration in the lateral tunnel of their Fontan with the Das AngelWings device between June 1995 and March 1998 at Duke University Medical Center. Two of the 32 patients were lost to follow-up. The remaining 30 patients were divided into 3 groups based on indication for device implantation. Group 1 consisted of 14 patients with a secundum ASD and predominantly left-to-right atrial shunting. Group 2 consisted of 8 patients who had a PFO and who suffered a thromboembolic event. Group 3 (compassionate use) consisted of 10 patients with multiple comorbid medical problems with predominantly right-to-left shunting at the atrial level causing hypoxemia. Eight of the patients in group 3 were severely ill at the time of device implantation. The 2 remaining patients in group 3 underwent AngelWings implantation for closure of right-to-left shunting through a Fontan fenestration. Mean follow-up was 59 months. RESULTS: There was no device embolization. No patient in the ASD or PFO/stroke group had a clinical complication. By radiographic examination, 2 of 27 patients had evidence of fracture of the nitinol framework at 2-year follow-up. Residual shunting was present in 44% at 24 hours, 20% at 1 year, and 18.8% at 2 years by use of Doppler color flow imaging and/or microcavitation echocardiographic studies. Mild mitral regurgitation caused by the AngelWings device occurred in 1 patient. One patient in the compassionate use group had a subsequent neurologic event. Five of the 10 patients in the compassionate use group died of comorbid illnesses in follow-up, none directly related to device complications. CONCLUSION: The late clinical outcome of secundum ASD and PFO/stroke patients in this study demonstrates that Das AngelWings closure of the atrial septum is effective and safe. These data are encouraging with respect to the expanding use of other percutaneously implanted ASD occlusion devices, although late clinical safety and efficacy data are needed for the specific devices being implanted.

Adolescent↗
PubMed2006

Percutaneous versus surgical closure of secundum atrial septal defect: comparison of early results and complications.

BACKGROUND: Surgical closure of atrial septal defect (ASD) provides excellent results. Given the increasing popularity of percutaneous techniques, a comparison between the 2 methods is needed. METHODS: Between December 1988 and June 2003, we performed 1284 procedures in 1268 consecutive patients with isolated secundum ASD. Five hundred and thirty-three patients underwent surgical repair of ostium secundum ASD (group A). Seven hundred and fifty-one consecutive patients underwent percutaneous ASD closure (group B). The following outcomes were studied: mortality, morbidity, hospital stay, and efficacy. RESULTS: There were no postoperative deaths. The overall rate of complications was higher in group A than in group B: 44% (95% CI 39.8%-48.2%) versus 6.9 % (95% CI 5%-8.7%) (P < .0001). Major complications were also more frequent in group A: 16% (95% CI 13%-19%) versus 3.6% (95% CI 2.2%-5.0%) (P = .002). Multiple logistic regression analysis showed that surgery was independently strongly related to the occurrence of total complication (odds ratio [OR] 8.13, 95% CI 5.75-12.20) and of major complications (OR 4.03, 95% CI 2.38-7.35). The occurrence of minor complications was independently related to surgery (OR 7.33, 95% CI 4.75-11.02), childhood (OR 1.52, 95% CI 1.01-2.34), and presence of systemic hypertension (OR 1.35, 95% CI 1.01-4.41). Hospital stay was shorter in group B (3.2 +/- 0.9 vs 8.0 +/- 2.8 days, P < .0001). CONCLUSIONS: Percutaneous ASD closure provides, in experienced hands and in highly specialized centers, excellent results with a lower complication rate and requires a shorter stay in hospital.

Adolescent↗
PubMed2004

Transthoracic echocardiographic guidance of transcatheter atrial septal defect closure.

This study examines the safety and efficacy of transthoracic echocardiographic (TTE) guidance of atrial septal defect (ASD) device closure. We evaluated 74 patients for TTE-guided ASD closure. Fifty-six patients had successful device implantation using TTE guidance. Twelve patients were referred for surgical ASD closure on the basis of TTE evaluation. Five patients with multiple ASDs or poor transthoracic acoustic windows had ASD device closure guided by transesophageal echocardiography (TEE).

Adolescent↗
PubMed2006

New minimally invasive technique to occlude secundum atrial septal defect in 53 patients.

BACKGROUND: Conventional surgical atrial septal defect (ASD) closure requires cardiopulmonary bypass, whereas percutaneous transcatheter closure is limited by maximal defect size of 34 mm and access to the neck. We describe a new minimally invasive approach using a right minithoracotomy to deploy an occluder without cardiopulmonary bypass. METHODS: Between October 2004 and April 2005, 53 secundum ASDs were closed by this method. Through a 3-cm incision in the right fourth intercostal space, a minithoracotomy exposes the right atrium to facilitate deployment of the septal closure device. The age of the patients was from 2 to 61 years. The ASD size was 12 to 39 mm. RESULTS: All ASDs were successfully closed with a mean device size of 33.1 +/- 8 mm (range, 16 to 46 mm). The procedure duration was 30 to 60 minutes. All patients were extubated on table, with less than a 1-day stay in the intensive care unit. The hospital stay was 3 to 7 days. There was no postoperative mortality. At mean follow-up of 1 to 8 months, there were no major morbidities. One patient had minimal residual shunt that resolved 1 month later. CONCLUSIONS: This new minimally invasive method of secundum ASD closure is safe and cosmetically superior to conventional surgery. Early results are encouraging.

Adolescent↗
PubMed2006

Three-dimensional echo and videocardioscopy-guided atrial septal defect closure.

BACKGROUND: Current real-time three-dimensional echocardiography systems (RT3DE) can provide sufficient visualization to permit atrial septal defect (ASD) closure. However, detailed visualization of small objects inside the heart is still suboptimal because of limited resolution, which is a limitation for clinical application. We evaluate the complementary use of videocardioscopy in image-guided ASD closure. METHODS: In a pig model (n = 5), a 4-mm to 8-mm ASD was created with RT3DE guidance. Defect closure was accomplished with a catheter-based patch-delivery system fixed around the defect with mini-anchors under combined RT3DE and videocardioscopy guidance. The endoscope was inserted into the heart through a custom built port designed to allow visualization in the presence of blood. RESULTS: All ASDs were successfully closed. The combination of RT3DE and videocardioscopy allowed detailed visualization of intracardiac structures, instruments, patch, and mini-anchors. CONCLUSIONS: Beating-heart ASD closure can be achieved with combined RT3DE and videocardioscopy imaging. Use of videocardioscopy provides high-resolution imaging and likely improves safety of the image-guided procedure.

Animals↗
PubMed2006

Sex differences in oxytocin and vasopressin: implications for autism spectrum disorders?

Autism spectrum disorders (ASD) are male-biased and characterized by deficits in social behavior and social communication, excessive anxiety or hyperreactivity to stressful experiences, and a tendency toward repetitiveness. The purpose of this review is to consider evidence for a role for two sexually dimorphic neuropeptides, oxytocin (OT) and arginine vasopressin (VP), in these features of ASD. Both VP and OT play a role in normal development. VP is androgen-dependent and of particular importance to male behavior. Excess VP or disruptions in the VP system could contribute to the male vulnerability to ASD. Alternatively, protective processes mediated via OT or the OT receptor might help to explain the relatively rare occurrence of ASD in females. Disruptions in either OT or VP or their receptors could result from genetic variation or epigenetic modifications of gene expression, especially during early development. Deficits in other developmental growth factors, such as reelin, which may in turn regulate or be regulated by OT or VP, are additional candidates for a role in ASD.

Amygdala↗