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PubMed1999

Food "cravings" and the acute effects of alprazolam on food intake in women with premenstrual dysphoric disorder.

Women with premenstrual dysphoric disorder (PMS) report negative mood premenstrually, and increased food cravings and food intake. Although the benzodiazepine alprazolam has been used to treat PMS, alprazolam has been shown to increase food intake. The present study investigated the acute effects of alprazolam (0, 0.25, 0.50, 0.75 mg) on food intake in 19 women with PMS. Each dose was tested once during the premenstrual phase and again during the postmenstrual phase. Each session, before drug administration, participants completed a Food Desirability Questionnaire and selected lunch, which was consumed 3.5 h after drug administration. Desire for foods containing fat were significantly increased premenstrually compared to postmenstrually, while desires for carbohydrate (CHO) alone and beverages did not change as a function of menstrual cycle phase. Cognitive Restraint scores predicted the amount of food consumed, i. e. restrained eaters consumed less food at lunch. Alprazolam significantly increased food intake, specifically fat, premenstrually compared to postmenstrually. Restrained eaters consumed 26% more calories premenstrually following 0.75 mg alprazolam relative to placebo, whereas unrestrained eaters consumed 9% more calories. Thus, women with PMS, particularly restrained eaters, are more sensitive to the food-intake increasing effects of alprazolam premenstrually.

Adult↗

PubMed1992

Serotonergic function and late luteal phase dysphoric disorder.

Thirty-eight subjects who met criteria for the DSM-III-R diagnosis late luteal phase dysphoric disorder (LLPDD) were compared with 18 controls in 5-HT uptake kinetics of the platelets in the premenstrual (day 26) as well as in the postmenstrual phase (day 4) of the cycle. Furthermore, 5-hydroxytryptophan (5-HTP) was administered to LLPDD patients and controls in both phases of the cycle, to investigate pituitary sensitivity for serotonin. Plasma samples for the measurement of cortisol and beta-endorphin were taken before and after oral administration of 200 mg 5-HTP, and considered as an index of pituitary-adrenal function. LLPDD was not associated with a lower platelet 5-HT uptake and content in the premenstrual phase of the cycle, compared with the postmenstrual phase. Patients appeared not to be different from controls in 5-HT uptake kinetics of platelets in the premenstrual phase of the cycle. No main differences were observed between LLPDD patients and controls in their ability to respond with secretion of cortisol and beta-endorphin to 5-HTP stimulation, either in the premenstrual, or in the postmenstrual phase. This observation could not be attributed to differences in 5-HTP metabolism. The findings of the present study do not support a specific role for 5-HT in the pathophysiology LLPDD.

5-Hydroxytryptophan↗

PubMed1995

The neuroendocrine response to d-fenfluramine in women with premenstrual depression.

An oral d-fenfluramine neuroendocrine challenge test was carried out in 17 women with premenstrual depression and 14 controls, twice in each subject, once in the late luteal phase when mood change was likely to be at its worst (i.e. premenstrual) and once postmenstrually. Women weighing < 65 kg received 15 mg, the remainder 30 mg of d-fenfluramine. Although there was considerable individual variability, a substantial average prolactin response was observed in both groups but no phase, group or group x phase interaction effects were found. Oestradiol levels were significantly higher during the postmenstrual test but showed no relationship to prolactin response. Cortisol showed a more modest response to the drug and a phase effect was found, with cortisol increase being greater during the postmenstrual test in both groups. In contrast to earlier findings with i.v. L-tryptophan challenge, the present study failed to show any difference in neuroendocrine response between women with premenstrual depression and controls. These results suggest that 5-hydroxy-tryptophan2 receptor function is unaltered in perimenstrual mood disorder although other interpretations of the negative findings are discussed.

Adult↗

PubMed1994

Developmental study of leptomeningeal glioneuronal heterotopia.

The timing of the appearance of leptomeningeal glioneuronal heterotopia (LGH) and its immunohistochemical development were examined on autopsied brains ranging from 12 to 43 weeks of postmenstrual age. LGH appeared at 20 weeks postmenstrual age and its incidence gradually increased until 28-31 weeks. All patients with trisomy 13 who were older than 34 weeks postmenstrual age had LGH. Glial fibrillary acidic protein-positive glial processes appeared earlier in the subpial layer of brainstems in patients with trisomy 13 than in the controls without LGH, and protruded along the perforating vessels into the leptomeninges; therefore, LGH may be formed from the midfetal period and develop with an increase of subpial glial processes along perforating vessels.

Abnormalities, Multiple↗

PubMed1996

Prognostic value of abnormal EEG transients in preterm and full-term neonates.

The prognostic value of abnormal EEG transients was investigated in 362 subjects submitted to EEG recording during the neonatal age and followed-up at least until the 12th month of corrected age. The incidence of negative and positive spikes and sharp waves, of rhythmic sharp theta and delta activities and of alpha discharges were evaluated by means of a quantitative score. These abnormal EEG transients appeared to be generally rare and even absent in a large number of subjects. In infants with normal outcome their incidence tends to increase from low postmenstrual ages towards term period. Full-term newborns with abnormal neurological outcome presented a significantly higher incidence of these transients. Preterm infants with unfavourable evolution showed a higher incidence only when submitted to EEG recording at around term age. However, no difference between subjects with normal and abnormal outcome was detected in preterm infants when evaluated at low postmenstrual ages. The hypothesis that at low postmenstrual ages brain damage might, on the one hand, give rise to abnormal transients and, on the other, alter the "capability' of manifesting them (together with other EEG maturational aspects), might explain these results.

Brain↗

PubMed2005

3-D ultrasonographic imaging of the cerebral ventricular system in very low birth weight infants.

The purpose of the study was to assess reference ranges for lateral ventricular volume of very low birth weight (VLBW) infants using 3-D ultrasound (US). A total of 108 patients with birth weights < or =1500 g or mother's postmenstrual age < or =32 weeks were examined prospectively in a longitudinal study. Infants in conditions considered being potential confounders such as intraventricular haemorrhage (IVH) and periventricular leukomalacia (PVL) were not included in the calculations. Hence, 77 subjects remained for final statistical analysis. Mean postmenstrual age at birth was 194.5 (27 weeks and 5.5 days) +/- 14 SD days, mean birth weight was 972.5 +/- 236.3 SD g. Reference ranges for lateral ventricle volume were established from serial images. The exponential regression analyses revealed a weekly increase in volume of 6.3% (95% CI 4.4%-8.3%) and 6.6% (95% CI 4.7%-8.6%) in respect to the left and the right ventricle (p < 0.001). Postmenstrual age correlated significantly (p < or = 0.015) with ventricle volume. No significant association to head circumference could be determined. Establishment of reference values for the lateral ventricle volume of VLBW infants should facilitate application of 3-D US in routine diagnostics in neonatal intensive care units and detection of ventricular enlargement as a prediction of risk for poor neurodevelopmental outcome in high-risk cohorts.

Aging↗

PubMed2000

The effect of selenium supplementation on outcome in very low birth weight infants: a randomized controlled trial. The New Zealand Neonatal Study Group.

BACKGROUND: Low selenium (SE) status has been documented in preterm infants and has been suggested to be a risk factor for chronic lung disease. METHODS: A total of 534 infants with birth weight <1500 g were enrolled in 8 New Zealand centers in a double-blind placebo-controlled randomized trial of SE supplementation from week 1 of life until 36 weeks' postmenstrual age or discharge home. Supplemented infants received 7 microg/kg/d of SE when fed parenterally and 5 microg/kg/d when fed orally. Plasma SE and glutathione peroxidase concentrations were measured in mothers after delivery and in infants before randomization and at 28 days and 36 weeks' postmenstrual age. Primary outcome measures were oxygen dependency at 28 days and total days oxygen dependency. RESULTS: No significant differences were seen between the groups with respect to primary or secondary outcome measures, with the exception that fewer supplemented infants had an episode of sepsis after the first week of life (P <.038). Mean plasma SE concentrations were 0.33 micromol/L before randomization in both groups and at 28 days had risen in the supplemented group (0.56 micromol/L) but fallen in the control group (0.29 micromol/L) (P <.0001). There was no association between outcome measures and SE concentrations at 28 days or 36 weeks' postmenstrual age. However, lower maternal and infant prerandomization SE concentrations were associated with increased respiratory morbidity. CONCLUSIONS: Postnatal SE supplementation in very low birth weight infants did not improve neonatal outcome. Further investigation of SE supplementation of mothers from the second half of pregnancy is warranted.

Double-Blind Method↗

PubMedDate not supplied

Operationalizing DSM-IV criteria for PMDD: selecting symptomatic and asymptomatic cycles for research.

While diagnostic criteria for premenstrual syndromes (PMS) exist, studies rarely state how these criteria are operationally applied. We examined the consequences of application of different operational methods for DSM-IV criteria for premenstrual dysphoric disorder (PMDD) to individual cycles in women with PMS and controls. PMDD criteria require the presence of both certain types or numbers of symptoms (5/11 symptoms present premenstrually, at least one being one of four mood symptoms) and certain phenomenal characteristics (present premenstrually, absent postmenstrually, causing interference premenstrually). We identified individual cycles as symptomatic or asymptomatic by applying criteria that operationalized the required phenomenal elements of PMDD according to four severity thresholds: literal (i.e. present or absent), 30%, 50%, 70%. Data examined were Daily Rating Form symptom scores from two symptomatic menstrual cycles both in 25 women with PMS and 25 controls. Literal thresholds correctly identified 28% of symptomatic and 4% of asymptomatic cycles, compared with 86 and 70% identification with a 30% threshold, 60 and 86% with a 50% threshold, and 0 and 100% with a 70% threshold. An "optimal" combination of 30% thresholds for premenstrual symptomatology and premenstrual interference and a 50% threshold for postmenstrual symptomatology correctly identified 92% of symptomatic cycles in women with PMS and 72% of asymptomatic cycles in controls. Different criteria for cycle inclusion yield markedly different sample compositions. No single operational threshold of the phenomenal features maximizes selection of both symptomatic and asymptomatic cycles, largely consequent to the ubiquity of postmenstrual symptoms and premenstrual "interference" even in women without PMS. At the very least, the method for operationalizing DSM-IV criteria should be described in studies of PMDD.

Adult↗

PubMed1999

Hormone synthesis and storage in the thyroid of human preterm and term newborns: effect of thyroxine treatment.

Iodine and thyroglobulin concentrations, as well as iodine, T3, T4 and sialic acid contents of thyroglobulin, were measured in thyroid glands collected postmortem from 42 human premature or term newborns and infants. Three groups were considered: very preterm newborns (24-32 postmenstrual weeks, < 5 days postnatal life), preterm and term newborns (34-41 postmenstrual weeks, < 5 days postnatal life) and infants (born at term, postnatal age 1-8 months). Five very preterm and seven preterm newborns received a daily dose of 10 microg/kg L-T4 for at least 3 days. Thyroid weight and sialic acid content of thyroglobulin progressed with maturation. Intrathyroidal concentrations of iodine and thyroglobulin did not increase significantly before the 42nd week of postmenstrual age. The level of thyroglobulin iodination increased during the postnatal life, except in the very preterm neonates. T4 and T3 content of thyroglobulin was directly proportional to its degree of iodination and positively related to its sialic acid content. L-T4 treatment of preterm newborns increased thyroglobulin iodination and T4-T3 content, without increasing thyroglobulin concentration in the thyroid. It was concluded that the storage of thyroglobulin and iodine in the thyroid develops around term birth. This, associated with the resulting rapid theoretical turnover of the intrathyroidal pool of T4 in Tg, could be an important factor of increased risk of neonatal hypothyroxinemia in the premature infants. The L-T4 treatment of preterm newborns does not accelerate the maturational process of the thyroid gland.

Humans↗

PubMed2000

Occipital sawtooth: a physiological EEG pattern in very premature infants.

OBJECTIVE: To evaluate EEG maturational features in preterm infants below 27 weeks postmenstrual age. METHODS: EEGs recorded from 5 preterm infants (postmenstrual age 24-26 weeks) were examined and selected maturational features were scored and quantified. The five infants also had serial cranial ultrasound scans (US) and magnetic resonance images of the brain within the first weeks after birth. RESULTS: Background activity was markedly discontinuous in all patients and very variable. Temporal sawtooths occurred but less frequently than in older preterm infants. All 5 infants also showed a particular novel feature, characterized by rhythmic, regularly shaped, medium-high amplitude 4-7 Hz activities, lasting 0.5-3 s and located in the occipital regions. This pattern was symmetrical but sometimes asynchronous. CONCLUSIONS: Occipital sawtooth, so called because it shares shape and frequency with temporal sawtooth but has an occipital localisation, constitutes a physiological EEG pattern characteristic of premature infants between 24 and 26 weeks of postmenstrual age.

Electroencephalography↗

PubMed2006

Modest changes in dietary intake across the menstrual cycle: implications for food intake research.

Food intake varies across the menstrual cycle in mammals, energy intake usually being greater in the premenstrual phase compared with the postmenstrual phase. Premenstrual increments in energy intake and a preferential selection of carbohydrate have been suggested to be greater in women with premenstrual syndrome (PMS), who may be more sensitive to cyclical hormonal or neurotransmitter fluctuations. This has direct implications for research within populations of women, especially where the primary outcome is diet or a change in energy balance. We aimed to determine whether: the premenstrual intake of energy and macronutrients differed from the postmenstrual intake; the change in intake across the menstrual cycle differed in women with PMS compared with controls; and the change in intake was related to the severity of premenstrual symptoms. We collected 3 d dietary intake data during the postmenstrual and premenstrual phases of the menstrual cycle in thirty-one women with PMS and twenty-seven control women. The consumption of energy and macronutrient intake were similar between the phases of the cycle in women with PMS. Conversely, intakes were usually greater premenstrually in control women, although not all differences were statistically significant. Exceptions were with non-milk extrinsic sugars and alcohol, which were both consumed in greater amounts in the premenstrual phase in women with PMS. Significant correlations were observed between the severity of symptoms and the change in the consumption of these nutrients. These data suggest that a consideration of the menstrual cycle phase and PMS in diet may not be warranted, especially in cross-sectional analysis, although it may need to be taken into account when examining change in intake during dietary interventions.

Adolescent↗

PubMed2005

Prolonged hospital stay for extremely premature infants: risk factors, center differences, and the impact of mortality on selecting a best-performing center.

OBJECTIVE: The first objective was to identify factors associated with prolonged hospital stay (PHS: hospitalized >42 weeks postmenstrual age) in extremely premature (EP: born less than or equal to 28 weeks gestation) infants. The second objective was to identify a PHS best-performing benchmark center. METHODS: This study was a retrospective cohort analysis of infants born < or =28 weeks gestation and admitted to one of 12 tertiary centers between January 1998 and October 2001. Risk-adjusted odds of PHS, defined as hospitalization beyond 42 weeks postmenstrual age, and the competing outcome, mortality, were assessed using logistic regression models. RESULTS: Among 3892 EP survivors who had complete data for multivariable analysis, 685 (18%) had PHS. Variables contributing to PHS included chronic lung disease (oxygen use at discharge home or 36 week postmenstrual age) (OR 6.75; 95% CI: 5.04 to 9.03), necrotizing enterocolitis requiring surgery (OR 13.83; 95% CI: 8.05 to 23.76), and >two episodes of late-onset sepsis (OR 2.39; 95% CI: 1.66 to 3.44). Centers' risk-adjusted PHS odds differed from the reference center, which had the lowest incidence of PHS and mortality (overall P-value <0.0001). Mortality contributed to PHS, but in an opposite direction compared to other factors. Centers with lowest PHS odds were among those with highest mortality. CONCLUSIONS: These findings suggest that reduction of CLD, surgical NEC, and late onset sepsis could reduce PHS in EP infants. Risk adjusted odds of PHS and mortality are both crucial for selecting a PHS best-performing center.

Health Facilities↗

PubMed1997

Development of fetal gyri, sulci and fissures: a transvaginal sonographic study.

We aimed to determine the feasibility of imaging specific sulci, gyri and fissures using transvaginal sonography and to correlate their first sonographic recognition with gestational age. Retrospectively, 262 fetal brain scans were analyzed from a total of 337 scans. Scans were selected if any of the following structures were seen: in the coronal plane the lateral, callosal and cingulate sulcus and gyrus; in the median plane the parieto-occipital and calcarine fissures, and the cingulate gyrus and sulcus; and, in an oblique section, the lateral sulcus. The gestational age at which the fissures, sulci and gyri were first imaged was recorded and subsequently compared with similar anatomical studies from the literature. It was possible to identify all the targeted structures. The gestational ages at which the structures were first imaged were: the callosal sulcus, from 14 weeks; the lateral sulcus, from 18 weeks; the parieto-occipital sulcus and calcarine fissure, from 18 weeks; and the cingulate gyrus, from 26 weeks. We concluded that the developmental maturation of the normal fetal brain follows a predictable timetable, and that this maturation can be grossly followed with sonography. The sonographic recognition of the fissures, gyri and sulci lagged behind the observations by anatomical studies. The greatest discrepancy was the first appearance of the cingulate gyrus which, in the anatomical studies, could be seen by 18 postmenstrual weeks and, in our study, was seen after 26 postmenstrual weeks. The one exception was the callosal sulcus, which was first seen at 14 postmenstrual weeks in both the sonographic and anatomical studies. In conclusion, the recognition of specific structures of the cortical map is possible. Sonography may be used to image the developing cortical surface.

Brain↗

PubMed2006

Caffeine therapy for apnea of prematurity.

BACKGROUND: Methylxanthines reduce the frequency of apnea of prematurity and the need for mechanical ventilation during the first seven days of therapy. It is uncertain whether methylxanthines have other short- and long-term benefits or risks in infants with very low birth weight. METHODS: We randomly assigned 2006 infants with birth weights of 500 to 1250 g during the first 10 days of life to receive either caffeine or placebo, until drug therapy for apnea of prematurity was no longer needed. We evaluated the short-term outcomes before the first discharge home. RESULTS: Of 963 infants who were assigned to caffeine and who remained alive at a postmenstrual age of 36 weeks, 350 (36 percent) received supplemental oxygen, as did 447 of the 954 infants (47 percent) assigned to placebo (adjusted odds ratio, 0.63; 95 percent confidence interval, 0.52 to 0.76; P<0.001). Positive airway pressure was discontinued one week earlier in the infants assigned to caffeine (median postmenstrual age, 31.0 weeks; interquartile range, 29.4 to 33.0) than in the infants in the placebo group (median postmenstrual age, 32.0 weeks; interquartile range, 30.3 to 34.0; P<0.001). Caffeine reduced weight gain temporarily. The mean difference in weight gain between the group receiving caffeine and the group receiving placebo was greatest after two weeks (mean difference, -23 g; 95 percent confidence interval, -32 to -13; P<0.001). The rates of death, ultrasonographic signs of brain injury, and necrotizing enterocolitis did not differ significantly between the two groups. CONCLUSIONS: Caffeine therapy for apnea of prematurity reduces the rate of bronchopulmonary dysplasia in infants with very low birth weight. (ClinicalTrials.gov number, NCT00182312.).

Apnea↗

PubMed1999

Effects of early reduced light exposure on central visual development in preterm infants.

The aim of this study was to determine, in infants born at < or =29 weeks postmenstrual age until 32 weeks postmenstrual age, whether reduction to light stimulation by occlusion of eyes affected central visual development. The pattern visual-evoked potential responses at 41 and 51 weeks postmenstrual age and 3 y of age did not differ between infants subjected or not to ocular occlusion. Hence, an early marked reduction in light stimulation in preterm infants does not seem deleterious to visual development.

Age Factors↗

PubMed1997

Perceptual and coping processes across the menstrual cycle: an investigation in a premenstrual syndrome clinic and a community sample.

Patients from a premenstrual symptoms clinic and asymptomatic controls monitored perceived stressors, coping processes, and emotional and physical symptoms daily for a complete menstrual cycle. Within-group comparisons revealed that, premenstrually, the patients reported encountering a greater number of personal competency stressors than they did postmenstrually. Between-group comparisons indicated that the patients encountered more stressors and perceived them as more stressful during the premenstruum than controls did, whereas postmenstrually the groups showed no difference in perceptual style. The patients used situational redefinition as a coping process during the premenstrual phase less frequently than the controls did. We observed positive relationships for patients between daily stressors and emotional and physical symptoms both premenstrually and postmenstrually. For controls, the only relationship demonstrated was that depression was associated with perceived stressfulness of stressors during the premenstrual phase. Results are discussed in the context of psychosocial factors (stressors, appraisal, and coping processes) influencing the manifestation of premenstrual symptoms.

Adaptation, Psychological↗

PubMed1991

Menstrual-cycle patterns in energy and macronutrient intake.

For 14 subjects drawn from the Beltsville One-Year Dietary Intake Study, patterns of energy, protein, fat, carbohydrate, protein/1000 kcal, fat/1000 kcal, and carbohydrate/1000 kcal were examined across pre- and postmenstrual periods. Individual subjects contributed data for one to four menstrual periods. Energy, fat, and fat/1000 kcal intakes were significantly higher in the 10 premenstrual days than in the 10 postmenstrual days. After elimination of effects attributable to between-subject differences and to balance periods included in the Beltsville study, fitted sine curves explained 14% and 25% of the variance in energy and fat intakes, respectively, across 14 premenstrual and 14 postmenstrual days, and 20% of the variance in fat/1000 kcal. Independent patterns were identified in absolute and relative protein intake. No patterns were discerned for carbohydrate. Physiological or behavioral factors appear to influence both total food intake (energy intake) and food selection (macronutrients/1000 kcal) across the menstrual cycle.

Adult↗

PubMedDate not supplied

Psychophysiological responses in women reporting severe premenstrual symptoms.

Sixteen women attending a Premenstrual Tension Clinic and eight control women were tested experimentally in the premenstrual and postmenstrual phases with assessments of heart rate, skin conductance level, and neck electromyogram during rest, relaxation, an emotionally upsetting film, and performance of mental arithmetic and video game tasks. All participants completed daily symptom assessments for two menstrual cycles prior to the study. The clinic attenders were divided into eight (Clinic+) who showed marked increases in symptoms premenstrually, and eight (Clinic-) who recorded only modest changes in symptom severity across the menstrual cycle. There were no marked differences in resting autonomic activity. During relaxation, skin conductance level decreased to a greater extent in the premenstrual than in the postmenstrual phase, while neck electromyogram showed the reverse pattern. Heart rate reactions to the mental arithmetic and video game tasks were smaller in the premenstrual than in the postmenstrual phase in Controls and Clinic- groups, but not in the Clinic+ group. Possible explanations of these results are discussed.

Adolescent↗