Autism spectrum disorder involves challenges in social communication and restricted, repetitive behaviors. Historically, males have received autism diagnoses at comparatively high rates, prompting an underrepresentation of females in research and an incomplete understanding of sex-specific symptom presentations and comorbidities. This review examines sex differences in the prevalence of common comorbidities of autism to inform tailored clinical practices. These conditions include attention deficit hyperactivity disorder, anxiety disorders, conduct disorder, depression, epilepsy, intellectual disability, and tic disorders. Attention deficit hyperactivity disorder is prevalent in both sexes; however, females may more frequently exhibit the inattentive subtype. Anxiety disorders display inconsistent sex differences, while conduct disorder more frequently impacts males. Depression becomes more common with age; some studies indicate more pronounced symptoms in adolescent girls, while others suggest greater severity in males. Epilepsy is more prevalent in females, especially those with intellectual disabilities. Despite displaying a male predominance, intellectual disability may exacerbate the severity of autism to a greater degree in females. No clear sex differences have been found regarding tic disorders. Overall, contributors to sex-based differences include biases stemming from male-centric diagnostic tools, compensatory behaviors like camouflaging in females, genetic and neurobiological differences, and the developmental trajectories of comorbidities. Recognizing these factors is crucial for developing sensitive diagnostics and sex-specific interventions. Inconsistencies in the literature highlight the need for longitudinal studies with large, diverse samples to investigate autism comorbidities across the lifespan. Understanding sex differences could facilitate earlier identification, improved care, and personalized interventions, thus enhancing quality of life for individuals with autism.
, Eunha Kim Neurodevelopmental disorders, which emerge early in development, include a range of neurological phenotypes and exhibit marked differences in prevalence between sexes. A male predominance is particularly pronounced in autism spectrum disorder (ASD). Although the precise cause of ASD is still unknown, certain genetic variations and environmental influences have been implicated as risk factors. Preclinical ASD models have been instrumental in shedding light on the mechanisms behind the sexual dimorphism observed in this disorder. In this review, we explore the potential processes contributing to sex bias by examining both intrinsic differences in neuronal mechanisms and the influence of external factors. We organize these mechanisms into six categories: 1) sexually dimorphic phenotypes in mice with mutations in ASD-associated genes related to synaptic dysfunction; 2) sex-specific microglial activity, which may disrupt neural circuit development by excessively pruning synapses during critical periods; 3) sex steroid hormones, such as testosterone and allopregnanolone, that differentially influence brain structure and function; 4) escape from X chromosome inactivation of the O-linked-N-acetylglucosamine transferase gene in the placenta; 5) sexually dimorphic activation of the integrated stress response pathway following maternal immune activation; and 6) immunological responses that are differentially regulated by sex. Understanding these mechanisms is essential for deciphering the underlying causes of ASD and may offer insights into other disorders with notable sex disparities.
, Kyu Man Shin The assessment of the vasoreactivity measured with transcranial doppler(TCD) provides information regarding to the reserve capacity of the cerebral circulation in patients with acute head injuries, which has important therapeutic consequencies because it allows for the diagnosis of impending ischemia and for the control of the effect of initiated corrective measures.
The authors performed TCD study to measure the CO2 reactivity to the entire basal cerebral arteries in 30 cases of control group and 14 cases of head inury group between the 3rd and the 7th day after insult. All patients were examined by single photon emission computed tomography and their results were compared to CO2 reactivities at 8 basal cerebral arteries. All of these results were analyzed by statistical analysis system(SAS).
The increase of MBFV(mean blood flow velocity) and decrease of PI(pulsatility index)were noted in the cerebral arteries with decreased CO2 reactivity. It meant that the arterial walls were dilated. There was no close relationship between region of interest(ROI) index and CO2 index but CO2 reactivity was remarkably decreased in the region which showed abnormal regional cerebral blood flow in SPECT(single photon emission computed tomogram)(P=0.04). In the relationship between the variables, ROI increased as the clinical status worsen(r=0.5, P=0.0008), the prognosis of the patients had positive correlation with CO2 index(r=0.32, P=0.04) or clinical status had negative correlation with ROI index(r=0.40, P=0.0094).
The doppler CO2 test in patients with head injury provides useful information regarding hemodynamic state, prognosis and determination of beneficial effects of specific therapy, especially during subacute stage. In the various TCD parameters CO2 index was correlated well with prognosis.
, Joo-Ho Lee, Ju Young Seoh Recently the advantages of a laparoscopy-assisted distal gastrectomy(LADG) including lymphadenectomy for early gastric cancer(EGC) have been reported. The purpose of this study was to perform a prospective randomized trial comparing the early results of LADO with open distal gastrectomy in EGC.
Forty-seven patients, endoscopically diagnosed as EGC on antrum and lower body, were included during the period from November 2001 to August 2003. Using a random number table, 23 patients were assigned to open group(group O) and 24 patients to LADG group(group L). Radical distal subtota 1gastrectomy with gastroduodenostomy was performed in all patients. The clinicopathologic findings, postoperative recovery, and morbidity were compared between two groups.
Age, sex, body weight, associated disease, history of previous abdominal surgery, location of lesion, size, gross type of EGC, and histologic differentiation were similar in both groups. On permanent pathologic examination, all cases of group O were diagnosed as EGC and in the group L, 21 cases were EGC, 3 cases were advanced cancer. The mean operation time was significantly shorter in the group L, but estimated blood loss and transfusion amount were similar in both groups. The mean postoperative days of first flatus, starting day of diet, postoperative hospital stay were shorter and deration of analgesic administered were lower in group O, but they did not reach statistical significance. The mean numbers of harvested lymph nodes were 38.1 in the group O and 31.8 in the group L, which was not statistically significant(p=0.098). Postoperative pulmonary complication based on chest X-ray occurred more frequently in the group O (p=0.043). There is no recurrence of disease in both groups in follow-ups.
LADG has advantage in terms of less phlmonary complications while main-taining the curatility. This is the preliminary result of prospective randomized study and the long-term results should be followed.
, Kyu-Man Shin, Jun-Hyeok Song The assessment of the cerebral vasoreactivity provides information regarding to the reserve capacity of the cerebral circulation in patients with cerebrovascular disease, which has important therapeutic consequencies because it allows for the diagnosis of impending ischemia and for the control of the effect of initiated correcitive measures.
The author performed transcranial doppler study to measure the CO2 reactivity to the entire basal cerebral arteries in 30 cases of control group and 10 cases of disease group between 3rd and 7th day after insult. The control persons involved 10 cases of 3rd decade, 10 cases of 5th, 10 cases of 7th, and the diasease persons involved 10 cases of spotanenous subarachnoid hemorrhages. All disease patients were examined by single photon emission computed tomography and their results were compared to Doppler CO2 reactivities.
In control group, the mean blood flow velocity and pulsatility index increased with age, but the CO2 reactivity decreased. In patient group, MBFV, PI index, MI ratio were not correlated to the presence of disease, but only CO2 index was decreased than the same age group of normal control. The regions showing abnormal ROI by SPECT well corresponded with the regions showing decreased CO2 reactivity. There was no close correlation between ROI(Region of Interest) index and CO2 index, but the CO2 reactivity was remarkably decreased in the region which showed abnormal regional cerebral blood flow in SPECT findings(p=0.04). In the relationship between the various prognostic factors, ROI increased as the clinical status worse(r=-0.05, p=0.0008), the acute prognosis(3Mo) had positive correlation with CO2 omdex(r=0.32, p=0.04) or clinical status, and negative correlation with ROI index(r=0.40, p=0.0094).
Transcranial doppler CO2 testing in patients with spotanenous subarachnoid hemorrhage provides useful information regarding hemodynamic state, prognosis and determination of beneficial effects specific therapy. In the various TCD parameters, CO2 index was correlated well with the acute prognosis.
Primary depression with cognitive impairment, referred to as depressive pseudodementia, may be mistaken for a progressive degenerative dementia. Recognition of primary depression is clinically important because of its treatability.
To differentiate depression from degenerative dementia, author rsed brain Tc 99m-HMPAO SPECT. By the result the regionar cerebral blood flew(rCBF) in elderly depressed patient was decreased in the left temporoparietal cortex. The pattern of rCBF was different from that of dementia which shows decreased rCBF in bilateral cortex.
By using brain SPECT in depressed elderly patient with cognitive impairment, the discrimination from dementia will be more effective and accurate.
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