Preschool-age children with autism exhibit no difference in brain activity when they are shown photographs of faces displaying different emotions, and their brains are larger than normal, according to new research at the UW’s Autism Center.

The findings were reported at the first International Meeting for Au- tism Research in San Diego last month by Geraldine Dawson, director of the 91探花Autism Center and a professor of psychology, and Stephen Dager, 91探花professor of psychiatry and radiology. The autism meeting was held in conjunction with the annual meeting of the Society for Neuroscience.

Both studies used the same pool of 3- and 4-year-old autistic, developmentally delayed and normally developing children.

In Dawson’s study, the children wore bonnets studded with 64 sensors that monitored brain activity. The children were shown photographs depicting fear and a neutral expression. The brains of normally developing and developmentally delayed children exhibited different activity depending on the picture being viewed. However, the brain activity of the autistic children remained the same when the different pictures were shown.

Dawson said that normally developing infants will notice their mothers’ facial expressions and emotions in the first six months of life and that they are able to recognize emotions from facial expressions by age 7 months. A region of the brain called the amygdala that is associated with emotions seems to be a center for recognizing and reacting to fear.

“The ability to react to fear is either innate in humans or develops very early in life,” she said. “It is a selective advantage for our brains to be able to pick up fear, an ability that comes from our early human ancestors.

“Children with autism do not appear to be able to pick up facial signals and notice other people’s emotions. They can’t read the signals or facial expressions of emotions in a normal way. This tells us the problem with the brain likely emerges very early and involves very basic brain systems, those responsible for encoding emotions.”

Understanding this deficit in reading facial expressions and noticing emotions should help parents understand the behavior of their autistic child and why the child doesn’t respond with empathy for others, according to Dawson.

“It also points to the importance of interventions, such as behavioral interventions that reward children for paying attention to facial cues. Computer programs are being developed at the 91探花that help children pay attention to proper cues and teach them what facial signals mean,” she said.

New research at the 91探花Autism Center is finding out how much impact early intervention programs have with these recognition system and whether they can help rewire the brain to process faces and emotions more normally.

Dager’s work found that the amygdala is disproportionately larger in preschool autistic children than in normally developing and mentally retarded youngsters.

“We looked both at brain structure and brain chemistry, using a specialized form of magnetic resonance imaging called PEPSI, or Proton Echo Planar Spectroscopic Imaging, that was developed at the UW,” Dager said. “We measured the volumes of different regions of the brain and found that the kids with autism had about 10 percent bigger brains on average.”

Dager added that both boys and girls with autism exhibited increased brain volume, in comparison to normally developing children of the same gender. Typically human males have larger brains than females, but Dager says that bigger is not necessarily better.

“Additional studies that we are conducting measuring brain chemistry suggest that the brain cellular composition is altered in the autistic children. This is potentially a very important finding, although we are still trying to better understand the functional significance of these abnormalities,” Dager said.

He said it’s puzzling that this region of the brain that is so closely involved with the normal expression of emotion should be enlarged in this particular group of children who have difficulty expressing normal emotional engagement.

Dager and his colleagues also are trying to determine what enlargement of the amygdala means in relationship to the clinical course or prognosis of autism and how brain developmental processes these children undergo as they grow older affect their brain chemistry. The children are being studied at ages 6 and 9 to evaluate the progression of these brain structural and chemical findings.

Dager cautioned that enlargement of the amygdala or of the brain in general cannot be used as a diagnostic tool to determine if a child has autism.

That headline sounds like an ad from the back of a magazine, doesn’t it? Amazingly, a recently released study says it’s true. What’s more, if you are at risk of developing Type 2 diabetes, you can do a lot to prevent it taking over your life just by putting one foot in front of the other, and making some changes in your diet.

Dr. Wilfred Fujimoto, professor of endocrinology in the School of Medicine, was a co-investigator for a recently released nationwide study on the prevention of Type 2 diabetes. He points out that the thousands of people who participated in the study were already known to be at risk for developing diabetes.

“These people have impaired glucose tolerance, as shown by an oral glucose tolerance test. Their fasting glucose levels put them in roughly the top 50 percent of those with impaired glucose tolerance,” Fujimoto says. “We also targeted recruitment toward people who had a family history of diabetes, women who had a history of gestational diabetes, people who were generally overweight and people in racial minority groups who are at high risk for developing Type 2 diabetes.”

While most people think making lifestyle changes will be hard, many participants in the Diabetes Prevention Program, or DPP, were able to make those changes less painful. They were first taught what to do, and then encouraged to walk for 30 minutes five days a week and to reduce the amount of calories and fats, especially saturated fats, in the diet.

“We allowed our subjects to go through about four months of training – meeting with dieticians, learning about the importance of exercise,” Fujimoto says. “It’s a gradual process. The thing that turns a lot of people off about diet and exercise is that they think it all has to be done quickly and they have to see results immediately. That’s not going to happen. A gradual weight loss is more acceptable than a fast one.”

The weight loss doesn’t have to be massive to make a difference. DPP participants were asked to lose about 7 percent of their body weight in the first year of the study, and maintain this. They were actually able to remain at a 5 percent loss at the end of the study. Since many participants were over 200 pounds, these losses of about 15 pounds didn’t make any of them skinny.”This goes to show that you don’t need major weight loss to get good medical results,” Fujimoto says. “There’s a difference between cosmetic weight loss and what is a medically effective weight loss.”

How can you translate these results into your own personal Diabetes Prevention Program? Try these first steps, particularly if you think you might be at risk for Type 2 diabetes, are obese or lead a sedentary lifestyle:

• First, check with your doctor. Ask for a glucose tolerance test, and talk to your health practitioner about whether you can participate in moderate exercise.

• Show a dietician what you eat in a typical week, and ask for suggestions on how to reduce animal fats and excess calories in your diet.

• Look for classes in low-fat cuisine at your local community college, county extension service or even at local stores. If you can’t find hands-on classes, check out the Internet or available cookbooks.

• Talk to the manager of your local grocery store, or check out the bulletin boards there. Many stores offer informal classes on understanding food labels, cooking healthy meals, choosing the best produce and much more.

Is this effort worth it? Fujimoto thinks so, and so do the participants in the DPP.

“Every year you save in delaying the onset of Type 2 diabetes,” Fujimoto says, “delays and reduces the costs of treating the disease and its complications.”

You finally get to sit down at the end of the day. The dog has been fed and so has the rest of the family. The dishes have been washed, homework is done and everything is in readiness for the next day. So why, just when you’ve finally settled into your armchair in front of the television, does your heart suddenly flutter, lurch or thump? Should you call an ambulance?

The problem is not always a symptom of heart disease, says Dr. Jeanne Poole, associate professor of medicine in the School of Medicine’s Division of Cardiology.

“It is most often a benign situation if the person is otherwise healthy. Drinking too much coffee, being under stress or not getting enough sleep frequently bring on premature ventricular contractions, or PVCs,” Poole says. “Taking a lot of over-the-counter decongestants or antihistamines, thyroid problems or electrolyte abnormalities can also cause an increase in PVCs.”

Electrolyte abnormalities caused by taking diuretics can also be a factor.

Poole says that when people complain of skipped heartbeats, thumps, or palpitations, they are actually feeling early beats.

“The beat comes early enough in the cardiac cycle that it doesn’t produce a full cardiac contraction of normal strength,” Poole says. “To them it seems like a skipped beat, because to them it may feel like a pause surrounding the early beat.”

PVCs are very common. Poole says studies have shown that up to 50 percent of people have them at one time or another in their lives. During the day, people are often too busy to notice PVCs, and only become aware of them when they are relaxing or preparing to go to sleep.

This isn’t to say that PVCs should be ignored. Whenever anyone experiences a new or different symptom, it is wise to check it out with a physician. Poole says this sign can point your family doctor toward some health or lifestyle problems that should be investigated.

She adds, “If someone is dizzy, lightheaded or passing out after a series of what feel like skipped beats, they should get immediate medical attention. Even without PVCs, these symptoms should alert you that something is wrong. A long string of PVCs becomes ventricular tachycardia, a problem calling for a thorough evaluation.”

Heart attack symptoms are usually very different from the thumps and flutters of PVC.

“Anyone who experiences the classic symptoms of a heart attack – chest pressure, shortness of breath, breaking out in a sweat or nausea – should seek medical attention immediately,” Poole says. “PVCs last only a moment, while heart attack symptoms tend to be longer-lasting.”

Poole adds if a person who has been healthy his entire life starts noticing PVCs, it’s worth mentioning to the doctor. In most cases, some simple lifestyle changes may help you reserve those heart flutters for your one-and-only.

For years, it seemed like a rite of passage, like a first car or a first grandchild. At a certain age, a lot of people went into the hospital for cardiac bypass surgery, to relieve narrowing – or stenosis – of blood vessels serving the heart muscle. As medical research advanced, some bypass surgeries were replaced by the use of balloons to open the blood vessel, and still later by the insertion of stents into the arteries.

As Dr. Larry Dean, director of the 91探花Regional Heart Center, explains, a stent is shaped somewhat like a little metal spring.

“About 3 to 5 percent of the time, balloon angioplasty – using a small balloon to stretch and break up a plaque that may be narrowing an artery – was ineffective. The patient would have to go into emergency bypass surgery.

“When we do a balloon angioplasty, there is trauma to the vessels,” Dean says. “There may be small tears to the vessel that cause some instability, so the vessel closes. If the artery will not stay open, a stent can be installed and will act as a scaffolding to keep the artery open. That has reduced the need for emergency bypass surgery down to half a percent or less of patients undergoing balloon angioplasty.”

Arteries also may re-close months later.

“The second problem is a matter of an over-exuberant response to the healing process, and stents have proven valuable here,” Dean says. “They get the absolute best result that you could possibly get.”

Previous research has shown that the use of a stent reduces the incidence of narrowing, or restenosis, by about 30 percent.

“This means you go from a rate of about 30 percent of coronary patients having restenosis on the average, in the several months following the procedure, to somewhere around 20 percent,” Dean says. “Other modern techniques, aside from using stents, have reduced the overall restenosis rate still further to about 10 to 15 percent of all cases.”

While stents have reduced restenosis rates immensely, there are still some patients who undergo more than one surgical procedure to correct restenosis. New therapies, such as radiation treatment of the affected vessel, are reducing that number.

“Radiation, known as brachytherapy, allows the vessel to heal, but not over-heal, avoiding restenosis,” Dean says. “Researchers are also looking at placing medications directly on the stents, which may reduce restenosis still further.”

Dean says the stents do not treat the underlying disease, so if you have atherosclerosis, you need to take very good care of yourself. That includes following the instructions of your primary care health provider and your cardiologist. Those guidelines usually include staying on a low-fat diet, exercising appropriately, taking prescribed medications for blood cholesterol problems, and stopping smoking.

“Everyone would like to be able to have that golden bullet that takes care of their problems without them having to do anything, but that’s not going to happen with most diseases,” Dean says. “Active participation by the patient is very important in determining how he or she will do in the long term.”

Women who’ve had a Caesarean and who later attempt to deliver by labor are more likely to suffer a uterine rupture than women who go on to have a repeat Caesarean delivery, according to a 91探花study published in the New England Journal of Medicine.

Uterine rupture is an uncommon, but serious, obstetrical condition that may result in hysterectomy, urologic injury or a need for blood transfusion for the mother, and neurologic impairment in the infant.

The study was done by Dr. Mona Lydon-Rochelle, senior research fellow in the Department of Family and Child Nursing in the School of Nursing and her colleagues Dr. Victoria L. Holt, associate professor in the Department of Epidemiology in the School of Public Health and Community Medicine; Dr. Thomas R. Easterling, associate professor of obstetrics and gynecology of the School of Medicine; and Dr. Diane P. Martin, professor in the Department of Health Services in the School of Public Health and Community Medicine, all at the UW. The study was published in the July 5 issue of NEJM.

Researchers used data from the delivery records of 20,095 mothers who delivered a single live infant in Washington state from 1987 through 1996 and also delivered a second single infant during the same time period. They found that a total of 91 women had a uterine rupture during the second birth. Women with a spontaneous onset of labor were 3.3 times more likely to have a uterine rupture than women who had a repeat Caesarean delivery without labor. Women with non-prostaglandin induction of labor were nearly five times more likely to have a uterine rupture and women with prostaglandin induction were 15 times more likely to have a uterine rupture than women who had repeat Caesarean deliveries without labor.

“These associations are most likely real, given the magnitude of reported risk,” said Lydon-Rochelle, the study’s lead author. “Although prior studies are not in complete agreement, it seems clear that whatever increased risk might be present in women whose labor is induced is considerably greater than what is present in women with repeat Caesarean delivery.”

Lydon-Rochelle said that since about 60 per cent of women with a prior Caesarean delivery who become pregnant again attempt a trial of labor, concern persists that a trial of labor increases the risk of uterine rupture.

“It is important for women who have had a Caesarean in the past to know that attempting a vaginal delivery increases the chances of uterine rupture,” said Holt, the study’s co-principal investigator. “The decision to make such an attempt should be made with the knowledge of the increased chance of other problems that may occur in a repeat Caesarean delivery.”

“Our work does not suggest that the practice of vaginal birth after Caesarean delivery should be abandoned,” Easterling said. “However, these births should be performed in a medical environment where complications can be managed rapidly and effectively. Given the potential risk to the mother and baby, the decision to attempt a vaginal birth after a Caesarean birth should be made between the pregnant woman and her health practitioner.”

The study data was derived by assessing birth certificate and hospital discharge data in the Washington State Birth Events Database. In prior studies, information about trials of labor was based on physician survey or hospital discharge data alone. The 91探花study’s approach increased the accuracy and completeness of the data on obstetrical diagnosis and procedures.

The research was funded in part by grants from the Agency for Healthcare Research and Quality and the National Institute of Nursing Research in the National Institutes of Health.