The neurobiological basis of ADHD

Attention-Deficit/Hyperactivity Disorder is not a single pathophysiological entity and appears to have a complex etiology. There are multiple genetic and environmental risk factors with small individual effect that act in concert to create a spectrum of neurobiological liability. Structural imaging studies show that brains of children with Attention-Deficit/Hyperactivity Disorder are significantly smaller than unaffected controls. The prefrontal cortex, basal ganglia and cerebellum are differentially affected and evidence indicating reduced connectivity in white matter tracts in key brain areas is emerging. Genetic, pharmacological, imaging, and animal models highlight the important role of dopamine dysregulation in the neurobiology of Attention-Deficit/Hyperactivity Disorder. To date, stimulants are the most effective psychopharmacological treatments available for Attention-Deficit/Hyperactivity Disorder. Currently only immediate release methylphenidate and atomoxetine are approved for the treatment of ADHD in Italy. Drug treatment should always be part of a comprehensive plan that includes psychosocial, behavioural and educational advice and interventions

The United States Information Agency and Italy during the Johnson Presidency 1963-1969

The United States Information Agency (USIA) was the official propaganda agency of the American government. During the period of the Johnson administration, its programme in Italy was the second largest in Western Europe, right after West Germany and immediately before France. This dissertation examines the USIA programme, and places it within the larger context of American policy towards Italy at this crucial juncture in the history of both countries. Beginning in the 1950s, following the traumatic experience of World War II and the unthinkable implications of nuclear warfare, the bipolar conflict was progressively channelled into non-military means of combat. In addition to the better known methods of traditional diplomacy, the threat of force, and economic aid, the United States deployed new instruments to win the ‘battle for hearts and minds’ against the Soviet Union. These new instruments included public diplomacy, cultural and educational exchanges, and ‘overt’ and ‘covert’ propaganda operations. This exercise of soft power became one of the main instruments used to stop the expansion of communism and to unite NATO countries behind American leadership. Yet this task was particularly demanding during the Johnson years, when the image of the Unites States abroad was tarnished as never before by the civil rights struggle and the escalation of the Vietnam War. Italy is a particularly interesting and important case study of American psychological warfare in Western Europe. Not only did the country host the largest Communist Party in the West, the Partito Comunista Italiano (PCI), for the entire duration of the cold war, –– but Italy also had more than twenty governments in the first two decades of the post-war era. At a deeper level, the country oscillated between two different political formulas, centrismo and a centre-left coalition. As a result it proved impossible to carry out the structural reforms needed to ensure the country’s stability. The government’s inability to ‘keep Italy on track’ and to effectively oppose the communist threat led to the deployment of an extensive USIA programme in Italy. Surprisingly, this topic has not been studied intensively. Although there is a rich literature on American influence in the Italian election of 1948, and there has been some discussion of American psychological warfare in Italy during the fifties, no scholar has carried out an in-depth study on the role of US public diplomacy in Italy during the sixties, particularly the Johnson era. The dissertation is based on detailed research in the Johnson and Nixon libraries as well as at the National Archives in College Park, Maryland where the official documents of the USIA (RG 306) are located. On the Italian side, I have analyzed the major Italian newspapers, radio and TV shows targeted by the agency.My PhD has been funded since 2012 by the AHR

New developments in the genetics, pathogenesis, and therapy of IgA nephropathy

Recent years have brought notable progress in the field of IgA nephropathy. Here, we highlight important new directions and latest developments, including successful discovery of several genetic susceptibility loci, formulation of the multihit pathogenesis model, introduction of the Oxford pathology scoring system, and formalization of the Kidney Disease Improving Global Outcomes (KDIGO) consensus treatment guidelines. We focus on the latest genetic findings that confirm a strong contribution of inherited factors and explain some of the geoethnic disparities in disease susceptibility. Most IgA nephropathy susceptibility loci discovered to date encode genes involved in the maintenance of the intestinal epithelial barrier and response to mucosal pathogens. The concerted pattern of interpopulation allelic differentiation across all genetic loci parallels the disease prevalence and correlates with variation in local pathogens, suggesting that multilocus adaptation might have shaped the present-day landscape of IgA nephropathy. Importantly, the 'Intestinal Immune Network for IgA Production' emerged as one of the new targets for potential therapeutic intervention. We place these findings in the context of the multihit pathogenesis model and existing knowledge of IgA immunobiology. Lastly, we provide our perspective on the existing treatment options, discuss areas of clinical uncertainty, and outline ongoing clinical trials and translational studies.Kidney International advance online publication, 16 September 2015; doi:10.1038/ki.2015.252

Collapsing glomerulopathy in sickle cell disease: a case report

<p>Abstract</p> <p>Introduction</p> <p>Sickle cell disease has been associated with many renal structural and functional abnormalities. Collapsing glomerulopathy or the collapsing variant of focal segmental glomerulosclerosis is a rare clinicopathologic entity in patients with sickle cell disease that requires timely diagnosis and aggressive management.</p> <p>Case presentation</p> <p>In this case report we describe a 21-year-old African-American woman with a medical history of significant sickle cell disease and asthma. She was admitted for pain, decreased urine output, bilateral leg swelling and reported weight gain. During her period of hospitalisation she developed acute renal failure requiring dialysis. Further investigation revealed the collapsing variant of focal segmental glomerulosclerosis.</p> <p>Conclusions</p> <p>Although focal segmental glomerulosclerosis is a common feature of sickle cell nephropathy, the collapsing variant of focal segmental glomerulosclerosis or collapsing glomerulopathy has been rarely documented. Even when other risk factors are controlled, collapsing glomerulopathy has a very poor prognosis. This is a rare case of a patient with massive proteinuria presenting as acute renal failure with a very poor response to corticosteroids and a much faster rate of progression to end-stage renal disease.</p

Atypical neural responses to vocal anger in attention-deficit/hyperactivity disorder

Background Deficits in facial emotion processing, reported in attention-deficit/hyperactivity disorder (ADHD), have been linked to both early perceptual and later attentional components of event-related potentials (ERPs). However, the neural underpinnings of vocal emotion processing deficits in ADHD have yet to be characterised. Here, we report the first ERP study of vocal affective prosody processing in ADHD. Methods Event-related potentials of 6–11-year-old children with ADHD (n = 25) and typically developing controls (n = 25) were recorded as they completed a task measuring recognition of vocal prosodic stimuli (angry, happy and neutral). Audiometric assessments were conducted to screen for hearing impairments. Results Children with ADHD were less accurate than controls at recognising vocal anger. Relative to controls, they displayed enhanced N100 and attenuated P300 components to vocal anger. The P300 effect was reduced, but remained significant, after controlling for N100 effects by rebaselining. Only the N100 effect was significant when children with ADHD and comorbid conduct disorder (n = 10) were excluded. Conclusion This study provides the first evidence linking ADHD to atypical neural activity during the early perceptual stages of vocal anger processing. These effects may reflect preattentive hyper-vigilance to vocal anger in ADHD