Quantitative measurement of impairment in ADHD: perspectives for research and clinical practice

Background Functional impairment is needed to make an attention deficit hyperactivity disorder (ADHD) diagnosis, but there is a paucity of instruments addressing this issue. Objective Perform psychometric analysis of a functional impairment scale (FIE). Methods A sample of 320 individuals, including ADHD probands, their siblings and parents, filled the FIE. We analyzed psychometric properties for the entire sample and age groups. Factor structure was determined by a principal component factor analysis, using oblique rotation with Kaiser normalization and Eigenvalues higher than 1. Cronbach’s alpha and Spearman-Brown were calculated. Results Family analysis revealed four components: a) “family life”, b) “self-perception”, c) “performance” and d) “social life”. Adults’ analysis revealed two components: a) “family life, social life and self-perception” and b) “performance”. Children showed the domains: a) “performance and social life”, b) “self-perception” and c) “family life” components. Cronbach’s alpha were above 0.9 in all components. Discussion Results revealed up to four domains depending on the group considered. Different life demands might explain the variability of domains on the groups

Trocar Site Recurrence after Laparoscopic Cholecystectomy for Unsuspected Isolated Gallbladder Metastasis of Melanoma: A Case Report and Review of the Literature

Cutaneous melanoma can metastasize to almost any organ, including in-transit metastases, lymph nodes, liver, lungs, brain, and bones. Spread to the gastrointestinal tract is less common and generally concerns the small bowel, colon, and stomach. Gallbladder involvement is rarer, and only few cases describe it as the sole site of metastasis upon diagnosis. Melanoma metastases to the gallbladder are usually detected on staging or surveillance imaging, as patients usually show few or no symptoms. In resectable stage IV melanoma patients, complete surgical resection appears to improve the prognosis. However, due to the rarity of isolated gallbladder metastasis of melanoma, there are no guidelines regarding the optimal surgical approach (endoscopic or open cholecystectomy). Here, we report the case of isolated gallbladder melanoma metastasis found after laparoscopic cholecystectomy performed in a 46-year-old female patient with no known history of cancer presenting with acute cholecystitis symptoms. Six weeks after surgery, the patient developed trocar site recurrence. This case highlights the importance of a planned and open surgery for resectable melanoma metastases rather than a laparoscopic approach

Novel translocation responses of cytosolic phospholipase A2α fluorescent proteins

AbstractCytosolic phospholipase A2 (cPLA2)α responds to the rise in cytosolic Ca2+ ([Ca2+]i) attending cell stimulation by moving to intracellular membranes, releasing arachidonic acid (AA) from these membranes, and thereby initiating the synthesis of various lipid mediators. Under some conditions, however, cPLA2α translocation occurs without any corresponding changes in [Ca2+]i. The signal for such responses has not been identified. Using confocal microscopy to track fluorescent proteins fused to cPLA2α or cPLA2α's C2 domain, we find that AA mimics Ca2+ ionophores in stimulating cPLA2α translocations to the perinuclear ER and to a novel site, the lipid body. Unlike the ionophores, AA acted independently of [Ca2+]i rises and did not translocate the proteins to the Golgi. AA's action did not involve its metabolism to eicosanoids or acylation into cellular lipids. Receptor agonists also stimulated translocations targeting lipid bodies. We propose that AA is a signal for Ca2+-independent cPLA2α translocation and that lipid bodies are common targets of cPLA2α and contributors to stimulus-induced lipid mediator synthesis

Quality of Private Ground-Water Supplies in Kentucky

About 3.7 million people live in Kentucky, of which 1.9 million (52 percent) live in urban areas (roughly defined as any community with 2,500 or more people) and 1.8 million (48 percent) live in rural areas (University of Kentucky, 1993). Figure 1 summarizes sources of drinking water for Kentucky residents. About 70 percent of Kentuckians get their daily supply of water from surface-water sources - lakes and streams; about 25 percent get their water from ground-water wells; and about 5 percent get their water from other sources - springs, cisterns, ponds, or hauled water

Relationship between endophenotype and phenotype in ADHD

<p>Abstract</p> <p>Background</p> <p>It has been hypothesized that genetic and environmental factors relate to psychiatric disorders through the effect of intermediating, vulnerability traits called endophenotypes. The study had a threefold aim: to examine the predictive validity of an endophenotypic construct for the ADHD diagnosis, to test whether the magnitude of group differences at the endophenotypic and phenotypic level is comparable, and to investigate whether four factors (gender, age, IQ, rater bias) have an effect (moderation or mediation) on the relation between endophenotype and phenotype.</p> <p>Methods</p> <p>Ten neurocognitive tasks were administered to 143 children with ADHD, 68 non-affected siblings, and 120 control children (first-borns) and 132 children with ADHD, 78 non-affected siblings, and 113 controls (second-borns) (5 – 19 years). The task measures have been investigated previously for their endophenotypic viability and were combined to one component which was labeled 'the endophenotypic construct': one measure representative of endophenotypic functioning across several domains of functioning.</p> <p>Results</p> <p>The endophenotypic construct classified children with moderate accuracy (about 50% for each of the three groups). Non-affected children differed as much from controls at the endophenotypic as at the phenotypic level, but affected children displayed a more severe phenotype than endophenotype. Although a potentially moderating effect (age) and several mediating effects (gender, age, IQ) were found affecting the relation between endophenotypic construct and phenotype, none of the effects studied could account for the finding that affected children had a more severe phenotype than endophenotype.</p> <p>Conclusion</p> <p>Endophenotypic functioning is moderately predictive of the ADHD diagnosis, though findings suggest substantial overlap exists between endophenotypic functioning in the groups of affected children, non-affected siblings, and controls. Results suggest other factors may be crucial and aggravate the ADHD symptoms in affected children.</p

Abnormal Striatal BOLD Responses to Reward Anticipation and Reward Delivery in ADHD

Altered reward processing has been proposed to contribute to the symptoms of attention deficit hyperactivity disorder (ADHD). The neurobiological mechanism underlying this alteration remains unclear. We hypothesize that the transfer of dopamine release from reward to reward-predicting cues, as normally observed in animal studies, may be deficient in ADHD. Functional magnetic resonance imaging (fMRI) was used to investigate striatal responses to reward-predicting cues and reward delivery in a classical conditioning paradigm. Data from 14 high-functioning and stimulant-naïve young adults with elevated lifetime symptoms of ADHD (8 males, 6 females) and 15 well-matched controls (8 males, 7 females) were included in the analyses. During reward anticipation, increased blood-oxygen-level-dependent (BOLD) responses in the right ventral and left dorsal striatum were observed in controls, but not in the ADHD group. The opposite pattern was observed in response to reward delivery; the ADHD group demonstrated significantly greater BOLD responses in the ventral striatum bilaterally and the left dorsal striatum relative to controls. In the ADHD group, the number of current hyperactivity/impulsivity symptoms was inversely related to ventral striatal responses during reward anticipation and positively associated with responses to reward. The BOLD response patterns observed in the striatum are consistent with impaired predictive dopamine signaling in ADHD, which may explain altered reward-contingent behaviors and symptoms of ADHD

Quantitative measurement of impairment in ADHD: perspectives for research and clinical practice

Background Functional impairment is needed to make an attention deficit hyperactivity disorder (ADHD) diagnosis, but there is a paucity of instruments addressing this issue. Objective Perform psychometric analysis of a functional impairment scale (FIE). Methods A sample of 320 individuals, including ADHD probands, their siblings and parents, filled the FIE. We analyzed psychometric properties for the entire sample and age groups. Factor structure was determined by a principal component factor analysis, using oblique rotation with Kaiser normalization and Eigenvalues higher than 1. Cronbach’s alpha and Spearman-Brown were calculated. Results Family analysis revealed four components: a) “family life”, b) “self-perception”, c) “performance” and d) “social life”. Adults’ analysis revealed two components: a) “family life, social life and self-perception” and b) “performance”. Children showed the domains: a) “performance and social life”, b) “self-perception” and c) “family life” components. Cronbach’s alpha were above 0.9 in all components. Discussion Results revealed up to four domains depending on the group considered. Different life demands might explain the variability of domains on the groups