Disentangling the Overlap between Tourette's Disorder and ADHD

Objective : To identify similarities and differences in neuropsychiatric correlates in children with Tourette's syndrome (TS) and those with ADHD. Method : The sample consisted of children with Tourette's syndrome with ADHD( N = 79), children with Tourette's syndrome without ADHD ( N = 18), children with ADHD ( N = 563), psychiatrically referred children ( N = 212), and healthy controls ( N = 140). Results: Disorders specifically associated with Tourette's syndrome were obsessive compulsive disorder (OCD) and simple phobias. Rates of other disorders, including other disruptive behavioral, mood, and anxiety disorders, neuropsychologic correlates, and social and school functioning were indistinguishable in children with Tourette's and ADHD. However, children with Tourette's syndrome plus ADHD had more additional comorbid disorders overall and lower psychosocial function than children with ADHD. Conclusions: These findings confirm previously noted associations between Tourette's syndrome and OCD but suggest that disruptive behavioral, mood, and anxiety disorders as well as cognitive dysfunctions may be accounted for by comorbidity with ADHD. However, Tourette's syndrome plus ADHD appears to be a more severe condition than ADHD alone.     

Immunophilin ligands and GDNF enhance neurite branching or elongation from developing dopamine neurons in culture

Neurotrophic effects of immunophilin ligands have been shown in animal models of peripheral and central nervous system insult. To investigate the specific growth-promoting effects of these compounds, we examined the effects of various immunophilin ligands on primary dopamine (DA) neurons in culture and compared these with a well-known DA trophic factor, glial cell line-derived neurotrophic factor (GDNF). In neuronal cultures from Embryonic Day 14 ventral mesencephalon, enhanced elongation of DA neurites was observed with immunophilin ligands, which inhibited the phosphatase activity of calcineurin (FK506 and cyclosporin A) when compared to vehicle-treated cultures. This elongation was also observed with GDNF, known to exert its trophic effects through phosphorylation-dependent pathways. In contrast, immunophilin ligands that do not inhibit calcineurin (rapamycin and V-10,367) increased branching of DA neurites, suggesting that elongation is dependent upon maintained phosphorylation while branching is not. In addition, both V-10,367 and rapamycin antagonized the elongation effects of FK506 and induced branching. The antagonism of elongation (and reappearance of branching) illustrates the intrinsic abilities of developing DA neurons to either elongate or branch, but not both. We show that the immunophilin FKBP12 (12-kDa FK506-binding protein) is expressed in ventral mesencephalic neuronal cultures and colocalizes with DA neurons. This work elucidates the specific growth-promoting effects by which GDNF and immunophilin ligands modify developmental growth processes of DA neurons, via their interactions with intracellular targets.     

Sex differences in response to red and blue light in human primary visual cortex: a bold fMRI study

Studies using a variety of investigative methods, including functional brain imaging and electroencephalography (EEG), have suggested that changes in central nervous system (CNS) dopamine function result in altered visual system processing. The discovery of abnormal retinal blue cone, but not red cone, electroretinogram in association with cocaine withdrawal and Parkinson's disease suggests that visual system response to blue light might be a marker for CNS dopamine tone. As there are numerous sex-related differences in central nervous system dopamine function, we predicted that blue and red light stimulation would produce sex-specific patterns of response in primary visual cortex when studied using the blood oxygen level dependent (BOLD) functional magnetic resonance imaging (fMRI) technique. We analyzed the BOLD response to red and blue light in male and female human volunteers (N=20). Red and blue light responses in primary visual cortex (V1) to stepped intensities of red and blue light were compared by sex for threshold to detectable BOLD signal increase and for stimulus intensity vs. BOLD signal response. Near threshold, males and females showed similar BOLD signal change to red light, but males showed a threefold greater increase (0.52%) to blue light stimulation when compared to females (0.14%). Log-linear regression modeling revealed that the slope coefficients for the red light stimulus intensity vs. signal change curve were not significantly different for males and females (z=0.995, P=0.320), whereas the slope coefficients for the blue light stimulus intensity vs. signal change curve were significantly larger in males (z=2.251, P=0.024). These findings support a sex and color-dependent differential pattern of primary visual cortical response to photic stimulation and suggest a method for assessing the influence of specific dopamine agonist/antagonist medications on visual function.     

Perforation of the bowel from intrauterine contraceptive devices: case series and discussion

The intrauterine contraceptive device is used extensively in the female population. Serious complications are rare, but they do occur. We discuss three cases of bowel perforation caused by these devices following their perforation through the uterine wall. It is important that cases of perforation be recognised swiftly and the possibility of involvement of other organs considered.     

美国国立健康研究院(NIH)资助的针灸临床研究内容与特点

近年来,美国国立健康研究院(National Institute of Health)对不少针灸临床研究进行了资助。在所资助的60项针灸临床研究中,美国本土的研究有39项,加拿大2项,欧洲7项,中东4项,东南亚8项,中国大陆的复旦大学有2项。有些与手术后或化疗后的病症有关,如幻肢痛,结肠切除术后、化疗后的慢性疲乏、防止放疗后的口腔干燥,减轻手术后的伤口疼,减轻放疗或化疗后的恶心呕吐,减轻手术后的肠梗阻等;有些与疼痛有关,如关节炎、癌症、手术后的疼痛管理等;有与心理精神疾病相关的,如儿童的孤独症,成人的药物滥用等;也有与妇女疾病有关的,如痛经、非周期性乳腺疼痛、生产过程中的生产延迟、生产后会阴修补术引起的疼痛、乳腺炎、妇女更年期以及乳腺癌后的潮热等都纳入了针灸临床研究的范围。与早期只注重于疼痛管理或癌症后的胃肠道反应相比,这些研究项目更深入更广泛。NIH资助的针灸临床研究有以下特点:①规模较小。国内的许多针灸临床往往规模较美国的研究要大。但近年来一些欧洲国家的临床研究参与的病例数就超过了国内一些临床研究项目。②设计严谨。由于NIH的针灸临床研究的研究对象是针灸疗法,在研究的报告中很少提及所用穴位或穴位配合。但大部分的研究都会在纳入或排除标准中注明受试者没有接触过针灸,因为往往在安慰组或假针灸组里,采用假刺或仅仅浅刺,受试者不可能有类似针灸得气的感觉。NIH研究设计的一个优点是随访周期可长达数月甚至数年。③立题新颖。总的来讲,NIH的针灸临床研究项目肯定没有国内的多和广,但它所涉及的领域,有些在国内还是空白。④实用性强。西方人往往是在常规或传统的治疗方法无效的情况下才会想到使用针灸的,在许多疾病如疼痛、癌症、艾滋病、糖尿病或吸毒(药物滥用),会求助于替代医学中的针灸疗法。因而,NIH只会选择那些实用性很强,能切实帮助解决问题的研究进行资助。⑤着重安全。美国NIH对于所有医学治疗的态度可能与国内有所不同,安全性是一个首要的而且是决定性的因素。几乎所有的针灸临床研究都需经过预试验(pilot),设立纳入或排除标准时一定要按照常规医疗的规范来进行,可以避免许多法律上的麻烦。     

Measurement of self-reported HIV risk behaviors in injection drug users: Comparison of standard versus timeline follow-back administration procedures

This study compares the frequencies of retrospective self-reported HIV high-risk drug use and sexual behaviors in 127 out-of-treatment injection drug users using the HIV Risk Questionnaire (HRQ) across two administration methods: (a) a brief standard quantity–frequency approach covering the past 30 days and (b) a lengthier timeline follow-back (TLFB) procedure for improving recall. The two procedures produced similar frequencies of risk behavior across most items (80%) and good intra- and interclass correlation coefficients. The TLFB, however, resulted in higher frequencies for two risk behavior questions—sharing of any drug injection equipment and having any type of unprotected sex. The TLFB is a well-established procedure for retrospective assessment of HIV risk behavior and a good choice when precision in measuring these behaviors is a primary focus of the work. In contrast, the brief HRQ-Standard interview procedure appears to be a reasonable choice for clinical, research, and health-related surveys where the primary focus is broader than HIV risk behavior.     

The Michigan Alcoholism Screening Test and Its Shortened Form: A Meta-Analytic Inquiry Into Score Reliability

Meta-analytic methods provide a framework around which an inquiry into MAST and SMAST score reliability was completed. Of the 470 measurement opportunities observed between 1971 and 2005, 62 (13.2%) were coupled with accurate reliability information. Weighted reliability estimates centered on. 80 suggesting that the MAST and SMAST generally produce scores of similar and adequate reliability for most research purposes. However, the variability of internal consistency estimates shows that at times these tools will not produce reliable scores, particularly among female and nonclinical respondents. Multiple regression equations provide practical guidelines to improve reliability estimates for the future use of these instruments.