Are planning,working memory,and inhibition associated with individual differences in preschool ADHD symptoms?

The association between executive function (EF; planning, working memory, and inhibition) and individual differences in symptoms of attention deficit hyperactivity disorder (ADHD) was explored in a sample of preschool children. One hundred sixty children (between the ages of 3 years, 0 months and 5 years, 6 months), selected so as to oversample high ADHD scorers, performed 3 tasks previously shown to measure planning (Tower of London), working memory (Noisy Book) and inhibition ("Puppet Says..."). EF measures were reliable (kappa > .77) and were correlated with IQ (rs > .38) and age (rs > .59). Once IQ and age were controlled, planning and working memory (r = .41) were correlated. Planning and working memory were not correlated with inhibition (rs < .20). There was no association between ADHD and working memory or planning (rs < .12). There was a significant negative association between ADHD and conduct problems and inhibition (r = -.30 and r = -.25, respectively). Only the link with ADHD persisted after the effects of other factors were controlled for in a multiple regression. Specific deficits in inhibitory control rather than general EF deficits are associated with ADHD in the preschool period. This association is linear in nature, supporting the idea that ADHD is better seen as a continuum rather than a discrete category. This association provides evidence for Barkley's (1997) view that ADHD is underpinned by inhibitory deficits in the preschool period.     

Langerhans cells and serum precipitating antibodies against fungal antigens in bronchioloalveolar cell carcinoma: possible association with pulmonary eosinophilic granuloma

In an ultrastructural study of 37 cases of bronchioloalveolar cell carcinoma (BAC), we identified seven cases (19%) in which Langerhans cells (LC) were closely associated with tumor cells. Serum precipitating antibodies against Aspergillus species and/or thermophilic actinomyces were present in five BAC patients whose tumors contained LC and in six patients whose tumors lacked LC. In a simultaneous study we identified marked atypical bronchiolar and alveolar lining cell hypertrophy and hyperplasma in pulmonary eosinophilic granuloma (PEG). Our data plus current information suggesting that PEG is a form of hypersensitivity pneumonitis support our hypothesis that those cases of BAC in which LC are present may arise in localized or diffuse pulmonary scars caused by PEG.     

Roles of gamma interferon and other cytokines in suppression of the spleen cell proliferative response to concanavalin A and toxoplasma antigen during acute toxoplasmosis.

Suppressed splenocyte proliferation in response to mitogen and toxoplasma lysate antigen (TLA) is observed in mice acutely infected with Toxoplasma gondii. Recently, we reported that NG-monomethyl-L-arginine (NMMA), an inhibitor of reactive nitrogen intermediate (RNI) production, partially restored proliferative responses of splenocytes from infected mice. In the present study we have examined the effect of NMMA on production of cytokines by splenocytes from mice acutely infected with T. gondii and assessed the role of gamma interferon (IFN-gamma) and interleukin-10 (IL-10) in the RNI-mediated suppression. Stimulation with concanavalin A (ConA) or TLA of splenocytes from CBA/Ca mice infected for 7 days resulted in increased production of IFN-gamma, IL-4, and IL-10 but reduced levels of IL-2 when compared with cultures of splenocytes from uninfected mice. Whereas addition of NMMA did not alter levels of cytokines produced by splenocytes from uninfected mice, splenocytes from infected mice stimulated with ConA produced significantly higher levels of IL-10 and reduced levels of IL-2 and IL-4. Addition of anti-IFN-gamma monoclonal antibodies to cultures of spleen cells from mice infected for 7 or 14 days remarkably decreased the levels of nitrite and resulted in a 47- and 4-fold increase in proliferation induced by stimulation with ConA or TLA, respectively. Anti-IL-10 did not reduce levels of nitrite produced in culture but did result in a fourfold increase in the proliferative response of splenocytes from mice infected for 14 days. In vivo administration of anti-IFN-gamma or anti-IL-10 monoclonal antibodies to infected mice partially restored ex vivo spleen cell proliferative responses by approximately 40 and 15%, respectively. Our data indicate that IFN-gamma is important in inducing the RNI-mediated immunosuppression, which, in turn, affects production of cytokines by splenocytes. Our data also demonstrate that IL-10 is involved in the suppression observed but that this activity is independent of RNI.     

Protection against Toxoplasma gondii in mice immunized with Toxoplasma cell fractions, RNA and synthetic polyribonucleotides

Mice immunized with fractions obtained by centrifugation of disrupted Toxoplasma gondii trophozoites as well as with 200 μg of Toxoplasma ribonucleic acid (RNA) were resistant (as measured by time to death and total mortality) to challenge with Toxoplasma 30 days later. When mice were challenged at 15 days no protection was noted. A dose of 50 μg of Toxoplasma RNA was effective in protecting mice against lethal challenge only when incorporated into Freund's incomplete adjuvant. In studies performed to determine the specificity of the resistance observed, resistance was also noted in mice immunized with 200 μg of RNA extracted from normal mouse peritoneal macrophages, as well as in mice immunized with 100 μg of the synthetic polyribonucleotide polycytidylic acid. Polyadenylicuridylic acid conferred protection only when incorporated into Freund's incomplete adjuvant and polyinosinic—cytidylic acid had no effect. The protection induced by Toxoplasma RNA was eliminated by prior treatment of the preparation with ribonuclease but not by treatment with pronase, suggesting that the moiety responsible for the protective effect was RNA. In experiments designed to explore the mechanism of resistance in the vaccinated mice, macrophages harvested from mice which had been injected with Toxoplasma RNA 15 days earlier were found to be activated in that they resisted challenge with Listeria monocytogenes.     

Delayed Hypersensitivity to Toxoplasma and Unrelated Antigens in Toxoplasma-Infected Mice: Induction and Elicitation of Delayed-Type Hypersensitivity by Antigen-Pulsed Macrophages

Delayed-type hypersensitivity (DTH) to Toxoplasma and unrelated antigens in Toxoplasma-infected BALB/c mice was investigated by the radioisotopic uptake method of Vadas et al. (Int. Arch. Allergy Appl. Immunol. 49: 670-692, 1975). DTH became positive on day 30 of infection and remained positive during chronic infection. The expression of DTH in mice infected with the relatively avirulent C37 strain of the parasite paralleled the Toxoplasma antibody response as detected by the Sabin-Feldman dye test. Mice sensitized with Toxoplasma, keyhole limpet hemocyanin, or sheep erythrocytes during the acute or chronic phase of Toxoplasma infection showed a DTH reaction similar to that of uninfected sensitized controls. No parasite antigens could be detected by immunofluorescence techniques on the surface of Toxoplasma-infected cells. When killed organisms were added to the cell cultures, specks of fluorescence appeared on cells containing intracellular parasites as well as on cells without intracellular organisms. That the antigens may be present in or on macrophages in a form readily recognizable by T cells is suggested by experiments in which we demonstrated that injection of uninfected normal macrophages pulsed with Toxoplasma-soluble antigens into the ears of chronically infected mice elicited a DTH reaction comparable to that observed when 10⁶ Formalin-fixed tachyzoites were used as the test antigen. When macrophages pulsed with Toxoplasma antigen were used in attempts to induce DTH in naive uninfected mice, the intensity of the reaction was similar to that observed in infected mice.     

Dichotomy between macrophage activation and degree of protection against Listeria monocytogenes and Toxoplasma gondii in mice stimulated with Corynebacterium parvum.

In vivo and in vitro experiments were conducted to determine the effect of Corynebacterium parvum treatment of mice on resistance of Listeria monocytogenes and Toxoplasma gondii. Intravenous immunization with C. parvum conferred transient protection against intravenous challenge with Listeria or an avirulent strain of Toxoplasma but did not protect against a virulent strain of Toxoplasma. Compared with the level of protection conferred by C. parvum, a higher degree of resistance was noted when mice infected with Listeria or Toxoplasma were challenged with the homologous infecting organism. Peritoneal macrophages from mice immunized intravenously with C. parvum were activated to kill Toxoplasma in vitro. Whereas resistance to challenge in vivo was transient, this population of activated macrophages persisted. Peritoneal macrophages from C. parvum mice also markedly inhibited [3H]thymidine uptake by L cells.     

From preventive policy to preventive practice

Characteristics of the relationship of preventive policy to preventive practice are reviewed. The relatively low emphasis on prevention compared with treatment programs is discussed and the particular problem of the "anonymity" of prevention is defined. Prevention programs suffer in part because of the lack of identity of the specific individuals benefited. Examples from the cardiovascular diseases are used to illustrate the general points. The contrast between community- and patient-oriented prevention is important. Adequate levels of disease prevention and health promotion will never be attained one case at a time. Interactions among individuals are determinants of environmental behavioral factors relevant to health. The policy forming process is intrinsically interactive in nature. The Institute of Medicine's 1988 study of the future of public health is reviewed with respect to its emphasis on professional participation in the health policy process. Prevention is an essentially multidisciplinary area requiring the participation of many professions and disciplines. This property of prevention will be enhanced in the future. Ten principles which can be useful in translating preventive policy into preventive practice are presented.     

Congenital pulmonary atresia with ventricular septal defect: angiographic and surgical correlates

Of 181 patients with severe congenital pulmonary atresia and ventricular septal defect or "type IV truncus" (an obsolete term), all but 11% had true central pulmonary arteries. These arteries were demonstrable by large serial biplane angiograms using multiple selective injections into collateral vessels, frequent photographic subtraction, and occasional pulmonary vein-wedge angiograms. These techniques are extremely important for accurate diagnosis and in planning corrective or palliative surgery, which was done in 77% of patients with pulmonary arteries.