How specific is a deficit of executive functioning for attention-deficit/hyperactivity disorder?

A selective review of research in the executive functioning (EF) is given for attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), conduct disorder (CD), higher functioning autism (HFA) and Tourette syndrome. The review is restricted due to changes in the classification of the disorder in recent years and secondly the heterogeneity of EF is restricted to five key areas of concern, inhibition, set shifting, working memory, planning, and fluency. The review makes clear that there are strong differences between child psychopathological groups and controls on these EFs. However, future research will be needed to identify an EF deficit or profile, which is specific for these disorders.     

Role of natural killer cells in the rejection process of corneal allografts in rats

BACKGROUND: The exact mechanism of human corneal allograft rejection, which is the major cause of corneal transplant failure, remains unclear. We investigated the role of natural killer (NK) cells in rat corneal allograft rejection by examining the aqueous humor (AH) cell infiltrate on different postoperative days. METHODS: Flow cytometric analysis was performed on the AH and submandibular draining lymph node (DLN) cells before transplantation and at different time points thereafter. In addition, we performed functional cytotoxicity assays with cells present in the AH during corneal rejection. RESULTS: We demonstrated a gradual increase in the absolute cell number of different hematopoietic subpopulations in the AH after allogeneic cornea transplantation. CD3CD4 cells, mainly monocytes and macrophages, were the predominant subpopulation 2 days after transplantation, followed by a successive relative increase of CD4 T cells, CD8 T cells, CD161 T cells, and NK cells. NK and CD161 T cells were present at a 10- to 15-fold higher percentage than in the DLN, suggestive of local expansion of these cells. A higher percentage of NK cells were CD8-negative compared with DLN NK cells. AH cells specifically lysed allogeneic cells, and this cytotoxicity was mainly attributable to NK cells but not to CD4 or CD8 T lymphocytes. CONCLUSION: These results confirm the crucial role of CD4 cells in the allogeneic corneal graft rejection process and implicate NK cells as possible mediators of the rejection.     

Dynamic contrast-enhanced MRI of the pancreas: initial results in healthy volunteers and patients with chronic pancreatitis

PURPOSE: To characterize pancreatic perfusion in volunteers and patients with chronic pancreatitis (CP) by dynamic contrast-enhanced (DCE) MRI. MATERIALS AND METHODS: Pancreatic enhancement after bolus injection of Gd-DTPA with a three-dimensional ultrafast partial-Fourier radiofrequency (RF) spoiled gradient-echo (GE) acquisition was examined prospectively. An acquisition volume of the pancreatic parenchyma was obtained every 4.2 seconds during a single breath-hold in 31 volunteers and 19 patients with CP. We calculated the wash-in rate and a newly defined parameter, the "time-to-inflow deceleration" (TID). A statistical analysis of the differences between both groups was performed with the use of Student's t-test. RESULTS: Significant differences in the TID and wash-in rate were found for the head and body of the pancreas: the TID was 22.4 sec +/- 4.4 sec and 23.5 sec +/- 6.1 sec in the pancreatic head and body of the healthy volunteers, and 29.8 sec +/- 8.6 sec and 29.4 sec +/- 3.8 sec in patients with CP. The wash-in rate was 96 +/- 37 sec(-1) and 101 +/- 27 sec(-1) in controls, and 62 +/- 17 sec(-1) and 75 +/- 27 sec(-1) in CP. CONCLUSION: CP can be identified by semiquantitative changes on DCE-MRI. Whether DCE-MRI of the pancreas can be used to detect early CP remains to be validated.     

Total joint arthroplasty for osteoarthritis of the thumb basal joint

A survey of 43 cemented arthroplasties of the trapeziometacarpal joint with a la Caffinière prosthesis in 40 patients is presented. A 70% patient satisfaction rate was obtained, with a mean DASH score of 24.2. Good range of motion was preserved (opposition 9/10 on Kapandji's scale) and gripping force as well as key pinch force increased from 18 kg to 24 kg and from 5.3 to 6.0 kg respectively. However loosening was seen in 44% of the implants. Loosening was related to younger age. We conclude that despite good clinical outcome, radiographic loosening is a threat for the future of this implant.     

Emotional strain,communication, and satisfaction of family members in the intensive care unit compared with expectations of the medical staff: experiences from a Norwegian University Hospital

Objectives To determine satisfaction in regard to information concerning, and support and facilities for relatives in the intensive care unit (ICU), and to compare this with the staffs expectations on these issues; to determine relatives degree of psychological distress and use of hypnotics, anxiolytics, and antidepressants; finally, to compare the distress of relatives of survivors and relatives of non-survivors.Design Prospective study.Setting University-affiliated ICU.Methods Relatives of 50 patients who survived at least 6 days in the ICU and relatives of 18 non-survivors who stayed for at least 24 h anonymously completed a mailed questionnaire at home 4 weeks after treatment in the ICU. Forty-three staff members (69%) answered the questionnaire. The degree of satisfaction was measured on a five-point scale (0–4).Main results The average satisfaction scores were 3.4±0.6 SD for relatives of survivors and 3.4±0.5 for relatives of non-survivors. Staff expected a significantly lower degree of satisfaction, with a score of 2.9±0.5 (P<0.001). The distress scores of relatives of survivors (2.7±1.0) were no higher than the ones of relatives of non-survivors (2.4±0.6) during the ICU stay, but significantly lower than staff expectations (3.2±0.5) (P<0.01). The use of medication was moderate.Conclusions The relatives satisfaction was greater than anticipated by the staff. Staff generally expected a higher degree of distress among relatives than was actually the case. Relatives were very satisfied with the support and communication in the ICU despite substantial distress. Relatives of survivors and non-survivors were equally satisfied.Electronic Supplementary Material Supplementary material is available in the online version of this article at     

Genetic and phenotypic characterization of tumor cells derived from malignant peripheral nerve sheath tumors of neurofibromatosis type 1 patients

Neurofibromatosis type 1 (NF1) patients have an 8-13% lifetime risk of developing malignant peripheral nerve sheath tumors (MPNST) which have a very poor prognosis. In this study, cells from eight MPNSTs (six primary and two recurrences) of six clinically and genetically well-characterized NF1 patients were taken into culture. Tracing of loss of heterozygosity (LOH) of the NF1, p53, and p16 gene regions or of abnormal karyotypes enabled identification of tumor cells from five MPNSTs. In two other MPNST-derived cell cultures, LOH of the relevant regions in the original tumors could not be detected, indicating that the obtained cells were nonneoplastic cells. Cells from most MPNSTs grew only under standard culture conditions but not under conditions optimized for Schwann cells. These cells were S100-negative and did not exhibit spindle shape which is a characteristic of Schwann cells. Drastically increased proliferation rates were found for most of the MPNST cells in comparison to Schwann cells derived from benign neurofibromas. Our study demonstrates that genetic analysis is effective and essential for verification of MPNST tumor cells in culture. These verified MPNST cells are valuable for further investigations of the biology and pathogenesis of this malignancy as well as for in vitro pharmacologic studies essential for the development of new therapies.     

Prognostic significance of electrocardiographic voltages and their serial changes in elderly with systolic hypertension

The aim of the present study was to assess the prognostic value of ECG voltages at baseline and their serial changes during follow-up in a large prospective study with standardized follow-up and strictly defined end points. Patients who were 60 years old or older, with systolic blood pressure of 160 to 219 mm Hg and diastolic pressure <95 mm Hg, were randomized into the double-blind placebo-controlled Systolic Hypertension in Europe trial. Active treatment consisted of nitrendipine, which could be combined with or replaced by enalapril, hydrochlorothiazide, or both. At the end of the double-blind part of the trial (median follow-up, 2.0 years), follow-up was extended and all patients received active study drugs (median total follow-up, 6.1 years). Electrocardiography was performed at baseline and yearly thereafter. Electrocardiographic left ventricular mass was prospectively defined as the sum of 3 voltages (RaVL+SV1+RV5), which averaged 3.1+/-1.0 mV. The adjusted relative hazard rate, associated with a 1 mV higher sum at baseline, amounted to 1.10 and 1.15 for all-cause and cardiovascular mortality and to 1.21 and 1.18 for strokes and cardiac events, respectively (P< or =0.01 for all). A 1-mV decrease in electrocardiographic voltages during follow-up independently predicted a lower incidence of cardiac events (relative hazard rate: 0.86; P< or =0.05), but not of stroke or mortality. In conclusion, electrocardiographic voltages at baseline and their serial changes during follow-up predict subsequent events in older patients with systolic hypertension.