Which treatment for whom for ADHD? Moderators of treatment response in the MTA

Using receiver operating characteristics, the authors examined outcome predictors (variables associated with outcome regardless of treatment) and moderators (variables identifying subgroups with differential treatment effectiveness) in the Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder (ADHD; MTA). Treatment response was determined using parent- and teacher-reported ADHD and oppositional defiant symptoms, with levels near or within the normal range indicating excellent response. Among 9 baseline child and family characteristics, none predicted but 3 moderated treatment response. In medication management and combined treatments, parental depressive symptoms and severity of child ADHD were associated with decreased rates of excellent response; when these 2 characteristics were present, below-average child IQ was an additional moderator. No predictors or moderators emerged for behavioral and community comparison treatments. The authors discuss conceptual and clinical implications of research on treatment moderators.     

Adeno-associated virus vector gene transfer and sarcolemmal expression of a 144 kDa micro-dystrophin effectively restores the dystrophin-associated protein complex and inhibits myofibre degeneration in nude/mdx mice

Duchenne muscular dystrophy is a severe life-threatening X-linked recessive disorder, caused by mutations in the dystrophin gene, for which currently there is no effective treatment. Because of the large size of the dystrophin cDNA (14 kb) this precluded it from being used in early adenovirus- or retrovirus-based gene therapy vectors. However, some therapeutic success has been achieved in mdx mice using adenovirus- and retrovirus-mediated transfer of a 6.3 kb recombinant mini-dystrophin cDNA. Despite this, problems with immunogenicity and inefficient transduction of mature myofibres make these vectors less than ideal for gene transfer to skeletal muscle. Adeno-associated viral (AAV) vectors overcome many of the problems associated with other vector systems. However, AAV vectors can only accommodate <5 kb of foreign DNA. For this reason we have produced a micro-dystrophin cDNA gene construct that is <3.8 kb. This construct, driven by a CMV promoter, was introduced into the skeletal muscle of 12-day-old nude/mdx mice using an AAV vector, resulting in specific sarcolemmal expression of micro-dystrophin in >50% of myofibres up to 20 weeks of age, and effective restoration of the dystrophin-associated protein (DAP) complex components. Additionally, evaluation of central nucleation indicated a significant inhibition of degenerative dystrophic muscle pathology. We have therefore shown that the current micro-dystrophin gene delivered in vivo using an AAV vector is not only capable of restoring sarcolemmal DAP complexes, but can also ameliorate dystrophic pathology at the cellular level.     

Systemic distribution of woodchuck hepatitis virus in the tissues of experimentally infected woodchucks

To better assess the extent of the tissue tropism of mammalian hepadnaviruses, 10 tissues from each of six woodchucks were examined for the presence and state of woodchuck hepatitis virus (WHV) nucleic acids 15 months after experimental WHV infection. The tissues examined were peripheral blood lymphocytes, lymph node, spleen, bone marrow, thymus, pancreas, kidney, ovary, testis, and liver. Tissue samples from three chronically infected animals and three animals with serologic patterns of recovery (serum: WHsAg-, anti-WHs+, anti-WHs+, WHV DNA-) from acute WHV infection were analyzed in parallel by in situ hybridization and Southern and Northern blot techniques. WHV nucleic acids were detected in several individual tissues from each animal examined, although not all tissues in every animal contained WHV. Substantial differences were observed among the various tissues and animals with respect to the frequency, level, and intratissue distribution of WHV nucleic acids, as well as the presence of different viral genomic forms. Active WHV DNA replication was present only in the liver and spleen of the chronically infected animals. No evidence of ongoing WHV DNA replication was found in any of the tissues from the recovered animals. WHV DNA was homogeneously distributed among all hepatocytes in the livers of the chronic carriers. By contrast, WHV DNA in all the extrahepatic tissues, and in the livers of the recovered animals, was detected only in scattered foci of cells.     

Individual T cells hold unexpected clues to the nature of anergy and memory

The primary interest of our laboratory is understanding how the signals that a T cell receives influence its behavior during an immune response. Recently, we have focused our attention on the examination of T cell responses at an individual cell level. This article outlines our approach, presents our initial findings, and discusses the implications of these findings relative to our current models of T cell activation.     

Validation of a brief screening instrument for substance abuse and mental illness in HIV-positive patients

BACKGROUND: Substance abuse (SA) and mental illness (MI) commonly co-occur with HIV infection in the United States and have important implications for clinical management of HIV/AIDS. Yet SA/MI often go untreated due in part to a lack of practical, validated screening tools. SETTING: HIV clinic in academic medical center. METHODS: The 16-item SA/MI Symptoms Screener (SAMISS) targets SA/MI in HIV-positive patients. Consecutive consenting HIV-positive patients completed the SAMISS and then a reference standard diagnostic tool, SCID, the Structured Clinical Interview for DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition). RESULTS: Twenty percent of participants (29/148) had an SA diagnosis and 41% (59/143) had an MI diagnosis in the past year on the SCID; 48% (68/143) had 1 or both. Thirty-seven percent (55/148) screened positive for SA and 69% (99/143) screened positive for MI on the SAMISS. The SAMISS had 86% (95% CI: 68%-96%) sensitivity and 75% (66%-82%) specificity for SA and 95% (86%-99%) sensitivity and 49% (38%-60%) specificity for MI. Patients with SA were likely to show up as false positives for MI and vice versa. CONCLUSION: The SAMISS functioned well as a first-line screening tool for SA/MI in this HIV clinic population. It missed few cases and was easily incorporated into a busy clinical setting. Persons screening positive require a more rigorous confirmatory psychiatric evaluation.     

The Site of Vascular Response to the α-Toxin of Clostridium Perfringens Type A in Skeletal Muscle

The vascular response to the α-toxin of Clostridium perfringens type A, was observed topographically in the cremaster muscle of the rat, in terms of exudation, labelling of damaged vessels by circulating carbon, and in addition histologically for patency of the vascular plexus.It was confirmed that the permeability response is biphasic. The short-lived immediate phase corresponds to that of venular labelling, and the delayed phase reaches its peak rather later than the corresponding phase of capillary labelling. The intensity and extent of these responses are determined by the degree of injury, but their shape and timing, especially in the immediate phase, vary almost as consistently with the duration of exposure to circulating dye or carbon.After the standard dose of toxin, vascular patency is largely unaffected until 24 hours. Apparently irreversible vascular occlusion occurs rather earlier with larger doses. A three-fold reduction of the standard dose proportionately reduces both exudation and capillary labelling but leaves immediate venular labelling unaffected, suggesting that the latter is not dose dependent and therefore non-specific. Prolongation of moderate venular labelling into the middle of the delayed phase may occur at this dosage. Its absence after the standard dose suggests that delayed inhibition of venular reactivity may be occurring.Irregular labelling of venules and small veins persists throughout the delayed phase with doses 2·4 or more times the standard dose. A brief ultramicroscopic survey revealed appearances in both venules and capillaries at 1-2 hours after injury closely comparable to those which have been described for Cl. oedematiens toxin at 6-24 hours.In rats given carbon during the delayed phase, the effective vascular patency 10 minutes later includes half of the labelled capillaries up to 10 μm in diameter. This proportion is little affected by toxin dose, but intensely so when the carbon clearance time is increased, suggesting that such injured microvessels may be a major source of plasma protein exudation.