Polymer-acid-metal quasi-ohmic contact for stable perovskite solar cells beyond a 20,000-hour extrapolated lifetime

The development of a robust quasi-ohmic contact with minimal resistance, good stability and cost-effectiveness is crucial for perovskite solar cells. We introduce a generic approach featuring a Lewis-acid layer sandwiched between dopant-free semicrystalline polymer and metal electrode in perovskite solar cells, resulting in an ideal quasi-ohmic contact even at elevated temperature up to 85 °C. The solubility of Lewis acid in alcohol facilitates nondestructive solution processing on top of polymer, which boosts hole injection from polymer into metal by two orders of magnitude. By integrating the polymer-acid-metal structure into solar cells, devices exhibit remarkable resilience, retaining 96% ± 3%, 96% ± 2% and 75% ± 7% of their initial efficiencies after continuous operation in nitrogen at 35 °C for 2212 h, 55 °C for 1650 h and 85 °C for 937 h, respectively. Leveraging the Arrhenius relation, we project an impressive T80 lifetime of 26,126 h at 30 °C.

AgIn5S8/ZnS Quantum Dots for Luminescent Down-Shifting and Antireflective Layer in Enhancing Photovoltaic Performance

Colloidal AgIn5S8/ZnS quantum dots (QDs) have recently emerged as a promising, efficient, nontoxic, down-shifting material in optoelectronic devices. These QDs exhibit a high photoluminescent quantum yield and offer a range of potential applications, specifically in the field of photovoltaics (PVs) for light management. In this work, we report an eco-friendly method to synthesize AgIn5S8/ZnS QDs and deposit them on commercial silicon solar cells (with an active area of 7.5 cm2), with which the short-circuit current (JSC) enhanced by 1.44% and hence the power conversion efficiency by 2.51%. The enhancements in PV performance are mainly attributable to the improved external quantum efficiency in the ultraviolet region and reduced surface reflectance in the ultraviolet and near-infrared regions. We study the effect of QD concentration on the bifunctions of downshifting and antireflection. The optimal 15 mg/mL QDs blade-coated onto the Si solar cells realize maximum current generation as the reflectance loss in the visible wavelength is compensated by the minimized reflection in the near-infrared region.

LPE growth of Tb3Al5O12:Ce single crystalline film converters for WLED application

Efficient phosphor converters for white LEDs based on TbAG:Ce single crystalline films, LPE grown onto YAG substrates, is developed. The film-substrate interface of TbAG:Ce SCF/YAG epitaxial structures was studied using high-resolution STEM images.

Prevalence of Diabetes Mellitus (DM) in a population of men affected by Erectile Dysfunction (ED)

AIMS

A) to evaluate the prevalence of patients affected by Diabetes Mellitus (DM) in a population of men with Erectile Dysfunction (ED); B) to define the epidemiological, biochemical and therapeutic aspects.

MATERIALS AND METHODS

N.934 subjects referred at our Andrology Unit for ED were studied. The diagnosis of ED was evaluated using the IIEF-5 questionnaire (Total score ≤21).

RESULTS

The prevalence of subjects affected by DM in a population of men with ED was 19.5% (182/934). The age ranges were: ≥55 years (108/182; 59.3%); ≥40<55 years (70/182; 38.5%); <40 years (4/182; 2.2%). HbA1c mean value was 7.9% ± 0.8%. No significant differences were found in DM onset timing or in anti-diabetic treatment. In n.125/182 cases (68.7%) the ED onset followed the diagnosis of DM; in n.34/182 cases (18.7%) it appeared at the same time; and in n.23/182 cases (12.6%) appeared before DM diagnosis.

ED TREATMENT

in n.18/182 subjects (9.9%) there was a concomitant hypotestosteronemia; these patients were treated only with testosterone replacement; this treatment was efficacious (IIEF-5 total score ≥22) in 8/18 subjects (44.4%). In n.146/182 subjects (80.2%) a treatment with PDE5-i was given. Of these 146 subjects, the therapy was given "on demand" to 108 subjects (efficacy in 50.9%; 55/108) and "once a day" to the remaining 38 subjects (efficacy 63.1%, 24/38) (p=0.428, n.s.). N.15/182 subjects (8.2%) were treated with intracavernous injections of Alprostadil (efficacy in 8/15, 53.3%). In n.3/182 subjects (1.6%) a penile prosthesis was implanted.

CONCLUSIONS

DM is one of the most frequent organic causes of ED; there were many strategies to treat this symptom without interfering with the antidiabetic treatment. Finally, ED can be predictive of DM.

ADHD & Pharmacotherapy: Past, Present and Future: A Review of the Changing Landscape of Drug Therapy for Attention Deficit Hyperactivity Disorder

Attention deficit hyperactivity disorder (ADHD) is the most common neurobiological disorder in children, with a prevalence of ~6-7%^1,2 that has remained stable for decades². The social and economic burden associated with patients³, families, and broader systems (healthcare/educational) is substantial, with the annual economic impact of ADHD exceed $30 billion in the US alone⁴. Efficacy of pharmacotherapy in treating ADHD symptoms has generally been considerable with at least ¾ of individuals benefitting from pharmacotherapy, typically in the form of stimulants⁵. In this review, we begin by briefly reviewing the history of pharmacotherapy in relation to ADHD, before focusing (primarily) on the state-of-the-field on themes such as biophysiology, pharmacokinetics, and pharmacogenomics. We conclude with a summary of emerging clinical and research studies, particularly the potential role for precision therapy in matching ADHD patients and drug types.

A cooperative interaction between LPHN3 and 11q doubles the risk for ADHD

In previous studies of a genetic isolate, we identified significant linkage of attention deficit hyperactivity disorder (ADHD) to 4q, 5q, 8q, 11q and 17p. The existence of unique large size families linked to multiple regions, and the fact that these families came from an isolated population, we hypothesized that two-locus interaction contributions to ADHD were plausible. Several analytical models converged to show significant interaction between 4q and 11q (P<1 × 10(-8)) and 11q and 17p (P<1 × 10(-6)). As we have identified that common variants of the LPHN3 gene were responsible for the 4q linkage signal, we focused on 4q-11q interaction to determine that single-nucleotide polymorphisms (SNPs) harbored in the LPHN3 gene interact with SNPs spanning the 11q region that contains DRD2 and NCAM1 genes, to double the risk of developing ADHD. This interaction not only explains genetic effects much better than taking each of these loci effects by separated but also differences in brain metabolism as depicted by proton magnetic resonance spectroscopy data and pharmacogenetic response to stimulant medication. These findings not only add information about how high order genetic interactions might be implicated in conferring susceptibility to develop ADHD but also show that future studies of the effects of genetic interactions on ADHD clinical information will help to shape predictive models of individual outcome.

Rare structural variation of synapse and neurotransmission genes in autism

Autism spectrum disorders (ASDs) comprise a constellation of highly heritable neuropsychiatric disorders. Genome-wide studies of autistic individuals have implicated numerous minor risk alleles but few common variants, suggesting a complex genetic model with many contributing loci. To assess commonality of biological function among rare risk alleles, we compared functional knowledge of genes overlapping inherited structural variants in idiopathic ASD subjects relative to healthy controls. In this study we show that biological processes associated with synapse function and neurotransmission are significantly enriched, with replication, in ASD subjects versus controls. Analysis of phenotypes observed for mouse models of copy-variant genes established significant and replicated enrichment of observable phenotypes consistent with ASD behaviors. Most functional terms retained significance after excluding previously reported ASD loci. These results implicate several new variants that involve synaptic function and glutamatergic signaling processes as important contributors of ASD pathophysiology and suggest a sizable pool of additional potential ASD risk loci.

Rare structural variants found in attention-deficit hyperactivity disorder are preferentially associated with neurodevelopmental genes

Attention-deficit/hyperactivity disorder (ADHD) is a common and highly heritable disorder, but specific genetic factors underlying risk remain elusive. To assess the role of structural variation in ADHD, we identified 222 inherited copy number variations (CNVs) within 335 ADHD patients and their parents that were not detected in 2026 unrelated healthy individuals. Although no excess CNVs, either deletions or duplications, were found in the ADHD cohort relative to controls, the inherited rare CNV-associated gene set was significantly enriched for genes reported as candidates in studies of autism, schizophrenia and Tourette syndrome, including A2BP1, AUTS2, CNTNAP2 and IMMP2L. The ADHD CNV gene set was also significantly enriched for genes known to be important for psychological and neurological functions, including learning, behavior, synaptic transmission and central nervous system development. Four independent deletions were located within the protein tyrosine phosphatase gene, PTPRD, recently implicated as a candidate gene for restless legs syndrome, which frequently presents with ADHD. A deletion within the glutamate receptor gene, GRM5, was found in an affected parent and all three affected offspring whose ADHD phenotypes closely resembled those of the GRM5 null mouse. Together, these results suggest that rare inherited structural variations play an important role in ADHD development and indicate a set of putative candidate genes for further study in the etiology of ADHD.

The impact of a diagnosis of couple subfertility on male sexual function

AIM

The aim was to study: a) the prevalence of sexual dysfunction in male partners of subfertile couples; b) the possible correlation between sexual dysfunction and seminal profile.

SUBJECTS AND METHODS

Male partners (no.=171) of subfertile couples were studied, aged between 25 and 40 yr, attending the Andrology Unit of Sant'Andrea Hospital. All the subjects responded to a modified International Index of Erectile Function (IIEF) questionnaire, made up of 5 questions: 2 regarding erectile function, 1 concerning orgasmic function, 1 question on sexual desire, and 1 on satisfaction with intercourse. The questionnaire investigated both spontaneous sex for pleasure and sex intended to lead to pregnancy. The subjects underwent standard semen analysis, according to World Health Organization guidelines.

RESULTS

The data showed a disorder in sexual intercourse for reproductive purposes in 37 subjects (23.7%). Of these, only 14 (8.9%) also had problems with sex for pleasure. On the other hand, there was no significant variation in the prevalence of sexual dysfunction related to seminal profile.

CONCLUSIONS

A diagnosis of subfertility represents a stressful situation which can reduce the pleasure of sex, especially in intercourse intended for reproductive purposes; this disorder in sexual activity does not seem to be directly correlated with awareness of the severity of the semen alterations.

New software for the automatic and semiautomatic assessment of sperm morphology

AIM

An attempt was made to improve the standardization of sperm morphology assessment.

METHODS

A software for computerized automatic/semiautomatic sperm morphology assessment was developed and a comparative study between this computerized system and the subjective micrometric method was carried out.

RESULTS

The software has shown to be very reliable and reproducible. The subjective micrometric method significantly underestimated the percentage of atypical forms compared with the objective method.

CONCLUSION

Until the development of new fully-automatic techniques, this system is certainly an effective first step in the objective, reproducible standardization of sperm morphology assessment.

Prevalence of diabetes mellitus in male partners of infertile couples

AIM

The aim of this study was to investigate the prevalence of diabetes mellitus (DM) in a population of male partners of infertile couples, to evaluate their seminal and biochemical parameters and to plan therapeutic strategies to achieve pregnancy.

METHODS

Standard semen analysis was carried out in 510 male partners of infertile couples, aged 25 to 51 years.

RESULTS

The prevalence of DM in the subjects studied was 1.18%, 4 cases with non insulin dependent diabetes mellitus (NIDDM) and 2 cases with insulin dependent diabetes mellitus (IDDM). Three subjects with NIDDM and 1 with IDDM had normal ejaculation. Semen analysis of these subjects showed qualitative alteration; the most important effects concerned the kinetic properties, especially progressive motility. Sperm morphology was also significantly compromised. On the other hand, sperm concentration did not show significant alterations. The therapeutic iter in these subjects is similar to that for other dyspermic male partners of infertile couples. The 2 remaining subjects (one with NIDDM and one with IDDM) had retrograde ejaculation (sperm recovery from post-orgasmic urine) and were included in intrauterine insemination or in vitro fertilization programs. In addition, in the subjects with DM, the biochemical seminal profile showed significantly higher levels of fructose compared with the nondiabetic subjects.

CONCLUSION

DM has a negative impact both in terms of sperm quality and of the ejaculation mechanism. The low prevalence of DM among this study population of 510 male partners of infertile couples is due to the low prevalence of DM in this age range.

Survival of micro-organisms in cryostorage of human sperm

The authors describe the clinical application of semen cryostorage, survival of micro-organism during cryostorage procedures and the risk of cross-contamination.

An attempt to improve standardization of sperm motility class assessment using the superimposed image analysis system (SIAS) software

AIM

An attempt was made to improve the standardization of sperm motility assessment.

METHODS

A computerized system based on image superimposition producing final image with a motion effect was employed. Numerical definition of straight-line velocity (VSL), curvilinear velocity (VCL) and linearity (LIN) related to these motility classes were made, at different frame/rates (20 frames/s, 30 frames/s and 60 frames/s).

RESULTS

At least 4 motility class categories were found to be necessary (instead of 3, WHO) for a valid assessment. According to the cut-offs suggested by the ROC curves, motility classes were defined as follows: Class 1 (straight progressive motility): VSL = or > 23 microm/s; LIN = or > 0.58 at 20 frames/s; LIN = or > 0.50 at 30 frames/s; LIN = or > 0.44 at 60 frames/s. Class 2 (straight slow motility): VSL > 10 microm/s and < 23 microm/s; LIN = or > 0.58 at 20 frames/s; LIN = or > 0.51 at 30 frames/s; LIN = or > 0.43 at 60 frames/s. Class 3 (progressive non straight motility): VSL > 10 microm/s; LIN < 0.58 at 20 frames/s; LIN < 0.51 at 30 frames/s; LIN<0.43 at 60 frames/s. Class 4 (non progressive motility): VSL <10 microm/s. A frame rate of 20 frames/s was found to be sufficient to distinguish sperm motility classes in standard semen analysis.

CONCLUSIONS

The numerical definition of sperm motility classes may contribute towards standardization in the objective evaluation of sperm kinematics.

49th Annual Meeting of the American Academy of Child & Adolescent Psychiatry. 22-27 October 2002, San Francisco, CA, USA

The diverse programme covered recent advances in developmental neurobiology, genetics, psychotherapy and pharmacotherapy. Presentations included clinical consultation breakfasts, with experts in their specialities, clinical case conferences, media theatre events, symposia, special interest groups, workshops and poster presentations. Several awards were presented to members to acknowledge their research achievements and service to the academy, and to children in need. All the presentations were focused on keeping the clinician and the researcher up-to-date on the advancements within the field of child and adolescent psychiatry. This report will focus on the new research poster presentations, which highlight the current status of paediatric pharmacotherapy. The data will be presented within the major diagnostic groups of the affective, behavioural, anxiety and developmental, autistic and psychotic syndromes. In paediatric pharmacotherapy particularly, several agents are administered as broad spectrum pharmacotherapeutics, and therefore, are used across several disorders.

Neonatal orbital abscess

PURPOSE

To describe two cases of orbital abscess in neonates and to review the literature of orbital cellulitis in neonates.

DESIGN

Two interventional case reports.

METHODS

Photographs, orbital computed tomography scans, and full pediatric examination were obtained in two cases of orbital abscess in neonates.

RESULTS

Acute ethmoiditis with orbital abscess formation was found in both infants. In one of them, Staphylococcus aureus was identified as the source of infection.

CONCLUSIONS

The clinical findings of our cases concur with the literature (eight cases) indicating that orbital abscess caused by Staphylococcal ethmoiditis is the most common form of orbital cellulitis in neonates.

Response of bronchiolar Clara cells induced by a domestic insecticide. Analysis of CC10 kDa protein content

Clara cells are the most reactive to xenobiotics among the mammalian respiratory tract cells. In this report, the response of Clara cells to acute or repetitive exposure to a commercial insecticide was studied, correlating the changes in the cell ultrastructure with the intracellular content of CC10 kDa protein as quantified by immunocytochemical morphometry. After a single exposure to insecticide, Clara cells reveal great expansion of their volume which is accompanied by a remarkable proliferation of smooth endoplasmic reticulum, swelling of the mitochondria, and changes in the nucleus. Morphometric analysis of CC10 bronchiolar content showed significant increases in both the number of Clara cells and the immunostained areas in individual cells. By western blot, CC10 immunoreactive bands strongly increased in lungs after insecticide treatment, but they were only slightly higher than the control when the vehicle of the insecticide was tested. By repetitive exposure to the insecticide, the rat bronchiolar epithelium undergoes extensive alterations, particularly on Clara cells, the number of which is considerably reduced. The remaining Clara cells shrink in size and the typical dome-like cytoplasm is lost. Secretory granule release is no longer seen and the changes of their shape and secretory content reflect a marked degradation and condensation process. Repetitive exposures to the insecticide produced a severe blockage of the proteinopoietic activity, particularly on the synthesis of CC10. Results reported here reveal that the acute inhalation of a commercial insecticide produces hypertrophy of Clara cells, a significant augmentation of CC10 synthesis, and probably differentiation de novo of Clara cells, and morphological changes compatible with a detoxification process. By contrast, exposure for 5 days provoked a general inhibitory effect on Clara cell activity with the loss of cell capability to synthesize and secrete CC10 kDa protein.

Aggressive behavior in patients with attention-deficit/hyperactivity disorder, conduct disorder, and pervasive developmental disorders

Aggressive behaviors are frequently observed in patients with attention-deficit/hyperactivity disorder, conduct disorder, and pervasive developmental disorders. Several theories have been postulated to explain the etiology of aggression in these disorders, but no one theory can account for all the different types of aggressive behaviors observed. Numerous uncontrolled studies with small sample sizes have produced mixed results of pharmacologic agents now being used to treat aggression. This article discusses the phenomenology, etiology, assessment, and pharmacologic treatment of aggressive behavior in patients who have attention-deficit/hyperactivity disorder, conduct disorder, and pervasive developmental disorders.

Multicenter open-label sertraline study in adolescent outpatients with major depression

OBJECTIVE

The aim of this multicenter outpatient study was to assess the therapeutic benefits, response patterns, and safety of sertraline in adolescent major depressive disorder (MDD).

METHOD

Fifty-three adolescent outpatients with MDD were treated in an open-label, 10-week, acute-phase trial with sertraline and, if responders, for an additional 12-week continuation phase. Diagnostic and response assessments included the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS), 17-item K-SADS-derived depression severity score, Hamilton Depression Rating Scale, Beck Depression Inventory, and Clinical Global Impression Scale.

RESULTS

By 2 weeks, when analyzed as continuous variables, all severity scores showed significant differences from baseline. This pattern persisted through 10 weeks, with a significantly greater response occurring when treatment was extended from 6 to 10 weeks. Both clinician- and patient-rated improvement was maintained during continuation treatment. Response rates varied considerably when depression rating scales were analyzed categorically. Sertraline was generally well tolerated and did not induce manic symptoms.

CONCLUSIONS

In open treatment of adolescent MDD with sertraline, significant improvement occurred early on and was maintained for 22 weeks. Absolute response rates varied depending on the rating scales used, definition of response, and length of treatment. Maximal response rates were obtained by clinician-defined ratings after 10 weeks of treatment.

Controlled stimulant treatment of ADHD and comorbid Tourette's syndrome: effects of stimulant and dose

OBJECTIVE

To determine the effects of methylphenidate (MPH) and dextroamphetamine (DEX) on tic severity in boys with attention-deficit/hyperactivity disorder (ADHD) comorbid with Tourette's syndrome.

METHOD

A 9-week, placebo-controlled, double-blind crossover using a wide range of doses was completed by 20 subjects in three cohorts.

RESULTS

Relatively high doses of MPH and DEX in the first cohort produced significant increases in tic severity which were sustained on higher doses of DEX but which attenuated on MPH. Overall, 14 of 20 subjects continued stimulant treatment for 1 to 3 years, generally in combination with other psychotropics. Stimulant-associated adverse effects, including tic exacerbations, were reversible in all cases.

CONCLUSION

A substantial minority of comorbid subjects had consistent worsening of tics on stimulants, although the majority experienced improvement in ADHD symptoms with acceptable effects on tics. MPH was better tolerated than DEX.

Isolation of human uteroglobin from blood filtrate

The purpose of this study was to assess the possibility of isolating biologically active peptides from human blood using large volumes of blood filtrate, which are available from patients undergoing extracorporeal ultrafiltration because of renal insufficiency. This filtrate was submitted to six chromatographic separation steps, yielding one purified peptide which was completely analysed in its primary structure. It was found to be strikingly similar to proteins, described initially as rabbit uteroglobin (or blastokinin) and, more recently, from human bronchial lavage as the '10 kDa Clare cell protein', as well as from human urine as 'protein-1'. The natural molecule contains two chains of identical amino acid sequences of 70 residues which are arranged as an antiparallel dimer due to the disulphide bonds between two cysteines at positions 3 and 69. Mass analysis of the molecular forms yielded molecular weights from 15827 Da (non-oxidized form) to 15859 Da (bi-oxidized form). We conclude that this peptide isolated from the filtrate represents the human uteroglobin, and we demonstrate for the first time that this peptide may be involved as a humoral factor in reproductive or other physiological functions.

Cerebrospinal fluid homovanillic acid predicts behavioral response to stimulants in 45 boys with attention deficit/hyperactivity disorder

Central dopaminergic activity has been assumed to play a role in the efficacy of stimulant drugs in attention deficit/hyperactivity disorder (ADHD), although supporting evidence has been scant. This study examined baseline cerebrospinal fluid (CSF) of boys with ADHD in relation to response to three different stimulant drugs. Forty five boys with DSM-III-R-diagnosed ADHD had a lumbar puncture before double-blind trials of methylphenidate, dextroamphetamine, and placebo. Sixteen also received pemoline as part of a subsequent open trial. Stepwise linear regressions determined significant predictors of drug response. Our prior report of a positive significant correlation between CSF homovanillic acid (HVA) and ratings of hyperactivity on placebo was replicated in a new sample of 20 boys. After baseline symptom severity, CSF HVA was the best predictor of stimulant drug response, with significant independent contribution to four of the ten measures of hyperactivity that changed significantly with medication. Higher HVA predicted better drug response, and lower HVA was associated with worsening on some measures. This supports the mediating role of central dopaminergic activity in stimulant drug efficacy in childhood hyperactivity.

Effect of dextroamphetamine and methylphenidate on calcium and magnesium concentration in hyperactive boys

Levels of calcium in plasma, red blood cells, and mononuclear blood cells, levels of calcium in plasma, and the plasma calcium-to-magnesium ratio were measured at baseline and after 3 weeks of each drug phase of a double-blind, placebo-controlled study of methylphenidate and dextroamphetamine in hyperactive boys. Levels of magnesium in plasma were significantly higher after 3 weeks of dextroamphetamine treatment, and the calcium-to-magnesium ratio was significantly lower after 3 weeks of either drug compared with the baseline or placebo condition. There was no change in magnesium levels in red blood cells or mononuclear blood cells. These measures were obtained 30 minutes before the morning dose and at 9 a.m., 9:30 a.m., 10:30 a.m., 11:00 a.m., and noon on the last day of each 3-week phase. Analysis of variance revealed a drug effect on plasma magnesium and on the calcium-to-magnesium ratio but no drug x time interaction. Although these changes were not correlated with the time course of acute symptomatic response to stimulant therapy, the decrease in the ratio may be relevant to side effects and treatment resistance associated with stimulant use.

Cerebrospinal fluid monoamine metabolites in boys with attention-deficit hyperactivity disorder

Cerebrospinal fluid (CSF), plasma, and urinary monoamine metabolites were determined for 29 boys, aged 6-12, with attention-deficit hyperactivity disorder (ADHD). Levels of CSF 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid (HVA), and 3-methoxy-4-hydroxyphenylglycol (MHPG), the metabolites of serotonin, dopamine, and norepinephrine, respectively, correlated significantly with behavioral measures of aggression and impulsivity/hyperactivity. However, these correlations were in the unexpected direction; for example, CSF 5-HIAA correlated positively with the Brown-Goodwin Lifetime History of Aggression Scale. HVA in CSF was positively correlated with several measures of hyperactivity. The replicability of these findings, as well as possible socioenvironmental effects, and the predictive value of CSF monoamines in prepubertal hyperactivity are the subjects of ongoing study.

Thyroid function and attention-deficit hyperactivity disorder

OBJECTIVE

To examine thyroid indices in a community referred sample of boys with attention-deficit hyperactivity disorder (ADHD) for evidence of generalized resistance to thyroid hormone (GRTH).

METHOD

TSH, T3, and T4 values were gathered prospectively in 53 physician, school, and/or parent referred ADHD subjects, and in 41 age and gender-matched normal controls.

RESULTS

None were in the range suggestive of global or pituitary thyroid hormone resistance.

CONCLUSIONS

GRTH is rare, and thyroid function should not be measured routinely in nonfamilial ADHD.

Drug treatment for hyperactive children. Therapeutic guidelines

Attention deficit hyperactivity disorder (ADHD) is a common childhood behavioural disorder and medication is one of the principal treatments. Methylphenidate and dexamphetamine (dextroamphetamine) have a long record of use in children and well proven efficacy, and are the preferred drugs. Current clinical guidelines recommend a trial of methylphenidate and of dexamphetamine for each child meeting criteria for the disorder in order to maximise response rate and minimise adverse effects.

Classroom academic performance: improvement with both methylphenidate and dextroamphetamine in ADHD boys

Daily academic classroom performance was recorded in a day hospital school using a commonly employed reading and math series as part of an 11-week double-blind, placebo controlled, crossover comparison of dextroamphetamine (d-AMPH) and methylphenidate (MPH) in 33 hyperactive boys. Students attempted more math and reading tasks while on either active drug. The percent correct and the number of attempted problems of the reading series improved with both drugs while the percent correct for the math series occurred with d-AMPH only. No dose-response relationship was found for either stimulant. Moderate, transient adverse effects were common for both drugs.

Antidepressant treatments in children and adolescents: II. Anxiety, physical, and behavioral disorders

Part II of this review critically evaluates antidepressants' (AD) efficacy in children and adolescents with anxiety, physical, and behavioral disorders as well as AD's side-effect spectrum. AD are administered increasingly to youths with specific anxiety syndromes phenomenologically paralleling those in adults which are responsive to AD (e.g., panic, obsessive-compulsive disorders). While several trials have not substantiated earlier theoretical considerations suggesting their usefulness in separation anxiety, their recent success in ameliorating obsessive-compulsive symptoms is encouraging. Systematic drug treatment studies however are limited because of the common overlap of anxiety syndromes with each other and other prominent psychiatric disturbances. More consistent benefits with AD are seen in the physical (e.g., enuresis, bulimia nervosa) and behavioral disorders (e.g., attention deficit-hyperactivity disorder). The wide-ranging benefits of AD in nonaffective disorders suggest AD are more appropriately viewed as broad spectrum pharmacotherapeutics.

Antidepressant treatments in children and adolescents. I. Affective disorders

Part I of this review critically evaluates antidepressants' benefits for children and adolescents with affective disorders. The effectiveness of antidepressants is characterized with specific references regarding diagnostic methodology, measurement characteristics, response definitions, recovery rates, length of treatment, and plasma level monitoring. Antidepressants' efficacy for depressed youths is quite circumscribed, and their superiority to placebo remains unproved. Their intriguing lack of efficacy in affective disorders is discussed based on methodological issues and from a theoretical perspective. Clinical and research implications are presented.

Quinolinic acid and kynurenine pathway metabolism in inflammatory and non-inflammatory neurological disease

Neurological dysfunction, seizures and brain atrophy occur in a broad spectrum of acute and chronic neurological diseases. In certain instances, over-stimulation of N-methyl-D-aspartate receptors has been implicated. Quinolinic acid (QUIN) is an endogenous N-methyl-D-aspartate receptor agonist synthesized from L-tryptophan via the kynurenine pathway and thereby has the potential of mediating N-methyl-D-aspartate neuronal damage and dysfunction. Conversely, the related metabolite, kynurenic acid, is an antagonist of N-methyl-D-aspartate receptors and could modulate the neurotoxic effects of QUIN as well as disrupt excitatory amino acid neurotransmission. In the present study, markedly increased concentrations of QUIN were found in both lumbar cerebrospinal fluid (CSF) and post-mortem brain tissue of patients with inflammatory diseases (bacterial, viral, fungal and parasitic infections, meningitis, autoimmune diseases and septicaemia) independent of breakdown of the blood-brain barrier. The concentrations of kynurenic acid were also increased, but generally to a lesser degree than the increases in QUIN. In contrast, no increases in CSF QUIN were found in chronic neurodegenerative disorders, depression or myoclonic seizure disorders, while CSF kynurenic acid concentrations were significantly lower in Huntington's disease and Alzheimer's disease. In inflammatory disease patients, proportional increases in CSF L-kynurenine and reduced L-tryptophan accompanied the increases in CSF QUIN and kynurenic acid. These responses are consistent with induction of indoleamine-2,3-dioxygenase, the first enzyme of the kynurenine pathway which converts L-tryptophan to kynurenic acid and QUIN. Indeed, increases in both indoleamine-2,3-dioxygenase activity and QUIN concentrations were observed in the cerebral cortex of macaques infected with retrovirus, particularly those with local inflammatory lesions. Correlations between CSF QUIN, kynurenic acid and L-kynurenine with markers of immune stimulation (neopterin, white blood cell counts and IgG levels) indicate a relationship between accelerated kynurenine pathway metabolism and the degree of intracerebral immune stimulation. We conclude that inflammatory diseases are associated with accumulation of QUIN, kynurenic acid and L-kynurenine within the central nervous system, but that the available data do not support a role for QUIN in the aetiology of Huntington's disease or Alzheimer's disease. In conjunction with our previous reports that CSF QUIN concentrations are correlated to objective measures of neuropsychological deficits in HIV-1-infected patients, we hypothesize that QUIN and kynurenic acid are mediators of neuronal dysfunction and nerve cell death in inflammatory diseases. Therefore, strategies to attenuate the neurological effects of kynurenine pathway metabolites or attenuate the rate of their synthesis offer new approaches to therapy.

P.r.n. medications in child psychiatric patients: a pilot placebo-controlled study

BACKGROUND

The administration p.r.n. (as needed) of sedative medications is a widespread practice in the management of acute dyscontrol of child psychiatric inpatients. Its efficacy, however, has never been tested in a controlled clinical trial.

METHOD

Twenty-one male inpatients, aged 5-13 years, participated in a double-blind, placebo-controlled study of the p.r.n. use of diphenhydramine, a sedative antihistaminic often used in child psychiatry wards. The patients' DSM-III-R diagnoses were conduct disorder, attention-deficit hyperactivity, and major depression. Each patient in acute dyscontrol blindly received either oral or intramuscular doses of diphenhydramine 25-50 mg (N = 9) or placebo (N = 12). The Conners Abbreviated 10-Item Teacher Rating Scale and the Clinical Global Impressions scale were completed before and 0.5, 1, and 2 hours after the dose.

RESULTS

Repeated measures ANOVA showed significant time effects, but no difference due to drug. The intramuscular route tended to be more effective than the oral, regardless of whether active drug or placebo was given.

CONCLUSION

The data indicate that if p.r.n. administrations are effective, this is a placebo effect. Likewise, intramuscular administrations are more effective because of a route effect ("the needle") and not because of a specific pharmacologic activity.

B cell precursors are decreased in senescent BALB/c mice, but retain normal mitotic activity in vivo and in vitro

The numbers of phenotypic (sIg- Ly5[220]+) and functional B cell precursors were significantly reduced in the bone marrow of senescent (22-24 months old) BALB/c mice when compared to their young (2-4 months old) cohorts. Little alteration in the numbers of B cell precursors occurred during the first 12 months of life in this strain. In contrast, an accelerated loss of B cell precursors between 15 and 18 months of age was observed. In particular, the levels of small Ly5(220)+ B cell precursors were decreased with advanced age, although a decline in numbers of large sIg- Ly5(220)+ B cell precursors was also evident. The percentages of large sIg- Ly5(220)+ B cell precursors in (S + G2/M) stages of cell cycle were similar (e.g., 60-80%) in aged and young BALB/c mice. Importantly, Ly5(220)+ pre-B cells from both young and aged BALB/c mice, either present in vivo or derived from Ly5(220)- cells in vitro, were capable of proliferation in response to rIL-7. These observations suggest that the aging process results in a progressive decline in the numbers of pre-B cells; however, this apparently is not due to failure of B lineage precursor cells to respond to growth mediators either in vivo or in vitro.

Methylphenidate and dextroamphetamine treatments of hyperactivity: are there true nonresponders?

The response to stimulant drugs of 48 boys with attention deficit/hyperactivity disorder was measured following dextroamphetamine, methylphenidate, and placebo in a double-blind crossover study. To distinguish lack of behavioral improvement from adverse drug effects, a day hospital setting and a wide dose range were used. Both drugs were highly and equally efficacious for the group as a whole, and frequently one drug or the other was superior for an individual child, or adverse effects occurred only on one of the stimulants. Only one of the 48 boys (2%) was discharged without the recommendation for continued stimulant drug treatment. "Nonresponse" appears to be extremely rare when both stimulants and a wide range of doses are given.