Neurorotective Effect of Chaihu Jia Longgu Mulitang on Parkinson's Disease with Depression Model Rats and Its Mechanism Based on AMPK/mTOR Signaling Pathway / 中国实验方剂学杂志

ObjectiveTo observe the protective effect of Chaihu Jia Longgu Mulitang （CLMT） on dopaminergic neurons in Parkinson's disease with depression （PDD） model rats， and to explore the mechanism based on adenosine monophosphate-activated protein kinase/mammalian target of rapamycin （AMPK/mTOR） signaling pathway. MethodAmong the 80 male SD rats， 10 were randomly selected as normal group and the rest were treated with long-term low-dose subcutaneous injection of rotenone in the neck and back combined with chronic unpredictable mild stress （CUMS） to establish PDD rat model. The successfully modeled PDD rats were randomly divided into model group， western medicine group （madopar 0.032 g·kg-1+fluoxetine hydrochloride 0.002 g·kg-1）， CLMT low-dose， medium-dose and high-dose groups （5， 10 and 20 g·kg-1）， 10 rats in each group. Normal group and model group were administrated with the same amount of normal saline by gavage for 4 consecutive weeks. Behavioral changes of rats in each group were evaluated by open field test and pole climbing test. The content of dopamine （DA） and 5-hydroxytryptamine （5-HT） in cerebrospinal fluid was determined by high performance liquid chromatography （HPCL）. The pathological changes of dopaminergic neurons in substantia nigra of rats were observed by hematoxylin-eosin （HE） staining. The positive expression of tyrosine hydroxylase （TH） and expression of α-synuclein in substantia nigra were detected by immunohistochemistry （IHC） and immunofluorescence （IF）， repsectively. The protein expression of microtubule-associated protein 1 light chain 3 （LC3）， adenosine monophosphate-activated protein kinase （AMPK）， phosphorylated AMPK （p-AMPK）， mammalian target of rapamycin （mTOR） and phosphorylated mTOR （p-mTOR） was detected by Western blot. ResultCompared with the conditions in normal group， the total horizontal distance and the activity time in the central region in open field test and the content of DA and 5-HT in cerebrospinal fluid were decreased （P<0.05， P<0.01）， and the time of pole climbing was shortened （P<0.01）， with increased score （P<0.01） in model group. Compared with model group， CLMT high-dose group and western medicine group increased the total horizontal distance and activity time in the central region and the content of DA and 5-HT （P<0.05， P<0.01）， and extended the time of climbing pole （P<0.05）， with decreased score （P<0.05， P<0.01）. Compared with those in normal group， the number of dopaminergic neurons in the substantia nigra was reduced， with narrowed and loosely arranged cell body. The fluorescence expression of α-synuclein was enhanced （P<0.01）， and the positive expression of TH was decreased （P<0.01） in model group. Compared with model group， CLMT high-dose group and western medicine group showed elevated number of dopaminergic neurons in the substantia nigra， with enlarged cell body， and decreased fluorescence expression of α-synuclein， and enhanced the positive expression of TH （P<0.05， P<0.01）. Compared with normal group， model group had lowered expression of LC3Ⅱ/Ⅰ， p-AMPK/AMPK in striatum （P<0.05， P<0.01） and increased expression of p-mTOR/mTOR （P<0.01）. Compared with those in model group， LC3Ⅱ/Ⅰ and p-AMPK/AMPK expression were increased （P<0.05， P<0.01） and p-mTOR /mTOR expression was decreased （P<0.01） in CLMT high-dose group and western medicine group. ConclusionCLMT exerts a neuroprotective effect by inhibiting rotenone neurotoxicity. It enhances the level of DA， and thus improves the depression condition in rats with Parkinson's disease. The underlying mechanism may be related to the regulation of AMPK/mTOR signaling pathway， activation of autophagy， and promotion of degrading α-synuclein.

Perceived Devaluation and Discrimination toward mental illness Scale (PDDs): Its association with sociodemographic variables and interpersonal contact in a Mexican sample / Escala de Percepción de la Devaluación y Discriminación hacia la enfermedad mental (PDDs): su relación con variables sociodemográficas y el contacto interpersonal en una muestra mexicana

Abstract Introduction Research about stigma on mental illness in different sociocultural contexts is crucial to guide international efforts to reduce discrimination. Objective Analyze the psychometric properties of the Perceived Devaluation and Discrimination (PDD) scale adapted for the Mexican population and its relationship with sociodemographic variables and interpersonal contact. Method The study was based on a psychometric and cross-sectional design. The PDD scale was applied to a sample of 295 participants recruited through community programs in the south of Mexico City. Data were analyzed using confirmatory factor analysis to identify the subscales of PDDs. These subscales were compared by age, gender, and education using a univariate analysis. One-way analysis of variance (ANOVA) was then performed to determine whether there were differences in educational level between three PDDM-subscales. Results The PDD scale obtained an adequate global internal consistency (α = .78). Three PDDs factors were identified: myths and stereotypes, favorable attitudes, and social exclusion, which explain 57.8% of the total variance. The results shows an Χ2SB = 140.88 (df = 143, p = .05, CFI = 1, RMSEA = .000, CI [.000, .029]). Other findings showed significant differences in favorable attitudes toward mental illness subscale by gender and age. The ANOVA results for the social perception of the devaluation subscale reveal that those with a higher educational level could be more aware about devaluation in society toward people with mental illness than other groups with lower education (F = 4.88, p = .005). Discussion and conclusion The PDD-M scale adapted in Mexico is a culturally valid and reliable measure that could be useful for evaluating the variations and commonalities of public stigma in comparative studies between Latino populations and other international research contexts.

Resumen Introducción La investigación acerca del estigma de la enfermedad mental en distintos contextos sociales es fundamental para combatir la discriminación. Objetivo Analizar las propiedades psicométricas de la Escala de Percepción de la Devaluación y la Discriminación hacia las enfermedades mentales adaptada en México (PDD) y su relación con variables sociodemográficas y el contacto interpersonal. Método Se utilizó un diseño transversal ex post facto. Se aplicó la escala PDD-M en población adulta (n = 295) de la Ciudad de México. Los datos se analizaron mediante un análisis factorial confirmatorio y análisis multivariados. Resultados Se identifican tres áreas del PDD-M: mitos y estereotipos, actitudes favorables y percepción social de la devaluación y discriminación, que explican el 57.8% de la varianza. Se obtuvo un buen ajuste del modelo Χ2SB = 140.88 (df = 143, p = .05, CFI = 1, RMSEA = .000, CI [.000, .029]). La consistencia interna global de la prueba (α = .78) fue adecuada. Los resultados muestran diferencias significativas por género, edad y escolaridad. El análisis multivariado reveló que quienes tenían mayor nivel educativo eran más conscientes de la devaluación y la discriminación que quienes tenían escolaridades más bajas (F = 4.88, p = .005). Discusión y conclusión Se obtuvo una medición culturalmente válida y confiable del estigma público de la enfermedad mental (PDD-M) que puede servir para impulsar la investigación en esta línea a través de estudios comparativos en América Latina y en otros contextos internacionales.

Drug utilization pattern of psychotropic medicines in tertiary care centre of Bastar Region, Chhattisgarh, India

Background: With the changing lifestyle, the incidence of psychiatric illness is increasing day by day. And the mental illnesses not only affect the social and personal life but also adds additional economic burden affecting quality of life of the person. So, proper diagnosis and management of psychiatric illnesses is utmost important. So, keeping this in mind, the present study has been conducted to evaluate drug utilization pattern of psychotropic medicines in tertiary care centre of Bastar region.Methods: After obtaining approval from Institutional Ethics Committee, present study was conducted in 237 patients for a period of 3 months from February 2019 to April 2019. The data of patients attending psychiatry OPD was collected in a structured case record form. The data were analysed using graph pad prism version 6.0.Results: Out of total 237 patients, males 136(57.38%) outnumbered females 101 (42.62%). The major psychiatric illness reported was schizophrenia (45.99%) followed by bipolar affective disorder (16%) and generalized anxiety disorder (14.35%). Average number of psychotropic drugs per prescription was 1.74±1.02. The percentage of drugs prescribed from state Essential drug List (EDL) was 93.05%.Conclusions: Overall, the principles of rational prescribing was tried to be maintained, as polypharmacy has been avoided and most of the drugs were prescribed from the state EDL. The use of generic drugs should be increased to make prescriptions more rational and to cut down the cost of the therapy which may be helpful in increasing the quality of life of the patients.

Cut-off points of the Portuguese version of the Montreal Cognitive Assessment for cognitive evaluation in Parkinson's disease / Valores de corte da versão em português do "montreal cognitive assessment" para avaliação cognitiva na doença de parkinson

ABSTRACT. The Movement Disorder Society has published some recommendations for dementia diagnosis in Parkinson disease (PD), proposing the Montreal Cognitive Assessment (MOCA) as a cognitive screening tool in these patients. However, few studies have been conducted assessing the Portuguese version of this test in Brazil (MOCA-BR). Objective: the aim of the present study was to define the cut-off points of the MOCA-BR scale for diagnosing Mild Cognitive Impairment (PD-MCI) and Dementia (PD-D) in patients with PD. Methods: this was a cross-sectional, analytic field study based on a quantitative approach. Patients were selected after a consecutive assessment by a neurologist, after an extensive cognitive evaluation, and were classified as having normal cognition (PD-N), PD-MCI or PD-D. The MOCA-BR was then applied and 89 patients selected. Results: on the cognitive assessment, 30.3% were PD-N, 41.6% PD-MCI and 28.1% PD-D. The cut-off score on the MOCA-Br to distinguish PD-N from PD-D was 22.50 (95% CI 0.748-0.943) for sensitivity of 85.5% and specificity of 71.1%. The cut-off for distinguishing PD-D from MCI was 17.50 (95% CI 0.758-0.951) for sensitivity of 81.6% and specificity of 76%.

RESUMO. A Movement Disorder Society publicou algumas recomendações para o diagnóstico de demência na doença de Parkinson (DP), propondo o Montreal Cognitive Assessment (MOCA) como ferramenta de triagem cognitiva nesses pacientes. Entretanto, poucos estudos foram aplicados à versão em português (MOCA-BR). Objetivo: o presente estudo tem o objetivo de definir os valores de corte na escala de MOCA-BR para diagnosticar o Comprometimento Cognitivo Leve (DP-CCL) e Demência (DP-D) em pacientes com DP. Métodos: trata-se de um estudo transversal, analítico, com uma abordagem quantitativa. Os pacientes foram selecionados depois de avaliações consecutivas por um neurologista, após avaliação cognitiva extensa, e foram classificados como cognição normal (DP-N), DP-CCL e DP-D e então o MOCA-BR foi aplicado, sendo selecionados 89 pacientes. Resultados: na avaliação cognitiva, foram encontrados 30.3% de DP-N, 41.6% de DP-CCL e 28.1% DP-D. O valor de corte no MOCA-BR para distinguir entre DP-N de DP-D foi 22.5 (IC 95%; 0.748-0.943), sensibilidade de 85.5% e especificidade de 71.1%. Para distinguir DP-P de CCL, o ponto de corte foi de 17.5 (IC 95%; 0.758-0.951), sensibilidade de 81.6% e especificidade de 76%.

Parkinson′s disease with cognitive impairment / 中国实用内科杂志

Parkinson's disease(PD) is a progressive neurodegenerative disease characterized by motor symptoms such as rigidity, rest tremor, and bradykinesia. However, evidence demonstrated that PD encompasses several non-motor disturbances as well, such as cognitive impairment. Mild cognitive impairment can be present since early stages of the disease, and characterized by impairments in several cognitive domains including executive functions, attention, and visuospatial skills, language, and memory; In advanced stages of the disease, cognitive defects can develop into dementia and there is a considerable heterogeneity in the cognitive impairments. In this review, we focus on the clinical characteristics, biomarkers, and drug and non-drug treatments of cognitive impairment in Parkinson's disease, hoping to provide help for clinical practice.

Effect of DAVID system on dosimetry of linear accelerator / 医疗卫生装备

Objective To explore the effect of DAVID system on the beam dosimetry of ELEKTA Synergy accelerator. Methods Three-dimensional water phantom system was used to measure the values of percentage depth dose (PDD) in different fields,gun-trarget(G-T)in different fields and depths as well off-axis ratio(OAR)at left-right(L-R)direction when the accelerator was equipped with DAVID system or not. Results DAVID system had no effects on PDD and OAR, while influenced the absorbed dose so that the ray was attenuated by 7%.Conclusion The field parameters have not to be modified for the planning system when using DAVID system,but the dose correction has to be performed according to ray transmission factors.

Proventricular dilatation disease (PDD) outbreak in blue-and-gold macaws (Ara ararauna) in the State of Santa Catarina, southern Brazil / Surto de doença da dilatação proventricular em araras-canindé (Ara ararauna) no estado de Santa Catarina, sul do Brasil

Proventricular dilatation disease (PDD) is a lethal and important disease of captive psittacine birds, and affects a wide range of species, including endangered ones, and lacks an effective treatment. This report describes PDD in three blue-and-gold macaws (Ara ararauna) in southern Brazil. All three macaws originated from the same aviary and presented similar clinical signs including anorexia, apathy, emaciation and prostration. At necropsy, one of the macaws presented an enlarged proventriculus. Histologically, lymphoplasmacytic infiltrates was observed in the ganglia and nerves of the esophagus, crop, proventriculus, ventriculus, heart, adrenal glands, and adrenal medulla of all three cases. Two macaws had meningoencephalomyelitis and one had myocarditis. Immunohistochemistry identified PaBV antigen in the brain, proventricular, ventricular ganglia, and epicardial ganglia, and cardiomyocytes of all three macaws.(AU)

A doença da dilatação proventricular (PDD) e uma importante e fatal doença de psitacídeos de cativeiro, que afeta uma grande variedade de espécies e não tem um tratamento efetivo até o momento. Este relato descreve PDD em três araras canindé (Ara ararauna) no sul do Brasil. Todas as três araras eram provenientes do mesmo criatório e apresentaram sinais clínicos semelhantes incluindo anorexia, apatia, emaciação e prostração. Na necropsia, uma das araras apresentou proventrículo dilatado. No exame histopatológico, infiltrados linfoplasmacitários foram observados em gânglios e nervos do esôfago, inglúvio, proventrículo, moela, coração, glândulas adrenais e rins de todos os casos. Adicionalmente, meningoencefalomielite foi observada em duas araras e miocardite em uma. A imuno-histoquímica identificou antígenos de PaBV no encéfalo, coração, proventrículo e moela de todos os casos.(AU)

A Child With Advanced Mucopolysaccharidosis Presenting With Severe Behavioural Problems

Objective: Clinicians are less familiar with clinical presentation of rare disorder like mucopolysaccharidosis (MPS), especially as presentation is complex and varied with different subtypes of this disorder. This case report highlights severe behavioural problems and non-recognition of MPS by clinicians. Though behavioural problems, hyperactivity and aggression are common in children suffering from mental disability, they are also seen in rare metabolic disorders like MPS. Methods: We have reported a seven year old girl who presented with severe episodes of hyperactivity, poor social interaction, impaired understanding of speech and delay as well as regression in developmental milestones is presented along with the investigations and treatment given. Results: Initially, the child was thought to be suffering from intellectual subnormality and/or pervasive developmental disorder. However, radiological studies showed x-ray findings suggestive of MPS. Her developmental history, physical findings, hearing loss as noted on BERA further supported this diagnosis. Due to financial constraints of the family detailed investigations (enzyme assays) to know the exact type of MPS could not be done. Behavioural problems had to be managed with low dose clonazepam and carbamazepine. Conclusion: It is worth considering metabolic disorders as one of the important differential diagnosis in any child presenting with developmental problems, dysmorphic facies along with behavioural problems.

Detección temprana en trastornos del espectro autista: una decisión responsable para un mejor pronóstico / Early detection of autism spectrum disorders: a responsible decision for a better prognosis

Introducción. La detección temprana del autismo es una variable determinante de un mejor pronóstico. Métodos. Se realizó un estudio descriptivo y retrospectivo del proceso de detección y diagnóstico de 42 niños con trastornos del espectro autista (TEA) por medio de una entrevista semiestructurada y a través de la revisión de historias clínicas. Resultados. Se encontró que los padres son las personas que inicialmente sospechan la presencia de algún trastorno, alrededor de un año diez meses de edad. Los signos de alarma más frecuentes son los comportamientos ausentes, la falta de lenguaje y el retraso motor. Para la detección y diagnóstico participan, en promedio, cinco profesionales. El neurólogo infantil y el psicólogo fueron quienes más diagnósticos de TEA realizaron, entre los tres y los cinco años de edad. Se recibieron diagnósticos de discapacidad intelectual, trastornos de déficit de atención e hiperactividad y retraso en el desarrollo. Conclusiones. Se resalta la importancia de formar y capacitar profesionales de la salud, para lograr que la detección e intervención de los TEA sea cada vez más oportuna.

Background. Early detection of autism is a decisive variable for a better prognosis. Methods. A study was conducted describing the process of detection and diagnosis of 42 children with autism spectrum disorders [ASD]. Results. Parents are those who initially suspect the presence of a disorder at about the age of 22 months. The most common warning signs include behavior described as appearing absent, lack of language, and motor delays. Five different health care professionals are involved in the detection process. The pediatric neurologist and psychologist are the professionals who most frequently diagnosed ASD between 3 and 5 years of age. Diagnoses given to the families include intellectual disability, attention deficit disorder with hyperactivity, and developmental delay. Conclusions. The results of the study show the importance of training healthcare professionals, leading to the early detection and intervention of ASD.

Prevalencia de los factores de riesgo perinatales en los Trastornos Generalizados del Desarrollo / Prevalence of Perinatal Risk Factors in the Pervasive Developmental Disorders

Los Trastornos Generalizados del Desarrollo (TGD) son perturbaciones graves y generalizadas que afectan áreas centrales del desarrollo (DSM-IV-TR). Se propone que el período perigestacional aglutina una serie de factores de riesgo que influyen y condicionan el desarrollo normal del feto. El objetivo de este artículo fue estudiar la presencia de riesgos durante el desarrollo perinatal, considerando las respuestas de 93 madres con hijos que presentan un Trastorno Generalizado del Desarrollo a un autoinforme estructurado, tal como es el caso del trastorno autista, trastorno de Asperger y TGD-no especificado. Del análisis de las respuestas al autoinforme se han encontrado diferencias significativas entre los grupos de TGD en la dimensión pregestacional -malnutrición/anorexia e hipertensión-, en la perigestacional -malnutrición/anorexia y problemas con el líquido amniótico- y en la psicosocial -género no deseado del bebé-.

Pervasive Developmental Disorders (PDDs) are severe and pervasive disturbances affecting central areas of development (DSM-IV-TR). It is proponed that the perigestational period encompasses a number of risk factors that influence and affect normal fetal development. The aim of this paper was to study the presence of risks during the perinatal development, considering the responses of 93 mothers of children with a pervasive developmental disorder -autistic disorder, Asperger disorder and PDD-NOS- to a structured self-report. We found significant differences among the PDD groups in the pregestational -malnutrition/anorexia and hypertension- , in the perigestational - malnutrition/anorexia and problems with the amniotic fluid-, and in the psychosocial -unwanted gender baby- dimensions from the analysis of the responses.

Efficacy of a Day-Center Treatment Program for Children with Developmental Disorders

OBJECTIVES: This study was conducted in order to evaluate the effectiveness of a day-center treatment program to promote development of children with pervasive development disorder (PDD) and pervasive development disorder/mental retardation (PDD/MR). METHODS: Twenty five children (14 in the PDD group and 11 in the PDD/MR group) participated in a day-center treatment program. They had been enrolled in the whole program for 2-3 years. Their performance was evaluated according to the Preschool Language Scale (PRES), Social Maturity Scale (SMS), and Korean version of the Childhood Autism Rating Scale (CARS). They were grouped by diagnosis at the beginning of the program and the treatment effect was compared. RESULTS: Children who participated in the day-center treatment program showed a significant increase in their PRES and SMS scores and a decrease in their CARS scores. CONCLUSIONS: A day-center treatment program is effective for development of children with PDD and PDD/MR.

Prácticas de escolarización y trastornos del espectro autista: herramientas y desafíos para la construcción de escenarios escolares inclusivos. Un estudio desde el marco de la teoría de la actividad histórico-cultural desarrollada por Engeström / Schooling practices and autism spectrum disorders: tools and challenges for the costruction of inclusive school settings. A study from C.H.A.T. (cultural-historical activity theory) framework developed by Engeström

El estudio explora procesos de escolarización y desafíos para la construcción de escenarios educativos con alumnos diagnosticados con TEA (Trastornos del Espectro Autista) o con TGD (Trastornos Generalizados del Desarrollo). Se analizan prácticas de escolarización en escuelas de Buenos Aires, que impulsan la participación de sujetos con TEA en el circuito de escolarización común. La coexistencia de políticas educativas, discursos profesionales, instituciones y prácticas de intervención configuran complejos escenarios socio-culturales. La teoría de la actividad histórico-cultural desarrollada por Engeström y las conceptualizaciones de Rodrigo sobre modelos mentales se articulan para analizar tensiones y conflictos que atraviesan los procesos de escolarización de alumnos diagnosticados con TEA/TGD y comprender las construcciones representacionales de actores educativos sobre problemas, herramientas e intervenciones. Estudio descriptivo y exploratorio, perspectiva etnográfica, análisis cualitativos, cuestionarios y entrevistas en profundidad. Convergencias y divergencias discursivas entre distintos agentes sobre problemas e intervenciones psicoeducativas y dificultades/ posibilidades de construcción de objetivos comunes de actividad.

This work explores processes of schooling and challenges for development of learning scenarios with students diagnosed with ASD (Autism Spectrum Disorders) or PDD (Pervasive Developmental Disorders). Practices of schooling are discussed in schools in Buenos Aires, which encourage the participation of subjects with ASD in the circuit of mainstream schooling. The coexistence of educational, professional discourses, institutions and practices of intervention, form complex socio-cultural settings. The theory of cultural-historical activity developed by Engeström and Rodrigo conceptualizations about mental models are organized to discuss tensions and conflicts that go through the processes of schooling of students diagnosed with ASD / PDD and understand the representational constructions of educational stakeholders on issues, tools and interventions. A descriptive and exploratory ethnographic perspective, qualitative analysis, questionnaires and interviews in depth. Discursive convergences and divergences between different actors and psychoeducational interventions on issues and challenges / opportunities of building common objectives of activity.

Usefulness of 5-aminolevulinic acid-photodynamic diagnosis in lung cancer / 대한내과학회지

Lung cancer remains the leading cause of cancer death despite 50 years of antismoking efforts and advances in treatment. Overall, the 5-year survival remains disappointing at 15%. The majority of lung cancers are inoperable at presentation, thereby limiting treatment options and the potential to cure. The best prognosis for lung cancer is expected when the diagnosis is made at an early stage of the disease. At present, the best way to diagnose lung cancer is a combination of three different screening tools: low-dose computed tomography (CT), sputum analyses, and fluorescence bronchoscopy. The tumor marking ability of 5-aminolevulinic acid (5-ALA) has been demonstrated. Inhalation of 5-ALA has been used to detect early lung cancer and is safe and reliable. The data of Yoon et al. in this issue describe the usefulness of photodynamic diagnosis with ALA inhalation.

Detección de los riesgos maternos perinatales en los trastornos generalizados del desarrollo / Detection of the perinatal maternal risks in the pervasive developmental disorders

Pervasive Developmental Disorders (PDD) refer to a group of severe neuropsychologic alterations. Symptoms affect three development components: social-interaction skills, language and communication skills and a set of behaviours and activities that become restricted and stereotyped. PDDs include the following disorders: Autistic, Rett's, Infantile Disintegrative, Asperger's and Generalized Non-specific Development Disorder. Regarding to its unknown causes, several explanations have been gathered as a challenging task. They highlight the idea of generalised alterations in the Central Nervous System (CNS). However, the strongest thesis defines a multicausal etiology, with different factors associated to PDDs. Never the less, over the past few years, the review of problems associated with pregnancy and labour have been stressed. This perspective is complemented by other elements that point towards genetic alterations and CNS deficits as causes behind PDD. It has been suggested that pregnancy, labour and even neonatal complications can act on different fronts: increasing the risk of autism or any other PDD, or interacting along with genetic determinants to increase the potential risk at a critical moment in the perinatal development process. The goal of this paper is to study the presence of perinatal risk in mothers of children with and without PDD. A total of 259 mothers took part in the study; 95 were used as an experimental group: they all had a PDD-diagnosed child, according to DSM-IV-TR criteria (68 had autistic disorder, six had Asperger's disorder, one had Rett's disorder and 19 had non-specific PDD). The remaining 165 women had children with a normal evolutive development and were selected as a control group. In order to collect information about perinatal risk, a Maternal Perinatal Risk Questionnaire (MPRQ) was used. This is a structured and specifically-designed autoreport that evaluates the presence or absence of 40 pregestational and perigestational risk factors annalysed from six perspectives: pregestational, perigestational, intrapartum, neonatal, psychosocial and sociodemographic. For every factor evaluated in the MPRQ, an analysis of the average scores and typical deviations was made, along with a frequency and percentage study. Furthermore, a comparative of the frequencies in the control and experimental groups was carried out for every MPRQ item. By means of descriptive analysis, both groups were classified according to the children's age and birth order, the mother's age during pregnancy, current parent's age and their educational and professional levels. When comparing the experimental group's frequencies to those of the control group in the pregestational stage, two significative items were found in Chi-square: the number of previous spontaneous abortions and the use of contraceptive methods. As a result, the control group had fewer spontaneous abortions than the experimental group (10.9% and 22.4% respectively). The use of contraceptive methods previous to pregnancy described the control group's superiority both for hormonal methods and intrauterine devices (IUD). The experimental group was defined by the absence of IUD and the scarce use of hormonal contraceptives (4.3%). In the perigestational dimension, the three significative items in Chi-square were: pharmacological consumption and presence of edema during pregnancy, and premature rupture of amniotic sac. Pharmacological consumption during pregnancy stresses the consumption of medicine or vitamines and iron in control group (81.2%), compared to the group of mothers of children with PDD (60.6%). The presence of gestational edema has been conclusively linked to the control group. As for the premature rupture of waters, a significantly higher presence of amniotic rupture was found in the experimental group compared to the control group. In the intrapartum dimension, the experimental group confirmed higher frequencies in situations that imply a higher perinatal risk such as: a very quick labour or one lasting over 12 hours. In the neonatal dimension, the control group showed with higher percentages (87.9%), the absence of blue coloration -which would be indicative of cyanosis-, when compared to the experimental group (79.8%). The psycho-social dimension included two significant items: the desired gender for the newborn and the desired pregnancy. The desired gender item confirmed that situations of happiness about finding out the baby's gender were higher in the control group (68.4%) than in the experimental group. The desired pregnancy item proved that situations of desired pregnancy were higher in the control group (91.5%) compared to the experimental group (84.0%). Finally, in the socio-demographic dimension, two siginificative items were identified when comparing both groups: the mother's profession and the baby's gender. In one hand, regarding the mother's profession, it was observed that mothers of PDD children were mainly found within home enviroment (37.2%) or unqualfied worker categories (18.1%). On the other hand, in the control group, the mothers who adscribed to the qualified professional category was notably higher (33.3%). Regarding the child's gender, a higher risk is detected in males, at a proportion of 1 to 3. The results of this study showed that there are significative differences between PDD children who developed perinatal risks, compared to children who have a regular evolutive development. Children with PDD will thus show significant differences compared to non-PDD children: they have an unequal perinatal development and developed perinatal risks. Therefore, many risks are present in a higher measure in PDD children when compared to the control group. An innovative contribution is also made, by strongly suggesting that physical risks define the presence of perinatal risks in PDD. However, the psychosocial and sociodemographic dimensions must also be taken into account.

Los trastornos generalizados del desarrollo (TGD), hacen referencia a un conjunto de alteraciones neuropsicológicas graves. Sus síntomas afectan a tres componentes del desarrollo: interacción social, lenguaje y comunicación e intereses, comportamientos y actividades restringidas y estereotipadas. Los TGD incluyen los siguientes trastornos: autismo, Rett, desintegrativo infantil, Asperger y el Trastorno generalizado del desarrollo no especificado. Su etiología resulta poco conocida y es un reto para la investigación actual. En los últimos años se ha acentuado la revisión de los problemas asociados con el embarazo y el parto. Diversas hipótesis sugieren que el embarazo, el parto e incluso las complicaciones neonatales, pueden actuar desde diversos frentes e incrementar el riesgo de autismo y de los demás TGD. El objetivo de esta investigación es estudiar la presencia de riesgos perinatales entre madres de hijos con TGD y madres de hijos sin TGD. En la investigación participaron un total de 259 madres. De ellas, 94 participaron como grupo experimental: todas tenían un hijo con un diagnóstico de TGD, según criterios del DSM-IV-TR (68 con trastorno autista, seis con trastorno de Asperger, uno con trastorno de Rett y 19 con TGD no especificado). Las mujeres restantes (165) fueron seleccionadas como grupo control y eran madres de infantes/niños con un desarrollo evolutivo normal. Para recoger la información sobre la presencia de riesgos perinatales, se utilizó el Cuestionario Materno de Riesgo Perinatal (CMRP). Este cuestionario es un autoinforme estructurado diseñado ad hoc que contempla, desde seis dimensiones -pregestacional, perigestacional, intraparto, neonatal, psicosocial y sociodemo-gráfica-la presencia o ausencia de 40 factores de riesgo pregestacionales y perigestacionales. Para cada factor valorado con el CMRP, se realizó un análisis de las puntuaciones medias y las desviaciones típicas, junto con un estudio de las frecuencias y los porcentajes resultantes. Asimismo, se efectuó una comparativa de las frecuencias y se utilizó el estadístico Chi-cuadrado de Pearson (χ²), de los grupos experimental y control en cada uno de los reactivos del CMRP. En la dimensión pregestacional, se encontraron dos reactivos significativos en Chi-cuadrado: el número de abortos espontáneos anteriores y el uso de métodos anticonceptivos. En la dimensión perigestacional tres reactivos resultaron significativos: el consumo de fármacos y la presencia de edema durante el embarazo, así como también la ruptura prematura de la fuente. En la dimensión intraparto el grupo experimental mostró frecuencias más altas en aquellas situaciones que implican un mayor riesgo perinatal; un parto muy rápido o la tardanza de más de 12 horas en el mismo. En la dimensión neonatal la coloración azulada del neonato, indicativa de cianosis, fue superior en el grupo experimental. Por otra parte, la dimensión psicosocial ofreció dos reactivos significativos: el sexo deseado del bebé y el embarazo deseado. Por último, en la dimensión sociodemográfica, se identificaron dos reactivos importantes al comparar el grupo experimental con el grupo control, que fueron: la profesión de la madre y el sexo del bebé. Los resultados de esta investigación indican que existen diferencias significativas en niños con TGD que presentaron riesgos perinatales frente a otros con desarrollo evolutivo sin dificultades. Los niños con TGD muestran diferencias significativas comparados con otros niños sin TGD: tienen un desarrollo perinatal desigual, con una presencia significativamente distinta de riesgos perinatales. De esta forma, los riesgos físicos definen la presencia de riesgos perinatales en los TGD. Ahora bien, las dimensiones psicosocial y sociodemográfica deben también ser tomadas en cuenta.

Dificultades en la evaluación y diagnóstico del autismo: Una discusión / Difficulties in assessing and measuring autism: A discussion

The detection of autism is very important because the lack of recognition of this disorder has elevated costs for the families, health care and education providers. Diagnosis is made frequently four or five years after parents notice the first signs. The reasons for this delay are many, but a common one is the lack of recognition of key symptoms that can lead to a more complex diagnosis assessment. Another reason is that screening and diagnostic instruments are not well known by primary caregivers in health and education systems, as these professionals are the first to hear parents' concerns. Moreover the instruments are not well known because the cost of acquiring them and receiving formal training is very high. The need to make comparable assumptions of this complex disorder makes it important to use the same instruments as other countries. Growing efforts for an early recognition have been made in recent years because early intervention programs benefit children with autism. In the last decade, important advances in the design of diagnostic and screening instruments have been made. These tools have primarily been used for clinical, epidemiological or research uses. In some countries their use has become routine in schools, leading to better detection and increasing prevalence rates of autism. Misdiagnosis is not uncommon in autism. Almost 60% of children with Asperger disorder first receive an erroneous diagnosis of attention deficit disorder, oppositionistic or bipolar disorder. Autism presents with a bizarre clinical picture during the years in which many thought it was untestable. Gradual characterization of behaviors and studying different aspects of the symptomatology had led to a better comprehension and descriptions. Most authors have incorporated this knowledge to design reliable instruments. The most common behaviors explored are: protodeclarative pointing, joint attention, repetitive/ stereotyped movements and absence of characteristic symbolic play. This target behavior can be explored through the diverse rating scales and interviews. The instruments are very diverse and varing form. There are rating scales for parents to record their children symptoms and observation schedules to be completed by a clinician or trained professional for that purpose. The best approach is to combine modalities to include as much information as possible. CHAT (Checklist for Autism in Toddlers) is a brief screening instrument intended to detect autism in toddlers. The first part consists of nine questions for parents to complete, while the second part is an observation schedule with five brief age-appropriate interactions with the children. This instrument is an important antecedent of more sophisticated and expanded play observation schedules. Checklist for Autism in Toddlers Modified (CHAT M) is a modified version which consists of an expansion of the parent questionnaire by eliminating the observational section. The Childhood Autism Rating Scale (CARS) is another instrument which assesses the severity of autism. This instrument is rated by clinicians or by trained observers. CARS was designed before DSM IV criteria were published so it does not contain an algorithm to distinguish between different developmental problems. In spite of this limitation, it is the most used rating scale for autism diagnosis. The Child Behavior Checklist (CBCL/1.5-5) is a broad band rating scale which evaluates psychopathology of children between 18 months and five years old. It has a DSM oriented subscale to evaluate developmental problems such as autism or Asperger disorder. It also contains a withdrawn subscale which has proven to be useful as demonstrated by some studies done with the CBCL/4-18. This instrument also allows assessing other associated problems common in autistic children such as attention problems, depression and anxiety. The Language Developmental Survey (LDS) associated to this rating scale, gives the opportunity to screen vocabulary for the identification of language delays, which are common in children with pervasive developmental disorders. It was necessary to have more structured instruments to diagnose autism and not only for screening purposes, so in 1989 the first diagnostic interview was published. The instrument has gone through an extensive review and creative process which has led to the most important tools for diagnosing autism in adults and children. The Autism Diagnostic Interview (ADI) was published in 1989 and correlated to the ICD-10 definition of autism. The original ADI was intended primarily for research purposes, providing behavioral assessment for subjects with a chronological age of at least five years and a mental age of at least two years. The ADI explores three key domains defining autism: (1) reciprocal social interaction, (2) communication and language, and (3) repetitive, stereotyped behaviors. The Autism Diagnostic Interview Revised ADI-R is a semi/ standardizer interview shorter than the ADI, which has been developed for clinical use. It is more appropriate for younger children than the ADI. The ADI-R takes from 2 to 3 hours to administer and can be used with children as young as two years of age (with a mental age greater than 18 months). It explores information about the child functioning in the present and the past. It contains an algorithm based on DSM criteria for autistic disorder, and allows for distinguishing between autistic disorder and non autistic disorder. Pre Linguistic Autism Diagnostic Observation Schedule (ADOS-PL) is a modified version of the ADOS used to diagnose young children (under the age of six years) who are not yet using phrase speech. It is a semi-structured assessment of play, interaction, and social communication and takes about 30 minutes for a trained clinician to administer. The Autism Diagnostic Observation Schedule-Generic (ADOS-G) is a standardized play observation schedule. Through structured play materials and activities promoted by the examiner, social interactions are rated for common autistic features like joint attention, protodeclarative pointing, quality of reciprocal social interaction and symbolic play. Different modules are available from one to four, with specified criteria to match the participants' developmental and language level. It contains an algorithm related to the DSM IV domains of an Autistic Disorder or PDD-NOS. The ADI, ADI/R, ADOS PL, and ADOS G are considered the gold standards for autism diagnosis. There are important reliable instruments for diagnosing autism but extensive training is needed to obtain useful diagnostic information. Since these instruments are very recent, they have not been validated in some countries and neither their cultural bias has been investigated. It is not enough to assess autistic symptoms only for diagnostic purposes; patients need further evaluation to determine their psychosocial functioning, cognitive abilities, and language delay or deviations. The information from these assessments is very important for planning well designed interventions. Even though there is a growing interest in perfecting these modern instruments, diagnosis cannot rely exclusively on them. They are important tools to facilitate the diagnosis, but broader assessment should be pursued. It is important to validate and culturally adapt these instruments so different countries can utilize the same tools and research results can be comparable. In the future more rating scales, observation schedules and diagnostic interviews will be developed for assessing Asperger disorder, to be used in genetic studies, for assessing broad band syndromes. Better cognitive measures will be necessary to evaluate psychosocial impact. But this growing specialization will increase costs so it is important to develop briefer and more cost-effective methods to evaluate persons with autism. The availability of these tools will guarantee early diagnosis and treatment not only for research purposes but for identification in the community.

La detección del autismo en México es muy importante ya que la falta de reconocimiento de este trastorno tiene costos muy elevados para las familias y los prestadores de servicios de salud y educación. Muy a menudo el diagnóstico de autismo se realiza cuatro o cinco años después de que los padres observan los primeros síntomas. Las razones para este reconocimiento tardío son diversas; pero una de las principales es la falta de identificación de síntomas clave que obliguen a una evaluación diagnóstica en forma. Otro motivo es que en nuestro país son poco conocidos los instrumentos de tamizaje y diagnóstico por parte de los profesionistas primarios como maestros y médicos familiares, quienes son los primeros en escuchar las quejas y preocupaciones de los padres. Aun en contextos más especializados, estas herramientas son poco conocidas pues su adquisición y aplicación es un proceso complejo y costoso que a menudo debe realizar el profesionista por su cuenta. A pesar de estos inconvenientes, en años recientes se han realizado grandes esfuerzos para el reconocimiento del autismo puesto que hay evidencias de que las intervenciones tempranas mejoran el pronóstico en estos niños. En la última década se han realizado avances muy importantes en el diseño de instrumentos de diagnóstico y tamizaje, a los que se han utilizado con propósitos de investigación clínica y epidemiológica. En algunos países su uso se ha vuelto una rutina en las escuelas y se ha logrado una mayor detección de autismo por lo que se han elevado las tasas de prevalencia. Los instrumentos son muy diversos, pueden ser listas de autoinforme dirigidos a los padres para que registren los síntomas de los niños, o cédulas de observación para ser completadas por el clínico o el personal entrenado para tal propósito. Lo mejor es el uso mixto de instrumentos para obtener la mayor cantidad de información posible como es el caso del CHAT que incluye una sección de interrogatorio y otra sección de observación con actividades que el niño debe desarrollar. Este instrumento es precursor de actividades sencillas y creativas con un componente lúdico, diseñadas con el propósito de evaluar al niño preescolar. Hoy este es un importante antecedente de otros instrumentos más elaborados. El cuestionario para el autismo en niños preescolares modificado CHAT M es una versión modificada del el cuestionario para el autismo en niños preescolares (CHAT) que consiste en una expansión de la sección de interrogatorio para el padre, con un formato de autoinforme que parte de la eliminación de la sección de observación. Otros instrumentos miden la gravedad del autismo como la Escala de Evaluación de Autismo Infantil (CARS), dirigida al clínico que evalúa la intensidad del autismo. La lista de síntomas del niño de 1.5-5 (CBCL/1.5-5) es un instrumento de banda ancha que evalúa la psicopatología general en niños con edad entre 18 meses y cinco años; contiene una subescala de problemas del desarrollo que sirve como tamizaje para evaluar el autismo y el trastorno por Asperger con base en los criterios del DSM. Se han diseñado y se han perfeccionando paulatinamente varias entrevistas de diagnóstico. La entrevista de diagnóstico de autismo (ADI), la entrevista de diagnostico para el autismo revisada (ADI-R), la cédula prelingüística genérica de observación para el autismo (ADOS PL), y la cédula de observación genérica para el autismo (ADOS G) son escalas consideradas standard de oro para el diagnóstico del autismo. Conforme se han mejorado las propiedades psicométricas, de los instrumentos, éstos también se han ajustado para cubrir las necesidades de evaluación de los pacientes autistas con un amplio rango de edad, destreza verbal y cognitiva. Como resultado, podemos contar con instrumentos confiables y adecuados para una población con necesidades muy diversas; estas herramientas nos han demostrado que un constructo tan complejo y amplio como el autismo se puede medir. En este artículo se presenta una breve revisión de la evolución histórica de la clasificación acorde a los criterios del DSM y a la descripción de los principales instrumentos de diagnóstico, y los datos de su validez y confiabilidad.

Brain Imaging Studies in Child & Adolescent Psychiatry / 신경정신의학

Brain imaging techniques in child and adolescent psychiatry are developing at an astonishing speed. Neuroimaging techniques in the field of psychiatry have yielded many meaningful and significant scientific results. Until 1980's, its application in child and adolescent psychiatry has been somewhat limited by technical and ethical reasons. Recently, however, there are cascade of neuroimaging studies in the field of child and adolescent psychiatry owing to rapid progression of the technical aspect of imaging and confirmation of the safety of human young subjects. In this article, we summarize scientific results in neuroimaging of child and adolescent psychiatric field from early 1990's up until now. We described the advantages, disadvantages and application of diverse structural and functional imaging techniques and suggest future prospect on imaging techniques.

Atualização sobre comorbidade entre transtorno do déficit de atenção e hiperatividade (TDAH) e transtornos invasivos do desenvolvimento (TID) / Update on the comorbidity of attention-deficit/hyperactivity disorder (ADHD) and pervasive developmental disorder (PDD)

CONTEXTO: Atualmente, a comorbidade transtorno do déficit de atenção e hiperatividade (TDAH) e transtornos invasivos do desenvolvimento (TID) não pode ser estabelecida por meio dos critérios da DSM-IV. Entretanto, diversos pesquisadores questionam esta impossibilidade descrevendo quadros clínicos de pacientes que apresentam características de ambos os transtornos. Esta revisão busca estes achados e propõe uma reflexão sobre o assunto. OBJETIVO: Revisar, de modo seletivo, estudos mais significativos da literatura para compilar uma atualização sobre a comorbidade transtorno do déficit de atenção e hiperatividade (TDAH) e transtornos invasivos do desenvolvimento (TID). MÉTODO: Por meio de busca no sistema Medline, selecionaram-se todos os artigos em inglês, publicados entre 2000 e 2005, sobre sintomas de TDAH em pacientes com TID, sintomas autistas em pacientes com TDAH e duplo diagnóstico TDAH/TID, utilizando-se os termos "ADHD", "pervasive", "autism", "ADD", "Asperger" e "PDD". RESULTADOS: Encontraram-se 10 artigos que atendiam aos critérios. Embora haja poucos estudos com amostras pequenas, diferentes autores identificaram um subgrupo distinto de pacientes com TID e maior freqüência e gravidade de sintomas de desatenção e hiperatividade, que aparentemente apresentam menor resposta ao tratamento com estimulantes. CONCLUSÃO: Embora o diagnóstico duplo TDAH e TID não seja corroborado pelo DSM-IV, alguns resultados sugerem que essa comorbidade não deva ser desconsiderada.

BACKGROUND: Nowadays, the attention-deficit hyperactivity disorder/pervasive developmental disorder (ADHD/PDD) comorbidity is not accepted by DSM-IV criteria. However, researchers from both areas put in check this impossibility and describe patients who have both clinical aspects from attention-deficit hyperactivity disorder (ADHD) and pervasive developmental disorder (PDD). In this article we search for this findings proposing new insights on this assumption. OBJECTIVE: To perform a selective review of the most significant studies in order to compile an update on comorbidity ADHD and PDD. METHOD: All papers from 2000 to 2005 in English obtained through Medline search, covering ADHD symptoms in patients with PDD, autistic symptoms in patients with ADHD and the double diagnosis of ADHD and PDD using the terms "ADHD", "pervasive", "autism", "ADD", "Asperger" e "PDD". RESULTS: Ten papers attending the criteria were found. Although there are only few studies with small samples, different authors have identified a subgroup of patients with PDD portraying more severe symptoms of ADHD, who apparently respond less well to stimulants CONCLUSION: Although DSM-IV criteria do not allow the diagnosis of this comorbidity, some results suggest that this possibility should not be discarded.

Observation on the curative effect of middle to advanced nasopharyngeal cancer treated by PDD+5-Fu combined with radiotherapy / 肿瘤研究与临床

0.05), and of metastatic cervical lymphnodes were 88.1 % and 64.3 % respectively (P

LiF TLD in TLD Holder for In Vivo Dosimetry / 대한방사선종양학회지

PURPOSE: LiF TLD has a problem to be used in vivo dosimetry because of the toxic property of LiF. The aim of this study is to develop new dosimeter with LiF TLD to be used in vivo dosimetry. MATERIALS AND METHODS: We designed and manufactured the teflon box(here after TLD holder) to put TLD in. The external size of TLD holder is 4x4x1 mm3. To estimate the effect of TLD holder on TLD response for radiation, the linearity of TLD response to nominal dose were measured for TLD in TLD holder. Measurement were performed in the 10 MV x-ray beam with LiF TLD using a solid water phantom at SSD of 100 cm. Percent Depth Dose (PDD) and Tissue-Maximum Ratio (TMR) with varying phantom thickness on TLD were measured to find the effect of TLD holder on the dose coefficient used for dose calculation in radiation therapy. RESULTS: The linearity of response of TLD in TLD holder to the nominal dose was improved than TLD only used as dosimeter. And in various measurement conditions, it makes a marginnal difference between TLD in TLD holder and TLD only in their responses. CONCLUSION: It was proven that the TLD in TLD holder as a new dosimetry could be used in vivo dosimetry.

Clinical observation of HEPP regimen in treatment of refractory Non-Hodgkin lymphoma / 肿瘤研究与临床

Objective To observe the short-term efficacy and toxicity of HEPP regimen in treatment of refractory Non-Hodgkin's Lymphoma. Methods HEPP regimen: HCPT 8 mg/m2 iv gtt d1~ d5, VP16 100 mg/d iv gtt d1~d5, PDD 20 mg/d iv gtt d1~d5, PDN 60 mg/m2 po d1~d14. The chemotherapy was repeated every 4 weeks as a cycle.The clinical effect was evaluated after 2 cycles and toxicity was observed during every cycle. Results 25 patients were eligible for toxicity evaluation and 22 patients for clinical response evaluation. The objective response rate was 60.0 %, including three cases complete remission and ten cases partial remission. Six cases achieved stable disease and three cases progressive disease. The major toxicity was bone marrow suppression, including 24.0 % grade Ⅲ/Ⅳ leukopenia and 12.0 % grade Ⅲ/Ⅳ thrombocytopenia. The incidence of nausea/vomiting, mucositis and hepatic toxicity was low. Conclusion HEPP regimen can achieve a satisfy result in the treatment of refractory Non-Hodgkin's Lymphoma. It is low toxic and well tolerated.