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Objective@#Subthreshold attention-deficit/hyperactivity disorder (ADHD) has been suggested to be a “morbid condition” which also needs medical attention. @*Methods@#The present study recruited 89 children with subthreshold ADHD (sADHD), 115 children with diagnosed ADHD (cADHD), and 79 healthy controls (HC) to explore the clinical manifestation, executive functions (EFs) of sADHD, and the caregiver strain. The clinical manifestation was evaluated through clinical interviews and parent-reports. Executive functions were assessed both experimentally and ecologically. Caregiver strain was measured by a parent-reported questionnaire. @*Results@#For the clinical manifestation, both sADHD and cADHD indicated impairments when compared with HC. The comorbidities and the scaled symptoms indicated that the externalizing behaviors were relatively less serious in sADHD than cADHD, whereas the internalizing behaviors between two groups were comparable. For ecological EFs, sADHD scored between cADHD and HC in inhibition and working memory. For experimental EFs, sADHD was comparable to cADHD in inhibition, shifting, and was worse than cADHD in verbal working memory. For the caregiver strain, all scores of sADHD were between that in cADHD and that in HC. @*Conclusion@#Our present findings supported the suggestion of subthreshold ADHD as “morbid condition,” which should be treated with caution in clinical practice, especially for the internalizing behaviors and some key components of EFs.
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Objective:To explore the changes of sympathetic and parasympathetic activity in children with chest pain and/or chest distress of unknown cause based on their plasma catecholamine and heart rate variability indexes, and to analyze the predictive value of each index in diagnosing pediatric sympathetic excitation-related chest pain and/or chest distress by used receiver operating characteristics (ROC) curve analysis.Methods:Fifty-seven children who complained of unexplained chest pain and/or chest distress and had no organic diseases according to routine examinations in the Chengdu Women′s and Children′s Hospital from June 2017 to June 2019 were enrolled in the study group.There were 22 males and 35 females, aged 5-15 years old[(8.40±0.35) years old]. Meanwhile, 54 healthy children in the same period were enrolled in the healthy control group, including 21 males and 33 females, aged 5-15 years old (8.87±0.36) years old]. The disease history enquiring, physical examination, chest X-ray, 12-lead electrocardiogram, echocardiogram, blood routine test and biochemical test excluded the organic heart, lung, digestive tract and chest wall diseases in both groups.Their blood samples were collected to detect catecholamine and they were monitored by dynamic electrocardiogram.SPSS 25.0 software was used for statistical analysis and ROC curve analysis.Results:The study group exhibited higher dopamine, adrenaline and norepinephrine levels than those in the healthy control group[(0.83±0.04) nmol/L vs.(0.54±0.03) nmol/L, (0.76±0.04) nmol/L vs.(0.56±0.03) nmol/L and(3.59±0.18) nmol/L vs.(2.51±0.15) nmol/L], and the differences were statistically significant( t=4.906, 3.611, 4.596, all P<0.01). The levels of standard deviation of NN intervals, standard deviation of all mean 5-minutes NN intervals, standard deviation of all NN intervals for all 5-minute segments of 24 hours, root mean squared successive difference and proportion of NN 50 in the total number of NN intervals in the study group were lower than those in the healthy control group [(110.49±2.81) ms vs.(132.13±2.55) ms, (86.37±3.26) ms vs.(118.96±2.00) ms, (33.46±2.21) ms vs.(68.91±1.29) ms, (37.63±1.22) ms vs.(48.93±1.75) ms and(17.37±1.45)% vs.(22.22±1.61)%], and the differences were statistically significant( t=-5.710, -8.419, -13.862, -5.354, -2.245, all P<0.05). The area under the curve of plasma dopamine, adrenaline and norepinephrine in the diagnosis of pediatric sympathetic excitation-related chest pain and/or chest distress were 0.753, 0.689 and 0.746, respectively, higher than that of all heart rate variability indexes. Conclusions:Children′s unexplained chest pain and/or chest distress is highly related with autonomic nervous dysfunction (increased sympathetic activity and decreased parasympathetic activity). The level of plasma catecholamine can be used to reflect the changes of sympathetic activity in these children and diagnose sympathetic excitation-related chest pain and/or chest distress.Psychological counseling and relaxation therapy are supposed to be effective in redu-cing sympathetic activity, improving subjective symptoms and elevating their quality of life.
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The effect of melatonin on juveniles with cardio fibrosis is poorly understood. We investigated whether HDACs participate in the anti-fibrotic processes regulated by melatonin during hypertrophic remodeling. Abdominal aortic constriction (AAC) was employed in juvenile rats resulting in pressure overload-induced ventricular hypertrophy and melatonin was subsequently decreased via continuous light exposure for 5 weeks after surgery. AAC rats displayed an increased cross-sectional area of myocardial fibers and significantly elevated collagen deposition compared to sham-operated rats, as measured by HE and Masson Trichrome staining. Continuous light exposure following surgery exacerbated the increase in the cross-sectional area of myocardial fibers. The expression of HDAC1, HDAC2, HDAC3, HDAC4 and HDAC6 genes were all significantly enhanced in AAC rats with light exposure relative to the other rats. Moreover, the protein level of TNF-α was also upregulated in the AAC light exposure groups when compared with the sham. However, Smad4 protein expression was unchanged in the juveniles' hearts. In contrast, beginning 5 weeks after the operation, the AAC rats were treated with melatonin (10 mg/kg, intraperitoneal injection every evening) or vehicle 4 weeks, and sham rats were given vehicle. The changes in the histological measures of cardio fibrosis and the gene expressions of HDAC1, HDAC2, HDAC3, HDAC4 and HDAC6 were attenuated by melatonin administration. The results reveal that melatonin plays a role in the development of cardio fibrosis and the expression of HDAC1, HDAC2, HDAC3, HDAC4 and HDAC6 in cardiomyocytes.