Predictors of pharmacological treatment outcomes with atomoxetine or methylphenidate in patients with attention-deficit/hyperactivity disorder from China, Egypt, Lebanon, Russian Federation, Taiwan, and United Arab Emirates.

BACKGROUND: The reduced availability of data from non-Western countries limits our ability to understand attention-deficit/hyperactivity disorder (ADHD) treatment outcomes, specifically, adherence and persistence of ADHD in children and adolescents. This analysis assessed predictors of treatment outcomes in a non-Western cohort of patients with ADHD treated with atomoxetine or methylphenidate. METHODS: Data from a 12-month, prospective, observational study in outpatients aged 6-17 years treated with atomoxetine (N = 234) or methylphenidate (N = 221) were analysed post hoc to determine potential predictors of treatment outcomes. Participating countries included the Russian Federation, China, Taiwan, Egypt, United Arab Emirates and Lebanon. Factors associated with remission were analysed with stepwise multiple logistic regression and classification and regression trees (CART). Cox proportional hazards models with propensity score adjustment assessed differences in atomoxetine persistence among initial-dose cohorts. RESULTS: In patients treated with atomoxetine who had available dosing information (N = 134), Cox proportional hazards revealed lower (< 0.5 mg/kg) initial dose was significantly associated with shorter medication persistence (p < 0.01). multiple logistic regression analysis revealed greater rates of remission for atomoxetine-treated patients were associated with age (older), country (United Arab Emirates) and gender (female) (all p < 0.05). CART analysis confirmed older age and lack of specific phobias were associated with greater remission rates. For methylphenidate, greater baseline weight (highly correlated with the age factor found for atomoxetine) and prior atomoxetine use were associated with greater remission rates. CONCLUSIONS: These findings may help clinicians assess factors upon initiation of ADHD treatment to improve course prediction, proper dosing and treatment adherence and persistence. TRIAL REGISTRATION: Observational study, therefore no registration.

Assessment of anastomotic reliability with pulse oximetry in graded intestinal ischemia: an experimental study in dogs.

BACKGROUND/PURPOSE: Pulse oximetry has been proposed as an appropriate and feasible technique in the assessment of intestinal ischemia in recent years. In this study the authors aimed to assess the reliability of anastomoses in the dog small intestine in which there is graded irreversible ischemia as measured by pulse oxymeter. METHODS: In a control group of four dogs, without any devascularization, three small bowel anastomoses were formed in each dog. The study group consisted of 12 dogs. In each animal three intestinal segments with different levels of ischemia were created by ligating the marginal vessels proximally and distally in sequence beginning from the midpoint of the segmental vascular arcade. Preanastomotic pulse oximeter readings between 80% and 90% were assigned to mild ischemia, 70% and 80% to moderate, and 60% and 70% to severe ischemia group. Pulse oximetry measurements were obtained from probes applied to the antimesenteric serosal surfaces at the midpoint of small intestinal segments. A total of 48 intestinal segments (12 nonischemic in the control group and 36 with three different levels of ischemia in the study group) were transected in the midpoint and anastomosed in double layers. Postanastomotic SaO2 values were also noted. The anastomoses were evaluated 48 hours later macroscopically if there was any leakage, and biopsy specimens were obtained for histopathologic ischemic gradings. All results were studied statistically. RESULTS: Histopathologic grades between each group were statistically different (P < .01 for each comparison) except for control and mild ischemia groups (P > .05), worsening as the level of ischemia increased. Pre- and postanastomotic pulse oximetry measurements correlated very well with the histological gradings (r = -0.90, P < .001 and r = -0.93, P < 0.001 respectively). Number of anastomotic leakages were none in control, one in mild, nine in moderate, and 12 (all of the anastomoses) in severe ischemia groups. In the moderate ischemia group with an average preanastomotic pulse reading of 76.75%, each of the leaking anastomoses had a postanastomotic pulse measurement of lower than 70%. The finding that the difference between histopathologic grades of control and mild ischemia groups with average preanastomotic pulse measurements of 96% and 85%, respectively is not statistically significant enables us to suggest that a saturation of at least 85% is necessary for a reliable anastomosis. CONCLUSION: These results suggest clearly that anastomotic reliability can be predicted objectively with pulse oximetry.

Neovascularization of the testicle through spermatic vessels by omental pedicle flap: a new experimental model.

The aim of this experimental study in rats was to consider the supplementary role of an omental pedicle flap on the neovascularization of the testicle through the spermatic vessels, for which a Fowler-Stephens procedure had been planned. To compare results, 12 animals had only the spermatic vessels ligated, without an additional procedure (Fowler-Stephens procedure [FS group]), and 12 others had omentopexy of the spermatic vessels of the left testes, with ligation of the vessels 4 weeks later (Fowler-Stephens procedure plus omentopexy [FSO group]). In the sham group (n = 8), only omentopexy of the left spermatic vessels was performed. Six rats served as controls. In each rat, both testes were evaluated by color Doppler ultrasonography to assess capsular and intratesticular blood flow, followed by orchiectomy to determine testicular weights, testicular biopsy scores, and mean seminiferous tubule diameters. Data were analyzed statistically. According to the color Doppler ultrasonography, the testicular blood flow in the FSO group was better than that of the FS group, but was less sufficient than that of the sham and control groups. The testicular weights and biopsy scores for the FSO group were statistically greater than those of the FS group, and less than those of the sham and control groups. There was no significant difference in the mean seminiferous tubule diameters of the FSO and FS groups. The contralateral tests of the four groups did not differ significantly for any parameter. In light of the data available, it is suggested that the omental pedicle flap neovascularizes the testicle through spermatic vessels. Given the high incidence of testicular atrophy associated with Fowler-Stephens orchiopexies, it might be beneficial to perform laparoscopic orchiopexy of testicles neovascularized with omental pedicle flaps as the first-stage procedure.

Ureteral injury due to Kirschner wire in a five-year-old girl. A case report.

Traumatic injury to the ureter in childhood is uncommon, and since it is not associated with hematuria may remain undiagnosed for a relatively long period of time. In this paper we reported the case of a five-year-old girl who had ureteral injury due to Kirschner wire application for hip dislocation. We drew attention to the fact that pelvic interventions may be complicated by ureteral injury, and intravenous pyelography to a useful tool to reach the final diagnosis.

Computer assisted quantification of vasospasm on angiograms.

We describe a new computer-based, automated method for the assessment of in vivo cerebral vasospasm. Arterial diameter measurements were performed on post-processed digital substraction angiographic images, using "pixel" as the unit. Vasospasm which was difficult to detect by visual inspection could be measured by the "stenosis quantification" program. A computer-assisted method such as we describe might decrease the risk of subjective errors.

Digital subtraction sialography: technique, advantages and results in 107 cases.

Sialographic examinations with the digital subtraction technique were performed in 107 salivary glands (90 parotid and 17 submandibular) of 99 patients. Diagnostic and technical advantages of the digital imaging and subtraction for sialography were investigated. Superior quality enabled detailed imaging of the entire ductal system. Reduced radiation exposure, short examination time and almost painless examinations with good patient tolerance proved to be the major advantages of digital subtraction sialography as a diagnostic tool.

Bronchogenic cyst in a 14-month old boy (a case report).

A patient with a bronchogenic cyst in the mediastinum is presented. This rare cyst was found by chance in a 14-month-old boy suffering from respiratory distress due to partial compression of a bronchus. Ultrasonographic and tomographic examinations revealed a cystic mass measuring 3 x 3 cm in diameter located within the apex of the right lobe of the lung. Bronchogenic cyst should be considered when these signs present in early childhood.

A novel lymphocyte activation antigen present on allospecific primed lymphocytes and defined by the monoclonal antibody VG01.

This study describes VG01, a monoclonal antibody to a novel lymphocyte activation antigen. The cells reacting with VG01 were first characterized by indirect immunofluorescence and fluorescence-activated cell sorter analysis. The antigen defined by VG01 was expressed on circulating T lymphocytes (23.8 +/- 9.0) and on the majority of large granular lymphocytes and monocytes (greater than 90%), while granulocytes stained weakly. All other cells tested so far--thymocytes, hematological malignancies and several cell lines--were negative. Upon activation with mitogens or allogeneic cells more than 90% of the transformed lymphocytes became VG01-positive. The kinetic studies demonstrated that the antigen defined by VG01 lags the expression of the IL-2 receptor by 48 hr and remains present for up to 18 days after stimulation in culture. Thus, this antigen does not seem to be involved in the initial steps of T cell activation and its expression continues after cell division has stopped. Assays with purified sorted populations showed that lymphocyte proliferation to mitogens and in mixed lymphocyte culture came primarily from the VG01- population. The responding cells became VG01+ during activation--and when alloantigen-primed lymphocytes were sorted and restimulated with the original stimulators, all the in vitro memory response came from the VG01+ population. Thus, VG01 antibody is efficient in selecting for alloreactive T lymphocytes in vitro and has potential for selective modulation of immune responses. Its reactivity with activated T cells and NK cells may also help define a common functional program for these two cell types, adding to the understanding of their mechanism of action and/or their origin.

Immunotherapy of primary immunological aborters: rationale for the use of pooled cryopreserved purified normal peripheral blood mononuclear cells.

Patients with recurrent spontaneous abortions have been successfully treated in many centers with third-party immunization directed to a putative TLX antigen system. This immunotherapy requires the screening of a large number of donors to match the patients' red blood cell (RBC) phenotype and has the potential risks associated with transfusions from 30 to 50 donors. Our modified approach to third-party immunization is to use irradiated frozen-stored purified lymphocytes pooled from five normal donors. Mononuclear cells from normal donors are obtained in a cell separator. After sedimentation and Ficoll-Hypaque separation, the cells are stored in liquid N2. The RBC depletion of the final preparation is of the order of 5 to 6 logs, theoretically decreasing the need for RBC phenotyping except for the Rh system. Using a highly sensitive fluorescence-activated cell sorter technique and an ADCC assay, we found that ABH, Rh, Fya Fyb, Jka Jkb, MNS, and Kell antigens are either not expressed by cryopreserved human mononuclear cells, or, if so, they are below the level of detection of these highly sensitive assays. We conclude that the use of pooled frozen mononuclear cells is an adequate alternative for immunotherapy. It decreases the transfusion risks associated with exposure to a large number of donors and the need for RBC phenotyping, making this modality of treatment more accessible.

Quantitation of helper factor activity. II. Inhibition of antibody binding.

A sensitive direct assay has been developed to quantitate antigen specific helper factors (ThF). The assay depends on the ability of ThF to block the binding of free antibody to immobilized antigen. It has been used to follow the course of purification of ThF produced in short-term cultures of in vitro primed helper cells and purified by affinity chromatography on antibody and antigen immunoabsorbents. The identity of the ThF was confirmed by assaying its biological activity and by its reactivity with anti-Ia antibody and with a monoclonal anti-ThF.

Neutrophil adherence in chronic liver disease and fulminant hepatic failure.

Abnormal adherence of neutrophils to nylon fibre in vitro was found in blood from 17 of 51 (33.3%) patients with chronic or acute liver disease of different aetiologies. Patients with chronic liver disease had a much wider range of values than the controls and the sub-group with alcoholic cirrhosis had significantly higher adherence (72.4 +/- SD 6.2%) than that of controls (65.8 +/- SD 5.2%). The patients with chronic active hepatitis (68.2 +/- 12.7%) or primary biliary cirrhosis (69.2 +/- 6.6%) were not different from controls. Significantly reduced neutrophil adherence (56.2 +/- 8.7%) was found in blood from patients with fulminant hepatic failure. These abnormalities in neutrophil adherence may be due to the effects of the split components of serum complement and dependent on the degree and duration of exposure of the neutrophils. Defects in neutrophil adherence may in part contribute to the increased susceptibility to infection in patients with acute and chronic liver disease.

Neutrophil adherence during hemoperfusion in fulminant hepatic failure.

Neutrophil adherence to nylon fibre packed in plastic syringes was determined in blood from patients with fulminant hepatic failure, both before and during charcoal hemoperfusion carried out with prostacyclin infusion and resin hemoperfusion without prostacyclin. During charcoal hemoperfusion there was a progressive decrease in neutrophil adherence, reaching the lowest value at 4 h (30.4 +/- SE 4.8%). After completion of hemoperfusion the adherence value returned to the pre-perfusion level (53.0 +/- 8.4%). These effects are probably attributable to the PGI2 infusion. No marked changes in neutrophil adherence were observed during resin hemoperfusion.