Brain Imaging of the Cortex in ADHD: A Coordinated Analysis of Large-Scale Clinical and Population-Based Samples.

OBJECTIVE: Neuroimaging studies show structural alterations of various brain regions in children and adults with attention deficit hyperactivity disorder (ADHD), although nonreplications are frequent. The authors sought to identify cortical characteristics related to ADHD using large-scale studies. METHODS: Cortical thickness and surface area (based on the Desikan-Killiany atlas) were compared between case subjects with ADHD (N=2,246) and control subjects (N=1,934) for children, adolescents, and adults separately in ENIGMA-ADHD, a consortium of 36 centers. To assess familial effects on cortical measures, case subjects, unaffected siblings, and control subjects in the NeuroIMAGE study (N=506) were compared. Associations of the attention scale from the Child Behavior Checklist with cortical measures were determined in a pediatric population sample (Generation-R, N=2,707). RESULTS: In the ENIGMA-ADHD sample, lower surface area values were found in children with ADHD, mainly in frontal, cingulate, and temporal regions; the largest significant effect was for total surface area (Cohen's d=-0.21). Fusiform gyrus and temporal pole cortical thickness was also lower in children with ADHD. Neither surface area nor thickness differences were found in the adolescent or adult groups. Familial effects were seen for surface area in several regions. In an overlapping set of regions, surface area, but not thickness, was associated with attention problems in the Generation-R sample. CONCLUSIONS: Subtle differences in cortical surface area are widespread in children but not adolescents and adults with ADHD, confirming involvement of the frontal cortex and highlighting regions deserving further attention. Notably, the alterations behave like endophenotypes in families and are linked to ADHD symptoms in the population, extending evidence that ADHD behaves as a continuous trait in the population. Future longitudinal studies should clarify individual lifespan trajectories that lead to nonsignificant findings in adolescent and adult groups despite the presence of an ADHD diagnosis.

Group therapy for adolescents with attention-deficit/hyperactivity disorder: a randomized controlled trial.

OBJECTIVE: To determine the efficacy of group cognitive-behavioral therapy (CBT) on adolescents with attention-deficit/hyperactivity disorder (ADHD) who were in pharmacological treatment but still had persistent symptoms. METHOD: We conducted a multicenter, randomized, rater-blinded, controlled trial between April 2012 and May 2014 in a cohort of 119 adolescents (15-21 years of age). Participants were randomly assigned to 12 manualized group CBT sessions (n = 45) or a waiting list control group (n = 44). Primary outcomes were assessed by a blinded evaluator (ADHD Rating Scale [ADHD-RS], Clinical Global Impression Scale for Severity [CGI-S], Global Assessment of Functioning [GAF]) before and after treatment, as well as by self-report and parent informant ratings. RESULTS: Of the initial 119 participants enrolled, 89 completed treatment. A mixed-effects model analysis revealed that participants who were assigned to the group CBT sessions experienced significantly reduced ADHD symptoms compared to the control group (ADHD-RS Adolescent: -7.46, 95% CI = -9.56 to -5.36, p < .001, d = 7.5; ADHD-RS Parents: -9.11, 95% CI = -11.48 to -6.75, p < .001, d = 8.38; CGI-S Self-Report: -0.68, 95% CI = -0.98 to -0.39, p < .001, d = 3.75; CGI-S Clinician: -0.79, 95% CI = -0.95 to -0.62, p < .001; d = 7.71). Functional impairment decreased significantly in the CBT group according to parents (Weiss Functional Impairment Scale -4.02, 95% CI = -7.76 to -0.29, p < .05, d = 2.29) and according to the blinded evaluator (GAF: -7.58, 95% CI = -9.1 to -6.05, p < .001, d = 7.51). CONCLUSION: Group CBT associated with pharmacological treatment is an efficacious intervention for reducing ADHD symptoms and functional impairment in adolescents. Clinical trial registration information-CBT Group for Adolescents With ADHD: a Randomized Controlled Trial; http://clinicaltrials.gov/; NCT02172183.

Efeitos da desvascularização da operação de abaixamento do cólon em cães / Effects of the devascularization on the pulled-through of dogs colon

O objetivo deste trabalho foi estudar os efeitos dadesvascularização sobre o cólon submetido à operação de abaixamento. Foram utilizados 20 cães da raça Beaggle, adultos, de ambos os sexos, distribuídos em 3 grupos. O primeiro grupo, de 6 animais, foi utilizado para estabelecer os parâmetros de normalidade. No segundo grupo, também de 6 animais, foi realizada a desvascularização parcial do cólon, com ligadura dos vasos mesentéricos caudais. No terceiro grupo, de 8 animais, foi realizada a operação de abaixamento endorretal do cólon. Nos 3 grupos, após a anestesia, foi realizado enema opaco pré-operatório. Após 6 meses de observação, os animais foram anestesiados, submetidos a enema opaco e, a seguir, reoperados, com retirada de fragmentos em 3 locais padronizados do cólon, para análise histológica e estudo da contractilidade, in vitro, da musculatura longitudinal, com estímulo pela acetilcolina. A evolução clínica dos animais ocorreu sem complicações. Também não foram observadas alterações radiológicas, quando comparados os exames pré e pós-operatórios. Na análise histológica não foram encontradas alterações significativas. As células ganglionares dos plexos mientéricos não sofreram alterações morfológicas ou numéricas. Do ponto de vista funcional, observou-se que a musculatura longitudinal do cólon manteve sua capacidade contráctil máxima. No entanto, apresentou diminuição da sensibilidade à acetilcolina. Esse fato pode ser correlacionado com a hipoxia, pois ocorreu no local de menor vascularização do cólon abaixado. Concluiu-se que a hipoxia provocada pelo abaixamento do cólon, em cães, não foi suficiente para promover alterações morfológicas do cólon, porém, provocou alteração da contractilidade...