[The effects of pharmacological treatment with stimulants on circadian activity patterns in children with attention deficit hyperactivity disorder]. / Efectos del tratamiento farmacológico estimulante sobre los patrones de actividad circadiana en niños con trastorno por déficit de atención/hiperactividad.

INTRODUCTION: Attention deficit hyperactivity disorder (ADHD) is one of the most common mental disorders in childhood. The nuclear symptoms of ADHD are treated with stimulant medication such as methylphenidate; however, there's a lot of controversy regarding its side effects. AIMS: To analyse the activity patterns in children with ADHD during a period of 24 hours for seven days, before and after taking pharmacological treatment with stimulants (methylphenidate) and observe the differences between the different presentations of ADHD (inattentive and combined subtype). PATIENTS AND METHODS: A total of 30 children and adolescents (newly diagnosed with ADHD according to DSM-IV). Analyses were carried out through actigraphy, an instrument that allows us to monitor body movements by analysing movement patterns and differences between sleep and wakefulness. RESULTS: There were significant differences before and after treatment showing higher activity levels in patients with ADHD before treatment, and a decrease in this situation after taking pharmacological treatment. There are also differences between inattentive and combined subtype, showing the last group, higher activity levels. CONCLUSIONS: The level of activation presented by ADHD subjects is higher before taking stimulant treatment, influencing circadian patterns, sleep and quality of life. Pharmacological treatments help to decrease the level of activation.

TITLE: Efectos del tratamiento farmacológico estimulante sobre los patrones de actividad circadiana en niños con trastorno por déficit de atención/hiperactividad.Introducción. El trastorno por déficit de atención/hiperactividad (TDAH) es uno de los trastornos mentales más comunes en la infancia. Los síntomas nucleares del TDAH se tratan con estimulantes como el metilfenidato; aun así, existe mucha controversia respecto a sus efectos secundarios. Objetivos. Analizar los patrones de actividad en niños con TDAH durante un período de 24 horas durante siete días, antes y después de tomar tratamiento farmacológico estimulante (metilfenidato), y observar si existen diferencias entre las diferentes presentaciones del trastorno (subtipo inatento y combinado). Pacientes y métodos. Un total de 30 niños y adolescentes (recién diagnosticados de TDAH según los criterios diagnósticos del DSM-IV) fueron evaluados a través de un actígrafo, un instrumento que permite monitorizar los movimientos corporales analizando los patrones de movimiento y las diferencias entre sueño y vigilia. Resultados. Existen diferencias significativas antes y después de realizar el tratamiento, con niveles de actividad más altos en los pacientes con TDAH antes de empezar el tratamiento y un decrecimiento de esta actividad tras el tratamiento farmacológico. También existen diferencias entre los subtipos inatento y combinado, y el último grupo muestra un nivel de actividad mayor. Conclusiones. El nivel de activación que presentan los sujetos con TDAH es mayor antes de tomar tratamiento, e influye en los patrones circadianos, el sueño y la calidad de vida. El tratamiento farmacológico ayuda a disminuir el nivel de activación.

Biarticular total femoral spacer for complete bone loss in periprosthetic joint infection. A technical modification. / Espaciador femoral total biarticulado para el tratamiento de la infección periprotésica de cadera y rodilla con pérdida completa de hueso. Modificación técnica.

BACKGROUND: The management of complete bone defects in hip and knee periprosthetic infection is still a real surgical challenge. MATERIAL AND METHODS: We present a technical modification for performing a biarticular total femoral spacer with a femoral nail without the need to approach the proximal tibia. RESULTS: Three patients were operated with this technique. There was no intraoperative complication. The infection was resolved in all patients operated at final follow-up. All patients improved their previous functional situation and could walk with different aids. CONCLUSIONS: This technical modification is an alternative for cases where it is necessary to resect the complete femur, but it is not necessary to approach the tibia.

[Side effects of methylphenidate in children and the young]. / Efectos secundarios del metilfenidato en poblacion infantil y juvenil.

INTRODUCTION: The use of psychostimulants has been present in common medical practice since the 20th century and has undergone an exponential growth in terms of the number of prescriptions. AIM: To review the current state of knowledge about the side effects of psychostimulants in the child and teen populations. DEVELOPMENT: A review was performed by searching in different databases and included clinical analyses, observational prospective studies and systematic reviews. A minimum increase in blood pressure and heart rate are observed, but some studies highlight an underestimation of the long-term risk. As regards appetite and growth, almost all the current literature points to a slowing of the rate of growth, which is regained on interrupting treatment. One important factor, as is the parallel evolution of bone age, has not been evaluated in most of the studies carried out to date. No significant worsening of sleep was noted in patients treated with psychostimulants with respect to those who are not being treated. With regard to the central nervous system, there does not seem to be any evidence of an increased risk of the appearance or exacerbation of tics following introduction of the treatment. Affect and emotion are areas that have been barely explored. CONCLUSIONS: It is important to have more evidence on the safety of these drugs. It is therefore essential to have access to studies that cover a period of time consistent with the duration of these treatments.

TITLE: Efectos secundarios del metilfenidato en poblacion infantil y juvenil.Introduccion. El uso de farmacos psicoestimulantes esta presente en la practica medica habitual desde principios del siglo XX y ha experimentado un incremento exponencial en cuanto a prescripciones. Objetivo. Revisar el estado de conocimiento actual sobre los efectos secundarios de los psicoestimulantes en poblacion infantil y juvenil. Desarrollo. Se realiza una revision tras consultar diferentes bases de datos, incluyendo en esta revision analisis clinicos, metaanalisis, estudios prospectivos observacionales y revisiones sistematicas. Se observa un incremento minimo en la tension arterial y la frecuencia cardiaca, pero algunos estudios recientes apuntan a una infraestimacion del riesgo a largo plazo. En lo que se refiere al apetito y el crecimiento, casi toda la bibliografia actual apunta a una ralentizacion del ritmo de crecimiento, que se recupera al interrumpir el tratamiento. Un factor importante, como es la evolucion en paralelo de la edad osea, no se ha valorado en la mayoria de los estudios realizados. En el sueño no habria empeoramiento significativo en los pacientes tratados con psicoestimulantes respecto a los no tratados. En relacion con el sistema nervioso central, no parece haber evidencia de un incremento del riesgo de aparicion o empeoramiento de tics tras introducir el tratamiento. El afecto y la emocion son areas poco exploradas. Conclusiones. Es importante tener una mayor evidencia de la seguridad de estos farmacos. Para ello es imprescindible poder disponer de estudios de una extension en el tiempo consecuente con la duracion de estos tratamientos.

[Evaluation and treatment of sleep problems in children diagnosed with attention deficit hyperactivity disorder: an update of the evidence]. / Evaluacion y tratamiento de los problemas de sueño en niños diagnosticados de trastorno por deficit de atencion/hiperactividad: actualizacion de la evidencia.

INTRODUCTION: Attention deficit hyperactivity disorder (ADHD) affects approximately 5% of all children and adolescents, and these patients frequently suffer from sleep problems. The association between sleep disorders and ADHD, however, is multifaceted and complex. AIMS: To explore the relationship between sleep disorders and ADHD. DEVELOPMENT: Sleep problems in children with ADHD include altered sleep and specific disorders per se or that may be due to comorbid psychiatric disorders or to the stimulants they receive as treatment for their ADHD. Today, an evaluation of the sleep conditions in children with ADHD is recommended before starting pharmacological treatment. The first step in managing their sleep problems is good sleep hygiene and cognitive-behavioural psychotherapy. Another option is to consider modifying the dosage and formulation of the stimulants. Atomoxetine and melatonin are therapeutic alternatives for children with ADHD and more severe sleep problems. Specific treatments exist for respiratory and movement disorders during sleep. CONCLUSIONS: It is important to evaluate sleep in children who present symptoms suggestive of ADHD, since problems during sleep can play a causal role or exacerbate the clinical features of ADHD. Correct evaluation and treatment of sleep disorders increase the family's and the child's quality of life and can lessen the severity of the symptoms of ADHD.

TITLE: Evaluacion y tratamiento de los problemas de sueño en niños diagnosticados de trastorno por deficit de atencion/hiperactividad: actualizacion de la evidencia.Introduccion. El trastorno por deficit de atencion/hiperactividad (TDAH) afecta aproximadamente al 5% de los niños y adolescentes, y los problemas del sueño son comunes en estos pacientes. Sin embargo, la asociacion entre los trastornos del sueño y el TDAH es multifacetica y compleja. Objetivo. Explorar la relacion entre los trastornos del sueño y el TDAH. Desarrollo. Los problemas del sueño en niños con TDAH incluyen alteraciones del sueño y trastornos especificos per se o debidos a trastornos psiquiatricos comorbidos o a los farmacos estimulantes para el TDAH. Actualmente se recomienda la evaluacion de las condiciones del sueño en niños con TDAH antes de la iniciacion del tratamiento farmacologico. La primera linea de actuacion para el manejo de los problemas de sueño es la higiene del sueño y la psicoterapia cognitivo-conductual. Otra opcion es considerar la modificacion de la posologia y formulacion de los farmacos estimulantes. La atomoxetina y la melatonina son alternativas terapeuticas para los niños con TDAH y problemas del sueño mas graves. Para los trastornos respiratorios y del movimiento en el sueño existen tratamientos especificos. Conclusiones. Es importante evaluar el sueño en los niños que presentan sintomas sugestivos de TDAH, ya que los problemas en el sueño pueden desempeñar un papel causal o exacerbar la clinica del TDAH. Una correcta evaluacion y tratamiento de los trastornos del sueño aumentan la calidad de vida de la familia y del niño y pueden disminuir la gravedad de los sintomas del TDAH.

Hierarchical nanoparticle ensembles synthesized by liquid phase directed self-assembly.

A liquid metal filament supported on a dielectric substrate was directed to fragment into an ordered, mesoscale particle ensemble. Imposing an undulated surface perturbation on the filament forced the development of a single unstable mode from the otherwise disperse, multimodal Rayleigh-Plateau instability. The imposed mode paved the way for a hierarchical spatial fragmentation of the filament into particles, previously seen only at much larger scales. Ultimately, nanoparticle radius control is demonstrated using a micrometer scale switch.

Competing liquid phase instabilities during pulsed laser induced self-assembly of copper rings into ordered nanoparticle arrays on SiO2.

Nanoscale copper rings of different radii, thicknesses, and widths were synthesized on silicon dioxide thin films and were subsequently liquefied via a nanosecond pulse laser treatment. During the nanoscale liquid lifetimes, the rings experience competing retraction dynamics and thin film and/or Rayleigh-Plateau types of instabilities, which lead to arrays of ordered nanodroplets. Surprisingly, the results are significantly different from those of similar experiments carried out on a Si surface. We use hydrodynamic simulations to elucidate how the different liquid/solid interactions control the different instability mechanisms in the present problem.

[GEITDAH consensus on attention deficit hyperactivity disorder]. / Consenso del GEITDAH sobre el trastorno por deficit de atencion/hiperactividad.

In this article, the GEITDAH -the Spanish abbreviation of the Special Interest Group on Attention Deficit Hyper-activity Disorder (ADHD)- presents a consensus reached by experts in the management of ADHD from all over Spain. The consensus concerns fundamental aspects that should be the starting point for future local or regional consensus guides. Another aim of this consensus is also to reduce the amount of variability that occurs in the health care offered to patients with ADHD in our country, as well as to act as a stimulus in educational matters. That fact that it is not very long will make it more popular among greater numbers of people and this will allow these goals to be reached more effectively. The conclusions in the consensus guide have been constructed around an introduction dealing with basic aspects and recommendations for diagnosis, treatment (both pharmacological and psychotherapeutic), patient flow and organisational aspects.

[Paratesticular dermoid cyst. Report of a case and review of the literature]. / Quiste dermoide paratesticular. Aportación de un caso y revisión de la literatura.

It is discussed a dermoid cyst case that depends on paratesticular structures, clinical entity which has low frequency of presentation. It is analyzed the controversial terminology of this tumours and are established anatomopathological criteria for this disease.

[Somatization symptoms. An emerging pediatric entity]. / Trastornos somatomorfos: una entidad emergente en pediatría.

BACKGROUND: Somatization symptoms are a clinical reality in our environment. However, many pediatricians have little information about this condition or experience of its management. OBJECTIVE: To determine the clinical and differential characteristics of these patients. The early identification of these patients and initiation of therapy in the initial stages of the process would improve prognosis. MATERIAL AND METHOD: A retrospective review was performed of the children admitted to the short-stay unit of a tertiary hospital because of somatic complaints and whose final diagnosis was that of a somatization disorder. RESULTS: Sixty medical records were analyzed, of which 38 (63 %) corresponded to girls, with a mean age of 11 years at presentation. The most frequent reasons for consultation were related to the digestive and neurological systems. Thirty-four patients (57 %) had previously consulted for the same reason. In the sample analyzed, the most frequent personality trait was anxiety. The main triggers were familial and school factors. The most frequent diagnosis was pain disorder in 42 children (70 %). All patients received psychotherapy and 39 received complementary pharmacological treatment. CONCLUSIONS: The data analyzed in this study indicate that somatization symptoms most frequently occur in anxious, prepubescent girls, with migraine or non-specific abdominal pain of approximately one month's duration. Patients have usually made several previous visits and no organic causes are discovered on physical examination.

Global models for moving contact lines.

We consider thin film flows driven by surface tension and gravity. Within the framework of the lubrication approximation, we study the contact line motion using global models where either precursor film or slip are allowed. We show that completely wetting films can be simulated under both conditions without requiring direct tracking of the contact line interface. We perform a comparative study of standard and positivity preserving numerical methods for these problems in one space dimension, with the ultimate goal of choosing the best method applicable to two-dimensional problems. We find a considerable computational advantage of the precursor film model over the slipping models.

Contact line instabilities of thin liquid films.

We present results of fully nonlinear time-dependent simulations of a thin liquid film flowing down an inclined plane. Within the lubrication approximation, and assuming complete wetting, we find that varying the inclination angle considerably modifies the shape of the emerging patterns (fingers versus sawtooth). Our results strongly suggest that the shape of the patterns is not necessarily related to either partial or complete coverage of the substrate, a technologically important feature of the flow. We find quantitative agreement with reported experiments and suggest new ones.

Evaluation of the application of pig slurry to an experimental crop using agronomic and ecotoxicological approaches.

The agronomic and ecotoxicological effects of the application of pig (Sus scrofa) slurry during a maize (Zea mays L.) crop cycle under conditions of forced irrigation were evaluated. The 0.2-ha experimental area, of typical xerofluvent soil and of known vulnerability to nitrate (NO3-) contamination, was divided into 12 plots and provided with water measurement instruments (TDR-probes, vertical tensiometers, and ceramic candles). Samples of soil, water, soil organisms, and the crop were subjected to analytical, agronomic, and biological test procedures. The following fertilizer treatments were applied to triplicate plots: urea (U;170 kg N ha(-1)), and an optimized (P1; 162 kg N ha(-1)) and triple (P3; 486 kg N ha(-1)) dose of pig slurry. Unfertilized plots (P0) served as controls. Calculation was made of seasonal drainage and leached NO3- and sodium losses during the experimental period. Conductivity, heavy metal concentration, hardness, pH, and redox potential were determined in soil solutions. The ecotoxicological evaluation of the soil solution and matrix was based on ecotoxicity bioassays and the quantification of organic and inorganic compounds [phenols, indols, polychlorinated biphenyls (PCBs)]. The results suggest that the P3 treatment is highly contaminating due to the leaching of nitrates and increased soil salinity. Despite the fact that a Folsomia candida reproduction test indicated chronic ecotoxicological effects on the soil in plots treated with P1 and P3, the absence of organic compounds suggests that these effects may be attributable to contaminants not considered in this study.

[Voluntary poisoning as a form of attempted suicide]. / Intoxicaciones voluntarias como intento de suicidio.

BACKGROUND: Voluntary intoxication as form of attempted suicide is currently a significant problem among the teenage population. Suicide attempt is the most frequent psychiatric emergency in adolescents. We present our 2-year experience of voluntary intoxication in a pediatric population. MATERIALS AND METHODS: Retrospective and descriptive study of patients admitted because of voluntary intoxication in our center from January 1996 to December 1997. We analyzed age, sex, approximate time of intoxication, toxic habit antecedents, psychiatric evaluations or previous intoxications, type of toxic substance and method of obtaining it, symptomatology on arrival at the emergency department, therapeutic attitude and most common complementary examinations, and days of hospital stay. RESULTS: Forty-six patients with voluntary intoxication were admitted during the study period. The mean age was 15.6 years; 40 patients (87%) were female. Twenty-eight patients (60.9%) had previously been evaluated in a psychiatric department. The toxic substance used was of pharmacological origin, and in 38 patients (82.6%) it was obtained from the home first-aid kit. In 22 patients (47.8%) intoxication was due to multiple drugs. Six patients (13%) required admission to the pediatric intensive care unit. Mean duration of admission was 3 days. COMMENTS: Voluntary intoxication as a form of attempted suicide is a significant problem among the teenage population, especially among teenage girls. The best preventive measure would be identification of the at-risk population, which consists mainly of teenage girls with depression, eating disorders, or previous suicide attempts.

Assembly of heteromeric connexons in guinea-pig liver en route to the Golgi apparatus, plasma membrane and gap junctions.

Guinea-pig liver gap junctions are constructed from approximately equal amounts of connexins 26 and 32. The assembly of these connexins into connexon hemichannels and gap junctions was studied using antibodies specific to each connexin. Intracellular membranes were shown to contain low amounts of connexin 26 relative to connexin 32 in contrast to the equal connexin ratios detected in lateral plasma membranes and gap junctions. Assembly of gap junctions requires oligomerization of connexins into connexons that may be homomeric or heteromeric. Immunoprecipitation using antibodies to connexins 26 and 32 showed that liver gap junctions were heteromeric. A chemical cross-linking procedure showed that connexons solubilized from guinea-pig liver gap junctions were constructed of hexameric assemblies of connexin subunits. The intracellular site of oligomerization of connexins was investigated by velocity sedimentation in sucrose-detergent gradients. Oligomers of connexins 26 and 32 were extensively present in Golgi membranes and oligomeric intermediates, especially of connexin 26, were detected in the endoplasmic reticulum-Golgi intermediate subcellular fraction. Two intracellular trafficking pathways that may account for the delivery of connexin 26 to the plasma membrane and explain the heteromeric nature of liver gap junctions are discussed.

Synthesis and assembly of connexins in vitro into homomeric and heteromeric functional gap junction hemichannels.

The biogenesis of connexins and their assembly into functional gap junction hemichannels (connexons) was studied with the use of a cell-free transcription/translation system. Velocity sedimentation on sucrose gradients showed that a small proportion of connexin (Cx) 26 and Cx32 that were co-translationally translocated into microsomes were oligomers of Cx26 and Cx32. Chemical cross-linking studies showed that these corresponded to hexameric connexons. Reconstitution of connexons synthesized in vitro into liposomes induced permeability properties consistent with the view that open gap junction hemichannels were produced. By using an immunoprecipitation approach, a simultaneous translation of Cx26 and Cx32 incorporated into microsomes resulted in homomeric connexons. However, supplementation of the translation system in vitro with liver Golgi membranes produced heteromeric connexons constructed of Cx32 and Cx26, and also resulted in an increased oligomerization especially of Cx32. All of the connexins analysed were inserted co-translationally into canine pancreatic microsomal membranes. In addition, Cx26 and Cx43, but not Cx32, were also inserted into microsomal membranes post-translationally. Analysis of various connexin constructs in which the cytoplasmic carboxy tails were transposed, the cytoplasmic tail of Cx43 was truncated or a reporter protein, aequorin, was attached to the C-terminus showed that tail length was not the major determinant of the post-translational membrane insertion of connexins.

The epidermal growth factor receptor tyrosine kinase phosphorylates connexin32.

The epidermal growth factor (EGF) receptor purified by calmodulin-affinity chromatography from solubilized rat liver plasma membranes phosphorylates connexin32 in gap junction plaques isolated from the same origin. Phosphorylation of connexin32 was stimulated by EGF and mainly occurs at tyrosine residue(s), although phosphorylation of serine and threonine residues was also detected. The kinetics parameters for the phosphorylation of connexin32 parallel those for the transphosphorylation of the EGF receptor. m-Calpain proteolyzes phosphoconnexin32, and its major 26 kDa proteolytic fragment only contains phosphotyrosine residue(s). Calmodulin binds to connexin32 in the absence of calcium and prevents in great extent its phosphorylation by the EGF receptor tyrosine kinase.