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Electrothermal instability plays an important role in applications of current-driven metal, creating striations (which seed the magneto-Rayleigh-Taylor instability) and filaments (which provide a more rapid path to plasma formation). However, the initial formation of both structures is not well understood. Simulations show for the first time how a commonly occurring isolated defect transforms into the larger striation and filament, through a feedback loop connecting current and electrical conductivity. Simulations have been experimentally validated using defect-driven self-emission patterns.
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Citoesqueleto , PlasmaRESUMEN
The purpose of this study was to evaluate whether a minimally-invasive cubital tunnel release using lighted retractors could be performed safely and completely by residents with no prior training in this technique. Ten residents participated in the study. Postoperative dissection of the specimens was performed utilizing a detailed checklist and global rating scale to evaluate the completeness of release as well as presence of neurologic injury. Performance of residents was compared. Rho correlation analysis was used to verify validity of the assessment tools. Training year most strongly correlated with Global Rating Scale assessment values. There was a trend correlating training year with faster surgical times, and Detailed Checklist scores. Validation measurements showed strong correlations between the pass/fail grade and the Detailed Checklist and the Global Rating Scale. Complete release of the ulnar nerve in situ utilizing lighted retractors can be performed with minimal training or experience. (Journal of Surgical Orthopaedic Advances 32(3):193-198, 2023).
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Ortopedia , Procedimientos de Cirugía Plástica , Humanos , Tempo Operativo , Periodo Posoperatorio , CadáverRESUMEN
BACKGROUND: Increasing methicillin resistance and recognition of Propionibacterium acnes as a cause of infection in shoulder arthroplasty has led to the adoption of local vancomycin powder application as a more effective method to prevent expensive periprosthetic infections. However, no study has analyzed the cost effectiveness of vancomycin powder for preventing infection after shoulder replacement. METHODS: Cost data for infection-related care of 16 patients treated for deep periprosthetic shoulder infection was collected from our institution for the break-even analysis. An equation was developed and applied to the data to determine how effective vancomycin powder would need to be at reducing a baseline infection rate to make prophylactic use cost effective. RESULTS: The efficacy of vancomycin (absolute risk reduction [ARR]) was evaluated at different unit costs, baseline infection rates, and average costs of treating infection. We determined vancomycin to be cost effective if the initial infection rate decreased by 0.04% (ARR). Using the current costs of vancomycin reported in the literature (range: $2.50/1000 mg to $44/1000 mg), we determined vancomycin to be cost effective with an ARR range of 0.01% at a cost of $2.50/1000 mg to 0.19% at $44/1000 mg. Baseline infection rate does not influence the ARR obtained at any specific cost of vancomycin or the cost of treating infection. CONCLUSIONS: We have derived and used a break-even equation to assess efficacy of prophylactic antibiotics during shoulder surgery. We further demonstrated the prophylactic administration of local vancomycin powder during shoulder arthroplasty to be a highly cost-effective practice.
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Antibacterianos/economía , Profilaxis Antibiótica/economía , Artroplastía de Reemplazo de Hombro , Infección de la Herida Quirúrgica/prevención & control , Vancomicina/economía , Antibacterianos/uso terapéutico , Análisis Costo-Beneficio , Humanos , Infección de la Herida Quirúrgica/economía , Estados Unidos , Vancomicina/uso terapéuticoRESUMEN
Psoriasis is a chronic inflammatory skin disorder that affects 2% of the population. Evidence suggests that interleukin (IL)-23 plays a pivotal role in the pathogenesis of psoriasis. Guselkumab is a subcutaneously administered, humanized anti-IL23 monoclonal antibody indicated for the treatment of moderate-to-severe plaque psoriasis. Data from Phase I-III trials in this patient population reveal that guselkumab has proven to be superior to placebo or adalimumab based on achieving a Psoriasis Area and Severity Index (PASI) 90% reduction, or a static Physician Global Assessment (sPGA) score of 0 or 1 from baseline. This article reviews the current status of guselkumab as a therapy for moderate-to-severe plaque psoriasis.
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Anticuerpos Monoclonales/uso terapéutico , Interleucina-23/antagonistas & inhibidores , Psoriasis/tratamiento farmacológico , Anticuerpos Monoclonales/administración & dosificación , Anticuerpos Monoclonales Humanizados , Ensayos Clínicos como Asunto , Humanos , Psoriasis/patología , Índice de Severidad de la EnfermedadRESUMEN
BACKGROUND: Occupational and environmental exposure to chemicals such as benzene has been linked to increased risk of leukemia. Cigarette smoking and alcohol consumption have also been found to affect leukemia risk. Previous analyses in a large cohort of Chornobyl clean-up workers in Ukraine found significant radiation-related increased risk for all leukemia types. We investigated the potential for additional effects of occupational and lifestyle factors on leukemia risk in this radiation-exposed cohort. METHODS: In a case-control study of chronic lymphocytic and other leukemias among Chornobyl cleanup workers, we collected data on a range of non-radiation exposures. We evaluated these and other potential risk factors in analyses adjusting for estimated bone marrow radiation dose. We calculated Odds Ratios and 95% Confidence Intervals in relation to lifestyle factors and occupational hazards. RESULTS: After adjusting for radiation, we found no clear association of leukemia risk with smoking or alcohol but identified a two-fold elevated risk for non-CLL leukemia with occupational exposure to petroleum (OR=2.28; 95% Confidence Interval 1.13, 6.79). Risks were particularly high for myeloid leukemias. No associations with risk factors other than radiation were found for chronic lymphocytic leukemia. CONCLUSIONS: These data - the first from a working population in Ukraine - add to evidence from several previous reports of excess leukemia morbidity in groups exposed environmentally or occupationally to petroleum or its products.
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Accidente Nuclear de Chernóbil , Leucemia/etiología , Neoplasias Inducidas por Radiación/etiología , Exposición Profesional , Benceno/toxicidad , Estudios de Casos y Controles , Sustancias Peligrosas/toxicidad , Humanos , Leucemia/epidemiología , Modelos Logísticos , Neoplasias Inducidas por Radiación/epidemiología , Exposición Profesional/efectos adversos , Exposición Profesional/análisis , Oportunidad Relativa , Petróleo/toxicidad , Exposición a la Radiación/efectos adversos , Exposición a la Radiación/análisis , Factores de Riesgo , Ucrania/epidemiologíaRESUMEN
BACKGROUND: A strong, consistent association between childhood irradiation and subsequent thyroid cancer provides an excellent model for studying radiation carcinogenesis. METHODS: We evaluated gene expression in 63 paired RNA specimens from frozen normal and tumour thyroid tissues with individual iodine-131 (I-131) doses (0.008-8.6 Gy, no unirradiated controls) received from Chernobyl fallout during childhood (Ukrainian-American cohort). Approximately half of these randomly selected samples (32 tumour/normal tissue RNA specimens) were hybridised on 64 whole-genome microarrays (Agilent, 4 × 44 K). Associations between I-131 dose and gene expression were assessed separately in normal and tumour tissues using Kruskal-Wallis and linear trend tests. Of 155 genes significantly associated with I-131 after Bonferroni correction and with ≥2-fold increase per dose category, we selected 95 genes. On the remaining 31 RNA samples these genes were used for validation purposes using qRT-PCR. RESULTS: Expression of eight genes (ABCC3, C1orf9, C6orf62, FGFR1OP2, HEY2, NDOR1, STAT3, and UCP3) in normal tissue and six genes (ANKRD46, CD47, HNRNPH1, NDOR1, SCEL, and SERPINA1) in tumour tissue was significantly associated with I-131. PANTHER/DAVID pathway analyses demonstrated significant over-representation of genes coding for nucleic acid binding in normal and tumour tissues, and for p53, EGF, and FGF signalling pathways in tumour tissue. CONCLUSION: The multistep process of radiation carcinogenesis begins in histologically normal thyroid tissue and may involve dose-dependent gene expression changes.
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Accidente Nuclear de Chernóbil , Expresión Génica/efectos de la radiación , Radioisótopos de Yodo/administración & dosificación , Neoplasias Inducidas por Radiación/etiología , Neoplasias Inducidas por Radiación/genética , Glándula Tiroides/efectos de la radiación , Neoplasias de la Tiroides/etiología , Neoplasias de la Tiroides/genética , Adolescente , Adulto , Niño , Femenino , Estudio de Asociación del Genoma Completo , Humanos , Masculino , Transcriptoma/efectos de la radiación , Adulto JovenRESUMEN
Using three-dimensional (3D) magnetohydrodynamic simulations, we study how a pit on a metal surface evolves when driven by intense electrical current density j. Redistribution of j around the pit initiates a feedback loop: j both reacts to and alters the electrical conductivity σ, through Joule heating and hydrodynamic expansion, so that j and σ are constantly in flux. Thus, the pit transforms into larger striation and filament structures predicted by the electrothermal instability theory. Both structures are important in applications of current-driven metal: The striation constitutes a density perturbation that can seed the magneto-Rayleigh-Taylor instability, while the filament provides a more rapid path to plasma formation, through 3D j redistribution. Simulations predict distinctive self-emission patterns, thus allowing for experimental observation and comparison.
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Antivirales/uso terapéutico , Hepatitis C/tratamiento farmacológico , Porfiria Cutánea Tardía/tratamiento farmacológico , Biopsia , Hepatitis C/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Porfiria Cutánea Tardía/complicaciones , Porfiria Cutánea Tardía/diagnóstico , Piel/patología , Resultado del TratamientoRESUMEN
BACKGROUND: Previous studies showed an increased risk of thyroid cancer among children and adolescents exposed to radioactive iodines released after the Chornobyl (Chernobyl) accident, but the effects of screening, iodine deficiency, age at exposure and other factors on the dose-response are poorly understood. METHODS: We screened 11 970 individuals in Belarus aged 18 years or younger at the time of the accident who had estimated (131)I thyroid doses based on individual thyroid activity measurements and dosimetric data from questionnaires. The excess odds ratio per gray (EOR/Gy) was modelled using linear and linear-exponential functions. RESULTS: For thyroid doses <5 Gy, the dose-response was linear (n=85; EOR/Gy=2.15, 95% confidence interval: 0.81-5.47), but at higher doses the excess risk fell. The EOR/Gy was significantly increased among those with prior or screening-detected diffuse goiter, and larger for men than women, and for persons exposed before age 5 than those exposed between 5 and 18 years, although not statistically significant. A somewhat higher EOR/Gy was estimated for validated pre-screening cases. CONCLUSION: 10-15 years after the Chornobyl accident, thyroid cancer risk was significantly increased among individuals exposed to fallout as children or adolescents, but the risk appeared to be lower than in other Chornobyl studies and studies of childhood external irradiation.
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Accidente Nuclear de Chernóbil , Radioisótopos de Yodo/efectos adversos , Neoplasias Inducidas por Radiación/diagnóstico , Neoplasias de la Tiroides/etiología , Adolescente , Adulto , Niño , Estudios de Cohortes , Relación Dosis-Respuesta en la Radiación , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Factores de Riesgo , Neoplasias de la Tiroides/patología , Adulto JovenRESUMEN
OBJECTIVE: To describe the status and results of thyroid disease screening and assessment of reliability of radiationthyroid doses in the Belarusian in utero cohort of 2,965 individuals exposed to Chernobyl (Chornobyl) fallout. MATERIALS AND METHODS: Thyroid screening examinations are currently underway including thyroid palpation by anendocrinologist, ultrasonographic examination by an ultrasonographer and analysis of blood samples for diagnosisof hypo- and hyperthyroidism, autoimmune thyroiditis, thyroid function tests (thyroid-stimulating hormone [TSH],thyroxine [T4], thyroid peroxidase antibody [anti-TPO], and thyroglobulin antibodies [anti-TG]). Reliability of (i)information from 780 pairs of questionnaires obtained during the first and second interviews of the mothers and (ii)thyroid doses, which were calculated for the cohort members using this information, is evaluated. RESULTS: As of 15 August 2021, 1,267 in utero exposed study subjects had been screened. A single thyroid nodule wasdiagnosed in 167 persons (13.2 % of the total) and multiple thyroid nodules in 101 persons (8.0 %): 189 (14.9 %)persons had nodules detected for the first time at the screening while 79 (6.2 %) persons had nodules detected pre-viously (pre-screening nodules). Fifty-nine out of 268 subjects (22.0 %) with a suspicious thyroid nodule werereferred to fine needle aspiration biopsy, and among them 33 (55.9 %) were biopsied. Reasonable agreement wasobserved for modelqbased doses calculated for the Belarusian in utero cohort members using data from the two inter-views (Spearman's rank-correlation coefficient rs = 0.74, p < 0.001), while measurementqbased doses yielded almost per-fect agreement (rs = 0.99, p < 0.001). CONCLUSIONS: During the thyroid screening, at least one thyroid nodule was identified in 268 of 1,267 (21.2 %) inutero exposed cohort members. Seven thyroid cancer cases were identified in the cohort, including 5 pre-screeningcases and 2 cases detected during the screening. Ongoing research on this unique cohort will provide importantinformation on adverse health effects following prenatal and postnatal exposure to radioiodine and radiocesium iso-topes, for which available epidemiological data are scant.
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Accidente Nuclear de Chernóbil , Feto/efectos de la radiación , Mujeres Embarazadas , Dosis de Radiación , Ceniza Radiactiva/efectos adversos , Glándula Tiroides/fisiopatología , Glándula Tiroides/efectos de la radiación , Nódulo Tiroideo/fisiopatología , Adulto , Estudios de Cohortes , Femenino , Humanos , Recién Nacido , Estudios Longitudinales , Masculino , Exposición Materna/estadística & datos numéricos , Neoplasias Inducidas por Radiación/epidemiología , Embarazo , Efectos Tardíos de la Exposición Prenatal , Reproducibilidad de los Resultados , República de Belarús , Nódulo Tiroideo/epidemiología , Nódulo Tiroideo/etiología , UcraniaRESUMEN
There are relatively few data on the risk of leukemia among those exposed to external radiation during cleanup operations after the Chornobyl nuclear accident, and results have not been consistent. To investigate this further, we assembled a cohort of 110,645 male cleanup workers from Ukraine and identified cases of leukemia occurring during the period 1986 to 2000. Detailed interviews were conducted and individual bone marrow doses estimated using a new time-and-motion method known as RADRUE described in companion paper II. For the initial analyses we used a nested case-control approach with a minimum of five controls per case, matched for year of birth, oblast (region) of registration, and residence. All identified cases were reviewed by an international panel of experts; 87 of 111 were confirmed. The dose-response analysis and results are given in companion paper III. As background, we describe herein the design, procedures, outcome of case finding and confirmation, control selection, dose estimation and interviewing of subjects.
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Accidente Nuclear de Chernóbil , Restauración y Remediación Ambiental , Leucemia/epidemiología , Mieloma Múltiple/epidemiología , Síndromes Mielodisplásicos/epidemiología , Neoplasias Inducidas por Radiación/epidemiología , Exposición Profesional , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Ciudades/epidemiología , Estudios de Cohortes , Relación Dosis-Respuesta en la Radiación , Diseño de Investigaciones Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Ucrania/epidemiología , Estados UnidosRESUMEN
CONTEXT: Due to the Chornobyl accident, millions were exposed to radioactive isotopes of iodine and some received appreciable iodine 131 (131I) doses. A subsequent increase in thyroid cancer has been largely attributed to this exposure, but evidence concerning autoimmune thyroiditis (AIT) remains inconclusive. OBJECTIVE: The objective of the study was to quantify risk of AIT after 131I exposure. DESIGN/SETTING/PARTICIPANTS: Baseline data were collected from the first screening cycle (1998-2000) of a large cohort of radiation-exposed individuals (n = 12,240), residents of contaminated, iodine-deficient territories of Ukraine. Study individuals were under the age of 18 yr on April 26, 1986, and had thyroid radioactivity measurements made shortly after the accident. OUTCOMES: AIT was defined a priori based on various combinations of elevated antibodies to thyroid peroxidase (ATPO), TSH, and clinical findings; elevated ATPO were considered to be an indicator of thyroid autoimmunity. RESULTS: No significant association was found between 131I thyroid dose estimates and AIT, but prevalence of elevated ATPO demonstrated a modest, significant association with 131I that was well described by several concave models. This relationship was apparent in individuals with moderately elevated ATPO and euthyroid, thyroid disease-free individuals. CONCLUSIONS: Twelve to 14 yr after the Chornobyl accident, no radiation-related increase in prevalence of AIT was found in a large cohort study, the first in which 131I thyroid doses were estimated using individual radioactivity measurements. However, a dose-response relationship with ATPO prevalence raises the possibility that clinically important changes may occur over time. Thus, further follow-up and analysis of prospective data in this cohort are necessary.
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Carcinoma/epidemiología , Accidente Nuclear de Chernóbil , Radioisótopos de Yodo/efectos adversos , Neoplasias Inducidas por Radiación/epidemiología , Enfermedades de la Tiroides/epidemiología , Neoplasias de la Tiroides/epidemiología , Tiroiditis Autoinmune/epidemiología , Adolescente , Autoanticuerpos/sangre , Autoantígenos/inmunología , Niño , Preescolar , Estudios de Cohortes , Estudios Transversales , Femenino , Humanos , Lactante , Recién Nacido , Yoduro Peroxidasa/inmunología , Proteínas de Unión a Hierro/inmunología , Masculino , Tamizaje Masivo/métodos , Dosis de Radiación , Ucrania/epidemiologíaRESUMEN
In a case-control study involving 268 cases of endometrial cancer and an equal number of population controls, we assessed the relationship of risk to body weight and fat distribution, examining weight at various ages and current anthropometric measurements. Weight gain during later adulthood and resultant high body masses were important risk predictors, indicating that obesity is an important risk factor, even in an area where the prevalence of obesity and incidence of endometrial cancer are low. Certain fat distribution patterns were related to risk of endometrial cancer independent of general obesity. In particular, fat deposits on the trunk were associated with elevated risks, with the odds ratio for the highest versus lowest quartile of subscapular skinfolds remaining significant even after adjustment for body mass index (odds ratio = 2.9; 95% confidence interval, 1.1-7.3). Central versus peripheral obesity, as measured by the subscapular:triceps ratio, also was related to increased risk, although the association failed to remain significant after adjustment for body mass (highest to lowest quartile, odds ratio = 1.7). In contrast, upper body obesity, as assessed by the waist:thigh ratio, was unrelated to risk. These results support the need for future studies assessing the relationship of hormonal and other biological parameters of fat distribution to assist in identifying causal mechanisms for this tumor.
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Peso Corporal , Neoplasias Endometriales/complicaciones , Obesidad/complicaciones , Grosor de los Pliegues Cutáneos , Adolescente , Adulto , Factores de Edad , Anciano , Estatura , Estudios de Casos y Controles , China/epidemiología , Femenino , Humanos , Persona de Mediana Edad , Obesidad/epidemiologíaRESUMEN
Ionized forms of vanadium are known to exert diverse biological activities. Of particular interest in the inhibitory action of the vanadium ion on (Na+ + K+)-ATPase. This report describes another action of the vanadium ion on the rabbit colonic epithelium. Micromolar quantities of vanadate, applied to the serosal side of the isolated rabbit colonic epithelium, result in a stimulation of electrogenic chloride secretion by this epithelium. Sodium transport is unaffected by the vanadium ion in the concentrations used in this study. It is proposed that the vanadyl ion activates adenylate cyclase and thereby initiates subsequent secretory events.
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Cloruros/metabolismo , Colon/metabolismo , Mucosa Intestinal/metabolismo , ATPasa Intercambiadora de Sodio-Potasio/antagonistas & inhibidores , Vanadio/farmacología , Animales , Transporte Biológico/efectos de los fármacos , Transporte Biológico Activo/efectos de los fármacos , Epitelio/metabolismo , Cinética , Masculino , Potenciales de la Membrana/efectos de los fármacos , Conejos , Sodio/metabolismo , VanadatosRESUMEN
A net absorption of oxalate and chloride was observed when isolated, short-circuited segments of rat colon were bathed by a calcium-containing buffer. Removal of calcium promoted a two-fold decrease in transmural resistance, while the net chloride flux was reduced and the net oxalate transport abolished. It was concluded that net oxalate absorption was not observed in previous studies (employing calcium-free buffers) because calcium is reqiured to maintain the integrity of the conductive pathways across colonic epithelia.
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Colon/metabolismo , Oxalatos/metabolismo , Animales , Transporte Biológico/efectos de los fármacos , Calcio/farmacología , Técnicas In Vitro , Mucosa Intestinal/efectos de los fármacos , Mucosa Intestinal/metabolismo , Masculino , RatasRESUMEN
During C4 photosynthesis, CO2 is released in bundle-sheath cells by decarboxylation of C4 acids and then refixed via ribulose-1,5-bisphosphate carboxylase. In this study we examined the efficiency of this process by determining the proportion of the released CO2 that diffuses back to mesophyll cells instead of being refixed. This leak of CO2 was assessed by determining the amount of 14CO2 released from leaves during a chase in high [12CO2] following a 70-s pulse in 14CO2. A computer-based analysis of the time-course curve for 14CO2 release indicated a first-order process and provided an estimate of the initial velocity of 14CO2 release from leaves. From this value and the net rate of photosynthesis determined from the 14CO2 fixed in the pulse, the CO2 leak rate from bundle-sheath cells (expressed as a percentage of the rate of CO2 production from C4 acids) could be deduced. For nine species of Gramineae representing the different subgroups of C4 plants and two NAD-malic enzyme-type dicotyledonous species, the CO2 leak ranged between 8 and 14%. However, very high CO2 leak rates (averaging about 27%) were recorded for two NADP-malic enzyme-type dicotyledonous species of Flaveria. The results are discussed in terms of the efficiency of C4 photosynthesis and observed quantum yields.
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Urinary iodine concentrations were measured in 11,926 subjects who are participants in the Ukrainian-American Cohort Study of Thyroid Cancer and Other Thyroid Diseases Following the Chornobyl Accident. Measurements were made in two time periods corresponding to the first and second thyroid screening cycles (1998-2000, 2001-2003). These time periods fall before and after initiation of a government program to increase iodine sufficiency. Median urinary iodine concentrations did increase in the later time period compared to the earlier [47.5 microg/L, 95% confidence interval (CI) 46.5-48.9 microg/L versus 41.7 microg/L, 95% CI 40.4-42.5 microg/L], but levels remained in the mild-to-moderate iodine deficiency range as defined by the World Health Organization (WHO), indicating the need for further efforts at iodination. In both time periods, urinary iodine levels were found to vary by place of residence and were lower in rural compared to urban areas. Iodine status needs to be considered when evaluating risk of thyroid cancer and other thyroid diseases.
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Accidente Nuclear de Chernóbil , Yodo/orina , Enfermedades de la Tiroides/epidemiología , Neoplasias de la Tiroides/epidemiología , Adolescente , Adulto , Factores de Edad , Niño , Preescolar , Estudios de Cohortes , Recolección de Datos , Conducta Alimentaria , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Estado Nutricional , Población Rural , Factores Sexuales , Encuestas y Cuestionarios , Ucrania/epidemiología , Población Urbana , Organización Mundial de la SaludRESUMEN
The Chernobyl nuclear power plant accident in Ukraine in 1986 led to widespread radioactive releases into the environment - primarily of radioiodines and cesium - heavily affecting the northern portions of the country, with settlement-averaged thyroid doses estimated to range from 10 mGy to more than 10 Gy. The increased risk of thyroid cancer among exposed children and adolescents is well established but the impact of radioactive contamination on the risk of other types of cancer is much less certain. To provide data on a public health issue of major importance, we have analyzed the incidence of non-thyroid cancers during the post-Chernobyl period in a well-defined cohort of 13,203 individuals who were <18 years of age at the time of the accident. The report is based on standardized incidence ratio (SIR) analysis of 43 non-thyroid cancers identified through linkage with the National Cancer Registry of Ukraine for the period 1998 through 2009. We compared the observed and expected number of cases in three cancer groupings: all solid cancers excluding thyroid, leukemia, and lymphoma. Our analyses found no evidence of a statistically significant elevation in cancer risks in this cohort exposed at radiosensitive ages, although the cancer trends, particularly for leukemia (SIR=1.92, 95% confidence interval: 0.69; 4.13), should continue to be monitored.
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Accidente Nuclear de Chernóbil , Neoplasias Inducidas por Radiación/epidemiología , Adolescente , Niño , Preescolar , Femenino , Humanos , Incidencia , Lactante , Riesgo , Ucrania/epidemiologíaRESUMEN
BACKGROUND: Recent studies indicate that attention-deficit hyperactivity disorder (ADHD) persists into adulthood, but little is known about the neuropsychological features of adult ADHD. Our objective was to assess neuropsychological functioning in adults with ADHD with a battery of executive function tests. METHODS: Subjects were 64 unmedicated adults, 19-59 years of age, with DSM-III-R ADHD of childhood onset who met criteria for ADHD when referred in adulthood and 73 non-ADHD controls of similar age and gender. Information on neuropsychological performance was obtained in a standardized manner blind to clinical status. RESULTS: Compared with controls, adults with ADHD were significantly impaired on measures of vigilance, semantic encoding for verbal memory, and written arithmetic, irrespective of age, gender, psychiatric comorbidity, or presence of learning disability. Despite comparable educational level and IQ, ADHD adults had a trend to lower occupational attainment and had significantly more academic problems in school. CONCLUSIONS: These executive, attention, and achievement dysfunctions demonstrated in adults with ADHD provide additional support for the validity of the syndrome in adults.
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Trastorno por Déficit de Atención con Hiperactividad/fisiopatología , Atención/fisiología , Trastornos del Conocimiento/fisiopatología , Pruebas Neuropsicológicas , Adulto , Estudios de Casos y Controles , Distribución de Chi-Cuadrado , Femenino , Lóbulo Frontal/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Solución de Problemas/fisiología , Análisis de Regresión , Aprendizaje Verbal/fisiología , Volición/fisiología , Escalas de WechslerRESUMEN
OBJECTIVE: The authors assessed the experimental noradrenergic compound tomoxetine as an alternative treatment for adult attention deficit hyperactivity disorder (ADHD). METHOD: They conducted a double-blind, placebo-controlled, crossover study of tomoxetine in 22 adults with well-characterized ADHD. RESULTS: Treatment with tomoxetine at an average oral dose of 76 mg/day was well tolerated. Drug-specific improvement in ADHD symptom was highly significant overall and sufficiently robust to be detectable in a parallel-groups comparison restricted to the first 3 weeks of the protocol. Eleven of 21 patients showed improvement after receiving tomoxetine, compared with only two of 21 patients who improved after receiving placebo. Significant tomoxetine-associated improvement was noted on neuropsychological measures of inhibitory capacity from Stroop tests. CONCLUSIONS: This preliminary study showed that tomoxetine was effective in treating adult ADHD and was well tolerated. These promising results provide support for further studies of tomoxetine over an extended period of treatment.