Attention-deficit/hyperactivity disorder and physical multimorbidity: A population-based study.

BACKGROUND: There has been little research on the association of attention-deficit/hyperactivity disorder (ADHD) with co-occurring physical diseases. The aim of this study was to examine the association between possible ADHD and physical multimorbidity (i.e.≥2 physical diseases) among adults in the English general population. METHODS: Data were analyzed from 7274 individuals aged≥18 years that came from the Adult Psychiatric Morbidity Survey 2007. ADHD symptoms were assessed with the Adult Self-Report Scale (ASRS) Screener. Information was also obtained on 20 self-reported doctor/other health professional diagnosed physical health conditions present in the past 12 months. Multivariable logistic regression and mediation analyses were conducted to assess the associations. RESULTS: There was a monotonic relation between the number of physical diseases and possible ADHD (ASRS score≥14). Compared to those with no diseases, individuals with≥5 diseases had over 3 times higher odds for possible ADHD (odds ratio [OR]: 3.30, 95% confidence interval [CI]: 2.48-4.37). This association was observed in all age groups. Stressful life events (% mediated 10.3-24.3%), disordered eating (6.8%), depression (12.8%), and anxiety (24.8%) were significant mediators in the association between possible ADHD and physical multimorbidity. CONCLUSION: Adults that screen positive for ADHD are at an increased risk for multimorbidity and several factors are important in this association. As many adults with ADHD remain undiagnosed, the results of this study highlight the importance of detecting adult ADHD as it may confer an increased risk for poorer health outcomes, including physical multimorbidity.

Examining cross-cultural differences in autism spectrum disorder: A multinational comparison from Greece, Italy, Japan, Poland, and the United States.

Autism spectrum disorder (ASD) is characterized by social and communication impairments as well as restricted, repetitive behavior patterns. Despite the fact that ASD is reported worldwide, very little research exists examining ASD characteristics on a multinational scale. Cross-cultural comparisons are especially important for ASD, since cultural differences may impact the perception of symptoms. Identifying behaviors that are similarly reported as problematic across cultures as well as identifying behaviors in which there is cultural variation could aid in the development and refinement of more universally effective measures. The present study sought to examine similarities and differences in caregiver endorsement of symptom severity through scores on the Baby Infant Screen for Children with aUtIsm Traits (BISCUIT). The BISCUIT was utilized to examine ASD core symptomology in 250 toddlers diagnosed with ASD from Greece, Italy, Japan, Poland, and the United States. Significant differences in overall ASD symptom severity and endorsement were found between multinational groups. Implications of the results are discussed.

Correction-less dosimetry of nonstandard photon fields: a new criterion to determine the usability of radiation detectors.

In the IAEA-AAPM dosimetry formalism, detector measurements in general nonstandard conditions are corrected using the factor k(f(clin),f(msr))(Q(clin),Q(msr)). This factor needs to be evaluated on a case-by-case basis which is difficult to accomplish in practice. The present paper aims to provide a method that allows neglecting correction factors for small and composite IMRT fields by first determining a radiation detector's usability in these fields. Detailed models of nine radiation detectors are built: four ionization chambers (NE2571, A12, A1SL, A14), three small field detectors (PTW31018 microLion, PTW60003 natural diamond, PTW60012 unshielded diode) and two near water-equivalent detectors (alanine, W1 scintillating fiber). Using the egs_chamber Monte Carlo code, dose response functions at 6 MV and 25 MV are sampled for each detector and their corresponding volume of water. These functions are then used with a newly derived criterion to evaluate an upper bound ξ(f(ns),f(msr))(Q(ns),Q(msr)) on the variable ε(f(ns),f(msr))(Q(ns),Q(msr)) if no field collimation/modulation occurs over a given perturbation zone. The variable ε(f(ns),f(msr))(Q(ns),Q(msr)) is defined as the absolute value of the relative deviation from unity of a nonstandard field quality correction factor k(f(ns),f(msr))(Q(ns),Q(msr)). Using the same criterion, perturbation zones are evaluated by finding the smallest field size allowed for correction-less dosimetry with a given tolerance ξ(f(ns),f(msr))(Q(ns),Q(msr)). For composite fields, the sensitivity of detectors to the non-uniformity of virtual symmetric collapsed beams over regions of interest specified by the criterion is studied to estimate an upper bound ξ ̃(f(ns),f(ref))(Q(ns),Q) on ε(f(ns),f(ref))(Q(ns),Q) for a given beam flatness. Finally, a newly defined perturbation function is used to minimize the perturbations of the microLion chamber through density compensation. The theoretical criterion shows good agreement with full Monte Carlo simulations of ε(f(ns),f(msr))(Q(ns) Q(msr)). Perturbation zones are shown to be sensitive to both the energy of the beam and the orientation of the detector. The density-compensated microLion shows significantly improved response in both axial and radial orientations in small and composite IMRT fields. Finally, the new Exradin W1 scintillator is shown to have ξ(f(ns),f(msr))(Q(ns),Q(msr)) values under 1% in small fields. The methods presented in this work theoretically show that correction-less dosimetry of nonstandard field can be accomplished by knowing the limit of usability of radiation detectors in these conditions. Potential applications include small field output factor measurements and absolute absorbed dose to water verification in the QA of clinical IMRT fields.

Quantitative autistic traits ascertained in a national survey of 22 529 Japanese schoolchildren.

OBJECTIVE: Recent epidemiologic studies worldwide have documented a rise in prevalence rates for autism spectrum disorders (ASD). Broadening of diagnostic criteria for ASD may be a major contributor to the rise in prevalence, particularly if superimposed on an underlying continuous distribution of autistic traits. This study sought to determine the nature of the population distribution of autistic traits using a quantitative trait measure in a large national population sample of children. METHOD: The Japanese version of the Social Responsiveness Scale (SRS) was completed by parents on a nationally representative sample of 22 529 children, age 6-15. RESULTS: Social Responsiveness Scale scores exhibited a skewed normal distribution in the Japanese population with a single-factor structure and no significant relation to IQ within the normal intellectual range. There was no evidence of a natural 'cutoff' that would differentiate populations of categorically affected children from unaffected children. CONCLUSION: This study provides evidence of the continuous nature of autistic symptoms measured by the SRS, a validated quantitative trait measure. The findings reveal how paradigms for diagnosis that rest on arbitrarily imposed categorical cutoffs can result in substantial variation in prevalence estimation, especially when measurements used for case assignment are not standardized for a given population.

Modulation in concentrative nucleoside transporters-mediated intestinal absorption of mizoribine, an immunosuppressive agent, in lipopolysaccharide-treated rats.

The characteristics of intestinal absorption of mizoribine and cephalexin, that are mediated by concentrative nucleoside transporters (CNTs) and PEPT1, respectively, was examined in lipopolysaccharide (LPS)-treated rats. LPS treatment is known to modify the expression of some transporters and induce cholestasis. At 24 h after the LPS treatment, averaged concentrations of IL-6 and total bile acids in plasma were 15-fold and 2-fold that in untreated control rats, respectively, and bile flow rate decreased by 40% of control, indicating the induction of inflammatory and cholestatic states. The oral bioavailability, estimated by urinary excretion percentage of unchanged form, of mizoribine in LPS-treated rats was 1.5-fold higher than that in control rats, whereas the bioavailability of cephalexin remained unchanged. When mizoribine and cephalexin were administered into in-situ jejunum loops, there were no differences in the absorption rates between control and LPS-treated rats. These results indicated that the functional expression of CNT1, CNT2, and PEPT1 were not modulated by LPS treatment. When mizoribine (a CNT1/CNT2 substrate) and gemcitabin (a CNT1 substrate) were administered as a solution dissolved in bile into the intestinal loop, their absorption rates decreased significantly. In contrast, the absorption rate of ribavirin (a CNT2 substrate) remained unchanged. In conclusion, LPS treatment exerted no significant effect on the expression of CNT1 and CNT2 in the intestine. Bile was found to suppress the CNT1-mediated intestinal absorption of mizoribine and gemcitabin. The increased oral bioavailability of mizoribine in LPS-treated rats could be ascribed to the less amount of bile or bile acids in the intestine under cholestatic state of rats.

Increased intestinal absorption of mizoribine, an immunosuppressive agent, in cholestatic rats.

The intestinal absorption of mizoribine, an imidazole nucleoside, is mediated by concentrative nucleoside transporter (CNT)1 and CNT2 in rat. Previously, bile and bile salts such as sodium glycocholate were found to suppress the intestinal absorption of mizoribine. In the present study, the contribution of bile on the intestinal absorption of mizoribine was further evaluated in rats. Cholestatic states were induced by an intraperitoneal injection (2 ml/kg) of 50% carbon tetrachloride (CCl4) dissolved in olive oil, or oral administration (100 mg/2 ml/kg) of alpha-naphthylisothiocyanate (ANIT) dissolved in olive oil. The animals were subjected to absorption studies 24 h after treatment. Cholestatic states were confirmed by measuring plasma concentrations of bile acids and bile flow rates. When oral bioavailability of mizoribine was estimated by the recovery amount in the urine, rats under cholestatic states exhibited significantly higher oral bioavailabilities than untreated control rats. In contrast, the intestinal absorption percentages of mizoribine from in-situ lavaged intestinal loops were the same magnitudes among untreated control, CCl4- and ANIT-treated rats. These results indicated that the increased oral bioavailability of mizoribine in cholestatic rats was not ascribed to the modulation of nucleoside transporter's expression. In conclusion, various diseased states accompanied with cholestasis may increase the oral bioavailability of mizoribine, possibly due to its less amounts of bile in the intestinal lumen.

A surgical case of pulmonary adenocarcinoma complicated with pulmonary infarction presenting as an intrapulmonary metastasis.

Pulmonary adenocarcinoma complicated with a pulmonary infarction presenting as an intrapulmonary metastasis is relatively rare. We present a case of pulmonary infarction manifesting as intrapulmonary metastases of lung cancer. A previously healthy 59-year-old woman was admitted to our hospital on May 16, 2002 for evaluation of multiple abnormal radiographic shadows in the right lower lung field. Laboratory tests showed no abnormalities except for a slight elevation of carcinoembryonic antigens. Computed tomography of the chest revealed a hilar mass lesion with parenchymal lesions in the periphery of the right lower lobe, highly suspected to be a pulmonary adenocarcinoma with intrapulmonary metastases. A diagnosis of pulmonary adenocarcinoma was confirmed by a transbronchial brushing examination. A right middle and lower bilobectomy with mediastinal lymph node dissection was needed by hilum lymphadenopathy and a lower lobe invasion of the main tumor. Histopathological findings of the resected specimens revealed poorly differentiated adenocarcinoma of the lung with N1 (#11i) disease and multiple pulmonary infarctions with coagulation necrosis and recanalization. Pulmonary infarctions are demonstrated on chest x-rays as round or polygonal in shape, and located at the periphery of the same lobe as the primary tumor. Computed tomography is more sensitive than conventional radiography in the detection of pulmonary infarction. Our case suggests that pulmonary infarction associated with lung cancer should be considered as one important cause of peripheral pulmonary nodules.

Field trial of time-spreading and wavelength-hopping OCDM transmission using FBG en/decoders.

In this paper, field trial on optical code division multiplexing through the commercial-used fiber line is presented. We fabricated fiber Bragg grating en/decoders with time-spreading and wavelength-hopping scheme, considering environmental fluctuation of transmission fiber. 200 km-long transmission of 2-channel x 10 Gb/s signals was achieved on the field photonic network test bed of JGN II. Error free transmission was demonstrated in real field deployed single-mode transmission fiber.

[Completion pneumonectomy 9 years after middle lobectomy for adenocarcinoma].

Completion pneumonectomy (CP) is a difficult operation in which the surgeon must use techniques such as intrapericardial ligation of the pulmonary vessels. We report herein a case of CP for a patient with recurrent lung cancer. A 63-year-old man was admitted to our hospital for evaluation of abnormal shadows in the right lung field in October 2002. Right middle lobectomy with mediastinal lymph node dissection had been performed in February 1993. Computed tomography (CT) revealed a hilar mass in the right upper lobe the day after admission. Bronchofiberscopic cytology revealed squamous cell carcinoma. Right completion pneumonectomy was performed on suspicion of metachronous multiple lung cancers 4 days later. Histopathologically, resected specimens represented adenosquamous carcinoma similar to the prior lesion from the middle lobe, and examination revealed that the tumor represented a recurrence following middle lobectomy. The patient remains well as of 19 months postoperatively.

[Aneurysmal bone cyst arising in the rib; report of a case].

We experienced with a relatively rare case of an aneurysmal bone cyst (ABC) arising in the left rib. A 34-year-old female, had experienced chest discomfort on the left anterior side and pain for 1 year. A chest X-ray suggested a left chest wall tumor involving the ribs. Computed tomography (CT), magnetic resonance imaging (MRI) and a bone scintigram revealed an expansive tumor of the anterior portion of the left 4th rib involving the 3rd and 5th rib with "blow out appearance" and "fluid-fluid level". Wide excision of the tumor and adjacent muscle tissue was performed with an antero-axillary incision. Chest wall reconstruction was performed with prolene mesh (140 x 90 mm). The resected specimen showed an encapsulated bony mass (75 x 60 x 35 mm) with multiple blood-filled spaces. Histopathological diagnosis was an ABC originating in the left 4th rib. She has been doing well with no evidence of recurrence 12 months postoperatively.

[Esophageal gastrointestinal stromal tumor surrounding the middle esophagus with dysphagia for 8 years; report of a case].

In September 2002, a 24-year-old woman complaining dysphagia with an abnormal shadow in a chest X-ray was admitted to our hospital. Endoscopic ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) showed a hypo-echoic, low-density mass surrounding the middle esophagus. Bronchofiberscopy and gastrofiberscopy showed compression from the outside of bronchus and esophagus. No ulcer formation was found. Transbronchial aspiration biopsy and esophageal biopsy showed no malignancy. After 14 cm thoractomy, extirpation of the tumor was performed. The solid tumor was 10.5 x 3.0 x 2.5 cm in dimension, and the cut surface of the tumor was light yellow. Immunohistochemically, the tumor cells were positive for c-kit, SMA, CD34, and S-100. Histopathologically, the tumor was diagnosed as gastrointestinal stromal tumor (GIST), combined smooth muscle-neural type. A postoperative upper gastrointestinal tract barium study showed no stenosis. She is doing well without evidence of tumor recurrence at 12 months postoperatively. Although GIST is the most common mensenchymal tumor of the human gastrointestinal tract, this case is reported because the GIST arising from the middle esophagus is very rare.

DNA inversion in the tail fiber gene alters the host range specificity of carotovoricin Er, a phage-tail-like bacteriocin of phytopathogenic Erwinia carotovora subsp. carotovora Er.

Carotovoricin Er is a phage-tail-like bacteriocin produced by Erwinia carotovora subsp. carotovora strain Er, a causative agent for soft rot disease in plants. Here we studied binding and killing spectra of carotovoricin Er preparations for various strains of the bacterium (strains 645Ar, EC-2, N786, and P7) and found that the preparations contain two types of carotovoricin Er with different host specificities; carotovoricin Era possessing a tail fiber protein of 68 kDa killed strains 645Ar and EC-2, while carotovoricin Erb with a tail fiber protein of 76 kDa killed strains N786 and P7. The tail fiber proteins of 68 and 76 kDa had identical N-terminal amino acid sequences for at least 11 residues. A search of the carotovoricin Er region in the chromosome of strain Er indicated the occurrence of a DNA inversion system for the tail fiber protein consisting of (i) two 26-bp inverted repeats inside and downstream of the tail fiber gene that flank a 790-bp fragment and (ii) a putative DNA invertase gene with a 90-bp recombinational enhancer sequence. In fact, when a 1,400-bp region containing the 790-bp fragment was amplified by a PCR using the chromosomal DNA of strain Er as the template, both the forward and the reverse nucleotide sequences of the 790-bp fragment were detected. DNA inversion of the 790-bp fragment also occurred in Escherichia coli DH5alpha when two compatible plasmids carrying either the 790-bp fragment or the invertase gene were cotransformed into the bacterium. Furthermore, hybrid carotovoricin CGE possessing the tail fiber protein of 68 or 76 kDa exhibited a host range specificity corresponding to that of carotovoricin Era or Erb, respectively. Thus, a DNA inversion altered the C-terminal part of the tail fiber protein of carotovoricin Er, altering the host range specificity of the bacteriocin.

Effect of a cysteinyl leukotriene antagonist, pranlukast hydrate, on acetaldehyde-induced bronchoconstriction in asthmatic patients.

Acetaldehyde is a main factor of alcohol-induced asthma. We previously reported that the cysteinyl leukotriene (cys-LT) receptor antagonist, pranlukast hydrate, inhibits acetaldehyde-induced airway hyperresponsiveness in guinea pigs. The purpose of this study was to evaluate the involvement of cys-LT on bronchial responsiveness to acetaldehyde in asthmatic patients. We investigated the bronchial response to inhalation of acetaldehyde in 10 asthmatic patients, who were treated with placebo or pranlukast hydrate (225.5 mg), a cys-LT receptor antagonist, twice a day for 1 wk using a double-blind, randomized, placebo-controlled, cross-over design. Although a remarkable improvement of acetaldehyde bronchoconstriction was observed in 3 out of 10 subjects, PC(20)-AcCHO values were identical between placebo [12.0 (GSEM, 1.192) mg/ml] and pranlukast [14.7 (GSEM, 1.245) mg/ml] groups. The changes in bronchial responsiveness to acetaldehyde were similar in the six patients who had never experienced alcohol-induced asthma and the four who had. In conclusion, cys-LTs are not involved in acetaldehyde-induced bronchoconstriction.

Successfully treated composite graft infection after Bentall's procedure.

A 47-year-old male patient underwent Bentall's modification with total arch replacement owing to type A acute dissection. Mediastinitis and composite graft infection occurred 3 weeks after the operation. Extensive debridement and irrigation followed by omental wrapping without graft removal were performed and the patient was successfully cured.

[Endoscopic transthoracic sympathectomy (ETS) with a fine 2-mm thoracoscope in palmar hyperhidrosis].

Endoscopic transthoracic sympathectomy (ETS) is an efficient, safe, minimally invasive procedure, and requires only a short period of hospitalization. We performed bilateral ETS using a thoracoscope 2 mm in diameter. We performed 120 ETS for the treatment of palmar hyperhidrosis from August 1997 to April 2000. The patient was placed in the semi-sitting position under general anesthesia, one-lung ventilation being used; the operation was performed with 2-mm two-puncture method. The sympathetic chain could be observed through parietal pleura riding on the costovertebral junctions. A 2-mm Kirschner wire was employed as an electrode, and the second and third thoracic sympathetic chains were electro cauterized. A thoracic drain was not used. The needling sites were only 2 mm in size and could be fixed without suture. For the patient, a small scar of this size means virtually no scar. The operative times were from 11 min to 81 min in bilateral ETS. Immediately and dramatic decrease in the sweat excretion in the palms was noted in all patients. The 95% patients were highly satisfied with the results. The commonest side effects were compensatory sweating. This procedure is recommended as the method of choice for the surgical treatments of palmar hyperhidrosis.

Phage conversion of Panton-Valentine leukocidin in Staphylococcus aureus: molecular analysis of a PVL-converting phage, phiSLT.

Staphylococcal Panton-Valentine leukocidin (PVL) is an important virulence factor, which causes leukocytolysis and tissue necrosis. Our previous report on the existence of the PVL genes (lukS-PV and lukF-PV) on the genome of prophage phiPVL in the Staphylococcus aureus strain V8 suggested the horizontal transmission of PVL genes by temperate bacteriophage among S. aureus (Kaneko, et al., 1998. Gene 215, 57-67). Here, we demonstrated the phage conversion of S. aureus leading to the production of PVL by discovery of a novel PVL-carrying phage, phiSLT (Staphylococcal Leukocytolytic Toxin) from a clinical isolate of S. aureus. phiSLT was able to lysogenize several clinical isolates of PVL-negative S. aureus strains as well as strain RN4220 at the conserved 29-bp sequence (attB) and all the lysogenized S. aureus strains had the ability to produce PVL. phiSLT had an elongated head of about 100x50 nm and a flexible tail of 400 nm long, that was quite different from phiPVL which had an isometric hexagonal head of about 60 nm diameter. The linear double-stranded phiSLT genome comprised 42,942 bp with 29-bp attachment core sequences and contained 62 open reading frames. Only 6.4 kbp region containing lysis cassette, PVL genes, attP, integrase, and orf204 of phiSLT was identical to that of phiPVL, while other regions were different from those of phiPVL. Thus, it can be concluded that PVL genes are carried by different temperate phages, which have the same attachment site.