Feasibility and tolerability of moderate intensity regular physical exercise as treatment for core symptoms of attention deficit hyperactivity disorder: a randomized pilot study.

Background: Attention deficit hyperactivity disorder (ADHD) is associated with sedentary lifestyle, low quality of life and low physical fitness. Studies in children with ADHD have shown that regular physical exercise can help reduce core ADHD symptoms, but evidence for this is lacking in adults. Although guidelines recommend multi-modal treatment, central stimulants (CS) remain the mainstay of treatment. CS are effective in the short-term, but their long-term efficacy remains to be established. There is thus huge unmet need for developing non-pharmacological treatment options, and for well-designed randomized controlled trials (RCTs). Objective: The study aimed to test the feasibility and tolerability of structured moderate-intensity 12-week physical exercise program for adults with ADHD, as a prelude to an adequately powered RCT which includes long-term follow-up. Materials and methods: Fourteen adults with ADHD were recruited, 9 randomized to an intervention group and 5 to a control group. The intervention group received physiotherapist-led 50-minute mixed exercise program, three times a week for 12 weeks, and the control group treatment as usual. Participants were assessed at baseline and after 6 and 12 weeks using clinical and physical evaluations, self-rating questionnaires, and functional magnetic resonance imaging (fMRI) together with paradigms that tested attention, impulsivity and emotion regulation. Results: Three participants (21%) dropped out shortly after inclusion before receiving any intervention, while roughly 80% completed the intervention according to protocol. One participant from the intervention group participated in less than 60% of treatment sessions, and one who had done baseline fMRI was unwilling to do post-intervention imaging. Four participants in the intervention group (67%) reported increased stress in prioritizing the intervention due to time-management difficulties. Overall, consistent trends were observed that indicated the feasibility and potential benefits of the intervention on core ADHD symptoms, quality of life, body awareness, sleep and cognitive functioning. Conclusion: Physiotherapist-led twelve-week regular physical exercise is a feasible and potentially beneficial intervention for adults with ADHD. There was a 20% drop-out initially and 67% of those who completed the intervention reported stress with time management difficulties due to participation. A third arm was thus added to the planned RCT where cognitive intervention administered by an occupational therapist will be given together with physical exercise.Clinical Trial Registration: https://clinicaltrials.gov, identifier NCT05049239.

Ibuprofen attenuates the inflammatory response and allows formation of migratory neuroblasts from grafted stem cells after traumatic brain injury.

PURPOSE: There is hope for neural stem and progenitor cells (NSPC) to enhance regeneration when transplanted to the injured brain after traumatic brain injury (TBI). So far, the therapeutic effects of NSPC transplantation have been hampered mainly by the notable death of the transplanted cells. Neuroinflammation may lead to additional cell death after TBI and we hypothesized that survival of grafted NSPC could be enhanced by anti-inflammatory treatment. METHODS: Mice that were subjected to controlled cortical impact TBI and grafted with NSPC, were treated with the non-steroidal anti-inflammatory drug ibuprofen. RESULTS: Ibuprofen was found to down-regulate the TBI-induced inflammatory response. In addition, migrating neuroblasts from transplanted cells were observed near the contusion and in the ipsilateral hippocampus in ibuprofen-treated animals only, suggesting that the anti-inflammatory treatment had beneficial effects on graft survival and/or differentiation. However, Morris Water Maze performance or TBI-induced tissue loss was not influenced by ibuprofen treatment. CONCLUSIONS: Our data suggests that anti-inflammatory strategies may be a complement to enhance the outcome for the cell transplants following TBI.

Effect of button location on driver's visual behaviour and safety perception.

Although buttons are a frequently used type of control in car interiors, little research has been undertaken on how the usage of buttons affects the visual behaviour of the driver. In this study, the aim was to analyse the effect of push button location and auditory feedback on drivers' visual time off road and safety perception when driving in a real traffic situation. The effect of six button locations (five on the centre stack, one near the gear stick) was tested. Drivers' visual behaviour was studied in real traffic on a motorway. An eye tracking system recorded the visual behaviour of eight drivers who, in 96 repeated trials each, were instructed to press a specific button. Data analysis focused on the drivers' visual time off road and safety perception in relation to the location of the button to be pressed. Auditory feedback did not show a significant effect on visual time off road. The time off road increased significantly as the angle increased between the normal line of sight and button location for the five buttons placed on the centre stack. Results for the button located close to the gear stick, with the highest eccentricity, produced a short time off road. This unexpected finding is discussed in terms of three potential explanations: 1) the role of perceptual discrimination; 2) risk perception; and 3) motor control.

Endostatin-induced tyrosine kinase signaling through the Shb adaptor protein regulates endothelial cell apoptosis.

Endostatin, which corresponds to the C-terminal fragment of collagen XVIII, is a potent inhibitor of angiogenesis. Fibroblast growth factor-2 (FGF-2)-induced angiogenesis in the chicken chorioallantoic membrane was inhibited by endostatin, but not by an endostatin mutant R158/270A, lacking heparin-binding ability. Endostatin was internalized by endothelial cells, but not by mouse fibroblasts. Treatment of murine brain endothelial (IBE) cells with endostatin reduced the proportion of cells in S phase, whereas growth-arrested IBE cells in collagen gels treated with endostatin displayed enhanced tubular morphogenesis. IBE cells overexpressing Shb, an adaptor protein implicated in angiostatin-induced apoptosis, displayed elevated apoptosis and decreased tubular morphogenesis in collagen gels in response to endostatin when added together with FGF-2. Induction of apoptosis was dependent on the heparin-binding ability of endostatin and the expression of Shb with a functional Src homology 2 (SH2)-domain. Endostatin treatment for 10 minutes or 24 hours induced tyrosine phosphorylation of Shb and formation of multiprotein complexes. An Shb SH2 domain fusion protein precipitated a 125-kd phosphotyrosyl protein in endostatin-treated cells. The 125-kd component either contained intrinsic tyrosine kinase activity or occurred in complex with a tyrosine kinase. In conclusion, our data show that endostatin induces tyrosine kinase activity and enhanced apoptosis in FGF-treated endothelial cells.

Casting the implant for reconstruction of pectus excavatum.

Fourteen patients with pectus excavatum underwent a total of 17 operations for the insertion of subcutaneous implants aimed at camouflaging their defects. A silicone prosthesis in one patient early in the series caused severe capsular formation. Although a block of Proplast may occasionally be used with success, the rational solution to the problem is to produce a custom made Silastic implant that adheres optimally to the defect in each individual case. This retrospective study shows that a subcutaneous implant clearly improves the appearance of the chest wall in most of the patients.

Replacement of carpal bones with exact-fitting silicone rubber implants. An experimental study.

In a pilot study in dogs, carpal bones were removed and replaced with silicone rubber implants fashioned to fit exactly into the space left by the excision. The implants were fabricated from Dow Corning MDX-4-4210 and Silastic 399 Medical Grade Elastomers. Bone cement was used for the cast and the mould was made of alginate or plaster of Paris. It was intended to replace the bone in a one-stage procedure. MDX-4-4210 was found unsuitable because adequate cure could only be achieved in about 5 hours, even when accelerated with external heating. Silastic 399 cured rapidly and was ideal for the experiment. Implants of exact fitting were fabricated, sterilized and inserted within 1--2 hours. 6 dogs were used and the follow-up period ranged from 1 to 7 months. The results were good in 5 and unsatisfactory in 1 dog because of postoperative infection. The method presented permits exact reproduction of the excised part, which guarantees an accurate fitting and consequently reduced risk of implant rotation and migration.