[ADHD and addiction: a complicated liaison]. / ADHD en verslaving: een ingewikkelde liaison.

BACKGROUND: The presence of ADHD has been linked to a 100% increase in a person's chance of developing a substance use disorder. The prevalence of childhood and adult ADHD in substance-abusing populations has been estimated to be three times higher than in the general population. In addiction centres ADHD is often unrecognized and untreated. AIM: To describe the obstacles to the diagnosis and treatment of ADHD in addicts. METHOD: Using a historical approach, we analysed the evolution of the diagnostic descriptions of the two disorders, giving attention to the influence of social change and scientific research. RESULTS: The two disorders have developed in remarkably similar ways; people have been and still are much inclined to make moral judgments about these disorders than about other psychic disorders. Neurobiological research has added a extra dimension to the debate on topics such as impulsivity, personal responsibility and free will. CONCLUSION: It is only recently that ADHD has been recognised as having a place in addiction treatment and, as a result, there is a growing need for explanatory models.

The economic burden of juvenile idiopathic arthritis-results from the German paediatric rheumatologic database.

OBJECTIVE: To estimate the cost of juvenile idiopathic arthritis (JIA) and to evaluate the influence of specific disease characteristics on the various costs domains. METHODS: Data on JIA outpatients (n=369) who were enrolled in the national paediatric rheumatologic database and completed a cost questionnaire were analysed. Direct JIA-related costs, families' out-of-pocket expenses and parents' income loss were calculated per patient and year, using physicians' reports, parents' 3-month recall, and average prices as the basis. RESULTS: The mean total cost of JIA was estimated to be 4,663 euro per patient per year. The highest costs were calculated for patients with seropositive polyarthritis and systemic arthritis (7,876 euro), and the lowest costs were seen for patients with persistent oligoarthritis (2,904 euro). Health-care costs accounted for 89% of total costs, and medication contributed to almost half of this value. A considerable amount of the cost was borne by the families, with a mean out-of-pocket cost of 223euro and a mean indirect cost due to time loss from work of 270 euros per year per family. Cost increased with disease activity and pain, disease duration, and time period from symptom onset to first paediatric rheumatologist visit; it also increased with the presence of uveitis. However, function, as measured by the Childhood Health Assessment Questionnaire, was the only factor significantly contributing to the variation in patient total costs. CONCLUSION: JIA imposes a significant economic burden. Medication (i.e. biologic drugs) contributes substantially to the total costs. However, these must be considered in the light of the patients' long-term outcomes.

Organization of butadienyl dyes containing benzodithiacrown-ether or dimethoxybenzene in monolayers at the air/aqueous salt solution interface.

Two amphiphilic butadienyl dyes 1 and 2 form stable monolayers at the air/water interface in the presence of various salts. Dye 1 consists of the basic amphiphilic butadienyl chromophore. In dye 2, the dimethoxybenzene part of dye 1 is substituted by benzodithia-15-crown-5. The monolayers have been characterized by surface pressure-area and surface potential-area isotherms as well as Brewster angle microscopy and reflection spectroscopy. In contrast to dye 1, dye 2 interacts specifically with Hg(2+) and Ag(+) cations forming complexes. No complex formation was observed with alkali and earth alkali metal ions. The nature of the anion (Cl(-) or ClO(4)(-)) influences the monolayer behaviour of both dyes. At the air/water interface, besides monomers of the dyes, two types of associates are coexisting in the pure dye monolayers on aqueous salt solutions, attributed to dimers and aggregates, respectively. Their equilibria depend on the nature of both cations and anions in the subphase, as in the case of dye 2, or only anions, as in the case of dye 1. The dimers may be organized as head-to-tail dimers with the intermolecular distances 0.38 and 0.45nm for dye 1 and dye 2, respectively. According to the extended dipole model, we propose formation of aggregates in which the chromophores are parallel to each other with the same intermolecular distances as in the dimers, and the centers of their transition moments shifted by 0.95nm (dye 1) and 1.2nm (dye 2).

Influence of the environment on photoinduced electron transfer: comparison between organized monolayers at the air-water interface and monolayer assemblies on glass.

Photoinduced electron transfer (PET) has been investigated in organized monolayers at the air-water interface and in monolayer assemblies on glass in an effort to evaluate the influence of solvent reorganization and molecular dynamics on PET. The donor monolayer contained an amphiphilic thiacyanine dye, and the electron acceptors were methyl viologen and dioctadecyl viologen, respectively. The distance dependence is described here by a hard disk model, where an acceptor molecule within a disk with a radius rDA around the excited donor molecule quenches the donor fluorescence due to electron transfer. Acceptor molecules outside the disk are considered ineffective. The critical radius rDA is larger in monolayer assemblies on glass (rDA = 1.97 nm) than at the air-water interface (rDA = 1.15 nm) as evaluated from steady-state fluorescence quenching. This large difference indicates that the time between thermal collisions generating and destroying the energetic match required for electron tunneling from the excited donor molecule to the acceptor is quite different in the two systems that are compared.

Monolayers of a novel ionoselective butadienyl dye.

The novel amphiphilic benzodithia-18-crown-6 butadienyl dye (1) forms relatively stable insoluble monolayers on distilled water (collapse pressure of 41 mN/m) and on aqueous subphases containing alkali metal or heavy metal salts (collapse pressures in the range of 27-38 mN/m, respectively). The dye 1 monolayer organization depends on chromophore association and interactions (especially complex formation) with heavy and alkali metal ions as deduced from surface pressure-area and surface potential-area isotherms as well as reflection spectra and Brewster angle microscopy observations. Dye 1 undergoes specific interactions with Hg(2+) and Ag(+), respectively (formation of different complexes). Nonspecific interactions have been observed with other salts, such as KClO(4) or Pb(ClO(4))(2). Further, dye 1 monolayers on 1 mM Hg(ClO(4))(2) solution undergo reversible photoisomerization, in contrast to monolayers on water and other aqueous salt subphases.

Periodic fever (TRAPS) caused by mutations in the TNFalpha receptor 1 (TNFRSF1A) gene of three German patients.

TNF-receptor-associated periodic syndrome (TRAPS) is a recently recognized disorder characterized by prolonged attacks of high fever and severe localized inflammation. TRAPS is caused by dominant mutations in the 55 kDa TNF receptor gene (TNFRSF1A). We here describe three German TRAPS patients of two families with Cys30-->Arg and Thr50-->Met mutations, respectively. Both mutations have already been observed before in other nonrelated families. The Thr50-->Met amino acid exchange, caused by an ACG-->ATG transition, has been reported in two other families of different ethnic background. The possibility that the ACG-->ATG sequence alteration is a mutational hot spot causing TRAPS is discussed. Furthermore, we describe and discuss the symptoms of our patients, possible inducers of febrile attacks, and treatments which the patients had received when their diagnoses were still unknown.

Occurrence of acute nonlymphoblastic leukemia in two girls after treatment of recurrent, disseminated Langerhans cell histiocytosis.

The occurrence of Langerhans cell histiocytosis (LCH) and acute leukemia in one individual has rarely been observed. Despite few exceptions, two distinct patterns of association appear evident: acute lymphoblastic leukemia preceding LCH and LCH preceding acute nonlymphoblastic leukemia (ANLL). The latency of ANLL after the diagnosis of LCH is suggestive of a therapy-related process. This report describes two new cases in whom ANLL was diagnosed 7 years 8 months and 5 years 8 months after the start of initial treatment of disseminated recurrent LCH. Morphology showed blasts from FAB-type M4/M5 in the first patient, who died due to progression of leukemia. The second patient showed myelodysplastic syndrome (refractory anemia with excess of blasts in transformation; RAEB-t) and is now in remission from leukemia 3 years 11 months after allogeneic bone marrow transplantation. The review of a total of 26 patients with ANLL after LCH suggests that the disease has a poor prognosis and allogeneic BMT seems to be the treatment of choice.

Physicochemical Characterization of Natural and ex-Situ Reconstructed Sea-Surface Microlayers.

Chemical composition and physico-chemical characteristics of natural and ex-situ reconstructed sea surface microlayer samples were studied using a complex methodological approach. Surface microlayer samples and the underlying seawater were collected in different seasons and different weather conditions in the northern most part of the Adriatic sea. The techniques used were thin layer chromatography with flame ionization detection for lipid classes analysis, electrochemical characterization of adsorbable organic substances using the ONP probe, and monolayer techniques for surface pressure (pi) and surface potential (DeltaV) measurements, as well as Brewster angle microscopy. Our results indicated higher enrichment of organic matter for the microlayer sample collected in the warm period of the year (summer). This was reflected in the high surface activity of the present organic substances, and formation of a more condensed layer than for the other two samples collected in the spring. Of the two spring samples, the one sampled on a sunny day was reacher in surface active organic material. We concluded that the most important source of surface active substances is the in-situ production of organic susbtances by the present plankton and bacteria, promoted by sunlight, while antrophogenic input comprises a smaller part of the present organic matter, around 10% for all samples. Copyright 1998 Academic Press.

[Morphology of the Meibomian lipid film. Results of Brewster angle microscopy]. / Morphologie des Meibom-Lipidfilms. Ergebnisse der Brewster-Winkel-Mikroskopie.

Meibomian lipid layers were studied in the anterior mirror area by reflecting microscopy and interference microscopy. Using these techniques, it was not possible to correlate the biophysical and morphological data. Brewster angle microscopy provides direct observation of the spread Meibomian lipid layer with simultaneous registration of the surface pressure. It is based on the fact that He-Ne laser light, which is incident at a water surface under the Brewster angle, does not reflect visible light. After spreading of a lipid film, the angle of the incident light beam varies, causing reflection of light. The Meibomian lipid layer was studied in a Langmuir-type trough. At 5.0 mN/m the lipid layers are homogeneous and mobile, consisting of areas of higher and lower reflectivity. In patients with meibomitis the films are inhomogeneous and immobile. The thickness of the areas of lower reflectivity is 2 nm, the high reflectivity lipids are 8-10 nm thick. According to these results, Meibomian gland secretion can form monolayers under in vitro conditions.

Biophysical behaviour of the infant Meibomian lipid layer.

Infants have been known occasionally to stare without blinking for almost a minute. This puts great demands on the stability of their tear-film. To verify the stability of infant tears, we performed biophysical experiments on Meibomian gland secretion, which forms the outermost layer of the tear-film. The secretion was taken from infants belonging to one of three age-groups (1.5 years, 4-5 years, 7-10 years). Under in vitro conditions we determined the surface pressure and the surface potential of the film by spreading the secretion over a water surface and subsequently compressing and decompressing it. Sufficient amounts of Meibomian gland secretion were expressed in all age-groups. The surface pressure and the surface potential of the tears in infants corresponded to those in healthy adults. It was also found that the younger the patient was, the better was the consistency of the surface potential under repeated periods of compression and expansion. In comparison with the secretion of healthy adults, the infant Meibomian gland secretion showed better biophysical characteristics and a correspondingly higher stability in the tear-film.

Therapeutical and immunological effects of methylprednisolone pulse therapy in comparison with intravenous immunoglobulin. Treatment in patients with juvenile chronic arthritis.

Twenty patients with polyarticular or systemic subtypes of juvenile chronic arthritis were primary treated with either Methylprednisolone (MP) pulses (group I) or i.v. Immunoglobulin (IG) (group II) in combination with Methotrexat and low dosages of Glucocorticosteroids. Clinical effects of treatment were rapid and excellent in both groups and also the regression of inflammatory activity. MP-pulses and also IG-treatment decrease significant the respective part of lymphocytes and T-cells. Significant is also the decrease of CD4 and CD8 cells and the normalization of the CD4/CD8 ratio in both groups. Different are the effects on B-cells and NK-cells between the two groups. Whereas MP-pulses decrease the number of B-cells. IG-treatment leads to high increase. The number of NK-cells increases after each single MP-pulse and decreases significant after IG-infusions.

Monolayer characteristics of valinomycin in the presence of various salts in aqueous subphase.

The surface pressure-molecular area, surface potential-molecular area and Brewster reflectivity-molecular area isotherms for valinomycin monolayers (states II and III) at various aqueous salt subphases were measured. Two additional states of valinomycin monolayers were observed in the presence of K+ and Rb+ as compared to the other alkali metal cations. This phenomenon correlates with the strong complexation between the valinomycin and these cations in bulk. State II corresponds to the very special 'bangle' conformation of the polypeptide ring of valinomycin, in which all carbonyl and carboxyl groups of the amino-acid residues are coordinated to the cation inside the polypeptide ring. State III corresponds to the vertical orientation of the 'bangle' conformation of valinomycin molecules with respect to the interface. An influence of the anion size on the stability of valinomycin-cation complexes at the interface was found.

Brewster angle microscopy. A new method of visualizing the spreading of Meibomian lipids.

The spreading behaviour of the Meibomian lipids is important for the integrity of the whole tear film. This paper presents the application of Brewster Angle Microscopy (BAM) for the observation of the spreading process in vitro. Meibomian gland secretions were studied in a Langmuir trough. The secretion was characterized by an extremely rapid continuous spreading, suggesting that enough material would be available to recover the superficial lipid layer of the tears between the blinks of the eye. This new technique provides important information on how the normal tear film works and how tear substitutes might act.

Biophysical characteristics of the Meibomian lipid layer under in vitro conditions.

The biophysical behaviour of the Meibomian gland secretion was tested under in vitro conditions. Thereby, simultaneous recording of surface pressure and surface potential was performed. The Meibomian lipid layer was compared with other surface-active components like polyvinylalcohol and polyvinylpyrrolidone. On the other hand, Eledoisin was tested as an example for a surface-inactive substance. An attempt was made to describe the biophysical interaction between a given artificial tear substitute and the Meibomian lipid layer. With respect to the surface potential Dipalmitoyl-phosphatidyl-choline was established as an analogue for Meibomian gland secretion. Fluorescence measurements in the presence of a cyanine dye (1 N,N'dioctadecyloxacarbocyanine) were used as a method to localize the site of the characteristic potential change. From the fluorescence spectra under compression we conclude that the molecular change takes place at the lipid-subphase interface of the Meibomian lipid layer.

Oxygen transport through a model lung surfactant surface layer: influence of the film compression on the kinetics.

The influence of the compression state of a model Lung Surfactant Surface Layer LSSL on the oxygen permeation kinetics was studied in vitro at 37 degrees C. In an attempt to mimic in vivo conditions, the oxygen from the air was allowed to cross a dipalmitoylphosphatidylcholine DPPC layer situated at an air/deaerated saline interface in an electrochemical vessel. The time dependent concentration change of the oxygen diffusing through this layer into the deaerated saline hypophase was measured electrochemically using a Hanging Mercury Drop Electrode HMDE, situated at a definite depth in the bulk of the saline. The surface pressure in the monolayer was monitored using a Wilhelmy balance. The oxygen permeability was measured through two differently compressed DPPC layers in which the area/phospholipid molecule differed by 30%. This is consistent with the difference in the alveolar area at the end-points of the compressed and expanded lung. The results, submitted to a linear regression analysis, showed that the DPPC film compression influences the oxygen permeation kinetics. The denser the lipid film, the slower the oxygen uptake by the deaerated hypophase. The results suggest that the LSSL might play an important role in the oxygen transport kinetics, the oxygen permeation through it being dependent on the actual lung area.

Evidence for the presence of a specific ganglioside GM1/valinomycin complex in mixed monolayers.

The effect of a negatively charged mono-sialoglyco-sphingolipid (GM1-ganglioside) on the molecular organization and on physiochemical properties of lipid/peptide (valinomycin) systems was investigated in monolayers at the air/water interface. At a high molar fraction of GM1, the surface pressure/area isotherms of the two-component films of the system GM1/valinomycin and the isotherm of the pure ganglioside monolayer are identical concerning the space requirement of the molecules and thereby the packing of the monolayer. Using space-filling molecular models, a simple calculation gives the theoretical amount of 4.5 ganglioside molecules associated with one molecule of the depsipeptide valinomycin. The average surface potential indicates, that valinomycin, interacting with the polar head group of GM1, becomes partly embedded within the lipid interface. For GM1/eicosanol and valinomycin/eicosanol mixtures, the agreement between theory and experimental data strongly supports the model of ideal mixing without any molecular interactions between the different components. The results suggest the formation of a ganglioside/valinomycin complex with simultaneous alteration of the surface potential and molecular structure of the single components.

[Population development and selected structural changes in the GDR (from the beginning of the 1960s to 1989)]. / Bevolkerungsentwicklung und ausgewahlte Strukturveranderungen in der DDR (Anfang der 60er Jahre bis 1989).

PIP: Population trends in East Germany are depicted from 1950 to 1989 using a series of maps and tables. The focus is on population totals and density by region, age and sex distribution, fertility, and migration.^ieng