Fibrosis and expression of extracellular matrix proteins in human interventricular septum in aortic valve stenosis and regurgitation.

Valvular heart disease leads to ventricular pressure and/or volume overload. Pressure overload leads to fibrosis, which might regress with its resolution, but the limits and details of this reverse remodeling are not known. To gain more insight into the extent and nature of cardiac fibrosis in valve disease, we analyzed needle biopsies taken from the interventricular septum of patients undergoing surgery for valve replacement focusing on the expression and distribution of major extracellular matrix protein involved in this process. Proteomic analysis performed using mass spectrometry revealed an excellent correlation between the expression of collagen type I and III, but there was little correlation with the immunohistochemical staining performed on sister sections, which included antibodies against collagen I, III, fibronectin, sarcomeric actin, and histochemistry for wheat germ agglutinin. Surprisingly, the immunofluorescence intensity did not correlate significantly with the gold standard for fibrosis quantification, which was performed using Picrosirius Red (PSR) staining, unless multiplexed on the same tissue section. There was also little correlation between the immunohistochemical markers and pressure gradient severity. It appears that at least in humans, the immunohistochemical pattern of fibrosis is not clearly correlated with standard Picrosirius Red staining on sister sections or quantitative proteomic data, possibly due to tissue heterogeneity at microscale, comorbidities, or other patient-specific factors. For precise correlation of different types of staining, multiplexing on the same section is the best approach.

The Revised Child Anxiety and Depression Scales (RCADS): Psychometric Evaluation in Children Evaluated for ADHD.

Co-occurring internalizing symptoms are common and important to assess in children with attention-deficit/hyperactivity disorder (ADHD). One frequently used child self-report measure of internalizing symptoms is the Revised Child Anxiety and Depression Scales (RCADS), yet the psychometric properties of the RCADS remain unexamined in children referred for ADHD specifically. The present study evaluated the RCADS in 117 children (ages 8-12; 66% male) evaluated for suspected ADHD at an ADHD specialty clinic (83% met criteria for ADHD). In addition to the RCADS, children completed measures of social anxiety and depression. Parents completed the RCADS-Parent Version (RCADS-P) in addition to other measures of internalizing and externalizing symptoms. Children and parents both completed a measure of aggression. Factor structure, reliability, and convergent/discriminant validity of the RCADS were examined. Results supported the six-factor structure of the child-report RCADS (Separation Anxiety, Social Phobia, Generalized Anxiety Disorder, Panic Disorder, and Obsessive Compulsive Disorder, Major Depressive Disorder). The RCADS demonstrated adequate reliability as well as convergent and discriminant validity with other child ratings. The total anxiety score on the RCADS also demonstrated convergent and discriminant validity with parent measures, though the depression score on the RCADS did not. Findings provide preliminary psychometric support for the RCADS in children referred for ADHD.

Psychometric Validation of the Revised Child Anxiety and Depression Scales-Parent Version (RCADS-P) in Children Evaluated for ADHD.

Children with attention-deficit/hyperactivity disorder (ADHD) frequently experience comorbid internalizing symptoms. The Revised Child Anxiety and Depression Scales-Parent Version (RCADS-P) is a frequently used measure of anxiety and depression in children, though its psychometric properties remain unexamined in children referred for ADHD specifically. The present study evaluated the RCADS-P in 372 children (age 7-12 years; 68% male) referred for evaluation at an ADHD specialty clinic (89% met criteria for ADHD). In addition to the RCADS-P, parents completed the Vanderbilt ADHD Diagnostic Rating Scale and Child Behavior Checklist and were administered the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children semistructured diagnostic interview. Teacher ratings were available for approximately half of the sample. Factor structure, reliability, convergent/discriminant validity, and sensitivity/specificity were examined. Results supported the six-factor structure of the RCADS-P. The RCADS-P demonstrated adequate internal consistency as well as convergent and discriminant validity with other parent ratings and, to a somewhat lesser extent, teacher ratings. Children with an internalizing diagnosis had higher RCADS-P scores than children without an internalizing diagnosis. Finally, the RCADS-P had good-to-excellent diagnostic efficiency, and a total sum score of 25 had excellent sensitivity and fair specificity. Findings provide psychometric support for the RCADS-P in children with ADHD.