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Background Although high-density lipoprotein (HDL) modulates many cell types in the cardiovascular system, little is known about HDL in the kidney. We assessed urinary excretion of apolipoprotein AI (apoAI), the main protein in HDL. Methods We enrolled 228 children with various kidney disorders and 40 controls. Urinary apoAI, albumin, and other markers of kidney damage were measured using ELISA, apoAI isoforms with Western blot, and renal biopsies stained for apoAI. Results Patients followed in nephrology clinic had elevated urinary apoAI vs. controls (median 0.074 [mu]g/mg; interquartile range (IQR) 0.0160-0.560, vs. 0.019 [mu]g/mg; IQR 0.004-0.118, p < 0.001). Patients with tubulopathies, renal dysplasia/congenital anomalies of the kidney and urogenital tract, glomerulonephritis, and nephrotic syndrome (NS) in relapse had the greatest elevations (p [less than or equal to] 0.01). Patients with NS in remission, nephrolithiasis, polycystic kidney disease, transplant, or hypertension were not different from controls. Although all NS in relapse had higher apoAI excretion than in remission (0.159 vs. 0.0355 [mu]g/mg, p = 0.01), this was largely driven by patients with focal segmental glomerulosclerosis (FSGS). Many patients, especially with FSGS, had increased urinary apoAI isoforms. Biopsies from FSGS patients showed increased apoAI staining at proximal tubule brush border, compared to diffuse cytoplasmic distribution in minimal change disease. Conclusions Children with kidney disease have variably increased urinary apoAI depending on underlying disease. Urine apoAI is particularly elevated in diseases affecting proximal tubules. Kidney disease is also associated with high molecular weight (HMW) apoAI isoforms in urine, especially FSGS. Whether abnormal urinary apoAI is a marker or contributor to renal disease awaits further study., Author(s): Amanda J. Clark [sup.1] , Kathy Jabs [sup.2] , Tracy E. Hunley [sup.2] , Deborah P. Jones [sup.2] , Rene G. VanDeVoorde [sup.2] , Carl Anderson [sup.2] , Liping [...]

Surprisingly few ecologically-valid assessments of executive function exist, but the Baycrest Multiple Errands Test (BMET) shows promise in identifying executive impairment. The goal of the present study was to develop both a revised version of the assessment (BMET-R), to improve the test's ability to discriminate between patients and healthy participants, and an alternate form of the BMET-R to permit repeat testing. Sixteen individuals with acquired brain injury (ABI) due to stroke or trauma and 16 healthy participants completed a series of neuropsychological assessments, questionnaires, the BMET-R and its alternate form (in counterbalanced order). The results of the study indicated that participants with ABI omitted more tasks, broke more rules, and were less efficient than healthy participants on both the revised BMET-R and its alternate form. Moreover, significant correlations were found between the two versions of the BMET-R for task completions, omissions, errors, rule breaks and inefficiencies but few significant correlations were observed between the BMET-R versions and measures of executive dysfunction in everyday life. These results indicate that the two versions of the BMET-R are able to dissociate the performance of participants with ABI from that of healthy participants. However, despite overlaps in performance and correlations between the two versions of the BMET-R, they did not identically assess executive deficits. This suggests that caution should be used when constructing and validating alternate versions of performance-based assessments. [ABSTRACT FROM AUTHOR]

This study examined the clinical utility of the Multiple Errands Test (MET) from the perspective of clinicians. Employing a qualitative descriptive design, in-depth semi-structured interviews were conducted with eight occupational therapists. Participants had an average of 12 years clinical experience and their experience using the MET varied. Interviews were transcribed and analysed using framework analysis. Three dominant themes emerged from the data. Theme 1 was that clinicians value the MET because it reflects real-life functioning. Clinicians perceived the MET to be a unique assessment collecting data on functional performance, and sensitive to higher level cognitive deficits. Theme 2 was that the MET could be used flexibly depending on one's rehabilitation goals. Clinicians employed the MET as an assessment to inform the direction of treatment and as a component of their intervention. Theme 3 was that the MET is a challenging assessment requiring buy in and commitment from therapists. This study is the first to report clinicians’ perspectives of the clinical utility of the MET. It reinforces the importance of ecologically valid tests, and augments existing research evaluating psychometric properties of the MET by describing how the MET has been employed in rehabilitation settings to improve health outcomes for adults with neurological conditions. [ABSTRACT FROM PUBLISHER]

Attention deficit hyperactivity disorder (ADHD) is marked by increased distractibility and inhibitory deficits. This study sought to understand how individuals diagnosed with ADHD respond when required to inhibit a routine in response to unexpected stimuli. Ten young adults diagnosed with adult ADHD and ten controls completed the Slip Induction Task (SIT), a measure of attention and inhibition during a routine. The SIT involves participants repeatedly responding to a series of arrow cues, and then later adjusting their routine in response to unexpected stimuli. The findings of this study suggest that those with ADHD do not respond less accurately to novel stimuli within a routine. The data also indicate that when adults diagnosed with ADHD do respond correctly to novel stimuli, they do so more quickly than controls. This could imply that those with adult ADHD may be able to more quickly disengage a usual response pattern if a novel stimulus requires attention. [ABSTRACT FROM AUTHOR]

Separate bodies of literature indicate that a history of a traumatic brain injury (TBI) and natural aging may result in overlapping cognitive profiles, yet little is known about their combined effect. We predicted that a remote TBI would compound normal age-related cognitive decline, particularly affecting executive function. Neuropsychological task performance was compared between a group of older adults who sustained a TBI in their distant past (N = 9) and a group of older adults with no history of head injury (N = 15). While all participants scored in the normal range on the Mini-Mental State Examination, the TBI group scored lower than the non-TBI group. Also, in line with predictions, the TBI group made more errors on measures of executive functioning compared to the non-TBI group (the Trail Making B test and the incongruent condition of the Stroop Test), but performed similarly on all tasks with little executive requirements. Findings from this exploratory study indicate that a past TBI may put older adults at a higher risk for exacerbated age-related cognitive decline compared to older adults with no history of TBI. [ABSTRACT FROM AUTHOR]

Separate bodies of literature indicate that a history of a traumatic brain injury (TBI) and natural aging may result in overlapping cognitive profiles, yet little is known about their combined effect. We predicted that a remote TBI would compound normal age-related cognitive decline, particularly affecting executive function. Neuropsychological task performance was compared between a group of older adults who sustained a TBI in their distant past (N = 9) and a group of older adults with no history of head injury (N = 15). While all participants scored in the normal range on the Mini-Mental State Examination, the TBI group scored lower than the non-TBI group. Also, in line with predictions, the TBI group made more errors on measures of executive functioning compared to the non-TBI group (the Trail Making B test and the incongruent condition of the Stroop Test), but performed similarly on all tasks with little executive requirements. Findings from this exploratory study indicate that a past TBI may put older adults at a higher risk for exacerbated age-related cognitive decline compared to older adults with no history of TBI.

Background: Plasma amino acid (PAA) levels can be largely normalized during parenteral nutrition (PN) in infants and children using a pediatric-specific amino acid (AA) formulation. However, these previous results were based on individual clinical studies of small populations of neonates and infants., Objective: We have now examined AA levels in 108 children (0-7 years of age) receiving a pediatric-specific AA formulation in PN using a single analytical methodology., Methods: Infants and children were enrolled in specific protocols and parents/caregivers gave informed consent. Patients were stable and receiving age-appropriate intakes of AA and non-protein calories. Samples were obtained between 8 and10 am, processed immediately, deproteinized, and AA concentrations (μmol/L) were determined on a Beckman 6300 analyzer. Means and SD were calculated for sub-populations stratified by age: 0-1 month (48 patients, n=139), 1-6 months (36 patients, n=124), 7-12 months (11 patients, n=41), and 1-7 years (13 patients, n=51). Z scores were calculated for each amino acid [(observed mean - normal control mean)/normal control SD]., Results: When compared to the neonatal reference range, nonessential AA had Z scores that ranged from -1.84 (asparagine) to +1.48 (threonine). Only plasma free cystine, free tyrosine, and phenylalanine had Z scores outside the -2.0 to +2.0 range (95% confidence limits). Plasma free cystine values were low in all groups except neonates. Free tyrosine levels were low in all groups despite the presence of N-acetyl-L-tyrosine in the pediatric AA formulation. Phenylalanine levels were elevated only in neonates. When children 1 to 7 years old were compared with an age-matched reference range, plasma free cystine values were low (Z score -2.47), as were plasma glutamine values (-3.11), but elevations were found in the dicarboxylic amino acids aspartic acid (+2.5) and glutamic acid (+4.27). Regardless of reference range used for comparison, all essential amino acids, except phenylalanine in neonates, were within range (-2 to +2 of the 95% confidence limits)., Conclusions: While most AAs were within the normal range, formulation modifications are needed to normalize free cystine in infants and young children, free tyrosine in all children, and phenylalanine in neonates. The decrease in glutamine concentrations in older children has been noted by our group before, and may imply limited ability to convert glutamic acid to glutamine, or increased consumption of glutamine. In either case, increased concentrations of glutamine in older children, especially those receiving home parenteral nutrition, should be considered.