The prognosis of attention deficit hyperactivity disorder(ADHD)is poor,and approximately two third patients still have obvious symptoms when they grow up into adults,thus interfering with their social functions including work,study,family and interpersonal relation etc,and even causing the mental disorders and/or antisocial personality disorder.The predictive factors of adult outcome of ADHD include genetic,environmental and clinical factors.This review deals with the adult outcome and its predictive factors,and explores the severes harmfulness against individual,family and society brought by ADHD and its underlying mechanisms so as to facilitate the clinical intervention and research.

Objective:To investigate the association between LPHN3 andattention-deficit/hyperactivity disor-der(ADHD)in Chinese Han children.Methods:Based on the Diagnostic and Statistical Manual of Mental Disor-ders,Fourth Edition (DSM-IV)diagnosis criteria,921 normal controls and 1052 ADHD children were included in the study.The Clinical Diagnostic Interview Scale (CDIS )was used to assess symptoms and ADHD sub-types.ADHD was divided into three subtypes,namely ADHD inattentive type (ADHD-I),ADHD hyperactive-im-pulsive type (ADHD-HI),and ADHD combined type (ADHD-C).The ADHD rating-scale was used to assess ADHD symptoms.Including inattentive symptoms,hyperactive symptoms,impulsive symptoms and ADHD total symptoms.Three single nucleotide polymorphisms (SNPs)of LPHN3 were genotyped.Case-control studies were conducted to investigate the association of each SNP with the ADHD and the subgroups using chi-square test.Results:rs11131347 was associated with ADHD P <0.05,OR =0.86(0.76 -0.98)],but the difference didn't survive significance after corrections,The frequency of minor allele C in cases and control was0.409 vs.0.445.For different genders,rs11131347 was significantly associated with ADHD boys [P <0.05,OR =0.82(0.71 -0.96)], The frequency of minor allele C in cases and control was0.402 vs.0.449.For different subtypes,rs11131347 was associated with ADHD-C [P <0.05,OR =0.85(0.74 -0.98)]and ADHD-C boys[P <0.05,OR =0.82(0.70 -0.97)],but none of the difference survived significance after corrections,The frequencies of minor allele C in cases and control were respectively 0.407 vs.0.445 and 0.401 vs.0.449.Genotypes distribution analysis indicated that rs11131347 was associated with ADHD in general (recessive model,P <0.05),ADHD boys (additive model,P <0.05;dominant model,P <0.05;recessive model,P <0.05),ADHD-C(recessive model,P <0.05)and ADHD-C boys (dominant model,P <0.05 ),however,none of the difference survived significance after correc-tions.rs11131347 was nominal associated with impulsive scores(P <0.05).Conclusion:These findings suggest that the polymorphism of LPHN3 is probably involved in the pathological mechanisms of ADHD and its core symptoms of impulsivity.

Objective The exploratory study aimed to characterize the clinical features and the patterns of comorbidity and psychosocial functioning of adult attention deficit hyperactivity disorder (ADHD). Methods The study initially recruited 88 children who diagnosed with ADHD at age 6～16 years. They were reevaluated and administered structured psychiatric interviews for DSM-IV when they were at least 18 years old. A total of 59 adults with ADHD and 29 controls with GAF>70 were included in the study. Results Fifty-one(86.4%)of the adult ADHD were diagnosed as predominantly inattentive subtype of ADHD. The most common adult ADHD symptoms included "often has difficulty organizing tasks and activities (98.3%); often avoiding doing work projects where effort at thinking a lot is required (96.6%); often has trouble paying close attention to details (94.9%); often has problems following through on instructions and finishing job tasks (96.6%); often has difficulty sustaining attention (88.1%); often is distracted easily by extraneous stimuli (72.9%)". The majority (66.1%) of the adult ADHD had one or more psychiatric axis-I/axis-II comorbidity. Among them, 39.0% had psychiatric axis-I comorbidity and 49.2% had personality axis-II comorbidity. The average GAF score was significant lower in adult ADHD than in controls ( t =12.96, P <0.001). The majority (74.6%) of the adult ADHD had mild or moderate impairment or distress of overall functioning. Conclusions The main feature of adult ADHD is attention deficit. Patients with adult ADHD usually have comorbid conditions such as other psychiatric disorders and personality disorders and their psychosocial functioning is relatively poor.

Objective To improve the establishment of rabbit model with VX2 liver tumor and assess sonographical value in monitoring the tumor growth.Methods Fifteen New Zealand white rabbits were implanted with VX2 tumor in two liver lobes under ultrasound guidance percutaneously.Ultrasound examinations were performed at twenty days and thirty-six days after implantation.At the same time exploratory laparotomy was performed.Results Among 30 implanted tumors of 15 rabbits,16(53%) tumors were successfully implanted with few complications.It took 15 to 40 minutes to implant tumors in one rabbit.Implantation rates of left lobe and right lobe were 53% and 50% respectively,and there was no significant difference.Ultrasound examination could monitor tumor growth well.Conclusions After the improvement,the establishment of model was easier,less time-consuming,minimally invasive and caused few complications than other implantation methods.Serial ultrasound examinations should be performed in monitoring the tumor growth.

Objective:To explore the characteristics of attention during visual search tasks in adults with attention-deficit/hyperactivity disorder (ADHD).Methods:Totally 45 adult patients with ADHD who met the Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition (DSM-IV) and 44 healthy controls matched with age,gender and IQ were selected.The reaction time and accuracy rate of two groups were compared under visual search tasks of low and high visual working memory load.Results:The reaction time was longer in patients with ADHD than in the healthy controls in both low-load task [(823 ± 144) ms vs.(754 ± 123) ms,P ＜ 0.01] and highload task [(912 ± 163) ms vs.(851 ± 162) ms,P ＜ 0.01].Compared with the performance in low load task,the search reaction time was longer in high load task [ADHD group:(823 ± 144) ms vs.(912 ± 163) ms,P ＜ 0.01;control group:(754 ± 123) ms vs.(851 ± 162) ms,P ＜0.01] and the accuracy rate was lower during high load task than low load task[ADHD group:(95.9 ±4.3)％ vs.(91.2 ± 14.29)％;control group:(95.8 ± 4.2)％ vs.(94.4 ±4.9) ％,P ＜ 0.01] in both ADHD and control groups.Conclusion:The results suggest impairment in top-down attentional control in ADHD adults.When the visual working memory load is increasing,ADHD patients allocate more working memory resources on storing the target representation and less resources on visual attention,so the search efficiency may be influenced.

Objective:To examine the role of dopamine D4 receptor gene(DRD4) in attention deficit hyperactivity disorder(ADHD) with/without disruptive behavior disorder(DBD) by focusing on a-521C/T SNP within the promoter region of this gene.Methods:A total of 401 DSM-Ⅳ ADHD children(including 284 trios) of Chinese Han descent were genotyped.Chi-square test and the transmission disequilibrium test(TDT) were used to test for associations in ADHD with and without DBD respectively.Results:In the comparison of ADHD with(n= 143) and without(n= 258) DBD,the-521T allele(?2 = 6.778,P= 0.009,OR= 1.485) and the TT genotype(?2 = 6.292,P= 0.012,OR= 1.729) showed higher frequency in children with ADHD and DBD simultaneously.For family based analysis,T allele of the-521C/T polymorphism was preferentially transmitted to ADHD children with comorbid DBD(n= 100,?2 = 3.868,P= 0.049),whereas no significant distortion was found in the transmission of the tested variant for ADHD without DBD(n= 184,?2 = 0.223,P= 0.637).Conclusion:Our findings suggest that the-521C/T SNP of DRD4 may contribute to the predisposition to ADHD with comorbid DBD.This study supports for the hypothesis that ADHD with comorbid DBD may be influenced by greater genetic effect compared to ADHD alone.

Objective To investigate the clinical efficacy of Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) battery for patients at the early stage of traumatic brain injury (TBI). Methods 72 patients with TBI hospitalized from January, 2013 to October, 2014 and 30 healthy controls matched gender, age and educational background were assessed with the Chinese version of LOTCA battery and Mini-Mental State Examination (MMSE) respectively. Results The score of MMSE and LOTCA were correlated (r=0.56, P<0.01). Compared with the controls, the scores of all the subtests of LOTCA decreased (P<0.01) in the patients, especially the orientation, visuomo-tor organization and thinking operation;with the more incidence of medium and serious dysfunction of all the subtests of LOTCA except perception (P<0.01), in which thinking operation was the most and attention was the least. The area under the receiver operating curve (ROC) was (0.84±0.04) in LOTCA, less than that of (0.91±0.03) in MMSE (P<0.05). Conclusion Cognition is widely impaired in patients after TBI, most involved thinking operation. LOTCA is less effective to identify cognitive dysfunction than MMSE, and can be used as an al-ternation or a supplement.

Objective: To investigate association of the 48 bp variable number of tandem repeat (VNTR) polymorphism in the D 4 receptor gene ( DRD4 ) exon 3 and 40 bp VNTR polymorphism in the dopamine transporter gene ( DAT1 ) 3′ untranslated region with attention deficit hyperactivity disorder (ADHD) in Han Chinese children. Methods: The study samples were comprised of 340 ADHD children, 226 unrelated controls and 202 integrated ADHD trios (included proband and biological parents). The polymorphisms consisted of 48 bp VNTR in exon 3 of DRD4 , and 40 bp VNTR in the 3′ untranslated region of DAT1 . Associations of polymorphisms with ADHD and its subtypes were examined by: (i) comparing cases and controls; and (ii) using family based association study in an extension of exact transmission disequilibrium test (ETDT) and haplotype based haplotype relative risk (HHRR). Results: The repeat numbers at the DRD4 48 bp locus ranged from 2—6 repeats in the Han Chinese controls, with the most common being the 4 repeat (77%) and 2 repeat (19.4%) alleles. Neither the 7 repeat allele nor longer repeats were found. For the DAT1 , the repeat numbers at the 40 bp locus ranged from 6—7 repeats and 9—11 repeats. The 10 repeat allele was the most frequent (90.7%). The long repeat alleles of DRD4 (ranging from 4—6 repeats) and DAT1 (ranging from 11—12 repeats), were present more frequently in ADHD probands than in controls. Our primary analyses failed to replicate the associations between ADHD and 7 repeat allele of DRD4 and the 10 repeat allele of DAT1 . Conclusion: The long repeat alleles of DRD4 (after a stratification by gender) and DAT1 may increase the risk for ADHD in Han Chinese children.

Objective To test the reliability and validity of the Chinese version of the John Hopkins Adapted Cognitive Exam ( ACE) in NICU patients. Methods The English ACE was translated and adapted into the Chinese version . Cognitive functions of 40 critically ill patients in NICU were assessed with the Chi?nese version of ACE and MMSE battery.The scores of ACE and MMSE were analyzed to test the content va?lidity,construct validity,concurrent validity,internal consistency,inter?rater reliability and test?retest reliabil?ity.Result The correlation coefficient between each factor and the total score ranged from 0.617 to 0.938, and the content validity was good.The ACE was significantly correlated with MMSE( r=0.822, P<0.05). Five factors were extracted by main principle analysis, the cumulative contribution was 85. 90%, the factor loading of each item was all over 0.5,the scale had good construct validity.There existed a good internal con?sistency ( Cronbach’ α=0.756 ) as well as a good inter?rater reliability ( ICC>0.95) and test?retest reliabil?ity (ICC=0.652?0.979) of the Chinese version of ACE.Conclusions The Chinese version of ACE has been proved to be a reliable and valid screening tool for cognitive impairment in NICU patients.