Asymmetries in the momentum distributions of electrons stripped by a XUV chirped pulse in the presence of a laser field

The ionization of hydrogen by a chirped XUV pulse in the presence of a few cycle infrared laser pulse has been investigated. The electron momentum distribution has been obtained by treating the interaction of the atom with the XUV radiation at the first order of the time-dependent perturbation theory and describing the emitted electron through the Coulomb-Volkov wavefunction. The results of the calculations agree with the ones found by solving numerically the time-dependent Schrödinger equation. It has been found that depending on the delay between the pulses the combined effect of the XUV chirp and of the steering action on the infrared field brings about asymmetries in the electron momentum distribution. These asymmetries may give information on both the chirp and the XUV pulse duration.

Comparison of the potency of 10 different brands of Serenoa repens extracts

BACKGROUND

The extract of Serenoa repens is the phytopharmaceutical product most often used for the treatment of urological symptoms associated with benign prostatic hyperplasia (BPH). Several extracts are commercially available but extraction processes vary between manufacturers and thus not all these products are equivalent in terms of active ingredient content and composition of preparations.

AIM

As there is a paucity of comparative studies, we compared the activity of different extracts of Serenoa repens widely available on the world market.

MATERIALS AND METHODS

Beltrax Uno, Permicaps, Permixon, Prostadyn, Prostagutt, Prostamen, Prostamol Uno, ProstaX, Urocaps and Urogutt were assayed for 5-alpha-reductase activity on 10 day fibroblasts and epithelial cells cocultures. Human fibroblast growth factor (hFGF)-induced-proliferation inhibition was also assayed.

RESULTS

As to extract activity, differences were observed between the tested extracts, but all were able to inhibit 5-a-reductase types I and II isoenzymes (5alphaR-I and 5alphaR-II) as well as fibroblast proliferation.

CONCLUSIONS

Extract potency differs between products and so does proliferation inhibition potency. Quantitative and qualitative variations in the active ingredient are likely to account for these differences.

Prevalence of asthma and allergies in 13- to 14-year-old adolescents and the frequency of risk factors in carriers of current asthma in Taubaté, São Paulo, Brazil

BACKGROUND

The objectives of this study were to determine the prevalence of asthma and allergies in 13- to 14-year-old adolescents in the city of Taubaté, São Paulo, Brazil using the INTERNATIONAL STUDY OF ASTHMA AND ALLERGIES IN CHILDHOOD (ISAAC) questionnaire and to describe the presence of risk factors in current asthma carriers.

METHODS

We used a cross-sectional study involving 920 adolescents who completed the ISAAC questionnaire and answered additional questions regarding smoking and the presence of pets and/or insects at home.

RESULTS

The mean prevalence rate of "current asthma" was 15.3% and "asthma ever" was 6.8%. The mean prevalence rate of "current rhinitis" was 36.6% and "rhinitis ever" 37.6%. The prevalence of "eczema ever" was 16.2%. The frequency of active smoking was low (0.7%), and the presence of indoor animals (34%) and of insects (55.1%) was high.

CONCLUSIONS

The prevalence of "current asthma" was twice as high as that of "asthma ever". There was no association between risk factors studied and current asthma.

Controlled growth of CNT in mesoporous AAO through optimized conditions for membrane preparation and CVD operation

Anodic aluminium oxide (RAAO) membranes with a mesoporous structure were prepared under strictly controlling experimental process conditions, and physically and chemically characterized by a wide range of experimental techniques. Commercial anodic aluminium oxide (CAAO) membranes were also investigated for comparison. We demonstrated that RAAO membranes have lower content of both water and phosphorus and showed better porosity shape than CAAO. The RAAO membranes were used for template growth of carbon nanotubes (CNT) inside its pores by ethylene chemical vapour deposition (CVD) in the absence of a catalyst. A composite material, containing one nanotube for each channel, having the same length as the membrane thickness and an external diameter close to the diameter of the membrane holes, was obtained. Yield, selectivity and quality of CNTs in terms of diameter, length and arrangement (i.e. number of tubes for each channel) were optimized by investigating the effect of changing the experimental conditions for the CVD process. We showed that upon thermal treatment RAAO membranes were made up of crystallized allotropic alumina phases, which govern the subsequent CNT growth, because of their catalytic activity, likely due to their Lewis acidity. The strict control of experimental conditions for membrane preparation and CNT growth allowed us to enhance the carbon structural order, which is a critical requisite for CNT application as a substitute for copper in novel nano-interconnects.

Non-nutritive sucking scoring system for preterm newborns

AIM

To validate a non-nutritive sucking (NNS) scoring system for oral feeding in preterm newborns (PTNB).

METHODS

A cohort study was carried out in two phases. In phase one of the study, 22 mastered speech-language pathologists received the protocol and procedure for a NNS scoring system to evaluate the content and presentation of the form and to define the grading scale. In phase two, six speech-language pathologists evaluated 51 PTNBs weekly, using the defined scoring system.

SETTING

This study was carried out in the Nursery Annex to the Maternity at the Intensive and Neonatal Pediatrics Service, Instituto da Criança, Hospital das Clinicas, School of Medicine, University of São Paulo (FMUSP) during the period from May 2004 to May 2006.

PARTICIPANTS

A total of 28 speech-language pathologist experts and 51 PTNBs.

RESULTS

In the first phase of the study, 22 speech-language pathologists selected the criteria, utilized in the NNS evaluation with 80% agreement. In the second phase of the study, the NNS evaluation was carried out on 51 PTNB, and a scoring system of 50 points was proposed, which corresponds to the smallest number of false positive and negative results regarding oral feeding ability.

CONCLUSION

An NNS evaluation system was validated that was able to indicate when oral feeding could safely begin in PTNBs with a high level of agreement among the speech-language pathologists who have participated.

Body mass index values for newborns according to gestational age

OBJECTIVE

The combination of twho anthropometric parameters has been more appropriate to assess body composition and proportions in children, with special attention to the Body Mass Index (BMI), as it relates weight and length. However the BMI values for the neonatal period have not been determined yet. This study shows the BMI for newborns at different gestational ages represented in a normal smoothed percentile curve.

METHODS

Retrospective study including 2,406 appropriate for gestational age newborns following the Alexander et al curve (1996) from 29 to 42 weeks of gestational age. Weight and lenght were measured following standard procedures. For the construction a of a normal smoothed percentile curve, the 3rd, 5th, 10th, 25th, 50th, 75th, 90th and 95th percentiles were determined and a statistical procedure based on the mathematical model "sinosuoidal fit" was applied to establish a curve that estimates biological growth parameters.

RESULTS

The Body Mass Index values for gestational age in all percentiles shows a steady increase up to 38 weeks, levels off up to the 40th week, followed by a slight decrease to the 42nd week in both genders.

CONCLUSION

The results show a direct correlation between gestational age and Body Mass Index for both genders in the nine percentiles, and can provide a useful reference to assess intra-uterine proportional growth.

Prevalence of asthma, rhinitis and eczema in 6 - 7 years old students from the western districts of São Paulo City, using the standardized questionnaire of the "International Study of Asthma and Allergies in Childhood" (ISAAC)-phase IIIB

The aims of the present work were the evaluation of allergic disease prevalence among 6 and 7 year-old students from the western districts of São Paulo city and the comparison of these data with those obtained in the International Study of Asthma and Allergies in Childhood (ISAAC) phase I, performed in the central-southern districts of São Paulo, using the ISAAC standardized written questionnaire.

METHODS

5,040 questionnaires were distributed and 3,312 were returned. Proportional differences were estimated by Chi square or Fisher exact tests. Odds Ratio and 95% confidence intervals between genders and allergic diseases were calculated. Values of p<0.05 were considered statistically significant.

RESULTS

The corrected prevalences found were: asthma 24.4%, medical diagnosis of asthma 5.7%, rhinitis 25.7%, rhinoconjunctivitis 11.3%, medical diagnosis of rhinitis 20.0%, atopic eczema 9.2%. Significant associations between asthma and rhinitis (OR=3.3), asthma and eczema (OR=2.2), and rhinitis and eczema (OR=2.8) occurred. The male gender was prevalent regarding asthma and rhinitis. Compared to data from ISAAC phase I, higher asthma prevalence and severity, and lower values for rhinitis and eczema were observed in this study.

CONCLUSIONS

The present study evidenced high prevalences for asthma and rhinitis compared to the children's medical diagnosis. The male gender predominated in all positive responses regarding asthma and rhinitis. The most frequent associations observed were between asthma and rhinitis and asthma and eczema. In the western districts of São Paulo, a higher prevalence of asthma symptoms and severity and lower prevalences for rhinitis and eczema occurred compared to the central-southern districts of the city.

Risk factors associated with the death of patients hospitalized for juvenile systemic lupus erythematosus

We assessed the risk factors associated with death in patients hospitalized for juvenile systemic lupus erythematosus (JSLE) and evaluated the autopsy reports. A total of 57,159 hospitalizations occurred in our institution from 1994 to 2003, 169 of them involving 71 patients with JSLE. The most recent hospitalization of these patients was evaluated. Patients were divided into two groups based on mortality during hospitalization: those who survived (N = 53) and those who died (N = 18). The main causes of hospitalization were JSLE activity associated with infection in 52% and isolated JSLE activity in 44%. Univariate analysis showed that a greater risk of death was due to severe sepsis (OR = 17.8, CI = 4.5-70.9), systemic lupus erythematosus disease activity index (SLEDAI) >or=8 (OR = 7.6, CI = 1.1-53.8), general infections (OR = 6.1, CI = 1.5-25), fungal infections (OR = 5.4, CI = 3.2-9), acute renal failure (OR = 5.1, CI = 2.5-10.4), acute thrombocytopenia (OR = 3.9, CI = 1.9-8.4), and bacterial infections (OR = 2.3, CI = 1.2-7.5). Stratified analysis showed that severe sepsis and SLEDAI >or=8 were not confounder variables. In the multivariate analysis, logistic regression showed that the only independent variable in death prediction was severe sepsis (OR = 98, CI = 16.3-586.2). Discordance between clinical diagnosis and autopsy was observed in 6/10 cases. Mortality of hospitalized JSLE patients was associated with severe sepsis. Autopsy was important to determine events not detected or doubtful in dead patients and should always be requested.

Procalcitonin does discriminate between sepsis and systemic inflammatory response syndrome

AIMS

To evaluate whether procalcitonin (PCT) and C reactive protein (CRP) are able to discriminate between sepsis and systemic inflammatory response syndrome (SIRS) in critically ill children.

METHODS

Prospective, observational study in a paediatric intensive care unit. Kinetics of PCT and CRP were studied in patients undergoing open heart surgery with cardiopulmonary bypass (CPB) (SIRS model; group I1) and patients with confirmed bacterial sepsis (group II).

RESULTS

In group I, PCT median concentration was 0.24 ng/ml (reference value <2.0 ng/ml). There was an increment of PCT concentrations which peaked immediately after CPB (median 0.58 ng/ml), then decreased to 0.47 ng/ml at 24 h; 0.33 ng/ml at 48 h, and 0.22 ng/ml at 72 h. CRP median concentrations remained high on POD1 (36.6 mg/l) and POD2 (13.0 mg/l). In group II, PCT concentrations were high at admission (median 9.15 ng/ml) and subsequently decreased in 11/14 patients who progressed favourably (median 0.31 ng/ml). CRP levels were high in only 11/14 patients at admission. CRP remained high in 13/14 patients at 24 h; in 12/14 at 48 h; and in 10/14 patients at 72 h. Median values were 95.0, 50.9, 86.0, and 20.3 mg/l, respectively. The area under the ROC curve was 0.99 for PCT and 0.54 for CRP. Cut off concentrations to differentiate SIRS from sepsis were >2 ng/ml for PCT and >79 mg/l for CRP.

CONCLUSION

PCT is able to differentiate between SIRS and sepsis while CRP is not. Moreover, unlike CRP, PCT concentrations varied with the evolution of sepsis.

Inflammation is more persistent in type 1 diabetic mice

Whether diabetes enhances or diminishes the host response to bacteria has been controversial. To determine how diabetes alters the inflammatory response, we inoculated P. gingivalis into the scalps of mice rendered diabetic with multiple low-dose streptozotocin treatment. On day 1, a moderate to severe inflammatory infiltrate was noted in both the diabetic and normoglycemic mice. After 3 days, the inflammatory infiltrate was significantly higher in the diabetic compared with the control group (P < 0.05). The mRNA expression of chemokines macrophage inflammatory protein-2 and monocyte chemoattractant protein-1 was strongly and similarly induced 3 hrs and 1 day post-inoculation. By day 3, the levels were reduced in normoglycemic mice but remained significantly higher in the diabetic group (P < 0.05). To determine whether persistent inflammation was specific for the streptozotocin-induced diabetic model, we directly compared the expression of TNF-alpha in streptozotocin-induced and db/db diabetic mice, which developed type 2 diabetes. Both exhibited prolonged TNF-alpha expression compared with controls. These results suggest that diabetes alters bacteria-host interactions by prolonging the inflammatory response.

Gonadal function in adolescents and young women with juvenile systemic lupus erythematosus

The authors analysed the gonadal function and age of menarche of 23 female adolescents and young women with SLE, and correlated these with clinical, SLEDAI and therapeutic parameters. The presence of one or more clinical and laboratory parameters defined normal gonadal function: normal menstrual cycles with or without dysmenorrhea; elevated cervical mucus length; normal levels of plasma FSH, LH, estradiol, progesterone, prolactin and testosterone; normal urinary hormonal cytology; serial pelvic ultrasound compatible with ovulatory pattern; and present or previous pregnancy. The mean age of menarche (13.5 +/- 1.4 years) was greater than that found among 2578 healthy Brazilian adolescents (12.5 +/- 1.3 years; P = 0.0002). The delay in menarche correlated with an increase in the duration of the disease (P = 0.0085) and the cumulative dose of prednisone (P = 0.0013) used until the appearance of the menarche. The mean phase length in SLE was 31.5 +/- 10.3. Sixteen female (70%) patients showed normal and seven (30%) abnormal gonadal function. Gonadal function was not correlated with parameters of SLE. These results suggest that the patients of this study reach adulthood with a high chance of fertility.

Pichia anomala outbreak in a nursery: exogenous source?

BACKGROUND

Pichia anomala is a rare cause of fungemia. From February to April, 1998, eight cases of fungemia occurred in the intensive care and high risk units of the Nursery. There were four infants with P. anomala infection, one of whom also had Candida parapsilosis infection, two cases with C. parapsilosis infection and two with Candida albicans infection.

OBJECTIVE

To determine factors associated with fungemia in the intensive care and high risk units of the Nursery, especially P. anomala.

METHODS

A cohort study with 59 newborns.

RESULTS

Factors associated with fungemia were: central venous catheter (CVC) (P = 0.0006); total parenteral nutrition (TPN) (P = 0.0005); lipid emulsion (P = 0.002); previous antimicrobial use (P = 0.002); and other invasive procedures (P = 0.002). Factors associated with P. anomala fungemia were: CVC (P = 0.004); TPN (P = 0.018); previous antibiotic use (P = 0.037); and other invasive procedures (P = 0.037). Evaluation of the units demonstrated that there were several technical problems involving administration of TPN that was manipulated in the Nursery without precautions. Changes in TPN formulation and education as to adequate technique were implemented. During follow-up (1998 to 1999) only two fungemias occurred that were caused by C. albicans. Cultures of hands of personnel were negative for P. anomala. Electrophoretic karyotyping of P. anomala showed three profiles.

CONCLUSIONS

Factors associated with fungemia were catheter use, invasive procedures and total parenteral nutrition, suggesting that the acquisition of P. anomala was exogenous.

Enameloplasty effects on microleakage of pit and fissure sealants under load: an in vitro study

Enameloplasty has been implicated in the successful application of pit and fissure sealants. The present study aimed to evaluate the effect of enameloplasty technique on microleakage of sealants when occlusal force was applied on the teeth. The study also allowed a direct comparison of the effectiveness of enameloplasty, when two different burs were used. Six groups of ten human extracted wisdom teeth were tested. Group A: no load, conventional (no enameloplasty--control); Group B: no load, enameloplasty 1/2 round bur (Brasseler USA); Group C: no load, enameloplasty diamond fissure bur REF/UP 791 (Ultradent); Group D: load 500 N, conventional, Group E: load 500 N, 1/2 round bur; Group F: load 500 N, diamond fissure bur. Specimens were thermocycled for 500 cycles at 5 degrees C and 55 degrees C with a dwell time of 30 seconds after load application. Microleakage was scored as distance of dye penetration with 0 = no microleakage and 3 = microleakage to underling fissure. The Kruskal-Wallis One Way Anova and Mann-Whitney U test showed group D having the greatest degree of microleakage statistically significant (p < 0.05) comparing with other groups. Sealants prepared with the conventional technique (A, D) had statistically significant differences in microleakage with those prepared with enameloplasty (B, C, E, F) (p = 0.01). Enameloplasty in groups with no load (B, C) did reduce microleakage, but not significantly (p = 0.3). However, loaded teeth with enameloplasty appeared to perform superior, as compared to those without (p = 0.005). Regarding the effect of load, teeth without load (Groups A, B, C) were found to have significantly less microleakage than teeth where mechanical force had been applied (Groups D, E, F), (p = 0.01). Microleakage in Group A (conventional technique without load) was significantly less than microleakage in Group D (conventional technique with load), (p = 0.04). However, load did not seem to influence microleakage when enameloplasty had been performed. This finding was true for both round bur enameloplasty (p = 0.29), and fissure bur enameloplasty (p = 0.26). There was no statistically significant difference between Groups B, E (round bur) and C, F (fissure bur) (p > 0.05), or between Groups B and C (p > 0.05) and between Groups E and F (p > 0.05). The results of the study indicated that enameloplasty reduced microleakage of pit and fissure sealants, especially when load was applied to teeth, irrespective of what bur was used to enlarge the fissure, as there was no statistical significant differences between the round and fissured diamond burs. The application of occlusal force to the tooth produces significantly more microleakage, unless enameloplasty is performed.

Growth deficits in Chilean school children

Stunting is highly prevalent in Latin American countries regardless of socioeconomic performance. The purpose of this study was to identify risk factors of growth deficit among children starting primary education whose parents were of short stature compared with those whose parents were not of short stature, in the poorest districts of Santiago, Chile. A case-control study was carried out with two types of cases. Case 1 included children whose height was between -1.0 and -3.0 (SD) of the height/age of the National Center for Health Statistics/World Health Organization standard and whose parent's height was below -2.0 SD (n = 115). Case 2 included stunted children (as defined previously) whose parent's height was above -2 SD (n = 76). Controls were children whose stature was +/-0.5 SD and whose parent's height was also above -2 SD (n = 115). Logistic regression models were carried out for case 1 and 2 children compared with the controls. Similar risk factors were found in both models, without any significant interaction: these included history of malnutrition, drunkenness in the family, lack of health care, unhygienic housing conditions, small length at birth and short period of exclusive breastfeeding. The most important risk factors for case 1 children were a history of malnutrition [with an odds ratio (OR) of 5.26 and confidence interval (CI) of 2.68-10.34] and short length at birth (OR = 4.87, CI 2.18-10.92). For case 2 children, the most important risk factors were a history of malnutrition (OR = 4.58, CI 2.20-9.53) and unhygienic housing conditions (OR = 4.29, CI 1.76-10.48). In conclusion, similar factors explained growth deficits in children starting primary school independent of the parent's height, suggesting that genetics would have a limited impact at this age and at this socioeconomic level. To reduce stunting in countries with an epidemiological profile such as that of Chile, it is still important to reduce adverse environmental conditions.

Sensation-seeking and differentially arousing television commercials

The authors predicted (a) that disinhibited consumers would react more favorably to advertising that was high in arousal and (b) that inhibited consumers would react more favorably to advertising that was low in arousal. They tested these predictions by having U.S. college students evaluate both the commercial and the product being marketed in 1 of 2 beer commercials. The prospective buyers then completed a measure of dispositional sensation-seeking tendencies. Although the participants who differed in disinhibition reacted differently to the 2 commercials, the nature of their responses was more complex than predicted.

Width of keratinized tissue after gingivoplasty of healed subepithelial connective tissue grafts

BACKGROUND

The subepithelial connective tissue graft has markedly broadened clinicians' abilities to treat gingival recession. Frequently, however, bulky soft tissue contours are sequelae of this procedure, and post-healing gingivoplasty is often performed to improve esthetics of the grafted site. As a secondary benefit, it is believed that the zone of keratinized tissue is additionally increased after gingivoplasty.

METHODS

To further investigate this clinical impression, 16 bilateral pairs of sites with recession in 6 consecutive patients (mean age = 38 +/- 9 years) were studied. At the time of initial grafting, one site in each pair was randomly assigned to receive either gingivoplasty 2 months later (GP+) or no further treatment (GP-). Clinical measurement of recession and keratinized tissue width was standardized using customized acrylic stents and Schiller iodine solution, which stains epithelia; values were recorded at baseline (day of graft) and at 2, 3, and 5 months after grafting. Mean clinical gingival widths over time between GP+ and GP- sites, as well as within GP+ sites, were analyzed by t test.

RESULTS

At 5 months, both the GP+ and GP- sites demonstrated a mean root coverage of 87.4% and increased keratinized tissue width (1.2 mm) when compared to their respective baseline measures. No differences in recession depth and width of keratinized tissue were seen at 5 months between the GP+ and GP- groups. In addition, no differences in recession or gingival width were found between 2- and 5-month observations for either the GP+ or GP- groups.

CONCLUSIONS

These data suggest that the observed clinical improvements are the outcome of the initial graft surgery and that the gingivoplasty procedure does not result in additional (or "rebound") increases in keratinized tissue width.

Eosinophil apoptosis in induced sputum from patients with seasonal allergic rhinitis and with asymptomatic and symptomatic asthma

BACKGROUND

Eosinophilic inflammation is known to play an important role in the pathogenesis of allergic diseases. Apoptosis, a form of programmed cell death, is characterized by morphologic cell changes and leads to recognition and ingestion by macrophages. Apoptosis could be an important mechanism controlling the resolution of tissue eosinophilia.

OBJECTIVE

This study was designed to investigate the presence of apoptotic eosinophils in induced sputum of patients with seasonal allergic rhinitis (SAR), when examined during natural pollen exposure and of patients with perennial asthma of different degrees of severity.

METHODS

We recruited 11 patients with SAR to grass pollens, 26 patients with asymptomatic asthma (AA), and 18 patients with symptomatic asthma (SA). The severity of asthma was assessed by clinical scoring. Sputum was induced following a standard method and differential cell count was estimated. Eosinophils showing cell shrinkage and nuclear coalescence were classified as apoptotic. The number of apoptotic eosinophils was expressed as the percentage of total cells in sputum and as the proportion of apoptotic eosinophils relative to normal bilobed eosinophils ("apoptotic ratio").

RESULTS

We found the number of eosinophils in the SA group was significantly greater than that in the SAR and the AA groups (P < .001 and P < .0001 respectively). The number of apoptotic eosinophils in the AA group was significantly lower than that in the SAR group (P < .001) and in the SA group (P < .0001). The apoptotic ratio for eosinophils in the SAR group was significantly greater than in the AA group (P < .05) and in the SA group (P < .05). There was no difference in the apoptotic ratio between the AA and SA groups.

CONCLUSIONS

This study confirms that apoptotic eosinophils are detectable in induced sputum of allergic patients. Further, the results of our study suggest that apoptosis could be an important mechanism in the control of acute eosinophilic inflammation in patients with SAR exposed to the sensitizing antigens. It appears that the apoptotic mechanism could be less effective in controlling tissue eosinophilia in asthmatic patients with chronic eosinophilic inflammation.

The measurement of locus of control: assessing more than meets the eye?

Ambiguities in the conceptions and measurement of locus of control were investigated in this study. Specifically, some psychometric properties of several widely used measures of perceived behavior-outcome contingency, interpersonal power, and social self-efficacy were assessed. To different degrees, the results indicated that all three measures of perceived behavior-outcome contingency lacked convergent and discriminant validity. Implications for interpreting past research, directions for future investigations, and limitations of the present study are discussed.

A double-blind, placebo-controlled comparison of treatment with fluticasone propionate and levocabastine in patients with seasonal allergic rhinitis. FLNCO2 Italian Study Group

Fluticasone propionate aqueous nasal spray (FPANS) is a topically active glucocorticoid which has been successfully used for the treatment of seasonal allergic rhinitis (SAR). Topical levocabastine is a highly selective H1 antagonist which has been proposed as an alternative treatment of SAR. The purpose of this study was to compare the clinical efficacy of two topical nasal treatments, FPANS and levocabastine, in the treatment of SAR. Additionally, the effect of treatments on nasal inflammation was examined during natural pollen exposure. A group of 288 adolescent and adult patients with at least a 2-year history of SAR to seasonal pollens participated in a multicenter, doubleblind, double-dummy, and placebo-controlled study. Patients were treated with either FPANS 200 microg, once daily (n = 97), or topical levocabastine, 200 microg, given twice daily (n = 96), or matched placebo (n = 95) for a period of 6 weeks, starting from the expected beginning of the pollen season. Clinically relevant pollens included Parietaria, olive, and grass. Assessment of efficacy was based on scores of daily nasal symptoms and on nasal cytology of nasal lavage. Nasal lavage was performed immediately before, during, and at the end of treatment in 39 patients. FPANS significantly increased the percentage of symptom-free days for nasal obstruction on waking and during the day, rhinorrhea, sneezing, and itching. FPANS provided a better control for night and day nasal obstruction (P<0.02 and P<0.01) and rhinorrhea (P<0.01) than levocabas tine. In addition, fewer patients treated with FPANS used rescue medication (P<0.025). The percentage of eosinophils in nasal lavage was reduced only during treatment with FPANS. The results of this study indicate that FPANS 200 microg, once daily, provides a better clinical effect than levocabastine 200 microg, twice daily, in patients with SAR. Unlike levocabastine, FPANS significantly attenuates nasal eosinophilia during pollen exposure, a feature which may explain its therapeutic efficacy.

Thrombosis of a mitral valve prosthesis resulting from Staphylococcus epidermidis endocarditis

A 70-year-old man with a Duromedics mitral valve prosthesis had two episodes of infective endocarditis caused by enterococcus (1994 and 1996). Colonoscopy revealed five polyps. Surgical resection was performed and 2 days later the patient had dyspnea and fever. Because of a suspected valve thrombosis, intravenous heparin was given which resulted in hematic effusion in the Douglas' cul-de-sac. Intravenous heparin was withdrawn but the patient continued to have a worsening dyspnea, hyperthermia and hypotension. The patient was transferred to our Institution in cardiogenic shock. Acute thrombosis of the valve was diagnosed by echocardiography, and the patient died before transesophageal Doppler echocardiography was performed. Post mortem examination revealed mitral valve infective thrombosis. In patients with valvular prostheses, endocarditis is an added thromboembolic risk.

Induced sputum in patients with newly diagnosed sarcoidosis: comparison with bronchial wash and BAL

OBJECTIVES

Sarcoidosis is characterized by a diffuse alveolar inflammatory process, although bronchial airways are often involved. This study compares the cellular profiles of induced sputum (IS), bronchial washing (BW), and BAL in newly diagnosed sarcoidosis patients to those in control subjects, and examines whether inflammatory cell counts from IS are correlated with inflammatory cell counts from BW and BAL in sarcoidosis patients.

PATIENTS AND MEASUREMENTS

We recruited 15 untreated patients with stage I and II pulmonary sarcoidosis and 12 healthy volunteers. Sputum was induced with hypertonic saline solution in all individuals. Bronchoscopy was performed on a different occasion in all patients and in five control subjects.

RESULTS

Mean lymphocyte counts in IS, BW, and BAL fluid from sarcoidosis patients were significantly higher than in control subjects (9.4% vs 3.8%, p < 0.05; 12.6% vs 3.9%, p < 0.05; 24.1% vs 2.6%, p < 0.05, respectively). Moreover, total cell count and percentage of epithelial cells in IS were significantly higher in sarcoidosis patients than in control subjects (p < 0.01 and p < 0.05, respectively). In sarcoidosis patients, comparison between different samples showed significantly higher percentages of macrophages in BW and BAL than in IS (p < 0.05 and p < 0.01, respectively), whereas the percentage of neutrophils was higher in IS compared with BW and BAL (p < 0.01 and p < 0.001, respectively). Finally, the percentage of lymphocytes in IS was significantly lower than that in BAL (p < 0.05) but not that in BW.

CONCLUSIONS

We demonstrated that, compared with IS in healthy control subjects, IS in untreated pulmonary sarcoidosis patients contains more total cells, lymphocytes, and epithelial cells. Although the relative proportion of inflammatory cells in the three samples differed, lymphocyte counts in IS were high. This finding suggests that IS could be used as a valuable alternative to more conventional invasive techniques in clinical assessment of pulmonary sarcoidosis patients.

The effects of smoking on periodontal disease and periodontal therapies

Cigarette smoking is a significant risk factor for the development of periodontal disease. In addition, there is an association between a reduced healing response subsequent to various periodontal therapies and cigarette smoking. As providers of dental care, it is our responsibility to inform our patients of the deleterious effects of smoking as well as the benefits of the cessation of this habit.

Bronchial responsiveness and airway inflammation in patients with nonallergic rhinitis with eosinophilia syndrome

BACKGROUND

Nonallergic rhinitis with eosinophilia syndrome (NARES) is characterized by persistent nasal symptoms without allergy and by a marked eosinophil recruitment in the nasal cavities.

OBJECTIVE

We studied whether patients with NARES had bronchial responsiveness to methacholine and airway inflammation and examined the relationship between these factors.

METHODS

We selected a group of 39 patients referred to our allergy clinic for symptoms of perennial rhinitis. Atopic status was excluded by skin prick tests and RASTs. None of the patients had a history of respiratory symptoms. We preliminarily performed nasal lavage in all patients, and the diagnosis of NARES was made on the basis of the presence of at least 10% eosinophils in nasal lavage fluid. A methacholine challenge and sputum induction were also done on two different days.

RESULTS

Eosinophils in nasal lavage fluid ranged between 10% and 86%. Serum IgE levels were within normal range. Total circulating eosinophils ranged between 40 and 890/mm3. Methacholine PD20 values were measurable in only 18 patients (range, 0.32 to 22.56 micromol; group 1). In the remaining 21 patients, methacholine PD20 values were greater than 24 micromol (group 2). We found that differential cell counts in nasal lavage fluid in group 1 were not different from those in group 2. Methacholine PD20 values were not significantly related to any cell count in the nasal lavage fluid. Induced sputum was accomplished only in 22 patients. Eosinophils in induced sputum ranged between 0% and 56.5%. Numbers of total cells, macrophages, lymphocytes, neutrophils, and epithelial cells in the two subgroups were not different. The number of metachromatic cells tended to be higher in group 1 compared with group 2 (0.31% vs 0.05%), but the difference was not significant. The eosinophil count in the induced sputum was significantly higher in group 1 compared with group 2 (16.8% vs 3.1%; p < 0.05). In the entire population, methacholine PD20 values were significantly correlated with the number of eosinophils in sputum (r = -0.63; p < 0.001).

CONCLUSION

We showed that 46% of patients with NARES but without histories of respiratory symptoms had a measurable bronchial responsiveness. The presence of bronchial responsiveness was associated with an increased number of eosinophils in induced sputum but not with the inflammatory process in the nose.

Eosinophils, mast cells, and basophils in induced sputum from patients with seasonal allergic rhinitis and perennial asthma: relationship to methacholine responsiveness

OBJECTIVES

We attempted to determine whether inflammation is present in induced sputum of patients with seasonal allergic rhinitis (AR) as compared with those with perennial asthma (AS) and examined its relationship with bronchial responsiveness to methacholine.

METHODS

Sputum was induced in 30 patients with seasonal rhinitis in response to grass pollens only and in 15 patients with stable, asymptomatic asthma. The AR group was divided according to methacholine PD20 value: the AR- group (n = 15) had a methacholine PD20 greater than 24 micromol; the AR+ group (n = 15) had a methacholine PD20 ranging between 2.2 and 19.6 micromol. In the AS group, methacholine PD20 ranged between 0.42 and 2.6 micromol. The percentage of eosinophils and metachromatic cells (alcian blue-positive) was assessed in sputum by light microscopy. Tryptase-positive cells and EG2+ cells were identified by immunocytochemistry with the mouse anti-human mast cell-tryptase monoclonal antibody and the monoclonal anti-eosinophil cationic protein antibody.

RESULTS

We found that the number of eosinophils in the AS group was greater than that in the AR+ group (p < 0.05) and in the AR- group (p < 0.01). Moreover, the eosinophil count was lower in the AR- group compared with the AR+ group (p < 0.05). Similarly, the number of EG2+ cells was greater in the AS group than in the AR group (p < 0.02) and the AR- group (p < 0.05). Moreover, the EG2+ cell count was lower in the AR- group than in the AR+ group (p < 0.05). The number of mast cells and basophils in the AS group was greater than that in the AR group (p < 0.05 and p < 0.01, respectively). Mast cells in sputum were tryptase-positive. Basophils were present in sputum from 23% of patients with AR and 53% of patients with asthma. There was a significant correlation between methacholine PD20 and eosinophils (p < 0.005) and mast cells (p < 0.02) but not with basophils in those patients showing a measurable methacholine PD20 (AR+ and AS groups).

CONCLUSIONS

Inflammatory cells are present not only in the airways of patients with asthma but also in airways of patients with seasonal AR, even outside natural exposure. Moreover, we provide evidence for the presence of basophils in sputum of patients with asthma even during clinical remission. The presence of bronchial responsiveness is associated with an increase in the number of eosinophils and metachromatic cells. Our findings are consistent with the hypothesis that eosinophils, as well as mast cells, contribute to bronchial responsiveness not only in AS but also in seasonal AR.

A review of root resective therapy as a treatment option for maxillary molars

Restorative treatment planning is often confounded when periodontal attachment loss, caries or tooth fracture involves the furcation area of the tri-rooted maxillary molars. Although such involvement invariably diminishes the long-term prognosis of the affected teeth, extraction is not always an option. Root resective therapy, which removes the involved root plus its associated crown portion (trisection), is one of several treatment modalities that can be used in such cases. This article reviews the indications and contraindications for root resective therapy, describes the techniques of surgical trisection and presents a case in which combined resective, endodontic and prosthetic management resulted in a successful outcome.

[Use of medicines by children attending nursery schools]

In order to study the pattern of the use of medicines by children, 1,382 children seen at 15 of the 16 day-care centers of Pinheiros, S. Paulo city (SP) (Brasil), were followed-up for 2 months. Of these, 37% received 1,409 drugs. Average drug use was 50.9 medicines/100 children/month and the number of medicines used by each child ranged from 0 to 13. Younger children (0-2 years) received more medicines and more frequently than older children; over 80% of the younger children received one or more medicines, and more than 20% received 5 or more medicines vs. less than 45% and 5%, respectively, in the group of children aged 2-7 years. The medications most frequently employed were anti-infective, respiratory medicines and antipyretics used by, respectively. 20.1%, 19.0% and 14.0% of the children studied (usually for respiratory problems). Physicians prescribed 93% of medicines, but there were many inappropriate therapies for benign conditions, such as bronchitis and common colds. Antibiotic measure was observed (66%) including an excessive number of cloramphenicol prescriptions. Also, there were many prescriptions of doubtful value (decongestants, expectorants, vitamin and mineral supplements) and usage of as yet un approved medications for children (diclofenac, benzidamin, iodides).

[Use of compression anastomosis devices in digestive surgery]

In this summary the authors report their experience of the clinical utilization in digestive surgery of a new compression anastomosis device consisting of a biofragmentable ring (BAR-Valtrac). From January 1993 through August 1994 26 patients underwent operations with Valtrac application: 22 for malignant colo-rectal neoplasms, 3 for diverticular disease and 1 for Crohn disease. The authors have performed 8 ileo-colic, 16 colo-colic and 2 colo-rectal anastomoses. There was no perioperatively mortality. Valtrac was discharged post-operatively between XVI and XXVIII days. There were no anastomotic leakage, bleeding or obstruction. Six months postoperatively an endoscopic control carried out in the 50% of the patients showed no anastomotic stenoses. These results, in association with those ones reported by the literature, confirm that anastomoses performed with Valtrac are safe, reliable and allow the same of better results than stapled anastomoses.

[Nutritional status of young children: a comparison among three anthropometric classifications]

OBJECTIVE

to compare the usefulness of the methods proposed by Gomez, Waterlow and W.H.O., to classify the nutritional status of children under 2 years of age.

METHOD

the nutritional diagnosis of 436 infants was defined at 6, 12, 18 and 24 months of age, using the three proposed methods. Predictive values, positive (PV+) and negative (PV-), and agreement coefficient (K) were calculated, comparing the nutritional classification of the children on each method with a gold standard of nutritional diagnosis, based on individual growth performance since their birth.

RESULTS

the three methods showed a good PV-, nearby 0.9, at all tested ages whereas the PV+ and K exhibited lower values. Among the three methods of classification of nutritional status, the method proposed by Gomez achieved the best levels of PV+, PV- and K, at all considered ages, mainly at 18 and 24 months of age.

CONCLUSIONS

the Gomez' method, as an unique criterion, is better than the others, because it has a lower risk of misdiagnosing a case of malnutrition. Nevertheless, this risk is big enough to not recommend its isolated use, mainly during the first year of life,when the risk of a false positive diagnosis of malnutrition is still higher.

[Comparison between nutritional status of school children of low socioeconomic level from Santiago, Chile and Sao Paulo, Brazil]

The objectives of this study were to determine and compare the anthropometric profiles of schoolchildren from low income household from Santiago, Chile and Sao Paulo, Brasil. A total of 1779 children from Santiago and 2210 from Sao Paulo were evaluated. Z-score distribution of the height/age (H/A), weight/age (W/A) and weight/height (W/H) indicators were utilized to assess the children. As a reference, the pattern recommended by WHO was used. The distribution of the H/A curves from both cities were deviated to the left. This deviation was more evident in Santiago. This situation points out the existence of a greater prevalence of growth retardation of the children from this city. In relation to the W/A indicator, both groups showed a similar distribution curves, Sao Paulo group however, had an increment of cases in the left extreme of the curve, under -2 <<Z score>>. According to the W/H indicator the profile of both groups are different; one-Santiago-is deviated to the excess and Sao Paulo to the deficit. The differences observed in both groups of children studied indicated higher deficit of height, but lower current undernutrition in Santiago and increased wasting with conservated height in Sao Paulo. The observed situation suggests that the distinct patterns are consequences of socioeconomic factors at different stages of the growing process of the children and/or etnic differences of the population.

[Use of sympathomimetic agents in fetal atrioventricular heart block]

A healthy pregnant was referred at 34 weeks gestation because an obstetrical ultrasound examination had shown fetal bradycardia and nonimmune hydrops. The heart was anatomically normal but complete heart block was present with a ventricular rate of 22bpm and atrial of 101bpm. We injected isoproterenol by cordocentesis direct in the umbilical vein of the fetus and a significant increase into the ventricular and atrial rates were obtained. The direct therapy with sympathomimetic drugs is a simple technique and may save fetuses with complete heart block and hidrops.