Chlorination for low-cost household water disinfection - A critical review and status in three Latin American countries

Chlorination has historically provided microbiologically safe drinking water in public water supplies. Likewise, chlorine has also been introduced as a low-cost disinfection method in rural and marginalized communities, both at community and household level, as well as during emergencies. Although this practice is common and well established for use as a household water treatment technology in the Global South, several challenges in effective and efficient implementation still need to be addressed. Here, we explored these issues by a literature review and narrowed them to the status of three Latin American countries (Mexico, Colombia, and Brazil). Overall, it was found that although guidance on household-based chlorination includes information on health risks and hygiene, this may not create enough incentive for the user to adapt the method satisfactorily. Physicochemical quality of the water influences chlorination efficiency and it is found that variations in quality are rarely considered when recommending chlorine doses during implementation. These are far more often based on a few measurements of turbidity, thereby not considering dissolved organic matter, or seasonal and day-to-day variations. Other factors such as user preferences, chlorine product quality and availability also represent potential barriers to the sustainable use of chlorination. For chlorination to become a sustainable household water treatment, more focus should therefore be given to local conditions prior to the intervention, as well as support and maintenance of behavioural changes during and after the intervention.

Similar glycaemic control with less nocturnal hypoglycaemia in a 38-week trial comparing the IDegAsp co-formulation with insulin glargine U100 and insulin aspart in basal insulin-treated subjects with type 2 diabetes mellitus

AIMS

To confirm non-inferiority of insulin degludec/insulin aspart (IDegAsp) once-daily (OD) versus insulin glargine (IGlar) U100 OD + insulin aspart (IAsp) OD for HbA_1c after 26 weeks, and compare efficacy and safety between groups at W26 + W38.

METHODS

A 38-week, randomised, open-label, treat-to-target (HbA_1c < 7.0%) trial in adults with type 2 diabetes mellitus (on basal insulin ± oral antidiabetic drugs; HbA_1c 7.0-10.0%). Randomisation (1:1): IDegAsp or IGlar U100 + IAsp. Intensification to IDegAsp twice daily (BID) was permitted at W26 + W32, or with additional IAsp injections at W26 (maximum IAsp BID) or W32 (maximum IAsp three-times daily).

RESULTS

For W0-W26, mean percentage-change (standard deviation) HbA_1c was: IDegAsp, -1.1 (0.9); IGlar U100 + IAsp, -1.1 (0.8); estimated treatment difference: 0.07% (95% confidence interval [CI]: -0.06; 0.21) confirmed non-inferiority. At W26 and W38, target HbA_1c achievement, and mean fasting and postprandial glucose were similar across groups. At W38, more subjects achieved target HbA_1c without hypoglycaemia with IDegAsp (22.5%) than with IGlar U100 + IAsp (21.1%), with significantly fewer nocturnal episodes (W0-W38, estimated rate ratio: 0.61 [95% CI: 0.40; 0.93]). Safety profiles were similar across treatment groups throughout.

CONCLUSIONS

IDegAsp OD/BID are effective treatment intensification options versus multiple injection basal-bolus therapies, achieving similar glycaemic control, with significantly less nocturnal hypoglycaemia.

[Injection of synthol in a bodybuilder can cause chronic wounds and ulceration]

In this case report we present a 45-year-old male bodybuilder, who had injected synthol and paraffin oil in both upper arms for augmentation purposes. This led to a circumference of 66 cm of his upper arms. His arms were rock solid and clearly deformed. Few years after the injections the patient suffered from spontaneous ulcerations on both arms. Conservative wound treatment with antibiotics and compression therapy had good effect on the ulcers of the right arm. The left arm needed surgical revision and negative pressure wound therapy preparing the tissue for a split skin graft.

[Marjolin's ulcer in a 54-year-old skin graft]

Marjolin's ulcer (MU) is a malignant degeneration of a chronic wound and spinocellular carcinoma is the most common type. MU is described as being aggressive in nature and carries a high incidence of metastases. A 71-year-old man developed spinocellular carcinoma 54 years after a primary amputation and a construction of a skin graft due to a severe foot trauma. The carcinoma was excised and a forefoot amputation was performed.

Structure and mechanism of Zn2+-transporting P-type ATPases

Zinc is an essential micronutrient for all living organisms. It is required for signalling and proper functioning of a range of proteins involved in, for example, DNA binding and enzymatic catalysis. In prokaryotes and photosynthetic eukaryotes, Zn(2+)-transporting P-type ATPases of class IB (ZntA) are crucial for cellular redistribution and detoxification of Zn(2+) and related elements. Here we present crystal structures representing the phosphoenzyme ground state (E2P) and a dephosphorylation intermediate (E2·Pi) of ZntA from Shigella sonnei, determined at 3.2 Å and 2.7 Å resolution, respectively. The structures reveal a similar fold to Cu(+)-ATPases, with an amphipathic helix at the membrane interface. A conserved electronegative funnel connects this region to the intramembranous high-affinity ion-binding site and may promote specific uptake of cellular Zn(2+) ions by the transporter. The E2P structure displays a wide extracellular release pathway reaching the invariant residues at the high-affinity site, including C392, C394 and D714. The pathway closes in the E2·Pi state, in which D714 interacts with the conserved residue K693, which possibly stimulates Zn(2+) release as a built-in counter ion, as has been proposed for H(+)-ATPases. Indeed, transport studies in liposomes provide experimental support for ZntA activity without counter transport. These findings suggest a mechanistic link between PIB-type Zn(2+)-ATPases and PIII-type H(+)-ATPases and at the same time show structural features of the extracellular release pathway that resemble PII-type ATPases such as the sarcoplasmic/endoplasmic reticulum Ca(2+)-ATPase (SERCA) and Na(+), K(+)-ATPase. These findings considerably increase our understanding of zinc transport in cells and represent new possibilities for biotechnology and biomedicine.

[Quality of care of patients with chronic heart failure in primary care]

INTRODUCTION

The prevalence of Chronic Heart Failure (CHF) in Spain is very high. It is the main cause of many hospital admissions and it is associated with high mortality rates. Its management in Primary Care is not always adequate. Our objective was to evaluate whether an educational intervention in general practitioners would improve the health care of their patients with chronic heart failure.

MATERIAL AND METHODS

Prospective, randomised, and controlled study. A structured formative course was given to the intervention group (IG) of practitioners. A year later changes were compared with a control group (CG). The settings were two Primary Care Centres. One of them was in a rural setting, and the other one with a mixture of rural and urban populations. The study included 185 patients diagnosed with CHF, with a mean age of 79.8 years, and they were assigned to 20 practitioners (Total population: 15, 921) We evaluated the quality of medical history, clinical examination, laboratory tests and treatment.

RESULTS

At the end of the study there were marked differences between both groups. In the IG, the Medical History improved 1.42 points (95% CI: 0.57 to 2.28), P = .001. The Clinical Examination improved 2.37 points (95% CI: 1.10 to 3.65), P > .001 and the Laboratory Tests, 0.75 points (95% CI: -0.15 to 1.66), P = .10; The Overall Difference was 5.44 points (95% Cl: 3.25 to 7.62), P > .001. There were slight improvements in Treatment.

CONCLUSIONS

The intervention promoted from our own work settings achieved a general improvement in the care of patients with heart failure.

Data management in automated external defibrillators: a call for a standardised solution

BACKGROUND

The ECG data stored in automated external defibrillators (AEDs) may be valuable for establishing a final diagnosis and deciding further diagnostics and treatment. Different data management systems are used and this may create significant problems for data storage and access for physicians treating victims in whom an AED has been used.

METHODS

In this descriptive study, we collected information (number, manufacturer and model) on 17 December 2010 from a web page used for the voluntary registration of AEDs in Denmark. The manufacturers were contacted and asked to provide information about data downloading.

RESULTS

There were 12 different manufactures and 20 different AED models. Five models were registered in a quantity <5. We report data from the remaining 15 models (3603 AEDs). Several models stored only one case or 15 min of ECG data. All models had a data transfer option, but most had outdated 'hardware': Seven had infrared transfer; one had a cable with a serial port. Four had a removable memory device, but only one was a USB. The software was available as freeware only in a few cases. Otherwise, a CD ROM was needed, some even with a licence. The software for the second most common AED could not be installed.

CONCLUSION

The development of data management solutions is not a high priority. We encourage the manufacturers to collaborate with researchers to develop a simple data transfer solution in order to improve patient care and facilitate research.

Chalcocite Oxidation and Coupled Carbon Dioxide Fixation by Thiobacillus ferrooxidans

The reaction of cell suspensions of Thiobacillus ferrooxidans with pulverized chalcocite (Cu(2)S) in a Warburg manometric apparatus resulted in oxygen uptake accompanied by increased solubilization of copper and fixation of carbon dioxide. Since the only detectable oxidized products were cupric ions and the more oxidized form of the sulfide mineral, that is, digenite or covellite, the apparent source of energy for the carbon dioxide fixation was provided by the oxidation of the cuprous copper of the chalcocite.

New Danish reference values for height, weight and body mass index of children aged 0-5 years

AIM

To derive new reference values for height, weight and body mass index (BMI) of children aged 0-5 years in Denmark and to compare them with the national reference from the 1970s and the 2006 WHO standard.

METHODS

The height and weight of 4105 healthy singleton children born in 1995 were obtained from a cohort study. Children were measured at birth and at seven regular health examinations by a general practitioner up to 5 years of age. Generalized additive models for location, scale and shape were used to construct percentile curves.

RESULTS

Mean length, weight and BMI at birth and during the first months of life increased significantly, but the differences diminished thereafter, and at 1 year BMI had decreased. In boys, weight and BMI had decreased by 2 years of age but had increased, together with height, at 5 years. Children were taller, heavier and had a higher BMI than that referred to in the WHO standard.

CONCLUSION

New references for length or height, weight and BMI by age were constructed for children in Denmark. Since the 1970s, weight, length and BMI at birth increased, and growth during the first year of life appears to be healthier.

[Calciphylaxis]

Calciphylaxis is a serious condition including ischaemic, nodular necrosis of the subcutaneous tissue and occlusion of small and medium-sized arteries. The prevalence of calciphylaxis among patients on chronic haemodialysis constitutes 1-4 percent. The condition is associated with high mortality due to co-morbidity. Calciphylaxis seems to be preventable by optimized control of calcium-phosphorous metabolism in susceptible individuals. New and promising therapies are evolving. It is important to focus on this condition in order to provide the relevant therapy to the affected cases.

Environmental properties of long-chain alcohols. Part 2: Structure-activity relationship for chronic aquatic toxicity of long-chain alcohols

Daphnia magna reproduction tests were performed with C(10), C(12), C(14) and C(15) alcohols to establish a structure-activity relationship of chronic effects of long-chain alcohols. The data generation involved substantial methodological efforts due to the exceptionally rapid biodegradability of the test substances and the need to test as close as possible to their water solubility limits. Test concentrations were determined by GC-MS before and after test solution renewal. Whereas apparent toxicity based on survival and reproduction increased with increasing C-chain lengths up to C(14), observations of toxicity to C(15) alcohol were not in line with lower chain lengths due to the lack of toxicity below the level of water solubility. When omitting C(15), the slope of most (Q)SARs approach -1, being consistent with the expectation of a non-polar narcotic mode of action. Further testing at higher chain lengths is not sensible due to progressively lower solubility, at remaining biodegradability. Effects on mortality and reproduction are not expected below the level of water solubility.

Assessment of the environmental risk of long-chain aliphatic alcohols

An environmental assessment of long-chain alcohols (LCOH) has recently been conducted under the OECD SIDS High Production Volume (HPV) Program via the Global International Council of Chemical Associations (ICCA) Aliphatic Alcohols Consortium. LCOH are used primarily as intermediates, as a precursor to alcohol-based surfactants and as alcohol per se in a wide variety of consumer product applications. Global production volume is approximately 1.58 million metric tonnes. The OECD HPV assessment covers linear to slightly branched LCOH ranging from 6 to 22 alkyl carbons (C). LCOH biodegrade exceptionally rapidly in the environment (half-lives on the order of minutes); however, due to continuous use and distribution to wastewater treatment systems, partitioning properties, biodegradation of alcohol-based surfactants, and natural alcohol sources, LCOH are universally detected in wastewater effluents. An environmental risk assessment of LCOH is presented here by focusing on the most prevalent and toxic members of the linear alcohols, specifically, from C(12-15). The assessment includes environmental monitoring data for these chain lengths in final effluents of representative wastewater treatment plants and covers all uses of alcohol (i.e., the use of alcohol as a substance and as an intermediate for the manufacturing of alcohol-based surfactants). The 90th percentile effluent discharge concentration of 1.979microg/L (C(12)-C(15)) was determined for wastewater treatment plants in 7 countries. Chronic aquatic toxicity studies with Daphnia magna demonstrated that between C(13) and C(15) LCOH solubility became a factor and that the structure-activity relationship was characterized by a toxicity maximum between C(13) and C(14). Above C(14) the LCOH was less toxic and become un-testable due to insolubility. Risk quotients based on a toxic units (TU) approach were determined for various scenarios of exposure and effects extrapolation. The global average TU ranged from 0.048 to 0.467 depending on the scenario employed suggesting a low risk to the environment. The fact that environmental exposure calculations include large fractions of naturally derived alcohol from animal, plant, and microbially mediated biotransformations further supports a conclusion of low risk.

Legume anchor markers link syntenic regions between Phaseolus vulgaris, Lotus japonicus, Medicago truncatula and Arachis

We have previously described a bioinformatics pipeline identifying comparative anchor-tagged sequence (CATS) loci, combined with design of intron-spanning primers. The derived anchor markers defining the linkage position of homologous genes are essential for evaluating genome conservation among related species and facilitate transfer of genetic and genome information between species. Here we validate this global approach in the common bean and in the AA genome complement of the allotetraploid peanut. We present the successful conversion of approximately 50% of the bioinformatics-defined primers into legume anchor markers in bean and diploid Arachis species. One hundred and four new loci representing single-copy genes were added to the existing bean map. These new legume anchor-marker loci enabled the alignment of genetic linkage maps through corresponding genes and provided an estimate of the extent of synteny and collinearity. Extensive macrosynteny between Lotus and bean was uncovered on 8 of the 11 bean chromosomes and large blocks of macrosynteny were also found between bean and Medicago. This suggests that anchor markers can facilitate a better understanding of the genes and genetics of important traits in crops with largely uncharacterized genomes using genetic and genome information from related model plants.

Calculating pH in pig manure taking into account ionic strength

Models such as the Anaerobic Digestion Model No. 1 (ADM1) assume that pH can be calculated directly from the concentration of hydrogen ions. However because pH is, by definition, the negative logarithm of the hydrogen ion activity, and thus pH measurements represent hydrogen ion activities, this approach may lead to a bias between measured and predicted pH values. Implementing ionic strength effects into the charge balance equation and the calculation of pH is a theoretical improvement to this. In this study a model, implementing a procedure for calculating pH, was developed to analyse the effect of ionic strength on pH in a pig manure. By adding KCl to samples of pig manure, experimental results could be analysed with help from the model. A modified form of the Davies equation was found to give the most accurate prediction of pH in the pig manure studied in this paper with changing ionic strength.

A general pipeline for the development of anchor markers for comparative genomics in plants

Background

Complete or near-complete genomic sequence information is presently only available for a few plant species representing a large phylogenetic diversity among plants. In order to effectively transfer this information to species lacking sequence information, comparative genomic tools need to be developed. Molecular markers permitting cross-species mapping along co-linear genomic regions are central to comparative genomics. These "anchor" markers, defining unique loci in genetic linkage maps of multiple species, are gene-based and possess a number of features that make them relatively sparse. To identify potential anchor marker sequences more efficiently, we have established an automated bioinformatic pipeline that combines multi-species Expressed Sequence Tags (EST) and genome sequence data.

Results

Taking advantage of sequence data from related species, the pipeline identifies evolutionarily conserved sequences that are likely to define unique orthologous loci in most species of the same phylogenetic clade. The key features are the identification of evolutionarily conserved sequences followed by automated design of intron-flanking Polymerase Chain Reaction (PCR) primer pairs. Polymorphisms can subsequently be identified by size- or sequence variation of PCR products, amplified from mapping parents or populations. We illustrate our procedure in legumes and grasses and exemplify its application in legumes, where model plant studies and the genome- and EST-sequence data available have a potential impact on the breeding of crop species and on our understanding of the evolution of this large and diverse family.

Conclusion

We provide a database of 459 candidate anchor loci which have the potential to serve as map anchors in more than 18,000 legume species, a number of which are of agricultural importance. For grasses, the database contains 1335 candidate anchor loci. Based on this database, we have evaluated 76 candidate anchor loci with respect to marker development in legume species with no sequence information available, demonstrating the validity of this approach.

Peritoneal mesotheliomas in Danish women: review of histopathologic slides and history of abdominal surgery

An unexpectedly large number of peritoneal mesotheliomas among women was reported to the Danish Cancer Registry during the years 1960 through 1985. In a case-control study, we tested whether this was due to diagnostic misclassification or to direct exposure of the peritoneal membranes to talc during abdominal surgery. Tissue specimens were available from 96 reported peritoneal mesotheliomas; 35 cases (37%) were regarded as verified mesotheliomas, and 33 (34%) as possible mesotheliomas. Information on any intraabdominal surgery was obtained from the hospital records of these 68 cases and for 206 controls with a cancer of the uterine corpus or pancreas. No association was seen between peritoneal mesotheliomas and abdominal surgery performed more than 25 years prior to cancer diagnosis (odds ratio, 0.83; 95% confidence interval, 0.35-1.94). CONCLUSION. Misclassification of other cancers was the reason for the observed excess of peritoneal mesotheliomas.

[Antral vascular ectasia--"water-melon stomach". An overlooked cause of iron deficiency anemia?]

Antral vascular ectasia or "the watermelon stomach" (WS) is an endoscopically, histologically and clinically distinct entity. The term WS reflects the endoscopic appearance of longitudinal antral erythematous folds containing visible vessels radiating from the pylorus. Histological examination demonstrates characteristic features including dilated mucosal capillaries, focal thrombosis and fibromuscular hypertrophy of the lamina propria. The clinical picture is characterized by severe chronic iron deficiency anaemia, and failure to recognize WS has frequently delayed adequate treatment for several years. Antrectomy is a definitive cure. Both endoscopic laser- and sclerotherapy seem to be promising alternative methods in the treatment of WS.

[Whooping cough in Denmark among children under 1 year of age during 1980-1986]

On the basis of individual notifications, reports of cases verified by culture and letters of discharge or case reports of infants under one year with whooping cough during the period 1980-1986, the distribution of the disease is described together with vaccine efficacy and the presumed sources of infection for infants in this age group. The incidence of whooping cough in infants under one year is estimated to be approximately three cases per 1,000 per annum as compared with 150 per 1,000 at the beginning of this century and 60 per 1,000 in the nineteen fifties before routine vaccination was introduced in 1961. The first vaccination is calculated to provide a vaccine efficacy of 39%, after the second vaccination the vaccine efficacy rises to 86% and after the third vaccination the vaccine efficacy is about 98% during the remainder of the first year of life. Even although the times of vaccination were advanced in 1970, this has not reduced the frequency of whooping cough in infants as the vaccination programme has simultaneously been weakened because children are now vaccinated only three times with a weaker vaccine and the immunity is of briefer duration. The commonest sources of infection for infants are siblings. A lower infective risk is desirable and this could be obtained by vaccinating infants an extra time. Alterations in the system of notification in 1980 have resulted in increased under-notification of whooping cough in children under one year while, simultaneously, the notified cases have been described better.

[Whooping cough necessitating hospitalization in Denmark, 1980-1986]

Information from the Danish National Patient Register revealed that 817 patients had been hospitalized with verified whooping cough during the period 1980-1986. The letters of discharge or the case records were obtained for all patients under one year for the entire period and for all patients over one year for the period 1984-1986, a total of 627 persons. These were supplemented by information from forms with information about positive cultures for whooping cough in nasopharyngeal swabs and from individual notifications about children under one year. 65% of the hospitalized patients were under one year and only 2% over 15 years. The severity of the disease measured by the duration of hospitalization and the presence of serious complications and symptoms decreased with age. The average duration of hospitalization was 15 days for children under one year and seven days for children over one year. Five children died. One child developed epilepsy, nine of the remainder required assisted respiration and recovered apparently without permanent damage. Out of the 627 patients who were hospitalized, pneumonia developed in 12%, seizures in 2% under one year and 5% over one year, apnoea occurred in 10% under one year and 2% over one year and cyanosis occurred in 61% under one year and 30% over one year. None of the vaccinated children developed seizures, required assisted ventilation or died and only 2% had apnoea as compared with 7% in the unvaccinated children. Children under two months and children in whom vaccination was contraindicated were responsible for 56% of the hospitalizations among children under one year and for 79% of the most severe cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Response of the goat carotid body to acute and prolonged hypercapnia

The effect of prolonged hypercapnia on carotid chemoreceptor discharge frequency has not been elucidated. In addition, the effect of acute hypercapnia on chemoreceptor discharge has not been determined in the goat, a species commonly used for ventilatory control studies. Therefore, we determined the effects of acute and prolonged normoxic-hypercapnia on single fiber output of the carotid body of chloralose anesthetized goats. The animals were paralyzed and artificially ventilated. The average acute response curve for 12 single fibers was linear over the range of 30-80 Torr PaCO2 with a mean slope of 0.115 +/- 0.057 (SD) imp.sec-1.Torr-1 PaCO2. Elevated discharge frequency was maintained during prolonged (up to 240 min, n = 11) steady-state hypercapnia (X PaCO2 = 85 Torr). No systematic time-dependent changes in afferent discharge frequency occurred during the period. The findings obtained during sustained hypercapnia are in contrast to the time-dependent increase in carotid body activity seen previously in our laboratory with prolonged normocapnic-hypoxia of up to 240 min duration.

Carotid chemoreceptor activity during acute and sustained hypoxia in goats

The role of carotid body chemoreceptors in ventilatory acclimatization to hypoxia, i.e., the progressive, time-dependent increase in ventilation during the first several hours or days of hypoxic exposure, is not well understood. The purpose of this investigation was to characterize the effects of acute and prolonged (up to 4 h) hypoxia on carotid body chemoreceptor discharge frequency in anesthetized goats. The goat was chosen for study because of its well-documented and rapid acclimatization to hypoxia. The response of the goat carotid body to acute progressive isocapnic hypoxia was similar to other species, i.e., a hyperbolic increase in discharge as arterial PO2 (PaO2) decreased. The response of 35 single chemoreceptor fibers to an isocapnic [arterial PCO2 (PaCO2) 38-40 Torr)] decrease in PaO2 of from 100 +/- 1.7 to 40.7 +/- 0.5 (SE) Torr was an increase in mean discharge frequency from 1.7 +/- 0.2 to 5.8 +/- 0.4 impulses. During sustained isocapnic steady-state hypoxia (PaO2 39.8 +/- 0.5 Torr, PaCO2, 38.4 +/- 0.4 Torr) chemoreceptor afferent discharge frequency remained constant for the first hour of hypoxic exposure. Thereafter, single-fiber chemoreceptor afferents exhibited a progressive, time-related increase in discharge (1.3 +/- 0.2 impulses.s-1.h-1, P less than 0.01) during sustained hypoxia of up to 4-h duration. These data suggest that increased carotid chemoreceptor activity contributes to ventilatory acclimatization to hypoxia.

Somatic manifestations in children suspected of having been maltreated

The present study revealed an incidence of maltreatment of 26.8 in 100,000 children under 15 years of age, higher than previously assumed. The sample comprises 41 children suspected of having been maltreated. A systematic examination included radiography and isotope scintigraphy of the skeletal system. In 9 cases the diagnosis was not confirmed, in 23 confirmed, and in 9 children it seemed likely. The most common form of maltreatment was physical violence with bruises. A total of 6 fractures were demonstrated. Three children had been exposed to sexual abuse. Intracranial haematoma, of long standing, was found in one child. Thirteen of the children (40%) were of short statute, their height and weight below the 25th percentile. Among 27 children examined by X-rays 16 (59%) had delayed skeletal maturation. Disturbances of growth, as well as behavioural abnormalities, were particularly striking in this group of patients. The findings suggest that even the slightest suspicion of maltreatment should lead to a general medical evaluation without delay.

Dopamine blockade alters ventilatory acclimatization to hypoxia in goats

Dopamine (DA) is generally accepted to be an inhibitory neurotransmitter in the carotid body (CB). It is released and depleted from the CB by acute hypoxia. From this background we made the hypothesis that hypoxic depletion of CB DA could be responsible for a time-dependent increase in CB afferent output and the early phase of ventilatory acclimatization to hypoxia (VAH) in goats. We reasoned, then, that blockade of DA receptors in the CB would accelerate the time course of VAH in the goat, i.e. produce a greater acute response to hypoxia (first 15 min) followed by a reduced rate of change of the subsequent time-dependent hyperventilation. We tested this hypothesis by exposing 7 adult female goats to up to 28 h of hypobaric hypoxia (PB = 380 Torr) on 3 different occasions separated by at least 2 months. The first was as control. During the second and third exposures different doses of the DA antagonist, domperidone, were administered prior to and during the hypoxic exposure (0.5 mg/kg followed by 0.25 mg/kg every 3 h and in the second study 1.0 mg/kg followed by 0.5 mg/kg every 2 h). The time course of acclimatization was assessed by measurement of arterial blood gases and pH in the awake goats. The data obtained in the first 4-5 h of hypoxia in domperidone treated animals appeared to support the hypothesis. Domperidone treated animals had a significantly greater acute ventilatory response to hypoxia followed by a lower rate of progressive hyperventilation in this period. However, variation in control values, greater respiratory alkalosis and a secondary significant hyperventilation after 6-7 h of hypoxia in the domperidone treated animals prevents a clear conclusion as to the precise role of CB dopaminergic mechanisms in acclimatization to hypoxia. Nevertheless, peripheral DA receptor blockade with domperidone does alter the time course and magnitude of hyperventilation during the first 7 h of hypobaric hypoxia in goats.

Phrenic nerve responses to hypoxia and CO2 in decerebrate dogs

Phrenic responses to isocapnic hypoxia and hypercapnia were studied using paralyzed vagotomized dogs (either decerebrate or chloralose-anesthetized). The hypoxia-induced increase in phrenic minute activity (PMA) was significantly greater in anesthetized dogs when compared with the response observed in decerebrate dogs. Phrenic responses to hypercapnia were also significantly different in the two groups of dogs. Increases in phrenic amplitude (AMP) and frequency (FREQ) were observed in anesthetized dogs, whereas decerebrate dogs responded to CO2 without a change in FREQ. Spontaneously breathing dogs (either decerebrate or anesthetized) were used for studying the effects of vagotomy on the integrated phrenic neurogram. Changes in phrenic pattern in response to vagotomy were qualitatively similar in anesthetized and decerebrate dogs. However, in decerebrate dogs, AMP was disproportionately increased relative to the decrease in FREQ such that PMA increased following vagal transection. Conversely, in anesthetized dogs, the increase in AMP and decrease in FREQ in response to vagotomy were proportional; PMA remained unchanged. These results suggest that mesencephalic decerebration disrupts neuronal circuits which participate in the chemical control of breathing. In addition, suprapontine structures may be involved in coupling FREQ and AMP (tidal volume) so that PMA (ventilation) is stabilized. Finally, these studies provide evidence for a vagally-independent frequency controller in dogs which is sensitive to hypoxia and hypercapnia, but appears to be highly dependent upon suprapontine structures.

Domperidone-induced potentiation of ventilatory responses in awake goats

Dopamine has been implicated in maintaining tonic inhibition of carotid body activity. We tested this hypothesis by assessing the ventilatory effects of a peripheral dopamine antagonist, domperidone. The effects of this agent on the ventilatory responses to hypoxia and hypercapnia were also examined. The study was performed in awake carotid body intact and carotid body denervated goats. Resting minute ventilation increased while PaCO2 decreased (4 Torr) following domperidone administration (0.5 mg/kg, I.V.) in carotid body intact goats. This response did not occur in carotid body denervated goats supporting the hypothesis that endogenous dopamine provides tonic inhibition in the carotid body. Hypoxic and hypercapnic ventilatory responses were significantly augmented following domperidone administration in the carotid body intact goats. This supports the concept of dopaminergic modulation of the response of the carotid body to stimuli. Domperidone allows study of carotid chemoreceptor dopaminergic activity in awake animals because of its high affinity for carotid body D2 dopamine receptors and its lack of CNS effects.

Role of beta adrenergic receptors in carotid body function of the goat

Previous studies in anesthetized or decerebrate cats and rabbits and awake man have shown conflicting results regarding a potential role for beta-adrenergic receptors in carotid body function. Therefore, we sought to clarify the role of beta-adrenergic receptor activity in carotid body function by assessing: the ventilatory response to intravenous isoproterenol infusion in awake and anesthetized carotid body intact and carotid body denervated goats, the effect of propranolol on the ventilatory response to isocapnic hypoxemia, and carotid sinus nerve chemoreceptor discharge rate response to isoproterenol and hypoxia. Isoproterenol increased ventilation to a similar degree in carotid body intact and denervated awake and anesthetized goats. This ventilatory increase was blocked by propranolol. Propranolol did not alter the hypoxic ventilatory response. Although ventilation increased, carotid sinus nerve chemoreceptor discharge rate was not altered by isoproterenol infusion or bolus IV injection in anesthetized goats. Hypoxia did increase carotid sinus nerve discharge rate. In this study, beta-adrenergic stimulation of ventilation did not occur via the carotid body, and beta-adrenergic blockade did not affect the carotid body hypoxic ventilatory response. Therefore, we found no evidence of functional beta-adrenergic activity within the carotid body of the goat.

Carotid bodies are required for ventilatory acclimatization to chronic hypoxia

We have compared the ventilatory responses of intact and carotid body-denervated (CBD) goats to moderate [partial pressure of O2 in arterial blood; (Pao2) approximately 44 Torr] and severe (Pao2 approximately 33 Torr) many time points for up to 7 days of hypobaria. In the intact group there were significant time-dependent decreases in partial pressure of CO2 in arterial blood (PaCO2) in both moderate and severe hypoxemia (approximately-7 and -11 Torr) that were largely complete by 8 h of hypoxemia and maintained throughout. Acute restoration of normoxia in chronically hypoxic intact animals produced time-dependent increases in Paco2 over 2 h, but hypocapnia persisted relative to sea-level control. Arterial plasma [HCO3-] and [H+] decreased, and [Cl-] increased with a time course and magnitude consistent with developing hypocapnia. Chronic CBD, per se, resulted in a sustained, partially compensated respiratory acidosis, as PaCO2 rose 6 Torr and base excess rose 3 mEq/1, [Cl-] fell 1 mEq/1, and pHa fell 0.01 units. During exposure to identical levels of arterial hypoxemia as in the intact group. CBD animals showed no significant changes in PaCO2, [H+]a, or [HCO3-]a at any time during moderate or severe hypoxemia. Plasma [C1-] remained within the normal range throughout exposure to moderate hypoxia and increased in severe hypoxia. In a few instances some hypocapnia was observed, but this was highly inconsistent and was always less than one-third of that observed in intact goats. In contrast to intact goats, acute restorations of normoxia in the chronically hypoxic CBD goats always caused hyperventilation.(ABSTRACT TRUNCATED AT 250 WORDS)

Reduction of gastric acid secretion by 10 mg and 30 mg omeprazole once daily

The reduction in gastric acid secretion by 10 mg and 30 mg omeprazole was studied in 12 patients with ulcer disease in a randomized, double-blind, two-way balanced crossover study. A standardized pentagastrin test was performed before the study and 24 h after each treatment period of 6 days. Treatment was followed by a washout period of 7 days. Omeprazole, 30 mg/day, significantly reduced basal acid output (BAO) by 90% and pentagastrin-stimulated acid output (PAO) by 45% (p less than 0.01), whereas BAO and PAO were not significantly reduced by omeprazole, 10 mg/day.

Differential effects on phrenic output of two dopamine agonists, apomorphine and bromocriptine

Effects of dopamine agonists upon phrenic output were studied in decerebrate, vagotomized, paralyzed, carotid-body denervated dogs. Intravenous administration of dopamine was without effect in these dogs. Apomorphine (APO) increased phrenic minute activity while bromocriptine (BRO) decreased phrenic minute activity following intravenous injection at doses of 100 micrograms/kg for each drug. BRO-induced decreases in phrenic minute activity were associated with decreases in phrenic amplitude; burst frequency remained unchanged. Conversely, APO-induced increases in phrenic minute activity resulted from significant increases in both frequency and amplitude. Both APO and BRO significantly prolonged inspiratory duration and shortened expiratory duration. Responses to APO and BRO were abolished with haloperidol. These results confirm previous evidence for the existence of dopaminergic receptors within the central nervous system, which are inaccessible to exogenous dopamine, and which can alter timing as well as amplitude characteristics of the integrated phrenic neurogram. Both excitation and inhibition of phrenic activity following administration of APO and BRO are mediated by mechanisms within or below the caudal brainstem.

Effect of emepronium bromide (Cetiprin) on symptoms and urinary bladder function after transurethral resection of the prostate. A double-blind randomized trial

75 patients were randomized to be treated with either emepronium bromide (Cetiprin) 200 mg 4 times a day or placebo after transurethral resection of the prostate. The patients were evaluated urodynamically pre- and postoperatively, and further evaluated by micturition symptom charts. No significant differences in symptoms or objective findings were found between the patients treated with emepronium bromide and those treated with placebo.

Dopaminergic modulation of respiratory timing mechanisms in carotid body-denervated dogs

The role of central dopaminergic mechanisms in ventilatory control was investigated by monitoring phrenic motorneuronal output of anesthetized dogs which were vagotomized, paralyzed and artificially ventilated and in which bilateral carotid body denervation had been performed. Intravenous administration of dopamine (DA) had no effect on phrenic output in these dogs. In contrast, apomorphine (APO), a potent dopaminergic agonist, which unlike dopamine, crosses the blood-brain barrier consistently and significantly prolonged inspiratory duration and shortened expiratory duration without altering phrenic amplitude. The dopaminergic antagonist haloperidol produced a frequency-dependent decrease in basal phrenic minute activity and reversed or abolished APO-induced changes in the phrenic profile. These data verify the specificity of APO for dopamine receptors and further suggest that DA receptors in the central nervous system exert a tonic effect on central respiratory control mechanisms. In contrast, domperidone, a dopaminergic antagonist which poorly penetrates the blood-brain barrier did not alter basal phrenic characteristics. Moreover, with the exception of inspiratory duration, domperidone did not antagonize APO-induced alterations in the phrenic profile. We conclude that dopaminergic mechanisms within the brain or spinal cord modulate timing relationships of central respiratory output.

Auranofin (SK + F 39162) induced enterocolitis in rheumatoid arthritis. A case report

A case of gold-induced enterocolitis in a 69-year-old female with rheumatoid arthritis who had received the new gold compound by oral administration (Auranofin (AF) for 4 weeks) is reported. Mild diarrhoea is a commonly described side effect accompanying AF, but in this case a severe colitis developed. The course of this case is very similar to those reported regarding Myochrysin. The pathogenesis is discussed. It might be a direct toxic effect on the mucosa of the bowel, evidenced by the relatively high excretion of oral gold with faeces.