A Clinical Prediction Rule for Thrombosis in Critically Ill COVID-19 Patients: Step 1 Results of the Thromcco Study

The incidence of thrombosis in COVID-19 patients is exceptionally high among intensive care unit (ICU)-admitted individuals. We aimed to develop a clinical prediction rule for thrombosis in hospitalized COVID-19 patients. Data were taken from the Thromcco study (TS) database, which contains information on consecutive adults (aged ≥ 18) admitted to eight Spanish ICUs between March 2020 and October 2021. Diverse logistic regression model analysis, including demographic data, pre-existing conditions, and blood tests collected during the first 24 h of hospitalization, was performed to build a model that predicted thrombosis. Once obtained, the numeric and categorical variables considered were converted to factor variables giving them a score. Out of 2055 patients included in the TS database, 299 subjects with a median age of 62.4 years (IQR 51.5-70) (79% men) were considered in the final model (SE = 83%, SP = 62%, accuracy = 77%). Seven variables with assigned scores were delineated as age 25-40 and ≥70 = 12, age 41-70 = 13, male = 1, D-dimer ≥ 500 ng/mL = 13, leukocytes ≥ 10 × 10³/µL = 1, interleukin-6 ≥ 10 pg/mL = 1, and C-reactive protein (CRP) ≥ 50 mg/L = 1. Score values ≥28 had a sensitivity of 88% and specificity of 29% for thrombosis. This score could be helpful in recognizing patients at higher risk for thrombosis, but further research is needed.

The problem of misidentification between edible and poisonous wild plants: Reports from the Mediterranean area

Today, in many European countries, people are looking for wild edible plants to experience new tastes and flavors, by following the new trend of being green and environmentally friendly. Young borage and spinach leaves can be easily confused by inexpert pickers with those of other plants, including poisonous ones, such as Mandragora autumnalis Bertol. (mandrake) or Digitalis purpurea L. (foxglove), common in southern and northern Italy respectively. In the last twenty years, several cases of intoxication by accidental ingestion of mandrake and foxglove have been reported. The purpose of this work was to perform a pharmacognostic characterization of young leaves from borage, mandrake, foxglove and spinach, by micro-morphological, molecular and phytochemical techniques. The results showed that each of the three techniques investigated could be sufficient alone to provide useful information for the identification of poisonous species helping the medical staff to manage quickly the poisoned patients. However, the multi-disciplinary approach proposed could be very useful to asses the presence of poisonous plants in complex matrices, to build a database containing morphological, molecular and phytochemical data for the identification of poisonous species or in forensic toxicology, given their increasingly frequent use due to their low cost and relatively common availability.

Epiglottic Non-Hodgkin's Lymphoma: Case Report

A locally recurrent head and neck nodal, B cell nodular, non-Hodgkin's lymphoma transformed to a diffuse histologic pattern with a peculiar bone marrow and epiglottic involvement without other apparent localizations is reported. Radiotherapy proved highly effective for local control of the epiglottic lesion but chemotherapy failed to eradicate bone marrow disease.

A preliminary longitudinal study on the cognitive and functional outcome of bipolar excellent lithium responders

BACKGROUND

Neurocognitive dysfunction in bipolar disorder represents a possible marker of underlying pathophysiology, but to date, most studies are cross-sectional and heterogeneous with regard to pharmacological treatments. In the present study we investigated the 6-year cognitive and functional outcome of a sample of euthymic excellent lithium responders (ELR).

METHOD

A total sample of twenty subjects was assessed at baseline and 6years later: ten diagnosed of bipolar disorder according to DSM-IV criteria and ten healthy matched controls. The sample size was enough to find statistical differences between groups, with a statistical power of 0.8. Bipolar patients were on lithium treatment during all this follow-up period and fulfilled ELR criteria as measured by the Alda scale. A neuropsychological test battery tapping into the main cognitive domains was used at baseline and at after 6-year of follow-up. Functional outcome was evaluated by means of the Functioning Assessment Short Test at study endpoint.

RESULTS

Repeated measures multivariate analyses of variance showed that bipolar patients were cognitively impaired in the executive functioning, inhibition, processing speed and verbal memory domains (p<0.03) compared to controls and such deficits were stable over time. Longer duration of illness and lower psychosocial outcome were significantly related to cognitive impairment (p<0.05).

CONCLUSIONS

Cognitive dysfunction was present even in euthymic ELR. These deficits remain stable over the long term, and are basically associated with greater symptoms and poorer psychosocial adjustment.

Uncovering Hospitalists' Information Needs from Outside Healthcare Facilities in the Context of Health Information Exchange Using Association Rule Learning

BACKGROUND

Important barriers to health information exchange (HIE) adoption are clinical workflow disruptions and troubles with the system interface. Prior research suggests that HIE interfaces providing faster access to useful information may stimulate use and reduce barriers for adoption; however, little is known about informational needs of hospitalists.

OBJECTIVE

To study the association between patient health problems and the type of information requested from outside healthcare providers by hospitalists of a tertiary care hospital.

METHODS

We searched operational data associated with fax-based exchange of patient information (previous HIE implementation) between hospitalists of an internal medicine department in a large urban tertiary care hospital in Florida, and any other affiliated and unaffiliated healthcare provider. All hospitalizations from October 2011 to March 2014 were included in the search. Strong association rules between health problems and types of information requested during each hospitalization were discovered using Apriori algorithm, which were then validated by a team of hospitalists of the same department.

RESULTS

Only 13.7% (2 089 out of 15 230) of the hospitalizations generated at least one request of patient information to other providers. The transactional data showed 20 strong association rules between specific health problems and types of information exist. Among the 20 rules, for example, abdominal pain, chest pain, and anaemia patients are highly likely to have medical records and outside imaging results requested. Other health conditions, prone to have records requested, were lower urinary tract infection and back pain patients.

CONCLUSIONS

The presented list of strong co-occurrence of health problems and types of information requested by hospitalists from outside healthcare providers not only informs the implementation and design of HIE, but also helps to target future research on the impact of having access to outside information for specific patient cohorts. Our data-driven approach helps to reduce the typical biases of qualitative research.

Persistence of cognitive impairment and its negative impact on psychosocial functioning in lithium-treated, euthymic bipolar patients: a 6-year follow-up study

BACKGROUND

Previous cross-sectional studies report that cognitive impairment is associated with poor psychosocial functioning in euthymic bipolar patients. There is a lack of long-term studies to determine the course of cognitive impairment and its impact on functional outcome. Method A total of 54 subjects were assessed at baseline and 6 years later; 28 had DSM-IV TR bipolar I or II disorder (recruited, at baseline, from a Lithium Clinic Program) and 26 were healthy matched controls. They were all assessed with a cognitive battery tapping into the main cognitive domains (executive function, attention, processing speed, verbal memory and visual memory) twice over a 6-year follow-up period. All patients were euthymic (Hamilton Rating Scale for Depression score lower than 8 and Young mania rating scale score lower than 6) for at least 3 months before both evaluations. At the end of follow-up, psychosocial functioning was also evaluated by means of the Functioning Assessment Short Test.

RESULTS

Repeated-measures multivariate analysis of covariance showed that there were main effects of group in the executive domain, in the inhibition domain, in the processing speed domain, and in the verbal memory domain (p<0.04). Among the clinical factors, only longer illness duration was significantly related to slow processing (p=0.01), whereas strong relationships were observed between impoverished cognition along time and poorer psychosocial functioning (p<0.05).

CONCLUSIONS

Executive functioning, inhibition, processing speed and verbal memory were impaired in euthymic bipolar out-patients. Although cognitive deficits remained stable on average throughout the follow-up, they had enduring negative effects on psychosocial adaptation of patients.

The DNA repair complex Ku70/86 modulates Apaf1 expression upon DNA damage

Apaf1 is a key regulator of the mitochondrial intrinsic pathway of apoptosis, as it activates executioner caspases by forming the apoptotic machinery apoptosome. Its genetic regulation and its post-translational modification are crucial under the various conditions where apoptosis occurs. Here we describe Ku70/86, a mediator of non-homologous end-joining pathway of DNA repair, as a novel regulator of Apaf1 transcription. Through analysing different Apaf1 promoter mutants, we identified an element repressing the Apaf1 promoter. We demonstrated that Ku70/86 is a nuclear factor able to bind this repressing element and downregulating Apaf1 transcription. We also found that Ku70/86 interaction with Apaf1 promoter is dynamically modulated upon DNA damage. The effect of this binding is a downregulation of Apaf1 expression immediately following the damage to DNA; conversely, we observed Apaf1 upregulation and apoptosis activation when Ku70/86 unleashes the Apaf1-repressing element. Therefore, besides regulating DNA repair, our results suggest that Ku70/86 binds to the Apaf1 promoter and represses its activity. This may help to inhibit the apoptosome pathway of cell death and contribute to regulate cell survival.

[Occupational health practice among law, evidence and ethics: a field study]

BACKGROUND

Quality in health care is defined as the degree to which health services increase the likelihood of desired health outcomes and are consistent with the law, the evidence and the ethical values.

MATERIALS AND METHODS

The paper aims at providing a framework in which the concept of quality is applied in the field of occupational health by analysing real-life decisions.

RESULTS

The Italian law states that the practice must be evidence-based and respectful of the code of ethics, emphasizeing that the practice should be relevant, knowledge-based, sound and appropriate. Any dilemma should be dealt according to the ethical principles of beneficience, autonomy and justice. Both the law and the code require that the practice is based on the available evidence. Results show that decisions in selected cases can be made according the above mentioned criteria. CONCLUSION; Decisions made on the basis of a process founded on scientific evidence result in effective and high-quality outcomes respectful of both law and ethics.

Reduced carbon solubility in Fe nanoclusters and implications for the growth of single-walled carbon nanotubes

Fe nanoclusters are becoming the standard catalysts for growing single-walled carbon nanotubes via chemical vapor decomposition. Contrary to the Gibbs-Thompson model, we find that the reduction of the catalyst size requires an increase of the minimum temperature necessary for the growth. We address this phenomenon in terms of solubility of C in Fe nanoclusters and, by using first-principles calculations, we devise a simple model to predict the behavior of the phases competing for stability in Fe-C nanoclusters at low temperature. We show that, as a function of particle size, there are three scenarios compatible with steady state growth, limited growth, and no growth of single-walled carbon nanotubes, corresponding to unaffected, reduced, and no solubility of C in the particles.

[Glucan solution nasal spray vs saline in the treatment of chronic rhinosinusitis: a multi-centric double blind randomised clinical trial]

OBJECTIVES

The aim of our study was to evaluate the efficacy of 30 days treatment with glucan solution nasal spray vs. saline in the treatment of signs and symptoms of chronic rhinosinusitis.

MATERIALS AND METHODS

100 patients affected by chronic rhinosinusitis were enrolled. At the beginning and at the end of the study were evaluated: nasal congestion, headache, rhinorrea, facial pain, rhinopharyngeal exudate, inferior turbinate hypertrophy; a complete instrumental analysis of nasal functions by Active Anterior Rhinomanometry, nasal Muco-Ciliary Transport time and scraping of nasal mucosa was also performed. The patients were randomized 1:1 for receiving intranasal saline or intranasal glucan solution spray. Treatment was administered as follows: 2 puffs/nostril 3 times a day for 30 days.

RESULTS

The patients in therapy with the glucan solution showed a significant improvement concerning rhinorrea facial pain, intensity of headache, inferior turbinate hypertrophy, rhinopharyngeal exudates, inspiratory/expiratory nasal resistences, Muco-ciliary transport time, normalization of nasal mucosas and rhinocytogram; saline lavage didn't show this effects. Both treatment improved rhinorrea, instead both treatment didn't affect nasal congestion.

CONCLUSIONS

According to the results of our multicentric double blind randomized study, we suggest the use of glucan solution nasal spray as an efficacious therapeutic tool in the management of nasal symptoms in patients affected by chronic rhinosinusitis.

Chemical activation of carbon mesophase pitches

This paper studies the chemical activation of mesophase pitches of different origins in order to obtain activated carbons suitable for use as electrodes in supercapacitors. The effect that the activating agent (NaOH, LiOH, and KOH), the alkaline hydroxide/pitch ratio, and the activation temperature had on the characteristics of the resultant activated carbons was studied. LiOH was found to be a noneffective activating agent, while activation with NaOH and KOH yielded activated carbons with high apparent surface areas and pore volumes. The increase of the KOH/pitch ratio caused an increase of the chemical attack on the carbon, producing higher burnoffs and development of porosity. Extremely high apparent surface areas were obtained when the petroleum pitch was activated with 5:1 KOH/carbon ratio. The increase of the activation temperature caused an increase of the burnoff, although the differences were not as significant as those derived from the use of different proportions of activating agent.

A double-blind randomized placebo-controlled trial with short-term beta-glucuronidase therapy in children with chronic rhinoconjunctivitis and/or asthma due to dust mite allergy

BACKGROUND

Enzyme potentiated desensitization, in which beta-glucuronidase (BG) is administered with low doses of mixed allergens, was proposed in the 1970s for specific immunotherapy. The BG currently commercially available in a purified and standardized preparation devoid of any allergen has been suggested as a regulator in the allergic immune response, acting on the cytokine-network of type 2 helper T cells. A double-blind trial with a single-dose of BG proved effective in preventing symptoms in adult patients with rhinoconjunctivitis due to grass pollens.

OBJECTIVE

The aim of this randomized double-blind placebo-controlled trial was to confirm the safety and effectiveness of double-dose intradermal BG immunotherapy in preventing symptoms in children suffering from chronic rhinoconjunctivitis and/or asthma due to dust mite.

METHOD

We randomized 125 children with dust-mite related chronic rhinoconjunctivitis and/or asthma to the BG treated group (67) or the placebo group (58). All patients were screened before treatment (TO), at BG or placebo administration (T1 and T3), and at 3 and 9 months after T1 (T2 and T4). Drug intake and bronchial, nasal and ocular symptoms were recorded in a diary.

RESULTS

Patients in both groups completed the study and BG treatment was well tolerated without side effects. Significant differences in symptoms were observed, in particular for conjunctivitis (P= .008). The total drug intake for allergic symptoms was significantly lower in the treated group than in the placebo group (P<. 01).

CONCLUSIONS

BG immunotherapy is efficacious, safe, and well tolerated in allergic children. Moreover, good compliance with the administration of 2 doses per year and the lack of significant side effects makes the benefit/risk ratio of this treatment particularly favorable.

Development of echolocation calls in the mustached bat, Pteronotus parnellii

Adult mustached bats employ Doppler-sensitive sonar to hunt fluttering prey insects in acoustically cluttered habitats. The echolocation call consists of 4-5 harmonics, each composed of a long constant frequency (CF) component flanked by brief frequency modulations (FM). The 2nd harmonic CF component (CF2) at 61 kHz is the most intense, and analyzed by an exceptionally sharply tuned auditory system. The maturation of echolocation calls and the development of Doppler-shift compensation was studied in Cuba where large maternity colonies are found in hot caves. In the 1st postnatal week, infant bats did not echolocate spontaneously but could be induced to vocalize CF-FM signals by passive body motion. The CF2 frequency emitted by the smallest specimens was at 48 kHz (i.e., 0.4 octaves lower than the adult signal). CF-FM signals were spontaneously produced in the 2nd postnatal week at a CF2 frequency of 52 kHz. The CF2 frequencies of induced and spontaneous calls shifted upward to reach a value of 60.5 kHz in the 5th postnatal week. Standard deviations of CF2 frequency were large (up to +/-1.5 kHz) in the youngest bats and dropped to values of +/-250 Hz at the end of the 3rd postnatal week. Some individuals in the 4th and 5th postnatal weeks emitted with adultlike frequency precision of about +/-100 Hz. In the youngest bats, the 1st harmonic CF component (CF1) was up to 22 dB stronger than CF2. Adultlike relative levels of CF1 (-28 dB relative to CF2) were reached in the 5th postnatal week. In spontaneously emitted CF-FM calls, the duration of the CF2 component gradually increased with age from 5 ms to maximum values of 18 ms. Durations of the CF2 component in induced calls averaged 7 +/- 2.6 ms in the 1st postnatal week and 8.2 +/- 1.5 ms in the 5th postnatal week. There were no age-related changes in duration of the terminal FM sweep (3 +/- 0.4 ms) in both induced and spontaneous calls. The magnitude of the terminal FM sweep in spontaneous calls was not correlated with age (mean 13.5 +/- 2 kHz). Values for induced calls slightly increased with age from 11 +/- 2 to 13 +/- 2 kHz. The emission rate of induced CF-FM signals increased with age from values of 2.5 +/- 2 to 17 +/- 5 pulses/s. Values for spontaneously emitted calls were 4.4 +/- 3 and 9 +/- 4.5 pulses/s, respectively. Doppler-shift compensation, as tested in the pendulum task, emerged during the 4th postnatal week in young bats that were capable of very brief active flights, but before the time of active foraging outside the cave.

[Characterization of neuronal ceroid lipofuscinosis in Venezuelan children]

INTRODUCTION

Neuronal ceroid lipofuscinosis (NCL), represents a group of inherited neurodegenerative disorders. Based on the age of the patient at onset, clinical course and ultrastructural morphology it has been identified three clinical types for the pediatric group: 1) Infantile NCL (INCL); 2) Late infantile NCL (LINCL); and 3) Juvenile NCL (JNCL). Other variants or atypical forms represent around 20% of the NCL in different populations. Genetic advances have made possible a better characterization, diagnostic and classification of these disorders.

CASE REPORTS

We present the clinical, neurophysiological, neuroradiological, and morphological data from 6 patients with NCL, who were assessed at the pediatric neurology department of the Hospital Universitario de Maracaibo during a ten years period (1993 2003). All 6 cases corresponded with the late infantile form. Age of onset ranged form 2 to 5 years. For most of the patients initial symptoms included seizures, psychomotor delay, accompanied by macular degeneration and optic atrophy. The EEG was characterized by high voltage spikes elicited by low frequency photic stimulation, in 5 cases. Neuroimaging findings were characteristic of the late infantile form of the NCL. In three patients a decreased intensity of signal was seen in the thalami and putamen on T2-weighted images. The ultrastructural examination of the samples obtained through a biopsy showed curvilinear bodies in all patients.

CONCLUSION

There is not epidemiological data of the NCL in Venezuela; it is presumed the presence of clinical forms and variants in the pediatric group. This first study could contribute to the knowledge and a better research of this group of disorders in our population.

Postnatal Development of Cochlear Function in the Mustached Bat,Pteronotus parnellii

Postnatal development of the mustached bat's cochlea was studied by measuring cochlear microphonic and compound action potentials. In adults, a cochlear resonance is involved in enhanced tuning to the second harmonic constant frequency component (CF2) of their echolocation calls at ∼61 kHz This resonance is present immediately after birth in bats that do not yet echolocate. Its frequency is lower (46 kHz) and the corresponding threshold minimum of cochlear microphonic potentials is broader than in adults. Long-lasting ringing of the cochlear microphonic potential after tone stimulus offset that characterizes the adult auditory response close to CF2 is absent in newborns. In the course of the first 5 postnatal weeks, there is a concomitant upward shift of CF2 and the frequency of cochlear threshold minima. Up to the end of the third postnatal week, sensitivity of auditory threshold minima and the Q value of the cochlear resonance increase at a fast rate. Between 2 and 4 wk of age, two cochlear microphonic threshold minima are found consistently in the CF2 range that differ in their level-dependent dynamic growth behavior and are 1.5–5.7 kHz apart from each other. In older animals, there is a single minimum that approaches adult tuning in its sharpness. The data provide evidence to show that during maturation of the cochlea, the frequency and the sensitivity of the threshold minimum associated with CF2 increases and that these increases are associated with the fusion of two resonances that are partly dissociated in developing animals.

[Computerized modification of Fukuda test]

OBJECTIVES

To study a new method to apply to Fukuda test in order to overcome the interpretational difficulty associated with a subjective evaluation of the exam.

MATERIALS AND METHODS

During the exam, the patient wears a specially-designed headpiece, with a band at the back fitted with a sensor accommodating both a gyroscope and a bi-axial accelerometer. When asked to step in place, he does so in the Romberg position, eyes closed, successively rotating his head to the right and to the left.

RESULTS

On analyzing the data obtained through the laterality variable (right/left oscillation) and time variable, it resulted that the difference between the averages referring to the laterality variable of right-handed and left-handed subjects was statistically significant (P = 0.001), while the difference between the averages of the time variable was not.

CONCLUSIONS

To be able to propose an evaluation of the clinical validity of the test, further research must be carried out on pathological subjects, thus verifying the applicability of the method to the full.

[Balloon pulmonary valvuloplasty in a 1,680 g preterm infant]

We report a preterm infant weighing 1,680-g with critical pulmonary stenosis. Pulmonary balloon valvuloplasty was successfully performed using a = 1.15 balloon/annulus ratio.

Computerized brain tomography in patients with Schizophrenia

We carried out brain tomography of 27 patients with schizophrenia and 17 normal control subjects. DSM-IV criteria were used for diagnosis. The parameters studied were: brain volume, lateral and third ventricles, brain surface and brain indexes. Previously the patients were evaluated with the following clinical scales: Positive and Negative Syndrome Scale (PANSS), Brief Psychiatric Rating Scale (BPRS), Global Assessment of Functioning Scale (GAF) and the GRAFFAR scale to evaluate cultural and socioeconomical levels. We detected an increase in the right and left lateral ventricles: brain ratios, an increase in the width of Sylvian fissures and in the third ventricle index. We did not find differences that could be related to sex or to a familial history of mental disease. No differences were observed in the group receiving medication when compared with the group of untreated patients.

Receptor cell habituation in the A1 auditory receptor of four noctuoid moths

Moths of both sexes of Empyreuma affinis (=pugione) and Syntomeida epilais (Arctiidae, Ctenuchinae), Maenas jussiae (Arctiidae, Arctiinae) and Spodoptera frugiperda (Noctuidae, Amphipyrinae) were studied. Spike activity in the A1 cell was recorded using a stainless-steel hook electrode from the tympanic nerve in the mesothorax. Acoustic stimuli consisting of 25 and 100 ms pulses at the best frequency for the species and at intensities that evoke A1 cell saturation response were used at repetition rates of 0.5 and 5 Hz for 100 ms stimuli, and between 2 and 20 Hz for 25 ms stimuli. Stimuli at a repetition rate corresponding to a duty cycle of 5 % (25 ms at 2 Hz and 100 ms at 0.5 Hz) did not evoke monotonic changes in the responses of the A1 cell. With 25 ms pulses, rates above 5 Hz evoked an exponential decrease in the number of spikes and an increase in the latency of the responses of all the 37 specimens tested. The response duration showed no apparent change with stimulus repetition rates even at the highest duty cycle used (50 %), i.e. 25 ms at 20 Hz and 100 ms at 5 Hz. The higher the rate of stimulus repetition, the more marked were the changes in the A1 cell responses. In 16 of 17 preparations from two species, habituation had no effect on the adaptation rate in each response, while in seven of eight specimens of another species, the adaptation rate decreased with stimulus repetition. These results, and those from another mechanoreceptor cell, indicate that receptor cell adaptation (changes evoked in the response by a stimulus of constant intensity) and habituation (changes in the responses due to stimulus repetition rate) are two distinctive phenomena. The A1 cell in its habituated state showed an increase in its response to incremental increases in stimulus intensity of 10 dB. This result supports the idea that receptor cell habituation does not seem to be due to fatigue, i.e. to a temporary loss of the ability to respond to stimulation induced in a sensory receptor by continued stimulation.

Prognostic value of gastric intramucosal pH in critically ill children

OBJECTIVE

To determine the association of tonometrically measured gastric intramucosal pH (pHi) to the occurrence of multiple organ dysfunction syndrome (MODS) and death in critically ill children.

DESIGN

Prospective, observational study.

SETTING

Pediatric intensive care unit (ICU) of a teaching children's hospital.

PATIENTS

Fifty-one critically ill children admitted (median age 5.4+/-5 [SD] yrs; range 1 mo to 16 yrs) with the following diagnoses: post major surgery (n=26), sepsis (n=8), multiple trauma (n=5), acute respiratory distress syndrome (n=4), and "miscellaneous" (n=8).

INTERVENTIONS

Placement of a tonometric catheter.

MEASUREMENTS AND MAIN RESULTS

Pediatric Risk of Mortality (PRISM) score and clinical data were collected on admission and pHi daily during their stay in the pediatric ICU. A sigmoid tonometer was used to determine the pHi. Unconditional logistic regression was used to investigate the prognostic value of pHi. On admission, 26 patients presented with low gastric pHi (< or =7.35) and 17 of them had values of <7.30. The mortality rate in children with pHi <7.30 was 47.1% (95% confidence interval, 26.2 to 69) in contrast with an 11.7% mortality rate (95% confidence interval, 4.6 to 26.6) in children having a pHi of > or =7.30 (p=.015). The pHi and PRISM score on admission were independent predictive factors of death. The risk of mortality is increased when the pHi is low (odds ratio=2.5). However, we did not find the pHi to be a predictor for developing MODS.

CONCLUSIONS

Our results show that pHi is an independent predictor of mortality in patients admitted to a pediatric ICU. Although no relationship was observed between the risk of MODS and gastric pHi, the univariate difference of 21% vs. 41% is highly suggestive. The pHi determination is a minimally invasive procedure and well tolerated in children of all ages.

[Outbreak of asthma caused by soybean dust allergy. Clinical and immunologic study of the affected patients]

BACKGROUND

To study the clinical and immunological data of patients affected by a soybean asthma outbreak in Tarragona, Spain.

PATIENTS AND METHODS

Characteristics of previous asthma, emergency rooms records and immediate outcome of 15 patients who attended emergency room departments the epidemic day were recorded. Functional respiratory studies, skin prick tests to aeroallergens, and prick tests, specific IgE and immunoblotting to soybean extracts were performed in all patients.

RESULTS

Thirteen patients were sensitized to soybean proteins. All of them were atopic (most sensitized to house dust mites) and half had started asthma symptoms after their thirties. The epidemic crisis was particularly severe in patients over 50 years, daily chronic asthma, severe obstructive pattern and/or non receiving steroids. Four patients were admitted to intensive care units. Seven patients showed asthma exacerbations (late reactions) 24 h after the beginning of the epidemic crisis. Specific IgE against a 5-6 kD and a 15.5-17 kD soybean proteins was detected in the sera of 8 patients and 10 patients, respectively.

CONCLUSIONS

The outbreak affected atopic patients exposed to soybean dust. The severity of the crisis was related with the previous severity of asthma. Besides the well known 5-6 kD allergenic soybean protein, the 15.5-17 kD protein seems also to be implicated in the sensitization of most of these patients.

Compounding Fumed Silicas into Polydimethylsiloxane: Bound Rubber and Final Aggregate Size

The properties of mechanically mixed suspensions of fumed silicas in polydimethylsiloxane (PDMS) were studied. The work focuses on two aspects: (i) Adsorption of PDMS onto silicas by means of the mechanical mixing of the bulk polymer and untreated or chemically modified fumed silicas. The silica-PDMS suspensions were completely dispersed or only swollen by a solvent, depending on the filler concentration, the silica surface chemistry, and the polymer molecular weight. The bound rubber content of the different preparations was determined by a weight difference technique and by carbon analysis of the samples and was compared with previously reported values in similar systems. (ii) The effect of the mechanical mixing on the final aggregate size of the silica and on the polymer molecular weight distribution. One PDMS and silicas of different surface area and surface chemistry were used. The final size of the aggregates after a long mixing time with the bulk polymer was approximately the same in all cases. Copyright 1997 Academic Press. Copyright 1997Academic Press

Cell kinetics and tumor regression during radiotherapy in head and neck squamous-cell carcinomas

Head and neck squamous-cell carcinoma (HN-SCC) patient management is mainly based on TNM classification and needs be improved by considering other potentially useful prognostic factors. We examined the pre-radiotherapy tumor potential doubling time (Tpot) evaluated after in vivo infusion of bromodeoxyuridine and flow-cytometric analysis and the early clinical tumor regression after 40 Gy (40 Gy-TR). Tpot values and clinical 40 Gy-TR classes (minor and major) were available for 82 HN-SCC patients. Radiation therapy completion was done either with 1 dose per day (conventional regimen) or 2 doses per day (accelerated regimen). Local control was also available for follow-up times above 4 years. We found that major 40 Gy-TR was strongly correlated with fast tumor growth, characterized by Tpot values below 5 days, and that patients with major 40 Gy-TR showed better local control than those with minor 40 Gy-TR, independently from the radiotherapy regimen type. We also found that treatment completion with accelerated radiotherapy gave better local control for patients with major 40 Gy-TR and fast tumor growth than conventional radiotherapy. Multivariate analysis, performed on all patients, assigned an independent prognostic value to Tpot, tumor classification and 40 Gy-TR.

Differential motility stimulation but not growth stimulation or adhesion of metastatic human colorectal carcinoma cells by target organ-derived liver sinusoidal endothelial cells

Liver is the most common distant metastatic site for colorectal cancers and when blood-borne colorectal cancer cells reach the liver, they first encounter hepatic capillary and sinusoidal endothelial cells. Thus we studied differences between highly (HT-29LMM) and poorly (HT-29P) liver-metastatic sublines of human colorectal cancer cells by examining the interactions between tumor cells and liver microvessel endothelial cells. Using hepatic sinusoidal endothelial (HSE) and lung microvessel endothelial (MLE) cell-conditioned medium we measured the growth and motility stimulating activities released from these endothelial cells and adhesion of these cancer cells to the endothelial cells. Differences in the ability of HSE-conditioned medium (HSE-CM) or MLE-conditioned medium (MLE-CM) to stimulate HT-29 cell growth were not observed. There was a small but significant increase in the rate of adhesion of highly metastatic HT-29LMM cells to HSE cell monolayers than poorly metastatic HT-29P cells, but there was no difference in adhesion to MLE cell monolayers. HSE-CM stimulated the motility of highly metastatic colorectal cancer cells to a greater extent than the poorly metastatic cells. Motility-stimulating activity for the colorectal cancer cell lines was not detected in MLE-CM. The HSE-CM motility-stimulating activity for human HT-29 cells was not removed using antibodies against hepatocyte growth factor (HGF/SF), complement component C3 or laminin, indicating that it is not related to these known liver-derived motility factors. The results suggest that the ability of highly metastatic HT-29LMM colorectal cancer cells to colonize the liver is related to their ability to respond to liver sinusoidal endothelial cell-derived motility factors and to a lesser degree to adhere to liver sinusoidal endothelial cells.

Enteral nutrition following total laryngectomy

Body composition was measured in patients who underwent total laryngectomy for carcinoma and who were enterally fed throughout the postoperative period with full liquid artificial mixtures. The intestinal complications were very mild and required no changes in the nutritional program. Body sector sizes remained essentially unchanged until the end of the support, malnutrition did not occur and the postoperative local infection rate was very low. On the contrary, in patients fed with blenderized food, the amount of enteral infusion had to be reduced because of poor tolerance or abdominal discomfort; in this case caloric intake was largely inadequate. Fall in BW and BCM size and increase of TBNa/TBK ratio demonstrated a postoperative impairment of the nutritional status. Furthermore, the postoperative infection rate, the number of days with fever and the length of antibioticotherapy were higher than those observed in patients fed with full liquid mixtures.

Biomaterial-induced alterations of neutrophil superoxide production

Because periprosthetic infection remains a vexing problem for patients receiving implanted devices, we evaluated the effect of several materials on neutrophil free radical production. Human peripheral blood neutrophils were incubated with several sterile, lipopolysaccharide (LPS)-free biomaterials used in surgically implantable prosthetic devices: polyurethane, woven dacron, and velcro. Free radical formation as the superoxide (O2-) anion was evaluated by cytochrome c reduction in neutrophils that were exposed to the materials and then removed and in neutrophils allowed to remain in association with the materials. Neutrophils exposed to polyurethane or woven dacron for 30 or 60 min and then removed consistently exhibited an enhanced release of O2- after simulation via receptor engagement with formyl methionyl-leucyl-phenylalanine. Enhanced reactivity to stimulation via protein kinase C with phorbol myristate acetate, however, was not consistently observed. The cells evaluated for O2- release during continuous association with the biomaterials showed enhanced metabolic activity during short periods of association (especially with polyurethane and woven dacron). Although O2- release by neutrophils in association with these materials decreased with longer periods of incubation, it was not obliterated. These studies, therefore, show that several commonly used biomaterials activate neutrophils soon after exposure and that this activated state diminishes with prolonged exposure but nevertheless remains measurable. The diminishing level of activity with prolonged exposure, however, suggests that ultimately a depletion of reactivity may occur and may result in increased susceptibility to periprosthetic infection.

Chief complaint of 3,545 pediatric patients at the emergency room of San Pablo Hospital during a five months period

A survey was made of the chief complaints at the Emergency Room of San Pablo Hospital of 3,545 pediatric patients seen between January 1 and May 31, 1988. Most common chief complaints involved the gastrointestinal system, trauma, and fractures. There was a wide range of chief complaints. Periodic surveys of this type should be useful in establishing priorities of pediatric training.

Plasma and synovial fluid lanthanides in rheumatoid arthritis: variations after intra-articular therapy

Lanthanides (Ln), or rare earth elements, are detectable in trace amounts in organisms. Increased concentrations of Ln have been observed in rheumatoid arthritis (RA) in plasma (pl) and synovial fluid (Sf). We have evaluated pl and Sf concentrations of Ln (in particular La, Nd, Ce, Yb, Lu, Eu), in rheumatoid arthritis patients, before and after intra-articular steroid injection. Increased pl and Sf concentrations of Ln were confirmed in RA. No detectable synovial fluid concentrations of Ln were observed in healthy controls. A statistically significant Ln reduction (p less than 0.001) was observed in Sf 3 and 6 days after local steroid injection and in pl after 6 days. The decrease in Ln concentrations in Sf and pl, after antiphlogistic therapy, reflects the reduction of the inflammatory condition.

The distribution of arsenic and cobalt in patients with laryngeal carcinoma

The objective of this study was to evaluate tissue and plasma concentrations of arsenic and cobalt in an attempt to discover the role of these elements in the malignant process. Using neutron activation analysis, arsenic and cobalt levels were determined in plasma and in non-malignant and malignant human tissues in 15 patients with laryngeal carcinoma. Arsenic and cobalt levels were about 60% higher in tumor than in adjacent non-malignant tissue (P less than 0.001): arsenic 72.4 +/- 18.0 ng/g versus 43.1 +/- 9.4 in non-malignant tissues, and cobalt 68.7 +/- 7.3 ng/g versus 39.6 +/- 7.0 in non-malignant tissues. Mean plasma arsenic and cobalt levels were also significantly higher in patients with laryngeal carcinoma than in healthy control subjects.

Effects of caponization on body weight, atherosclerosis, and cardiovascular variables in hypertensive and hypotensive turkey lines

Effects of caponization and blood pressure selection on serum lipids, severity of atherosclerosis, body weight, hematocrit, and relative ventricular weight in hypertensive and hypotensive lines of turkeys were evaluated in two trials. At 8 weeks of age, half the turkeys from each line were caponized. Body weights, blood pressure, and blood samples were obtained from each treatment at 8, 20, and 30 weeks of age. A total of 56 and 72 birds were used in Trials 1 and 2, respectively. Birds were necropsied at 30 weeks of age. Hypertensive turkeys had significantly greater serum cholesterol and total lipid than hypotensive turkeys only at 30 weeks of age in Trial 1. Lower relative ventricular weights were observed in hypotensive turkeys within both trials. Hypertensive birds exhibited a more severe degree of atherosclerosis and higher relative heart weight than hypotensive turkeys. Caponization significantly increased total serum lipid only at 20 weeks of age in Trial 2. Average body weight of caponized turkeys was significantly lower (1.2) than the control turkeys at 30 weeks of age. Caponized turkeys exhibited lower relative ventricular weight in Trial 1 but not Trial 2 and an increase in blood pressure only in Trial 2. Caponization suppressed body weight, decreased hematocrit values, and had no significant effect upon plaque severity. The presence or absence of male sex hormones had virtually no effect on proposed atherogenic stimuli thereby suggesting another mechanism by which the female is afforded a higher degree of protection.

Choroid plexus papilloma containing bone

The presence of bone in choroid plexus papillomas is a rare event. The authors report a case of choroid plexus papilloma of the IVth ventricle containing bone in a 18-year-old man, and review two previously reported cases, as well as the mechanisms proposed for the presence of bone and cartilage in neuroepithelial neoplasms.

[Lidocain clearance after oral and intravenous application in rats with low grade ANIT-cholestasis and galactosamine-induced hepatitis (author's transl)]

Each of 6 rats with a low grade of ANIT-cholestasis and a low grade of GalN-hepatitis received either 3 mg Lidocain i.v. or 24 mg Lidocain orally. The plasma concentrations of Lidocain were measured over a period of 3 1/2 hrs. The systemic clearance of Lidocain (Cli.v. = Di.v. divided by AUCi.v.) was significantly increased on ANIT-cholestasis (17 +/- 3) and GalN-hepatitis rats (13 +/- 2) (control rats: 7 +/- 1 ml/min x 100 g bw). Oral clearance of Lidocain (Clor = Dor divided by AUCor) was not significantly different in the three respective groups. In both groups with experimental liver disease the hepatic blood flow--calculated by comparing the systemic to the oral clearance--was significantly increased (22 +/- 4 and 19 +/- 3 vs 8 +/- 1 ml/min x 100 g bw). Due to this increase, the hepatic extraction ratio of Lidocain was significantly decreased (ANIT-cholestasis 0.73 +/- 0.07; GalN-hepatitis 0.74 +/- 0.05; controls 0.85 +/- 0.03). Because of an increase of systemic Lidocain clearance, no toxic plasma concentrations were observed.