Fatigue Failure Load of a Bonded Simplified Monolithic Feldspathic Ceramic: Influence of Hydrofluoric Acid Etching and Thermocycling

Objective:

To evaluate the effect of hydrofluoric acid (HF) etching and thermocycling (Tc) on fatigue failure load of feldspathic ceramic restorations cemented with two resin cements.

Methods:

Disc-shaped feldspathic ceramic (Vitablocs Mark II; Ø=10 mm, 1.0-mm thick) and G10 epoxy resin (Ø=10 mm, 2.5-mm thick) specimens were made and randomly allocated considering three factors: ceramic etching (ie, with vs without 10% HF plus silane application), resin cement (ie, self-adhesive [RelyX U200; U200] or conventional [Multilink Automix; MA]), and Tc (ie, with vs without 5-55°C/12,000 cycles). Adhesive cementation followed each manufacturer's instructions. The fatigue test (n=20) was based on the staircase approach (250,000 cycles; 20 Hz). Contact angle, surface topography, and fractography analysis were also executed. Specific statistical tests were employed for each outcome (α=0.05).

Results:

The interaction of HF and Tc factors decreased the fatigue resistance for both cements (U200 542.63>U200/HF-Tc 495.00; MA 544.47>MA/HF-Tc 506.84). Comparing the cements associated with HF or Tc, there was statistical superiority for MA (U200-Tc 537.37<MA-Tc 561.32; U200/HF 535.79<MA/HF 557.11), and no statistical difference was detected when only cement type or its association with HF-Tc was compared (U200 542.63=MA 544.47; U200/HF-Tc 495.00=MA/HF-Tc 506.84). The fracture always originated from defects at the ceramic-intaglio surface as radial cracks.

Conclusion:

HF etching plus silane agent increased the ceramic surface free energy and its wettability, but it did not provide better results in terms of fatigue resistance compared with silane agent application only. The association of HF etching and aging significantly reduced the fatigue resistance of the material, regardless of the resin cement used.

Observation of environment-induced double sudden transitions in geometric quantum correlations

Correlations in quantum systems exhibit a rich phenomenology under the effect of various sources of noise. We investigate theoretically and experimentally the dynamics of quantum correlations and their classical counterparts in two nuclear magnetic resonance setups, as measured by geometric quantifiers based on trace norm. We consider two-qubit systems prepared in Bell diagonal states, and perform the experiments in real decohering environments resulting from Markovian local noise which preserves the Bell diagonal form of the states. We then report the first observation of environment-induced double sudden transitions in the geometric quantum correlations, a genuinely nonclassical effect not observable in classical correlations. The evolution of classical correlations in our physical implementation reveals in turn the finite-time relaxation to a pointer basis under nondissipative decoherence, which we characterize geometrically in full analogy with predictions based on entropic measures.

Measuring bipartite quantum correlations of an unknown state

We report the experimental measurement of bipartite quantum correlations of an unknown two-qubit state. Using a liquid state Nuclear Magnetic Resonance setup and employing geometric discord, we evaluate the quantum correlations of a state without resorting to prior knowledge of its density matrix. The method is applicable to any 2 ⊗ d system and provides, in terms of number of measurements required, an advantage over full state tomography scaling with the dimension d of the unmeasured subsystem. The negativity of quantumness is measured as well for reference. We also observe the phenomenon of sudden transition of quantum correlations when local phase and amplitude damping channels are applied to the state.

Aldehyde dehydrogenase in combination with CD133 defines angiogenic ovarian cancer stem cells that portend poor patient survival

Markers that reliably identify cancer stem cells (CSC) in ovarian cancer could assist prognosis and improve strategies for therapy. CD133 is a reported marker of ovarian CSC. Aldehyde dehydrogenase (ALDH) activity is a reported CSC marker in several solid tumors, but it has not been studied in ovarian CSC. Here we report that dual positivity of CD133 and ALDH defines a compelling marker set in ovarian CSC. All human ovarian tumors and cell lines displayed ALDH activity. ALDH(+) cells isolated from ovarian cancer cell lines were chemoresistant and preferentially grew tumors, compared with ALDH(-) cells, validating ALDH as a marker of ovarian CSC in cell lines. Notably, as few as 1,000 ALDH(+) cells isolated directly from CD133(-) human ovarian tumors were sufficient to generate tumors in immunocompromised mice, whereas 50,000 ALDH(-) cells were unable to initiate tumors. Using ALDH in combination with CD133 to analyze ovarian cancer cell lines, we observed even greater growth in the ALDH(+)CD133(+) cells compared with ALDH(+)CD133(-) cells, suggesting a further enrichment of ovarian CSC in ALDH(+)CD133(+) cells. Strikingly, as few as 11 ALDH(+)CD133(+) cells isolated directly from human tumors were sufficient to initiate tumors in mice. Like other CSC, ovarian CSC exhibited increased angiogenic capacity compared with bulk tumor cells. Finally, the presence of ALDH(+)CD133(+) cells in debulked primary tumor specimens correlated with reduced disease-free and overall survival in ovarian cancer patients. Taken together, our findings define ALDH and CD133 as a functionally significant set of markers to identify ovarian CSCs.

Mercury exposure, serum antinuclear/antinucleolar antibodies, and serum cytokine levels in mining populations in Amazonian Brazil: a cross-sectional study

Mercury is an immunotoxic substance that has been shown to induce autoimmune disease in rodent models, characterized by lymphoproliferation, overproduction of immunoglobulin (IgG and IgE), and high circulating levels of auto-antibodies directed at antigens located in the nucleus (antinuclear auto-antibodies, or ANA) or the nucleolus (antinucleolar auto-antibodies, or ANoA). We have reported elevated levels of ANA and ANoA in human populations exposed to mercury in artisanal gold mining, though other confounding variables that may also modulate ANA/ANoA levels were not well controlled. The goal of this study is to specifically test whether occupational and environmental conditions (other than mercury exposure) that are associated with artisanal gold mining affect the prevalence of markers of autoimmune dysfunction. We measured ANA, ANoA, and cytokine concentrations in serum and compared results from mercury-exposed artisanal gold miners to those from diamond and emerald miners working under similar conditions and with similar socio-economic status and risks of infectious disease. Mercury-exposed gold miners had higher prevalence of detectable ANA and ANoA and higher titers of ANA and ANoA as compared to diamond and emerald miners with no occupational mercury exposure. Also, mercury-exposed gold miners with detectable ANA or ANoA in serum had significantly higher concentrations of pro-inflammatory cytokines IL-1beta, TNF-alpha, and IFN-gamma in serum as compared to the diamond and emerald miners. This study provides further evidence that mercury exposure may lead to autoimmune dysfunction and systemic inflammation in affected populations.

Abstract 10: Characterization of ovarian CSC using ALDH and CD133 identifies a cancer stem cell hierarchy

Recent studies in ovarian cancer suggest that the protein CD133 may be a marker of cancer stem cells (CSC). CSC studies in several solid tumors have identified Aldehyde dehyrogenase (ALDH) enzymatic activity as a CSC marker, however ALDH has not been studied in ovarian cancer. We sought to determine if ALDH alone or in combination with CD133 could better define CSC in ovarian cancer. We analyzed the expression of these markers in 13 consecutive primary human ovarian tumor specimens and 8 cell lines. 70% of primary ovarian tumors analyzed had CD133+ cells detectable in low number in, and many tumor cell lines lacked CD133 expression. In contrast, 100% of the primary human ovarian tumor specimens and ovarian cancer cell lines demonstrated ALDH activity. ALDH+ cells isolated from 6 ovarian cancer cell lines preferentially grew larger tumors at a faster rate compared to ALDH− cells. In some cases ALDH− cells were incapable of generating tumors, suggesting ALDH is a good marker of ovarian CSC in cell lines. Importantly, as few as 1000 ALDH+ cells directly isolated from human ovarian tumors were capable of generating tumors in immune deficient mice. ALDH− cells did not form tumors in mice. Interestingly, when ALDH was used in combination with CD133 to analyze ovarian cancer cell lines we observed greater growth in the ALDH+CD133+ cells compared to ALDH+CD133− cells suggesting a potential hierarchy of the stem cells. Consistent with this, as few as 11 ALDH+CD133+ cells freshly isolated from human tumors were capable of forming tumors in mice. Consistent with a stem cell hierarchy, tumors formed from ALDH+CD133+ cells demonstrated a poorly differentiated histology, whereas tumors formed from ALDH+ cells alone demonstrated a more differentiated histology. Finally analysis of tumors generated from ALDH+ and ALDH+CD133+ tumors demonstrated a significant increase in microvascular density compared to ALDH− tumors. qRT-PCR analysis demonstrated that ALDH+ cells compared to ALDH− cells preferentially express numerous angiogenic factors. Taken together our studies: (1) indicate ALDH as a marker of ovarian CSC, (2) suggest a hierarchy of ovarian cancer stem cell differentiation state, and (3) demonstrates that ovarian CSC are highly angiogenic to recruit vasculature to create a stem cell niche.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 10.

Secondary lymphoid organs contribute to, but are not required for the induction of graft-versus-host responses following allogeneic bone marrow transplantation: a shifting paradigm for T cell allo-activation

Graft-versus-host disease (GVHD) remains the major complication of allogeneic bone marrow transplantation (allo-BMT). GVHD fundamentally depends upon the activation of donor T cells by host antigen-presenting cells (APCs), but the precise location of these interactions remains uncertain. We examined the role of secondary lymphoid organs (SLO) in the induction of GVHD by using homozygous aly/aly mice that are deficient in lymph nodes (LNs) and Peyer's patches (PPs). Lethally irradiated, splenectomized, aly/aly (LN/PP/Sp-/-) mice and sham-splenectomized, aly/+ (LN/PP/Sp+/+) mice received BMT from either syngeneic (aly/aly) or allogeneic, major histocompatibility complex (MHC) disparate donors. Surprisingly, although LN/PP/Sp-/- allo-BMT recipients experience a survival advantage, they developed significant systemic and target organ GVHD that is comparable to LN/PP/Sp+/+ controls. Early after allo-BMT, the activation and proliferation of donor T cells was significantly greater in the BM cavity of LN/PP/Sp-/- mice compared to LN/PP/Sp+/+ controls. Donor T cells in LN/PP/Sp-/- mice demonstrated cytolytic activity in vitro, but Graft vs Leukemia (GVL) activity could be overcome by increasing the tumor burden. These data suggest that SLO contribute to, but are not required for, allogeneic T cell responses, and suggest that the BM may represent an alternative, albeit less efficient site for T cell activation following allo-BMT.

Identifying alemtuzumab as an anti-myeloid cell antiangiogenic therapy for the treatment of ovarian cancer

Background

Murine studies suggest that myeloid cells such as vascular leukocytes (VLC) and Tie2⁺ monocytes play a critical role in tumor angiogenesis and vasculogenesis. Myeloid cells are a primary cause of resistance to anti-VEGF therapy. The elimination of these cells from the tumor microenvironment significantly restricts tumor growth in both spontaneous and xenograft murine tumor models. Thus animal studies indicate that myeloid cells are potential therapeutic targets for solid tumor therapy. Abundant VLC and Tie2⁺ monocytes have been reported in human cancer. Unfortunately, the importance of VLC in human cancer growth remains untested as there are no confirmed therapeutics to target human VLC.

Methods

We used FACS to analyze VLC in ovarian and non-ovarian tumors, and characterize the relationship of VLC and Tie2-monocytes. We performed qRT-PCR and FACS on human VLC to assess the expression of the CD52 antigen, the target of the immunotherapeutic Alemtuzumab. We assessed Alemtuzumab's ability to induce complement-mediated VLC killing in vitro and in human tumor ascites. Finally we assessed the impact of anti-CD52 immuno-toxin therapy on murine ovarian tumor growth.

Results

Human VLC are present in ovarian and non-ovarian tumors. The majority of VLC appear to be Tie2+ monocytes. VLC and Tie2+ monocytes express high levels of CD52, the target of the immunotherapeutic Alemtuzumab. Alemtuzumab potently induces complement-mediated lysis of VLC in vitro and ex-vivo in ovarian tumor ascites. Anti-CD52 immunotherapy targeting VLC restricts tumor angiogenesis and growth in murine ovarian cancer.

Conclusion

These studies confirm VLC/myeloid cells as therapeutic targets in ovarian cancer. Our data provide critical pre-clinical evidence supporting the use of Alemtuzumab in clinical trials to test its efficacy as an anti-myeloid cell antiangiogenic therapeutic in ovarian cancer. The identification of an FDA approved anti-VLC agent with a history of clinical use will allow immediate proof-of-principle clinical trials in patients with ovarian cancer.

CCR1/CCL5 (RANTES) receptor-ligand interactions modulate allogeneic T-cell responses and graft-versus-host disease following stem-cell transplantation

Acute graft-versus-host disease (GVHD) and leukemic relapse are serious complications of allogeneic stem-cell transplantation (SCT). Recruitment of activated T cells to host target tissues or sites of leukemic infiltration (graft-versus-leukemia [GVL]) is likely mediated by chemokine receptor-ligand interactions. We examined the contribution of donor cell CCR1 expression to the development of GVHD and GVL using a well-established murine SCT model (B6 --> B6D2F1) and CCR1-deficient mice (CCR1(-/-)). Allo-SCT with CCR1(-/-) donor cells significantly reduced systemic and target organ GVHD severity, and CCR1 expression on both T cells and accessory cells contributed to GVHD mortality. Significant GVL activity was preserved following CCR1(-/-) SCT, but the survival advantage diminished with increasing tumor burden. We then explored the effects of CCR1 expression on allo-specific T-cell responses. Although cytolytic effector function was maintained on a per-cell basis, T-cell proliferation and IFNgamma secretion were significantly reduced both in vivo and in vitro. T-cell function was partially dependent on interactions between CCR1 and CCL5. Collectively, these data demonstrate that CCR1 expression on donor cells contributes to the development of both GVHD and GVL, and suggest that CCR1/CCL5 receptor-ligand interactions modulate allo-specific T-cell responses occurring in this context.

Mercury and autoimmunity: implications for occupational and environmental health

Mercury (Hg) has long been recognized as a neurotoxicant; however, recent work in animal models has implicated Hg as an immunotoxicant. In particular, Hg has been shown to induce autoimmune disease in susceptible animals with effects including overproduction of specific autoantibodies and pathophysiologic signs of lupus-like disease. However, these effects are only observed at high doses of Hg that are above the levels to which humans would be exposed through contaminated fish consumption. While there is presently no evidence to suggest that Hg induces frank autoimmune disease in humans, a recent epidemiological study has demonstrated a link between occupational Hg exposure and lupus. In our studies, we have tested the hypothesis that Hg does not cause autoimmune disease directly, but rather that it may interact with triggering events, such as genetic predisposition, exposure to antigens, or infection, to exacerbate disease. Treatment of mice that are not susceptible to Hg-induced autoimmune disease with very low doses and short term exposures of inorganic Hg (20-200 microg/kg) exacerbates disease and accelerates mortality in the graft versus host disease model of chronic lupus in C57Bl/6 x DBA/2 mice. Furthermore, low dose Hg exposure increases the severity and prevalence of experimental autoimmune myocarditis (induced by immunization with cardiac myosin peptide in adjuvant) in A/J mice. To test our hypothesis further, we examined sera from Amazonian populations exposed to Hg through small-scale gold mining, with and without current or past malaria infection. We found significantly increased prevalence of antinuclear and antinucleolar antibodies and a positive interaction between Hg and malaria. These results suggest a new model for Hg immunotoxicity, as a co-factor in autoimmune disease, increasing the risks and severity of clinical disease in the presence of other triggering events, either genetic or acquired.

In vitro HgCl2 exposure of immune cells at different stages of maturation: effects on phenotype and function

This is the first study to investigate the hypothesis that the immunotoxic effects of inorganic mercury may be modulated by inherent differences in the responsiveness of immune cells related to the age of the donor. We exposed cells from lymph nodes, spleen, and thymus, collected from 7- and 10-day-old CD.1 pups, as well as from adult CD.1 mice, in terms of the effects of mercury in vitro on responses to Con-A stimulation with respect to proliferation, cytokine production, and cell phenotype. The effects of mercury on proliferation were age and organ dependent, while effects on cytokine production were only age dependent. Effects of mercury were observed only on splenocyte T-cell subpopulations and only in cells from 10-day-old pups and from adults. Mercury had no effect on IFN-gamma and IL-4 production by splenocytes from 7-day-old pups, but significantly decreased release of these cytokines by splenocytes from 10-day-old pups and adults. Hg did not affect IL-4 production by lymph node cells or thymocytes. In lymph node cells Hg affected IFN-gamma production only at 7 days. These data indicate that inherent properties of immune cells at different stages of development may influence the response to immunotoxicants.

Prenatal HgCl2 exposure in BALB/c mice: gender-specific effects on the ontogeny of the immune system

Because mercury is highly toxic to developing organisms, we tested the hypothesis that prenatal exposure to HgCl(2) can induce persistent immune dysfunction. Pregnant BALB/c mice were administrated every other day, for 11 days with HgCl(2) (200 microg/kg). Their offspring were studied at PND10, 14, 21, and 60. Lymph nodes (LN), spleens, and thymus were harvested and proliferation and cytokine production were studied in vitro. We report that prenatal HgCl(2) exposure exerts organ-specific effects on cell number, proliferation, and cytokine production in pre-weaning pups. At adulthood (PND60), effects of prenatal HgCl(2) exposure were still observed, but expressed differently in females and males. In adult females, an inhibitory effect was observed on cytokine production by thymocytes, LN cells, and splenocytes. In males, a stimulatory effect was observed. Overall, we conclude that in vivo exposures to low doses of HgCl(2) can induce persistent sex-specific immunotoxic effects, observable in adulthood.

Mercury exposure, malaria, and serum antinuclear/antinucleolar antibodies in Amazon populations in Brazil: a cross-sectional study

BACKGROUND

Mercury is an immunotoxic metal that induces autoimmune disease in rodents. Highly susceptible mouse strains such as SJL/N, A.SW, B10.S (H-2s) develop multiple autoimmune manifestations after exposure to inorganic mercury, including lymphoproliferation, elevated levels of autoantibodies, overproduction of IgG and IgE, and circulating immune complexes in kidney and vasculature. A few studies have examined relationships between mercury exposures and adverse immunological reactions in humans, but there is little evidence of mercury-associated autoimmunity in humans.

METHODS

To test the immunotoxic effects of mercury in humans, we studied communities in Amazonian Brazil with well-characterized exposures to mercury. Information was collected on diet, mercury exposures, demographic data, and medical history. Antinuclear and antinucleolar autoantibodies (ANA and ANoA) were measured by indirect immunofluorescence. Anti-fibrillarin autoantibodies (AFA) were measured by immunoblotting.

RESULTS

In a gold mining site, there was a high prevalence of ANA and ANoA: 40.8% with detectable ANoA at > or =1:10 serum dilution, and 54.1% with detectable ANA (of which 15% had also detectable ANoA). In a riverine town, where the population is exposed to methylmercury by fish consumption, both prevalence and levels of autoantibodies were lower: 18% with detectable ANoA and 10.7% with detectable ANA. In a reference site with lower mercury exposures, both prevalence and levels of autoantibodies were much lower: only 2.0% detectable ANoA, and only 7.1% with detectable ANA. In the gold mining population, we also examined serum for AFA in those subjects with detectable ANoA (> or =1:10). There was no evidence for mercury induction of this autoantibody.

CONCLUSIONS

This is the first study to report immunologic changes, indicative of autoimmune dysfunction in persons exposed to mercury, which may also reflect interactions with infectious disease and other factors.

Molluscicidal activity against Biomphalaria glabrata of Brazilian Cerrado medicinal plants

Alcoholic extracts of six Brazilian Cerrado medicinal plants were evaluated for their molluscicidal activity against Biomphalaria glabrata, intermediate host of schistosomiasis. Stryphnodendron polyphyllum bark extract, rich in condensed tannins, was the most promising as molluscicide.

[Nursing and breastfeeding: combining secular practices]

Support for breastfeeding, one of the factors contributing to mother-child wellbeing, has increased through innumerable government and non-government initiatives. Despite this, women still have difficulty finding specialised help to solve problems related to breastfeeding and lactation after discharge from hospital. We describe the Domiciliary Attendance to Mother and son, whose aim it is to give assistance and advice to mothers in their homes. This assistance consists of teaching simplified breastfeeding management techniques, based on the Symbolic Interactionism Model. All the women assisted under this program have been able to continue breastfeeding or to re-lactate successfully.

[Gastric probe used in pre-term newborns: study of changes in flexibility of constituent polymer]

The pre-term newborn care at neonatal units, which makes continued use of orogastric probes have drawn our attention to an apparent alteration in probes flexibility upon removal thereof for routine replacement at approximately 72 hours. Due to the lack of elements explaining such facts and information as to whether or not such findings are additional risks to the health condition of such children, the main objective of this study was as follows: to compare the flexibility of vinyl-made gastric probes use for pre-term newborn at 24 48 and 72 hours.

[Revealing the different aspects of breastfeeding through qualitative research]

The purpose of this study is to understand the issues related to breastfeeding, which have generated the current scene, as well as, new scientific trends in this area. It also indicates current concepts, which emerged from qualitative studies done by nurses having as reference different theoretical models. These studies show that breastfeeding depends on the meanings women attribute to this experience built through their personal history and interactions within the family and community context. In general, their studies elucidate the experience of breastfeeding and provide tools for nursing professionals to develop in their practice with the mother, infant and family during the breastfeeding period.

[Constructing the meaning of breast feeding through nursing care]

From the referential of Symbolic Interactionism and Dada Based Theory we have searched to achieve the objectives of comprehending the meaning, attributed by the nursing student to breastfeeding and to nursing interventions in this process. The study was accomplished with graduation students from Sao Paulo University (USP) Nursing School. The study results show that the student experience his relation to breastfeeding and to his learning process in assisting the nutrice and her child expressed by two themes: BUILDING UP A VIEW OVER BREASTFEEDING and BUILDING UP ASSISTANCE TO BREASTFEEDING. These themes portrait students' conceptual and technical evolutive process about breastfeeding assistance and their perception of being a nurse, attributing meanings to their performance in the process that is experienced by woman and her child.

[Production of scientific papers by nurses from public and private hospitals in the district of Sao Paulo]

This study shows the nurse's scientific publication from seven public and six private hospitals in São Paulo city, from january/1989 to june/1995. From a total of 486 papers identified, 242 were published as abstracts, 124 in annals, 92 in nationals and international journals, 21 as book chapters and 7 as books in nursing. The facilities and difficulties in publishing nursing scientific production were also discussed.

[Reflections on the practice of breast feeding]

The author makes analyses of breast feeding, doing a reflexion about the mainly indicators who has determined the actual situation, looking for identify ways for win the ideal cenary to future of breast feeding.

[Breast feeding: assuming risks or guaranteeing benefits]

The development of several action of promotion of the breastfeeding seems do not reach many of the variables that determinate the breastfeeding course. With the proposal of understanding what makes the woman decide about breastfeeding or wearing, this study was developed trying to get the conscious meaning of the breastfeeding experience for the woman, how the importance of the breastfeeding is shown by the woman's action and develop a theoretical sample that represents the experience of breastfeeding for the woman. Based on the theoretical presupposition of the Symbolic Interactionism and taking the Grounded Theory as the methodology, we described the breastfeeding based on the woman's point of view. The research shows that the woman experiences the breastfeeding from a process that evaluates and gives value to it, and that is understood by the themes: Evaluating the capability of breastfeeding, Evaluating the woman's feeling and Taking Decisions which the central phenomenon, representative of the process, is called WEIGHING THE RISKS AND BENEFITS. This study shows that the elements that give the policies for the breastfeeding result from the relation between the action of breastfeeding and several significant symbols shown in the interactive situations experienced by the woman.

[The integration of teaching programs in the disciplines of obstetrical nursing and the administration of nursing services in maternity]

Este relato descreve as dificuldades e os pontos positivos sentidos pelas alunas, enfermeiras e docentes que participaram no 29 semestre de 1989, da integração das disciplinas " Enfermagem Obstétrica" e "Administração de Serviços de Enfermagem em Maternidade " na Escola de Enfermagem da Universidade de São Paulo — EEUSP.

[A descriptive study of the defining characteristics of nursing diagnosis: sexual dysfunction]

The defining characteristics of the nursing diagnosis "Sexual Dysfunction" were gathered from NAAM assessment records. From this population 96 records with the defining characteristics of Sexual Dysfunction were selected. The 9 defining characteristics proposed by The North American Nursing Diagnosis Association were used as a framework for the data collection tool. The 3 most frequently defining characteristics were absence of sexual desire (71.9%), vaginal discharge (64.5%), and pain (44.8%). The authors concluded that 6 defining characteristics have not appeared; absence of sexual desire and vaginal discharge can be considered as minor characteristics. The authors recommend the implementation of other studies to clarify the subjective defining characteristics.

[A systematized procedure for the technical nursing care of puerperae with breast engorgement]

This research approaches a systematized Procedure of Nursing Care to puerperas with mammary engorgement. The author verified the kind of engorgement most frequent, mammary sector most affected and some interference factors in the evolution of mammary engorgement.

[The emotional reactions of the woman in the puerperium]

A autora procurou obter, através de declarações de enfermeiras, informação sobre se estas conseguem identificar manifestações de comportamento de puérperas que evidenciam reações emocionais e se as mesmas se julgam preparadas para atender adequadamente as puérperas, considerando tanto os aspectos físicos quanto os emocionais.

Response of factor VIII/von Willebrand factor to intranasal DDAVP in healthy subjects and mild haemophiliacs (with observations in patients with combined deficiency of factors V and VIII)

The effect of a single standard dose of intranasal DDAVP (260 micrograms) was investigated in healthy subjects and in patients with mild deficiencies of VIII:C. Changes in FVIII/VWF activities were measured from baseline after 30, 60, 120 and 360 min of administration of the drug. Intranasal DDAVP was followed by a two-fold increase of VIII:C in both groups studied. VIIIR:AG and VIIIR:RCo increased to a lesser extent. Even though FVIII/VWF activities reached their maximum after 60-120 min, a significant increase over baseline was still observed after 360 min. The rise of VIII:C was unrelated to the body weight of the patients and was proportional to the baseline levels of this factor. In two sisters with combined deficiencies of FV/FVIII, the responses in all activities of FVIII/VWF were similar to those seen in mild hemophiliacs. Factor V did not undergo any variation. No alteration in serum osmolarity and no consistent variation in blood pressure or pulse rate were noted. It is concluded that the i.n. administration of a single high dose of DDAVP might be adopted to provide an emergency aid in bleeding patients with mild to moderate haemophilia A and to yield higher VIII:C levels in blood donors.