Best Fit Sphere Back and Adjusted Maximum Elevation of Corneal Back Surface as Novel Predictors of Keratoconus Progression

Purpose

We evaluated the Maximum Elevation of Corneal Back Surface adjusted to the same Best Fit Sphere Back (BFSB) between timeline measurements (AdjEleBmax) and the BFSB radius (BFSBR) itself as new tomographic parameters for documentation of ectasia progression and compare them with the most recent and reliable parameters used on keratoconus (KC) progression.

Results

We evaluated the performance and the ideal cutoff point of Kmax, D-index, posterior radius of curvature from the 3.0 mm centered on the thinnest point (PRC), EleBmax, BFSBR, and AdjEleBmax as isolated parameters to document KC progression (defined as a significant change in two or more variables), we found a sensitivity of 70%, 82%, 79%, 65%, 51%, and 63% and a specificity of 91%, 98%, 80%, 73%, 80%, and 84% to detect KC progression. The area under the curve (AUC) for each variable was 0.822, 0.927, 0.844, 0.690, 0.695, 0.754, respectively.

Conclusion

AdjEleBmax presented a greater specificity, larger AUC, and better performance compared to EleBmax without any adjustment, with similar sensitivity. Although AdjEleBmax and BFSB demonstrated smaller AUC and specificities comparing with Kmax and D-Index, AdjEleBmax still presented a good performance with a reasonable AUC. Since the shape of the posterior surface, more aspheric and curved than the anterior, may facilitate detection of change, we suggest the inclusion of AdjEleBmax in the evaluation of KC progression in conjunction with other variables to increase the reliability of our clinical evaluation and early detection of progression.

The influence of overweight and obesity in the oral health of a sample of portuguese adults

Background

Overweight and obesity may lead to different problems in various body systems and in the oral cavity. Dental caries and periodontal disease have been related with overweight. The aim of this study was to assess how overweight and obesity have impact on the lifestyle, oral habits and oral pathologies.

Methods

We conducted an observational cross-sectional study where we applied a questionnaire to 140 individuals from Lisbon and Viseu, Portugal., which 70 had a normal Body Mass Index (BMI) (control group) and 70 had an excessive BMI. We also made an oral observation in each individual to record the permanent teeth decayed, missing and filled index (DMFT), the Community Periodontal Index and the oral hygiene status.

Results

From the final sample, 30% of the subjects with overweight brushed their teeth once a day or less, while the majority (62.9%) of the control group brushed twice a day. In the oral examination, 70% had calculus, while in the control group only 22.5% presented calcified plaque. The DMFT was higher among the obesity group in comparison with the control group. Regarding periodontal disease, the participants with overweight need more dental intervention (81.4%) in contrast with the control group (14%).

Conclusions

Most overweight and obese individuals present precarious oral hygiene habits, higher prevalence of dental caries, and worse periods of periodontal health. They are not aware of the repercussions of the association between their cariogenic diet, oral health and overweight.

Key messages

• Oral health behaviors are related with other health conditions, namely obesity and this is a fundamental public health issue.

• Primary preventive strategies should be established having in consideration the oral health status of adults in treatment for obesity and in weight control programs.

A New Portable Device to Reliably Measure Maximal Strength and Rate of Force Development of Hip Adduction and Abduction

ABSTRACT

Gonçalves, BM, Mesquita, RNO, Tavares, F, Brito, J, Correia, P, Santos, P, and Mil-Homens, P. A new portable device to reliably measure maximal strength and rate of force development of hip adduction and abduction. J Strength Cond Res 36(9): 2465-2471, 2022-Groin injuries are a major issue in sports involving kicking or quick changes of direction. Decreased hip adduction and abduction strength have been indicated as one of the main risk factors for groin injury. The methods currently available to measure hip adduction and abduction strength are reliable but highly dependent on the evaluator skills. Furthermore, several studies have reported the reliability of maximal strength (MVIC), but very few studies investigated the reliability of explosive strength (RFD), a parameter that has been previously shown to have a higher functional value. The aim of the current investigation was to assess the reliability of a user-independent portable dynamometer that concurrently measures MVIC and RFD. Twenty-five healthy young subjects performed maximal isometric hip adduction and abduction in both sitting and supine positions. Measurements occurred in 2 different days separated by 48-72 hours. Test-retest reliability was calculated for both MVIC and RFD. Both MVIC and RFD showed good relative reliability (intraclass correlation coefficient = 0.77-0.98) with no differences between positions or muscle actions. Measurement error was similar between positions for MVIC in both hip adduction and abduction. Measurements of RFD showed higher reliability using a time window of at least 0-100 milliseconds, and lower measurement error was observed in sitting for adduction and in supine for abduction. This study shows that portable dynamometry can be used to concurrently measure hip adduction and abduction maximal and explosive strength, with levels of reliability that are similar to previously described methods.

Self-perception of childrenś oral health by their parents

Background

Neglecting oral hygiene can lead to early tooth loss, pain, discomfort and, consequently, a great monetary investment to repair the damage caused in the stomatognathic system, whether of masticatory, phonetic or aesthetic origin. The aim of the present study consists in the characterization of oral health perception and oral hygiene habits of the children by their own parents and the creation of a scale to classify children's oral health perception by their parents.

Methods

A cross-sectional observational epidemiological study was performed. The population of this study was made up of 422 parents whose children are between five and eleven years of age and who attend schools in the districts of Viseu and Lisbon. The data collection was achieved through the application of a self-administered questionnaire in order to characterize the parentś perception of the oral health of their own children.

Results

Through the analysis of the questionnaires, 54.8% of the sample considered that their own children present inadequate oral health behaviors; 40.3% sufficient and only 4.8% consider that their children have good and adequate oral health behaviors. Regarding oral hygiene, most of the children did it one to five times a day, 44.7% took ‘2 minutes' to perform this activity, 70.3% did not use dental floss, 77.9% do not brush their teeth after lunch, 49.3% only use toothbrush for oral hygiene, 13.6% never went to the dentist, 26.9% are afraid, 38.1% have already suffered from toothache, 28.8% had gingival hemorrhage and 12.6% had gingival inflammation.

Conclusions

Oral health is a determining factor for a good quality of life. To this end, it is essential to implement oral health education and promotion strategies with all members of the household, in order to guarantee better oral health indexes in the community.

Key messages

Oral health literacy and knowledge is essential in order to improve oral health indexes in the community. The characterization of the oral health of children and adolescents is crucial to improve oral health behaviors and establish the correct oral health promotion programs.

Ischemic stroke on hormonal contraceptives: Characteristics, mechanisms and outcome

Introduction

Systemic contraceptives increase the risk of ischemic stroke but little is known about the characteristics, mechanisms and long-term outcome post stroke of patients on hormonal contraception. We sought to To assess characteristics and outcome of acute ischemic stroke (AIS) in young women using systemic hormonal contraceptives (SHC) and compare them to strokes in non-contraceptive users.

Patients and methods

Using the Acute STroke Registry and Analysis of Lausanne (ASTRAL), we analyzed demographics, risk factors, clinical, radiological and treatment data of consecutive female patients of <50 years between 2003 to 2015. We compared groups with and without SHC in a logistic regression analysis.

Results

Of the 179 female patients of <50 years during the observation period, 57 (39.6%) used SHC, 71.9% of whom, a combined oral contraceptive pill. On logistic regression contraceptive users were significantly younger but had comparable stroke severity. They had less migraine with aura and tobacco use, and more hyperlipidaemia. Also, contraceptive users had significantly less intra and extracranial stenosis and occlusion on arterial imaging, but more focal hypoperfusion on CT-perfusion. Undetermined mechanism of stroke was more frequent with SHC users, whereas rare mechanisms were more frequent in non-users. The contraceptive user group had a more favourable adjusted 12-month outcome with significantly fewer ischemic recurrences after stopping systemic contraception in all.

Conclusion

Contraceptive users with ischemic strokes are younger and have lesser tobacco use and migraine with aura and more hyperlipidemia. Their stroke mechanism is more often undetermined using a standardised work-up, and their adjusted long-term outcome is more favourable with less stroke recurrence.

Sex differences in muscle fatigue following isokinetic muscle contractions

Muscle fatigue is a limiting factor of human performance. It is unclear whether sex-based differences in fatigability exist during dynamic exercise of varying velocities of contraction. We aimed at exploring sex differences in muscle fatigue elicited by maximal isokinetic muscle contractions performed at different angular velocities. Twenty-six healthy participants (13 men: 23.2 ± 1.5; 13 women: 21.9 ± 3.0 years) were tested for concentric knee-extension at slow, moderate and fast angular isokinetic velocity (60, 180 and 300º.s^-1, respectively), on non-consecutive days. The impact of sex on fatigue resistance and consecutive recovery for each isokinetic condition was explored by calculating the percent change in maximal voluntary isometric contraction (MVIC) and in rate of torque development (RTD), from pre- to post-isokinetic exercise (30 repetitions). The isokinetic fatigue index was also determined. No sex differences were obtained in response to isokinetic contractions completed at 60º.s^-1. After performing muscle contractions at 300º.s^-1, women had a significantly greater loss in MVIC than men (- 18.4 ± 5.5 vs. - 12.9 ± 3.8%; p = 0.009) and larger decreases in work output during isokinetic exercise (- 34.2 ± 8.9 vs - 27.5 ± 10.6%; p = 0.017). Recovery of initial MVIC strength was greater for women post-exercise at 180º.s^-1 (15.6 ± 4.1% vs. 6.7 ± 9.5; p = 0.003). No differences were found between sexes in any condition for RTD from pre- to post-fatigue. These results suggest the presence of a sexually dimorphic fatigability in response to dynamic (isokinetic) contractions favouring men at higher absolute velocities of contraction.

Resuscitation fluid practices in Brazilian intensive care units: a secondary analysis of Fluid-TRIPS

Objective

To describe fluid resuscitation practices in Brazilian intensive care units and to compare them with those of other countries participating in the Fluid-TRIPS.

Methods

This was a prospective, international, cross-sectional, observational study in a convenience sample of intensive care units in 27 countries (including Brazil) using the Fluid-TRIPS database compiled in 2014. We described the patterns of fluid resuscitation use in Brazil compared with those in other countries and identified the factors associated with fluid choice.

Results

On the study day, 3,214 patients in Brazil and 3,493 patients in other countries were included, of whom 16.1% and 26.8% (p < 0.001) received fluids, respectively. The main indication for fluid resuscitation was impaired perfusion and/or low cardiac output (Brazil: 71.7% versus other countries: 56.4%, p < 0.001). In Brazil, the percentage of patients receiving crystalloid solutions was higher (97.7% versus 76.8%, p < 0.001), and 0.9% sodium chloride was the most commonly used crystalloid (62.5% versus 27.1%, p < 0.001). The multivariable analysis suggested that the albumin levels were associated with the use of both crystalloids and colloids, whereas the type of fluid prescriber was associated with crystalloid use only.

Conclusion

Our results suggest that crystalloids are more frequently used than colloids for fluid resuscitation in Brazil, and this discrepancy in frequencies is higher than that in other countries. Sodium chloride (0.9%) was the crystalloid most commonly prescribed. Serum albumin levels and the type of fluid prescriber were the factors associated with the choice of crystalloids or colloids for fluid resuscitation.

Rapid hamstrings to quadriceps ratio at long muscle lengths in professional football players with previous hamstring strain injury

Hamstring strain injuries (HSI) are the most common injury in male professional football and are potentially a primary risk factor to re-injury. Although the isokinetic strength ratios have often been used to identify strength imbalances that can augment the risk of injury in football players, the rate of torque development hamstring to quadriceps ratio (RTD H/Q) has rarely been considered in previous reports. Furthermore, little consideration has been given to selective hamstring lengths (30° of knee flexion) and its influence on torque production. The aim of this study was to investigate the RTD H/Q at long hamstring lengths, conventional (concentric/concentric) and functional (eccentric/concentric) H/Q ratios in football players with and without previous HSI. Twenty-four professional male football players (12 and 12 without previous HSI) performed maximal voluntary isometric contractions at long hamstring lengths (knee and hip flexed at 30° and 85°, respectively) and isokinetic concentric and eccentric contractions at 180°.s^-1 and 60°.s^-1. Conventional and functional H/Q ratios based on peak torque throughout the entire isokinetic range of motion and at long hamstring lengths were calculated. The RTD H/Q was extracted at long hamstring lengths in incrementing time periods of 50 milliseconds (ms) from the onset of contraction (50-250 ms). No significant differences were found between groups in any H/Q ratios studied. However, small effects (d = 0.4) were found in previously injured hamstrings to lower RTD H/Q at 50 ms and flexor eccentric torque. Previous HSI group showed small to moderate (0.4 > d < 0.6) higher RTD H/Q in late time intervals (>100 ms).

Associação entre estados afetivos negativos e comportamentos sexuais de risco

O presente trabalho teve como objetivo analisar, através da revisão da literatura, a associação entre estados afetivos negativos (e.g., depressão, ansiedade) e comportamentos sexuais de risco. Verificou-se que alguns estudos indicam uma associação entre problemas ao nível da saúde mental e/ou estados afetivos negativos e comportamentos sexuais de risco. Através da revisão da literatura concluiu-se que os estados afetivos negativos como a depressão, a ansiedade, e as experiências traumáticas se encontram associadas com comportamentos sexuais de risco e têm sido alvo de pouca atenção por parte da comunidade científica.    

Predictors of emotional distress in pregnant women: the mediating role of relationship intimacy

Background: Assessment and treatment of emotional distress during pregnancy show that worries during pregnancy and interpersonal relationships with partners are the important factors determining psychological health.Aims: The present study aimed to investigate the impact of worries during pregnancy, relationship intimacy, and marital satisfaction on anxiety, depression, and stress symptoms in pregnant women, as well as to analyse the mediating effect of relationship intimacy between marital satisfaction and emotional distress.Method: During their second and third trimester of pregnancy, 200 Portuguese women were recruited during childbirth preparation consultations and completed the Cambridge Worry Scale (CWS), the Personal Assessment of Intimacy in Relationships Scale (PAIR), the Marital Life Areas Satisfaction Evaluation Scale (MLASES), and the Depression, Anxiety, and Stress Scale (DASS-21).Results: Hierarchical multiple regression analyses showed that being unemployed or on sick leave, being younger, having a history of miscarriage, having more worries during pregnancy, and declaring low-relationship intimacy were the main predictors of emotional distress. Relationship intimacy mediated the relation of marital satisfaction to anxiety and depression symptoms.Conclusions: This study highlights the importance of the worries during pregnancy and relationship intimacy in shaping pregnant women's emotional distress, and identifies both as targets of intervention.

Small Cell Carcinoma of the Vulva: Case Report

Neuroendocrine tumours are rare in the gynaecologic tract, comprising approximately 2% of all gynaecological tumours. They have an aggressive behaviour and are a diagnostic and clinical challenge, due to their rarity and the lack of standardized therapeutic approaches. There are a few case reports. It is defined as a high-grade carcinoma exhibiting neuroendocrine differentiation. The authors describe the case of a 70-year-old woman, with vulvar neuroendocrine small cell carcinoma after superficial vulvectomy. The patient was submitted to a surgery with wide local excision and adjuvant radiation therapy. A review of the literature on this topic is also presented.

Development and multi-center evaluation of a novel immunoadsorption method for anti-DFS70 antibodies

OBJECTIVE

Antinuclear antibodies (ANA) represent a hallmark in the diagnosis of ANA-associated rheumatic diseases (AARD). However, anti-DFS70 antibodies are present in a higher portion of the healthy individuals (HI) than in patients with AARD. Consequently, we developed a novel, highly specific indirect immunofluorescence (IIF) method that blocks anti-DFS70 antibodies from binding to HEp-2 cells and to evaluate the method in a multi-center study.

METHODS

A total of 18 samples from systemic lupus erythematosus patients (SLE, n = 7) and HI (n = 11) were used for the initial development of the immunoadsorption method. For the multi-center evaluation, samples with a dense fine speckled (DFS) pattern (n = 99) were collected at three different sites based on their established IIF screening procedure at the respective laboratories. Additionally, four characterized samples with established clinically relevant IIF patterns (centromere, nucleolar, speckled, homogeneous) were blended in five different ratios (10%, 25%, 50%, 75%, 90%) with a sample positive for anti-DFS70 antibodies, which by itself showed a dense fine speckled (DFS) IIF pattern. All samples were tested by IIF with NOVA Lite HEp-2 ANA and NOVA Lite HEp-2 Select on the NOVA View® instrument, and also tested by QUANTA Flash DFS70 chemiluminescent immunoassay (CIA) for confirmation of anti-DFS70 antibodies (Inova Diagnostics, San Diego, CA, USA).

RESULTS

For the development of the immunoadsorption method, only 1/7 ANA-positive samples from SLE patients, but 8/10 ANA-positive samples from healthy individuals turned negative using the immunoadsorption. Subsequently, 73/99 (73.7%) of the DFS pattern samples were positive by CIA for anti-DFS70 antibodies showing a strong quantitative Spearman's correlation (rho = 0.57 (95% CI, 0.39-0.71, p < 0.0001)) between light intensity units (LIU) measured by NOVA View and CIA. Intensities measured with NOVA Lite HEp-2 and NOVA Lite HEp-2 Select demonstrated significantly lower intensity values after inhibition with DFS70 antigen (p < 0.0001). When samples were processed to mimic samples with mixed patterns (DFS + clinically relevant pattern), the new immunoadsorption method demonstrated that all clinically relevant patterns remained unchanged whereas the LIUs from NOVA View analysis significantly decreased after inhibition (p < 0.0001).

CONCLUSION

The data showed that the NOVA Lite HEp-2 Select kit effectively inhibits anti-DFS70 antibody binding to its cellular target antigen.

Primary Vaginal Non-Hodgkin's Lymphoma: Report of a Rare Clinical Entity

A 52-year-old woman was referred to the gynecology outpatient clinic with a 2 months history of vaginal bleeding with intercourse, and no other symptoms. Vaginal examination revealed a firm, non-tender, mass in the posterior vaginal wall. The initial clinical impression was that of a vaginal carcinoma and a biopsy under local anesthesia was performed, but the result was inconclusive. A deeper biopsy, under general anesthesia, was performed and a histological diagnosis of non-Hodgkin’s lymphoma was done. The staging workup permitted to exclude any other site of the body affected by the malignancy. Hematologists reviewed the patient and recommended chemotherapy. A complete tumor regression was observed and the patient has now a disease-free survival of 72 months. This case report intends to create awareness of this rare clinical entity. Although the gynecologist will rarely be faced to extranodal lymphoma, it should be included in the differential diagnosis of gynecologic malignancies.

Carateres de seleção do Toiro de Lide para a tourada à corda dos Açores

Com o objetivo de identificar caraterísticas com interesse na seleção do toiro de lide para as touradas à corda, foi elaborado um inquérito, incluindo 38 questões, tendo sido inquiridos, no período de janeiro a março de 2013, todos os ganadeiros (n=18) inscritos na Associação Regional de Criadores de Toiros da Tourada à Corda. Os resultados foram submetidos a análise estatística com um teste não paramétrico de qui-quadrado por simulação Monte Carlo (MMC–10 000 bootstraps) (p≤0,05). Os resultados obtidos evidenciaram que todos os ganadeiros definiram elevada mobilidade para os toiros das touradas à corda (pontuações ≥3), e 88,89 % (p≤0,05) destacaram esta caraterística como uma das mais importantes para a seleção. Para os ganadeiros os toiros têm de responder rapidamente aos estímulos de investida e com temperamento altamente agressivo e combativo. Esta caraterística foi apontada como uma das mais importantes na seleção do toiro de lide para a tourada à corda (94,44 % - p≤0,05). Os toiros devem estar atentos ao que ocorre à sua volta, (94,44 %; p≤0,05). Os resultados ainda aferiram que todos os ganadeiros destacaram a resistência como um caracter a selecionar nos animais. Ficou demonstrado que os ganadeiros valorizam a melhoria do desempenho dos toiros ao longo de uma tourada à corda. Através da avaliação dos itens REG34, REG36, REG35 e REG37, ficou evidenciado que a regularidade dos desempenhos dos toiros nas várias touradas é um caráter muito levado em consideração pelos ganadeiros. No final foram identificados e definidos sete caracteres: mobilidade; capacidade de arremeter; capacidade de fixar; codícia; resistência; crescer e regularidade. Os caracteres foram organizados numa escala de avaliação para o seu uso na seleção do toiro de lide para a as touradas à corda.

Factores Preditivos de Metastização Ganglionar Retroperitoneal no Cancro do Endométrio

<strong>Introduction:</strong> It has been suggested that a complete staging may be safely omitted in endometrial carcinoma patients at low risk for lymph node metastasis. The purposes of our study were to explore the prognostic significance of pathologic factors for pelvic and paraaortic nodal spread and to validate the Mayo algorithm in order to identify patients in whom lymphadenectomy may be avoided.<br /><strong>Material and Methods:</strong> We conducted a retrospective review including 208 patients, regarding the evaluation of pathologic variables and nodal metastases. Statistical analysis was performed using the chi-square test, the Fisher exact test and the Student’s t-test.<br /><strong>Results:</strong> Myometrial invasion &gt; 50% (p &lt; 0.001), cervical invasion (p = 0.001), lymphovascular space invasion (p = 0.003) and positive peritoneal cytology (p = 0.03) were significant predictors of retroperitoneal lymph node dissemination. Pelvic lymph node metastases were predictive of positive paraaortic lymph nodes (p &lt; 0.001).<br /><strong>Discussion:</strong> The Mayo algorithm identified patients without pelvic or paraaortic nodal metastases with a 98.4% negative predictive value (61/62). Myometral invasion ≤ 50% and absence of cervical and lymphovascular invasion presented a negative predictive value of 98.8% (79/80).<br /><strong>Conclusion:</strong> Although the Mayo criteria predict a very low likelihood of retroperitoneal nodal metastases, the combination of myometral invasion ≤ 50% and absence of cervical or lymphovascular invasion would have safely avoided lymphadenectomy in a larger number of women.

Genetic relationships of the Portuguese Lidia bovine populations

To clarify the genetic relationships among the Lidia breed lineages and two main Portuguese Lidia bovine populations, Casta Portuguesa and Brava dos Açores, 24 autosomal microsatellites were analyzed in 120 samples. Brava dos Açores showed the highest observed and expected heterozygosity (0.73 and 0.70, respectively) while Casta Portuguesa showed the lowest observed and expected heterozygosity (0.51 and 0.50, respectively). The results of this study were compared with the previous microsatellites data from the main Lidia bovine lineages. Casta Portuguesa was the most genetically isolated Lidia bovine population as revealed by the average FST genetic distance value with respect to the other lineages (32%). All the populations of Portuguese Lidia had negative FIS values. The Neighbour-joining dendrogram grouped Casta Portuguesa in the same branch with Miura, which was supported by the STRUCTURE software. The results evidenced low levels of genetic diversity and high levels of genetic differentiation in Casta Portuguesa and high levels of genetic diversity in Brava dos Açores populations, probably due to the crossbreeding of different bovine lineages at origin, and genetic flow among herds.

[Factors predictive of retroperitoneal lymph node metastasis in endometrial cancer]

INTRODUCTION

It has been suggested that a complete staging may be safely omitted in endometrial carcinoma patients at low risk for lymph node metastasis. The purposes of our study were to explore the prognostic significance of pathologic factors for pelvic and paraaortic nodal spread and to validate the Mayo algorithm in order to identify patients in whom lymphadenectomy may be avoided.

MATERIAL AND METHODS

We conducted a retrospective review including 208 patients, regarding the evaluation of pathologic variables and nodal metastases. Statistical analysis was performed using the chi-square test, the Fisher exact test and the Student's t-test.

RESULTS

Myometrial invasion > 50% (p < 0.001), cervical invasion (p = 0.001), lymphovascular space invasion (p = 0.003) and positive peritoneal cytology (p = 0.03) were significant predictors of retroperitoneal lymph node dissemination. Pelvic lymph node metastases were predictive of positive paraaortic lymph nodes (p < 0.001).

DISCUSSION

The Mayo algorithm identified patients without pelvic or paraaortic nodal metastases with a 98.4% negative predictive value (61/62). Myometral invasion ≤ 50% and absence of cervical and lymphovascular invasion presented a negative predictive value of 98.8% (79/80).

CONCLUSION

Although the Mayo criteria predict a very low likelihood of retroperitoneal nodal metastases, the combination of myometral invasion ≤ 50% and absence of cervical or lymphovascular invasion would have safely avoided lymphadenectomy in a larger number of women.

Group B streptococci causing neonatal infections in barcelona are a stable clonal population: 18-year surveillance

We analyzed 212 group B streptococci (GBS) from newborns with invasive infections in the area of Barcelona, Spain, between 1992 and 2009, with the aim of documenting changes in the prevalences of serotypes, antimicrobial resistance, and genetic lineages and evaluating their associations with either early-onset disease (EOD) or late-onset disease (LOD). Serotypes III (n = 118) and Ia (n = 47) together accounted for nearly 78% of the isolates. All isolates carried an alpha or alpha-like protein gene, and specific associations between genes and serotypes, such as serotype Ib and bca, serotype II and bca, serotype III and rib, and serotype V and alp3, reflected the presence of particular genetic lineages. Macrolide resistance (14.2%) was significantly associated with serotype V. Pulsed-field gel electrophoresis (PFGE) clustering was an excellent predictor of serotype and antibiotic resistance. The combination of PFGE and multilocus sequence typing revealed a large number of genetically distinct lineages. Still, specific lineages were dominant in our collection, particularly the serotype III/ST17/rib lineage, which had enhanced potential to cause LOD. Serotype Ia was concentrated in a single PFGE cluster composed of two genetic lineages: ST23/eps and ST24/bca. The ST24/bca sublineage of serotype Ia, which is found infrequently elsewhere, may be emerging as an important cause of neonatal invasive infections in the Mediterranean region. In spite of the introduction of prophylaxis, resulting in a pronounced decline in the frequency of EOD, the study revealed a remarkably stable clonal structure of GBS causing neonatal infections in Barcelona over a period of 18 years.

Clinical and biochemical studies in mucopolysaccharidosis type II carriers

The aim of the study was to characterize clinically and biochemically mucopolysaccharidosis type II (MPS II) heterozygotes. Fifty-two women at risk to be a carrier, with a mean age of 34.1 years (range 16-57 years), were evaluated through pedigree analysis, medical history, physical examination, measurement of iduronate sulfatase (IDS) activities in plasma and in leukocytes, quantification of glycosaminoglycans (GAGs) in urine, and analysis of the IDS gene. Eligibility criteria for the study also included being 16 years of age or older and being enrolled in a genetic counselling programme. The pedigree and DNA analyses allowed the identification of 40/52 carriers and 12/52 non-carriers. All women evaluated were clinically healthy, and their levels of urinary GAGs were within normal limits. Median plasma and leukocyte IDS activities found among carriers were significantly lower than the values found for non-carriers; there was, however, an overlap between carriers' and non-carriers' values. Our data suggests that MPS II carriers show lower plasma and leukocyte IDS activities but that this reduction is generally associated neither with changes in levels of urinary GAGs nor with the occurrence of clinical manifestations.

Rat salivary gland ligation causes reversible secretory hypofunction

AIM

To determine the influence of inflammation on salivary secretion. Secretion by salivary glands involves interactions between nerves, blood vessels and salivary cells. The present study investigated the effects of inflammation on rat submandibular gland function following acute ductal obstruction.

METHODS

Under recovery anaesthesia a metal clip was placed on the main duct of the submandibular gland. After 24 h salivary secretion was evoked by nerve and methacholine stimulation. For recovery experiments the clip was removed after 24 h and the animal left to recover for 3 days when salivary function was again assessed.

RESULTS

By 24 h of obstruction an inflammatory infiltrate had developed within the obstructed gland and stimulated salivary flows were just 20% of the normal secretion, whilst protein secretion and ion reabsorption were also severely impaired. If ductal obstruction was removed after 24 h the salivary function returned to normal after 3 days of recovery. In vitro analysis of cells from 24-h ligated glands revealed normal changes in intracellular calcium (the main secondary messenger involved in fluid secretion) in response to methacholine stimulation. Protein secretion from isolated cells indicated some changes in particular to methacholine-induced protein secretion although a significant protein secretion was still seen in response to isoprenaline - the main stimulus for protein secretion.

CONCLUSION

This report demonstrates reversible salivary inhibition associated with an inflammatory infiltrate within the salivary gland.

The concept of bimaxillary transverse osteodistraction: a paradigm shift?

Severe crowding due to narrow upper and lower apical bases can be corrected by the extraction of four premolars, or by bimaxillary transverse osteodistraction. The first strategy is prone to unaesthetic changes in lip posture, nasolabial angle and buccal corridors. Life-long retention is necessary because of the known correlation between increased intercanine distance and relapse of crowding. The second strategy involves surgery and the final outcome regarding stability is not yet known. Theoretically, because the canines have not been moved outside of the skeletal envelope, and because the functional matrix positively influences the dental arches, relapse of crowding should be less. Facial appearance is improved because of the reduction of the buccal corridors and the fullness of the mouth both at rest, and upon smiling.

Corrélation entre les données échographiques et radiographiques dans l’évaluation de la maturation du cal osseux symphysaire après distraction

OBJECTIVE

To search for means of reducing ionizing radiation during treatment planning for transmandibular osteodistraction.

MATERIAL AND METHODS

Eleven patients (6 female, 5 male) underwent combined bimaxillary osteodistraction at a mean age of 18 Years. The following investigations were performed to determine symphyseal callus maturation: occlusal radiographs (O-RX) preoperatively, after the active phase of distraction (mean 27 days); ultrasound investigations (US) after the active and consolidation phase.

RESULTS

US showed calcification foci at the end of the active phase, when O-RX failed to do so. Both US and O-RX detected callus immaturity after 2 Months of consolidation in 1 patient. Both detected bridging ossification one Month later.

DISCUSSION

US can replace radiography in the diagnosis of callus maturation related to distractor removal.

13C-IRIS: an improved method to detect the addition of low levels of C4-derived sugars to juices

A method to improve the detection of cane or corn sugar addition to fruit juices has been developed. This involves the isolation of the individual sugars and measurement of their carbon isotope ratios. Using the Isotopic Relations of Individual Sugars approach, the additions of cane sucrose or cane invert as low as 4% of the total sugars can be detected in orange juice. This method offers a significant improvement over the conventional carbon isotopic method that has a detection limit of about 10%.

Mutation analysis and embryonic expression of the HLXB9 Currarino syndrome gene

The HLXB9 homeobox gene was recently identified as a locus for autosomal dominant Currarino syndrome, also known as hereditary sacral agenesis (HSA). This gene specifies a 403-amino acid protein containing a homeodomain preceded by a very highly conserved 82-amino acid domain of unknown function; the remainder of the protein is not well conserved. Here we report an extensive mutation survey that has identified mutations in the HLXB9 gene in 20 of 21 patients tested with familial Currarino syndrome. Mutations were also detected in two of seven sporadic Currarino syndrome patients; the remainder could be explained by undetected mosaicism for an HLXB9 mutation or by genetic heterogeneity in the sporadic patients. Of the mutations identified in the 22 index patients, 19 were intragenic and included 11 mutations that could lead to the introduction of a premature termination codon. The other eight mutations were missense mutations that were significantly clustered in the homeodomain, resulting, in each patient, in nonconservative substitution of a highly conserved amino acid. All of the intragenic mutations were associated with comparable phenotypes. The only genotype-phenotype correlation appeared to be the occurrence of developmental delay in the case of three patients with microdeletions. HLXB9 expression was analyzed during early human development in a period spanning Carnegie stages 12-21. Signal was detected in the basal plate of the spinal cord and hindbrain and in the pharynx, esophagus, stomach, and pancreas. Significant spatial and temporal expression differences were evident when compared with expression of the mouse Hlxb9 gene, which may partly explain the significant human-mouse differences in mutant phenotype.

A de novo complex chromosomal rearrangement with nine breakpoints characterized by FISH in a boy with mild mental retardation, developmental delay, short stature and microcephaly

A de novo complex chromosome rearrangement (CCR) involving chromosomes 1, 6, 7, 15 and Y was detected in a boy with mental retardation, short stature, and microcephaly. Fluorescence in situ hybridisation (FISH) with whole chromosome painting libraries, band-specific cosmids and telomeric probes was essential for the characterisation of the rearrangement. The CCR was shown to be the result of at least nine chromosomal breaks and involved the alternating insertion of two segments of the short arm of chromosome 1 and two segments of the long arm of chromosome 6 into a novel derived chromosome 7. A non-reciprocal translocation between the distal short arm of the same chromosome 7 and the distal long arm of the Y chromosome was also found, together with a paracentric inversion of the long arm of chromosome 15. The only detectable imbalance was a deletion of the heterochromatic Yq telomeric region. FISH investigations in this case have revealed an additional complexity in this CCR, which has implications for reproductive risk assessment and genetic counselling.

Cystic fibrosis: low frequency of DF508 mutation in 2 population samples from Rio de Janeiro, Brazil

Blood samples from 44 unrelated cystic fibrosis (CF) patients from Rio de Janeiro, Brazil, were analyzed for the 8 European CF mutations. Six homozygous and 15 heterozygous carriers of the DF508 mutation were found, corresponding to 47.7% of CF patients (allele frequency 0.3068). The G542X and G551D mutations were also observed with allele frequencies of 0.0227 and 0.0114, respectively. An analysis of the DF508 mutation in 291 randomly chosen, healthy individuals was performed, and only 3 heterozygous carriers were identified. These results show that the frequency of the DF508 allele in Rio de Janeiro is much lower than the world average; this may be due to the extremely heterogeneous ethnic admixture of the study population. By combining the results of these 2 different samples (CF patients and random population) and admixture data from Rio de Janeiro, we can estimate the CF incidence in this population to be 1:3542 individuals. However, taking into account the Rio de Janeiro ethnic admixture, we can find an estimate of 1:6902 individuals.

Analysis of the human Sonic Hedgehog coding and promoter regions in sacral agenesis, triphalangeal thumb, and mirror polydactyly

The human Sonic Hedgehog gene (SHH) is one of the vertebrate homologs related to the Drosophila segment polarity gene hedgehog. The entire coding and promoter region of the SHH gene, including 2 kb 5' of the transcriptional start site has been screened for mutations in families with autosomal dominant sacral agenesis and autosomal dominant triphalangeal thumb, two conditions previously known to be linked to 7q36. We have also studied the SHH gene in five families with mirror polydactyly associated with tibial hemimelia and in 51 unrelated patients with neural tube defects. Except for two sequence variants in exon 3, no mutations were found in these disease categories. OFF

Circulating immune complexes in Buerger's disease. Endarteritis obliterans in young men

Auto-antibodies such as anti-elastin, anti-collagen, anti-nuclear and anti-arterial, circulating immune complexes, and cellular responses to collagen I and III are known to be present in Buerger's disease (EO). Deposits of IgG, C3 and C4 have also been found in the vascular lesions of endarteritis obliterans (EO) in young men. The purpose of this study was to correlate clinical evidence of vascular disease with the presence of the circulating immune complexes. Thirty-three patients suffering from Buerger's disease (EO), 20 patients suffering from atherosclerosis (AT) and 20 normal controls (Norm) were studied. All were male, heavy smokers, and age-matched. Five techniques were used: direct nephelometry, nephelometry with protamine, two polyethyleneglycol precipitation methods (PegIgG and PegC4), and an immuno-enzymatic C1q fixation test (C1qE). The results seem to confirm the presence of circulating immune complexes in peripheral arterial disease in young men who are heavy smokers, particularly those suffering from EO.

[Kidney disease and pregnancy. Experience at the nephrology unit of Saint Mary's Hospital]

29 pregnancies in 27 renal patients were reviewed. The etiology of renal disease was mainly glomerular (14 patients). At the beginning of pregnancy 11 patients had renal failure and 14 patients had a high blood pressure. Only two patients had pregnancy related worsening of the renal function (the two patients had a normal renal function before pregnancy). Maternal morbidity was infrequent with no mortality. Fetal loss was 21.5% related to prematurity. There were no congenital anomalies. Renal failure at the beginning of pregnancy caused an obstetric risk factor. (greater fetal prematurity and mortality).

Why do patients with lupus nephritis die?

Over 20 years 42 of 138 patients with systemic lupus erythematosus "died"--that is, suffered actual death or went into terminal renal failure, or both; data from 41 were available for analysis. In most patients the causes of death were multiple. Twenty seven patients went into terminal renal failure, of whom 25 were offered dialysis treatment. Three regained renal function later, 12 survived on dialysis or with functioning kidney allografts--almost all with inactive lupus--but 13 died after starting dialysis, most within a few weeks or months. The principal causes were active lupus or infection. In those patients with renal failure after rapid deterioration in renal function (n = 14) there were nine deaths, while of 10 patients with a slow evolution into renal failure, only four died. Four patients with impaired and 10 with normal renal function died, again most often from complications of lupus or from infection. Vascular disease was a major cause of death in seven patients, all but two of whom were young; of 15 postmortem examinations, eight showed severe coronary artery atheroma, and three surviving patients required coronary bypass operations. Analysis of the timing of death or entry into renal failure showed that in 12 out of 13 patients who died within two years of onset the lupus was judged to be active, while this was true in only eight out of 19 patients who died later. Six of the seven vascular deaths occurred later than two years from onset, while only nine of 26 renal "deaths" occurred before two years; deaths from infections (n = 13) were distributed equally. Despite this and aggressive treatment of active disease, the principal cause of actual death was uncontrolled lupus.

End-stage renal failure in systemic lupus erythematosus with nephritis

The survival of patients in end-stage renal failure from lupus nephritis offered renal substitution therapy has been the subject of conflicting reports. Trying to clarify the reasons for this discrepancy, we analysed our experience with dialysis and transplantation in systemic lupus erythematosus (SLE). Of our 138 patients with lupus nephritis, 26 reached end-stage renal failure, of whom 24 received replacement therapy. Fourteen patients had a marked acute deterioration in renal function immediately before reaching terminal uremia, associated with active SLE in 12 and acute tubular necrosis after hypotension in one. Nine patients in this group died, 8 within 1 month of beginning dialysis. Nine patients progressed slowly to endstage renal failure over 2 to 7 years, without evidence of active SLE: only 1 required aggressive treatment and only 3 patients died, 1 five years after transplantation. Eight patients received altogether 10 allografted kidneys; 4 still functioning 10-24 months later; 2 patients are back on dialysis and 2 died, 1 of a myocardial infarct. There was no evidence of active SLE after transplantation. Ten patients were dialysed for more than 3 months; most were maintained on prednisolone and azathioprine whilst on dialysis and lupus activity tended to abate. The exclusion of the group of patients with rapid pre-terminal decrease in renal function from some series may explain some of the differences in reported survival. Stable patients with SLE present few problems in end-stage renal failure or after transplantation.