Effects of presynchronization and bovine somatotropin on pregnancy rates to a timed artificial insemination protocol in lactating dairy cows

The objective was to examine the effects of presynchronization and bovine somatotropin (bST) on pregnancy rates to a timed artificial insemination protocol in lactating dairy cows. Lactating Holstein cows (n = 543) were assigned randomly in a 2 x 3 factorial experiment in which cows received a presynchronization treatment or not, and were treated with bST (500 mg) at 63 +/- 3, 73 +/- 3, or 147 +/- 3 d postpartum. The latter group was used as a control. Presynchronization treatment consisted of two injections of PGF2alpha (25 mg) given 14 d apart, with the second injection of PGF2alpha being administered 12 d before initiation of the timed artificial insemination protocol. All cows received GnRH (100 microg) at 63 +/- 3 d postpartum, an injection of PGF2alpha (40 mg) 7 d later, a GnRH injection at 48 h after PGF2alpha and were inseminated 16 to 20 h later. Cows were resynchronized if determined to be nonpregnant at ultrasonography at 32 d after insemination with a GnRH injection (100 microg), an injection of PGF2alpha (40 mg) 7 d later, and a GnRH injection at 48 h after PGF2alpha and were inseminated 16 to 20 h later. Cows were examined for pregnancy at 32 d and reexamined at 74 d after insemination. No differences in pregnancy rates were observed between cows receiving bST treatment at 63 +/- 3 d postpartum or at 73 +/- 3 d postpartum. An interaction between presynchronization and bST treatment indicated that pregnancy rates were increased for cows treated with bST when cows were presynchronized. When anestrous cows were excluded from the analyses, both an effect of bST and of presynchronization were observed, indicating that bST increased pregnancy rates regardless of presynchronization treatment and that presynchronization also increased pregnancy rates independently of bST treatment. Presynchronization and bST treatment may be used to increase first-service pregnancy rates to a timed artificial insemination protocol.

Ovarian damage from chemotherapy and current approaches to its protection

BACKGROUND

Anti-cancer therapy is often a cause of premature ovarian insufficiency and infertility since the ovarian follicle reserve is extremely sensitive to the effects of chemotherapy and radiotherapy. While oocyte, embryo and ovarian cortex cryopreservation can help some women with cancer-induced infertility achieve pregnancy, the development of effective methods to protect ovarian function during chemotherapy would be a significant advantage.

OBJECTIVE AND RATIONALE

This paper critically discusses the different damaging effects of the most common chemotherapeutic compounds on the ovary, in particular, the ovarian follicles and the molecular pathways that lead to that damage. The mechanisms through which fertility-protective agents might prevent chemotherapy drug-induced follicle loss are then reviewed.

SEARCH METHODS

Articles published in English were searched on PubMed up to March 2019 using the following terms: ovary, fertility preservation, chemotherapy, follicle death, adjuvant therapy, cyclophosphamide, cisplatin, doxorubicin. Inclusion and exclusion criteria were applied to the analysis of the protective agents.

OUTCOMES

Recent studies reveal how chemotherapeutic drugs can affect the different cellular components of the ovary, causing rapid depletion of the ovarian follicular reserve. The three most commonly used drugs, cyclophosphamide, cisplatin and doxorubicin, cause premature ovarian insufficiency by inducing death and/or accelerated activation of primordial follicles and increased atresia of growing follicles. They also cause an increase in damage to blood vessels and the stromal compartment and increment inflammation. In the past 20 years, many compounds have been investigated as potential protective agents to counteract these adverse effects. The interactions of recently described fertility-protective agents with these damage pathways are discussed.

WIDER IMPLICATIONS

Understanding the mechanisms underlying the action of chemotherapy compounds on the various components of the ovary is essential for the development of efficient and targeted pharmacological therapies that could protect and prolong female fertility. While there are increasing preclinical investigations of potential fertility preserving adjuvants, there remains a lack of approaches that are being developed and tested clinically.

Effects of hormonal treatments on reproductive performance and embryo production

Developments in the use of drugs to improve reproduction and embryo production have focused on estrus and ovulation synchronization protocols and embryonic survival. Protocols for synchronization of ovulation eliminate the need for detection of estrus and allow timed insemination of all cows enrolled. Various estrogenic, progestational, GnRH and PGF2 alpha-like drugs are used to synchronize follicle development, CL regression and induction of ovulation. Strategies are discussed to optimize such programs to maximize herd pregnancy rates. Use of bovine Somatotrophin (bST) in combination with the Ovsynch protocol resulted in increased pregnancy rates, indicating possible effects on oocyte and embryonic development. Treatment of embryo donor cows with bST reduced the proportion of unfertilized oocytes and increased the number of transferable embryos. Furthermore, bST increased pregnancy rate when given to the recipient. Sub-luteal plasma progesterone concentrations after insemination have been associated with lower pregnancy rates. Injection of hCG on day 5 post-insemination resulted in induction of an accessory CL, increased plasma progesterone concentrations and increased conception rates. Strategies involving the use of sustained GnRH agonists to enhance CL development and alter follicular development are considered for future programs to enhance pregnancy rates.

Use of estradiol cypionate in a presynchronized timed artificial insemination program for lactating dairy cattle

Experiment 1 evaluated pregnancy rates when estradiol cypionate (ECP) was used to induce ovulation as part of a timed artificial insemination (TAI) protocol in comparison to Ovsynch for lactating dairy cows in Florida (n = 371) and Texas (n = 321). Cows were presynchronized with two injections of PGF2, (25 mg, im) given 14 d apart with TAI protocols beginning 14 d after the second injection of PGF20. The TAI protocols consisted of an injection of GnRH (100 microg, im) followed by PGF2alpha 7 d later. Then, cows either received an injection of GnRH (Treatment I, Ovsynch) at 48 h after PGF2alpha and inseminated 16 to 24 h later or received an injection of ECP (1 mg, i.m.) at 24 h after PGF2alpha, (Treatment II; Heatsynch) and inseminated 48 h later. In Florida, pregnancy rates after TAI were 37.1 +/- 5.8% for Ovsynch compared with 35.1 +/- 5.0% for Heatsynch. In Texas, pregnancy rates were 28.2 +/- 3.6% for Ovsynch and 29.0 +/- 3.5% for Heatsynch. Overall pregnancy rates did not differ between Ovsynch and Heatsynch treatments. In Experiment 2, estrus and ovulation times were determined in lactating dairy cows submitted to the Heatsynch protocol. Frequencies of detected estrus and ovulation after ECP were 75.7% (28/37) and 86.5% (32/37), respectively. Mean intervals to ovulation were 55.4 +/- 2.7 h (n = 32) after ECP and 27.5 +/- 1.1 h (n = 27) after onset of estrus. Estrus occurred at 29.0 +/- 1.8 h (n = 28) after ECP. It is recommended that any cow detected in estrus by 24 h after ECP injection be inseminated at 24 h and all remaining cows be inseminated at 48 h because 75% (n = 24/32) of the ovulations occurred between > or = 48 h to < or = 72 h after ECP. Synchronization of ovulation and subsequent fertility indicated that estradiol cypionate could be used to induce ovulation for successful timed insemination.

Unearthing the roles of imprinted genes in the placenta

Mammalian fetal survival and growth are dependent on a well-established and functional placenta. Although transient, the placenta is the first organ to be formed during pregnancy and is responsible for important functions during development, such as the control of metabolism and fetal nutrition, gas and metabolite exchange, and endocrine control. Epigenetic marks and gene expression patterns in early development play an essential role in embryo and fetal development. Specifically, the epigenetic phenomenon known as genomic imprinting, represented by the non-equivalence of the paternal and maternal genome, may be one of the most important regulatory pathways involved in the development and function of the placenta in eutherian mammals. A lack of pattern or an imprecise pattern of genomic imprinting can lead to either embryonic losses or a disruption in fetal and placental development. Genetically modified animals present a powerful approach for revealing the interplay between gene expression and placental function in vivo and allow a single gene disruption to be analyzed, particularly focusing on its role in placenta function. In this paper, we review the recent transgenic strategies that have been successfully created in order to provide a better understanding of the epigenetic patterns of the placenta, with a special focus on imprinted genes. We summarize a number of phenotypes derived from the genetic manipulation of imprinted genes and other epigenetic modulators in an attempt to demonstrate that gene-targeting studies have contributed considerably to the knowledge of placentation and conceptus development.

Para além da barreira dos números: desigualdades raciais e saúde

Este artigo parte do conceito de saúde como o conjunto de condições integrais e coletivas de existência, influenciado pelo contexto político, sócio-econômico, cultural e ambiental. Desse modo, mostra que os estudos sobre as desigualdades, disparidades ou iniqüidades em saúde devem ir muito além da comparação de dados estatísticos, uma vez que o racismo nem sempre se apresenta de forma explícita e mensurável nas interações sociais. É preciso analisar as diversas experiências vivenciadas por negros e não-negros numa dada condição social, considerando sexo, idade, região de moradia, educação, origem familiar, ocupação, renda, orientação sexual, filiação religiosa, suas capacidades e incapacidades, sua rede social e suas possibilidades de acesso aos serviços e bens sociais. Por fim, o artigo enumera diretrizes que possam colaborar com o grande desafio de formulação de políticas públicas que combatam e erradiquem as imensas desigualdades entre brancos e negros.

Rumen morphometrics and the effect of digesta pH and volume on volatile fatty acid absorption

The effects of rumen digesta volume and pH on VFA absorption and its relation to rumen wall morphology were evaluated. Nine rumen cannulated cows formed 3 groups based on desired variation in rumen morphology: The High group was formed by Holsteins yielding 25.9 kg milk/d and fed on a high-grain total mixed ration (TMR); the Medium group by Holstein-Zebu crossbreds yielding 12.3 kg milk/d and fed on corn silage, tropical pasture, and a commercial concentrate; and the Dry group by nonlactating grazing Jerseys fed exclusively on tropical pasture. Within each group, a sequence of 3 ruminal conditions was induced on each cow in 3 × 3 Latin Squares, with 7-d periods: high digesta volume and high pH (HVHP), low volume and high pH (LVHP), and low volume and low pH (LVLP). Rumen mucosa was biopsied on the first day of Period 1. Ruminal morphometric variables evaluated were mitotic index, absorptive surface and papillae number per square centimeter of wall, area per papillae, papillae area as a percentage of absorptive surface, and epithelium, keratinized layer, and nonkeratinized layer thickness. There was marked variation in rumen morphology among the groups of cows. Grazing Jerseys had decreased rumen wall absorptive surface area and basal cells mitotic index, and increased thickness of the epithelium and of the keratin layer compared with cows receiving concentrates. Mean rumen pH throughout the 4 h sampling period was: 6.78 for HVHP, 7.08 for LVHP, and 5.90 for LVLP (P < 0.01). The capacity of the rumen wall to absorb VFA was estimated by the Valerate/CrEDTA technique. The fractional exponential decay rate for the ratio of valeric acid to Cr (k Val/Cr) was determined by rumen digesta sampling at 20-min intervals during 4 h, after the mixing of markers and the return of the evacuated ruminal content. The k Val/Cr values for treatments HVHP, LVHP, and LVLP were, respectively: 19.6, 23.9, and 35.0 %/h (SEM = 2.01; P = 0.21 for contrast HVHP vs. LVHP and P < 0.01 for contrast LVHP vs. LVLP). The k Val/Cr was faster under low pH, but decreasing digesta volume under high pH did not elicit such a response. The correlation between the absorptive surface area per square centimeter of rumen wall and the mean of the 3 k Val/Cr values of each cow was 0.90 (P < 0.01). Cows capable of maintaining a less-acidic rumen environment had greater inflow of water into the digestive cavity, had a more developed rumen mucosa, and were more efficient VFA absorbers.

Motor Cortex Reorganization in Limb Amputation: A Systematic Review of TMS Motor Mapping Studies

Purpose: The purpose of this systematic review is to evaluate motor cortex reorganization in amputees as indexed by transcranial magnetic stimulation (TMS) cortical mapping and its relationship with phantom limb pain (PLP). Methods: Pubmed database were systematically searched. Three independent researchers screened the relevant articles, and the data of motor output maps, including the number of effective stimulation sites, center of gravity (CoG) shift, and their clinical correlations were extracted. We calculated a pooled CoG shift for motor cortex TMS mapping. Results: The search yielded 468 articles, 11 were included. Three studies performed correlation between the cortical changes and PLP intensity, and only one study compared cortical mapping changes between amputees with pain and without pain. Results showed (i) enlarged excitable area and a shift of CoG of neighboring areas toward the deafferented limb area; (ii) no correlation between motor cortex reorganization and level of pain and (iii) greater cortical reorganization in patients with PLP compared to amputation without pain. Conclusion: Our review supports the evidence for cortical reorganization in the affected hemisphere following an amputation. The motor cortex reorganization could be a potential clinical target for prevention and treatment response of PLP.

Cold: a risk factor for stroke?

A retrospective study was performed to investigate seasonal variation in stroke incidence and to evaluate the hypothesis that cold might be a risk factor. Data were obtained from the central registry of the Hospital de S. João, Porto, Portugal, concerning 4048 patients consecutively admitted for cerebrovascular disease during a period of 33 months. Monthly admissions for stroke and its subtypes were related to mean values of ambient temperature using linear correlation. There was a strong inverse correlation between average temperature and total admissions for cerebrovascular disease (r = -0.72, P < 0.00005), intracerebral haemorrhage (r = -0.66, P < 0.00005), ischaemic stroke (r = -0.46, P = 0.007) and transient ischaemic attack (r = -0.41, P = 0.017). These correlations were independent of any seasonal variation in the number of hospital admissions due to all causes. No relation was found between temperature and subarachnoid haemorrhage. The rhythmometric analysis showed the presence of a statistically significant rhythm with an acrophase in the coldest months. These results support the hypothesis of stroke being a chronorisk disease to which cold might represent a triggering factor.

[Quality of life of people living with HIV/AIDS in São Paulo, Brazil]

OBJECTIVE

To assess quality of life of people living with HIV/AIDS.

METHODS

Cross-sectional study conducted in an AIDS outpatient service based on consecutive sampling during the second half of the year 2002. There were selected 365 men and women aged 18 years or older who were attended by the infectious disease physician. Sociodemographic and recent drug use variables and data on clinical conditions were obtained using a questionnaire and quality of life was analyzed using WHOQOL-bref.

RESULTS

Scores of the four domains (physical, psychological, social relationships and environment) were very similar. There were statistically significant differences in mean scores for the environment domain according to skin color, with blacks and pardos having lower scores. Women also had the lowest scores for the psychological and environmental domains. Higher income was significantly associated to higher scores in all domains of quality of life, except for the social relationships domain. Subjects with CD4+ cell counts below 200 cells/mm(3) had lower scores for the physical domain. In all domains significantly lower scores were seen for those receiving psychiatric treatment or with an indication for such treatment.

CONCLUSIONS

Despite differences in sex, skin color, income, and mental and immunological status, people living with HIV/AIDS have better (physical and psychological) quality of life than other patients but lower quality in social relationships domain. The latter domain could reflect stigmatization and discrimination associated to the difficulties of disclosing their HIV status in social settings and for a safe sex life.

Inhibitors of the mitochondrial electron transport chain and de novo pyrimidine biosynthesis as antimalarials: The present status

Malaria is a major worldwide public health threat with worrying social and economic burdens due to the rapid emergence of multidrug-resistant Plasmodium falciparum strains. As a result, there is an urgent need to find novel drugs that might overcome clinical resistance to marketed antimalarials. In recent years, the mitochondrial electron transport chain (mtETC) has been explored for the development of new antimalarials. Type II NADH:quinone oxidoreductase (PfNDH2), succinate dehydrogenase (SDH) and cytochrome bc1 have become a major focus of those efforts, leading to several studies of its biochemistry and the design of potent inhibitors. Furthermore, de novo pyrimidine biosynthesis in malaria parasites, particularly dihydroorotate dehydrogenase (PfDHODH), is also receiving increasing attention. The enzymes involved in the mtETC are valuable targets in malaria chemotherapy, not only because they play a critical role in metabolic pathways of P. falciparum, but also because they differ significantly from the analogous mammalian system. Inhibition of such enzymes results in the shutdown of mitochondrial electron flow, leading to the arrest of pyrimidine biosynthesis and consequent parasite death. In this review, we aim to outline recent advances in the inhibition of mitochondrial metabolic pathways, highlighting the major classes of known inhibitors and those that are currently being developed.

Smoking and psychiatric disorders: a comorbidity survey

Epidemiological and clinical studies have shown a positive correlation between smoking and psychiatric disorders. To investigate the prevalence of cigarette smoking, 277 psychiatric outpatients with anxiety or depressive disorders (DSM-IV) answered a self-evaluation questionnaire about smoking behavior and were compared with a group of 68 control subjects. The diagnoses (N = 262) were: 30.2% (N = 79) major depressive disorder, 23.3% (N = 61) panic disorder, 15.6% (N = 41) social anxiety disorder, 7.3% (N = 19) other anxiety disorders, and 23.7% (N = 62) comorbidity disorders. Among them, 26.3% (N = 69) were smokers, 23.7% (N = 62) were former smokers and 50.0% (N = 131) were nonsmokers. The prevalence of nicotine dependence among the smokers was 59.0% (DSM-IV). The frequency of cigarette smoking did not show any significant difference among the five classes of diagnosis. The social anxiety disorder patients were the heaviest smokers (75.0%), with more unsuccessful attempts to stop smoking (89.0%). The frequency of former smokers was significantly higher among older subjects and nonsmokers were significantly younger (chi2 = 9.13, d.f. = 2, P = 0.01). Our data present some clinical implications suggesting that in our psychiatric outpatient sample with anxiety disorder, major depression and comorbidity (anxiety disorder and major depression), the frequency of cigarette smoking did not differ from the frequency found in the control group or in general population studies. Some specific features of our population (outpatients, anxiety and depressive disorders) might be responsible for these results.

Validation of an approach to predict total-tract fiber digestibility using a standardized in vitro technique for different diets fed to high-producing dairy cows

The experimental objective was to validate an in vitro model to predict total-tract neutral detergent fiber (NDF) digestibility in dairy cattle. Twenty-one diets from 7 studies conducted at University of Wisconsin-Madison were analyzed for in vitro fiber digestibility. Forages varied among diets (corn, alfalfa, tall and meadow fescue, and wheat straw silages) and nutrient composition (ranges: NDF = 22.5 to 33.8%; crude protein = 15.8 to 18.9%; nonfiber carbohydrates = 38.0 to 51.0%). Total-tract NDF digestibility (TTNDFD) observed in in vivo trials was determined using different markers as described in the individual studies. The in vitro TTNDFD model predicted total-tract fiber digestibility from the proportion of total NDF potentially digestible (pdNDF), rate of pdNDF degradation, and rate of passage of pdNDF. The model predicted TTNDFD similar to in vivo measurements. The relationship between TTNDFD measured in vivo and TTNDFD predicted by the in vitro assay was significant (R(2) = 0.68). The relationship between in vitro 30-h NDF digestibility values and in vivo total-tract NDF digestibility values was not significant, whereas in vitro 48-h NDF digestibility values were correlated (R(2) = 0.30) with in vivo TTNDFD measurements. Indigestible NDF (iNDF) showed a negative relationship (R(2) = 0.40) with TTNDFD in vivo. Each 1-percentage-unit increase of iNDF resulted in a decrease of 0.96 percentage units of total-tract NDF digestibility; however, iNDF by itself was not a good predictor of TTNDFD because of the difference among the means. This study showed that an in vitro TTNDFD model that uses iNDF, pdNDF, and rates of pdNDF digestion and passage can predict (R(2) = 0.68) total-tract NDF digestibility. Most importantly, we demonstrated the ability to predict total-tract fiber digestibility from a model based on in vitro NDF degradation, which could improve our ability to optimize forage utilization and milk production.

Refining the phenotype associated with biallelic DNAJC21 mutations

Inherited bone marrow failure syndromes (IBMFS) are caused by mutations in genes involved in genomic stability. Although they may be recognized by the association of typical clinical features, variable penetrance and expressivity are common, and clinical diagnosis is often challenging. DNAJC21, which is involved in ribosome biogenesis, was recently linked to bone marrow failure. However, the specific phenotype and natural history remain to be defined. We correlate molecular data, phenotype, and clinical history of 5 unreported affected children and all individuals reported in the literature. All patients present features consistent with IBMFS: bone marrow failure, growth retardation, failure to thrive, developmental delay, recurrent infections, and skin, teeth or hair abnormalities. Additional features present in some individuals include retinal abnormalities, pancreatic insufficiency, liver cirrhosis, skeletal abnormalities, congenital hip dysplasia, joint hypermobility, and cryptorchidism. We suggest that DNAJC21-related diseases constitute a distinct IBMFS, with features overlapping Shwachman-Diamond syndrome and Dyskeratosis congenita, and additional characteristics that are specific to DNAJC21 mutations. The full phenotypic spectrum, natural history, and optimal management will require more reports. Considering the aplastic anemia, the possible increased risk for leukemia, and the multisystemic features, we provide a checklist for clinical evaluation at diagnosis and regular follow-up.

SSRI and Motor Recovery in Stroke: Reestablishment of Inhibitory Neural Network Tonus

Selective serotonin reuptake inhibitors (SSRIs) are currently widely used in the field of the neuromodulation not only because of their anti-depressive effects but also due to their ability to promote plasticity and enhance motor recovery in patients with stroke. Recent studies showed that fluoxetine promotes motor recovery after stroke through its effects on the serotonergic system enhancing motor outputs and facilitating long term potentiation, key factors in motor neural plasticity. However, little is known in regards of the exact mechanisms underlying these effects and several aspects of it remain poorly understood. In this manuscript, we discuss evidence supporting the hypothesis that SSRIs, and in particular fluoxetine, modulate inhibitory pathways, and that this modulation enhances reorganization and reestablishment of excitatory-inhibitory control; these effects play a key role in learning induced plasticity in neural circuits involved in the promotion of motor recovery after stroke. This discussion aims to provide important insights and rationale for the development of novel strategies for stroke motor rehabilitation.

Mulheres negras e não-negras e vulnerabilidade ao HIV/Aids no estado de São Paulo, Brasil

OBJETIVO: Analisar características relacionadas à vulnerabilidade individual de mulheres com sorologia positiva para o HIV segundo cor da pele. MÉTODOS: Pesquisa multicêntrica realizada em 1999-2000, em serviços de saúde especializados em DST/Aids no Estado de São Paulo, envolvendo 1.068 mulheres maiores de 18 anos, vivendo com HIV. Informações sociodemográficas e características relacionadas à infecção e aos cuidados em saúde foram obtidas em entrevistas individuais com questionário padronizado. A variável raça/cor foi auto-referida, tendo sido agrupadas como negras as mulheres pretas e pardas. A descrição das variáveis segundo raça/cor foi feita por medidas de tendência central e proporções, e o estudo de associação pelo teste chi2 Pearson. RESULTADOS: As diferenças entre negras e não-negras foram estatisticamente significantivas em relação a: escolaridade; renda mensal, individual e familiar per capita; número de dependentes diretos; oportunidades de ser atendida por nutricionista, ginecologista ou outro profissional médico; de compreender o que o infectologista diz; de falar com o infectologista ou com o ginecologista sobre sua vida sexual; de ter conhecimento correto sobre os exames de CD4 e carga viral; a via sexual de exposição. CONCLUSÕES: O uso de raça/cor como categoria analítica indica caminhos para melhor compreender como as interações sociais, na intersecção gênero e condições socioeconômicas, produzem e reproduzem desvantagens na exposição das mulheres negras aos riscos à sua saúde, assim como impõem restrições quanto ao uso de recursos adequados para o seu cuidado.

Double-blind clonazepam vs placebo in panic disorder treatment

OBJECTIVE

To assess the effectiveness of clonazepam, in a fixed dose (2 mg/day), compared with placebo in the treatment of panic disorder patients.

METHOD

24 panic disorder patients with agoraphobia were randomly selected. The diagnosis was obtained using the structured clinical interview for DSM-IV. All twenty-four subjects were randomly assigned to either treatment with clonazepam (2 mg/day) or placebo, during 6 weeks. Efficacy assessments included: change from baseline in the number of panic attacks; CGI scores for panic disorder; Hamilton rating scale for anxiety; and panic associated symptoms scale.

RESULTS

At the therapeutic endpoint, only one of 9 placebo patients (11.1%) were free of panic attacks, compared with 8 of 13 (61.5%) clonazepam patients (Fisher exact test; p=0,031).

CONCLUSION

the results provide evidence for the efficacy of clonazepam in panic disorder patients.

Children's (in)dependent mobility in Portugal

OBJECTIVES

To characterize children's independent mobility in Portugal, by studying the influence of age, sex, school type (primary/secondary) and location (urban/rural). To explore associations between mobility licences and children's actual independent mobility.

DESIGN

Cross-sectional study of 1099 children between 8 and 15 years of age and their parents. Children attended primary (n=660, 49% boys, 69% urban) and secondary (n=439, 43% boys, 72% urban) schools.

METHODS

The Portuguese version of the child independent mobility survey (Policy Studies Institute, London) was completed. Parents reported the mobility licences granted to their children. Children reported their independent mobility on school journeys and on weekends. Differences were examined in mobility licences and independent mobility by sex, urban/rural setting and primary/secondary schools. Multiple logistic regression models examined the associations between different variables and actual independent mobility.

RESULTS

Secondary school children are granted more licences and have greater levels of independent mobility than primary school children. Only 21% of primary school children and 45% of secondary school children come home from school actively and independently. Overall, sex does not influence the licences granted to children in Portugal but boys have greater levels of independent mobility during the weekends than girls. Children in rural settings report engaging in more activities during the weekend. The number of mobility licences granted to the child was identified as predictor for actual independent mobility on school days and during the weekend.

CONCLUSIONS

Portuguese children lack independent mobility. Complementary qualitative research will be important to inform about the better practices to tackle this problem.

[HIV, HPV, and syphilis prevalence in a women's penitentiary in the city of São Paulo, 1997-1998]

Incarcerated women as a group are particularly vulnerable to infections. The lack of public programs for prevention, early diagnosis, and treatment contribute to the increase in the incidence and prevalence of diseases in general and especially sexually transmitted diseases. This article aims to estimate the prevalence of infection by the human immunodeficiency virus (HIV), human papillomavirus (HPV), and syphilis among inmates at the Women's Penitentiary in the State capital of São Paulo, Brazil. All inmates were invited to participate in the study, which was divided into two stages: 1. STD/AIDS preventive workshops including interviews and 2. laboratory tests. The interview covered knowledge of STD/AIDS, risk behavior, and individual reproductive health history. A total of 262 women, with a mean age of 32.4 years and limited schooling, participated in more than one stage of the study. Prevalence rates were 14.5% for HIV, 16.3% for high-oncogenic-risk HPV probes, 4.8% for low-oncogenic-risk HPV probes, and 5.7% for syphilis. The authors conclude that STD/HIV constitute a serious health problem in the prison system, requiring urgent preventive measures.

Clinical features of panic patients sensitive to hyperventilation or breath-holding methods for inducing panic attacks

Our aim was to compare the clinical features of panic disorder (PD) patients sensitive to hyperventilation or breath-holding methods of inducing panic attacks. Eighty-five PD patients were submitted to both a hyperventilation challenge test and a breath-holding test. They were asked to hyperventilate (30 breaths/min) for 4 min and a week later to hold their breath for as long as possible, four times with a 2-min interval. Anxiety scales were applied before and after the tests. We selected the patients who responded with a panic attack to just one of the tests, i.e., those who had a panic attack after hyperventilating (HPA, N = 24, 16 females, 8 males, mean age +/- SD = 38.5 +/- 12.7 years) and those who had a panic attack after breath holding (BHPA, N = 20, 11 females, 9 males, mean age +/- SD = 42.1 +/- 10.6 years). Both groups had similar (chi(2) = 1.28, d.f. = 1, P = 0.672) respiratory symptoms (fear of dying, chest/pain discomfort, shortness of breath, paresthesias, and feelings of choking) during a panic attack. The criteria of Briggs et al. [British Journal of Psychiatry, 1993; 163: 201-209] for respiratory PD subtype were fulfilled by 18 (75.0%) HPA patients and by 14 (70.0%) BHPA patients. The HPA group had a later onset of the disease compared to BHPA patients (37.9 +/- 11.0 vs 21.3 +/- 12.9 years old, Mann-Whitney, P < 0.001), and had a higher family prevalence of PD (70.8 vs 25.0%, chi(2) = 19.65, d.f. = 1, P = 0.041). Our data suggest that these two groups--HPA and BHPA patients--may be specific subtypes of PD.

Parents-child role reversal in trilogue play: case studies of trajectories from pregnancy to toddlerhood

Role reversal, whereby a child attempts to meet her parent's adult needs for parenting, intimacy, or companionship, has been identified as a risk factor for developmental disturbances. It has been defined from diverse perspectives as a child attachment strategy, a parent - toddler relational disturbance, and a boundary disturbance between parents and child. The recently discovered infant's triangular capacity, namely the sharing of her attention and affects with both parents, allows one to analyse the infant's contribution to early family dynamics. Role reversal was detected in 4 out of 45 father - mother - infant interactions observed in trilogue play from pregnancy to toddlerhood. The developmental trajectories towards role reversal are explored by means of case analyses. Results are compared with cases of problematic triangulation encountered in the same sample. In role reversal, family interactions are rigidly organized around a "two against one" coalition, whereby the normative hierarchy between parents and child is reversed. The child's triangular capacity is overactivated, controlling the tension between her parents by provocation - animation strategies.

Comparison of 3, 5 and 7 days' treatment with Quinimax for falciparum malaria in Guinea-Bissau

For treatment of malaria, the World Health Organization recommends 10 mg of quinine per kg body-weight 3 times a day for at least 7 d. In Guinea-Bissau, as in several other African countries, a 3 d treatment regimen (10 mg/kg twice daily) is currently used. We therefore compared the 3 d treatment period with periods of 5 and 7 d. A total of 145 children with clinical malaria due to monoinfection with Plasmodium falciparum, with > or = 20 parasites per 200 leucocytes, were treated with intramuscular Quinimax 10 mg per kg body-weight twice daily for 3, 5 or 7 d. The children were then examined once weekly for 4 weeks. Following the 3 d treatment regimen, 34 of 43 children (79%) had parasitaemia on day 28 or before; following the 5 d treatment regimen, 36 of 40 children (90%) did so; and following the 7 d treatment regimen, 7 of 62 children (11%) were parasitaemic at that time. This study thus suggests that the currently recommended 3 d Quinimax treatment regimen in Guinea-Bissau for moderate and severe malaria is not effective.

CK-19 expression by RT-PCR in the peripheral blood of breast cancer patients correlates with response to chemotherapy

BACKGROUND

The recent introduction of sensitive RT-PCR-based techniques for the detection of epithelial antigen expression, such as CK-19, in the peripheral blood and bone marrow of breast cancer patients may provide an opportunity to evaluate tumor response at the molecular level, even in the absence of measurable disease while patients are still receiving chemotherapy.

METHODS

We studied serially collected blood samples of 53 patients with breast cancer before, during, and after adjuvant, neoadjuvant, and palliative chemotherapy to evaluate its effects on the expression of CK-19 measured by RT-PCR.

RESULTS

The percentage of CK-19 RT-PCR positivity decreased consistently from 43% (23/53) before chemotherapy to 14.3% (7/49), and to 18.9% (7/37) after 3 and 6 cycles, respectively (chi-square for linear trend = 7.948; p = 0.0048). Furthermore, there was a significant correlation between a negative CK-19 at three months and the response to chemotherapy (p = 0.024).

CONCLUSION

We conclude that RT-PCR negativity for CK-19 expression at 3 months after the beginning of chemotherapy correlates with tumor response and, as treatment progresses, there is a significant trend for the occurrence of more negative RT-PCR results. Further studies are needed to confirm if this technique can be useful to assess response to chemotherapy in patients without measurable disease and if negativation of CK-19 expression while on chemotherapy is of prognostic significance.

Acyloxymethyl as a drug protecting group. Part 6: N-acyloxymethyl- and N-[(aminocarbonyloxy)methyl]sulfonamides as prodrugs of agents containing a secondary sulfonamide group

Tertiary N-acyloxymethyl- and N-[(aminocarbonyloxy)methyl]sulfonamides were synthesised and evaluated as novel classes of potential prodrugs of agents containing a secondary sulfonamide group. The chemical and plasma hydrolyses of the title compounds were studied by HPLC. Tertiary N-acyloxymethylsulfonamides are slowly and quantitatively hydrolysed to the parent sulfonamide in pH 7.4 phosphate buffer, with half-lives ranging from 20 h, for 7d, to 30 days, for 7g. Quantitative formation of the parent sulfonamide also occurs in human plasma, the half-lives being within 0.2-2.0 min for some substrates. The rapid rate of hydrolysis can be ascribed to plasma cholinesterase, as indicated by the complete inhibition observed at [eserine] = 0.10 mM. These results suggest that tertiary N-acyloxymethylsulfonamides are potentially useful prodrugs for agents containing a secondary sulfonamide group, especially with pKa < 8, combining a high stability in aqueous media with a high rate of plasma activation. In contrast, N-[(aminocarbonyloxy)methyl]sulfonamides 7h-j do not liberate the parent sulfonamide either in aqueous buffers or in human plasma and thus appear to be unsuitable for development as sulfonamide prodrugs.

Short-term memory and cognitive variability in adult fragile X females

We investigated the possibility that adult fragile X [fra(X)] heterozygotes have a distinct or specific cognitive profile, with a particular focus on visuospatial and/or memory deficits. With a sample of 13 adult fra(X) female carriers (2 fra(X) positive) and age-matched control women, we performed 2 tests: Wechsler Adult Intelligence Scale-Revised (WAIS-R) and the Revised Visual Retention Test (RVRT). An identifiable cognitive profile was not evident in the study group, but significant differences were evident in RVRT performance in number correct and number of errors when compared to controls and normative data. The combination of the WAIS-R and RVRT data suggests that the short-term memory component of the tasks may be of more significance than visuospatial performance in the deficits observed.