Strong infrared photoluminescence in highly porous layers of large faceted Si crystalline nanoparticles.

Almost all physical processes in solids are influenced by phonons, but their effect is frequently overlooked. In this paper, we investigate the photoluminescence of large silicon nanoparticles (approximately 100 nm size, synthesized by chemical vapor deposition) in the visible to the infrared detection range. We find that upon increasing laser irradiance, an enormous photoluminescence emission band appears in the infrared. Its intensity exhibits a superlinear power dependence, increasing over four orders of magnitude in the investigated pump power range. Particles of different sizes as well as different shapes in porous layers are investigated. The results are discussed taking into account the efficient generation of phonons under high-power pumping, and the reduced capability, porosity dependent, of the silicon nanoparticles to exchange energy with each other and with the substrate. Our findings are relevant for heat management strategies in silicon.

Effects of a new nutraceutical ingredient on allergen-induced sulphidoleukotrienes production and CD63 expression in allergic subjects.

Allergic diseases represent conditions affecting millions of individuals across the world. The objective of this study was to investigate the potential anti-allergic effects of a new nutraceutical ingredient, Pantescal (Bionap, Italy), contained in different food supplements. Pantescal is a mixture of plant extracts, such as Capparis spinosa, Olea europaea, Panax Ginseng and Ribes nigrum. The study was a randomized, double-blind, placebo controlled design. 60 patients allergic to common aeroallergens were chosen. Allergic patients were divided into two groups: one group was supplemented by Pantescal and the other, using a placebo formulation. Two in vitro tests were performed on blood samples taken from patients before and at 2 h, 2, 3 and 10 days after supplementation: cellular antigen stimulation test (CAST) was used to analyze the amount of sulphidoleukotrienes (SLT) production and flow-cytometric antigen stimulation test (FAST) to measure expression of basophil degranulation marker (CD63) was also performed. CAST showed that after 2 and 3 days, a slight decrease of SLT production was evident but only after 10 days did it become significant with a percentage of inhibition (P.I)=43.3%. FAST revealed that there were no statistical differences for the first 2 days after supplementation although there was an inhibitory trend in the supplemented patients. CD63 expression was significantly reduced after 10 days (P.I.=64.8%). This study suggests that Pantescal is effective in reducing allergic biomarkers such as CD63 protein and SLT in atopic subjects. The higher inhibitory effect on CD63 expression compared to SLT production allows us to hypothesize cell membrane stabilization as the main potential mechanism to explain the observed Pantescal protective effects.

Atacicept (TACI-Ig) inhibits growth of TACI(high) primary myeloma cells in SCID-hu mice and in coculture with osteoclasts.

APRIL (a proliferation-inducing Ligand) and BLyS/BAFF (B-lymphocyte stimulator/B-cell-activating factor of the TNF (tumor necrosis factor) family have been shown to be the survival factors for certain myeloma cells in vitro. BAFF binds to the TNF-related receptors such as B-cell maturation antigen (BCMA), transmembrane activator and CAML interactor (TACI) and BAFFR, whereas APRIL binds to TACI and BCMA and to heparan sulfate proteoglycans (HSPG) such as syndecan-1. TACI gene expression in myeloma reportedly can distinguish tumors with a signature of microenvironment dependence (TACI(high)) versus a plasmablastic signature (TACI(low)). We tested the effect of atacicept (formerly TACI-Ig, which blocks APRIL and BAFF) and BAFFR-Ig (which blocks BAFF only) on primary myeloma growth in the SCID-hu model and in coculture with osteoclasts. With only few exceptions, atacicept and to a lesser extent BAFFR-Ig, inhibited growth of TACI(high) but not TACI(low) myeloma samples in vivo and ex vivo, and the response rate was inversely correlated with TACI expression. Most TACI(high) myeloma cells were molecularly classified as being low risk with our recently described 70-gene model. APRIL and BAFF were highly expressed by osteoclasts and were upregulated in myeloma cells after coculture with osteoclasts. Our findings suggest that APRIL plays an essential role in the survival of TACI(high) bone marrow-dependent myeloma cells and TACI gene expression may be a useful predictive marker for patients who could benefit from atacicept treatment.

[Neonatal conjunctivitis in a hospital at Gran Buenos Aires. Last 5 years up-date]. / Conjuntivitis neonatal en un hospital del Gran Buenos Aires. Situación de los últimos 5 años.

Neonatal conjunctivitis is one of the most important consultation reasons in the first days of life. Causes may be chemical or infectious. Neonatal conjunctivitis study for common microorganisms and Chlamydia trachomatis is being performed at Posadas Hospital since 1995, in a progressive form. The objective of this study was to know the epidemiological situation in the last five years (1999-2003), and to describe the variations detected between two periods, 1995-1998, and 1999-2003. It was observed no change about C. trachomatis prevalence (8%), during all the time in the population studied. With regard to common microorganisms it was showed a decrease in the second period (36.6%) with respect to the first (52.4%). Likely, the causes may be due to changes about sample collection conditions, or to epidemiological variations. The most frequent microorganisms found were: Staphylococcus aureus 69 (27.6%), Streptococcus pneumoniae 68 (27.2%), and Haemophilus influenzae 64 (25.6%). We consider important to evaluate the kind of ocular secretions at the first consultation, which can lead to a symptomatic treatment that will be corroborated or not, according to microbiological results.

Conjuntivitis neonatal en un hospital del Gran Buenos Aires. Situación de los últimos 5 años / [Neonatal conjunctivitis in a hospital at Gran Buenos Aires. Last 5 years up-date]

Neonatal conjunctivitis is one of the most important consultation reasons in the first days of life. Causes may be chemical or infectious. Neonatal conjunctivitis study for common microorganisms and Chlamydia trachomatis is being performed at Posadas Hospital since 1995, in a progressive form. The objective of this study was to know the epidemiological situation in the last five years (1999-2003), and to describe the variations detected between two periods, 1995-1998, and 1999-2003. It was observed no change about C. trachomatis prevalence (8

), during all the time in the population studied. With regard to common microorganisms it was showed a decrease in the second period (36.6

) with respect to the first (52.4

). Likely, the causes may be due to changes about sample collection conditions, or to epidemiological variations. The most frequent microorganisms found were: Staphylococcus aureus 69 (27.6

), and Haemophilus influenzae 64 (25.6

). We consider important to evaluate the kind of ocular secretions at the first consultation, which can lead to a symptomatic treatment that will be corroborated or not, according to microbiological results.

[Management of multiple myeloma]. / Terapia del mieloma multiplo.

Multiple myeloma (MM) remains an incurable malignancy, the median overal survival of patients receiving conventional chemotherapy being only 36-60 months. MGUS can evolve to MM in a percentage of 0.6-3% per year. The therapeutic management of multiple myeloma (MM) for the last several decades has mainly involved regimens based on use of glucocorticoids and cytotoxic chemotherapeutics. Melphaln and Prednisone (MP) are recognized as the classic treatment of MM. In patients candidate to bone marrow transplantation, VAD (Vincrisrine, Adriamicin, Dexamethasone) regimen is more indicated because it does not cause stem cell injury. High dose chemotherapy and and Autologous stem cells transplantation represent the best treatment for patients with MM who are younger than 65 years and free of severe comorbidities. Thalidomide alone or in combination with steroids has significant activity in multiple myeloma (MM). After the role of thalidomide in the management of patients with advanced or refractory MM had been established, many studies are evaluating the efficacy and toxicity of thalidomide as first-line therapy for patients with newly diagnosed disease. Recent studies have enhanced our understanding of disease pathogenesis and also provided the framework for a new treatment paradigm targeting the MM cell in its bone marrow microenvironment to overcome drug resistance and improve patient outcome. Clinical trials are confirming the remarkable activity and improved tolerability of some of the new agents identified through this paradigm.

First Report of Phytophthora palmivora on Grevillea spp. in Italy.

The genus Grevillea (family Proteaceae) comprises over 300 species and is a popular and widely cultivated group of Australian plants. In the last 3 years, numerous potted grevilleas with symptoms of decline associated with a rot of feeder roots were found in ornamental nurseries in Sicily. Aboveground symptoms were reduced growth, yellowing of foliage, wilt, dieback, and death of the entire plant. The disease was observed on many commercial cultivars and was especially severe on G. alpina (mountain grevillea), G. juniperina (juniper-leaf grevillea), G. lavandulacea (lavender grevillea), and G. rosmarinifolia (rosemary grevillea) as well as the hybrid cultivars Clearview David (G. lavandulacea × rosmarinifolia) and Poorinda Rondeau (G. baueri × lavandulacea), while G. lanigera (woolly grevillea) cv. Mount Tamboritha and G. thelemanniana subsp. obtusifolia appeared resistant. A species of Phytophthora was consistently isolated from rotted roots of symptomatic plants using a selective medium (4), and pure cultures were obtained by single-hypha transfers. The species was identified as P. palmivora (E.I. Butler) E.I. Butler on the basis of morphological and cultural characters. On solid media, all isolates produced elliptical to ovoid, papillate sporangia with a mean length/width ratio of 1.8. Sporangia were caducous with a short pedicel (5 µm) and a conspicuous basal plug. All isolates were heterothallic (mating type A1) and produced oogonia and oospores only when paired with A2 mating type reference isolates of P. nicotianae and P. palmivora. Antheridia were amphyginous. Identification was confirmed by electrophoresis of mycelial proteins in polyacrylamide slab gels (1). The electrophoretic patterns of total soluble proteins and six isozymes (alkaline phosphatase, esterase, fumarase, NAD-glucose dehydrogenase, malate dehydrogenase, and superoxide dismutase) of isolates from grevillea were identical to those of a reference isolate of P. palmivora from Coronilla valentina subsp. glauca (2) but distinct from those of reference strains of eight other papillate species of Phytophthora included in Waterhouse's taxonomic group VI. Koch's postulates were fulfilled using 6-month-old rosemary grevillea plants that were transplanted into pots filled with soil that was artificially infested with chlamydospores (50 per gram of soil) produced in submerged cultures (3) by grevillea isolate IMI 390579. Plants were maintained in a glasshouse at 20 to 28°C and watered to field capacity once a week. One month after transplanting, infected plants showed decline symptoms similar to those of naturally infected plants. Control plants grown in pots containing noninfested soil remained healthy. P. palmivora was reisolated from roots of symptomatic plants. It appears that P. palmivora has become a widespread root pathogen in commercial ornamental nurseries in Italy (2). References: (1) S. O. Cacciola et al. EPPO Bull. 20:47, 1990.D. (2) S. O. Cacciola et al. Plant Dis. 86:327, 2002. (3) J. Y. Kadooka and W. H. Ko. Phytopathology 63:559, 1973. (4) H. Masago et al. Phytopathology 67:425, 1977.

First Report of Botrytis Blight on Medinilla magnifica and Various Species of Mandevilla and Allamanda in Italy.

Medinilla magnifica Lindl., Mandevilla splendens (Hook.) Woodson, the hybrid Mandevilla × amoena 'Alice du Pont' (pink allamanda), and various species of Allamanda, such as A. cathartica L. and A. blanchetii A. DC. (purple allamanda), are grown in Sicily as ornamentals. After a frost in early December 2001, a sudden wilt of container-grown cuttings of these tropical species was observed in a plastic-covered production greenhouse, with ≈30% of M. magnifica plants and 70% of Mandevilla and Allamanda plants affected. Medinilla plants (≈35 cm high) had been rooted in trays and transplanted individually in 30-cm-diameter pots. Allamanda (recently rooted cuttings) and Mandevilla (well-established) plants showed symptoms ranging from a dark brown rot at the base of stems to a tan-to-brown rot of stem midsection, respectively. Tissues surrounding lesions were water-soaked and covered by gray mycelium. On Allamanda and Mandevilla plants, lesions extended rapidly to lateral branches, and to the petiole and midrib of leaves that became chlorotic and wilted. As stems were girdled, infected plants collapsed, although the roots appeared healthy. Botrytis cinerea Pers.:Fr. was consistently isolated from infected stem pieces surface-disinfested with 1% NaOCl for 1 min and placed on potato dextrose agar (PDA, Oxoid). Morphology and size (6 to 8 × 8 to 12 µm, modal values 7 × 10 µm) of conidia produced on PDA matched those reported for B. cinerea (1). Dark, spherical, and irregularly shaped sclerotia (1 to 6 mm diameter, mean size 3.3 × 2.3 mm) were produced on PDA. Pathogenicity of a single-conidium isolate isolated from M. magnifica was confirmed using two inoculation methods. Twenty 3-month-old cuttings of M. magnifica and pink and purple allamanda were sprayed with a conidial suspension (106 conidia per ml in a 2% glucose solution). A 2% glucose solution was sprayed on 20 control plants. Plants were sealed in transparent plastic bags for 7 days at 15 to 24°C. Typical symptoms developed only on stems of inoculated pink and purple allamanda cuttings 7 days after inoculation. B. cinerea was reisolated from affected tissues. In a separate test, stems of 10 6-month-old plants of M. magnifica and pink allamanda were inoculated by inserting a 3-mm plug taken from 10-day-old sporulating colonies growing on PDA on a superficial cut made with a sterile scalpel. The inoculated wounds were sealed with Parafilm. Ten wounded but noninoculated plants were used as controls. Plants were kept in high humidity at 10 to 20°C. After 10 days, stem necrosis, leaf chlorosis, and wilt were observed on inoculated pink allamanda plants. On inoculated M. magnifica plants, necrotic lesions were observed on stems (45 to 70 mm long and 10 to 18 mm wide) covered by gray mycelium, but the stem was not girdled. B. cinerea was reisolated from infected tissues of inoculated plants to complete Koch's postulates. No lesions developed on noninoculated control plants. To our knowledge, this is the first report from Italy of Botrytis blight on these species. The occurrence of frost may have predisposed these tropical species to infection by B. cinerea. Reference: (1) M. B. Ellis and J. M. Waller. No 431 in: Descriptions of Pathogenic Fungi and Bacteria, CMI, Kew, Surrey, UK, 1974.

Phytophthora palmivora a New Pathogen of Lavender in Italy.

Root rot caused by Phytophthora nicotianae is considered the most serious disease of lavender in commercial cultivations in Italy. In summer 2001, in the Gela area (Sicily), ≈60% of 34,000 2-year-old landscape shrubs of English lavender (L. angustifolia) grown in a clay loam soil showed symptoms of dieback associated with root rot. Plants had been transplanted from pots in May and watered using a trickle irrigation system. A species of Phytophthora was isolated consistently from roots of symptomatic plants using potato dextrose agar (PDA) containing benomyl, nystatin, pentachloronitrobenzene, rifampicin, ampicillin, and hymexazol. The species was identified as P. palmivora on the basis of morphological and cultural characters. Ten representative single-zoospore isolates were characterized. On agar media, the isolates produced elliptical to ovoid, papillate sporangia, with a mean length/breadth ratio of 1.8. Sporangia, produced on sporangiophores forming simple sympodia (as many as 20 sporangia per sympodium), were caducous with a short pedicel (mean pedicel length = 5 µm) and a conspicuous basal plug. In addition to typical sporangia, all isolates produced sporocysts, i.e., subglobose, nonpapillate sporangia (2). The minimum temperature for mycelium growth on PDA was 10°C, the optimum was 27°C, and the maximum was 35°C. All isolates were A1 mating type. Antheridia were amphyginous. The identification was confirmed by electrophoresis of mycelial proteins on a polyacrylamide slab gel. Electrophoretic banding patterns of total soluble proteins and eight isozymes of the isolates from lavender were identical to those of a reference isolate of P. palmivora from olive (1). Conversely, the electrophoretic phenotype of the isolates from lavender was distinct from those of reference isolates of other species, including P. cactorum, P. capsici, P. citrophthora, P. nicotianae, and P. tropicalis. The pathogenicity of a representative isolate of P. palmivora from lavender was tested in the greenhouse using 6-month-old plants of English lavender, Rosea, a commercial cultivar very susceptible to root rot caused by P. nicotianae (3). Inoculum was produced on a mixture of vermiculite and autoclaved oat seeds (4) and mixed with soil (sand/lime/peat 1:1:1) at a concentration of 4% (vol/vol). Plants were transplanted to pots filled with infested soil. Control plants were grown in pots containing noninfested soil. After transplanting, all pots were flooded for 24 h by plugging the drain hole. Three months after transplanting all plants grown in pots containing infested soil showed extensive root necrosis and dieback symptoms. Control plants remained healthy. P. palmivora was recovered from roots of symptomatic plants. To our knowledge, this is the first report from Italy of P. palmivora on lavender. Root rot caused by P. palmivora may be a potential problem for commercial cultivation of lavender. References: (1) S. O. Cacciola et al. Plant Dis. 84:1153, 2000. (2) D. C. Erwin and O. K. Ribeiro. Phytophthora Diseases Worldwide. The American Phytopathological Society, St Paul, MN, 1996. (3) G. Minuto et al. Inf. Fitopatol. 51:69, 2001. (4) E. Sánchez-Hernández et al. Plant Dis. 85:411, 2001.

Co dimers observed by extended x-ray absorption fine structure spectroscopy.

Cobalt was introduced into a silver matrix by ion implantation and observed by extended x-ray absorption fine structure (EXAFS) spectroscopy. In the range 0.10--0.70 at. % evidence of Co dimers dispersed in the matrix was found. The dimers are somewhat contracted with respect to the bulk Co nearest neighbor distance and distributed in a chainlike configuration with each dimer at 90 degrees from each other along opposite square faces of the Ag fcc lattice.

Use of autologous growth factors in lumbar spinal fusion.

The results of spinal fusion, especially posteriorly above the lumbosacral junction, have been mixed. Autologous growth factor concentrate (AGF) prepared by ultraconcentration of platelets contains multiple growth factors having a chemotactic and mitogenic effect on mesenchymal stem cells and osteoblasts and may play a role in initiating bone healing. The purpose of this retrospective study is to review our results with AGF in lumbar spinal fusions. To date, AGF has been used in 39 patients having lumbar spinal fusion. The study group consisted of the first 19 consecutive cases to allow at least 6 months follow-up. The average follow-up was 13 months (range 6 to 18 months). Follow-up compliance was 91%. There were 7 men and 12 women. Average age was 52 years (range 30-72 years). Nine patients had prior back surgery. There were 8 smokers. AGF was used in posterior (n = 15) or anterior intradiscal (n = 4) fusions. AGF was used with autograft and coraline hydroxyapatite in all posterior fusions, and autograft, coral, and intradiscal spacer (carbon fiber spinal fusion cages or Synthes femoral ring) in intradiscal fusions. Posterior stabilization was used in all cases. Eight cases were single-level fusions, 6 were two-level, and 1 was a three-level fusion. Autologous iliac crest bone graft was taken in 14 cases and local autograft used in 5 cases. Posteriorly, a total of 23 levels were fused; of these, nine were at L5-S1, eight at L4-L5, five at L3-L4, and one at L2-L3. No impending pseudoarthroses were noted on plain radiographic examination at last follow-up visit. Solid fusion was confirmed in 3 patients having routine hardware removal, and in 2 patients who had surgery at an adjacent level. There was one posterior wound infection, which was managed without sequelae. When used as an adjunct to autograft, AGF offers theoretical advantages that need to be examined in controlled studies. Further study is necessary to determine whether coralline hydroxyapatite used as a bone graft extender in lumbar spinal fusion may help to obviate the need for secondary site graft harvesting.

Variations in HIV risk behaviors of incarcerated juveniles during a four-year period: 1989-1992.

OBJECTIVE: To retrospectively monitor over several years change in incarcerated juveniles' human immunodeficiency virus (HIV) risk behaviors. METHODS: From 1989 to 1992, detainees who volunteered after an HIV class or were referred by a health care provider were counseled individually and privately by health educators using a standardized questionnaire and counseling form developed from an instrument used to counsel prostitutes in Los Angeles, California. RESULTS: The number counseled each year was 1045, 1745, 2354 and 1428 from 1989 to 1992, respectively. Those agreeing to HIV testing rose from 72% of total participants in 1989 to 84% of total participants in 1992. Eight of those youth tested as HIV positive. Four blind seroprevalence studies during the same time yielded one case in 1000 for 1988, one case in 1005 for 1989, two cases in 751 in late 1989 (2.7/1000), and one case in 1214 for 1990 (1.25/1000). The number worrying about AIDS and considering themselves vulnerable to AIDS increased, but protective behaviors did not. Sexual partners per year were 2.1 regardless of the age of first sexual activity. Alcohol was associated with an increased number of sexual partners (2.6/year) and higher rates of sexually transmissible infections (STIs) and pregnancy. Although 96% of boys and girls were sexually active, only 4% used a condom consistently during the first 3 years, and only 7% in 1992. Those reporting having used condoms with the intention to prevent both STIs and pregnancy had a higher rate of use. Those carrying condoms all the time used condoms more often. Males having sex with both males and females rarely used condoms, and 45% had one or more STIs. CONCLUSIONS: Although the rate of HIV infection remains low in juveniles detained by the County of Los Angeles, their rates of risky behaviors place them at high risk for HIV acquisition.

Insensitivity to Metalaxyl Among Isolates of Phytophthora capsici Causing Root and Crown Rot of Pepper in Southern Italy.

Pepper (Capsicum annuum L.) has become an economically important crop in the coastal provinces of Catanzaro and Vibo Valentia, in Calabria (southern Italy). An old local selection Riggitano, very susceptible to root and crown rot caused by Phytophthora capsici Leonian, is the prevalent cultivar in this area. Although repeated applications of metalaxyl are used as a soil drench, severe outbreaks occur each year on greenhouse crops. To examine metalaxyl resistance in P. capsici, 60 single-hypha isolates of P. capsici were tested in vitro for their level of sensitivity to metalaxyl. The isolates were collected from 1992 to 1997, during epidemic outbreaks of root and crown rot, from two commercial greenhouse pepper crops, near Vibo Valentia and Lametia Terme (Catanzaro). Fungicide sensitivity was determined by plating mycelial plugs onto potato dextrose agar (PDA) amended with metalaxyl. The fungicide was added to PDA after autoclaving, at final concentrations of 0.1, 1, 5, 10, 50, 100, and 200 µg/ml a.i. The percentage of inhibition of radial growth on metalaxyl-amended medium compared with the growth on unamended medium was determined after 6 days of incubation in the dark at 25°C. Three replicate petri dishes were used per treatment and each test was performed twice. The isolates were paired in culture on V8 agar with isolates of P. capsici of known mating type and all proved to be A2 mating type. Significant variation was observed among the isolates tested in responce to metalaxyl. The ED50 values for in vitro inhibition of mycelial growth by metalaxyl ranged from 1 to 11 µg/ml, whereas an ED 50 value of 0.1 µg/ml had been reported for a wild-type isolate of P. capsici obtained from pepper in northern Italy (3). The variation observed among the isolates from Calabria appeared unrelated to both the geographical origin and the year of isolation. The isolates from Calabria were inhibited by between 1 and 12% at 0.1 µg/ml and by between 7 and 27% at 1 µg/ml, proving to be less sensitive to metalaxyl than isolates from Capsicum spp. originating from Central America, tested by other authors (1). According to the criterion used in a recent screening for sensitivity to metalaxyl (2), 19% of the isolates from Calabria should be considered sensitive, as they were inhibited by more than 60% at 5 µg/ml, while all the others were intermediate, as they were inhibited less than 60% at 5 µg/ml but more than 60% at 100 µg/ml. On the basis of this preliminary screening, we report the presence of insensitivity to metalaxyl in field isolates of P. capsici in southern Italy. Although no isolate tested appeared highly resistant to metalaxyl, the presence of a high proportion of isolates with an intermediate level of resistance should be a reason for the growers to use metalaxyl more cautiously to control root and collar rot. References: (1) M. D. Coffey and L. A. Bower. Phytopathology 74:502, 1984. (2) G. Parra and J. Ristaino. Plant Dis. 82:711, 1998. (3) M. L. Romano and A. Garibaldi. La difesa delle piante 3:153, 1984.

Evaluating the accuracy of transcribed computer-stored immunization data.

OBJECTIVE: To evaluate the accuracy of immunization records transcribed into a computer-based immunization tracking system and to assess factors that contribute to inaccurate or incomplete immunization record keeping. DESIGN: Computer-stored immunization records were analyzed for 2098 children up to 2 years of age at the time of their most recent well-child visit to the UCLA Children's Health Center over a 12-month period. For children whose immunizations were not up to date, the computer-stored records were analyzed for sources of inaccuracy by comparison with the handwritten records from which the computer-stored data were transcribed. RESULTS: An underimmunization rate of 22.5% (472 of 2098) was observed based on analysis of the computer-stored records. Comparison of the computer-stored and handwritten records revealed an overall transcription error rate of at least 10.2%. In addition, 38.4% of these apparently underimmunized children had received unrecorded immunizations from providers outside UCLA. When transcription errors were corrected and other available sources of immunization data were taken into account, the estimated rate of underimmunization decreased from 22.5% to 10.9%. CONCLUSION: Unavoidable inaccuracies can diminish the utility of the data recorded in an immunization tracking system. Some inaccuracies are related to the process of transcription, but failures to record and communicate immunization data consistently also contribute to the inaccuracy of computer-stored immunization records.

Neutral endopeptidase inhibitor thiorphan increases airway narrowing to inhaled sodium metabisulfite in normal subjects.

Possible mechanisms involved in inhaled sodium metabisulfite (MBS)-induced bronchoconstriction include cholinergic reflex and release of tachykinins from sensory nerve endings. Tachykinins are potent bronchoconstrictors cleaved and inactivated by neutral endopeptidase (NEP) in the airways. To investigate the role of tachykinins in airway response to MBS, we assessed the effect of NEP-inhibitor thiorphan on airway response to MBS in nine nonatopic, nonasthmatic subjects. Two inhalational challenges with doubling doses of MBS (0.03 to 16 mumol) were performed 3 d apart. Ten minutes before MBS challenge, subjects randomly inhaled either thiorphan (1.25 mg) or placebo according to a double-blind cross-over design. Airflow at 30% of vital capacity (V30p) from partial expiratory flow-volume curves was measured at baseline, 10 min after thiorphan or placebo, and 2 min after each MBS dose. The dose of MBS causing 40% fall in V30p (PD40V30p) was calculated. Neither thiorphan nor placebo affected baseline airway caliber. Thiorphan caused a leftward shift of the dose-response curve to MBS. After placebo a measurable PD40V30p was obtained in four of nine subjects. In these subjects PD40V30p fell significantly after thiorphan inhalation. Four of five subjects who did not exhibit PD40V30p after placebo showed measurable PD40V30p after thiorphan. Percent fall in V30p caused by highest dose of MBS was significantly greater after thiorphan compared with placebo (55.9 +/- 4.6% versus 30.8 +/- 5.6%; mean +/- SE; p < 0.001). Results of this study demonstrate that the NEP-inhibitor thiorphan increases MBS-induced bronchoconstriction in normal subjects, suggesting that tachykinins are involved in airway responses to inhaled MBS.

Inhaled platelet-activating factor increases airway sensitivity but not maximal airway narrowing to methacholine in normal subjects.

To examine the effect of inhaled platelet-activating factor (PAF) on airway sensitivity and on maximal airway narrowing, we measured airway response to doubling concentrations of methacholine (MCh) 48 h before and 48 h after inhalation of 10, 50 and 100 micrograms of PAF in six nonatopic, nonasthmatic subjects. The forced expiratory volume in one second (FEV1) and airflow at 30 percent of vital capacity (V30) from partial forced expiration were used to assess changes in airway calibre. Inhalation of PAF caused only minor changes in FEV1. In contrast, inhalation of 100 micrograms of PAF caused a significant fall in V30 from 2.64 +/- 0.35 to 1.35 +/- 0.43 l.min-1 (p < 0.05). Two days after PAF inhalation a leftward shift of the concentration-response curve to MCh was observed. The MCh concentration causing a 20% fall in FEV1 (PC20FEV1) was 11.25 +/- 1.78 and 2.38 +/- 1.29 mg.ml-1 (geometric mean +/- GSEM; p < 0.05) before and after PAF inhalation, respectively. PAF did not affect the maximal airway response to MCh. The maximum percentage fall in FEV1 was 36.2 +/- 1.9% at baseline and 37.6 +/- 1.8% after PAF inhalation. Likewise, maximum percentage change in V30 was 72.8 +/- 3.7% at baseline and 73.6 +/- 3.4% after PAF inhalation. The results of this study show that PAF inhalation increases airway sensitivity without altering the maximal bronchoconstrictive response to MCh in normal subjects.

Insurance coverage and residents' experience in a pediatric teaching clinic.

To examine the relationship between insurance coverage and the diagnostic content of residents' experience in a hospital-based pediatric teaching clinic, we analyzed outpatient problem lists for 6543 patients seen in our clinic over a 15-month period. Problem-list contents were categorized using diagnostic clusters. The frequency distribution of clustered problems was compared for patients with four types of insurance coverage: indemnity insurance, health maintenance organization, Medicaid, and no insurance. The four insurance categories differed in the overall distribution of problems, but the differences could not be attributed to a disparity in the frequency of any single diagnosis or diagnostic cluster. We conclude that there was no important effect of insurance coverage on the diagnostic content of residents' experience in a teaching clinic.

Evaluating the accuracy of transcribed clinical data.

This study evaluated the accuracy of data transcribed into a computer-stored record from a handwritten listing of pediatric immunizations. The immunization records of 459 children seen in the UCLA Children's Health Center in March, 1993 were transcribed into a clinical computer system on an ongoing basis. Of these records, 27 (5.9%) were subsequently found to be inaccurate. Reasons for inaccuracy in the transcribed records included incomplete written records, incomplete transcription of written records, and unavailability of immunization records from multiple health-care providers. The utility of a computer-stored clinical record may be adversely affected by unavoidable inaccuracies in transcribed clinical data.

Paranasal sinus mucormycosis in an immunologically competent host.

A case of paranasal sinus mucormycosis in an immunocompetent patient is reported. After an extensive evaluation, no evidence of either diabetes mellitus or underlying immunologic abnormality was found. The combination of excisional surgery and amphotericin B therapy resulted in an excellent response. High-resolution axial and coronal computed tomography was useful in both planning treatment and monitoring the response to therapy.