Prevalence of streptococci and increased polymicrobial diversity associated with cystic fibrosis patient stability.

Diverse microbial communities chronically colonize the lungs of cystic fibrosis patients. Pyrosequencing of amplicons for hypervariable regions in the 16S rRNA gene generated taxonomic profiles of bacterial communities for sputum genomic DNA samples from 22 patients during a state of clinical stability (outpatients) and 13 patients during acute exacerbation (inpatients). We employed quantitative PCR (qPCR) to confirm the detection of Pseudomonas aeruginosa and Streptococcus by the pyrosequencing data and human oral microbe identification microarray (HOMIM) analysis to determine the species of the streptococci identified by pyrosequencing. We show that outpatient sputum samples have significantly higher bacterial diversity than inpatients, but maintenance treatment with tobramycin did not impact overall diversity. Contrary to the current dogma in the field that Pseudomonas aeruginosa is the dominant organism in the majority of cystic fibrosis patients, Pseudomonas constituted the predominant genera in only half the patient samples analyzed and reported here. The increased fractional representation of Streptococcus in the outpatient cohort relative to the inpatient cohort was the strongest predictor of clinically stable lung disease. The most prevalent streptococci included species typically associated with the oral cavity (Streptococcus salivarius and Streptococcus parasanguis) and the Streptococcus milleri group species. These species of Streptococcus may play an important role in increasing the diversity of the cystic fibrosis lung environment and promoting patient stability.

Using client satisfaction surveys to evaluate and improve services in locked and unlocked adult inpatient facilities.

This article describes the implementation, in five inpatient subacute treatment facilities, of a satisfaction survey designed especially for adults with serious and persistent mental illnesses. The survey measures not only global satisfaction but also client perceptions about different treatment modalities and services, important treatment goals, and the philosophy of treatment. Data are presented from 770 completed surveys, illustrating patterns of satisfaction across facilities and services and patterns over time of stability and change in satisfaction. Data are also presented showing how the surveys were used to facilitate and measure improvements in clinical services. Finally, the implications for mental health services delivery are summarized.

The use of a metal detector for localisation of a metallic foreign body in the floor of the mouth.

The case illustrates the valuable assistance provided by a metal detector in localising an elusive broken instrument which was hidden in a recess on the medial side of the mandibular angle and encapsulated in fibrous tissue. A relative degree of sophistication built into the detector aided early localisation.

[Corticotropin-releasing factor and anorexia nervosa: reactions of the hypothalamus-pituitary-adrenal axis to neurotropic stress]. / Système corticolibérinergique et anorexie mentale: réactions du système hypothalamo-hypophyso-corticosurrénalien à un stress neurotrope.

The aim of this study is to obtain CRF (Corticotropin Releasing Factor) stimulation at a suprahypothalamic level with a psychological stressor and to evaluate its response in anorexia nervosa. CRF plays a major role in the mechanisms underlying the hypothalamo-pituitary-adrenal (HPA) system's response to stress. Animal studies clearly showed that CRF is involved both in the adaptation to a novel environment and the regulation of eating behaviour. CRF's staietogenic effect is mediated via the paraventricular nucleus. Three groups of age matched young women were studied: 8 patients meeting the DSM III-R criteria for anorexia nervosa, 8 underweight healthy volunteers and 10 normal weight volunteers. All subjects were submitted to an auditory stimulation test ("psychosocial stress test") consisting of an intellectual task in which maximal performance is impossible to achieve, the subjects being permanently disturbed by various meaningful noises. Subjects were asked to answer self-rating scales for anxiety and tension prior to and after the test. CRF reactivity was measured by salivary cortisol (RIA). After the test, anorexia nervosa patients exhibit a significantly higher salivary cortisol response compared to the normal weight volunteers. In most of cases, salivary cortisol response was not correlated with the psychological variables. The range of the response is very explosive in two anorectic patients. Our data are consistent with the hyperactivity of the corticotropic axis stress response in anorexia nervosa, but request further investigations to prove that.

[Chronobiology and depression: the seasonal depressions. Clinical aspects, physiopathology and specific treatments]. / Chronobiologie et dépression: les dépressions saisonnières. Clinique, physiopathologie et traitements spécifiques.

Seasonal Affective Disorder, described in 1984 by Rosenthal in the United States of America, was individualized in France since this concept entered the DSM III-R in 1989. Firstly, the purpose of the authors was an attempt to draw the historical evolution of the concept, his clinical and epidemiological aspects. Secondly, they considered the physiological hypothesises, which followed two ways of research: on the one hand the impairment of endogenous chronobiological rhythms, especially melatonin and serotonin rhythms; on the other hand the photoperiodical hypothesis. Thildly, the authors proposed the main specific prospects of treatments: chimiotherapeutic methods--particularly 5-methoxypsoralen--and non chimiotherapeutic such as phototherapy.

Sch 1000: a new anticholinergic bronchodilator.

Sch 1000 is a derivative of atropine with equivalent bronchodilator activity. A double blind controlled study of Sch 1000 administered to asthmatic subjects by inhalation in 4 doses from 10 mug to 80 mug was conducted. The onset of action was between 15 and 30 min, compared to 5 min for isoproterenol, but persisted for 4 hours compared to 1 hour for isoproterenol. The maximal level of bronchodilatation produced by Sch 1000 was comparable to but not as great as that after isoproterenol. Dose-response data suggested that maximal bronchodilatation may be achieved by 10 to 20 mug of Sch 1000; larger doses did not result in significantly greater increases in forced expiratory volume in 1 sec or maximal mid-expiratory flow. The Sch 1000-mediated increase in maximal mid-expiratory flow was significantly greater than that of forced expiratory volume in 1 sec. Fewer side effects were encountered after Sch 1000 than after isoproterenol and no atropine-like effects could be attributed to Sch 1000 in the doses studied.

Influence of different chemical treatments on transport of Alcaligenes paradoxus in porous media.

Seven chemicals, three buffers, and a salt solution known to affect bacterial attachment were tested to quantify their abilities to enhance the penetration of Alcaligenes paradoxus in porous media. Chemical treatments included Tween 20 (a nonionic surfactant that affects hydrophobic interactions), sodium dodecyl sulfate (an anionic surfactant), EDTA (a cell membrane permeabilizer that removes outer membrane lipopolysaccharides), sodium PPi (a surface charge modifier), sodium periodate (an oxidizer that cleaves surface polysaccharides), lysozyme (an enzyme that cleaves cell wall components), and proteinase K (a nonspecific protease that cleaves peptide bonds). Buffers included MOPS [3-(N-morpholino)propanesulfonic acid], Tris, phosphate, and an unbuffered solution containing only NaCl. Transport characteristics in the porous media were compared by using a sticking coefficient, alpha, defined as the rate at which particles stick to a grain of medium divided by the rate at which they strike the grain. Tween 20 reduced alpha by 2.5 orders of magnitude, to alpha = 0.0016, and was the most effective chemical treatment for decreasing bacterial attachment to glass beads in buffered solutions. Similar reductions in alpha were achieved in unbuffered solutions by reducing the solution ionic strength to 0.01 mM. EDTA, protease, and other treatments designed to alter cell structures did not reduce alpha by more than an order of magnitude. The number of bacteria retained by the porous media was decreased by treatments that made A. paradoxus more hydrophobic and less electrostatically charged, although alpha was poorly correlated with electrophoretic mobility and hydrophobicity index measurements at lower alpha values.(ABSTRACT TRUNCATED AT 250 WORDS)

Intra-radicular hydrostatic pressure changes during the cementation of post-retained crowns.

The intra-radicular hydrostatic pressures generated during the cementation of parallel-sided dental posts have been measured. Pressures are generated only when cement is inserted into the prepared post hole. Using zinc phosphate cement, with posts placed 2 min from the commencement of mixing, pressure has been shown to depend on post diameter, the closeness of fit, and the powder-liquid ratio. The maximum pressure recorded was 1.7 x 10(4) kN/m2 using a 1.3 mm diameter post, a mean cement film thickness of 37 microns, and an ideal powder-liquid ratio of 3.0. Pressures similar to that generated using zinc phosphate cement were recorded when black copper phosphate was used as the lute, but zinc polycarboxylate generated less pressure, and an ortho-ethoxy benzoic acid cement markedly less pressure. Before it is possible to confirm the ideal luting cement for posts, further studies of the effectiveness of cement release channels, and post retention, are necessary.

Investigation of hydrostatic pressure changes during cementation of screw-retained posts, and posts with integral cement release channels.

Intra-radicular pressures during the cementation of screw-retained posts have been found to reach 1.5 x 10(4) KN/m2 when cement is inserted into the prepared post hole or no pressure, indicating that an incomplete cement lute had developed, when the post was coated with cement. The effectiveness of cement channels was investigated and for the traditional single channel, using the cement 'insertion' method, there was an intra-radicular pressure of 8.5 x 10(4) KN/m2, compared with 1.1 x 10(4) KN/m2 for the corresponding round post. Multiple cement release channels gave an enhanced pressure reduction to 2.0 x 10(3) KN/m2.

Distinguishing between malignant and cirrhotic ascites by computerized step-wise discriminant functional analysis of its biochemistry.

This study was designed to evaluate the ability of a specifically programmed computer to select those biochemical substances most capable of distinguishing "cirrhotic ascites" from "malignant ascites". After simultaneously performing selected biochemical and electrophoretic studies on fresh unstored serum and ascites of 23 patients with documented cirrhosis and 18 patients with proven malignancies, computerized step-wise discriminant analysis of the multiple input revealed that the serum-to-ascites LDH ratio was able to distinguish "cirrhotic ascites" from "malignant ascites" with greater than 86% accuracy. Assignment to proper groups was increased to 89% with the addition of the ratio to serum total protein-to-ascites total protein. The predictive value of a positive result was 100%; specificity was 100%; the predictive value of a negative result was 85%. This type of computer analysis also permits incorporation of both additional cases and new substances thus increasing predictability and reducing type II statistical errors.

Plasmodium falciparum: immunogenicity of circumsporozoite protein constructs produced in Escherichia coli.

The immunogenicity of Plasmodium falciparum recombinant circumsporozoite protein constructs R16tet32, R32tet32, and R48tet32 in mice was examined by measuring antibody responses by enzyme linked immunosorbent assay, immunofluorescence, circumsporozoite precipitation, and inhibition of sporozoite invasion. All three constructs were found to be immunogenic when administered alone, but antibody responses were greater for the larger constructs, R32tet32 and R48tet32. Increased dose, boosting, and the use of adjuvants further augmented antibody responses. R32tet32 was found to be the most immunogenic of the three constructs, and high levels of protective antibodies were found to persist for at least 44 weeks when the construct was given with alum. Clinical trials with alum adjuvanted R32tet32 have now begun.

Importancia del manejo del ductus arterioso persistente en la XII Región al implementar el diagnóstico ecográfico y tratamiento quirúrgico a nivel local / Surgical management of persistent ductus arteriosus in the Xllth Region of Chile

Introducción: El Ductus Arterioso Persistente (DAP) representa un problema muy importante en los Recién Nacidos de Pretérmino (RNPT) menores de 1500 g. Diversos adelantos en el Servicio de Pediatría del Hospital Regional de Punta Arenas desde 1997 hicieron posible que iniciáramos la resolución local de ésta patología, tanto en Neonatos como en pacientes Pediátricos. Objetivo: Mostrar la experiencia obtenida después de 9 a±os de iniciado el diagnóstico y cirugía del DAP a nivel regional. Metodología: Evaluación prospectiva-retrospectiva de todos los pacientes operados de DAP desde Septiembre de 1997 hasta Agosto de 2006, recolectando información clínica, técnica quirúrgica y complicaciones, seguimiento y sobrevida. Se separan los pacientes en 2 grupos, los RNPT (Grupo A) y los niños de edad pediátrica (Grupo B). Resultados: Se han intervenido quirúrgicamente 16 pacientes del Grupo A y 10 pacientes del Grupo B. La edad al momento de la operación fluctuó entre 9 días y los 6 años 3 meses. En el grupo A, el peso al momento de la cirugía se encontraba entre 527 g y 2062 g. Para el diagnóstico ecocardiográfico se utilizó desde envío de imágenes por video hasta telemedicina con ecocardiografistas experimentados, hasta lograr la experiencia local. El equipo quirúrgico fue apoyado inicialmente por Cirujano Infantil con experiencia en cirugía Ductal, siendo parte del equipo en el 20 por ciento de las cirugías en el grupo A y en el 60 por ciento del grupo B. Se abordó el tórax por vía transpleural en 4 casos y extrapleural en 22 casos, sin dejar drenajes pleurales. No hubo complicaciones significativas. El tiempo de seguimiento varió entre 2 meses y 9 años, y la sobrevida fue de un 96 por ciento, con 1 paciente fallecido hasta Diciembre 2006. Conclusiones: La resolución quirúrgica de ésta patología es posible en el ámbito local, lo cual tiene gran importancia en los casos en que el traslado sea imposible o riesgoso por las condiciones de los enfermos...

Patent ductus arteriosus (PDA) accounts is a very important problem for extreme premature newborns < 1500 g due to a high associated morbi-mortality in this group of patients. After the arrival of a pediatric cardiac surgeon and training in appropriate echocardiography diagnosis, surgical treatment of this condition began at the Regional Hospital in Punta Arenas, Chile. Aim. to repon local results of PDA surgical treatment in neonates and children during a 9 year period. Method. All patients operated on for closure of PDA from September 1997 to August 2006 were included. A retrospective recollection of data, age weight at time of surgery (preterm neonates), means used to diagnose PDA, co-morbidity, surgical technique, complications and survival, was performed. A separate analysis of preterm neonates (PTN) and pediatric age patients (PA) was carried out. Results. 16 PTN and 10 PA patients were operated on. Overall, age at operation ranged from 9 days to 6 years. Weight of PTN ranged from 572 to 2062 g. Diagnosis was confirmed by echocardiography in all but one patient. Echocardiographic findings were discussed via tele-medicine with experienced specialists in many cases. The local surgical team was supported by an experienced surgeon in 20 percent of PTN and 60 percent of PA patients. A transpleural approach was used in 4 and an extrapleural approach in 22 patients; no pleural drainage was used. There were no significant complications. Only 1 patients has died in follow-up ranging from 2 months to 9 years. Conclusions. Local resolution of PDA in neonates and small children has been made possible in Punta Arenas, avoiding dangerous transfer of these patients. Assistance by trained specialists was essential to accomplish this goal. Use of tele-medicine proved to be an important factor to increase safety in the management of PDA.