Erosion of the long process of the incus with incomplete ossicular discontinuity in simple chronic otitis media: Should we reconstruct or leave it be?

OBJECTIVE: To determine whether patients with simple chronic otitis media and incomplete ossicular discontinuity should undergo ossicular reconstruction. DESIGN: Prospective, randomised surgical trial comparing no intervention with incus interposition over a 5-year period. SETTING: Tertiary referral hospital. PARTICIPANTS: Seventy-six participants with simple chronic otitis media and erosion of the long process of the incus but apparent good transmission throughout the ossicular chain as tested intra-operatively. Forty-four patients had partial erosion of the incus but still bony contact with the stapes head (Group A-Type I), and 32 had mainly connective tissue binding the incus and stapes (Group B-Type II). Each of these groups was randomised to either leaving the ossicular chain as it was (A1 and B1) or performing an incus interposition (A2 and B2). MAIN OUTCOME MEASURES: Average postoperative air-bone gap and the degree of ABG closure. A postoperative air-bone gap under 20 dB was considered a successful result. RESULTS: In group A, there was no significant difference between no intervention and incus interposition. In group B, patients in the no reconstruction subgroup had a significantly worse hearing result than the incus interposition subgroup (postoperative air-bone gap of 27.5 dB and 31% closure within 20 dB vs 15 dB and 75% closure). CONCLUSIONS: For Type I patients, the postoperative hearing results were similar for the reconstruction and no reconstruction groups. For Type II patients, the results clearly favour reconstruction.

Rutin increases critical wavelength of systems containing a single UV filter and with good skin compatibility.

BACKGROUND/PURPOSE: Ultraviolet (UV) radiation is responsible for sunburns, skin cancer, photoaging, and the production of reactive oxygen species (ROS). The awareness on preventing these deleterious effects made the use of anti-UVB formulations an important part of population habits; however, despite the availability of several antioxidants capable of ROS scavenging, the pharmaceutical market lacks products associating UV filters with natural compounds of proven efficacy. Here, we investigated the effect of rutin, a flavonoid with antioxidant activity, associated with UVB filters in dermocosmetic preparations. METHODS: Formulations were assessed through its antioxidant activity, in vitro photoprotective effectiveness, photostability, and in vivo skin tolerance (hydration, transepidermal water loss, and erythema). RESULTS: Samples containing rutin were compatible with the human skin and presented a pronounced antioxidant potential, with scavenging activity values 75% higher than the ones containing only UVB filters. Although rutin could not prevent the sunscreens photodegradation post-irradiation, the bioactive compound significantly increased the formulations critical wavelengths, showing a photoprotective gain, especially in the UVA range. CONCLUSION: In conclusion, the absorption in the UVA range, coupled with ROS scavenging potential, proved the positive effect of rutin applied to anti-UVB formulations, making this bioactive compound a promising candidate for photoprotection improvement.

Cholesterol reduction ameliorates glucose-induced calcium handling and insulin secretion in islets from low-density lipoprotein receptor knockout mice.

AIMS/HYPOTHESIS: Changes in cellular cholesterol level may contribute to beta cell dysfunction. Islets from low density lipoprotein receptor knockout (LDLR(-/-)) mice have higher cholesterol content and secrete less insulin than wild-type (WT) mice. Here, we investigated the association between cholesterol content, insulin secretion and Ca(2+) handling in these islets. METHODS: Isolated islets from both LDLR(-/-) and WT mice were used for measurements of insulin secretion (radioimmunoassay), cholesterol content (fluorimetric assay), cytosolic Ca(2+) level (fura-2AM) and SNARE protein expression (VAMP-2, SNAP-25 and syntaxin-1A). Cholesterol was depleted by incubating the islets with increasing concentrations (0-10mmol/l) of methyl-beta-cyclodextrin (MßCD). RESULTS: The first and second phases of glucose-stimulated insulin secretion (GSIS) were lower in LDLR(-/-) than in WT islets, paralleled by an impairment of Ca(2+) handling in the former. SNAP-25 and VAMP-2, but not syntaxin-1A, were reduced in LDLR(-/-) compared with WT islets. Removal of excess cholesterol from LDLR(-/-) islets normalized glucose- and tolbutamide-induced insulin release. Glucose-stimulated Ca(2+) handling was also normalized in cholesterol-depleted LDLR(-/-) islets. Cholesterol removal from WT islets by 0.1 and 1.0mmol/l MßCD impaired both GSIS and Ca(2+) handling. In addition, at 10mmol/l MßCD WT islet showed a loss of membrane integrity and higher DNA fragmentation. CONCLUSION: Abnormally high (LDLR(-/-) islets) or low cholesterol content (WT islets treated with MßCD) alters both GSIS and Ca(2+) handling. Normalization of cholesterol improves Ca(2+) handling and insulin secretion in LDLR(-/-) islets.

Transmission of Citrus leprosis virus C by Brevipalpus phoenicis (Geijskes) to Alternative Host Plants Found in Citrus Orchards.

The equivalent of US$75 million is spent each year in Brazil to control Brevipalpus phoenicis, a mite vector of Citrus leprosis virus C (CiLV-C). In this study, we investigated the possibility that hedgerows and windbreaks normally found in citrus orchards could host CiLV-C. Mites confined by an adhesive barrier were reared on sweet orange fruit with leprosis symptoms then were transferred to leaves of Hibiscus rosa-sinensis, Malvaviscus arboreus, Grevilea robusta, Bixa orellana, and Citrus sinensis. Ninety days post infestation, the descendant mites were transferred to Pera sweet orange plants to verify the transmissibility of the virus back to citrus. Nonviruliferous mites which had no feeding access to diseased tissue were used as controls. Local chlorotic or necrotic spots and ringspots, symptoms of leprosis disease, appeared in most plants tested. Results generated by reversetranscription polymerase chain reaction with primers specific for CiLV-C and by electron microscope analyses confirmed the susceptibility of these plants to CiLV-C.

Does silver diammine fluoride concentration influence on bonding to carious dentinal lesions in primary teeth?

PURPOSE: This in vitro study evaluated the microshear bond strength (µSBS) of a universal adhesive after silver diammine fluoride (SDF) application at different concentrations on carious dentinal lesions in primary teeth. METHODS: Flat dentin carious-induced surfaces from 40 primary molars were randomly assigned to four experimental groups: without SDF treatment (control), 12% SDF, 30% SDF, or 38% SDF application. After 14 days of storage in artificial saliva at 37 °C, a universal adhesive system (Scotchbond Universal, 3 M ESPE) was applied in the etch-and-rinse mode and resin composite cylinders were built (0.72 mm2). After 24 h of water storage, the µSBS test was performed and the failure mode was determined. Data were analysed using one-way ANOVA and Tukey's post hoc tests (α = 0.05). RESULTS: The application of 38% SDF resulted in higher µSBS mean than control and use of 12% SDF (p = 0.006). No significant differences were observed among control, 12% SDF, and 30% SDF. All specimens tested showed adhesive/mixed failure. CONCLUSION: The use of SDF does not jeopardise the bonding of a universal adhesive applied in the etch-and-rinse mode to carious dentinal lesions in primary teeth, irrespective of the product concentration.

Pregnancy restores insulin secretion from pancreatic islets in cafeteria diet-induced obese rats.

Insulin resistance during pregnancy is counteracted by enhanced insulin secretion. This condition is aggravated by obesity, which increases the risk of gestational diabetes. Therefore, pancreatic islet functionality was investigated in control nonpregnant (C) and pregnant (CP), and cafeteria diet-fed nonpregnant (Caf), and pregnant (CafP) obese rats. Isolated islets were used for measurements of insulin secretion (RIA), NAD(P)H production (MTS), glucose oxidation ((14)CO(2) production), intracellular Ca(2+) levels (fura-2 AM), and gene expression (real-time PCR). Impaired glucose tolerance was clearly established in Caf and CafP rats at the 14th wk on a diet. Insulin secretion induced by direct depolarizing agents such as KCl and tolbutamide and increasing concentrations of glucose was significantly reduced in Caf, compared with C islets. This reduction was not observed in islets from CP and CafP rats. Accordingly, the glucose oxidation and production of reduced equivalents were increased in CafP islets. The glucose-induced Ca(2+) increase was significantly lower in Caf and higher in CafP, compared with all other groups. CP and CafP islets demonstrated an increased Ca(2+) oscillation frequency, compared with both C and Caf islets, and the amplitude of oscillations was augmented in CafP, compared with Caf islets. In addition, Ca(v)alpha1.2 and SERCA2a mRNA levels were reduced in Caf islets. Ca(v)alpha1.2, but not SERCA2a, mRNA was normalized in CafP islets. In conclusion, cafeteria diet-induced obesity impairs insulin secretion. This alteration is related to the impairment of Ca(2+) handling in pancreatic islets, in especial Ca(2+) influx, a defect that is reversed during pregnancy allowing normalization of insulin secretion.

Dengue infection in mice inoculated by the intracerebral route: neuropathological effects and identification of target cells for virus replication.

Dengue is an important arboviral infection, causing a broad range symptom that varies from life-threatening mild illness to severe clinical manifestations. Recent studies reported the impairment of the central nervous system (CNS) after dengue infection, a characteristic previously considered as atypical and underreported. However, little is known about the neuropathology associated to dengue. Since animal models are important tools for helping to understand the dengue pathogenesis, including neurological damages, the aim of this work was to investigate the effects of intracerebral inoculation of a neuroadapted dengue serotype 2 virus (DENV2) in immunocompetent BALB/c mice, mimicking some aspects of the viral encephalitis. Mice presented neurological morbidity after the 7th day post infection. At the same time, histopathological analysis revealed that DENV2 led to damages in the CNS, such as hemorrhage, reactive gliosis, hyperplastic and hypertrophied microglia, astrocyte proliferation, Purkinje neurons retraction and cellular infiltration around vessels in the pia mater and in neuropil. Viral tropism and replication were detected in resident cells of the brain and cerebellum, such as neurons, astrocyte, microglia and oligodendrocytes. Results suggest that this classical mice model might be useful for analyzing the neurotropic effect of DENV with similarities to what occurs in human.

Ovarian function in Nelore (Bos taurus indicus) cows after post-ovulation hormonal treatments.

Maternal recognition of pregnancy in the cow requires successful signaling by the conceptus to block luteolysis. Conceptus growth and function depend on an optimal uterine environment, regulated by luteal progesterone. The objective of this study was to test strategies to optimize luteal function, as well as prevent a dominant follicle from initiating luteolysis. Nelore (Bos taurus indicus) beef cows (n=40) were submitted to a GnRH/PGF(2alpha)/GnRH protocol. Cows that ovulated from a dominant ovarian follicle (ovulation=Day 0) were allocated to receive: no additional treatment (G(C); n=7); 3000IU of hCG on Day 5 (G(hCG); n=5); 5mg of estradiol-17beta on Day 12 (G(E2); n=6); or 3000IU of hCG on Day 5 and 5mg of estradiol-17beta on Day 12 (G(hCG/E2); n=5). Ultrasonographic imaging of the ovaries, assessment of plasma progesterone concentration, and detection of estrus were done daily from Day 5 to the day of subsequent ovulation. Treatment with hCG induced an accessory CL, increased CL volume, and plasma progesterone concentration throughout the luteal phase (P<0.01). Estradiol-17beta induced atresia and recruitment of a new wave of follicular growth; it eliminated a potentially estrogen-active, growing ovarian follicle within the critical period for maternal recognition of pregnancy, but it also hastened luteolysis (Days 16 or 17 vs. Days 18 or 19 in non-treated cows). In conclusion, the approaches tested enhanced luteal function (hCG) and altered ovarian follicular dynamics (estradiol-17beta), but were unable to extend the life-span of the CL in Nelore cows.

Peripheral effects induced in BALB/c mice infected with DENV by the intracerebral route.

The lack of an immunocompetent animal model for dengue mimicking the disease in humans is a limitation for advances in this field. Inoculation by intracerebral route of neuroadapted dengue strains in mice is normally lethal and provides a straightforward readout parameter for vaccine testing. However, systemic effects of infection and the immune response elicited in this model remain poorly described. In the present work, BALB/c mice infected by the intracerebral route with neuroadapted DENV2 exhibited several evidences of systemic involvement. DENV-inoculated mice presented virus infective particles in the brain followed by viremia, especially in late stages of infection. Infection induced cellular and humoral responses, with presence of activated T cells in spleen and blood, lymphocyte infiltration and tissue damages in brain and liver, and an increase in serum levels of some pro-inflammatory cytokines. Data highlighted an interplay between the central nervous system commitment and peripheral effects under this experimental condition.

Pathologic study of a fatal case of dengue-3 virus infection in Rio de Janeiro, Brazil.

Dengue hemorrhagic fever (DHF) is a severe febrile disease, characterized by abnormalities in hemostasis and increased vascular permeability, which in some cases results in hypovolemic shock syndrome and in dengue shock syndrome. The clinical features of DHF include plasma leakage, bleeding tendency and liver involvement. We studied the histopathological features of a fatal case of dengue-3 virus infection. The patient, a 63-year old male, presented with an acute onset of severe headache, myalgia and maculopapular rash. Tissue fragments (liver, spleen, lung, heart, kidney and lymph nodes) were collected for light microscopy studies and stained by standard methods. Histopathology revealed severe tissue damage, caused by intense hemorrhage, interstitial edema and inflammation. Some tissue sections were also processed with the immunoperoxidase reaction, which revealed the dengue viral antigen. Dengue-3 virus was isolated and identified with electron microscopy in a C6/36 cell culture inoculated with the patient's serum. Viral particles were detected in the infected cell culture.

Gastric cytomegalic inclusion bodies diagnosed by histologic examination of endoscopic biopsies in patients with gastric ulcer.

Gastric cytomegalovirus (CMV) inclusion bodies, indicating CMV infection were detected in three patients with erosions and ulcers in the upper gastrointestinal tract. In all cases, histologic examination of endoscopic biopsies enabled a diagnosis of CMV infection to be made quickly and safely. We emphasize the importance of the histologic examination of gastrointestinal biopsies in the early diagnosis of CMV infection.

Latrunculin A is a potent inhibitor of phagocytosis by macrophages.

We have found that latrunculin A, a Red Sea sponge toxin, is a potent inhibitor of immunological phagocytosis by mouse peritoneal macrophages, but does not block the binding (recognition) of the immune complexes (erythrocytes sensitized with IgG antibodies) to the cells. The inhibition begins to be appreciable around 12 nM latrunculin A, and is complete with a toxin concentration of 60 nM. This inhibitory effect does not interfere with the cell viability, and can be reversed when the macrophages are incubated in fresh medium. Since latrunculin A is a disrupting agent of microfilament organization, these results strengthen the evidence for the active participation of microfilaments in the mechanism of phagocytosis and at the same time provide a new tool for the investigation of phagocytosis at the molecular level.

Morphology of the copulatory apparatus of the spotted tinamou Nothura maculosa (Aves: Tinamiformes).

The components of the copulatory apparatus of Nothura maculosa were identified and studied by means of dissections, parenteral latex injections and standard histological and histochemical techniques. N. maculosa possesses an intromittent phallus with a tubular cavity, within which a fixed base and a tubular portion can be distinguished. An ejaculatory groove, which is supported by a fibrous body, runs dorsally at the base of the phallus. The tubular portion of the phallus inserts into the fibrous body, the former possessing two continuous but morphologically distinct parts, one of which is eversible and is extruded during erection while the other is a fixed non-eversible glandular portion. The walls of both parts are formed by the mucosa, an intermediate layer of connective tissue containing a wide lymphatic space which surrounds the whole perimeter of the tube, and an external layer of dense connective tissue. The mucosa of the eversible portion, which lodges the phallic groove, is lined by a non-keratinized stratified squamous epithelium. In the fixed tubular portion, the tubular lumen is reduced in size, the phallic groove disappears, the mucosa becomes folded and there occurs an abrupt change to a pseudostratified columnar secretory epithelium. The copulatory apparatus of N. maculosa includes the vascular bodies of the phallus, which show morphofunctional continuity with the phallic structures, thus forming a single system involved in erection. On erection, the eversible portion of the phallus evaginates and emerges from the cloacal opening as a spiral shaped structure directed towards the left.

Cloacal morphology of Nothura maculosa (Temminck, 1815), Aves tinamiformes.

Cloacae of male Nothura maculosa (spotted tinamous) were dissected and studied with routine histological and histochemical techniques. In the cloaca of this species the following cranio-caudally oriented regions can be recognized: the coprodeum, the urodeum and the proctodeum, separated by the coprourodeal and the uroproctodeal folds respectively. The coprodeum is an abrupt dilatation of the rectum which receives the ureters, contrary to other birds in which they open into the urodeum. The urodeum is the smallest compartment of the cloaca. Its wall presents the paracloacal vascular bodies and the ductus deferens receptacles which open into the ejaculatory fossa through a pair of papillae. The ejaculatory fossa forms the ventral floor of the urodeum and is characterized by the presence of a secretory epithelium and a lamina propria showing rich vascularization. The proctodeum is connected to the exterior through the cloacal opening and ventrally it presents the phallic structures and the proctodeal lamella. Its dorsolateral wall forms the cloacal bursa, its mucosa shows morphological variations depending on the degree of regression. Enclosing the uroproctodeal wall are the cloacal sphincter muscle and the skin.

Sequential order of appearance of ossification centers in the opossum Didelphis albiventris (Didelphidae) skeleton during development in the marsupium.

Pouch-young of the opossum Didelphis albiventris were studied. They were removed from the marsupium at a crown-rump length (CRL) of 9.0 to 100.0 mm and submitted to differential staining of the bone and cartilage. Newborn D. albiventris of 9.0 to 10.0 mm CRL have a cartilaginous skeleton, with no macroscopic evidence of ossification. In 10.5 to 13.0 mm CRL pouch-young, ossification occurs in the bones surrounding the oral cavity, clavicle, ribs, cervical and thoracic vertebrae and thoracic limbs, structures necessary to ensure the survival and maintenance of the newborn in the marsupium. Ossification of most of the skull begins in 15.5 to 16.0 mm CRL pouch-young. The ossification in the pelvis and the pelvic limbs is observed at 18.0 mm CRL and in the sternum and the epipubic bone at 25.0 to 28.0 mm CRL. Most of the skeleton is ossified in 45.0 to 58.0 mm CRL pouch-young, except in the carpus, tarsus and epiphyses of the long bones where ossification occurs in 60.0 to 100.0 mm CRL pouch-young. In the skeleton of D. albiventris the omosternum, haemal arches, prepollex, prehallux and parafibula, are present. These are inconstant or absent elements in eutherian mammals.

Infectious and neoplastic disorders of the thyroid in AIDS patients: an autopsy study.

The course of human immunodeficiency virus infection and the acquired immunodeficiency syndrome can be complicated by a variety of endocrine abnormalities. This article describes the findings of a prospective autopsy study of the thyroid in 100 patients who died of complications of AIDS before the advent of the so-called highly active antiretroviral therapy [corrected]. A wide range of bacterial, fungal, viral, and neoplastic disorders were observed. Mycobacterium tuberculosis was recorded in 23% of the patients, cytomegalovirus in 17%, Cryptococcus in 5%, Mycobacterium avium in 5%, Pneumocystis in 4%, and other bacteria or fungi in 7%. Kaposi's sarcoma was recorded in 2% of patients and occult papillary carcinoma in 4%. Four patients had dual infections of the thyroid. The mean weight of the thyroid was lower than normal, and 1 case of thyroid follicular atrophy is presented. A review of the medical literature on thyroid disorders in HIV-infected patients is included. Physicians caring for HIV patients should be aware of the possibility of thyroid dysfunction in their patients.

Whipple's disease. Report of five cases with different clinical features.

Whipple's disease (WD) is a rare systemic disease of infectious etiology which involves the small intestine but can virtually affect any organ. We present here five cases (four males and one female) ranging in age from 20 to 59 years. All patients had intestinal involvement associated or not with clinical manifestations linked to this organ. Vegetation in the tricuspid valve was observed in one patient, suggesting endocarditis caused by Tropheryma whippelii, with disappearance of the echocardiographic alterations after treatment. In one of the male patients the initial clinical manifestation was serologically negative spondylitis, with no diarrhea occurring at any time during follow-up. Ocular involvement associated with intestinal malabsorption and significant weight loss were observed in one case. In the other two cases, diarrhea was the major clinical manifestation. All patients were diagnosed by histological examination of the jejunal mucosa and, when indicated, of extraintestinal tissues by light and electron microscopy. After antibiotic treatment, full remission of symptoms occurred in all cases. A control examination of the intestinal mucosa performed after twelve months of treatment with sulfamethoxazole-trimethoprim revealed the disappearance of T. whippelii in four patients. The remaining patient was lost to follow-up.

137Cs internal contamination involving a Brazilian accident, and the efficacy of Prussian Blue treatment.

In an accident involving the stealing and breaching of a radiotherapy source in Goiânia, Brazil, 39 individuals had a high level of 137Cs internal contamination. Prussian Blue was used, in doses that varied from 3-10 g d-1 for adults, to enhance the elimination of 137Cs from the body. The total internal committed doses and the effect of Prussian Blue treatment for 15 contaminated adults involved in this accident have been evaluated in this paper. Prussian Blue caused dose reductions in the range of 51-84%, with an average of 71%. This reduction was shown to be independent of the dosage of Prussian Blue. Total internal committed doses were in the range of 4.6 x 10(-3) Gy to 9.7 x 10(-1) Gy for the most-contaminated adults. Data on 137Cs biological half-lives for seven children contaminated in the accident are also presented.

[Presence of intestinal parasites in vegetables sold in the metropolitan region of São Paulo, SP, Brazil. I--Search of helminths]. / Estudo da ocorrência de enteroparasitas em hortaliças comercializadas na região metropolitana de São Paulo, SP, Brasil. I--Pesquisa de helmintos.

Vegetables in natura, commercially traded in the metropolitan area of S. Paulo, were analysed by the appropriate methodology with a view to discovering an identifying the paths of transmission of enteroparasites of medical interest. The vegetables under study consisted of 50 samples of each variety listed below: lettuce (Lactuca sativa)-oily leaves and crisphead varieties, endive (Chicorium sp) and water-cress (Nasturtium Officinale). Results showed high rates of contamination in all the vegetable varieties analysed. However, the water-cress was that which presented the highest frequencies of enteroparasites. The endive presented middle values ranking, in general, between the lettuces and the water-cress. Though high, the average number of helminth eggs and larvae obtained per 100 gr. of sample did not present statistically significant differences as between the four vegetable varieties studied. A great variety of helminths and protozoans such as occur frequently in the resident population of the metropolitan area of S. Paulo, were observed in the samples. However, the most frequent were: hookworms and Ascaris sp. Eggs of Toxocara sp, Fasciola sp and Trichostrongylidae were also recovered from the samples thus corroborating the occurrence of vegetables contamination with faeces of domestic animals. In view of the results obtained, the importance of these kinds of food in the transmission of enteroparasites is stressed, as well as the need for actions which improve the sanitary conditions of these products.