Modular CBT for Childhood Anxiety Disorders: Evaluating Clinical Outcomes and its Predictors.

This study examined clinical outcomes of a modular individual CBT for children with anxiety disorders (AD), and predictors of outcomes, in usual clinical practice. Participants were 106 children with ADs (7-17 years), and parents. Assessments were pre-, mid-, post-test, and 10 weeks after CBT (follow-up). Predictors (measured pre-treatment) were child characteristics (gender, age, type of AD, comorbid disorders), fathers' and mothers' anxious/depressive symptoms, and parental involvement (based on parents' presence during treatment sessions and the use of a parent module in treatment). At follow-up, 59% (intent-to-treat analyses) to 70% (completer analysis) of the children were free from their primary anxiety disorder. A significant decrease in anxiety symptoms was found. Higher parental involvement was related to lower child anxiety at follow-up, but only for children with comorbid disorders. Findings suggest that it is beneficial to treat anxiety with modular CBT. Future steps involve comparisons of modularized CBT with control conditions.

The influence of edible coatings and natural antioxidants on fresh-cut potato quality, stability and oil uptake after deep fat frying.

The effect of four edible hydrocolloid coatings (carboxymethyl cellulose, chitosan, pectin and gum arabic) on fresh-cut potato's colour, pH and moisture content during storage was studied. Possibility of coating enrichment with natural olive leaf extract and sodium ascorbate was also evaluated. Coatings scored as the best ones straight after coating or during storage for 7 days at 10 ± 1 °C, were used for deep fat frying of potato. Chitosan was shown to cause significant decrease in pH and browning of potato strips. Pectin was classified as good coating alone but in combination with olive leaf extract showed lower quality parameters of fresh-cut samples compared to control. Only carboxymethyl cellulose and gum arabic itself or enriched with olive leaf extract or sodium ascorbate were shown not to affect colour, pH and moisture during storage. Moreover, these coatings significantly reduced fat content in deep fat fried potato strips, without influence on L*, b*, whiteness index (WI), and ΔE.

Forensic determination of dental age by cementum thickness of human teeth.

The purpose of this study was to assess the correlation between the known chronological age and the dental cementum thickness (DCT) in male and female subjects in different age groups. MATERIAL AND METHODS: The study sample consisted of 57 donor teeth of both sexes. Teeth were classified by donors' sex and divided into three age groups: 10-19, 30-39 and 60-69 years. Tooth roots were cut with transverse ground sections in the apical, middle, and cervical thirds. DCT measurements were made on photomicrographs of light microscope. The correlation between DCT and the chronological age was calculated using the Spearman correlation coefficient. RESULTS: A positive correlation was found (r=0.47, p <0.001) between DCT and age of the donor. DCT decreased from apical to cervical ground section (median [IQR] apical section 216.72 [128.25-375.00] µm, middle section 158.44 [87.66-284.90] µm; cervical section 96.60 [70.05-165.59] µm). DCT variability was influenced by sex, number of tooth roots and the condition of the tooth crown. The influence differed depending on the location of the section, being most prominent cervically. CONCLUSION: The present study showed correlation of DCT with age, with significant influence of sex, number of tooth roots, condition of the tooth crown and location of the root section.

Sleep restriction therapy may be effective for people with insomnia and depressive complaints: evidence from a case series.

BACKGROUND: Insomnia and depression are clearly interrelated. Several studies showed that treating insomnia with cognitive behavioural therapy positively affects concurrent depressive symptoms. However, it is unclear what treatment component is responsible for the change in depressive symptoms. AIMS: To develop the evidence base we employed a case series design in which we administered a single component sleep restriction treatment to individuals with both insomnia and depressive symptoms. METHOD: Seven patients were included, of whom six completed the intervention. Patients completed weekly assessments during the 4-week wait period and 6-week treatment phase. RESULTS: At the post-assessment, two out of six patients showed clinical improvement in depressive symptoms. All six patients showed clinically meaningful improvement at the 3-month follow-up assessment, and two patients had maintained gains at 6-month follow-up. CONCLUSIONS: This case series study shows that, especially at 3-month follow-up, sleep restriction therapy is associated with clinically relevant treatment gains in patients with both insomnia and depressive symptoms.

Differential Contributions of Nucleus Accumbens Subregions to Cue-Guided Risk/Reward Decision Making and Implementation of Conditional Rules.

The nucleus accumbens (NAc) is a key node within corticolimbic circuitry for guiding action selection and cost/benefit decision making in situations involving reward uncertainty. Preclinical studies have typically assessed risk/reward decision making using assays where decisions are guided by internally generated representations of choice-outcome contingencies. Yet, real-life decisions are often influenced by external stimuli that inform about likelihoods of obtaining rewards. How different subregions of the NAc mediate decision making in such situations is unclear. Here, we used a novel assay colloquially termed the "Blackjack" task that models these types of situations. Male Long-Evans rats were trained to choose between one lever that always delivered a one-pellet reward and another that delivered four pellets with different probabilities [either 50% (good-odds) or 12.5% (poor-odds)], which were signaled by one of two auditory cues. Under control conditions, rats selected the large/risky option more often on good-odds versus poor-odds trials. Inactivation of the NAc core caused indiscriminate choice patterns. In contrast, NAc shell inactivation increased risky choice, more prominently on poor-odds trials. Additional experiments revealed that both subregions contribute to auditory conditional discrimination. NAc core or shell inactivation reduced Pavlovian approach elicited by an auditory CS+, yet shell inactivation also increased responding during presentation of a CS-. These data highlight distinct contributions for NAc subregions in decision making and reward seeking guided by discriminative stimuli. The core is crucial for implementation of conditional rules, whereas the shell refines reward seeking by mitigating the allure of larger, unlikely rewards and reducing expression of inappropriate or non-rewarded actions.SIGNIFICANCE STATEMENT Using external cues to guide decision making is crucial for adaptive behavior. Deficits in cue-guided behavior have been associated with neuropsychiatric disorders, such as attention deficit hyperactivity disorder and schizophrenia, which in turn has been linked to aberrant processing in the nucleus accumbens. However, many preclinical studies have often assessed risk/reward decision making in the absence of explicit cues. The current study fills that gap by using a novel task that allows for the assessment of cue-guided risk/reward decision making in rodents. Our findings identified distinct yet complementary roles for the medial versus lateral portions of this nucleus that provide a broader understanding of the differential contributions it makes to decision making and reward seeking guided by discriminative stimuli.

Intermittent noninvasive ventilation at San José Hospital in Chile: report of a German donation.

Home mechanical ventilation is currently expanding in Chile, but its application along the country is hindered by financial and geographical reasons. In 2006 the San José Hospital in Santiago de Chile developed a non-invasive ventilation (NIV) center as a strategy to overcome the limitations of ventilator availability from public resources. Since then, this center provides intermittent diurnal sessions of NIV to patients with chronic hypercapnic respiratory failure. In 2013, a collaboratory work between the Chilean doctors, the German Interdisciplinary Society of Home Mechanical Ventilation (DIGAB = Deutsche Interdisziplinäre Gesellschaft für Außerklinische Beatmung) and the German non-invasive (NIV) home care provider "Heinen und Löwenstein" organized a donation of 100 second-hand ventilators (BiPAP Synchrony; Respironics, USA) including masks and tubing systems, which were provided by Heinen und Löwenstein. The ventilator devices arrived in Santiago in January 2014. Since then, the following initiatives have been launched: 1) the establishment of a domiciliary mechanical ventilation program independent of governmental founding, 2) NIV setting-titration, 3) renewal of ventilators at the hospital's intermittent NIV unit. Future goals are the establishment of a rehabilitation unit with concomitant NIV therapy and a clinical research program. Therefore, the German donation of ventilators and equipment has a reported impact on the development of NIV in Chile.

Electromagnetically induced transparency in Rb-filled coated hollow-core photonic crystal fiber.

We report the observation of lambda-configuration electromagnetically induced transparency as well as optical pumping in rubidium-filled kagome-structure hollow-coated-core photonic crystal fiber. We show that a polydimethylsiloxane coating of the fiber core reduces the linewidth of the transparency below that which could be expected for an uncoated fiber. The measured 6 MHz linewidth was dominated by optical broadening.

[Verification of maxillary and mandibular asymmetry via orthopantogram's analysis]. / Verifica dell'asimmetria mascellare e mandibolare tramite analisi di ortopantomografia.

AIM: The purpose of this study was to analyse the homologous variables' symmetry (horizontal, vertical, angular and of area surface) of the right and left segment in the maxilla and in the mandible of subjects with a normal occlusion and a malocclusion. METHODS: Two-hundred and two orthopantomograms were analysed (162 with malocclusion, 40 with normal occlusion). These points of reference were used: orbital, condilion, gonion, menton, point A (intersection point between the vertical line passing through the centre of the nasal septum and the horizontal line which links the 2 points O), point B (intersection point between the mandibular margin and the vertical line passing through point O) and point T (intersection point of A-Cn on the maxillary tuberosity). RESULTS: This study did not confirm any statistically significant differences between the right and left analysed variables studied in both groups. CONCLUSION: Orthopantomography may be a useful test in the screening for facial asymmetry.

Defective antigen processing in GILT-free mice.

Processing of proteins for major histocompatibility complex (MHC) class II-restricted presentation to CD4-positive T lymphocytes occurs after they are internalized by antigen-presenting cells (APCs). Antigenic proteins frequently contain disulfide bonds, and their reduction in the endocytic pathway facilitates processing. In humans, a gamma interferon-inducible lysosomal thiol reductase (GILT) is constitutively present in late endocytic compartments of APCs. Here, we identified the mouse homolog of GILT and generated a GILT knockout mouse. GILT facilitated the processing and presentation to antigen-specific T cells of protein antigens containing disulfide bonds. The response to hen egg lysozyme, a model antigen with a compact structure containing four disulfide bonds, was examined in detail.

[Peritoneal dialysis and kidney transplantation]. / Peritoneumska dijaliza i transplantacija bubrega.

The results of pretransplantation preparation of patients undergoing peritoneal dialysis program before the kidney transplantation at our clinic have been presented. Residual kidney function, and bladder function, respectively, as well as the incidence of the hepatotropic viruses B and C infections and cytotoxic antibodies percentage following blood transfusion have been particularly analyzed. Obtained results have been correlated with those found in 40 patients on hemodialysis and to whom kidneys were transplanted at our clinic. Satisfactory bladder function, the absence of urologic posttransplantation complications, non-existence of hepatotropic viral infections and cytotoxic antibodies resulted in an introduction of a new strategy based on the peritoneal dialysis as the first method of the dialysis treatment prior to kidney transplantation.

[Estimating facial asymmetries in individuals with malocclusion and normocclusion]. / Valutazione delle asimmetrie facciali in soggetti con normocclusione e malocclusione.

BACKGROUND: The en face photographs taken in standard conditions were used to examine the facial symmetry in examinees with normocclusion and malocclusion. METHODS: A total of 80 examinees were included in the study (40 of whom had normocclusion and another 40 had malocclusion) without any prior orthodontic therapy. The face was divided into six squares by the mediosagittal line drawn through the Trihion, Glabella, Subnasals and Gnathion as well as by horizontal lines drawn through the same points. The four lower squares - the middle and the lower thirds of the face were taken into account to analyse facial symmetry. The symmetry between individual squares was measured by applying transparent paper with a millimetre-sized squares web and a planimetry. RESULTS: The results did not show any asymmetry between left and right parts of the face in either group of examinees. CONCLUSIONS: A high correlation was established among all the analysed variables.

[Replacement of mycophenolate mofetil with azathioprine in patients with renal transplants]. / Zamena mikofenolat mofetila azatioprinom kod bolesnika sa presadjenim bubregom.

Numerous clinical studies demonstrated that mycophenolate mofetil (MMF) was significantly more effective in prevention of acute rejection episodes than azathioprine. Since the data supporting the long-term benefits of MMF therapy are not available, and considering the high cost of this therapy, we examined the safety of conversion from MMF to azathioprine in renal transplant patients. In 12 renal transplant patients (4 cadaveric and 8 living related donors) on triple immunosuppressive therapy (prednisone/MMF/cyclosporine) conversion from MMF to azathioprine was done after the first six to twelve post-transplant months. The majority of patients were in the low immunological risk of transplantation, and 7 (58.3%) received antithymocite globulin due to the delayed graft function. The mean follow-up period after the conversion to azathioprine was 6.4 months (range 3-12 months). Acute rejection episode was noticed only in one patient 8 months after the conversion following acute graft pyelonephritis. In all other patients graft function remained unchanged. We have concluded that the conversion from MMF to azathioprine in renal transplant patients on triple immunosuppressive therapy is safe and without detrimental effects on short-term allograft function. Long-term follow-up studies on larger number of patients are needed to confirm these observations.

[Use of mycophenolate mofetil in patients with a transplanted kidney and cyclosporin nephrotoxicity]. / Primena mikofenolat mofetila kod bolesnika sa presadjenim bubregom i ciklosporinskom nefrotoksicnoscu.

Cyclosporine (CsA) nephrotoxicity is an important problem in renal transplant recipients, which can influence long-term graft survival. The safety of conversion from CsA to azathioprine (AZA) remains controversial and can result in higher incidence of acute rejection. Mycophenolate mofetil (MMF) is a new immunosuppressive agent superior to AZA in the prevention of acute rejection. Five patients with cyclosporine nephrotoxicity were converted from CsA/AZA/prednisolon to MMF/prednisolon protocol. All patients had low immunological risk and 4 out of 5 patients received antithymocyte globulin before conversion as the induction therapy or as the treatment for acute rejection. Mean follow-up after conversion was 16.8 months (range 4-32 months). No patient experienced acute rejection during follow-up period. The mean serum creatinine concentration decreased from 219 +/- 44.18 (range 168-280) to 122.6 +/- 48.02 mumol/l (range 72-187 mumol/l) (p = 0.002). Arterial hypertension improved after CsA withdrawal in 20% of patients. We have concluded that, in selected patients with cyclosporine nephrotoxicity, CsA withdrawal with concomitant use of MMF is safe and effective in the improvement of graft function and arterial hypertension.

[Interleukin-1 beta in patients with primary immunocomplex glomerulonephritis]. / Interleukin-1 beta kod bolesnika sa primarnim imunokompleksnim glomerulonefritisom.

Interleukin-1 is one of the most important pro-inflammatory cytokines whose role in the pathogenesis of glomerulonephritic process was proved in numerous studies. The aim of this study was to determine the urinary level of this cytokine in patients with primary immunocomplex glomerulonephritis and its significance in diagnosis of this disease. This prospective study comprised a total of 96 patients (84 males and 12 females) with primary immunocomplex glomerulonephritis. The elevated urinary IL-1 beta level was noticed in 43 (49.4%) patients with different histological forms of glomerulonephritis. The mean concentration was significantly higher in patient's group (57.7 +/- 120.7 pg/mg creatinine) (range 1.1-731) compared to control group (10.2 +/- 5.96 pg/mg creatinine) (range 1.6-25.4) (p < 0.05). There was no significant difference in the frequency of elevated urinary IL-1 beta concentration in different patients group based on histological type of glomerulonephritis (chi 2 = 6.377, p > 0.05). On the basis of our results we concluded that the elevated concentration of IL-1 beta in majority of patients with primary immunocomplex glomerulonephritis had suggested its role in the pathogenesis of glomerulonephritic process. The urinary level of IL-1 beta represents a novel, non-invasive parameter in the diagnosis of this disease, but its measurement is not useful in predicting the histological type of primary immunocomplex glomerulonephritis. The results of our study suggest the possibility that urinary IL-1 beta level reflects the activity of glomerulonephritic process and it could be useful in non-invasive monitoring of the disease progression.

Cathepsin S regulates the expression of cathepsin L and the turnover of gamma-interferon-inducible lysosomal thiol reductase in B lymphocytes.

Loading of antigenic peptide fragments on major histocompatibility complex class II molecules is essential for generation of CD4(+) T cell responses and occurs after cathepsin-mediated degradation of the invariant chain chaperone molecule. Cathepsins are expressed differentially in antigen presenting cells, and mice deficient in cathepsin S or cathepsin L exhibit severely impaired antigen presentation in peripheral lymphoid organs and the thymus, respectively. To determine whether these defects are due solely to the block in invariant chain cleavage, we used cathepsin-deficient B cells to examine the role of cathepsins S and B in the degradation of other molecules important in the class II presentation pathway. Our data indicate that neither cathepsin S nor B is critical for H-2M degradation or processing of precursor gamma-interferon-inducible lysosomal thiol reductase (GILT) to a mature thiol reductase, but suggest a role for cathepsin S in the turnover of mature GILT and in regulating levels of mature cathepsin L protein in B cells. Despite the presence of mature cathepsin L protein, no enzyme activity could be detected in B cells or dendritic cells. These experiments suggest a novel mechanism by which these functionally important enzymes may be regulated.

[Outcome of kidney transplantation in patients on peritoneal dialysis]. / Ishod transplantacije bubrega kod bolesnika na peritoneumskoj dijalizi.

The initial experience suggested that kidney transplantation could be hazardous for patients on peritoneal dialysis due to the high risk of peritonitis and a possible high incidence of acute rejection. In this paper we have presented our experience with kidney transplantation in these patients. During the last four years kidney transplantation was performed in 9 patients on peritoneal dialysis. The average time spent on peritoneal dialysis was 20.6 +/- 7.6 months. In all patients peritoneal catheter was removed during the surgery. During the posttransplantation period a triple immunosuppressive therapy including steroids, cyclosporin and azathioprineor mycophenolate mofetil was administered in all patients. In comparison to patients on hemodialysis no significant difference in the incidence of acute rejection episodes, delayed graft function, graft arterial thrombosis and graft function recovery was observed. Patients on peritoneal dialysis had significantly greater and longer wound drainage in comparison to patients on hemodialysis. It was concluded that peritoneal dialysis had no negative influence on short-term outcome of kidney transplantation.

The meaning of air quality and flue gas emission standards for public acceptance of new thermal power plants.

For the time being only 30-40% of the electric energy supply in Croatia comes from burning fossil fuel. New capacities of 800-1400 MW for the next decade will have to rely on the exclusive use of fossil fuels in thermal power plants (TPP). Public opinion will probably have a decisive influence on the issuing of construction permissions. The potential adverse effects on air seem to be the main argument against construction of TPPs. The priority is therefore to unambiguously state what air quality is warranted in the influenced area for the whole operation period of a TPP. It is important that the public should understand the real meaning of current air quality standards and emission limits. The only known way to do it today is through comparison with the corresponding standards and limits accepted worldwide. This paper discusses some important aspects of such comparison.

[Significance of blood transfusion in the development of cytotoxic antibodies in patients on hemodialysis]. / Znacaj transfuzija krvi za razvoj citotoksicnih antitela kod bolesnika na hemodijalizi.

The aim was to evaluate the influence of red blood cells (RBC) transfusion on the development of cytotoxic antibodies (C-Ab) in patients subjected to hemodialyses (HD) and planned for the kidney transplantation. The group of 71 HD patients, of mean age 42 years (19-65), 48 males and 23 females, planned for the kidney information was examined. Out of 71 HD patients, only 42 (59.19%) HD patients (group I) received subcutaneously recombinant human erythropoietin--rhuEPO (Eprex--epoetin-alpha or Recormon SE--epoetin-beta in dosage of 4,000 IU during every HD; i.e. one to three times a week) and they were not treated by RBC transfusion. The other 29 (40.85%) HD patients (group II) received RBC transfusion: 18 (62.07%) HD patients received < 10 units 18 of RBC, 8 (27.59%) HD patients received 10-20 units of RBC; 3 (10.35%) HD patients received > 20 units of RBC. Testing of C-Ab was done in all patients every three months by standard lymphocytotoxicity test on the panel from 20 different lymphocyte donors with definite class I phenotype of antigen HLA. C-Ab was not found in HD patients who were not treated by RBC transfusion. Out of 18 HD patients who received < 10 units of RBC only 3 (16.67%) HD patients developed C-Ab; out of 8 HD patients who received 10-20 units of RBC, in 4 (50%) patients was proved C-Ab; and C-Ab was proved in all 3 HD patients who received > 20 units of RBC. RhuEPO administration is very important for the transfusiologic treatment of HD patients; especially those who are planned for the kidney transplantation. Development of C-Ab is in direct correlation with the number of transfunded units of RBC. HD patients who received 10 or more units of RBC were at great risk to develop C-Ab.

Strong cytotoxic T lymphocyte responses to a macrophage inflammatory protein 1alpha-expressing tumor: linkage between inflammation and specific immunity.

Leukocyte infiltration is an important histological sign of resistance to tumors. However, it is unclear whether local inflammatory responses can promote specific antitumor immunity. Here we report that local expression of macrophage inflammatory protein 1alpha, which results in strong inflammation of leukocytes in tumors, leads to the induction of strong antitumor CTL responses. The induction of CTL effectors requires co-stimulatory molecules B7-1 and/or B7-2 on host antigen-presenting cells but not on the tumors. These results establish a critical linkage between inflammation and specific immunity.