Potential lethality of suicide attempts in youth.

Rates of suicide in youth have increased over the last 50 years, yet our ability to predict suicidal behaviours has not significantly improved during this time. Examining predictors of suicide attempt lethality can enhance our understanding of suicidality in youth, yet research has focused on actual medical lethality (the actual danger to life resulting from a suicide attempt) rather than potential lethality (the potential for death that is associated with a suicide attempt). Thus, the aim of the present study was twofold: first, we quantified the percentage of youth for whom the severity of suicide attempt was misclassified by considering only actual lethality; second, we tested whether key variables that predict the actual lethality of suicide attempts also predict the potential lethality of suicide attempts in youth. We examined these questions in a sample of children and adolescents admitted to a psychiatric inpatient unit following a suicide attempt. Over 70% of youth who made serious suicide attempts would have been misclassified by assessments relying on only actual lethality. Although several variables relevant to the construct of actual lethality significantly predicted potential lethality (e.g., male sex, substance use disorder), others did not. In addition, we found that the subset of youth who would have been misclassified as low risk based on actual lethality had a disproportionately high need for healthcare resources due to future hospital admissions. The present study provides evidence to suggest that considering potential lethality may lead to improved detection and prediction of suicide risk in youth, and in doing so supports recent calls to broaden considerations of the lethality associated with suicide attempts.

Serological Determination of Toxoplasma gondii among Sheep (Ovis aries) in Guilan Province, Iran.

Toxoplasma gondii is one of the most common foodborne protozoan parasite causing congenital infection, abortion, and stillbirth in humans and animals. The temperate and humid climate is one of the most important factors in the high prevalence of T. gondii. Sheep are among the important sources of meat production in Guilan province, Iran. Therefore, the consumption of raw and half-cooked meat is one of the major risk factors for T. gondii infection. Toxoplasmosis in patients with intact immune systems is usually asymptomatic; however, it but can be life-threatening in patients with a weak immune system (for example, patients with the human immunodeficiency viruses/acquired immunodeficiency syndrome or cancer and transplant recipients). Guilan is divided into three geographical regions of plains with a temperate climatic condition, hillsides with a semi-humid climate, and heights with cold mountainous climate. Climate situations play a role in the prevalence of toxoplasmosis. The present study aimed to investigate the seroprevalence of T. gondii infection among sheep in Guilan province, north of Iran. In the current cross-sectional study, a total of 400 sheep sera samples were tested for the determination of immunoglobulin G (IgG) antibody against T. gondii using the enzyme-linked immunosorbent assay. The samples were divided into different groups according to the geographical location and animal age. T. gondii antibody (i.e., IgG) was detected in 166 sheep (41.5%). The highest frequency of T. gondii infection (72.7%; n=56) was observed for the age group of > 4 years; the difference was statistically significant in this regard (P=0.0001) in comparison to that reported for other groups. In addition, the seroprevalence of T. gondii was significantly higher in the plains (53.9%) than that of the hillsides and heights (P=0.0001). Consequently, the seroprevalence of T. gondii infection in Guilan was high indicating a significant relationship with geographical location and animal age.

Viscoplastic fingering in rectangular channels.

We experimentally study the viscous fingering problem of viscoplastic fluids in channels of rectangular cross section. We find that a yield stress-dependent capillary number (Ca^{*}) and an aspect ratio-dependent Bond number (Bo^{*}) can classify the finger shape into ramified and unified fingering patterns, and the finger flow regime into yield stress, viscosity, and aspect ratio-buoyancy-dominated regimes. For these regimes, we provide the transition boundaries using Ca^{*} and Bo^{*} and propose simple relations to predict the finger width, for a wide range of flow parameters, versus the capillary number, the channel aspect ratio, and the rheology of the viscoplastic fluid.

A survey of social cognitive determinants of physical activity among Iranian women using path analysis method.

INTRODUCTION: This cross-sectional study was carried out on 400 women selected from urban health centers in Isfahan through stratified sampling. The study was designed to evaluate the social cognitive theoretical model in explaining the determinants of physical activity among women using path analysis method. METHODS: In a hypothetical framework, the relationship between self-efficacy, outcome expectation, social support and self-regulation and physical activity were assessed using path analysis and indices of fitness. Furthermore, the predictive power of the model was evaluated. RESULTS: The social cognitive theoretical model had a good predictive power for physical activity. Confirmatory factor analysis revealed the suitability of the theoretical model; this model is able to cover 80% of the physical activity variance. Evaluation of the social cognitive theoretical model using path analysis showed that self-regulation was the strongest determinant of physical activity. Social support and outcome expectation had very weak effects on physical activity; nonetheless, their effect was enhanced by the presence of self-regulation. Self-efficacy had a weak effect on physical activity, however, as an intermediate variable, it reinforced the impact of social support and outcome expectation on physical activity. CONCLUSIONS: The use of the present hypothetical model is suggested as an appropriate framework in research related to physical activity among women as well as to strengthening self-regulation skills in designing and implementing programs promoting physical activities.

Removal of dibutyl phthalate from aqueous environments using a nanophotocatalytic Fe, Ag-ZnO/VIS-LED system: modeling and optimization.

An (Fe, Ag) co-doped ZnO nanostructure was synthesized by a simple chemical co-precipitation method and used for the degradation of dibutyl phthalate (DBP) in aqueous solution under visible light-emitting diode (LED) irradiation. (Fe, Ag) co-doped ZnO nanorods were characterized by powder X-ray diffraction, Fourier transform infrared spectroscopy, UV-VIS diffuse reflectance spectroscopy, elemental mapping, Field emission scanning electron microscopy, transmission electron microscope and Brunauer-Emmett-Teller surface area analysis. A Central Composite Design was used to optimize the reaction parameters for the removal of DBP by the (Fe, Ag) co-doped ZnO nanorods. The four main reaction parameters optimized in this study were the following: pH, time of radiation, concentration of the nanorods and initial DBP concentration. The interaction between the four parameters was studied and modeled using the Design Expert 10 software. A maximum reduction of 95% of DBP was achieved at a pH of 3, a photocatalyst concentration of 150 mg L-1 and a DBP initial DBP concentration of 15 mg L-1. The results showed that the (Fe, Ag) co-doped ZnO nanorods under low power LED irradiation can be used as an effective photocatalyst for the removal of DBP from aqueous solutions.

Different combinations of glucose tolerance and blood pressure status and incident cardiovascular disease and all-cause mortality events.

The purpose of this study was to evaluate the effect of combinations of blood pressure and glucose tolerance status on cardiovascular and all-cause mortality. A total of 7619 participants aged ⩾30 years old were stratified to nine categories as follows: (1) normotension (NTN) and normal glucose tolerance (NGT) (reference group), (2) NTN and pre-diabetes mellitus (pre-DM), (3) NTN and DM, (4) pre-hypertension (pre-HTN) and NGT, (5) pre-HTN and pre-DM, (6) pre-HTN and DM, (7) HTN and NGT, (8) HTN and pre-DM and (9) HTN and DM. Cox proportional hazards were applied to calculate the multivariate hazard ratios (HRs) of different groups for outcomes. For all-cause mortality outcomes, prevalent cardiovascular disease (CVD) was also adjusted. In a median follow-up of 11.3 years, 696 CVD and 412 all-cause mortality events occurred. Among the population free from CVD at baseline (n=7249), presence of HTN was associated with increased risk of CVD, regardless of glucose tolerance status with HRs of 1.97 (95% confidence interval (CI), 1.49-2.61), 2.25 (1.68-3.02) and 3.16 (2.28-4.37) for phenotypes of HTN and NGT, HTN and pre-DM and HTN and DM for CVD, respectively; corresponding HRs for all-cause mortality were 1.65 (95% CI, 1.15-2.37), 1.69 (1.15-2.49) and 2.73 (1.80-4.14), respectively. Phenotypes of NTN and pre-DM (1.48; 1.03-2.14) and NTN and DM (2.04; 1.06-3.92) were also associated with CVD and all-cause mortality, respectively. HTN was significantly associated with CVD/mortality events, regardless of glucose tolerance status. Blood pressure <120/80 mm Hg among pre-diabetic/diabetic population, not on antihypertensive medications, was generally associated with worse outcomes.

A microfluidic method and custom model for continuous, non-intrusive biofilm viscosity measurements under different nutrient conditions.

Straight, low-aspect ratio micro flow cells are used to support biofilm attachment and preferential accumulation at the short side-wall, which progressively reduces the effective channel width. The biofilm shifts downstream at measurable velocities under the imposed force from the constant laminar co-flowing nutrient stream. The dynamic behaviour of the biofilm viscosity is modeled semi-analytically, based on experimental measurements of biofilm dimensions and velocity as inputs. The technique advances the study of biofilm mechanical properties by strongly limiting biases related to non-Newtonian biofilm properties (e.g., shear dependent viscosity) with excellent time resolution. To demonstrate the proof of principle, young Pseudomonas sp. biofilms were analyzed under different nutrient concentrations and constant micro-flow conditions. The striking results show that large initial differences in biofilm viscosities grown under different nutrient concentrations become nearly identical in less than one day, followed by a continuous thickening process. The technique verifies that in 50 h from inoculation to early maturation stages, biofilm viscosity could grow by over 2 orders of magnitude. The approach opens the way for detailed studies of mechanical properties under a wide variety of physiochemical conditions, such as ionic strength, temperature, and shear stress.

Wrist circumference as a novel negative risk factor for cardiovascular disease among adult men: a median follow-up of 9 years.

PURPOSE: Wrist circumference is an easy to measure anthropometric index of body frame and bone size. The aim of this study was to examine the association of wrist circumference with incidence of cardiovascular disease (CVD) among adult men. METHODS: For this study 2531 male participants aged ≥30 years, without any history of CVD were selected and followed from 1999 to 2011. Cox proportional hazard models and logistic regression were used to examine the relation of wrist circumference with incident CVD. RESULTS: A total of 339 cases of CVD were reported throughout a median follow-up of 9.4 years. In the multi-variable Cox model, 1 unit increase of wrist circumference was inversely associated with incident CVD with a HR (95 % CI) of 0.84 (0.72-0.98, P value = 0.02). The receiver operating characteristics curve in a logistic regression model for wrist circumference in prediction of CVD showed a cutoff of 17.75 cm, beyond which was associated with a lower risk for CVD. CONCLUSION: In a population with a high prevalence of CVD risk factors, it was shown that a higher wrist circumference was associated with lower risk for incident CVD. Further studies are needed to explore the underlying mechanisms of this inverse relation.

PARVB overexpression increases cell migration capability and defines high risk for endophytic growth and metastasis in tongue squamous cell carcinoma.

BACKGROUND: Tongue squamous cell carcinoma (TSCC) is highly diverse, even in its early stages. This cancer is classified into three subtypes (superficial, exophytic, and endophytic) based on macroscopic appearance. Of these subtypes, the endophytic tumours have the worst prognosis because of their invasiveness and higher frequency of metastasis. METHODS: To understand the molecular mechanism underlying the endophytic subtype and to identify biomarkers, we performed a comprehensive gene expression microarray analysis of clinical biopsy samples and also confirmed the clinical relevance of differential gene expression. RESULTS: Expression of the parvin-beta (PARVB) gene and its encoded protein was significantly upregulated in endophytic-type TSCC. PARVB is known to play a critical role in actin reorganization and focal adhesions. Knockdown of PARVB expression in vitro caused apparent decreases in cell migration and wound healing, implying that PARVB has a crucial role in cell motility. Moreover, metastasis-free survival was significantly lower in patients with higher tumour expression of PARVB. CONCLUSIONS: These findings suggest that PARVB overexpression is a candidate biomarker for endophytic tumours and metastasis. This protein may be a clinically useful target for adjuvant TSCC therapy.

Standardized evaluation framework for evaluating coronary artery stenosis detection, stenosis quantification and lumen segmentation algorithms in computed tomography angiography.

Though conventional coronary angiography (CCA) has been the standard of reference for diagnosing coronary artery disease in the past decades, computed tomography angiography (CTA) has rapidly emerged, and is nowadays widely used in clinical practice. Here, we introduce a standardized evaluation framework to reliably evaluate and compare the performance of the algorithms devised to detect and quantify the coronary artery stenoses, and to segment the coronary artery lumen in CTA data. The objective of this evaluation framework is to demonstrate the feasibility of dedicated algorithms to: (1) (semi-)automatically detect and quantify stenosis on CTA, in comparison with quantitative coronary angiography (QCA) and CTA consensus reading, and (2) (semi-)automatically segment the coronary lumen on CTA, in comparison with expert's manual annotation. A database consisting of 48 multicenter multivendor cardiac CTA datasets with corresponding reference standards are described and made available. The algorithms from 11 research groups were quantitatively evaluated and compared. The results show that (1) some of the current stenosis detection/quantification algorithms may be used for triage or as a second-reader in clinical practice, and that (2) automatic lumen segmentation is possible with a precision similar to that obtained by experts. The framework is open for new submissions through the website, at http://coronary.bigr.nl/stenoses/.

Amphistome species in cattle in South coast of caspian sea.

BACKGROUND: Knowledge about the amphistomid fauna in Iranian domestic ruminants depends on the studies conducted almost 30 years ago. The last situation in cattle is introduced here in the provinces in south coast of Caspian Sea. METHODS: Amphistomid species were collected from cattle at slaughter houses of the provinces Gilan and Mazanderan in 2010. Median sagittal sections were prepared by the conventional method. Species were identified by the histomorphological pecularities of the muscular argans. RESULTS: Five amphistomid species, Paramphistomum cevri, P. gotoi, Calicophoron calicophorum, Carmyerius spatiosus and Gastrothylax compressus, recovered. Calicophoron calicophorum is a new species for Iran. Criteria used in identification of the species were illustrated. CONCLUSION: Iran has a rich amphistomid fauna and mostly under the influence of oriental conditions.

Benzimidazole -Resistance in Haemonchus contortus: New PCR-RFLP Method for the Detection of Point Mutation at Codon 167 of Isotype 1 ß-Tubulin Gene.

BACKGROUND: Due to the lack of a suitable and economic test for the analysis of the polymorphism at codon 167, we developed a new PCR-RFLP technique, based on a modified forward primer (UT-HC167 MF-primer), to identify simultaneously the SNPs at codons 167 and 200 of isotype 1 ß-tubulin gene of Haemonchus contortus. METHODS: There already are several safe and easy methods for identification of point mutations at codons 198 and 200. Due to the lack of a reliable and easy method for the detection of the single nucleotide polymorphism (SNP) at codon 167, we developed an innovative PCR-RFLP technique based on a modified forward primer (UT-HC167 MF-primer), in which the nucleotide T at the position 443 was substituted through a nucleotide A creating a restriction site for restriction endonuclease SnaB I in the nucleotide sequences including codon 167. A total of 138 adult male H. contortus were collected from three different geo-climatic areas of Iran. The isolated genomic DNA of each single worm was amplified by PCR using primers flanking codon 167. The PCR product (527 bp) was then amplified by semi-nested PCR using the UT-HC167 MF-primer and the reverse primer achieving a PCR product of 451 bp in length. This PCR product was subsequently digested with the restriction endonucleases SnaB I and TaaI for analysis of the mutations at codons 167 and 200, respectively. RESULTS: All worms had two alleles encoding for phenylalanine (BZ(ss) homozygote) for both codons. CONCLUSION: Using the UT-HC167 MF-primer and a suitable reverse primer designed upstream from codon 200, it is possible to amplify a PCR product which can be used for analysis of the SNPs at all three mentioned codons using RFLP.

Epidemiological aspects of canine dirofilariasis in the north of iran.

BACKGROUND: Dirofilaria immitis is an important parasite in dog and other carnivores. Our objective was study on incidence and periodicity of heartworm in north of Iran and using other methods for its diagnosis in addition to Parasitology exam. METHODS: This survey spanned two years, between 2006 and 2008. Blood samples were collected from 431 stray dogs distributed along north of Iran, the coastal areas of the Caspian Sea. The Knott's modified test was used for diagnosis of D. immitis and other filariae. Meanwhile, the periodicity of microfilaria in peripheral blood circulation was calculated and the imaging diagnosis techniques of four dogs that had positive results were done. RESULTS: Diagnostic parasitology results indicated that 16.01% of stray dogs were microfilaremic. Two different microfilariae were diagnosed: D. immitis in 13.69%, Dipetalonema reconditum in 1.86% and in 0.46% both of them. There was no statistically significant between infection to fiariae with sex and age of dogs. Also study on the periodicity of the presence of microfilaria in peripheral circulation showed that the highest rate of those was at 1 am and the lowest rate at 12 pm. Radiographic study showed distinctive signs with varied degrees of severity included: Tortuous and enlargement of main and lobar pulmonary artery, pulmonary parenchymal lesions and Right side heart enlargement that confirmed in electrocardiography. Also in echocardiographic images observed short parallel-sided images with the appearance of equal signs that indicated the presence of the heartworm. CONCLUSION: These results showed that to obtain a reliable diagnosis of heartworm infection, imaging tests could support parasitological exams.

Gastrointestinal Helminths of Magpies (Pica pica), Rooks (Corvus frugilegus) and Carrion Crows (Corvus corone) in Mazandaran Province, North of Iran.

BACKGROUND: Corvidae is a cosmopolitan family of oscine birds including crows, rooks, magpies, jays, chough, and ravens. These birds are migratory species, especially in the shortage of foods, so they can act like vectors for a wide range of microorganisms. They live generally in temperate climates and in a very close contact with human residential areas as well as poultry farms. There is no available information in the literature concerning the parasitic infections of these three species of corvidae in Mazandaran Province, northern Iran, so this study was conducted to clarify this. METHODS: As there are three species of corvid birds in Mazandaran Province, 106 birds including 79 magpies, 11 rooks, and 16 carrion crows were examined between winter 2007 and spring 2008 at post mortem for gastrointestinal helminths. The helminths were drawn and identified morphologically in the Laboratory of Parasitology, Islamic Azad University, Science and Research Branch, Tehran and also partly in the School of Public Health, Tehran University of Medical Sciences, based on the reference books and identification keys like Soulsby, Khalil et al. and Anderson et al. RESULTS: Four species of nematodes, 2 species of cestodes, 1 species of trematodes and 1 species of acanthocephalans were identified in these three corvid species. CONCLUSION: Five species of the helminths are identified for the first time in Iran, and the acanthocephalan species is new host record for rooks. It is clear that these corvid birds have diverse range of helminths and can act as carriers for infecting the domestic fowls.

Evaluation of Benzimidazole Resistance in Haemonchus contortus Using Comparative PCR-RFLP Methods.

BACKGROUND: In order to deworm the ruminants especially of sheep in Iran, consumption of benzimidazoles has more than 2 decades history and today farmers are using imidazothiazoles, macrocyclic lactones and mostly benzimidazole compounds (BZs) to treat infected farm animals. It has been demonstrated that the most common molecular mechanism leading to BZsresistance in Haemonchus contortus is a single mutation at amino acid 200 (phenylalanine to tyrosine) of the isotype 1 of beta tubulin gene. According to the report of such mutations in Iranian Teladorsagia circumcincta isolates with Restriction Site Created PCR-RFLP, we decided to evaluate the frequency of such mutations in H. contortus in three different geographical areas of Iran. METHODS: A total of 102 collected adult male H. contortus were evaluated with PCR-RFLP (using PSP1406I as restriction enzyme). By means of a second step to compare function of different methods and to increase sensitivity of detection mechanism, a third of samples were examined by another PCR-RFLP method (using TaaI as restriction enzyme) and finally beta tubulin gene of two samples was sequenced. RESULTS: All of samples were detected as BZss homozygote. Finally, beta tubulin gene sequencing of two samples showed no point mutation at codon 200. CONCLUSION: It seems that BZresistance of H. contortus in Iran is not a serious problem as anticipated before.

Infection of Anisakids Larvae in Long Tail Tuna (Thunnus tonggol) In North Persian Gulf.

BACKGROUND: The aim of this paper was to study the prevalence and intensity of Anisakids larvae in the long tail tuna fish captured from Iranian shores of Persian Gulf. METHODS: Different organs including skin, abdominal cavity, stomach and intestinal contents, stomach sub serous tissues, liver, spleen, gonads and 20 grams of muscles of 100 long tail tuna fish (Thannustonggol) caught from waters of the north parts of Persian Gulf were searched for anisakid nematodes larvae. Twenty grams of around the body cavity muscles were digested in artificial gastric juice. Different organs and digested muscles were examined with naked eyes for the presence of anisakids larvae. The collected larvae were preserved in 70% alcohol containing 5% glycerin, and cleared in lactophenol for identification. RESULTS: Our findings revealed that 89% of fish harbored 3(rd) stage larvae of Anisakis sp. of which 2% were infected with both Anisakis and Raphidascaris. All inspected organs except that of skin were found to be infected, while stomach sub serous tissues were the most infected organ (80%) followed by abdominal cavity (10%), liver (4%), testicle (3%), stomach contents and spleen (2%) and intestinal contents (1%). Intestine and abdominal cavity were the organs harbored Raphidascaris sp. Digested muscles were free of parasite. Mean intensity was low for both species and ranged between 1.5 for Raphidascaris sp. and 3.67 for Anisaki sp. CONCLUSION: Anisakids larvae especially Anisakis are very prevalent in some fish including tunas of Persian Gulf, and consumption of infected fish if it is not properly cooked may lead to human anisakiasis.

Natural radioactivity levels of (226)RA and (40)K in soil of Zanjan province, Iran.

Radioactivity concentration of naturally occurring radionuclides, (226)Ra and (40)K, in soil samples of Zanjan province, in north-west of Iran and from 21 geographical areas was measured by gamma spectrometry. The activity concentration of (226)Ra ranged from 58.4 + or - 1.8 to 132 + or - 3.1 Bq kg(-1) with the mean value of 88.5 + or - 22.9 Bq kg(-1). The activity concentration of (40)K ranged from 267 + or - 5.9 to 791 + or - 8.1 Bq kg(-1) with the mean value of 497.4 + or - 162.6 Bq kg(-1). The mean values for absorbed dose rate in air and annual effective dose were determined as 62.6 + or - 16.5 nGy h(-1) and 0.076 + or - 0.02 mSv, respectively.

Incidence and Genetic Characterization of Gongylonema pulchrum in Cattle Slaughtered in Mazandaran Province, Northern Iran.

BACKGROUND: The gullet worm, Gongylonema pulchrum Molin, 1857, is a thread-like spirurid nematode found in a variety of mammals worldwide. Its incidences in Iranian cattle of different breed or age have not been reported. The aims of the present study are to disclose the infection status of G. pulchrum in cattle slaughtered in northern region of Iran. METHODS: Full-length esophagi of cattle of 97 native dairy breed and 41 Holstein-Friesian breed were collected at four local abattoirs in Mazandaran Province, northern Iran, from March 2006 to August 2007, and were examined parasitologically. Eight overlapping segments of the small- and large-subunits of rDNA were amplified by PCR, and the obtained nucleotide sequences were characterized. RESULTS: The incidences of G. pulchrum in female and male native dairy breed were 38.9% and 24.0%, respectively, whereas those in female and male Holstein-Friesian breed were 4.2% and 0%, respectively. The first internal transcribed spacer (ITS1) region of G. pulchrum rDNA showed an intra-individual variation in the sequence and length, and the variation was ascribed to some unstable repeats of "A" or "CA". CONCLUSION: Distinct incidences of G. pulchrum infection in native dairy breed and Holstein-Friesian breed might be ascribed to different animal husbandry manners for each breed in Iran; the former breed grazes freely in the pasture, but the latter breed is usually held in a pen. The rDNA sequence of Iranian G. pulchrum, obtained for the first time by us, might facilitate a reliable species identification of the parasite with a wide spectrum of morphological variations.

Helminth infections of stray dogs from garmsar, semnan province, central iran.

BACKGROUND: The aim was to study the gastro-intestinal helminths of stray dogs of Garmsar, Semnan Province, Central Iran, and its impacts on human health and animal production. METHODS: During 2006, the alimentary tracts of 50 stray dogs at necropsy, selected from villages around Garmsar, were removed, and examined for helminth infections. Subsequently helminths were collected from the contents of each part and scraped sample of small intestines of washed materials in a 100-mesh sieve. To identify the species of helminths, the nematodes were cleared in lactophenol and cestodes were stained using carmine acid. RESULTS: Mixed infection was the rule and 40 dogs (80%) harbored more than one species of helminth. Taenia hydatigena was the most prevalent species (80%) followed by Echinococcus granulosus (64%), Toxocara canis (22%), Mesocestoides lineatus (12%), Taenia multiceps (10%) and Dipylidium caninum (4%). The mean intensity of worm infection was low (1-3) except for that of E. granulosus (645). No significant difference was noticed between sex, age and most helminth infections except for that of sex and T. hydatigena (P=0.001) as well as age and T. canis (P=0.001). CONCLUSION: Although human infection with T. hydatigena is unlikely, but other helminths reported in this study are of zoonotic importance, and may pose a threat to community health, and reduce the productions of ruminants harboring taeniid metacestodes.

Iron lung versus mask ventilation in acute exacerbation of COPD: a randomised crossover study.

OBJECTIVE: To compare iron lung (ILV) versus mask ventilation (NPPV) in the treatment of COPD patients with acute on chronic respiratory failure (ACRF). DESIGN: Randomised multicentre study. SETTING: Respiratory intermediate intensive care units very skilled in ILV. PATIENTS AND METHODS: A total of 141 patients met the inclusion criteria and were assigned: 70 to ILV and 71 to NPPV. To establish the failure of the technique employed as first line major and minor criteria for endotracheal intubation (EI) were used. With major criteria EI was promptly established. With at least two minor criteria patients were shifted from one technique to the other. RESULTS: On admission, PaO(2)/FiO(2), 198 (70) and 187 (64), PaCO(2), 90.5 (14.1) and 88.7 (13.5) mmHg, and pH 7.25 (0.04) and 7.25 (0.05), were similar for ILV and NPPV groups. When used as first line, the success of ILV (87%) was significantly greater (P = 0.01) than NPPV (68%), due to the number of patients that met minor criteria for EI; after the shift of the techniques; however, the need of EI and hospital mortality was similar in both groups. The total rate of success using both techniques increased from 77.3 to 87.9% (P = 0.028). CONCLUSIONS: The sequential use of NPPV and ILV avoided EI in a large percentage of COPD patients with ACRF; ILV was more effective than NPPV on the basis of minor criteria for EI but after the crossover the need of EI on the basis of major criteria and mortality was similar in both groups of patients.