Morpho-colorimetric characterisation of Malva alliance taxa by seed image analysis.

Seed morphometric and -colorimetric features describing shape, size and textural seed traits of 28 taxa belonging to the genera Lavatera L. and Malva L., were recorded by means of computer vision techniques. The data were statistically analysed to contribute to the taxonomical treatment of the Malva alliance and to assess some doubtful systematic positions. A clear differentiation between taxa traditionally attributed to Lavatera or Malva was highlighted. Furthermore, the identification system proposed here was able to discriminate among the Lavatera sections, confirming the taxonomic organization of this genus. The results obtained for Malva, both at the species level and among sections, supported this analytical tool as diagnostic for systematic purposes.

Working in public health services in Brazil: the relationship between different rationalities.

Success in a public health system is related to its ability to change its production process and to deal with general principles of the health system, such as universality and equity. The frameworks proposed by service marketing scholars have been developed primarily for private services; they focus on acceptance by the targeted client-users, and on the technical specifications of the new service delivery processes. Little attention has been given to the employees' point of view and their activities to maintain service operations modulated by innovation. In a public health system, workers make decisions in real time related to users' needs and the technical specifications of the process; therefore, it is very important to understand how the changes impact on employees' activities and on the quality delivered for citizens. This article discusses how changes implemented in Sao Paulo, Brazil impact the organizational parameters and working activities for front-line workers.

Mechanisms of immune-mediated skin diseases: an overview.

The skin is a frequent site of pathological immune responses that can take place in the dermal and/or the epidermal compartments.These immunopathological reactions often occur towards innocuous antigens and may be the result of T cell-dependent and/or autoantibody dependent mechanisms. Defective immune regulation is increasingly recognized as very relevant in many skin and systemic immune-mediated disorders. In some instances (e.g., psoriasis and atopic dermatitis) genetic predisposition can affect also the capacity of keratinocytes to initiate or perpetuate inflammatory responses. A more precise understanding of the molecular and cellular mechanisms underlying each disorder may allow the identification of novel targets for more effective therapeutic strategies.

Keratinocytes from patients with atopic dermatitis and psoriasis show a distinct chemokine production profile in response to T cell-derived cytokines.

BACKGROUND: Atopic dermatitis (AD) and psoriasis are genetically determined inflammatory skin disorders. Keratinocytes actively participate in cutaneous inflammatory responses by elaborating various chemokines. OBJECTIVE: We investigated the capacity of IL-4, IFN-gamma, and TNF-alpha to modulate the expression of CCL and CXCL chemokines in cultured keratinocytes from patients and healthy individuals, as well as chemokine expression in situ. METHODS: Keratinocyte cultures were established from normal-looking skin of adult patients with AD or psoriasis vulgaris and from healthy subjects. Monocyte chemoattractant protein 1 (MCP-1)/CCL2, RANTES/CCL5, IL-8/CXCL8, and IFN-gamma-induced protein of 10 kd (IP-10)/CXCL10 production was evaluated at the mRNA and protein levels by using RNase protection assay and ELISA, respectively. The expression of the same chemokines was studied in chronic lesional skin by means of immunohistochemistry or in situ hybridization. RESULTS: Only IL-8 mRNA was detected in unstimulated ke-ratinocyte cultures. MCP-1 and IP-10 were potently induced by IFN-gamma, whereas IL-8 and RANTES were preferentially upregulated by TNF-alpha and, to a lesser extent, by IFN-gamma. IL-4 weakly induced IP-10, RANTES, and IL-8 but not MCP-1. Keratinocytes of patients with AD invariably responded with significantly earlier and higher RANTES expression. By contrast, keratinocytes of patients with psoriasis displayed much higher levels of both constitutive and induced IL-8 and a stronger induction of MCP-1 and IP-10. RANTES and MCP-1 mRNA(+) keratinocytes were detected in the basal layer of lesions of patients with AD and psoriasis. IP-10 and IL-8 were consistently upregulated in the epidermis of patients with psoriasis but not in lesions of patients with AD. CONCLUSIONS: Keratinocytes of patients with AD and psoriasis show an intrinsically abnormal and different chemokine production profile and may thus favor the recruitment of distinct leukocyte subsets into the skin.

Dysregulated activation of activator protein 1 in keratinocytes of atopic dermatitis patients with enhanced expression of granulocyte/macrophage-colony stimulating factor.

Keratinocytes of patients with atopic dermatitis produce high amounts of granulocyte/macrophage colony-stimulating factor, a factor essential for dendritic cell function and thus for the development of skin immune responses. In contrast to keratinocytes cultured from nonatopic, healthy individuals, granulocyte/macrophage colony-stimulating factor mRNA could be detected in unstimulated cultures of atopic dermatitis keratinocytes, and phorbol myristate acetate induced much greater granulocyte/macrophage colony-stimulating factor mRNA levels in these cells, although the decay kinetics were not altered. Using reporter gene (chloramphenicol acetyl transferase) analysis, a minimal granulocyte/macrophage colony-stimulating factor promoter was shown to confer constitutive and phorbol-myristate-acetate-induced regulation of transcriptional activity in keratinocytes, and significantly higher levels of chloramphenicol acetyl transferase activity were measured in lysates of unstimulated and phorbol-myristate-acetate-treated atopic dermatitis keratinocytes than in control keratinocyte cultures. Electrophoretic mobility shift assays showed that low levels of NF-kappa B binding activity could be induced by phorbol myristate acetate in both normal and atopic dermatitis keratinocytes. By contrast, activator protein 1 complexes were efficiently induced, and they were invariably present at higher levels in nuclear lysates of atopic dermatitis keratinocytes. Atopic dermatitis keratinocyte nuclear lysates had higher constitutive levels of c-Jun, and phorbol myristate acetate promoted an earlier and stronger expression of c-Jun, JunB, and of the phosphorylated forms of c-Fos. A dysregulated activation of activator protein 1 may be implicated in the molecular mechanisms leading to increased granulocyte/macrophage colony-stimulating factor expression in atopic dermatitis keratinocytes. J Invest Dermatol 115:1134-1143 2000

Pathogenetic mechanisms of atopic dermatitis.

Atopic dermatitis (AD) is a chronic inflammatory disease which results from complex interactions between genetic and environmental mechanisms. An altered lipid composition of the stratum corneum is responsible for the xerotic aspect of the skin and determines a higher permeability to allergens and irritants. Keratinocytes of AD patients exhibit a propensity to an exaggerated production of cytokines and chemokines, a phenomenon that can have a major role in promoting and maintaining inflammation. Specific immune responses against a variety of environmental allergens are also implicated in AD pathogenesis, with a bias towards Th2 immune responses. In particular, dendritic cells expressing membrane IgE receptors play a critical role in the amplification of allergen-specific T cell responses. Cross-linkage of specific IgE receptors on dermal mast cells provokes the release and synthesis of a vast series of mediators. Following their recruitment and activation into the skin, eosinophils are also thought to contribute relevantly to tissue damage. Thus, a complex network of cytokines and chemokines contributes to establishing a local milieu that favors the permanence of inflammation in AD skin.

Ergonomics and work organization: the relationship between tayloristic design and workers' health in banks and credit cards companies.

The discussion developed in this paper is based on the results of an ergonomic work analysis carried out with attendants at call centers. Some critical issues and difficulties, like working pace, inadequate tools and workstations, and software inadequacies were detected in working situations. Operator-customer interactions are presented, attempting to put in evidence working constraints, working conditions, and their connection with health problems. The main conclusion is that serving clients, especially when the job is to provide information, is not a simple task, as information is not always available in the computerized system and is completely fragmented. The scope of workers' actions is very restricted and complicated and recurrent requests are redirected to others. Workers (individually or as groups) have limited possibilities to make adjustments to be able to give more adequate and personalized treatment to clients and, at the same time, to work in a less stressful environment. In periods of increased workload and work intensification, the situation is very much favorable to the incidence of health disorders, such as work related musculoskeletal disorders (WMSD) and others. Some suggestions to improve the work situation are discussed.

Forecasting correct sodium balance in hemodiafiltration procedures involving infusions.

Four patients, stable on acetate hemodialysis (AHD), were switched to acetate-free biofiltration (AFB) which differs from AHD and bicarbonate hemodialysis (BHD) in that the dialysate contains no buffer, which is given intravenously as a hypertonic (1/6 M) Na bicarbonate solution. Within the 1st month the patients developed thirst and hypertension attributed to a positive Na balance. The aim of this investigation was to check this (1) by a study based on the predictable changes induced in the body compartments of 13 patients by the infusion and ultrafiltration (UF) of a hypertonic solution and (2) by direct determination and calculation of 28 Na mass balances in BHD and AFB. The theoretical model indicated that infusion of 4.87 liters of a 166.7 mEq/l Na bicarbonate solution and UF of the same amount caused a positive balance of 233 mosm of Na. The Na mass balances showed a relationship between Na transmembrane gradient and loss or gain of Na in both methods (p less than 0.0001). The slopes of the regression lines were not significantly different but there was a highly significant difference between the y axis intercepts (p less than 0.0001), which indicates that the same Na transmembrane gradient that gives no net change of Na in BHD, induces a net gain of 240 mosm (120 mEq of Na) in AFB and that to obtain the same Na balance dialysate Na should be reduced by about 8 mEq/l in AFB. These data are the same as the theoretical forecast which could be extended to all hemodiafiltration methods in which solutions of any tonicity have to be infused, in order to correctly predict the Na balance.

[Spontaneous grade I bundle of His block. Clinical, electrocardiographic and electrophysiological studies in 37 patients]. / Il blocco intrahisiano di I grado spontaneo. Osservazioni cliniche, elettrocardiografiche ed elettrofisiologiche in 37 pazienti.

The clinical, ECG and electrophysiological data of 37 patients (28 males and 9 females) with spontaneous intra-hisian block are reported. Of these patients, 11 had hypertensive heart disease and 5 had ischemic heart disease with previous myocardial infarction; in 21 patients, clinical signs of heart disease were not evident. In 18 patients, a single or recurrent episode of syncope had occurred. One patient had junctional rhythm and 36 sinus rhythm; among these, 12 patients presented PR greater than 200 msec (7 with a narrow and 5 with a wide QRS); 12 patients had a single or bilateral bundle branch block; 12 had a normal ECG. The electrophysiological study showed a split H-H1 in 22 patients, a wide His deflection (H greater than 25 msec) in 4 and HV greater than 65 msec with narrow QRS in 11. In 17 patients a more or less marked sinoatrial node and/or atrioventricular node dysfunction was present. Atrial pacing, performed in all, induced 2nd degree Mobitz 2 intra-hisian block in 9 patients. Ajmaline was used in 16 patients but induced a complete intra-hisian block in only one. In 28 patients a preventive pacemaker was implanted after electrophysiological study. During the follow-up (mean 25 months/pt.), 38% of the patients developed complete atrioventricular block. No recurrence of syncope occurred in the paced patients. Comparison of patients who developed atrioventricular block and those who maintained normal atrioventricular conduction did not show differences as far as heart disease, previous syncope, ECG pattern and results were concerned.(ABSTRACT TRUNCATED AT 250 WORDS)

Potassium removal as a factor limiting the correction of acidosis during dialysis.

The diffusional fluxes of urea, potassium and bicarbonate across the dialysis membrane (external balance) were determined in seven patients during haemodialysis using potassium free dialysate and dialysate containing 2.0mEq/L of potassium. The results show an inverse correlation between extraction of potassium and intake of bicarbonate in both external and internal balances. This is probably due to the increase in cell membrane electrical potential resulting from a fall in blood potassium and emphasises the importance of electrical driving forces in diffusional fluxes across cellular membranes.

[Potassium removal: a factor limiting the correction of acidosis during dialysis]. / La soustraction potassique: facteur limitant la correction de l'acidose pendant la dialyse.

The diffusional fluxes of urea, potassium and bicarbonate across the dialytic membrane (external balance), and across the cellular membrane (internal balance), were determined in 7 patients in haemodialysis using potassium free dialysate and dialysate containing 2.0 mEq/1 of potassium. The results obtained show an inverse correlation between extraction of potassium and intake of bicarbonate in both external and internal balance. This is probably due to the increase in membrane electrical potential resulting from a fall in blood potassium and emphasizes the importance of electrical driving forces in diffusional fluxes across cellular membranes.

[Rheographic evaluation of peripheral blood flow during isometric exercise]. / Valutazione reografica del flusso sanguigno periferico in corso di esercizio isometrico.

A rheographic evaluation of peripheral blood flow during isometric contraction (handgrip) has been done in 25 attendants of the Air Force Medical Service (mean age :20 years). The velocity of sphygmic wave, the sphygmic amplitude and, the peak time, heart rate and blood pressure have been measured at rest and during handgrip. The velocity of sphygmic wave does not change in all the subjects; the sphygmic amplitude is decreased of 10% (p less than .001), the peak time is decreased of 9% (p less than .001). Because sphygmic amplitude and peak time are directly proportional to flow volume, and their reduction significantly express a decrease of flow volume. The authors believe that the blood flow reduction is induced by the excitation of sympathetic peripheral alpha-receptors, not more balanced from sympathetic cholinergic vasodilator fibers. The actual result is an increase of the peripheral vascular resistances.

[Effects of isometric exercise on the pulmonary circulation in aortic patients]. / Effetti dell'espercizio isometrico sul circolo polmonare negli aortici.

The hemodynamic changes of the pulmonary vascular system in patients with aortic stenosis, has been evaluated during isometric exercise (handgrip). Heart rate, left ventricular sistolic pressure and pulmonary artery sistolic pressure, increase significantly while pulmonary vascular resistences are uneffected. In conclusion, the pulmonary response to handgrip olso in patients with aortic stenosis shows the same.

[Effect of isometric exercise on the lesser circulation in a group of patients with mitral stenosis]. / Effetti dello sforzo isometrico sul piccolo circolo in un gruppo di pazienti affetti da stenosi mitralica.

The hemodynamic changes of the pulmonary vascular system in patients with mitral stenosis, has been evaluated during isometric exercise (handgrip). Heart rate, pulmonary artery sistolic, dyastolic, mean and "wedged" pressure, end-dyastolic pulmonary vascular and trans-mitralic gradient, total pulmonary resistences increase significantly. Cardiac output and pulmonary vascular bed are probably related to the tachycardia induced by the handgrip, and to the conseguent shortening of the dyastolic left ventricular filling time.