A reporter transgene indicates renal-specific induction of tumor necrosis factor (TNF) by shiga-like toxin. Possible involvement of TNF in hemolytic uremic syndrome.

We have examined the hypothesis that TNF may play a pathogenetically important role in the hemolytic uremic syndrome. Specifically, we considered the possibility that shigatoxin, which eventuates this syndrome, might induce TNF biosynthesis, and/or that TNF and shigatoxin might sensitize animals, each to the toxic effects of the other agent. Shigatoxin was found to sensitize mice to the lethal effect of LPS and to the lethal effect of TNF. On the other hand, pretreatment of animals with either TNF or LPS did not noticeably sensitize mice to the lethal effect of shigatoxin. Intraperitoneal injections of shigatoxin did not induce the production of detectable quantities of TNF in the plasma of mice. When shigatoxin was injected into transgenic mice bearing a chloramphenicol acetyltransferase (CAT) reporter gene that indicates TNF synthesis, CAT activity was induced within the kidney, but not in other tissues. We therefore conclude that shigatoxin acts to induce TNF synthesis within the kidney, and at the same time increases renal sensitivity to the toxic effects of TNF. While this mouse model does not reproduce the hemolytic uremic syndrome as it occurs in humans, it does suggest that local synthesis of TNF within the kidney may contribute to renal injury induced by shigatoxin.

Prolonged response times characterize cognitive performance in multiple sclerosis.

Cognitive impairment is amongst the main symptoms affecting multiple sclerosis (MS) and should be comprehensively and accurately assessed. To study the added value of a computerized neuropsychological battery enabling the measurement of response times in the cognitive domains, 58 randomly selected MS patients and 71 age-, gender- and education-matched healthy subjects were evaluated. Construct and discriminant validity were assessed for the standard Neuropsychological Screening Battery for Multiple Sclerosis (NSBMS) and the Mindstreams Computerized Cognitive Battery (MCCB). The MCCB demonstrated good construct validity in comparison with the NSBMS in memory (P < 0.001), executive function (P < 0.001), attention (P < 0.05) and information processing (P < 0.05) domains. In addition, it showed high discriminant validity most prominently for executive function, attention and motor skills (P < 0.001). Response times measured by the computerized battery were longer in all cognitive domains and varied with cognitive load, demonstrating that response time deficits in MS are associated with particular task demands. We conclude that in MS prolonged response times on a range of cognitive tasks signify abnormal conduction within demyelinative tracts.

Newly discovered ergot alkaloids in Sorghum ergot Claviceps africana occurring for the first time in Israel.

Sorghum ergot is a disease caused commonly by C. africana. In 2015, ergot was identified for the first time in sorghum fields in Israel, leading to measures of eradication and quarantine. The aims of the study were to identify the ergot species by molecular and ergot alkaloid profile analysis, to determine the ergot alkaloid profile in pure honeydew and in infected sorghum silages and to estimate the safety of sorghum silages as a feed source. C. africana was rapidly and reliably identified by microscopical and molecular analysis. Dihydroergosine was identified as the major ergot alkaloid. Dihydrolysergol and dihydroergotamine were identified for the first time as significant ergot alkaloid components within the C. africana sclerotia, thereby providing for the first time a proof for the natural occurrence of dihydroergotamine. The sorghum silages were found to be safe for feed consumption, since the ergot alkaloids and the regulated mycotoxins were below their regulated limits.

The epidemiology of non-fatal injuries among 11-, 13- and 15-year old youth in 11 countries: findings from the 1998 WHO-HBSC cross national survey.

The primary objective was to present a cross-country comparison of injury rates, contexts and consequences. The research design was the analysis of data from the 1998 cross-national Health Behaviour in School-aged Children survey and 52955 schoolchildren from 11 countries, aged 11, 13 and 15 years, completed a self-administrated questionnaire. A total of 41.3% of all children were injured and needed medical treatment in the past 12 months. Injury rates among boys were higher than among girls, 13.3% reported activity loss due to injury and 6.9% reported severe injury consequences. Most injuries occurred at home and at a sport facility, mainly during sport activity. Fighting accounted for 4.1% of injuries. This paper presents the first cross-national comparison of injury rates and patterns by external cause and context. Findings present cross-country similarities in injury distribution by setting and activity. These findings emphasize the importance of the development of global prevention programmes designed to address injuries among youth.

Test characteristics of self-reported hypertension among the Hispanic population: findings from the Hispanic Health and Nutrition Examination Survey.

Data from the Hispanic Health and Nutrition Examination Survey conducted from 1982 to 1984 were analyzed for the sensitivity, specificity, and positive and negative predictive value of self-reported hypertension in 5195 Hispanics of both sexes between the ages of 18 and 74 years. On the basis of a hypertension definition of 140/90 mmHg or of the use of antihypertensive medications, overall sensitivity of self-reported hypertension was 56% for Mexican-Americans, 71% for Cuban-Americans and 72% for Puerto Ricans. Sensitivity was higher among women, among the obese, and among those with access to a regular place for medical care; increased with increasing age; and decreased with education and the time interval since last medical visit. Independent associations for sensitivity were noted for sex, body mass index (BMI), and time interval since last medical visit among Mexican-Americans; and for time interval since last medical visit and for being divorced or separated for Cuban-Americans. Overall positive predictive value reached 49% among Mexican-Americans, 53% among Cuban-Americans, and 39% among Puerto Ricans. Raising the hypertension-threshold to 160/95 mmHg tended to increase the sensitivity but reduced the positive predictive value.

Sports and recreation injuries in US children and adolescents.

OBJECTIVES: To estimate and describe morbidity from sports and recreation injuries in children and adolescents. DESIGN: Survey conducted by the National Center for Health Statistics--the Child Health Supplement to the 1988 National Health Interview Survey. SETTING: The general community. PARTICIPANTS: Representative sample of the noninstitutionalized civilian US population. Five percent of the eligible households did not participate. The subject of this report is 11,840 children and adolescents aged 5 to 17 years. MAIN OUTCOME MEASURES: Medically attended nonfatal injuries resulting from sports and recreation, and serious sports injuries, defined as injuries resulting in hospitalization, surgical treatment, missed school, or half a day or more in bed. Sports and recreation injuries were defined as those occurring in a place of recreation or sports, or receiving any of the following International Classification of Diseases, Ninth Revision (ICD-9) E-codes: struck in sports, fall in sports, bicycle-related injury, riding an animal, water sports, overexertion, fall from playground equipment or other vehicles, primarily skates and skateboards. RESULTS: The estimated annual number of all injuries from sports and recreation in US children and adolescents is 4,379,000 (95% confidence interval = 3,147,000 to 5,611,000); from serious sport injuries, 1,363,000 (95% confidence interval = 632,000 to 2,095,000). Sports account for 36% of injuries from all causes. Cause and nature of injury are strongly related to age. Sports do not account for a disproportionate number of serious or repeated injuries compared with other causes of injuries. CONCLUSION: Sports activities account for a large number and substantial proportion of all injuries to children and youth.

Platelet peripheral-type benzodiazepine receptor in major depression.

The peripheral-type benzodiazepine receptor (PBR) plays a major role in steroidogenesis. This receptor is sensitive to endocrine changes and stress. Antidepressants have been demonstrated to modulate adrenal and hepatic PBR in rats. To evaluate the relationship between depression and PBR, we measured platelet PBR in untreated depressed patients (n = 14) in comparison to normal controls (n = 13). Platelet PBR density (Bmax) and the dissociation constant (kd) of the receptor did not differ in the patients when compared with normal controls. Furthermore, no correlation was found between Bmax values and the severity of the depression (as measured by the Hamilton Depression Rating Scale and Beck Depression Inventory) as well as with the severity of the anxiety (as measured by the Hamilton Anxiety Rating Scale). It seems that major depression, in contrast to stress and some anxiety disorders, is not associated with alteration of PBR.

Major depressive disorder and panic disorder. Effects of comorbidity on treatment outcome with antidepressant medications.

Recent studies suggest that major depressive disorder (MDD) and panic disorder (PD) may coexist in a significant number of patients. The relevance of this association may be such that patients with the simultaneous diagnosis are at risk for more severe psychopathology and poorer treatment outcome. To explore this possibility further, we compared treatment outcome of two groups of patients: one with comorbidity of MDD and PD (N = 19) and another with MDD only (N = 22). Patients with comorbidity of MDD and PD scored significantly worse on a number of outcome assessments.

Simultaneous panic and depressive disorders: clinical and sleep EEG correlates.

Panic and depressive symptoms occur simultaneously in many depressed patients. To study the frequency of this association and to determine whether patients with simultaneous panic and major depression differed from those with only major depressive disorder (MDD) in clinical features and in sleep electroencephalographic (EEG) variables, we evaluated a total sample of 336 patients with MDD. Fifty-eight (17%) had both panic and MDD; 50 had complete data and were matched for age and severity of illness with other patients having only MDD. Patients with simultaneous panic and depression had significantly higher ratings for psychic and somatic anxiety, and rapid eye movement (REM) latencies approximating normal values. Patients with only MDD (without panic disorder) rated significantly higher in guilt feelings and had shorter REM latencies. Our results suggest that the simultaneous occurrence of panic and depression is relatively frequent, is accompanied by differences in sleep EEG variables, and may have implications for treatment.

The current practice patterns of mechanical ventilation for respiratory failure in pediatric patients.

OBJECTIVE: To quantify the current practice patterns of mechanical ventilation for respiratory failure in pediatric patients. DESIGN: Mail survey using 2 hypothetical case studies sent to pediatric critical care physicians. MEASUREMENTS AND MAIN RESULTS: The required arterial blood gas (ABG) on conventional mechanical ventilation (CMV) is pH = 7.25 to 7.29, PO2 = 50 to 59 torr, O2 saturation = 0.85 to 0.89. Most of our survey participants will treat a patient failing conventional mechanical ventilation in their pediatric intensive care units (PICUs) with inverse ratio ventilation (IRV) (95%) and with high-frequency oscillatory ventilation (HFOV) (92%). CONCLUSION: Most of the surveyed pediatric critical care physicians practice permissive hypercapnia in the treatment of their patients who receive ventilatory assistance. More than 90% of surveyed pediatric critical care physicians are presently using inverse ratio ventilation and high-frequency oscillatory ventilation. These data suggest that these innovative modes of therapy are already accepted as part of the standard therapeutic spectrum by the surveyed group of physicians.

Extubation failure due to post-extubation stridor is better correlated with neurologic impairment than with upper airway lesions in critically ill pediatric patients.

The incidence of post-extubation stridor (PES) in a pediatric intensive care unit (PICU) and the need for reintubation is not known. Predictors of success on a subsequent extubation attempt and the efficacy of dexamethasone treatment prior to a subsequent extubation attempt are not established. In a prospective randomized double blind-controlled study in two PICU's in a university children's hospital setting, of 5,566 admissions over 35-months, we identified 32 patients who failed primary extubation and were reintubated for PES. Twenty-six patients were enrolled in the study and three subsequently excluded. Twelve were randomized to receive dexamethasone and 11 received sodium chloride placebo. Fifteen patients succeeded study extubation and eight failed. Of those receiving dexamethasone, nine patients succeeded and three failed. Of those receiving placebo, six patients succeeded and five failed. There was a poor correlation between anatomical abnormalities of the airway and failure of study extubation. Extubation failure was better correlated with neurologic impairment in the patients. We present a stridor score and demonstrate that it is an excellent predictor of success versus failure for the study extubation. Dexamethasone pre-treatment did not reduce stridor score. We are unable to conclude if dexamethasone pre-treatment reduces extubation failure. We speculate that neurologic impairment leads to extubation failure in critically ill pediatric patients.

Living arrangements, knowledge of health risks, and stress as determinants of health-risk behavior among college students.

The association of knowledge of health risks, living arrangements, and perceived stress with health-risk behaviors was examined in a sample of college students included in the Health Promotion and Disease Prevention Supplement of the National Health Interview Survey. Regressions of each health-risk behavior (dependent variable) were performed on the predicted correlates. Although knowledge was not associated with participation in physical activity or smoking, the study found that students who knew more about the harmful effects of alcohol drank less, and those with greater knowledge of health risks practiced fewer risky behaviors. Students living independently were more likely to smoke, and those living in residence halls were less like to do so. Drinking, however, was more common among students living in residence halls or independently than among those living at home. Hall residents engaged in more group physical activity than other students did, but their physical activity was unrelated to health-risk behaviors. Stress was associated with smoking but not with other health practices. The findings suggest that smoking may be less influenced by health knowledge and more associated than drinking is with a response to stress. Drinking appears to be a social activity associated with living among peers and is potentially modifiable by increased knowledge about the effects of alcohol on health.

Cognitive patterns and progression in multiple sclerosis: construction and validation of percentile curves.

BACKGROUND AND OBJECTIVES: Rate and pattern of progression of cognitive decline in multiple sclerosis (MS) has not been clearly identified. The present study aimed to identify correlations between cognitive tests and disease duration, construct longitudinal cognitive curves, and assess pattern of change over time. METHODS: The Neuropsychological Screening Battery for Multiple Sclerosis was administered in 150 consecutive MS patients, and tests that correlated with disease duration were identified. Percentile curves were constructed and the pattern of cognitive decline over time explored. The cognitive curves were validated in an additional group of 83 patients with MS. RESULTS: Three of four measures of the spatial recall test (SPART 7/24), and the paced auditory serial addition task for two seconds (PASAT 2'), correlated with disease duration. These tests were used to construct cross-sectional curves identifying the pattern of cognitive decline over time in the MS population. On the basis of this cross-sectional analysis, the earliest cognitive decline occurred in the SPART 7/24 trials 1-5 between one and three years from onset, followed by decline in the SPART delayed recall between three and seven years, and then by decline in the PASAT 2' after seven years from onset. CONCLUSIONS: Verbal fluency and verbal memory appear to be affected earliest in MS. The pattern of cognitive decline is further characterised by a decrease in visuospatial learning, followed by delayed recall, and then by attention and information processing speed. Cognitive percentile curves can be used to evaluate the pattern of progression and identify patients at increased risk.

Cross national study of injury and social determinants in adolescents.

OBJECTIVES: To compare estimates of the prevalence of injury among adolescents in 35 countries, and to examine the consistency of associations cross nationally between socioeconomic status then drunkenness and the occurrence of adolescent injury. DESIGN: Cross sectional surveys were obtained from national samples of students in 35 countries. Eight countries asked supplemental questions about injury. SETTING: Surveys administered in classrooms. SUBJECTS: Consenting students (n = 146 440; average ages 11-15 years) in sampled classrooms. 37 878 students (eight countries) provided supplemental injury data.Exposure measures: Socioeconomic status (material wealth, poverty) and social risk taking (drunkenness). OUTCOME MEASURES: Specific types and locations of medically treated injury. RESULTS: By country, reports of medically treated injuries ranged from 33% (1060/3173) to 64% (1811/2833) of boys and 23% (740/3172) to 51% (1485/2929) of girls, annually. Sports and recreation were the most common activities associated with injury. High material wealth was positively (OR>1.0; p<0.05) and consistently (6/8 countries) associated with medically treated and sports related injuries. Poverty was positively associated with fighting injuries (6/8 countries). Drunkenness (social risk taking) was positively (p<0.01) and consistently (8/8 countries) associated with medically treated, street, and fighting injuries, but not school and sports related injuries. CONCLUSION: The high prevalence of adolescent injury confirms its importance as a health problem. Social gradients in risk for adolescent injury were illustrated cross nationally for some but not all types of adolescent injury. These gradients were most evident when the etiologies of specific types of adolescent injury were examined. Prevention initiatives should focus upon the etiologies of specific injury types, as well as risk oriented social contexts.