Confirmatory factor analysis of the Strengths and Difficulties Questionnaire in Singaporean kindergartners.

BACKGROUND: The Strengths and Difficulties Questionnaire (SDQ) assesses behavioural adjustment in children aged 3 to 16 years. To ascertain the appropriateness of the scale for a specific population, it is important to examine whether the distinctiveness of the scale dimensions can be verified empirically. AIMS: Confirmatory factor analysis was used to test explicitly which of three models better explain our data, and whether model fit was improved by the addition of method factors. METHODS: Parents of 411 Singaporean kindergartners completed the SDQ. RESULTS: A four-factor multi-trait multi-method model (Prosocial, Conduct, Hyperactivity, Internalizing and two method factors) provided the best fit to the data. There was strong evidence for convergent and discriminant validity. However, differences in configural loading pattern indicated gender-related differences in the mapping of the SDQ items. DISCUSSION: Differences in factor structure across countries and gender may reflect differing conceptions of the underlying dimensions, as well as differences in normative expectations. However, our findings may allow its use as a screening tool to identify Singaporean children at risk of emotional and behavioural difficulties.

Patterns of renal and splanchnic sympathetic vasomotor activity in an animal model of survival to experimental sepsis.

Sepsis causes long-term disability, such as immune dysfunction, neuropsychological disorders, persistent inflammation, catabolism, and immunosuppression, leading to a high risk of death in survivors, although the contributing factors of mortality are unknown. The purpose of this experimental study in rats was to examine renal (rSNA) and splanchnic (sSNA) sympathetic nerve activity, as well as baroreflex sensitivity, in acute and chronic post-sepsis periods. The rats were divided into two groups: control group with naïve Wistar rats and sepsis group with 2-mL intravenous inoculation of Escherichia coli at 108 CFU/mL. Basal mean arterial pressure, heart rate, rSNA, sSNA, and baroreflex sensitivity were evaluated in all groups at the acute (6 h) and chronic periods (1 and 3 months). Basal rSNA and sSNA were significantly reduced in the surviving rats, as was their baroreflex sensitivity, for both pressor and hypotensive responses, and this effect lasted for up to 3 months. A single episode of sepsis in rats was enough to induce long-term alterations in renal and splanchnic sympathetic vasomotor nerve activity, representing a possible systemic event that needs to be elucidated. These findings showed that post-sepsis impairment of sympathetic vasomotor response may be one of the critical components in the inability of sepsis survivors to respond effectively to new etiological illness factors, thereby increasing their risk of post-sepsis morbidity.

Patterns of renal and splanchnic sympathetic vasomotor activity in an animal model of survival to experimental sepsis

Sepsis causes long-term disability, such as immune dysfunction, neuropsychological disorders, persistent inflammation, catabolism, and immunosuppression, leading to a high risk of death in survivors, although the contributing factors of mortality are unknown. The purpose of this experimental study in rats was to examine renal (rSNA) and splanchnic (sSNA) sympathetic nerve activity, as well as baroreflex sensitivity, in acute and chronic post-sepsis periods. The rats were divided into two groups: control group with naïve Wistar rats and sepsis group with 2-mL intravenous inoculation of Escherichia coli at 108 CFU/mL. Basal mean arterial pressure, heart rate, rSNA, sSNA, and baroreflex sensitivity were evaluated in all groups at the acute (6 h) and chronic periods (1 and 3 months). Basal rSNA and sSNA were significantly reduced in the surviving rats, as was their baroreflex sensitivity, for both pressor and hypotensive responses, and this effect lasted for up to 3 months. A single episode of sepsis in rats was enough to induce long-term alterations in renal and splanchnic sympathetic vasomotor nerve activity, representing a possible systemic event that needs to be elucidated. These findings showed that post-sepsis impairment of sympathetic vasomotor response may be one of the critical components in the inability of sepsis survivors to respond effectively to new etiological illness factors, thereby increasing their risk of post-sepsis morbidity.

Effect of pentoxifylline on lung inflammation and gas exchange in a sepsis-induced acute lung injury model.

Experimental models of sepsis-induced pulmonary alterations are important for the study of pathogenesis and for potential intervention therapies. The objective of the present study was to characterize lung dysfunction (low PaO2 and high PaCO2, and increased cellular infiltration, protein extravasation, and malondialdehyde (MDA) production assessed in bronchoalveolar lavage) in a sepsis model consisting of intraperitoneal (ip) injection of Escherichia coli and the protective effects of pentoxifylline (PTX). Male Wistar rats (weighing between 270 and 350 g) were injected ip with 10(7) or 10(9) CFU/100 g body weight or saline and samples were collected 2, 6, 12, and 24 h later (N = 5 each group). PaO2, PaCO2 and pH were measured in blood, and cellular influx, protein extravasation and MDA concentration were measured in bronchoalveolar lavage. In a second set of experiments either PTX or saline was administered 1 h prior to E. coli ip injection (N = 5 each group) and the animals were observed for 6 h. Injection of 10(7) or 10(9) CFU/100 g body weight of E. coli induced acidosis, hypoxemia, and hypercapnia. An increased (P < 0.05) cell influx was observed in bronchoalveolar lavage, with a predominance of neutrophils. Total protein and MDA concentrations were also higher (P < 0.05) in the septic groups compared to control. A higher tumor necrosis factor-alpha (P < 0.05) concentration was also found in these animals. Changes in all parameters were more pronounced with the higher bacterial inoculum. PTX administered prior to sepsis reduced (P < 0.05) most functional alterations. These data show that an E. coli ip inoculum is a good model for the induction of lung dysfunction in sepsis, and suitable for studies of therapeutic interventions.

Can bacterial translocation be a beneficial event?

Infection is a major concern in intestinal transplant recipients. Bacterial migration to extraintestinal sites is a central component of the gut hypothesis of sepsis. However, some studies have cited the beneficial effects of bacterial translocation (BT) on the host acquired immune system. We evaluated the role of previous BT on a subsequent BT challenge, examined the BT index in organs as well as changes in white blood cell (WBC) count in mesenteric lymph and blood for correlation with outcomes. Wistar rats (n = 60) were divided into a BT group (n = 20), which underwent inoculation of 10 mL of 10(10) CFU/mL Escherichia coli R-6 confined to the small intestine as opposed to a BT1-14 group (n = 20), which underwent the BT procedure on days 1 and 14 or a S1-BT14 group (n = 20) that received 10 mL of saline on day 1 and the BT procedure on day 14. Half of the animals were killed 2 hours following the BT procedure. Samples from different compartments were collected for culture. Mesenteric lymph and peripheral blood were examined for WBC counts. The other half of the hosts was subjected to outcome evaluation concerning weight gain and mortality. Animals undergoing double BT showed a significantly lower index of bacterial recovery (liver, spleen, and blood) compared with those having a single BT (P < .05). The WBC count of mesenteric lymph cells after double BT was similar to naïve animals, but significantly lower than the single BT group (P < .05). The outcome was unchanged among double BT versus other groups. A previous BT challenge was efficient to generate a host-defense mechanism against a second BT episode induced by intestinal overgrowth with the same bacterial strain.

The effects of 16, 16 dimethyl prostaglandin E2 therapy alone and in combination with low-dose cyclosporine on rat small intestinal transplantation.

The use of prostaglandin E (PGE) in the setting of allotransplantation both clinically and experimentally has been suggested because PGE has significant immunosuppressive effects and potentially could lessen the toxic effects of cyclosporine. In the present study, we examined the immunosuppressive effects of 16,16 dimethyl prostaglandin E2 (dmPGE2) alone and in combination therapy with low-dose CsA to assess the clinical course, histology and expression of monocyte/macrophage procoagulant activity (PCA) following small intestinal transplantation in a heterotopic model of rat allograft rejection. Therapy with low-dose CsA (1 mg/kg) failed to prevent rejection and all animals reached a terminal state by day 26. In contrast, animals treated with high-dose CsA (10 mg/kg) showed no clinical or histological evidence of rejection and all animals survived. The dmPGE2 (100 micrograms/kg/twice daily) delayed the onset of rejection, but all animals developed severe rejection and subsequently died. Treatment of animals with low-dose CsA (1 mg/kg) in combination with dmPGE2 (100 micrograms/kg twice daily) resulted in a delay in the onset (P = 0.05) and a reduction in the intensity of allograft rejection (P = 0.0001) compared with either agent used alone. Monocyte/macrophage procoagulant activity levels correlated with the degree of rejection in all animals (P = 0.03). There was a statistically significant relationship between PCA levels and the time of onset of rejection and histologic grade of rejection in all groups. The data presented here, therefore, demonstrate a beneficial role for long-term combination therapy with CsA and PGE in small intestinal transplantation and strongly suggest a role for allogeneic induction of PCA in the pathogenesis of rejection.

[Effect of hypovolemic shock in anastomose of small intestine of rats]. / Efeito do choque hipovolêmico na anastomose do intestino delgado de ratos.

OBJECTIVE: Study the effect of hypovolemic shock on small intestinal anastomose in adult rats. METHOD: Ninety male rats were randomly divided into five groups: standard, hypovolemic shock, anastomose alone, hypovolemic shock + anastomose and hypovolemic shock + anastomose + blood reinfusion. Hypovolemic shock was achieved by bleeding 30% of the blood volume of the animal. A single layer extramucosal intestinal anastomose was performed. Following intestinal anastomose, the blood volume was restored in group shock, anastomose and blood reinfusion, using heparinized autologous. RESULTS AND CONCLUSION: In the experimental model used, hypovolemic shock provoked histological lesions to the mucosa and increased colagen fiber deposition into the submucosa in the region of intestinal anastomose which were progressive with post-operative period. In addition, when the hypovolemic shock group were pressure tested there was a tendency towards a weakening of the intestinal wall at day 7 which became more evident at day 21 as compared to the control groups.

Endoscopic versus open release in patients with de Quervain's tenosynovitis: a randomised trial.

The purpose of this study was to compare the outcome and complications of endoscopic versus open release for the treatment of de Quervain's tenosynovitis. Patients with this condition were randomised to undergo either endoscopic (n = 27) or open release (n = 25). Visual Analogue Scale (VAS) pain and Disabilities of Arm, Shoulder, and Hand (DASH) scores were measured at 12 and 24 weeks after surgery. Scar satisfaction was measured using a VAS scale. The mean pain and DASH scores improved significantly at 12 weeks and 24 weeks (p < 0.001) in both groups. The scores were marginally lower in the endoscopic group compared to the open group at 12 weeks (p = 0.012 and p = 0.002, respectively); however, only the DASH score showed a clinically important difference. There were no differences between the groups at 24 weeks. The mean VAS scar satisfaction score was higher in the endoscopic group at 24 weeks (p < 0.001). Transient superficial radial nerve injury occurred in three patients in the endoscopic group compared with nine in the open release group (p = 0.033). We conclude that endoscopic release for de Quervain's tenosynovitis seems to provide earlier improvement after surgery, with fewer superficial radial nerve complications and greater scar satisfaction, when compared with open release.

Typical and atypical enteropathogenic Escherichia coli bacterial translocation associated with tissue hypoperfusion in rats.

Although enteropathogenic Escherichia coli (EPEC) are well-recognized diarrheal agents, their ability to translocate and cause extraintestinal alterations is not known. We investigated whether a typical EPEC (tEPEC) and an atypical EPEC (aEPEC) strain translocate and cause microcirculation injury under conditions of intestinal bacterial overgrowth. Bacterial translocation (BT) was induced in female Wistar-EPM rats (200-250 g) by oroduodenal catheterization and inoculation of 10 mL 10(10) colony forming unit (CFU)/mL, with the bacteria being confined between the duodenum and ileum with ligatures. After 2 h, mesenteric lymph nodes (MLN), liver and spleen were cultured for translocated bacteria and BT-related microcirculation changes were monitored in mesenteric and abdominal organs by intravital microscopy and laser Doppler flow, respectively. tEPEC (N = 11) and aEPEC (N = 11) were recovered from MLN (100%), spleen (36.4 and 45.5%), and liver (45.5 and 72.7%) of the animals, respectively. Recovery of the positive control E. coli R-6 (N = 6) was 100% for all compartments. Bacteria were not recovered from extraintestinal sites of controls inoculated with non-pathogenic E. coli strains HB101 (N = 6) and HS (N = 10), or saline. Mesenteric microcirculation injuries were detected with both EPEC strains, but only aEPEC was similar to E. coli R-6 with regard to systemic tissue hypoperfusion. In conclusion, overgrowth of certain aEPEC strains may lead to BT and impairment of the microcirculation in systemic organs.