bluuebunny/crossref_metadata_2025 huggingface dataset:
Efeito da teofilina associada ao beta2-agonista inalatório de curta ou longa duração, em pacientes com doença pulmonar obstrutiva crônica estável: revisão sistemática
Authors: Zacarias Eliane Cristina , Castro Aldemar Araújo , Cendon Sônia
Published: September 2007

OBJETIVOS: Avaliar se o tratamento com teofilina associada ao beta2-agonista inalatório de curta ou longa duração é mais eficaz que o placebo e que o uso isolado de cada um dos fármacos, para os pacientes com doença pulmonar obstrutiva crônica estável. MÉTODOS: Realizou-se uma revisão sistemática com metanálise, sendo selecionados todos os ensaios clínicos aleatórios e duplo-cegos encontrados na literatura. RESULTADOS: Foram incluídos oito estudos. Teofilina associada ao beta2-agonista vs. placebo: houve melhora estatisticamente significante para o VEF1 (L), com média 0,27 (IC95% 0,11 a 0,43); e para a dispnéia, com média -0,78 (IC95% -1,26 a -0,29). Teofilina associada ao beta2-agonista vs. beta2-agonista isolado: nenhuma das metanálises realizadas detectou diferença entre os grupos. Teofilina associada ao beta2-agonista vs. teofilina isolada: houve melhora estatisticamente significante para a dispnéia, com média -0,19 (IC95% -0,34 a -0,04). CONCLUSÕES: Em pacientes com doença pulmonar obstrutiva crônica estável: 1) teofilina associada ao beta2-agonista é mais eficaz que o placebo, em relação ao VEF1 e dispnéia; 2a) teofilina associada ao beta2-agonista é mais eficaz que a teofilina isolada, em relação à dispnéia; e 2b) teofilina associada ao beta2-agonista não é mais eficaz que o beta2-agonista isolado, para quaisquer das variáveis estudadas.
Impacto da implantação de um guia terapêutico para o tratamento de pneumonia nosocomial adquirida na unidade de terapia intensiva em hospital universitário
Authors: Garcia Joseani Coelho Pascual , Ferreira Filho Olavo Franco , Grion Cíntia Magalhães Carvalho , Carrilho Claudia Maria Dantas de Maio
Published: September 2007

OBJETIVO: Avaliar o impacto da implantação de um guia terapêutico para o tratamento empírico de pneumonia hospitalar. MÉTODOS: Foi realizado um ensaio clínico com controle histórico, no período de junho de 2002 a junho de 2003, em pacientes internados na unidade de terapia intensiva (UTI) que adquiriram pneumonia hospitalar. Todos foram tratados de acordo com um guia terapêutico desenvolvido pela Comissão de Controle de Infecção Hospitalar da instituição (grupo com intervenção). Para o controle, foram analisados os prontuários dos pacientes que adquiriram pneumonia hospitalar no período de junho de 2000 a junho de 2001 (grupo sem intervenção). Foram determinados taxa de mortalidade, tempo médio de tratamento e tempo de internação na UTI e no hospital dos pacientes que adquiriram pneumonia hospitalar. RESULTADOS: A mortalidade relacionada à pneumonia foi menor no grupo tratado de acordo com o guia terapêutico (26 x 53,6%; p = 0,00). Quanto à mortalidade geral, não houve diferença estatisticamente significativa entre os dois períodos (51 x 57,9%; p = 0,37). Também não foi encontrada diferença quanto aos tipos de microorganismos isolados, tempo de tratamento e tempo de internação na UTI e no hospital. CONCLUSÃO: A implantação do guia terapêutico para tratamento de pneumonia hospitalar adquirida em UTI pode ser eficaz na diminuição das taxas de mortalidade.
Estudo descritivo sobre a implantação da estratégia de tratamento de curta duração diretamente observado no controle da tuberculose em São José do Rio Preto e seus impactos (1998-2003)
Authors: Gazetta Cláudia Eli , Vendramini Silvia Helena Fiqueiredo , Ruffino-Netto Antônio , Oliveira Maria Rita de Cássia , Villa Tereza Cristina Scatena
Published: September 2007

OBJETIVO: Descrever os resultados de tratamento (cura, abandono ou óbito) após a implantação da estratégia de tratamento de curta duração diretamente observado (Directly Observed Treatment, Short-course - DOTS) no controle da tuberculose em São José do Rio Preto, São Paulo, no período de 1998 a 2003. MÉTODOS: Estudo descritivo que utilizou fontes secundárias de informações (Sistema Nacional de Agravos de Notificação, Sistema de Notificação de Tuberculose, Livro de Registro/Livro Preto) por meio de um instrumento específico. Os dados foram analisados por estatística descritiva. RESULTADOS: Após a implantação da estratégia DOTS houve uma diminuição das taxas de abandono e detecção de casos e um aumento das taxas de cura e óbito. O aumento do número de óbitos por tuberculose pode ter ocorrido devido a três fatores: o predomínio da doença em indivíduos acima de 50 anos; a co-infecção tuberculose/HIV e a presença de doenças associadas. CONCLUSÕES: A implantação da estratégia DOTS fortaleceu a descentralização das ações de controle da tuberculose e a integração das equipes das Unidades Básicas de Saúde com a equipe do Programa de Controle da Tuberculose. O compromisso político do gestor com o combate à tuberculose, aliado à política de benefícios e incentivos, é fundamental para a sustentabilidade da estratégia DOTS.
Lesão pulmonar aguda associada à transfusão
Authors: Fabron Junior Antonio , Lopes Larissa Barbosa , Bordin José Orlando
Published: September 2007

Lesão pulmonar aguda associada à transfusão (transfusion-related acute lung injury, TRALI) é uma complicação clínica grave relacionada à transfusão de hemocomponentes que contêm plasma. Recentemente, TRALI foi considerada a principal causa de morte associada à transfusão nos Estados Unidos e Reino Unido. É manifestada tipicamente por dispnéia, hipoxemia, hipotensão, febre e edema pulmonar não cardiogênico, que ocorre durante ou dentro de 6 h, após completada a transfusão. Embora o exato mecanismo não tenha sido totalmente elucidado, postula-se que TRALI esteja associada à infusão de anticorpos contra antígenos leucocitários (classes I ou II ou aloantígenos específicos de neutrófilos) e a mediadores biologicamente ativos presentes em componentes celulares estocados. A maioria dos doadores implicados em casos da TRALI são mulheres multíparas. TRALI, além de ser pouco diagnosticada, pode ainda ser confundida com outras situações de insuficiência respiratória aguda. Um melhor conhecimento sobre TRALI pode ser crucial na prevenção e tratamento desta severa complicação transfusional.
Modelo mecânico para simulação do condicionamento pulmonar do ar respirado
Authors: Bergonse Neto Nelson , Von Bahten Luiz Carlos , Moura Luís Mauro , Coelho Marlos de Souza , Stori Junior Wilson de Souza , Bergonse Gilberto da Fontoura Rey
Published: September 2007

OBJETIVO: A criação de um modelo mecânico que pudesse ser regulado para simular o condicionamento do ar inspirado e expirado nos mesmos valores normais de temperatura, pressão e umidade relativa do aparelho respiratório de um homem jovem hígido sob ventilação mecânica. MÉTODOS: Utilizando-se diversos tipos de materiais, um aparelho mecânico foi construído e regulado com valores normais de capacidade vital, volume corrente, pressão inspiratória máxima, pressão expiratória final positiva e temperatura do gás dentro do sistema. O aparelho foi submetido a ventilação mecânica por um período de 29,8 min. A cada dois segundos, foram registradas as alterações de temperatura do ar circulado no sistema. RESULTADOS: Mediante análise estatística dos dados coletados observou-se que o aparelho construído foi eficiente no condicionamento do ar aproximadamente nos moldes do aparelho respiratório de um ser humano. CONCLUSÃO: Ao final deste estudo, conseguiu-se desenvolver um aparelho mecânico capaz de simular o condicionamento do ar respirado nas mesmas condições de temperatura, pressão e umidade do aparelho respiratório de um ser humano hígido.
Qualidade de sono e função pulmonar em adolescentes portadores de anemia falciforme clinicamente estáveis
Authors: Souza Lisliê Capoulade Nogueira Arrais de , Viegas Carlos Alberto de Assis
Published: September 2007

OBJETIVO: Avaliar a qualidade de sono e função pulmonar em adolescentes portadores de anemia falciforme (AF), clinicamente estáveis. MÉTODOS: Estudo trasversal descritivo de 50 pacientes portadores de AF submetidos a polissonografia noturna e espirometria no Hospital Universitário de Brasília. Analisamos dados antropométricos, polissonográficos e de função pulmonar. Dividimos os pacientes em dois grupos segundo a saturação periférica de oxigênio (SpO2) em sono com movimentos oculares rápidos (MOR): SpO2 < 93%; e SpO2 > 93%. Realizamos estatística descritiva, teste t de Student, qui-quadrado e correlação de Pearson. RESULTADOS: A média de idade foi de 13,9 ± 2,5 anos. O tempo total de sono e percentagem do sono em MOR estavam diminuídos; dois pacientes (4%) não apresentaram sono MOR. Latência de sono MOR, número de despertares, movimentação em sono, mudança de estágio, índice de distúrbios respiratórios e índice de apnéia obstrutiva estavam aumentados. Entre os dois grupos, houve diferenças estatisticamente significativas na maioria das variáveis polissonográficas. A SpO2 em sono MOR correlacionou-se de forma forte e positiva com a SpO2 em vigília, bem como com a SpO2 em sono não-MOR; e correlacionou-se de forma forte e negativa com a percentagem do tempo total de sono em que a SPO2 foi < 90%. Os valores médios espirométricos estavam dentro da normalidade. O volume residual e a relação volume residual/capacidade pulmonar total/capacidade residual funcional estavam aumentados. CONCLUSÃO: A qualidade de sono alterada nos pacientes portadores de AF, clinicamente estáveis, se deve provavelmente à dessaturação da hemoglobina e não às alterações individuais da função pulmonar.
Inter-relação entre asma, atopia e infecções helmínticas
Authors: Ponte Eduardo Vieira , Rizzo José Ângelo , Cruz Álvaro Augusto
Published: September 2007

Este estudo teve como objetivo descrever as principais evidências encontradas na literatura acerca da inter-relação entre infecções helmínticas, atopia e asma. Foi feita uma revisão não sistemática da literatura. Encontramos numerosas publicações sobre o tema nas quais se verifica controvérsia quanto à capacidade das infecções por geohelmintos de inibir a reatividade ao teste alérgico cutâneo e os sintomas das doenças alérgicas. Por outro lado, estudos em pacientes infectados por Schistosoma spp., apesar de escassos, sugerem que estes helmintos são capazes de inibir a reatividade ao teste alérgico cutâneo e os sintomas de asma. Nos estudos in vitro, as evidências sugerem que as helmintíases inibem as respostas imunes mediadas por linfócitos T auxiliares do tipo 1 e 2, o que abre novas possibilidades terapêuticas para o tratamento de doenças do sistema imunológico.
Radiographic prevalence of root canal ramifications in a sample of root canal treatments in a Brazilian Dental School
Authors: Quadros Iadasa de , Zaia Alexandre Augusto , Ferraz Caio Cezar Randi , Souza Filho Francisco José de , Gomes Brenda Paula Figueiredo de Almeida
Published: September 2007

The aim of this study was to radiographically investigate the presence of root canal ramifications found after endodontic treatment, and to determine any relationship between their presence and the type of the auxiliary chemical substance used. The study evaluated 1,470 endodontic treatments performed by final year undergraduate students at the Dental School of Piracicaba, State University of Campinas (UNICAMP), SP, Brazil, during the period from 1998 to 2000. The X-rays taken during treatment were evaluated in order to establish the presence of ramifications of the root canal system. The initial X-ray did not show the presence of any canal ramifications. After filling, X-rays showed only 3 ramification types: 3.06% of lateral canals, 2.99% of apical deltas, and 0.1% of interradicular canals. The maxillary premolars showed the highest number of lateral canals (n = 13), followed by mandibular premolars (n = 10) and maxillary incisors (n = 10). Apical deltas were mostly found in mandibular molars (n = 14), followed by maxillary incisors (n = 9). Only mandibular molars had interradicular canals. The detection of ramifications increased with the use of EDTA. However, no statistically significant relationship was found between the type of auxiliary chemical substance used and the number of root canal ramifications detected after root canal filling. It was concluded that the frequency of root canal ramifications found radiographically was low in treatments performed by undergraduate students.
Validation of computed tomography protocols for simulated mandibular lesions: a comparison study
Authors: Perrella Andréia , Borsatti Maria Aparecida , Tortamano Isabel Peixoto , Rocha Rodney Garcia , Cavalcanti Marcelo Gusmão Paraíso
Published: September 2007

Computed tomography is the choice technique to assess oral and maxillofacial osseous lesions because it provides hard and soft tissues visualization in one examination without superimposition of surrounding structures. This examination offers a significant advance in maxillofacial lesions detection with an excellent anatomic resolution. The aim of this research was to evaluate the validity of two protocols, in axial sections, in simulated mandibular lesions. Two CT protocols were obtained in dry mandibles in which perforations were done simulating lesions. Two observers, previously calibrated, evaluated the images according to different parameters. The results indicated that the sensitivity and specificity in lesion detection were 100% for both protocols, but the detection of loci number of multilocular lesions and the location and detection of medullar invasion obtained reduced validity values, which were influenced by the acquisition protocol. We concluded that thinner axial slices and reconstructions were more effective in detecting early medullar invasion and loci number. Thicker protocols were not considered appropriate to detect multilocular lesions and early stages of medullar invasion.
Evaluation of the apical seal after intraradicular retainer removal with ultrasound or carbide bur
Authors: Campos Tomie Nakakuki , Inoue Cleber Henrique , Yamamoto Elcio , Araki Ângela Toshie , Adachi Lena Katekawa , Rodriguez Jose Eduardo Chorres
Published: September 2007

There are situations in which intraradicular retainers have to be removed and replaced. The objective of this research was to evaluate the apical seal after the removal of a custom cast post and core with a carbide bur or with an ultrasound apparatus. Twenty five roots of extracted human incisors were used. They were endodontically treated and prepared to receive the posts. The posts and cores were cast with 2 types of dental alloys, CuAlZn and PdAg, and were cemented with zinc phosphate cement. After 24 hours, they were removed using the two above mentioned techniques. Then, the roots had their external surface made impermeable by two layers of cyanoacrylate adhesive, leaving only the cervical area for dye penetration. The teeth were immersed in rhodamine for 24 hours. They were then cut and observed under an optical microscope and analyzed with appropriate software (Imagelab). The results were submitted to ANOVA, and they evidenced that, regarding the alloy factor, PdAg posts presented a larger mean infiltration value (2.23 ± 0.48 mm) as compared to the posts made of CuAlZn (1.39 ± 0.48 mm) (p = 0.025). Regarding the technique factor, there was no significant difference (p = 0.9) between the removal of the intraradicular retainer using ultrasound (1.99 ± 0.62 mm) or using a rotating cutting instrument (1.62 ± 0.62 mm). Under these experimental conditions, it was possible to conclude that the degree of apical leakage was directly related to the alloy type, and it was present in both techniques used.
Microenvironments Engineered by Inkjet Bioprinting Spatially Direct Adult Stem Cells Toward Muscle- and Bone-Like Subpopulations
Authors: Phillippi Julie A. , Miller Eric , Weiss Lee , Huard Johnny , Waggoner Alan , Campbell Phil
Published: September 2007

In vivo, growth factors exist both as soluble and as solid-phase molecules, immobilized to cell surfaces and within the extracellular matrix. We used this rationale to develop more biologically relevant approaches to study stem cell behaviors. We engineered stem cell microenvironments using inkjet bioprinting technology to create spatially defined patterns of immobilized growth factors. Using this approach, we engineered cell fate toward the osteogenic lineage in register to printed patterns of bone morphogenetic protein (BMP) 2 contained within a population of primary muscle-derived stem cells (MDSCs) isolated from adult mice. This patterning approach was conducive to patterning the MDSCs into subpopulations of osteogenic or myogenic cells simultaneously on the same chip. When cells were cultured under myogenic conditions on BMP-2 patterns, cells on pattern differentiated toward the osteogenic lineage, whereas cells off pattern differentiated toward the myogenic lineage. Time-lapse microscopy was used to visualize the formation of multinucleated myotubes, and immunocytochemistry was used to demonstrate expression of myosin heavy chain (fast) in cells off BMP-2 pattern. This work provides proof-of-concept for engineering spatially controlled multilineage differentiation of stem cells using patterns of immobilized growth factors. This approach may be useful for understanding cell behaviors to immobilized biological patterns and could have potential applications for regenerative medicine.

Disclosure of potential conflicts of interest is found at the end of this article.
Estimating Numbers of Unsheltered Homeless People Through Plant-Capture and Postcount Survey Methods
Authors: Hopper Kim , Shinn Marybeth , Laska Eugene , Meisner Morris , Wanderling Joseph
Published: September 2007

Objectives. We sought to increase the accuracy of New York City’s estimates of its unsheltered homeless population.

Methods. We employed 2 approaches to increasing count accuracy: a plant-capture strategy in which embedded decoys (or “plants”) were used to estimate the proportion of visible homeless people missed by enumerators and a postcount survey of service users designed to estimate the proportion of unsheltered homeless people who were not visible.

Results. Plants at 17 sites (29%) reported being missed in the count, because counters either did not visit those sites or did not interview the plants. Of 293 homeless service users who were not in shelters, 31% to 41% were in locations deemed not visible to counters.

Conclusions. Both plant-capture estimation and postcount surveys are feasible approaches that can increase the accuracy of estimates of unsheltered homeless populations.
Lifetime Prevalence of Mental Disorders and Suicide Attempts in Diverse Lesbian, Gay, and Bisexual Populations
Authors: Meyer Ilan H. , Dietrich Jessica , Schwartz Sharon
Published: September 2007

Past studies have reported little about variability in mental disorders among lesbians, gay men, and bisexual individuals. We assessed the prevalence of psychiatric disorders in 388 lesbian, gay, and bisexual Black, Latino, and White individuals. Black lesbians, gay men, and bisexual individuals had lower prevalence of all disorders than did Latino and White individuals; younger cohorts had fewer mood disorders than did older cohorts; bisexual persons had more substance use disorders than did gay men and lesbians; and Latino respondents attempted suicide more often than did White respondents.
Declines in Hospital Admissions for Acute Myocardial Infarction in New York State After Implementation of a Comprehensive Smoking Ban
Authors: Juster Harlan R. , Loomis Brett R. , Hinman Theresa M. , Farrelly Matthew C. , Hyland Andrew , Bauer Ursula E. , Birkhead Guthrie S.
Published: September 2007

Objectives. Reductions in exposure to environmental tobacco smoke have been shown to attenuate the risk of cardiovascular disease. We examined whether the 2003 implementation of a comprehensive smoking ban in New York State was associated with reduced hospital admissions for acute myocardial infarction and stroke, beyond the effect of moderate, local and statewide smoking restrictions, and independent of secular trends.

Methods. We analyzed trends in county-level, age-adjusted, monthly hospital admission rates for acute myocardial infarction and stroke from 1995 to 2004 to identify any association between admission rates and implementation of the smoking ban. We used regression models to adjust for the effects of pre-existing smoking restrictions, seasonal trends in admissions, differences across counties, and secular trends.

Results. In 2004, there were 3813 fewer hospital admissions for acute myocardial infarction than would have been expected in the absence of the comprehensive smoking ban. Direct health care cost savings of $56 million were realized in 2004. There was no reduction in the number of admissions for stroke.

Conclusions. Hospital admission rates for acute myocardial infarction were reduced by 8% as a result of a comprehensive smoking ban in New York State after we controlled for other relevant factors. Comprehensive smoking bans constitute a simple, effective intervention to substantially improve the public’s health.
Setting a Challenging Yet Realistic Smoking Prevalence Target for Healthy People 2020: Learning From the California Experience
Authors: Mendez David , Warner Kenneth E.
Published: September 2007

Objectives. We sought to outline an optimistic yet achievable goal for future US smoking prevalence rates based on empirical evidence reflecting the success of smoking control efforts in California.

Methods. Using a dynamic model and the smoking initiation and cessation rates achieved in California as a guide, we projected US adult smoking prevalence rates through the year 2020.

Results. If smoking initiation and cessation rates for the nation do not change, population dynamics will result in smoking prevalence rates falling to 19.1% in 2010 and 16.8% in 2020. If the country attains California’s initiation and cessation rates by 2010, adult smoking prevalence rates will be 18.5% in 2010 and 14.7% as of 2020.

Conclusions. If California’s smoking initiation and cessation rates are attained nationwide, the US smoking prevalence rate could be 5.9 percentage points lower than the 2005 rate by the year 2020, and there would be 10.2 million fewer smokers than in 2005. A target of 14% smoking prevalence by 2020 is aggressive yet feasible, given that it takes into account the constraints imposed by population demographics.
The Interplay of Public Health Law and Industry Self-Regulation: The Case of Sugar-Sweetened Beverage Sales in Schools
Authors: Mello Michelle M. , Pomeranz Jennifer , Moran Patricia
Published: September 2007

It is increasingly recognized that sugar-sweetened beverage consumption contributes to childhood obesity. Most states have adopted laws that regulate the availability of sugar-sweetened beverages in school settings. However, such policies have encountered resistance from consumer and parent groups, as well as the beverage industry.

The beverage industry’s recent adoption of voluntary guidelines, which call for the curtailment of sugar-sweetened beverage sales in schools, raises the question, Is further policy intervention in this area needed, and if so, what form should it take?

We examine the interplay of public and private regulation of sugar-sweetened beverage sales in schools, by drawing on a 50-state legal and regulatory analysis and a review of industry self-regulation initiatives.
Politics and the Erosion of Federal Scientific Capacity: Restoring Scientific Integrity to Public Health Science
Authors: Rest Kathleen M. , Halpern Michael H.
Published: September 2007

Our nation’s health and prosperity are based on a foundation of independent scientific discovery. Yet in recent years, political interference in federal government science has become widespread, threatening this legacy.

We explore the ways science has been misused, the attempts to measure the pervasiveness of this problem, and the effects on our long-term capacity to meet today’s most complex public health challenges. Good government and a functioning democracy require public policy decisions to be informed by independent science.

The scientific and public health communities must speak out to defend taxpayer-funded science from political interference. Encouragingly, both the scientific community and Congress are exploring ways to restore scientific integrity to federal policymaking.
Root growth dynamics in golf greens with different compression intensities and winter survival
Authors: MARJAMÄKI T. , PIETOLA L.
Published: September 2007

The aim of this study was to measure root growth dynamics under Nordic putting green conditions in order to estimate the sensitivity of root growth to winter damages and compression. Root numbers of turfgrasses were measured from soil depths of 040 cm by minirhizotrons. The minirhizotrons tubes were installed in the most compressed (center) and less walked (edge) parts of putting greens with good or weak winter survival. The highest root numbers were recorded under less walked green edge areas with good winter survival. The lowest root numbers were measured from center areas of greens, especially from areas suffering winter damage in previous years. Morphological parameters of roots were studied by a destructive soil sampling method in midseason 1998. Based on image analysis of washed roots, root length density at soil depths of 02.5 cm was 400 cm cm3 in greens of weak winter survival and up to 900 cm cm3 in greens of good winter survival. Our findings emphasize that root growth of turfgrasses is highly dynamic and sensitive to compression despite of non significant effects on soil porosity. Reduced root growth of greens with weak winter survival continued despite of recovery of shoot growth.;
Metal Ion Uptake from Aqueous Solution by Olive Stones: A Carbon‐13 Solid‐State Nuclear Magnetic Resonance and Potentiometric Study
Authors: Nurchi Valeria Marina , Floris Costantino , Pinna Rosalba , Fiol Núria , Villaescusa Isabel
Published: September 2007

The use of biomasses that result from the agriculture and food industries in removing heavy metals from wastewaters is attracting increasing interest. We present a joined potentiometric and cross polarization magic angle spinning (CP‐MAS) carbon‐13 (13C) nuclear magnetic resonance (NMR) study on the interaction of olive stones with copper(II), nickel(II), and cadmium(II). The potentiometric measurements allow both to distinguish two kind of basic sites in the olive stones and to postulate the coordination models for the three studied metals. The NMR spectral analysis allows the attribution of the different signals to the components of the olive stone matrix. A comparison of CP‐MAS 13C NMR spectra of the samples after metal treatment suggests a specific complexation between metal ions and hydroxyl groups on guaiacyl and syringyl moieties.
Immobilized Cell Augmented Activated Sludge Process for Enhanced Nitrogen Removal from Wastewater
Authors: Jittawattanarat Rungrod , Kostarelos Konstantinos , Khan Eakalak
Published: September 2007

The immobilized cell augmented activated sludge (ICAAS) system combines a cell immobilization technique and an offline enricher‐reactor for the bioaugmentation of the activated sludge system to improve treatment performances. In this study, enhanced nitrogen removal using ICAAS was investigated. Laboratory‐scale, offline, batch enricher‐reactors were used to maintain nitrification and denitrification activities of coimmobilized nitrifiers and denitrifiers used to augment a laboratory‐scale completely mixed activated sludge system (CMAS) treating synthetic wastewater. Cellulose triacetate was the media used to entrap nitrifiers and denitrifiers at a 2:1 mass ratio. The ICAAS augmented with the coimmobilized cells between 5 and 20% by volume gained 24 ± 5% higher nitrogen removal than a control CMAS, which provided nitrogen removal of 28 ± 7%. The ICAAS scheme is a viable alternative for upgrading existing activated sludge systems to gain better nitrogen removal.
Effect of Chlorides and Sulfates on the Performance of a Fe 3+/H 2O 2 Fenton‐Like System in the Degradation of Methyl Tert‐Butyl Ether and its Byproducts
Authors: Siedlecka Ewa M. , Stepnowski Piotr
Published: September 2007

The effect of chloride and sulfate ions on the oxidation of methyl tert‐butyl ether (MTBE) and its degradation products in a Fenton‐like system was studied. Although both chloride and sulfate ions inhibited the decomposition of H 2O 2, chlorides were found to be the more effective inhibitor of MTBE degradation. In the presence of sulfates, MTBE decomposition can be attributed to oxidation not only by hydroxyl radicals, but also likely by SO 4 ·− species. In the presence of chloride ions, it is possible that the dichloride radical is formed, which is less reactive than OH•. In the system under investigation, t‐butyl alcohol was found to be the major byproduct, followed by t‐butyl formate and acetone. The degradation rates of all intermediates and their inhibition in the presence of inorganic ions are similar to those obtained for MTBE, although their distributions are related to the concentrations of inorganic salts added.
Measurement of Cord Insulin and Insulin-Related Peptides Suggests That Girls Are More Insulin Resistant Than Boys at Birth
Authors: Shields Beverley M. , Knight Bridget , Hopper Heather , Hill Anita , Powell Roy J. , Hattersley Andrew T. , Clark Penelope M.
Published: September 2007

OBJECTIVE— We aimed to examine sex differences in insulin and insulin propeptide concentrations at birth using validated cord blood collection.

RESEARCH DESIGN AND METHODS— We tested the impact on insulin and insulin propeptides of taking 13 cord blood samples in heparin and EDTA and then centrifuging and separating plasma after 1, 2, 24, or 48 h at room temperature (heparin) or 4°C (EDTA). Cord plasma insulin and insulin propeptides concentrations were measured in 440 babies and correlated with offspring anthropometry measured at birth.

RESULTS— Cord insulin concentrations significantly decreased (74% those at baseline by 24 h; P = 0.01) in the samples taken in heparin and stored at room temperature, but those taken on EDTA and refrigerated remained stable for up to 48 h. Insulin propeptides were stable in both. Cord plasma insulin and insulin propeptides measured in EDTA were related to all measures of birth size and maternal glycemia and BMI (r > 0.11; P < 0.03 for all) and were higher in those delivered via caesarean section. Girls were lighter (3,497 vs. 3,608 g; P = 0.01) but had higher cord insulin (46.7 vs. 41.2 pmol/l; P = 0.031), total proinsulin (34.1 vs. 25.8 pmol/l; P < 0.001), and intact proinsulin (9.5 vs. 8.3 pmol/l; P = 0.004) concentrations than boys; this was further confirmed when cord insulin concentrations of boys and girls were compared after pair matching for birth weight (insulin 49.7 vs. 42.1 pmol/l; P = 0.004).

CONCLUSIONS— When using appropriate sample collection methods, female newborns have higher insulin concentrations than male newborns, despite being smaller, suggesting intrinsic insulin resistance in girls.
Relationship of Liver Enzymes to Insulin Sensitivity and Intra-Abdominal Fat
Authors: Wallace Tara M. , Utzschneider Kristina M. , Tong Jenny , Carr Darcy B. , Zraika Sakeneh , Bankson Daniel D. , Knopp Robert H. , Kahn Steven E.
Published: September 2007

OBJECTIVE— The purpose of this study was to determine the relationship between plasma liver enzyme concentrations, insulin sensitivity, and intra-abdominal fat (IAF) distribution.

RESEARCH DESIGN AND METHODS— Plasma γ-glutamyl transferase (GGT), aspartate transaminase (AST), alanine transaminase (ALT) levels, insulin sensitivity (insulin sensitivity index [SI]), IAF area, and subcutaneous fat (SCF) area were measured in 177 nondiabetic subjects (75 men and 102 women, aged 31–75 years) with no history of liver disease. On the basis of BMI (< or ≥27.5 kg/m2) and SI (< or ≥7.0 × 10−5 min/pmol) subjects were divided into lean insulin sensitive (LIS, n = 53), lean insulin resistant (LIR, n = 60), and obese insulin resistant (OIR, n = 56) groups.

RESULTS— Levels of all three liver enzymes were higher in men than in women (P < 0.0001 for each). In men, GGT levels were higher in insulin-resistant than in insulin-sensitive subjects (P < 0.01). In women, GGT levels were higher in the OIR than in the LIS group (P < 0.01) but no different in the LIR group. There was no difference in ALT and AST levels among the LIS, LIR, and OIR groups. GGT was associated with SI (r = −0.26, P < 0.0001), IAF area (r = 0.22, P < 0.01), waist-to-hip ratio (WHR) (r = 0.25, P = 0.001), BMI (r = 0.17, P < 0.05), and SCF area (r = 0.16, P < 0.05) after adjustments for age and sex. In men, only SI (r = −0.29, P < 0.05) remained independently correlated with GGT in multiple regression analysis. In women, IAF area (r = 0.29, P < 0.01) and WHR (r = 0.29, P < 0.01) were independently associated with GGT, but SI was not.

CONCLUSIONS— In nondiabetic men GGT but not AST or ALT levels, are inversely related to insulin sensitivity independent of IAF area. However in women, GGT is related to measures of central body fat rather than to insulin sensitivity.
Challenges in Design of Multicenter Trials
Authors: Dyck Peter J. , Norell Jane E. , Tritschler Hans , Schuette Klemens , Samigullin Rustem , Ziegler Dan , Bastyr Edward J. , Litchy William J. , O'Brien Peter C.
Published: September 2007

OBJECTIVE—Assessing clinimetric performance of diabetic sensorimotor polyneuropathy (DSPN) end points in single and multicenter trials.

RESEARCH DESIGN AND METHODS—Assessed were placebo-treated patients with DSPN in the Viatris and Eli Lilly trials and an epidemiologic cohort.

RESULTS—Test reproducibility in clinical trial cohorts (rI ∼ 0.7–0.85) approached that in the epidemiologic cohort (rI ∼ 0.85–0.95). Associations between pairs of end points explained <10% of the variability of data (sometimes 15–35%), being higher in the epidemiologic cohort and the Viatris trial than in the Lilly trial. Most end points did not show monotonic worsening over 4 years. However, sural nerve amplitude and peroneal motor conduction velocity did. A nerve conduction score (Σ 5 NC nds [5 attributes of nerve conduction expressed as normal deviates]) did not show monotonic worsening in established DSPN. In the epidemiologic cohort followed for 9.5 years, monotonic worsening of small magnitude occurred for sural amplitude, vibration detection threshold, and especially for composite quantitative sensation.

CONCLUSIONS—The main reason why it is difficult to demonstrate monotonic worsening of neuropathic end points appears to be a very slow worsening of DSPN, a placebo effect for symptoms and signs, and measurement noise. Demonstrating disease progression in controlled trials of DSPN is more likely when 1) patients with developing rather than established DSPN are selected, 2) type 1 diabetic patients are preferentially recruited, 3) patients are selected who cannot or will not achieve ideal glycemic control, 4) end points chosen are known to show monotonic worsening, and 5) a restricted number of centers and expert examiners (trained, certified, using standard approaches, and reference values and interactive surveillance of tests) are used.
Risk Factors for Mortality in a Diverse Cohort of Patients With Childhood-Onset Diabetes in Chicago
Authors: Burnet Deborah L. , Cooper Andrew J. , Drum Melinda L. , Lipton Rebecca B.
Published: September 2007

OBJECTIVE—We sought to determine whether risk of death differed by demographic or other characteristics in a population-based cohort of patients with childhood-onset diabetes.

RESEARCH DESIGN AND METHODS—The Chicago Childhood Diabetes Registry is an ethnically diverse cohort of patients with diabetes onset between ages 0 and 17 years. Cases that accumulated from 1 January 1985 to 31 December 2000 (n = 1,238) were assessed for vital status using death certificates, family reports, and two large administrative databases (Social Security Death Index and National Death Index). Mortality was compared between subgroups using Poisson and Cox proportional hazards regression.

RESULTS—Thirty subjects died, with a mean follow-up time of 7.75 years, yielding a crude case fatality rate of 2.4%. Six subjects died of diabetic ketoacidosis (DKA) at initial presentation. Onset age was the predominant risk factor, driven by a substantially higher fatality rate among those diagnosed at age 17 years (13.36/1,000 person-years) than among other ages and by moderately higher rates for those diagnosed in early adolescence (ages 10–13 years) (3.49/1,000 person-years), compared with children diagnosed before age 10 years (0.89/1,000 person-years) or at ages 14–16 years (0.81/1,000 person-years). Mortality did not differ significantly by other factors examined; data for whites were insufficient to allow comparisons with that group. In addition to diabetes, frequent causes of death were trauma, infectious disease, and cardiovascular disease.

CONCLUSIONS— This study provides short- to medium-term follow-up in a diverse cohort of patients. DKA remains a significant cause of death in young people with diabetes. Young people diagnosed at the threshold of adulthood are at increased risk for mortality.
Factors That Impact Symptomatic Diabetic Peripheral Neuropathy in Placebo-Administered Patients From Two 1-Year Clinical Trials
Authors: Tesfaye Solomon , Tandan Rup , Bastyr Edward J. , Kles Keri A. , Skljarevski Vladimir , Price Karen L. ,   for the Ruboxistaurin Study Group
Published: September 2007

OBJECTIVE—The purpose of this study was to evaluate the change in neuropathy symptoms and disease progression in placebo-administered patients from two 1-year studies in which the impact of ruboxistaurin (RBX) in mild diabetic peripheral neuropathy (DPN) was tested.

RESEARCH DESIGN AND METHODS—Data from 262 placebo-administered patients from two identical phase 3, randomized, double-blind trials were combined and analyzed.

RESULTS—After 1 year, change in the neuropathy impairment score of lower limbs [NIS(LL)] (−0.63 points; P = 0.005), vibration detection threshold (VDT) (−0.42 just noticeable difference units; P = 0.003), and Neuropathy Total Symptom Score-6 (NTSS-6) questionnaire (−3.73 points; P < 0.001) improved, whereas some electrophysiology measures and heart rate deep breathing (HRDB) (−0.78 beats; P = 0.003) worsened compared with baseline values. There was a small but significant worsening of A1C (0.28%; P < 0.001), and a greater percentage of patients were using analgesics at the end of the trials (33.6%; P = 0.003). At 1 year, the change in NTSS-6 directly correlated with changes in NIS(LL) and VDT and inversely correlated with the peroneal nerve conduction velocity. On logistic regression analyses, a ≥50% reduction in NTSS-6 score was less likely in patients who used antihypertensive or chronic symptom medication at baseline.

CONCLUSIONS—In placebo-administered patients with mild symptomatic DPN, there was a progressive improvement in symptoms over 12 months, whereas nerve conduction studies and HRDB declined, and clinically significant worsening of DPN would require >1 year of observation.
Corneal Confocal Microscopy Detects Early Nerve Regeneration After Pancreas Transplantation in Patients With Type 1 Diabetes
Authors: Mehra Sanjay , Tavakoli Mitra , Kallinikos Panagiotis A. , Efron Nathan , Boulton Andrew J.M. , Augustine Titus , Malik Rayaz A.
Published: September 2007

OBJECTIVE—Corneal confocal microscopy (CCM) is a rapid, noninvasive, clinical examination technique that quantifies small nerve fiber pathology. We have used it to assess the neurological benefits of pancreas transplantation in type 1 diabetic patients.

RESEARCH DESIGN AND METHODS—In 20 patients with type 1 diabetes undergoing simultaneous pancreas and kidney transplantation (SPK) and 15 control subjects, corneal sensitivity was evaluated using noncontact corneal esthesiometry, and small nerve fiber morphology was assessed using CCM.

RESULTS—Corneal sensitivity (1.54 ± 0.28 vs. 0.77 ± 0.02, P < 0.0001), nerve fiber density (NFD) (13.8 ± 2.1 vs. 42 ± 3.2, P < 0.0001), nerve branch density (NBD) (4.04 ± 1.5 vs. 26.7 ± 2.5, P < 0.0001), and nerve fiber length (NFL) (2.23 ± 0.2 vs. 9.69 ± 0.7, P < 0.0001) were significantly reduced, and nerve fiber tortuosity (NFT) (15.7 ± 1.02 vs. 19.56 ± 1.34, P = 0.04) was increased in diabetic patients before pancreas transplantation. Six months after SPK, 15 patients underwent a second assessment and showed a significant improvement in NFD (18.04 ± 10.48 vs. 9.25 ± 1.87, P = 0.001) and NFL (3.60 ± 0.33 vs. 1.84 ± 0.33, P = 0.002) with no change in NBD (1.38 ± 0.74 vs. 1.38 ± 1.00, P = 1.0), NFT (15.58 ± 1.20 vs. 16.30 ± 1.19, P = 0.67), or corneal sensitivity (1.23 ± 0.39 vs. 1.54 ± 00.42, P = 0.59).

CONCLUSIONS—Despite marked nerve fiber damage in type 1 diabetic patients undergoing pancreas transplantation, small fiber repair can be detected within 6 months of pancreas transplantation using CCM. CCM is a novel noninvasive clinical technique to assess the benefits of therapeutic intervention in human diabetic neuropathy.
Reduced Incidence of Lower-Limb Amputations in the Diabetic Population of a German City, 1990–2005
Authors: Trautner Christoph , Haastert Burkhard , Mauckner Peter , Gätcke Lena-Maria , Giani Guido
Published: September 2007

OBJECTIVE—We evaluated whether the incidence of amputations in one German city (Leverkusen, population ∼160,000) had decreased between 1990 and 2005.

RESEARCH DESIGN AND METHODS—From all three hospitals in the city, we obtained complete lists of nontraumatic lower-limb amputations in 1990–1991 and 1994–2005. Only the first observed amputation in residents of Leverkusen was counted. A total of 692 patients met the inclusion criteria. Data about the population stucture, separately for each year of the observation period, were received from the city administration and the Federal Office of Statistics. To test for time trend, we fitted Poisson regression models.

RESULTS—Of all subjects, 72% had known diabetes and 58% were male. Mean age was 71.7 years. Incidence rates in the diabetic population (standardized to the estimated German diabetic population per 100,000 person-years) varied considerably between years (maximum 549 in 1990, minimum 281 in 2004). In the diabetic population, the estimated relative risk (RR) per year was 0.976 (95% CI 0.958–0.996, P = 0.0164). The same trend was observed when only amputations above the ankle (n = 352) (RR 0.970 [95% CI 0.943–0.997], P = 0.0318) were considered. Over 15 years, an estimated reduction of amputations above the toe level by 37.1% (95% CI 12.3–54.8) results. There was no significant change of incident amputations in the nondiabetic population (RR 1.022 [0.989–1.056], P = 0.1981).

CONCLUSIONS—This finding is likely to be due to improved management of the diabetic foot syndrome after a network of specialized physicians and defined clinical pathways for wound treatment and metabolic control were introduced.
Proliferative Activity and Cytometric Characteristics in Polyps of the Nasal Cavity and Paranasal Sinuses
Authors: Welkoborsky Hans-J. , Portmann Katharina , Hoffmann Frank , Jacob Roland , Mann Wolf J. , Amedee Ronald G.
Published: September 2007

Although several investigations have revealed the influence of cytokines, allergy, and environmental factors in polyp development, the etiology of nasal polyps is still unknown. To estimate the biology of this common disease the operative specimens of 50 patients who underwent surgery for polyps of the nasal cavity and the paranasal sinuses were examined; of these, 10 patients had recurrent disease and 23 patients had an allergy. The investigations included routine histology and quantitative DNA measurements, along with immunohistochemical identification of proliferation markers (i.e., MIB-1; proliferating cell nuclear antigen, PCNA). Histologically, most polyps revealed an infiltration with lymphocytes, eosinophilic granulocytes, and plasma cells. Twenty-five percent had a squamous metaplasia of the respiratory epithelium. Quantitative DNA analysis demonstrated diploid stem-lines and lack of aneuploid cells with a DNA content exceeding 5c in most cases. Immunohistochemical detection of proliferation markers showed low proliferation rates in all cases. In 27 polyps no MIB-1 expression was detected, and in 7 polyps no PCNA expression was detected. The polyps of the 23 patients with proven allergic diathesis did not reveal higher scores for the parameters of DNA analysis (i.e., ploidy status and percentage of aneuploid cells) and proliferation scores. Nasal polyps of 10 patients with recurrent disease displayed higher scores for proliferation markers, and in five cases aneuploid cells with 5c exceeding rate (5cER) of 1.5–11.7% were detected. According to these results, polyps of the nasal cavity and paranasal sinuses showed low proliferation scores and were diploid. The data demonstrated that there was no increase of proliferation activity or ploidy shift toward aneuploidy in patients with allergy. Nevertheless, in recurrent disease some increase in proliferation activity and some changes in the parameters of the DNA analysis occurred, indicating more aggressive behavior of recurrent polyps in single cases.
The Use of Acoustic Rhinometry in Predicting Outcomes after Sinonasal Surgery
Authors: Gosepath Jan , Belafsky Peter , Kaldenbach Titus , Rolfe Kevin W. , Mann Wolf J. , Amedee Ronald G.
Published: September 2007

Today's healthcare environment demands objective assessment of surgical outcomes. The recent otolaryngologic literature has established acoustic rhinometry (AR) as a valid instrument to objectively document nasal patency. The purpose of this article is to evaluate the utility of AR in predicting outcomes after sinonasal surgery. All patients scheduled for sinonasal surgery at the Tulane University and University of Mainz Departments of Otolaryngology between 10/1/98 and 12/15/98 were enrolled. All subjects underwent AR and completed a sinonasal outcome survey (SNOT-20) one day before and two months after their surgical procedure. Thirty-one patients were enrolled. The SNOT-20 raw scores improved from a mean of 7.93 (±3.78) preoperatively to 3.35 (±2.33) postoperatively (p < 0.05). The 1-notch revealed no significant change postoperatively. The mean bilateral predecongestion C-notch increased from 1.257 cm2 to 1.451 cm2 (p < 0.05). Patients with a bilateral C-notch >1 cm2 were 1.96 times more likely to have a five-point improvement in the SNOT-20 raw score (95% CI = 1.17, 3.27). The mean value of the C-notch is significantly altered (increased) as a result of sinonasal surgery. Patients with a preoperative cross-sectional area <1 cm2 are less likely to report large postoperative subjective improvement. These results indicate that patients with poor geometry at the area of the C-notch do not fare as well surgically as those with better preoperative measurements.
Antibiotic Treatment of Rhinitis and Sinusitis
Authors: MacKay Donald N.
Published: September 2007

The most common organisms causing bacterial sinusitis are pneumococci and Haemophilus influenzae. Accordingly, in a patient not allergic to penicillin, ampicillin or amoxicillin appears to be the antibiotic of choice in empirical treatment of bacterial sinusitis. In penicillin-allergic patients, or in areas with a high incidence of β-lactamase-producing H. influenzae, co-trimoxazole would probably be a better choice. Organisms obtained by culture of nasal secretions do not correlate well with organisms obtained from sinuses by direct puncture aspiration. Therefore, culture of nasal secretions is not recommended.
Cromolyn Sodium and Its Effect on Nasal Disease
Authors: Schwartz Howard J.
Published: September 2007

Current understanding of the mechanism of action of cromolyn sodium in allergic reactions is reviewed with special attention to its role in rhinitis. Currently, the 4% cromolyn sodium solution available for nasal use is efficacious in seasonal and perennial allergic rhinitis. There are few complications associated with its use, and it is a rational choice for first-line or primary therapy in the prevention and treatment of allergic nasal disease.