Current methods for assessing mucociliary transport disorders in the diagnosis of chronic rhinosinusitis]

This paper summarises the findings of a systematic review of research on preschool vision screening. The review concludes that the provision of such screening programmes should be reconsidered, if not abandoned.     

Responses to acellular pertussis vaccines and component antigens in a coughing-rat model of pertussis

Two acellular pertussis vaccines (SmithKline Beecham 3-component and Connaught 5-component), and a whole-cell pertussis vaccine (Evans), were similarly protective against paroxysmal coughing and leukocytosis in a coughing-rat model of pertussis. A two-dose immunization schedule was followed by sublethal intrabronchial challenge with Bordetella pertussis strain 18-323, encased in fine agarose beads, and the coughing monitored by sound-activated tape recorders. Pertussis toxoid by itself gave some protection against coughing, but lower than that afforded by the vaccines, despite inducing a higher serum anti-PT titre. The other component antigens, given individually, failed to protect against coughing although inducing antibodies. Immunization with the whole-cell and acellular vaccines and with their component antigens, as well as challenge with B. pertussis, caused significant elevation of total serum IgE antibodies. Antigen-specific IgG and IgA were detected in tracheobronchial washings from rats recovering from B. pertussis challenge, but vaccination prior to challenge had little influence on these antibody levels. The coughing-rat model of pertussis may be useful for the comparative testing of different formulations of pertussis vaccines before trials in human infants.     

Efficacy of a two-component acellular pertussis vaccine in infants

OBJECTIVE: This case-control study investigated the protective efficacy against pertussis of three doses of a two-component acellular pertussis vaccine (manufactured by Biken in Japan) combined with diphtheria and tetanus toxoids (manufactured by Connaught Laboratories in the US) in infants. METHODS: A case-control study was performed in 63 pediatric practices in Germany. Prospective recruitment of 16,780 infants ages 6 to 17 weeks took place between February, 1993, and July, 1994. According to parental choice infants received either Biken acellular pertussis vaccine combined with diphtheria and tetanus toxoids (DTacP) (74.6%) at approximately 2, 4 and 6 months of age, or a licensed German diphtheria-tetanus toxoids-whole cell pertussis vaccine (10.9%), diphtheria-tetanus toxoids vaccine (12.5%) or no vaccine (2.0%). Prospective surveillance of pertussis cases between February, 1993, and May, 1995, was accomplished by culturing all infants < or =2 years of age presenting with cough > or = 7 days. A pertussis case was defined as any cough of 21 days or longer plus a positive Bordetella pertussis culture or household contact exposure. RESULTS: We identified 241 pertussis cases prospectively by 11,017 B. pertussis cultures and 949 controls matched for age were selected from the same pediatric practices. Medical history and demographic and vaccine status data were collected from each case and for four controls. Data were analyzed through conditional logistic regression taking into account individual matching and adjusting for potential confounding variables. DTacP combined with diphtheria and tetanus toxoids vaccine was 82% protective (95% confidence interval, 68 to 90), diphtheria-tetanus toxoids-whole cell pertussis vaccine was 96% protective (95% confidence interval, 78 to 99). Protection against typical B. pertussis infection characterized by paroxysmal cough lasting > or =21 days was 96% (95% confidence interval, 87 to 99) for DTacP and was 97% (95% confidence interval, 79 to 100) for diphtheria-tetanus toxoids-whole cell pertussis vaccine. Adjustment for potentially confounding variables did not change the results significantly. CONCLUSIONS: Three doses of the two-component acellular pertussis vaccine protected infants against pertussis disease during the period before the recommended booster vaccination. For typical pertussis disease as defined by the WHO efficacy was high and similar to that of a licensed German diphtheria-tetanus toxoids-whole cell pertussis vaccine.     

Radiation safety in the cardiac catheterization laboratory

Over the years, permissible radiation exposure of operators working with x-ray equipment has become progressively reduced. The number of cardiac catheterizations and related interventional procedures has increased and the procedures have become more prolonged. The patient receives relatively infrequent primary radiation while the operator receives frequent but mainly secondary radiation. The operator uses protective barriers, correct positioning of the patient and careful techniques to reduce radiation exposure. The effects of radiation are cumulative and permanent. They may be stochastic or nonstochastic, and somatic and/or genetic, and onset may be delayed for many years. To minimize exposure of patient and operator, cardiologists need a better understanding of radiation physics and of cardiac x-ray equipment. Technical breakthroughs such as digital imaging, pulse fluoroscopy, reduction of frame rates from 60 or 30 frames/s to 15 frames/s, and progression to the filmless laboratory will substantially reduce radiation. This review discusses current cardiac x-ray equipment, possible future developments, radiation, and techniques for reducing radiation and improving safety in the cardiac catheterization laboratory.     

Study of methods of inactivating a concentrated, purified cultured antirabies vaccine]

Two methods of inactivation, with ultraviolet (UV) and gamma (gamma) rays, of the concentrated purified tissue culture rabies vaccine from the Vnukovo-32 strain were studied. Under the optimal conditions of treatment of 100-fold concentrated purified virus-containing suspension, a completely inactivated vaccine with high immunogenicity indices (4.1 to 78) was obtained. Both the inactivation methods were found to be of equal value.     

The effect of pertussis toxin and whole-cell pertussis vaccine on haemodynamics and autonomic responsiveness in the rat depends on route of administration and age

Vaccination of children with Diphtheria, Tetanus, Poliomyelitis and pertussis vaccine (DTPoP-vaccine) containing the whole-cell pertussis component is known to be associated with manifestation of side-effects such as acute encephalopathy, convulsions and hypotensive-hyporesponsive episodes. In young and adult rats the effects of pertussis toxin and DTPoP-vaccine on haemodynamics and autonomic responsiveness are evaluated following treatment with high dose via different routes of administration (s.c., i.p. and i.v.). The effect of pertussis toxin is dose-dependent (between 1 and 20 micrograms kg-1) and largest responses are observed after i.v. administration. At 20 micrograms kg-1, i.v. pertussis toxin decreases baseline diastolic blood pressure and increases baseline heart rate by 31% and inhibits autonomic responsiveness (salbutamol-induced increase in diastolic blood pressure and arecoline-induced decrease in heart rate). In adult rats DTPoP-vaccine induces generally more prominent effects than in young rats. In adult rats DTPoP-vaccine reduces baseline diastolic blood pressure by 25% while no response is observed in young rats. In adult rats DTPoP inhibits the adrenergic response though less compared to treatment of pertussis toxin. After treatment with DTPoP-vaccine (single or twice) only minor differences are observed between young and adult rats. Present results show that adult rats are more sensitive to pertussis toxin and pertussis vaccine than young rats and that the responses depend on the route of administration.     

Two methods of assessing unconscious communication in psychotherapy.

Explores the relation between 2 quantitative measures of unconscious communication: (1) referential activity, which emerged from the dual-coding model of mental representation, and (2) newness of themes and extent of narrative/imagery, first identified as bearers of derivative material in the communicative approach to psychotherapy. The measures are applied to data from 2 female patients, each of whom was seen separately by 3 out of a group of 6 psychoanalysts in videotaped consultation interviews. Findings include significant correlations between referential activity and both newness of themes and extent of narrative/imagery. Newness of themes and extent of narrative/imagery also correlated significantly with each other. Scores on the measures tended to be lowest with the analysts who spoke most often. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Identification and characterization of PtlC, an essential component of the pertussis toxin secretion system

PtlC is a member of a set of proteins necessary for the secretion of pertussis toxin (PT) from Bordetella pertussis. Using polyclonal antibodies specific for PtlC, we identified PtlC as a protein with an apparent molecular weight of 85,000 that localizes to the membrane fraction of bacterial cell extracts. We found that a mutant strain of B. pertussis that contains an in-frame deletion in ptlC is unable to secrete PT and that PT secretion is fully restored by expressing ptlC in trans, indicating that PtlC is essential for transport of PT across the bacterial membrane(s). PT secretion was inhibited in wild-type B. pertussis after introduction of a plasmid expressing a mutant ptlC altered in the putative nucleotide-binding region, suggesting that this region of PtlC is essential for proper function. Moreover, the observed dominant negative phenotype suggests that PtlC either functions as a multimer or interacts with some other component(s) necessary for secretion of PT.     

Effectiveness of the use of immunological methods in clinical laboratory diagnosis

The efficacy of treatment of stomatological manifestations and visceral diseases in patients with Sjogren's disease (syndrome) by therapeutic complexes including plasmapheresis is assessed. Plasmapheresis was administered to 7 inpatients in an intermittent mode with exfusion of up to 1 liter of plasma per session. A course consisted of one to three sessions, the total duration of treatment was three to four weeks. The efficacy of plasmapheresis in a complex of therapeutic measures was assessed from the time course of the clinical picture, results of studies of the function of salivary glands, and parameters of metabolic processes and immunity. Plasmapheresis helped attain long remissions and improved the general status of the patients, this being paralleled by a positive time course of local symptoms of the disease and the principal homeostasis parameters.     

铁基混合料成分偏析分析方法

在利用粉末冶金工艺制备铁基混合粉末过程中,由于铁基零部件各组分的密度及粒度差异,混合料经常存在偏析现象,这会引起烧结产品尺寸和性能的不稳定,因此对混合料的成分偏析程度进行测试或评定具有实际意义。本文系统总结了铁基混合料成分偏析分析方法,包括耐扬尘性分析法、成分分析法、色泽观察法、烧损测试法;在实际工程中,可以根据实际需求选取上述试验方法。     

Stepwise safety trial of a killed Leishmania vaccine in Iran

We retrospectively analyzed 36 patients requiring temporary abdominal wall closure on admission to a level I trauma center from 1988 to 1992. There were 10 deaths (28%) in the study population. Of the 26 survivors, 8 patients (31%) had primary fascial closure at initial hospitalization, whereas 18 patients (69%) required split-thickness skin grafting to visceral granulation tissue. Of these 18 patients, 13 have had ventral herniorrhaphy at subsequent admission. Eight of these patients had primary fascial closure, 4 required primary fascial approximation with prosthetic onlay reinforcement, and 1 required multiple operations including prosthetic reconstruction and eventual complex tissue transfer. Complications occurred in 3 patients (14%) and included two wound seromas, which were drained nonoperatively, and a wound infection necessitating removal of prosthetic material and subsequent reconstruction with complex tissue transfer. Follow-up reveals no recurrent hernia at 24 months. Abdominal wall reconstruction after temporary closure can be done safely and promptly, with good functional and esthetic results.     

Relative value of three laboratory methods in the diagnosis of multiple sclerosis

We compared three methods of analysis for IgG in cerebrospinal fluid, using samples from 158 patients with clinically suspected multiple sclerosis and from 200 neurological controls. The tests were: search for oligoclonal bands, calculation of rate of synthesis of IgG in the cerebrospinal fluid, and determination of the IgG/albumin ratio. Paired cerebrospinal fluid and serum samples were collected and their IgG and albumin concentrations measured. Oligoclonal bands were detected by electrophoresis on agarose. Positive results were obtained in 94, 75, and 67% of patients with probable or definite multiple sclerosis by the three respective methods. In contrast, for patients for whom the clinical diagnosis of multiple sclerosis was considered possible, positive results were obtained in 10, 43, and 13%, respectively. Evidently, detection of oligoclonal bands remains the best single test for the presence of abnormal IgG in suspected multiple sclerosis patients. A combination of the first two tests is most sensitive for both probable and definite multiple sclerosis (97%) and possible multiple sclerosis (50%). Some infectious or immunologic disorders can also produce these IgG abnormalities, but they can usually be distinguished from multiple sclerosis by other clinical and laboratory data.     

Comparison of parental and health care professional preferences for the acellular or whole cell pertussis vaccine

PURPOSE: To evaluate the efficacy and toxicity of gamma knife radiosurgery in the treatment of melanoma metastases to the brain. PATIENTS AND METHODS: We retrospectively reviewed 55 patients with single or multiple intracranial melanoma metastases treated at the University of California, San Francisco, with gamma knife radiosurgery from 1991 through 1995. Sixteen patients were treated with gamma knife radiosurgery for recurrence following previous radiation therapy, 11 received radiosurgery as a boost to whole-brain radiation therapy, and 28 had radiosurgery alone for initial management of brain metastases. The median minimum radiosurgery tumor dose for 140 treated lesions was 19 Gy (range, 10-22 Gy) prescribed at the 35% to 90% isodose contour (median, 50%). The median total target volume per patient was 6.1 cc (range, 0.25-28.3 cc). RESULTS: With a median follow-up of 75 weeks in living patients, the median survival times were 35 weeks overall: 35 weeks for patients with solitary metastases versus 33 weeks for those with multiple metastases. A factor that was significant in univariate analysis of survival was total target volume treated. This parameter remained significant on multivariate analysis. The actuarial median freedom from progression analyzed by lesion for 113 lesions in 46 patients with imaging follow-up was 89 weeks with 6-month and 1-year actuarial freedom from progression rates of 89% (95% confidence interval, 80%-95%) and 77% (95% confidence interval, 62%-87%). In univariate analysis, improved freedom from progression was associated with smaller target volume treated, smaller maximum diameter, or higher prescribed dose. Four patients (7%) developed acute Radiation Therapy Oncology Group grade > or = 2 morbidity, and five patients (9%) developed late grade > or = 2 morbidity. DISCUSSION: Median survival and freedom from progression in patients treated with radiosurgery for melanoma metastatic to the brain are comparable to results in published radiosurgery series of grouped histologies. For melanoma patients, total intracranial tumor volume appears to be of greater prognostic significance than the absolute number of metastases treated. We conclude that gamma knife radiosurgery is effective and should be considered among various management strategies.     

Legal basis of vaccine prophylaxis in Russia]

As a complementary modality, therapeutic touch is gaining increasing recognition. Not only are nurses incorporating therapeutic touch into their daily patient care, but patients also are requesting this healing modality. Nurse leaders also use this nursing intervention to weave their vision of healing into their managerial role.     

Hepatitis B component does not interfere with the immune response to diphtheria, tetanus and whole-cell Bordetella pertussis components of a quadrivalent (DTPw-HB) vaccine: a controlled trial in healthy infants

The aim of this single-blind, parallel trial was to assess whether the hepatitis B (HB) component of a DTPw-HB vaccine interferes with the immune response to the other three components when administered at 3, 5 and 7 months of age. One hundred and six infants were randomized to receive three doses of DTPw or DTPw-HB vaccines. Seroprotection (or seroresponse) rates and geometric mean titers (GMT) of antibodies were assessed 3-6 weeks after the third dose. Anti-diphtheria, anti-tetanus and anti-Bordetella pertussis antibodies were measured by ELISA and anti-HBs by radioimmunoassay. Local and general signs and symptoms were recorded for a 4-day follow-up period after each vaccination. After the full vaccination course all subjects in both groups had seroprotective titers (> or = 0.1 IU ml-1) against diphtheria and tetanus and seroresponded (titers > or = 15 EL.U ml-1) to B. pertussis, and there was no significant difference between groups in relation to GMT. All subjects vaccinated with DTPw-HB had seroprotective levels (> or = 10 mIU ml-1) of anti-HBs antibodies after the third dose (GMT of 2318 mIU ml-1). Overall there were no significant differences between groups in relation to the incidence of local and general symptoms. These results show that the HB component did not interfere with the immune response to the other three components of the vaccine.