Intramuscular ceftriaxone compared with oral amoxicillin-clavulanate for treatment of acute otitis media in children

Two hundred and fifteen children aged 4 months 6 years with acute otitis media (AOM) were randomized to be treated either by a single i.m. injection of ceftriaxone, 50 mg/kg, with a second dose in the event of unsatisfactory response after 48 h or a history of recurrent AOM (109 patients) or amoxicillin clavulanate 12.5 mg tid (106 patients). The failure rate was similar in children treated by ceftriaxone and amoxicillin clavulanate, 4.6% and 4.7%, respectively (standard error for intergroup difference -2.87%, 95% confidence interval -5.62% to 5.87%). No significant differences between the groups were found in the dynamics of the resolution of the acute symptomatology, otoscopy findings, relapse rate at 30 days or tympanographic evidence of middle ear effusion at the scheduled visits on days 30, 60 and 90. Recurrence of AOM between days 31 and 90 was observed significantly in more children treated with amoxicillin clavulanate than with ceftriaxone--25 out of 84 (29.4%) versus 11 out of 81 (13.6%) (P = 0.012). Conclusion: Ceftriaxone injection(s) is as efficient at least as 10-day oral amoxicillin clavulanate for treatment of acute otitis media in children. Although not recommended as routine, ceftriaxone can be considered in the management of acute otitis media under special circumstances, particularly in cases when the ability to tolerate or absorb oral drugs is compromised, in children refusing or unable to take oral therapy or when the compliance is questionable.     

Load sharing of the phases in 1080 steel during low-cycle fatigue

By means of X-ray diffraction, the stress response of the individual phases in a 1080 steel were measured. Specimens with pearlitic, spheroidal, and tempered martensitic microstructures were subjected to low-cycle fatigue and the stress-strain hysteresis loops were separated into components for the carbide and matrix phases. Calculations of the microstresses formed by differential plastic deformation of the matrix and inclusions accurately model the spheroidite. Measured microstresses in the pearlite are smaller than the predicted values, probably due to yielding of the cementite and limitations on modeling the morphology. Work-hardening rates associated with the microstresses also qualitatively agree with the measurements. The tempered martensite cyclically softens with fatigue loading. The increased plastic strain range in the tempered martensite with cyclic softening is accompanied by an increase in the microstresses. These microstresses are significantly larger than predicted. Formerly Research Assistant, Department of Materials Science and Engineering, McCormick School of Engineering, Northwestern University     

A 533-MHz BiCMOS superscalar RISC microprocessor

This 533-MHz BiCMOS very large scale integration (VLSI) implementation of the PowerPC architecture contains three pipelines and a large on-chip secondary cache to achieve a peak performance of 1600 MIPS. The 15 mm×10 mm die contains 2.7 M transistors (2M CMOS and 0.7 M bipolar) and dissipates less than 85 W. The die is fabricated in a six-level metal, 0.5-μm BiCMOS process and requires 3.6 and 2.1 V power supplies     

Self-representation of suicidal adolescents

This study focused on the self-representations of suicidal adolescent. Twenty-six Israeli suicidal inpatients, 24 nonsuicidal inpatients, and 24 control participants completed scales on suicidal tendencies, the hedonic value of self-representations, the complexity (differentiation, integration) of these self-representations, and the discrepancies among self domains (actual, ideal, ought). Suicidal adolescents showed more negative self-representations, a less differentiated and less integrated organization of self-attributes, and more discrepancies between the 3 assessed domains of the self than did control participants. In addition, compared with psychiatric nonsuicidal participants, suicidal adolescents showed a less complex organization of self-attributes and a higher discrepancy between ideal self and ought self. Results were discussed in terms of the vulnerable self of suicidal adolescents, characterized by uneven processing of positive and negative information, confusion, and simplicity.     

Exceptionally high seizure threshold: ECT device limitations

Numerous studies have confirmed the distinct biological behavior of two subsets of prostate cancer diagnosed incidentally after either transurethral resection (TURP) or open prostatectomy for presumed benign prostatic hyperplasia (BPH). Focal, low-grade lesions are associated with a low risk for clinical progression and are designated as stage T1a or A1. These cases have traditionally been managed conservatively with close clinical observation. In contrast, multifocal, high-volume, or high-grade tumors are associated with a more aggressive clinical course and are designated as stage T1b or A2. Early definitive intervention is usually advocated for these latter patients. Therefore, accurate pathological assignment to either stage T1a or T1b is crucial for selection of appropriate management options. A variety of methods for staging patients with incidentally detected prostate cancer have been proposed, including detailed histological analysis, repeat TURP or transurethral biopsy, serial prostate-specific antigen (PSA) analysis, and imaging with either transrectal ultrasound (TRUS) or magnetic resonance (MRI) techniques. This article critically examines the clinical utility of these staging modalities for patients with incidentally detected prostate cancer.     

Effect of feedback from peripheral movements on neuron activity in the aplysia abdominal ganglion

We have made reasonably comprehensive measurements of action potential activity in the Aplysia californica abdominal ganglion to determine the amount of feedback the central nervous system (CNS) receives from a movement which it initiates. Voltage-sensitive dye measurements of action potential activity of cells in the ganglion were made during the gill-withdrawal reflex elicited by siphon stimulation. We compared recordings in two situations which differed dramatically in the amount the gill moved. In the control sea water, the gill withdrawal was normal; in low-Ca2+, high-Mg2+ sea water, the gill movement was blocked. Both the timing and the number of spikes of the individual neurons were similar in the two situations. Histograms of the summed spike activity versus time and histograms of the number of active neurons versus time in the two conditions were also similar. Finally, two numerical measures of trial-to-trial differences, a paired t-test and a measure we named fractional similarity, did not indicate larger differences between two trials in the different sea waters than two trials in the same sea water. Feedback from sensory neurons activated by the gill movement itself does not make a large contribution to the spike activity in the abdominal ganglion. Apparently the Aplysia CNS issues the command for the withdrawal and does not make adjustments for the magnitude of the actual withdrawal. It may not even receive the information necessary for such adjustments to be made. A second motivation for these experiments was to test whether removing the feedback might simplify the neuronal activity that occurs during the gill-withdrawal reflex. This did not occur.     

Immunity to Cryptosporidium muris infection in mice is expressed through gut CD4+ intraepithelial lymphocytes

The role of gut intraepithelial lymphocytes (IEL) in immunity to cryptosporidial infection was investigated with a murine infection model involving Cryptosporidium muris. Oocyst shedding was monitored in severe combined immunodeficiency (SCID) mice infected with C. muris following intravenous injection of mesenteric lymph node (MLN) cells or intestinal IEL from BALB/c donor mice which were naive or previously infected with C. muris. SCID mice receiving no lymphoid cells developed chronic infections and excreted large numbers of oocysts until the end of the experiment. SCID mice injected with IEL from immune animals, however, were able to overcome the infection, and furthermore, these animals produced fewer oocysts and recovered sooner than ones which received IEL or MLN cells from naive BALB/c donors. Similar levels of protection were obtained in SCID mice injected with either 2 X 10(6) IEL or MLN cells from immune donor mice. Depletion of CD4+ cells from immune IEL, however, abrogated the ability to transfer immunity to SCID mice, while depletion of CD8+ cells only marginally reduced the protective capacity of immune IEL. Finally, control SCID mice which received no lymphocytes had < or = 1% CD4+ cells in the IEL from the small intestine, whereas the IEL from SCID mice recovered from infection, as a result of injection with immune IEL, contained 15% CD4+ cells. Thus, the ability to control C. muris infection correlated with the presence of the protective CD4+ cells in the gut epithelium.     

Cross-validiation of the Neuropsychology Behavior and Affect Profile in stroke patients.

Internal stability and discriminant validity of the Neuropsychology Behavior and Affect Profile (L. Nelson et al, 1989) were examined in samples of 70 stroke patients and 88 elderly controls. The test is designed to yield indices of premorbid (before-item subset) and present (now-item subset) levels of emotional functioning in each of 5 scales. With coefficient alphas ranging from .76 to .87, results indicated moderate to high internal stability. The test was also able to reliably distinguish between the criterion stroke sample (n?=?42) and a matched group of elderly controls in terms of present levels of emotional functioning (2 wks poststroke). When discriminant validity was examined in terms of premorbid emotional status (before-item subset), group differences were unexpectedly obtained. Clinical and research implications of these results are discussed, noting the possibility of early, noncognitive correlates preceding stroke. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

On the possible role of positive end-expiratory pressure ventilation in the treatment of chylothorax caused by blunt chest trauma

Recent reports on the treatment of chylothorax postulate a benefit to ventilator therapy, especially using positive end-expiratory pressure (PEEP). This report describes the use of mechanical ventilation with PEEP in the management of a 24-year-old male motorcyclist who sustained a ligamentous Chance fracture of the thoracic spine at the T6-7 level with bilateral traumatic chylothorax. Treatment of the chylothorax consisted of high PEEP ventilation, bilateral chest tube thoracostomies, and total parenteral nutrition. The chylothoraces resolved within 4 days of treatment and mechanical ventilation was stopped. Ventilator therapy of traumatic chylothorax and the physiologic grounds for its use are discussed. A review of the literature and experimental evidence seem to suggest that ventilator treatment of traumatic chylothoraces is effective.