Implementation and evaluation of a pilot WHO community first aid responder training in Kinshasa, DR Congo: A mixed method study

Introduction: Prehospital care in many low- and middle-income countries is underdeveloped and needs strengthening for improved outcomes. Where formal prehospital care systems are under development, integration of a layperson first responder programme may help improve access for those in need. The World Health Organization recently developed the Community First Aid Responder (CFAR) learning program in support of this system, providing that it may require adaptation to be contextually suitable and sustainably implemented at country level. This study assesses a pilot WHO CFAR course in Kinshasa, Democratic Republic of Congo, to inform future rollouts and related research. Methods: We conducted a 3-day in-person pilot CFAR training with 42 purposively selected community health workers. Data collection involved quantitative and qualitative phases. The first consisted of structured pre- and post-training surveys, and a course evaluation by participants. The second consisted of two focus group discussions involving purposively selected community health workers in one group, and a convenience sample of course instructors and organisers in the other. Perceptions regarding course content, perceived knowledge acquisition and self-confidence gain were analysed using descriptive statistics for the quantitative data and content analysis for qualitative data. Results: Course participants were predominantly male (76.3 %) with a median age of 42 years and most (80.5 %) had no prior first aid training. Most were satisfied that the learning objectives were reached, the logistics were adequate, and that the content and teaching language were appropriately tailored to local context. The majority (94.7 %) found the 3-day duration insufficient. There was a significant self-confidence gain regarding first aid skills (average 17.9 % in pre- to 95.3 % in post-training, p < 0.001). Favourable opinions on the course structure, content, logistics and teaching methods were noted. Conclusion: A CFAR course pilot was successfully conducted in Kinshasa. The course is appropriate for context and well received by participants. It can form a key component of developing prehospital care systems in resource-constrained settings.

Effect of Catechol-O-Methyltransferase Genotype on Self-Reported Efficacy and Activity Changes in the Brain Prefrontal Area in Response to a Caffeine Placebo / 医薬品情報学

Objective: The placebo effect can enhance the response to treatment, even in the absence of pharmacological ingredients. One possible factor explaining the likelihood of the placebo effect in individuals is genetic polymorphisms in neurotransmitters. This study focused on gene polymorphisms in the catechol-O-methyltransferase (COMT) as an interindividual variable of the placebo effect.Design・Methods: All 120 participants were explained the effects of caffeine, including its ability to ameliorate drowsiness and increase concentration, and then given a placebo (lactose). The onset of the placebo effect was measured in terms of the degree of caffeine-reduced sleepiness using subjective indices of the Stanford Sleepiness Scale (SSS) and a feeling of drowsiness-Visual Analogue Scale (VAS). The mechanism of the placebo effect was objectively examined in terms of changes in cerebral blood flow in the prefrontal cortex of the brain. In addition, we investigated participants’ susceptibility to the placebo effect by examining genetic polymorphisms in COMT.Results: After taking the drug, sleepiness on the SSS and VAS was significantly improved (p＜0.001), although there was no change in prefrontal cortex activity. Among the 120 participants, 63 had a Val/Val-type polymorphism in COMT (52.5%), 45 had a Val/Met-type (37.5%), and 12 had a Met/Met-type (10.0%). There were no significant differences among COMT gene polymorphisms in the subjective measures of SSS and VAS. However, there was a tendency for the cerebral blood flow changes to be larger in the left hemisphere of the brain in individuals with the Met/Met type.Conclusion: There seems to be a relationship between prefrontal cortex activity and genetic polymorphisms. In particular, there may be a correlation between the expression of a placebo effect and COMT gene polymorphisms.

The role of growth hormone in improving oocyte quality in IVF cycles

Background@#Growth hormone has been used as an adjunct in ovarian stimulation of IVF cycles for the past three decades. However, the exact mechanism of its role in improving oocyte quality has not been thoroughly investigated. Although a clear indication for GH co-treatment is in infertile women with GH deficiency, GH has been given mostly to poor ovarian responders.@*Method@#This paper is a review of the most recent published data on the role of GH supplementation in improving oocyte quality in younger women who are suboptimal or unexpected poor responders to standard ovarian stimulation.@*Results@#Retrospective cohort and randomized trials demonstrated an improvement in oocyte quality through morphological parameters, mitochondrial function, biomarkers, GH receptors, insulin growth factor, markers of oxidative stress, mature oocytes, good quality embryos, implantation rate, clinical pregnancy and live birth.@*Conclusion@#Current data suggest GH supplementation may improve oocyte and embryo qualities, endometrial receptivity, clinical pregnancy and live birth. However, better quality evidence is needed before a recommendation can be made for GH supplementation to be given to infertile women who are suboptimal or poor ovarian responders.

Impact of dispatcher-assisted cardiopulmonary resuscitation on survival after out-of-hospital cardiac arrest: A Meta-analysis / 中华急诊医学杂志

Objective:To evaluate the outcome of the patients receiving dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) delivered by first-responders who witnessed the out-of-hospital cardiac arrest (OHCA) before the Emergency Medical Service (EMS) arrived.Methods:We performed a search of the relevant literature exploring major scientific databases. We assessed the quality of the included cohort study according to the Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. Meta-analysis was performed on three outcome indicators (recovery of spontaneous circulation survival to hospital discharge and survival with favourable neurologic outcome) using the Revman5.3 software.Results:A total of 21 studies with 349 822 patients were selected for the meta-analysis, including 182 125 patients in the DA-CPR group and 167 697 in the CPR-only group. The meta-analysis showed no significant difference between the DA-CPR and CPR-only groups in ROSC [ RR=1.10, 95% confidence interval ( CI): 0.94-1.29, P=0.24], survival to hospital discharge ( RR=1.10, 95% CI: 0.90-1.34, P=0.34) and survival with favourable neurologic outcome ( RR=1.01, 95% CI: 0.79-1.28, P=0.97) of the patients in America, Japan and Korea. However, there was a significant difference between the DA-CPR and the CPR-only groups in ROSC ( RR=2.61, 95% CI:1.53-4.46, P=0.0005), survival to hospital discharge( RR=6.08, 95% CI: 1.84-20.04, P=0.003), and survival with favourable neurologic outcome( RR=9.76, 95% CI: 1.87-51.02, P=0.007) of the patients in China. Conclusions:The overall effect of DA-CPR is significantly different for each country. In detail, DA-CPR offers a survival advantage (Return of spontaneous circulation, survival to hospital discharge and survival with favourable neurologic outcome) over CPR alone in China but no advantage in developed countries.

Sondas de Discriminação na Avaliação da Aprendizagem de Relações Emergentes Nome-Objeto por Exclusão / Pruebas de Discriminación en la Evaluación del Aprendizaje de Relaciones Emergentes Nombre-Objeto por Exclusión / Discrimination Probes for Evaluating Learning of Emergent Name-Object Relations by Exclusion

Resumo O responder por exclusão é um padrão de resposta robusto, entretanto, a ocorrência regular da resposta que atesta a relação condicional nome-objeto não corresponde à aprendizagem consistente da relação. Este estudo visou avaliar a aprendizagem de relações nome-objeto, após a emergência da relação condicional no responder por exclusão, empregando sondas de discriminação as quais foram expostas 19 crianças, entre 14 e 25 meses. Discriminações condicionais nome-objeto com estímulos familiares foram ensinadas para compor a linha de base. Sondas controle, de exclusão e de discriminação verificaram respectivamente o controle pela novidade dos estímulos, a emergência da relação nome-objeto e a aprendizagem da relação emergente. Se não ocorresse a aprendizagem da relação emergente, inseria-se o ensino por exclusão. Seis participantes responderam por exclusão. Sondas de discriminação atestaram a aprendizagem de duas relações nome-objeto para três participantes. Um participante respondeu consistentemente com a aprendizagem de duas relações, após o ensino da relação nome-objeto emergente. As sondas de discriminação constituíram-se em medida efetiva da aprendizagem de relações emergentes nome-objeto por crianças pequenas.

Resumen La respuesta por exclusión es un patrón de respuesta robusta. Sin embargo, la ocurrencia regular de la respuesta que da cuenta de la relación condicional nombre-objeto no se corresponde al aprendizaje consistente de dicha relación. Este estudio tuvo como objetivo evaluar el aprendizaje de relaciones nombre-objeto, después de la emergencia de la relación condicional al responder por exclusión, utilizando ensayos de prueba de discriminación a las cuales fueron expuestos 19 niños, de entre 14 y 25 meses. Discriminaciones condicionales nombre-objeto con estímulos familiares se enseñaron para constituir la línea base. Las pruebas de control, exclusión y discriminación verificaron, respectivamente, el control por novedad de los estímulos, la emergencia de la relación nombre-objeto y el aprendizaje de la relación emergente. Si no ocurría el aprendizaje de la relación emergente, se inserta la enseñanza por exclusión. Seis participantes respondieron por exclusión. Las pruebas de discriminación mostraron el aprendizaje de las relaciones nombre-objeto para tres participantes. Un participante respondió consistentemente con el aprendizaje de dos relaciones, después de la enseñanza de la relación nombre-objeto emergente. Las pruebas de discriminación se constituyeron como una medida efectiva del aprendizaje de relaciones emergentes nombre-objeto para niños pequeños.

Abstract Responding by exclusion is a robust response pattern; however, regular occurrence of responses that attest the name-object conditional relation does not correspond to consistent learning of the relation. This study aimed to evaluate learning of name-object relations, after emergence of the conditional relation in responding by exclusion, through discrimination probes presented to 19 children between 14 and 25 months old. Familiar name-object conditional stimuli were taught as baseline. Control, exclusion, and discrimination probes found control by stimulus novelty, emergence of name-object relation, and learning of emergent relation, respectively. If the learning of the emergent relation did not occur, the teaching by exclusion was inserted. Six participants responded by exclusion. Discrimination probes attested learning of two name-object relations by three participants. One participant's responses were consistent with learning two relations after teaching of emergent name-object relations. Discrimination probes were found to be an effective measure for learning of emergent name-object relations by small children.

Aprendizagem de discriminação auditivo-visual a partir de uma única tentativa de exclusão com objetos tridimensionais / Learning auditory-visual discrimination from a single exclusion trial with three-dimensional objects

O responder por exclusão é um padrão consistente de comportamento descrito como a tendência em selecionar o objeto indefinido, entre outros definidos, diante de um nome indefinido. Como a relação nome-objeto nem sempre se mantém após uma tentativa, o objetivo deste estudo foi verificar o efeito da apresentação de características do objeto indefinido na aprendizagem. Foi solicitado que os participantes (10 crianças de 24 a 34 meses) selecionassem brinquedos correspondentes às palavras ditadas, dentre um conjunto (linha de base com objetos e palavras definidos); então, eram conduzidas sondas de exclusão e de verificação de aprendizagem. Características específicas dos objetos indefinidos eram demonstradas antes das sondas na Condição Com Demonstração (CD) e não ocorriam na Condição Sem Demonstração (SD). Oito crianças responderam por exclusão em todas as sondas; não houve diferenças significativas entre as condições na aprendizagem. Os dados sugerem que a demonstração de características do objeto não contribui para a aprendizagem.

Responding by exclusion is a consistent pattern of behavior described as the tendency to select the undefined object, among other defined, to an undefined name. Since the relationship (object name) does not always hold after a trial, the aim of this study was to investigate the effect of presentation of the undefined object characteristics in learning. It was requested that participants (10 children 24-34 months) choose a toy to the word dictated, among a set (baseline with defined objects and words); then, were conducted exclusion and learning probes. Features of the undefined object was demonstrated before the probes in Condition CD and did not occur in Condition SD. Eight children accounted for exclusion in all probes; there was no difference in learning probes. The data suggest that the demonstration of the object’s features does not contribute to learning.

Intraocular Pressure Elevation after 0.7 mg Intravitreal Dexamethasone (Ozurdex(R)) Implantation: A One Year Follow-Up

PURPOSE: To investigate the percentage and time of intraocular pressure (IOP) elevation and the factors influencing IOP elevation and treatment. METHODS: Thirty patients (33 eyes) who received intravitreal dexamethasone implantation from July 2012 to December 2013 and followed up more than 1 year were evaluated by measuring Goldmann IOP and confirming changes in IOP. The definition of IOP elevation was IOP above 20 mm Hg or IOP increase greater than 6 mm Hg. RESULTS: In 16 eyes (48.5%), IOP was elevated after intravitreal dexamethasone implantation. The first IOP elevation was mean 2.0 +/- 0.7 months. In 21 eyes which received intravitreal dexamethasone implantation more than twice, the mean intervals of implantation were 4.5 months. In steroid responders, IOP after dexamethasone implantation was significantly increased at 1, 2, 3, 6, and 7 months. IOP increase in the treated eye was significant at 1, 2, 3, 5, and 7 months after dexamethasone implantation. CONCLUSIONS: After intravitreal dexamethasone implantation, IOP was highest at 2 months. Additionally, IOP was elevated in approximately half of the patients (48.5%). Although the intravitreal dexamethasone implantation is effective against various diseases which occur due to macular edema, thorough identification of suitable patients and frequent IOP control is necessary for long-term treatment.

Molecular evolution and expression profile of the chemerine encoding gene RARRES2 in baboon and chimpanzee

BACKGROUND: Chemerin, encoded by the retinoic acid receptor responder 2 (RARRES2) gene is an adipocytesecreted protein with autocrine/paracrine functions in adipose tissue, metabolism and inflammation with a recently described function in vascular tone regulation, liver, steatosis, etc. This molecule is believed to represent a critical endocrine signal linking obesity to diabetes. There are no data available regarding evolution of RARRES2 in non-human primates and great apes. Expression profile and orthology in RARRES2 genes are unknown aspects in the biology of this multigene family in primates. Thus; we attempt to describe expression profile and phylogenetic relationship as complementary knowledge in the function of this gene in primates. To do that, we performed A RT-PCR from different tissues obtained during necropsies. Also we tested the hypotheses of positive evolution, purifying selection, and neutrality. And finally a phylogenetic analysis was made between primates RARRES2 protein. RESULTS: RARRES2 transcripts were present in liver, lung, adipose tissue, ovary, pancreas, heart, hypothalamus and pituitary tissues. Expression in kidney and leukocytes were not detectable in either species. It was determined that the studied genes are orthologous. CONCLUSIONS: RARRES2 evolution fits the hypothesis of purifying selection. Expression profiles of the RARRES2 gene are similar in baboons and chimpanzees and are also phylogenetically related.

Evaluation of IL-10 and IL-12B Gene Polymorphisms on the Response to the Standard of Care Therapy in Chronic Hepatitis C Patients: An Egyptian Cohort Study.

Background: Interleukin-10 (IL-10) and IL–12B single nucleotide polymorphisms (SNPs) are confirmed to influence the natural history of hepatitis C virus (HCV) infection, and the response to treatment. This work aimed at evaluating the impact of SNPs in IL-10 gene at positions _1082, _819, and_592 and IL-12B gene on the response to the standard of care (SOC) treatment in Egyptian patients with chronic HCV. Methods: Eighty seven patients with chronic HCV treated by SOC therapy and 20 healthy controls were tested for SNPs in IL-10 at _1082 G/A, _819 C/T and_592 C/A and in IL- 12B (30-UTR 1188-A/C) by polymerase chain reaction (PCR). Patients were divided according to their virologic response into 2 groups; group Ι=patients who achieved sustained virologic response (SVR) and group Π = non responder (NR) patients. Results: SNPs of IL-10 at _1082 G/A and_819 C/T showed that; GA and TT genotypes were significantly related to SVR (P=0.001 and 0.007 respectively). IL-12 genepolymorphisms showed that; CC genotype was significantly related to SVR group (P=0.01) while AA genotype was significantly related to NR (P=0.01). Conclusions: Studying SNPs of IL-10_1082 G/A, IL-10_819 C/T and IL-12B (30-UTR 1188-C/A) proved GA, TT and CC genotypes, respectively, to be good predictors for SVR. Conversely, SNPs of IL-12 C/A proved AA genotype to be good predictor for NR.

The effect of aromatase inhibitor letrozole incorporated in gonadotrophin-releasing hormone antagonist multiple dose protocol in poor responders undergoing in vitro fertilization

OBJECTIVE: To evaluate whether letrozole incorporated in a gonadotrophin-releasing hormone (GnRH) antagonist multiple dose protocol (MDP) improved controlled ovarian stimulation (COS) and in vitro fertilization (IVF) results in poor responders who underwent IVF treatment. METHODS: In this retrospective cohort study, a total of 103 consecutive IVF cycles that were performed during either the letrozole/GnRH antagonist MDP cycles (letrozole group, n=46) or the standard GnRH antagonist MDP cycles (control group, n=57) were included in 103 poor responders. COS results and IVF outcomes were compared between the two groups. RESULTS: Total dose and days of recombinant human follicle stimulating hormone (rhFSH) administered were significantly fewer in the letrozole group than in the control group. Duration of GnRH antagonist administered was also shorter in the letrozole group. The number of oocytes retrieved was significantly higher in the letrozole group. However, clinical pregnancy rate per cycle initiated, clinical pregnancy rate per embryo transfer, embryo implantation rate and miscarriage rate were similar in the two groups. CONCLUSION: The letrozole incorporated in GnRH antagonist MDP may be more effective because it results comparable pregnancy outcomes with shorter duration and smaller dose of rhFSH, when compared with the standard GnRH antagonist MDP.

Drug Induced Sleep Endoscopy for Poor-Responder to Uvulopalatopharyngoplasty in Patient with Obstructive Sleep Apnea Patients / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The purpose of this study is to evaluate drug-induced sleep endoscopy (DISE) findings in patients with persistent obstructive sleep apnea (OSA) after uvulopalatopharyngoplasty (UPPP) surgery. SUBJECTS AND METHOD: Patients were included in this study if they had a postoperative DISE evaluation as well as pre- and postoperative polysomnography. DISE findings included the obstructive sites (velum, oropharyngeal lateral walls, tongue base, and epiglottis), and the obstructive patterns of velopharynx (anteroposterior, lateral, and concentric). RESULTS: A total of 77 patients were included in this study. Poor-responder patients to UPPP (n=50) and well-responder patients to UPPP (n=27) were similar with regard to age, gender, body mass index, preoperative AHI, and minimal O2 saturation. In our analysis of DISE findings on poor-responder, velopharynx was the most common obstruction site (100%), followed by oropharynx (88%), tongue base (70%), and epiglottis (44%). Results showed that most patients (n=49) had multiple obstructive sites. No significant differences according to position dependency and REM dependency were found in obstructive sites. However, severe OSA patients had tongue base obstruction more frequently than the moderate OSA patients did. The obstructive pattern of velopharynx usually showed concentric configuration (70%, 35 of 50). CONCLUSION: Our results suggest that the preoperative DISE may be a useful method for determination of the personalized surgery to OSA patients because of its more precise information to upper airway obstruction.

Emergência de leitura em crianças com fracasso escolar: efeitos do controle por exclusão / Emergence of reading in children with school failure: effects of control by exclusion

Em estudo prévio, crianças jovens responderam por exclusão em um procedimento de escolha de acordo com modelo (MTS), mas não aprenderam todas as relações entre nomes e objetos após uma única tentativa. Com objetivo de investigar a escolha por exclusão no ensino de leitura de palavras em um contexto de brincadeira após uma única tentativa, e testar a eficácia desse procedimento para o desenvolvimento de leitura de palavras formadas pela recombinação de sílabas, cinco crianças com histórico de fracasso escolar foram submetidas ao procedimento de MTS. Todos os participantes escolheram por exclusão, aprenderam novas relações condicionais entre palavra ditada e palavra impressa em uma única tentativa e foram capazes de ler parte das palavras do teste de generalização. Esses resultados apontam que responder por exclusão em um procedimento de MTS foi eficaz para: ensinar relações condicionais em uma única tentativa e estabelecer o controle parcial pelas unidades silábicas.

In a previous study children responded by exclusion in a matching to sample procedure (MTS), but not all learned the relationships between names and objects after a single exclusion trial. Aiming to investigate exclusion responding on teaching to read words in a play setting after a single exclusion trial, and test the efficacy of this procedure to develop reading words formed by the recombination of syllables, five children with a history of school failure were submitted to a MTS procedure. All participants chose by exclusion, learned new conditional relations between written words and spoken words after a single exclusion trial, and were able to read some of the words of the generalization test. These results show that responding by exclusion on a MTS procedure was effective to: teach new conditional relations in a single trial, and to establish partial control by syllables.

Efectos en la dsstribución temporal de la respusta as0ciados a la variación enn la probabilidad de entrega de agua en programas señalados: análisis del tipo de contacto y ajuste a relaciones de contingencia tempoaal / Effects n temporral distribution of response associated with the variation in the probability of water deliverty using stimuli-correlated temporal schedules: analysis of the type of contact and adjustment to temporal contingency relations

Se evaluaron los efectos de manipular los valores de P en la distribución temporal del responder bajo programas temporales. Se utilizaron 6 ratas albinas experimen-talmente ingenuas las cuales se dividieron en dos grupos. Cada uno de los grupos se expuso a un programa temporal de distinta longitud. El Grupo 1 T= 30 s., el Grupo 2 T=120". Cada grupo se expuso a cuatro fases distintas. El parámetro P se manipuló entre fases en los valores de 1.0, 0.5 y 0.1. Durante las fases experimentales se entregó agua de manera contingente al responder de las ratas de acuerdo al valor de P. En las primeras tres fases se señalizaron de manera diferencial los subintervalos de ∂t y Δt. Durante la fase cuatro (redeterminación de P a 1.0), la señalización se eliminó en ambos subintervalos. Posterior a las fases experimentales las ratas se sometieron a sesiones de sondeo en las cuales la entrega de agua fue independiente al responder. En la medida que los programas temporales prescriben contingencias temporales respecto de las ocurrencias de respuestas y eventos de estímulo, los resultados se analizan en términos de la modulación de las propiedades temporales de dichos eventos. En este sentido, se evidenciaron diferencias en la distribución temporal de las respuestas efectivas e inefectivas bajo condiciones de señalización y no señalización. Se analizan los resultados en términos del tipo de ajuste a las contingencias de ocurrencia característica de los programas definidos temporalmente, además se sugiere que los programas definidos temporalmente representan una herramienta metodológica pertinente para el análisis de las funciones contextual y suplementaria sugeridas por Ribes y López (1985).

One study was conducted to evaluate the effects of manipulating the values of P on performance under temporal defined schedules. It was used 6 experimentally naive albino rats that were divided into two groups. Each group was exposed to a temporal defined schedule with different cycle length. Group 1 was T = 30 s. and Group 2 was T = 120 s. Each group was exposed to four distinct experimental phases. The parameter P was manipulated between phases with the values of 1.0, 0.5 and 0.1. The first three phases the subintervals ∂t and Δt were signaled differentially. During the phase fourth (redetermination), signaling was eliminated in both subintervals. The results suggest that the T-cycle length determines the response patterns. In addition, differences were observed in temporal properties of effective and ineffective responses under signaling and no signaling conditions. The results were analyzed in terms of type of the behavioral adjustment to occurring contingencies featured into temporal defined schedules. We suggest that this procedure represent a relevant methodological tool for analyzing the contextual and supplementary functions suggested by Ribes and Lopez (1985).

Whether Alzheimer's Disease is Responsive to a Single Oral Dose of Donepezil and this Response is Predictive Factor in Alzheimer's Disease

OBJECTIVES: Though a proportion of Alzheimer's disease(AD) patients treated with donepezil have shown positive response on cognition, but the responders' characteristics are still uncertain. This study attempts to identify whether a single oral dose of donepezil(5mg) can change cognition and the relationship between single dose responder items and long-term responder are examined. METHODS: Twenty-three AD patients for single donepezil challenge study group and eleven AD patients for controls were participated in the study. Seven days after baseline study for neuropsychological test and EEG, same studies were rechecked after donepezil medication in study group. In donepezil study groups, 12 weeks after donepezil medication, neuropsychological test and EEG were rechecked. RESULTS: After single donepezil challenge, forward digit span, Rey-Osterrieth Complex Figure Test copy, SVLT delayed recall were significantly improved, and beta spectra power in anterior, theta spectra power in posterior field were significantly decreased. According to linear regression analysis, forward digit span after single donepezil challenge was significantly positive correlated with long-term responders. CONCLUSIONS: This study suggests that single donepezil medication can significantly change cognitive functions and EEG in AD patients. Among these responsive items, forward digit span was significantly correlated with long-term responder.

Anatomical Non-Responder to Intravitreal Bevacizumab for Neovascular Age-Related Macular Degeneration

PURPOSE: To analyze the characteristics of anatomical non-response to intravitreal bevacizumab (IVB) in patients with neovascular age-related macular degeneration (AMD). METHODS: Neovascular AMD patients who were treated with IVB were studied. A non-responder was defined as a patient whose eyes had no change in choroidal neovascularization (CNV) lesion size or fluorescein leakage and no change in foveal thickness (FT) after at least two administrations of IVB. Demographic findings and efficacy outcomes were compared between responders and non-responders based on patient gender, age, visual acuity (VA), FT, CNV lesion type, CNV lesion size, presence of serous retinal detachment (SRD), presence of pigment epithelial detachment (PED), PED size, and presence of sub-macular hemorrhage (SMH). RESULTS: Five patients (six eyes; 13.6%) were identified as non-responders to treatment with IVB. The mean age of the non-responder group (75.17 +/- 3.66 yers) was greater (p = 0.237) than that of the responder group (71.89 +/- 8.06 years), and the proportion of occult CNV (85.7% versus 55.3%, p = 0.375) was higher in the non-responder group, although there was no significant difference compared with that of the responder group. The PED size of the non-responder group (4.42 +/- 1.56 mm2) was significantly larger than that of the responder group (1.51 +/- 2.33 mm2, p = 0.001). CONCLUSIONS: The authors report a group of patients in AMD with poor treatment response to IVB. The PED size of the non-responder group was confirmed to be significantly larger than that of the responder group.

Adquisición del responder bajo condiciones de reforzamiento demorado en programas temporales señalados / Response acquisition under signaled delay of reinforcement in temporally defined schedules

El estudio se diseñó con el propósito de evaluar los efectos de diferentes duraciones de demora de reforzamiento sobre la adquisición de la respuesta de presión de la palanca en ratas, empleando un programa definido temporalmente señalado. Manteniendo un ciclo T constante (64 s), para cada tres ratas se empleó una duración de demora de reforzamiento (8,24 y 56 s) que resultó de variar la posición temporal del subciclo Td al interior del ciclo T (intervalo Td-T). Se encontraron tasas de respuesta que variaron sistemáticamente en función de la duración del intervalo de demora. Los resultados se discuten atendiendo a la tasa de respuesta y a la efectividad del responder como medidas de adquisición.

A temporally defined schedule of delayed reinforcement was used to establish lever pressing by rats. A constant 8 s Td subinterval was introduced at different temporal locations into reinforcement cycle (64 s). The first response during Td produced reinforcement at the end of the cycle. Varying the temporal location of Td generated reinforcement delays of either 8 s, 24 s or 56 s. Three rats each were assigned to different delay duration. Response rates were considerably lower when Td was at the beginning of the cycle (56 s) than when the opportunity to respond was at the middle (24 s) and its end (8 s). The results are discussed focusing in the response rates and the convenience of responses per reinforcement proportion as an effectiveness acquisition measure.

Seroconvertion to hepatitis B vaccine after weight reduction in obese non-responder

Decreased responses to hepatitis B vaccine have been associated with some host conditions including obesity. Susceptible non-responders to a primary three-dose vaccine series should be revaccinated. Those who maintain a non-responder condition after revaccination with three vaccine doses are unlikely to develop protection using more doses. This is a description of an obese woman who received six doses of hepatitis B vaccine and persisted as a non-responder. She was submitted to a vertical banded gastroplasty Roux-en-Y gastric bypass Capellas's technique. After weight reduction, she received three additional doses of vaccine and seroconverted. Further studies should help clarify the need to evaluate antibody levels and eventually revaccinate the increasing population of individuals who undergo weight reduction.

A diminuição da resposta à vacinação contra hepatite B já foi relacionada a algumas condições clínicas, inclusive à obesidade. Indivíduos que não responderam à série de três doses devem ser revacinados. Caso continuem não-respondedores após duas séries de vacina, não há indicação de doses adicionais. Esta é a descrição de mulher obesa que não havia soroconvertido após ter recebido seis doses de vacina contra hepatite B. Ela foi submetida à gastroplastia em Y de Roux, pela técnica de Capella. Após a redução de peso, a paciente recebeu mais três doses de vacina contra hepatite B e soroconverteu. Novos estudos poderão indicar a necessidade de avaliação de níveis de anticorpos contra antígenos vacinais e eventualmente revacinar esta população cada vez maior de pacientes que se submetem à cirurgia para redução de peso.

Effect of Lamivudine Treatment on Chronic Hepatitis B Infection in Children Unresponsive to Interferon / 대한소아소화기영양학회지

PURPOSE: Interferon is a widely used treatment for chronic hepatitis B in children. However, additional treatment options are needed because more than 50% of hepatitis B patients are unresponsive to interferon. Although lamivudine is widely used to treat hepatitis B, there are few studies on the effect of lamivudine in hepatitis B patients unresponsive to interferon. METHODS: Eight interferon unresponsive patients (6 males and 2 females) were treated with lamivudine (3 mg/kg/day, maximum 100 mg/day) from 6~12 months after interferon treatment was discontinued among 33 children with chronic hepatitis B. They were treated with interferon (interferon alpha-2b, 10 MU/m2 or pegylated interferon 1.5 microgram/kg) for 6 months from January 2000 to December 2007 at the Pusan National University Hospital. The medical records were analyzed retrospectively. RESULTS: The age at treatment with interferon and lamivudine was 4.9+/-3.1 and 6.1+/-3.2 years, respectively. The serum ALT level before treatment with interferon was 148.1+/-105.8 IU/L and the log HBV-DNA PCR mean value was 6.95+/-0.70 copies/mL. The serum ALT level after treatment with interferon was 143.1+/-90.4 IU/L and the log HBV-DNA mean PCR value was 6.46+/-2.08. HBeAg negativization occurred in 2 patients. For all patients, normalization of the serum ALT levels and HBeAg seroconversion (except 2 patients with HBeAg negativization) occurred at 7.4+/-2.1 and 7.9+/-2.1 months respectively after lamivudine treatment. The HBV-DNA PCR became negative in 7 patients (87.5%) at 2.4+/-2.8 months. Complete response was achieved in 7 patients and no recurrence was observed in 2 patients for 3 years after the completion of treatment. Five patients are still under treatment for a mean treatment duration of 24.4+/-9.1 months. In one patient, viral breakthrough occurred and the treatment was stopped. CONCLUSION: The number of patients was small, however, lamivudine treatment in patients with chronic hepatitis B who were unresponsive to interferon was highly effective.

Responder por exclusão em crianças de 2 a 3 anos em uma situação de brincadeira / Exclusion responding by 2 to 3 year-old children in a play setting

O responder por exclusão, que se supõe ser um dos mecanismos pelos quais crianças aprendem a relacionar palavras novas a objetos ou eventos, tem sido amplamente replicado em situação de laboratório. O presente estudo, conduzido com seis crianças, teve por objetivo investigar o responder por exclusão em um contexto de brincadeira, com estímulos manipuláveis, e verificar se este contexto favorece a aprendizagem da relação nome - objeto, após uma única tentativa de exclusão. Em cada tentativa o experimentador falava o nome de um brinquedo conhecido e a tarefa da criança era pegá-lo e jogá-lo dentro de uma caixa grande, disposta à frente da criança. Em meio a essas tentativas, eram introduzidas três sondas de exclusão (o nome falado era novo e havia um brinquedo novo exposto no ambiente); três outras sondas verificavam se a relação entre o nome e o brinquedo havia sido aprendida. Todas as crianças responderam por exclusão, mas somente uma mostrou aprendizagem após uma única tentativa.

Laboratory studies have repeatedly replicated the phenomenon of exclusion responding, which has been assumed as one of the mechanisms by which children learn to relate novel words to objects or events. The present study, conducted with six children, aimed to investigate exclusion responding in a play setting, with stimuli that could be manipulated, and to verify whether the play setting would favor learning of the relationships between names and objects after a single exclusion trial. In several trials the experimenter spoke the name of a familiar toy and the child's task was to pick this toy up and throw it into a box, placed in front of the child. Three exclusion probes were interspersed among these trials (the spoken name was novel and there was a novel toy available); three other probes verified whether the relationships between the novel name and the toy had been learned. All children responded by exclusion but only one of them demonstrated learning the relationships in a single trial.

Statistical Analysis of the Findings in Patients Responded to Goshuyuto / 日本東洋医学雑誌

The purpose of this study was to reevaluate the sho of goshuyuto, which has been established in an unscientific manner, and to create a new concept of the sho of goshuyuto. Eighty-four patients suffering from chronic headache were instructed to orally consume 7.5g. day of a spray-dried powder of goshuyuto (TJ-31) for 4 weeks. Before consuming the TJ-31, all subjects underwent Kampo examinations that were based on 43 diagnostic items. After the 4-week period of medication, all the subjects were classified as either responders or nonresponders. After excluding insignificant items from the 43 diagnostic items, discriminant analysis, which discriminated between responders and nonresponders, was conducted. Of the 80 subjects who completed the trial period, 57 were judged to be responders and 23 to be nonresponders. “Cold feet,” “fluid and gas retention in the stomach,” “kyokyo-kuman,” “tenderness at side of navel,” and “pulsation at abdomen” were selected by stepwise selection. The results of the discriminant analysis using these 5 items suggest that 28 subjects were misclassified and that the misclassification rate was 35%. Of the actual 23 nonresponders, 20 were accurately discriminated as nonresponders. The 5 selected items are suggested to be more useful in selecting the nonresponders than the responders. In conclusion, the empirically established sho of goshuyuto seemed to not be abele to completely explain the indication of goshuyuto. However, the inclusion of “tenderness at side of navel” and “pulsation at abdomen,” as new components comprising the sho of goshuyuto, may facilitate a more accurate indication of goshuyuto.