Indentation as a technique to assess the mechanical properties of fallback foods.

A number of living primates feed part-year on seemingly hard food objects as a fallback. We ask here how hardness can be quantified and how this can help understand primate feeding ecology. We report a simple indentation methodology for quantifying hardness, elastic modulus, and toughness in the sense that materials scientists would define them. Suggested categories of fallback foods-nuts, seeds, and root vegetables-were tested, with accuracy checked on standard materials with known properties by the same means. Results were generally consistent, but the moduli of root vegetables were overestimated here. All these properties are important components of what fieldworkers mean by hardness and help understand how food properties influence primate behavior. Hardness sensu stricto determines whether foods leave permanent marks on tooth tissues when they are bitten on. The force at which a food plastically deforms can be estimated from hardness and modulus. When fallback foods are bilayered, consisting of a nutritious core protected by a hard outer coat, it is possible to predict their failure force from the toughness and modulus of the outer coat, and the modulus of the enclosed core. These forces can be high and bite forces may be maximized in fallback food consumption. Expanding the context, the same equation for the failure force for a bilayered solid can be applied to teeth. This analysis predicts that blunt cusps and thick enamel will indeed help to sustain the integrity of teeth against contacts with these foods up to high loads.

Evaluation of body mass index percentiles for assessment of malnutrition in children with cystic fibrosis.

OBJECTIVE: To compare the performance of recently released body mass index percentiles (BMIp) with standard anthropometric indexes, including height-for-age percentile (HAP), weight-for-age percentile (WAP) and percent ideal body weight (%IBW), as measures for nutritional failure in children with cystic fibrosis (CF). DESIGN: Cross-sectional analysis of growth and lung function data from 4577 children with CF reported to the German CF quality assurance (CFQA) project from 1995 to 2004. RESULTS: Frequency distribution of HAP (mean+/-s.d.: male 30.0+/-27.5; female 31.3+/-27.4) and WAP (male 28.9+/-27.0; female 29.6+/-26.7) were skewed, with significant numbers of patients below the fifth percentiles of a healthy reference population. However, because deficits occurred in both measures simultaneously, mean %IBW (male 97.0+/-12.1; female 98.1+/-12.3) assumed subjects weight close to the nominal weight-for-height at all ages. In contrast, mean BMIp was markedly reduced (male 35.7+/-27.9; female 35.6+/-27.2) and steadily declined with age. Ideal weight-for-age was significantly lower when predicted by %IBW compared with BMIp method, particularly in subjects with shorter-than-average stature. Consequently, less CF children were identified with nutritional failure according to %IBW method (male 20.5%; female 22.7%) compared with BMIp method (male 30.4%; female 28.7%). The clinical relevance of these findings was confirmed by stronger correlation of BMIp with impaired %forced expiratory volume/s, a marker for disease progression in CF. CONCLUSION: BMIp predicts nutritional failure more sensitively and accurately than conventional anthropometric indexes, at least in children with CF. Screening of CF patients by BMIp could provide an early warning sign and allow for timely therapeutic intervention.

Pulmonary fibrosis and other clinical manifestations of small vessel vasculitis in a family with seropositive juvenile rheumatoid arthritis.

We report on a family (mother, daughter, and son) suffering from progressive pulmonary fibrosis associated with deforming arthritis, sinusitis, glomerulonephritis, and cutaneous vasculitis. We suggest that these clinical features display the variable expressions of small-vessel vasculitis in juvenile rheumatoid arthritis.

[Mucoviscidosis screening of newborn infants in the Dresden district. Results from 1 June 1996 to 31 March 2000]. / Mukoviszidose-Screening bei Neugeborenen im Regierungsbezirk Dresden. Ergebnisse vom 1.6.1996 bis zum 31.3.2000.

PROBLEM: Cystic fibrosis (CF) is the most common congenital defect of metabolism in Europe. Therefore we tried to detect this disease as early as possible before clinical symptoms occur. Thus early diagnosis can be the basis for an early start of treatment. PATIENTS AND METHODS: As part of a complete neonatal screening program in our region we investigated the concentration of immuno-reactive trypsin (IRT) in dried blood samples. Genomic investigation of the same blood sample for the most common CF mutations was performed when a critical value of IRT was exceeded. RESULTS: From 6/1996 until 3/2000 (46 months) we investigated the blood of 49,926 newborn children. Due to a high IRT value (> 70 ng/ml) in 579 cases, a genomic investigation was performed. In 38 children we detected one of the three most frequent CF mutations (delta F508, G551D, R553X) by polymerase chain reaction (PCR). The sweat test (pilocarpine iontophoresis) confirmed cystic fibrosis in 8 newborns. Four times a homocygocity for the mutation delta F508 was found and four times a compound heterocygocity (one time delta F508/R553X und three times delta F508/others). Only three of these eight CF patients already had clinical symptoms of the disease at this time, only in one case had this diagnosis been considered. An additional newborn with meconium ileus had been diagnosed as cystic fibrosis before performing the screening. Up to now we have not found any case of false negative testing. CONCLUSION: We found this procedure of neonatal testing practicable and therefore recommend its continuation. The genomic test should include the search for additional CF mutations. As alternative method a second IRT-test should be considered at the end of the first month of life for those children with initial IRT-concentrations above 150 ng/ml and without evidence of the three tested CFTR-mutations.

Quality of life in patients with cystic fibrosis and their parents: what is important besides disease severity?

BACKGROUND: Cystic fibrosis is the most common inherited disease with a fatal outcome in industrialised nations. With the improvement in life expectancy, supporting patients and their families in adapting to life with this chronic progressive disease has become increasingly important. The aim of the present study was to investigate the relationship between health related quality of life (HRQOL) in this population, severity of disease, and cognitive/behavioural factors such as subjective health perception and ways of coping. METHODS: A sample of 89 adolescent and adult patients with cystic fibrosis and 125 parents of younger patients with cystic fibrosis completed questionnaires on health related quality of life and on ways of coping with the illness. Parents were asked to fill out the questionnaires regarding their own quality of life and coping. Multiple regression analyses were performed to examine the relationship between different predictor variables and quality of life. RESULTS: After accounting for the impact of disease severity and hours of treatment per day, the subjective health perception of patients significantly explained variance in their quality of life. Ways of coping were also significantly correlated with HRQOL. In parents the most important factor in explaining variance of HRQOL seems to be the coping style, whereas disease severity of the child and subjective health perception did not show any influence. CONCLUSIONS: The findings support the important role of cognitive and behavioural factors in specific subjective health perception and ways of coping in the adaptation to this severe chronic disease, both in patients themselves and in parents. The results call for a careful assessment of issues of coping and professional support for families of patients with cystic fibrosis in the early course of disease.

[Noninvasive nocturnal nasal mask ventilation (NIPPV) in childhood and adolescence. Dresden experiences with 11 patients]. / Nichtinvasive nächtliche nasale Maskenbeatmung (NIPPV) im Kindes- und Jugendalter. Dresdener Erfahrungen mit elf Patienten.

BACKGROUND: There are only small experiences with mechanical ventilation via nasal mask in childhood. PATIENTS AND METHODS: Eleven patients using NIPPV (9 patients aged 4 to 18 years and 2 patients with cystic fibrosis aged 20 and 25 years). RESULTS: NIPPV was effective in all 11 patients. Seven patients needed supplemental oxygen. Theophyllin, Almitrin and Salbutamol could support the nasal ventilation in special conditions. CONCLUSION: Intermittent ventilation via nasal mask is a noninvasive and effective treatment of chronic respiratory failure in childhood. Monitoring with continuous pulse-oximetry is necessary.

Restoration of extensor excitability in the acute spinal cat by the 5-HT2 agonist DOI.

1. The decerebrate cat preparation with an intact spinal cord is characterized by a high degree of excitability in extensor motoneuron pools, which is eliminated by acute spinalization. Subtype-specific agonists for serotonin (5-HT) were investigated in terms of their effectiveness in restoring the extensor excitability following spinalization. 2. Our hypothesis was that 5-HT2 receptors have the primary role in enhancement of extensor reflex excitability, whereas 5-HT1A and 5-HT1B/D receptors are relatively unimportant. Reflex excitability was assessed from the tonic levels of force and electromyographic (EMG) output from the ankle extensors medial gastrocnemius (MG) and soleus (SOL), and from the reflex forces in both these muscles generated by ramp-and-hold stretches of MG. 3. Before spinal transection, MG and SOL usually exhibited a small amount of tonic background EMG activity and force output. Ramp-and-hold stretch of MG generated a large-amplitude reflex response. Spinal transection at the level of T10 virtually abolished tonic background activity in both extensors and greatly attenuated the MG stretch reflex. Ventral topical application of the selective 5-HT2A/2C agonist (+-)-1-(2,5-dimethoxy-4-iodophenyl)-2-amino-propane hydrochloride (DOI) restored the amplitude of the MG stretch reflex in a dose-dependent fashion. However, a considerable portion of the DOI-mediated restoration of MG stretch reflex force was due to elevation of tonic background force levels above previous intact cord levels. 4. The DOI-induced increase in extensor tonic background excitability and facilitation of MG stretch reflex were reversed by ventral topical administration of the selective 5-HT2 antagonist ketanserin. No increase in extensor excitability was observed in spinalized preparations after administration of either the 5-HT1A agonist (+-)-8-hydroxy-dipropylaminotetralin hydrobromide or the 5-HT1B/1D agonist 7-trifluoromethyl-4-(4 methyl-1-piperazinyl)-pyrrolo[1,2- a]quinoxaline maleate. These data strongly suggest that the DOI-induced facilitation of extensor stretch reflex and tonic activity in spinalized preparations is mediated through an action on spinal 5-HT2 receptors. 5. One important difference between the actions of DOI in spinalized versus intact states was that the DOI-induced tonic and reflex forces in the spinalized state were subject to irregular oscillations. In contrast, DOI did not noticeably affect the smoothness of reflex force generation in the intact state. This discrepancy was probably due to the effects of clasp knife inhibition from muscular free nerve endings, which have potent reflex actions in the spinalized but not intact states. Thus DOI elevated excitability levels but did not alter the effects of spinalization on stretch reflex patterns.

[Allergic bronchopulmonary aspergillosis (ABPA) in patients with cystic fibrosis (CF): clinical significance, diagnosis and therapy]. / Die allergische bronchopulmonale Aspergillose (ABPA) bei Patienten mit Mukoviszidose (CF): Klinische Bedeutung, Diagnostik und Therapie.

Intermittent or long term treatment with antibiotics, progredient destruction of the lungs as well as dystrophy of individuals are predisposing factors for the colonization of the respiratory tract with Aspergillus fumigatus in CF patients. Allergic bronchopulmonary aspergillosis (ABPA) is a significant problem in CF patients. It has been reported with an incidence of 10%. The diagnosis of ABPA in patients with CF is difficult since it is common for both diseases to have several of the same clinical and laboratory features. Prednisolone with an initial dose of between 0,5-1,0 mg/kg/day remains the treatment of choice for ABPA. The doses reduction and the duration of the treatment depend on clinical findings and on serum IgE levels.

5-HT1B/1D agonist CGS-12066B attenuates clasp knife reflex in the cat.

1. The effect of intrathecal injection of the selective serotonin (5-HT)1B/1D receptor agonist CGS-12066B maleate (825 nmol) was assessed on stretch-evoked clasp knife inhibition of hindlimb ankle extensor muscle reflex force in precollicular decerebrate cats in which neural transmission in dorsolateral spinal pathways was blocked bilaterally by focal cooling. 2. During cold block, ramp and hold stretches of the medial gastrocnemius muscle (MG) evoked only a brief reflex excitation that was followed by powerful, long-lasting inhibition (the clasp knife reflex). Both the amplitudes of peak force evoked by the ramp and sustained force output during the last 500 ms of the hold phase of the stretch were depressed by > 50%. 3. Reflex force output during the hold portion of stretch was significantly improved on postdrug cold block trials, although peak force remained depressed. CGS-12066B did not significantly alter stretch-evoked force output in decerebrate cats when spinal cord neural transmission was unimpaired. 4. These data suggest that selective 5-HT1B/1D agonists may be of therapeutic usefulness in the treatment of reflex disorders arising from partial spinal cord injury.

Effect of reversible dorsal cold block on the persistence of inhibition generated by spinal reflexes.

The effects of bilateral focal cooling of dorsolateral thoracic spinal cord on segmental reflex pathways to the triceps surae muscles were assessed in decerebrate cats from the reflex forces produced by single shocks or trains of electrical stimuli applied to the ipsilateral caudal cutaneous sural and the contralateral tibial nerves. The validity of the dorsal cold block technique as a substitute for acute surgical dorsal hemisection was established by showing that focal cooling reliably reproduced the stretch-induced "clasp knife" inhibition of triceps surae reflexive force seen following dorsal hemisection. Under control (warm) conditions, the inhibitory components of electrically evoked ipsilateral sural and contralateral tibial reflexes faded rapidly during sustained trains, with a resultant production of large-amplitude reflex force as measured from either the entire triceps surae or from the medial gastrocnemius muscle alone. Dorsal cold block greatly reduced the amplitude of reflexive force evoked by sustained electrical stimulation of either nerve. Indeed, the cold block completely reversed the sign of train-evoked reflexes to a net inhibition of reflex force output in one-half of the sural and one-half of the contralateral tibial stimulation experiments. Peak transient forces evoked by single shocks to the sural or contralateral tibial nerves were also sometimes reduced, but this result was more variable than for prolonged nerve stimulation. The persistence of activity in segmental inhibitory pathways during dorsal cold block, as indicated by instances of reflex sign reversal, suggests that descending bulbospinal pathways traversing the dorsolateral funiculi may be responsible for "fading" of segmental inhibitory reflex components in decerebrate cats with intact spinal cords during sustained afferent input. The possibility that the enhanced magnitude and duration of segmental inhibition during cold block will increase the likelihood of disruption of the size principle for motoneuron recruitment is also discussed.

Reduction in postsynaptic inhibition during maintained electrical stimulation of different nerves in the cat hindlimb.

1. Steady-state postsynaptic potentials (PSPs) were generated by prolonged (approximately 1 s) high-frequency (100-200 Hz) electrical stimulation of nerves in the cat hindlimb. The characteristics of these steady-state PSPs were compared for two polysynaptic afferent pathways (ipsilateral cutaneous sural vs. contralateral peroneal nerves), two animal preparations (decerebrate vs. chloralose), and two motoneuron pools (medial gastrocnemius vs. lateral gastrocnemius-soleus). 2. PSPs from both nerves usually (36 of 51 cases) contained a mixture of depolarizing and hyperpolarizing components. In all 36 cases where the PSP contained a hyperpolarizing component, a consistent qualitative pattern emerged during prolonged stimulation: the hyperpolarization reached a peak approximately 20 ms after stimulation onset and then decayed with a biphasic time course that consisted of an initial rapid phase (20-40 ms) and a later slower phase (200-400 ms) before the steady-state value was reached. This pattern occurred regardless of the differences in polysynaptic afferent pathways, animal preparations, and motoneuron pools. 3. The consistency of this overall pattern was remarkable, given the existence of several quantitative differences among the PSPs. These differences include the following: hyperpolarizing components were least common in the sural and peroneal PSPs in the decerebrate preparation. And only these sural and peroneal PSPs tended to have prolonged afterpotentials after stimulus cessation. The steady-state sural PSPs in the decerebrate preparation tended to generate the largest PSPs and, moreover, these PSPs did not follow the overall trend of having a statistically significant relation between the amplitude of the initial hyperpolarization and the amount of its decay. Finally, transient sural PSPs in lateral gastrocnemius-soleus motoneurons in the decerebrate preparation tended to have the largest hyperpolarizations. 4. To determine whether the decay of the hyperpolarization and the subsequent dominance of depolarization was due to a decreased inhibition or an increased excitation, injected current pulses were utilized to measure the changes in the cell's input resistance during the course of the synaptic input. A strong decrease in input resistance accompanied the initial period of maximal hyperpolarization (50% with respect to the resting input resistance). Input resistance then returned toward resting values as hyperpolarization faded and depolarization became dominant. However, there remained a persistent decrease in input resistance during the final phase of the PSP that amounted to < 10% of the initial decrease. These findings indicated that much of the reduction in hyperpolarization reflected a progressive decrease in synaptic efficacy for the inhibition.(ABSTRACT TRUNCATED AT 400 WORDS)

[Detection of Exophiala dermatitidis (Kano) De Hoog 1977 in septicemia of a child with acute lymphatic leukemia and in patients with cystic fibrosis]. / Nachweis von Exophiala dermatitidis (Kano) De Hoog 1977 bei Septikämie eines Kindes mit akuter lymphatischer Leukämie und bei Patienten mit Mukoviszidose.

In 1992 black yeasts of the species Exophiala dermatitidis were isolated for the first time from patients at the University Clinics in Dresden. Since that time this relatively rarely detected fungus has been frequently cultivated from clinical specimens. Our observations were: Patient with acute lymphatic leukaemia: In a 3 1/2 years old boy E. dermatitidis was isolated from 8 blood cultures during a septicaemic phase. Elimination of the fungus and decreasing of the fever were reached after removing a central venous catheter and treatment with amphotericin B and 5-fluorocytosine for 3 weeks. In this patient E. dermatitidis was assessed to be the cause of the septicaemia setting in via catheter. Patients with cystic fibrosis: In 8 of 51 mycologically surveyed patients E. dermatitidis was frequently - in 2 cases for a long time up to 7 months - isolated from sputum specimens. The occurrence of this fungus was considered to be a colonization with subclinical development. In these patients no fungal invasion or systemic mycosis were seen. The administration of itraconazole for 4 respectively 7 months did not succeed in eliminating E. dermatitidis out of the respiratory tract. It is recommended to include mycological longtime cultures in the surveillance of cystic fibrosis patients for detection of E. dermatitidis.

[Mycological surveillance of children with cystic fibrosis]. / Mykologische Uberwachung von Kindern mit Mukoviszidose.

The mycological surveillance included 121 patients aged 1 to 21 years treated from 1981 to 1987 in the Centre of Cystic Fibrosis in Dresden. The control groups comprised 136 resp. 140 healthy children aged 1 to 16 years. The study evaluated the incidence of fungi in the oral cavity, bronchial secreta, sputum, faeces and urine as well as the specific serum antibodies to Candida albicans and Aspergillus fumigatus in correlation to the course of the cystic fibrosis and the applied chemotherapy. The study pointed out a parallel run concerning the progression of the clinical manifestation of the basic disease, the duration of the required chemotherapy and the mycological findings indicating more and more pathological levels. The mycological results of the children with a moderate course of cystic fibrosis were conformable to the findings of the children of the control groups. Systemic candidosis or aspergillosis were not seen. Because patients suffering from cystic fibrosis are predisposed for infections with fungi, especially with Aspergillus fumigatus, the authors recommend a mycological surveillance of these patients depending on the clinical course of cystic fibrosis: once in twelve months for patients with mild symptoms and every third month for patients with severe symptoms.

[Doppler echocardiographic diagnosis of pulmonary hypertension in children with mucoviscidosis]. / Dopplerechokardiographische Diagnostik der pulmonalen Hypertension bei Kindern mit Mukoviszidose.

Today Doppler echocardiography is a reliable noninvasive method in the diagnostic of pulmonary hypertension. We investigated 52 patients (age 1 to 19 years) with pulsed- or continuous-wave Doppler. Systolic pulmonary artery pressure (SPAP) was calculated about the equation of Akiba using acceleration time, corrected by heart rate. SPAP estimated in this way was less than 20 mmHg in 14% of the patients. 20-39 mmHg in 29%, 40-59 mmHg in 31% and about 60 mmHg in 26%. No correlation was found between age and SPAP and only low correlation between score of Shwachman (r = 0.37) or score of Norman-Crispin and SPAP. Between body fat, calculated from the thickness of skin folds, and SPAP was found a good correlation (r = -0.73, p = 0.01).

Value of inhaled antibiotics in cystic fibrosis patients.

The authors give a survey of problems concerning the use of antibiotic aerosols in cystic fibrosis patients. They give recommendations when and how to use this form of treatment. The combination of inhaled antibiotics with the oral or intravenous antibiotic therapy can be recommended best for patients with a chronic lung infection with Pseudomonas aeruginosa.