Probing Water Mobility in Human Dentine with Neutron Spectroscopy.

The aim of this study was to investigate hydrogen mobility within innate and demineralized human dentine. Dentine sections from extracted human molars, demineralized or not, were analyzed by combining neutron spectroscopy with thermal analysis. For the thermal analysis of the samples, differential scanning calorimetry and thermal gravimetric analysis, coupled with Fourier transform infrared spectroscopy, were performed. The hydrogen dynamics of water, collagen, and hydroxyl groups present in the samples were investigated via neutron spectroscopy. From the mass loss observed from the thermogravimetric analysis curves up to 600 °C, the same amount of organic content is identified in the samples. From the differential scanning calorimetry curves, a higher change in enthalpy associated with the denaturation of collagen is registered in the demineralized dentine; that is, a structural change occurs in the collagen subsequent to demineralization. Since the intensity measured by neutron spectroscopy is dominated by the signal from hydrogen, in our samples-coming mostly from the bulk-like and loosely bound water as well as from the collagen itself-higher proton mobility within the demineralized dentine was detected when compared with innate dentine. In the demineralized dentine, this proton mobility amounts to 80%, while the remaining hydrogen accounts for a combination of 1) structural hydroxyls, as a result of the incomplete dissolution of the mineral phase by acid etching, and 2) hydrogen tightly bound in the collagen structure. By combining neutron spectroscopy with the calorimetry data, our findings support the idea that hydroxyapatite protects the collagen in innate dentine. Demineralized dentine, however, acts as a sponge where free bulk-like water is trapped.

Antimicrobial peptide CAP18 and its effect on Yersinia ruckeri infections in rainbow trout Oncorhynchus mykiss (Walbaum): comparing administration by injection and oral routes.

The antimicrobial peptide CAP18 has been demonstrated to have a strong in vitro bactericidal effect on Yersinia ruckeri, but its activity in vivo has not been described. In this work, we investigated whether CAP18 protects rainbow trout Oncorhynchus mykiss (Walbaum) against enteric red mouth disease caused by this pathogen either following i.p. injection or by oral administration (in feed). It was found that injection of CAP18 into juvenile rainbow trout before exposure to Y. ruckeri was associated with lowered mortality compared to non-medicated fish although it was less effective than the conventional antibiotic oxolinic acid. Oral administration of CAP18 to trout did not prevent infection. The proteolytic effect of secretions on the peptide CAP18 in the fish gastrointestinal tract is suggested to account for the inferior effect of oral administration.

Electroconvulsive therapy as a treatment for protracted refractory delirium in the intensive care unit--five cases and a review.

PURPOSE: Delirium in the intensive care unit (ICU) is conventionally treated pharmacologically but can progress into a protracted state refractory to medical treatment--a potentially life-threatening condition in itself. METHODS: We treated 5 cases of severe protracted delirium in our ICU with electroconvulsive therapy (ECT) after failure of conventional medical therapy. RESULTS: The delirious state of long standing agitation, anxiety, and discomfort was controlled in all patients. Electroconvulsive therapy was effective in controlling delirium in 4 patients. The last patient became calm, relieved of stress, and able to cooperate with the ventilator but remained in a state of posttraumatic amnesia after a head trauma. CONCLUSION: Although controversial, ECT is nevertheless recognized as an efficient and safe treatment for various psychiatric illnesses including delirium. Considering the significantly increased mortality and severe cognitive decline associated with delirium in the ICU, we find ECT to be a valuable treatment option for this vulnerable patient population. It can be considered when agitation cannot be controlled with medical treatment, when agitation and delirium make weaning impossible, or prolonged deep sedation the only alternative.

Lactate concentrations in the rectal lumen in patients in early septic shock.

BACKGROUND: Previously, we observed that rectal luminal lactate was higher in non-survivors compared with survivors of severe sepsis or septic shock persisting >24 h. The present study was initiated to further investigate this tentative association between rectal luminal lactate and mortality in a larger population of patients in early septic shock. METHODS: A prospective observational multicentre study of 130 patients with septic shock at six general ICU's of university hospitals. Six to 24 h after the onset of septic shock, the concentration of lactate in the rectal lumen was estimated by a 4-h equilibrium dialysis. Dialysate concentrations of lactate were determined using an auto-analyser. RESULTS: The overall 30-day mortality was 32%, with age and Simplified acute physiology scores II and sequential organ failure assessment scores being significantly higher in non-survivors. In contrast, there were no differences in concentrations of lactate in the rectal lumen [2.2 (1.4-4.1) and 2.8 (1.6-5.1) mmol/l (P=0.34)] (medians and 25th-75th percentiles) or arterial blood [2.1 (1.4-4.2) and 2.0 (1.3-3.2) mmol/l (P=0.15)] between non-survivors and survivors. The rectal-arterial difference of the lactate concentration was higher in survivors. There were no differences in blood pressure, noradrenaline dose or central venous oxygen saturation between the groups. CONCLUSION: In this prospective, observational study of unselected patients with early septic shock, there was no difference in the concentration of lactate in the rectal lumen between non-survivors and survivors. TRIAL REGISTRATION: Clinicaltrials.gov (no: NCT00197938).

[Forensic examination of sexually abused children]. / Den retslaegelige undersøgelse af mindreårige udsat for seksuelle overgreb.

INTRODUCTION: The Department of Forensic Medicine, Aarhus, performs examinations of children suspected to have been sexually abused when reported to and requested by the police. A preliminary study was taken to evaluate all cases in one year including the legal outcome. MATERIAL AND METHODS: The material included all cases in one year, all examined on request by the police. All written material including court decisions were reviewed. RESULTS: The material included 34 cases with three boys, median-age 11 years, and 31 girls, median age six years, at the time of examination. The sexual abuse events were fondling, vaginal (14), anal (7) and oral (5) intercourse as well as showing pornography. The medical examination was most often performed more than one week after the abuse. The examination revealed normal findings in 20 cases, non specific findings including erythema of the vestibulum in 13 cases and in only one child was a traumatic lesion with rupture of the hymen seen. The perpetrators were above 25 years of age and were family members or someone known to the child. Eight perpetrators were convicted in court, of whom three admitted having abused the child. DISCUSSION: The time interval between the sexual abuse and the time of examination is important to the ano-genital findings at the examination. A medical examination in cases of sexual child abuse seldom provides legal proof of sexual abuse. The most important evidence is the story told by the child. Therefore, the examination is a supplement which may support or remain neutral to the story told by the child.

[Percutaneous transluminal coronary angioplasty and stenting of main coronary artery stenosis. Successful procedure after resuscitation of long duration]. / Perkutan transluminal koronar angioplastik og stentning af hovedstammestenose. Succesfuld procedure efter langvarig genoplivning.

The use of balloon angioplasty (PTCA) for stenosis of the left main coronary artery has been associated with poor long-term results, but, according to a recent report, PTCA with stent implantation appears to be attended by acceptable complication rates, as compared with coronary artery bypass grafting. This paper reports a case of successful cardiopulmonary resuscitation of long duration, followed by successful balloon angioplasty and stent implantation in acute thrombosis of a stenosis of the left main coronary artery.

Medical examination of sexually abused children: medico-legal value.

UNLABELLED: The Department of Forensic Medicine (forensic pathology and clinical forensic medicine), Aarhus, Jutland, Denmark, performs examinations of children suspected to have been sexually abused when reported to and requested by the police in Jutland, Denmark. Jutland covers an area of 210,000 km2 with about 300,000 inhabitants in Aarhus. A colposcope initially equipped with an Olympus camera, but now with a video camera attached has been used since 1994. Since 1994 the department has performed more than 100 examinations of children suspected of having been sexually abused. A preliminary study was taken to evaluate all cases from 1995 including the legal outcome. RESULTS: The material included 34 cases with three boys, mean age 11 years, and 31 girls, mean age 8 years, at the time of the examination. The sexual abuse events were fondling including penetration of the vagina, vaginal (14), anal (7), and oral (5) intercourse as well as cunnilingus and nontouching abuses. The medical examination was most often performed more than a week after the abuse. The examination revealed normal findings in 23 cases, nonspecific findings including erytherma in 13 cases, and in only one child was a traumatic lesion with rupture of the hymen seen. The perpetrators were above 25 years of ane and were family members or someone known to the child. Nine perpetrators were convicted at court, of whom three admitted having abused the child. CONCLUSION: A medical examination in cases of sexual child abuse seldom provides a legal proof of sexual abuse. The most important is the story told by the child. Therefore, the examination is a supplement which may support or remain neutral to the story told by the child.

Adjunctive corticosteroid therapy in bacterial meningitis.

Experimental studies of bacterial meningitis have shown that components of bacterial cell walls stimulate the local production of inflammatory cytokines in the cerebrospinal fluid, leading to inflammation and alterations in the cerebral microvasculature. Animal studies and clinical trials have demonstrated that adjunctive corticosteroid therapy reduces the production of cytokines in the CSF. This results in decreased severity of the inflammatory process and fewer neurologic sequelae. These data support the use of adjunctive dexamethasone in infants and children with S. pneumoniae and H. influenzae type B (HiB) meningitis. There is not sufficient evidence supporting the use of adjunctive corticosteroid therapy in children with meningitis caused by N. meningitidis. Also, the routine use of dexamethasone in adult meningitis cannot presently be recommended. When using dexamethasone timing is crucial. Administration before or with antibiotics is optimal for attenuating the subarachnoid space inflammatory response. Patients receiving the therapy need careful monitoring for the possibility of gastrointestinal bleeding. Future studies of the pathogenesis and pathophysiology of bacterial meningitis may lead to the development of other adjunctive treatment strategies, improving the outcome of this serious disease.