Augmenting PTSD treatment with physical activity: study protocol of the APPART study (Augmentation for PTSD with Physical Activity in a Randomized Trial).

Background: New intensive trauma-focused treatment (TFT) programmes that incorporate physical activity have been developed for people with post-traumatic stress disorder (PTSD). However, the unique contribution of physical activity within these intensive TFT programmes has never been investigated in a controlled manner. Objectives: This randomized controlled trial will investigate the effectiveness of physical activity added to an intensive TFT programme. In addition, the study aims to investigate the underlying mechanisms of the effects of physical activity on the change in PTSD symptoms. Methods: Individuals with PTSD (N = 120) will be randomly allocated to two conditions: a physical activity or a non-physical active control condition. All participants will receive the same intensive TFT lasting eight days within two consecutive weeks, in which daily prolonged exposure and EMDR therapy sessions, and psycho-education are combined. The amount of physical activity will differ per condition. While the physical activity condition induces daily physical activities with moderate intensity, in the non-physical active control condition no physical activity is prescribed; but instead, a controlled mixture of guided (creative) tasks is performed. The two primary outcome measures are change in PTSD symptoms from pre- to post-treatment and at six months follow-up, measured with the Clinician-Administered PTSD Scale (CAPS-5), and the PTSD Checklist for DSM-5 (PCL-5). Additionally, self-reported sleep problems, depressive symptoms, emotion regulation, dissociation symptoms and anxiety sensitivity will be measured as potential underlying mechanisms. Conclusions: This study will contribute to the research field of augmentation strategies for PTSD treatment by investigating the effectiveness of physical activity added to intensive TFT. Trial registration: This trial is registered in the Netherlands Trial Register (Trial NL9120).

Antecedentes: Se han desarrollado para personas con TEPT nuevos programas de tratamiento intensivos centrados en trauma (TFT por sus siglas en inglés) que incorporan actividad física. Sin embargo, la contribución única de la actividad física dentro de estos programas de TFT intensivos nunca se ha investigado de manera controlada.Objetivos: Este ensayo controlado aleatorizado investigará la efectividad de la actividad física agregada a un programa intensivo de TFT. Además, el estudio tiene como objetivo investigar los mecanismos subyacentes de los efectos de la actividad física sobre el cambio en los síntomas de TEPT.Métodos: Las personas con TEPT serán asignadas en forma aleatoria a dos condiciones: una actividad física o una condición de control activo no físico. Todos los participantes recibirán la misma TFT intensiva que durará 8 días dentro de dos semanas consecutivas, en las que se combinarán diariamente la exposición prolongada y las sesiones de terapia EMDR y psicoeducación. La cantidad de actividad física diferirá según la condición. Mientras que la condición de actividad física induce actividades físicas diarias de moderada intensidad, en la condición de control activo no físico no se prescribe actividad física, sino que se realiza una mezcla controlada de tareas guiadas (creativa). Las dos medidas de resultado primarias son el cambio en los síntomas de TEPT antes y después del tratamiento y a los seis meses de seguimiento, medidos con la Escala de TEPT administrada por el clínico (CAPS-5) y la Lista de verificación de TEPT del DSM-5 (PCL-5). Adicionalmente, los problemas del sueño autoinformados, los síntomas depresivos, la regulación de emociones, los síntomas disociativos y la sensibilidad a la ansiedad se medirán como potenciales mecanismos subyacentes.Conclusiones: Este estudio contribuirá al campo de la investigación de las estrategias de potenciación para el tratamiento del TEPT al investigar la efectividad de la actividad física agregada a la TFT intensiva.Registro de ensayo: este ensayo esta registrado en el Registro de ensayos de los Países Bajos (ensayo NL 9120).

Unravelling the relation between processed crude oils and the composition of spent caustic effluents as well as the respective economic impact.

Spent caustic discharges are responsible for increasing oil and grease (O&G) matter in refineries wastewater, leading to increasing treatment costs due to low water quality and environmental constraints associated with high O&G concentration discharges. As a way to settle and optimize treatment technologies for such complex effluents, more insight regarding the effluents impact and deeper characterization is necessary. The present study intends to assess the possibility of a relationship between the processed crude oils with the polar O&G concentration in naphthenic spent caustic as well as in the final wastewater; Sines refinery was considered as case-study. Also, in order to get insights about the nature of the polar O&G compounds, their structures and their prevalence in the effluent treatment system was carried out through detailed analytical characterization studies. Proton nuclear magnetic resonance (1H NMR), Fourier transform infrared spectroscopy (FT-IR) and gas chromatography-mass spectrometry (GC-MS) were chosen. It was found that, for the Sines refinery, spent caustic discharges may increase the refinery effluent management cost up to 3 €/ton of processed crude oil, every time a high kerosene cut acid crude oil is processed. It was also found that the typical spent caustic O&G effluents are composed by organic contaminants with low molecular weight (MW), with aromatic and polar arrangements, like phenolic groups and naphthenic acids. This outcome is crucial for subsequently establishing the best technologies able to deal with such complex effluents.

Do emotion regulation difficulties affect outcome of intensive trauma-focused treatment of patients with severe PTSD?

Background: There is ongoing debate as to whether emotion regulation problems should be improved first in order to profit from trauma-focused treatment, or will diminish after successful trauma processing. Objective: To enhance our understanding about the importance of emotion regulation difficulties in relation to treatment outcomes of trauma-focused therapy of adult patients with severe PTSD, whereby we made a distinction between people who reported sexual abuse before the age of 12, those who were 12 years or older at the onset of the abuse, individuals who met the criteria for the dissociative subtype of PTSD, and those who did not. Methods: Sixty-two patients with severe PTSD were treated using an intensive eight-day treatment programme, combining two first-line trauma-focused treatments for PTSD (i.e. prolonged exposure and EMDR therapy) without preceding interventions that targeted emotion regulation difficulties. PTSD symptom scores (CAPS-5) and emotion regulation difficulties (DERS) were assessed at pre-treatment, post-treatment, and six month follow-up. Results: PTSD severity and emotion regulation difficulties significantly decreased following trauma-focused treatment. While PTSD severity scores significantly increased from post-treatment until six month follow-up, emotion regulation difficulties did not. Treatment response and relapse was not predicted by emotion-regulation difficulties. Survivors of childhood sexual abuse before the age of 12 and those who were sexually abused later in life improved equally well with regard to emotion regulation difficulties. Individuals who fulfilled criteria of the dissociative subtype of PTSD showed a similar decrease on emotion regulation difficulties during treatment than those who did not. Conclusion: The results support the notion that the severity of emotion regulation difficulties is not associated with worse trauma-focused treatment outcomes for PTSD nor with relapse after completing treatment. Further, emotion regulation difficulties improved after trauma-focused treatment, even for individuals who had been exposed to early childhood sexual trauma and individuals with dissociative subtype.

Antecedentes: hay un debate en curso sobre si los problemas de regulación de las emociones deben mejorar primero para beneficiarse del tratamiento centrado en el trauma o si disminuirán después del procesamiento exitoso del trauma.Objetivo: mejorar nuestra comprensión sobre la importancia de las dificultades de la regulación emocional en relación con los resultados del tratamiento de la terapia centrada en el trauma de pacientes adultos con trastorno de estrés postraumático grave, para lo cual hicimos una distinción entre las personas que informaron abuso sexual antes de los 12 años, aquellas que tenían 12 o más años al inicio del abuso, personas que cumplieron con los criterios para el subtipo disociativo de TEPT y aquellos que no lo hicieron.Métodos: Sesenta y dos pacientes con trastorno de estrés postraumático grave fueron tratados mediante un programa de tratamiento intensivo de ocho días, que combina dos tratamientos de primera línea centrados en el trauma para el trastorno de estrés postraumático (exposición prolongada y EMDR) sin intervenciones previas dirigidas a las dificultades de regulación emocional. Los puntajes de síntomas de TEPT (CAPS-5) y las dificultades de regulación emocional (DERS) se evaluaron antes, después del tratamiento y a los seis meses de seguimiento.Resultados: la severidad del TEPT y las dificultades de regulación emocional disminuyeron significativamente después del tratamiento centrado en el trauma. Si bien los puntajes de severidad del TEPT aumentaron significativamente desde el postratamiento hasta los seis meses de seguimiento, las dificultades de regulación emocional no lo hicieron. La respuesta al tratamiento y la recaída no fueron precedidas por las dificultades de regulación de las emociones. Los sobrevivientes de abuso sexual infantil antes de los 12 años y aquellos que fueron abusados sexualmente más tarde en la vida mejoraron igualmente bien con respecto a las dificultades de regulación de las emociones. Las personas que cumplieron con los criterios del subtipo disociativo de TEPT mostraron una mayor disminución en las dificultades de regulación emocional durante el tratamiento que aquellos que no lo hicieron.Conclusión: Los resultados apoyan la noción de que la gravedad de las dificultades de regulación de las emociones no se asocia con peores resultados del tratamiento centrado en el trauma para el TEPT ni con recaídas después de completar el tratamiento. Además, las dificultades de regulación de las emociones mejoraron después del tratamiento centrado en el trauma, incluso para las personas que habían estado expuestas a traumas sexuales en la primera infancia y las personas con subtipo disociativo.

The impact of brief intensive trauma-focused treatment for PTSD on symptoms of borderline personality disorder.

Background: It is generally recommended to exercise caution in applying trauma-focused treatment to individuals with posttraumatic stress disorder (PTSD) and comorbid borderline personality disorder (BPD). Objective: To investigate the effects of a brief, intensive, direct trauma-focused treatment programme for individuals with PTSD on BPD symptom severity. Methods: Individuals (n = 72) with severe PTSD (87.5% had one or more comorbidities; 52.8% fulfilled the criteria for the dissociative subtype of PTSD) due to multiple traumas (e.g. 90.3% sexual abuse) participated in an intensive eight-day trauma-focused treatment programme consisting of eye movement desensitization and reprocessing (EMDR) and prolonged exposure (PE) therapy, physical activity, and psychoeducation. Treatment did not include any form of stabilization (e.g. emotion regulation training) prior to trauma-focused therapy. Assessments took place at pre- and post-treatment (Borderline Symptom List, BSL-23; PTSD symptom severity, Clinician Administered PTSD Scale for DSM-5, CAPS-5), and across the eight treatment days (PTSD Checklist, PCL-5). Results: Treatment resulted in significant decreases of BPD symptoms (Cohen's d = 0.70). Of the 35 patients with a positive screen for BPD at pre-treatment, 32.7% lost their positive screen at post-treatment. No adverse events nor dropouts occurred during the study time frame, and none of the patients experienced symptom deterioration in response to treatment. Conclusion: The results suggest that an intensive trauma-focused treatment is a feasible and safe treatment for PTSD patients with clinically elevated symptoms of BPD, and that BPD symptoms decrease along with the PTSD symptoms.

Antecedentes: generalmente se recomienda tener precaución al aplicar un tratamiento centrado en el trauma a las personas con trastorno de estrés postraumático (TEPT) y trastorno de personalidad límite comórbido (TPL).Objetivo: Investigar los efectos de un programa de tratamiento breve, intensivo y directo centrado en el trauma para personas con TEPT sobre la gravedad de los síntomas de TPL.Métodos: los participantes (n = 72) con TEPT grave (87.5% tenían una o más comorbilidades; 52.8% cumplieron los criterios para el subtipo disociativo de TEPT) debido a múltiples traumas (por ejemplo, 90.3% abuso sexual) participaron en un programa intensivo de ocho días de tratamiento centrado en el trauma, consistente en EMDR, terapia de exposición prolongada (PE), actividad física y psicoeducación. El tratamiento no incluyó ninguna forma de estabilización (por ejemplo, entrenamiento de regulación emocional) antes de la terapia centrada en el trauma. Las evaluaciones se realizaron antes y después del tratamiento (Lista de síntomas límite, BSL-23; severidad de los síntomas de TEPT, Escala de TEPT administrada por clínicos para DSM-5, CAPS-5) y durante los ocho días de tratamiento (Lista de verificación de TEPT, PCL-5).Resultados: el tratamiento resultó en una disminución significativa de los síntomas de TPL (d de Cohen = 0.70). De los 35 pacientes con un tamizaje positivo de TPL en el pretratamiento, el 32,7% perdió su tamizaje positivo en el postratamiento. No ocurrieron eventos adversos ni abandonos durante el período de tiempo del estudio, y ninguno de los pacientes experimentó deterioro de los síntomas en respuesta al tratamiento.Conclusión: Los resultados sugieren que un tratamiento intensivo centrado en el trauma es un tratamiento factible y seguro para pacientes con TEPT con síntomas clínicamente elevados de TPL, y que los síntomas de TLP disminuyen junto con los síntomas de TEPT.

Aliskiren effect on non-alcoholic steatohepatitis in metabolic syndrome.

BACKGROUND: Non-alcoholic steatohepatitis (NASH) is highly associated with metabolic syndrome, a major cause of morbidity in the globalized society. The renin-angiotensin system (RAS) influences hepatic fatty acid metabolism, inflammation and fibrosis. Thus, in the present study, we aimed to evaluate the effect of aliskiren, a direct renin inhibitor, on metabolic syndrome-related NASH. METHODS: C57BL/6 male mice (n = 45) were divided into three groups: controls; animals inoculated with streptozotocin (STZ) (40 mg/kg/day) for 5 days and fed with high fat diet (HFD) for 8 weeks; and animals inoculated with STZ for 5 days, fed with HFD for 8 weeks and treated with aliskiren (100 mg/kg/day) for the final 2 weeks. Glycemic and insulin levels, hepatic lipid profile, histological parameters and inflammatory protein expression were analyzed. RESULTS: Aliskiren normalized plasma glucose and insulin levels, reduced cholesterol, triglycerides and total fat accumulation in liver and diminished hepatic injury, steatosis and fibrosis. These results could be explained by the ability of aliskiren to block angiotensin-II, lowering oxidative stress and inflammation in liver. Also, it exhibited a beneficial effect in increasing insulin sensitivity. CONCLUSION: These findings support the use of aliskiren in the treatment of metabolic syndrome underlying conditions. However, clinical studies are indispensable to test its effectiveness in the treatment of patients with metabolic syndrome.

Pilot scale nanofiltration treatment of olive mill wastewater: a technical and economical evaluation.

The treatment of large volumes of olive mill wastewater is presently a challenge. This study reports the technical and economical feasibility of a sequential treatment of olive mill wastewater comprising a dissolved air flotation pre-treatment and nanofiltration. Different pilot nanofiltration assays were conducted in a concentration mode up to different volume reduction factors (29, 45, 58, and 81). Data attained demonstrated that nanofiltration can be operated at considerably high volume reduction factors and still be effective towards the removal of several components. A flux decline of approximately 50% was observed at the highest volume reduction factor, mainly due to increase of the osmotic pressure. Considerably high rejections were obtained across all experiments for total suspended solids (83 to >99%), total organic carbon (64 to 99%), chemical oxygen demand (53 to 77%), and oil and grease (67 to >82%). Treated water was in compliance with European legal limits for discharge regarding total suspended solids and oil and grease. The potential recovery of phenolic compounds was evaluated and found not relevant. It was demonstrated that nanofiltration is economically feasible, involving operation costs of approximately 2.56-3.08 €/m3, depending on the working plan schedule and volume reduction factor, and requiring a footprint of approximately 52 m2 to treat 1000 m3 of olive mill wastewater.

The role of lymph node revealing solution on the improvement of lymph node harvest in colorectal cancer specimens.

AIM: The correct analysis of lymph node status is one of the most important parameters for the accurate pathological diagnosis of colorectal cancer. Our aim was to evaluate the number of lymph nodes among the specimens obtained from colorectal resections due to colorectal cancer, before and after the routine use of a lymph node revealing solution (LNRS). METHOD: Data from 780 surgical specimens from patients of both genders with colorectal cancer were studied. The cases were divided chronologically into two groups: the conventional group included 497 specimens treated with conventional methods, i.e. without the use of the LNRS (January 2000 to July 2007), and the LNRS group included 283 specimens examined through the routine use of this solution (August 2007 to July 2012). RESULTS: Most patients were female (57.4%) with a median age of 62 years. The median lymph node number was 18, and 75.9% of the cases (592) had 12 or more nodes dissected. Lymph node metastases were noted in 334 cases (42.8%). A median of 24 lymph nodes was dissected in the LNRS group compared to 15 in the conventional group (P < 0.001). The LNRS group had 9.2% of cases with fewer than 12 lymph nodes dissected compared with 32.6% in the conventional group (P < 0.001). CONCLUSIONS: The use of the LNRS increases the number of lymph nodes obtained from colorectal cancer surgical specimens and can help to reduce the number of cases with < 12 lymph nodes.

New evidence of heterogeneity in social anxiety disorder: defining two qualitatively different personality profiles taking into account clinical, environmental and genetic factors.

PURPOSE: To study qualitatively different subgroups of social anxiety disorder (SAD) based on harm avoidance (HA) and novelty seeking (NS) dimensions. METHOD: One hundred and forty-two university students with SAD (SCID-DSM-IV) were included in the study. The temperament dimensions HA and NS from the Cloninger's Temperament and Character Inventory were subjected to cluster analysis to identify meaningful subgroups. The identified subgroups were compared for sociodemographics, SAD severity, substance use, history of suicide and self-harm attempts, early life events, and two serotonin transporter gene polymorphisms (5-HTTLPR and STin2.VNTR). RESULTS: Two subgroups of SAD were identified by cluster analysis: a larger (61% of the sample) inhibited subgroup of subjects with "high-HA/low-NS", and a smaller (39%) atypical impulsive subgroup with high-moderate HA and NS. The two groups did not differ in social anxiety severity, but did differ in history of lifetime impulsive-related-problems. History of suicide attempts and self-harm were as twice as frequent in the impulsive subgroup. Significant differences were observed in the pattern of substance misuse. Whereas subjects in the inhibited subgroup showed a greater use of alcohol (P=0.002), subjects in the impulsive subgroup showed a greater use of substances with a high-sensation-seeking profile (P<0.001). The STin2.VNTR genotype frequency showed an inverse distribution between subgroups (P=0.005). CONCLUSIONS: Our study provides further evidence for the presence of qualitatively different SAD subgroups and the propensity of a subset of people with SAD to exhibit impulsive, high-risk behaviors.

Hypermobility and joint hypermobility syndrome in Brazilian students and teachers of ballet dance.

The current literature has been discussing the risks and benefits of joint hypermobility (JHM) for careers in ballet This study aimed to evaluate the prevalence of JHM and joint hypermobility syndrome (JHS) in a group of ballet teachers and students, looking both at aspects related to the flexibility required to dance, as at the risk of injuries when hypermobility is associated with other symptoms, in the case of JHS. We evaluated ballet teachers and ballet students, with age ranging from 18 to 40 years. All participants completed identification and sociodemographic questionnaires and underwent a physical examination. JHM was assessed using the Beighton score with goniometry. Symptoms of JHS were evaluated according to the Brighton criteria. Final sample consisted of 77 participants, being 44 ballet students and 33 ballet teachers. The prevalence of JHM in the sample as a whole was 58 %. Teachers and students had no significant differences regarding the prevalence of JHM (p = 0.74) (OR 1.21; 95 % CI 0.48-3.07). However, the prevalence of JHS was significantly different (p = 0.04) between students (16 %) and teachers (36 %). Teachers were three times more likely than student to have JHS (OR 3.02; 95 % CI 1.03-8.85). Teachers and students also presented differences in the frequency of specific items of Beighton score and Brighton criteria. These data provide elements to discuss the relationship between hypermobility, ballet technique and selection for dance, suggesting that dancers with JHS could find in ballet teaching an alternative to maintain professional activity with dance, while remaining protected from the higher risk of injury that professional dancers may be exposed to.

Association between joint hypermobility and anxiety in Brazilian university students: gender-related differences.

INTRODUCTION: Anxiety disorders may be associated with several non-psychiatric disorders. Current literature has been investigating the association between anxiety and joint hypermobility (JHM), with special interest in non-articular symptoms that may be related to autonomic dysfunction. This study investigated the association between anxiety and JHM in a sample of Brazilian university students. METHODS: Data were cross-sectionally collected in two Brazilian universities (N=2600). Participants completed three validated self-rating anxiety scales: Beck Anxiety Inventory (BAI), Social Phobia Inventory (SPIN) and the brief-version of SPIN (Mini-SPIN). They also answered the self-rating screening questionnaire for JHM: the Five-part Questionnaire for Identifying Hypermobility. RESULTS: Hypermobile women showed significantly higher scores in all the anxiety scales, when compared with men: BAI total score (t=3.77; p<0.001), its four subscales, SPIN score (t=2.71; p<0.007) and Mini-SPIN (t=2.58; p<0.01). Among BAI subscales, the autonomic subscale was shown to be more significantly (t=3.89; p<0.001) associated with joint hypermobility in women. CONCLUSIONS: The results of the present study support earlier evidence on the relationship between anxiety and JHM in women, showing specific gender-related features in this field. It also directs attention to non-articular symptoms that may be enrolled in this association.

Methods for thermal inactivation of pathogens in mozzarella: a comparison between stretching and pasteurization / Métodos para inativação térmica de patógenos em mozarela: comparação entre filagem e pasteurização

This study aimed to evaluate the efficiency of stretching in the reduction of pathogens when compared to milk pasteurization, the official method to ensure safe cheese production. Whole buffalo milk was contaminated with Mycobacterium fortuitum, Listeria monocytogenes, Salmonella typhimurium, and Staphylococcus aureus. Part of the milk was used in mozzarella production and the other part was submitted to holder pasteurization. Pathogens were quantified before and after thermal processing (mozzarella stretching and milk pasteurization). Pasteurization and stretching led to the following reductions in log cycles, respectively: 4.0 and 6.3 for Mycobacterium sp.; 6.0 and 8.4 for Listeria sp.; >6.8 and 4.5 for Staphylococcus sp.; and >8.2 and 7.5 for Salmonella sp.

Este estudo teve como objetivo avaliar a eficácia da filagem na redução de patógenos,em comparação coma pasteurizaçãodo leite, que é o método oficialpara garantir aprodução de queijos seguros. Leite de búfala integral foi contaminado com Mycobacterium fortuitum, Listeria monocytogenes, Salmonella typhimurium e Staphylococcus aureus. Parte desse leite foi empregada na fabricação da mozarela e outra parte foi submetida à pasteurização lenta. Os patógenosforam quantificadosantes e após os processos térmicos (filagem da mozarela e pasteurização do leite). As reduções, em ciclos logarítmicos, causadas pela pasteurização e pela filagem, respectivamente, foram: 4,0 e 6,3 de Mycobacterium sp., 6,0 e 8,4 de Listeria sp., >6,8 e 4,5 de Staphylococcus sp. e >8,2 e 7,5 de Salmonella sp.

Comparison of screening methods for conductive hearing loss identification in children: low-cost proposal.

OBJECTIVE: To evaluate the effectiveness of two screening methods (imitanciometry screening and questionnaire) to identify children at risk for conductive hearing loss, comparing this data with complete audiologic evaluation. METHODS: Of 507 children aged between three and six, 111 completed all procedures. The observational methods used were: imitanciometry screening, a questionnaire to identify risk factors for hearing loss and complete audiologic evaluation. Results obtained in the first two instruments were compared with results from complete audiologic evaluation (gold standard). From these comparisons, sensitivity and specificity, accuracy, positive and negative predictive values, and odds ratio were determined for the two screening methods and for the combination of both methods. RESULTS: The two methods applied in series (questionnaire and after imitanciometry screening) showed a greater odds ratio and better correlation between sensitivity and proportion of false-positives (ROC curve). CONCLUSION: Combining the two tests in series improved screening accuracy. This combination was the best tool for identifying children at risk for conductive hearing loss.

Direct photolysis of polycyclic aromatic hydrocarbons in drinking water sources.

The widely used low pressure lamps were tested in terms of their efficiency to degrade polycyclic aromatic hydrocarbons listed as priority pollutants by the European Water Framework Directive and the U.S. Environmental Protection Agency, in water matrices with very different compositions (laboratory grade water, groundwater, and surface water). Using a UV fluence of 1500 mJ/cm(2), anthracene and benzo(a)pyrene were efficiently degraded, with much higher percent removals obtained when present in groundwater (83-93%) compared to surface water (36-48%). The removal percentages obtained for fluoranthene were lower and ranged from 13 to 54% in the different water matrices tested. Several parameters that influence the direct photolysis of polycyclic aromatic hydrocarbons were determined and their photolysis by-products were identified by mass spectrometry. The formation of photolysis by-products was found to be highly dependent on the source waters tested.

Contralateral suppression of transient evoked otoacoustic emissions in children with auditory processing disorder.

This study concerns contralateral white noise suppression of transient evoked otoacoustic emissions (TEOAEs) in children with auditory processing disorder (APD). Fifty-one children between 7 and 11 years were assigned to 1 of 3 experimental groups: those without auditory complaints (n = 15), those with APD who scored high on a standardized test (n = 20) and those with APD who scored lower on the same test (n = 16). For all groups TEOAE suppression was determined in both linear and nonlinear acquisition mode. The results provide evidence that abnormal TEOAE suppression was significantly more common in the APD groups than in the control group. Contralateral suppression of TEOAE is an additional tool for assessing the efferent pathway in children with APD.

Monitoring the active sessile-colonisation of two drinking water distribution systems based on the protein contents in native biofilm samples.

Biofilms are present to a greater or lesser degree in virtually all drinking water distribution systems. In order to investigate the relative intensity and the spatial and temporal distributions of the active sessile-colonization, protein was determined in native biofilm samples from the Oeiras-Amadora (OADS) and the Almada (ADS) distribution systems in Portugal. Samples (25 cm2) were taken from lengths of asbestos cement pipes of different ages and diameters. Protein was detected at levels from 0.3 to 68 microg/cm2 in samples from all analysed pipe diameters and ages. At OADS, protein was found at 0.3 to 1 mg/cm2 in 99% of the samples. At ADS, protein was only found in 30% of the samples, but at significantly higher levels (0.3 to 68 mg/cm2). In addition to displaying a more intense and scattered active colonization, ADS's oldest-pipes (in use for over 30 years) solely exhibited protein at the highest levels found (> 19 mg/cm2), in contrast with the younger pipes where protein levels ranged from 0.3 to 19 mg/cm2. Observed results suggest that the spatial and temporal distribution patterns of the active biofilm colonization may vary significantly among drinking water networks and may have a rather slow evolution, possibly at the decades scale.

Inhibition of angiotesin-converting enzyme by quercetin alters the vascular response to brandykinin and angiotensin I.

Quercetin, one of the most widely distributed flavonoids in the plant kingdom, inhibits various enzymes. This study examined its inhibitory effect on the angiotensin-converting enzyme activity through the cardiovascular response to bradykinin and angiotensin I. Quercetin pre-treatment (88.7 micromol/kg p.o., 45 min; 14.7 micromol/kg i.v., 5 min) significantly potentiated the hypotensive effect of bradykinin (10 nmol/kg i.v.). This association was significantly attenuated by an antagonist of the B2 receptor. In addition, the hypertensive response to angiotensin I (0.1 nmol/kg i.v.) was significantly reduced by quercetin pretreatment using the same parameters as before. These results suggest an inhibitory effect of quercetin on the angiotensin-converting enzyme activity, similar to that of captopril. Quercetin was equally effective when given orally or intravenously.

Influência dos padröes timpanométricos na captaçäo de emissöes otoacústicas / Influency of tympanometric patterns in the captation of the otoacoustic emissions

A aplicação combinada de emissões otoacústicas e de medidas de imitância acústica, em uma mesma população, pode esclarecer certas questões sobre o grau de comprometimento de orelha média que impede a captação das emissões otoacústicas. Assim, os objetivos deste estudo são: 1. Identificar a melhor freqüência das provas de imitância acústica para identificação de alteração de orelha média, comparando-a com presença e ausência de emissões otoacústicas, tanto EOAT como EOAPD; 2. Estimar a probabilidade de captação de EOAs em orelhas médias normais em jovens e em idosos. Foram estudadas as respostas auditivas de 66 orelhas de adultos jovens entre 19 e 32 anos, exibindo média de limiares tonais entre 500 e 2000 Hz de até 20 dBNA , e de 44 orelhas de idosos entre 60 e 79 anos, exibindo média de limiares tonais entre 500 e 2000 Hz de até 30 dBNA. Foram submetidas a Emissões Otoacústicas (EOAT e EOAPD) e timpanometria simultânea em Susceptância e Condutância (B/G) com sondas de 226, 678 e 1000 HZ. Os resultados revelaram: 1. A timpanometria com sonda de 1000Hz mostrou maior concordância entre os achados de normalidade e alteração timpanométrica em relação à captação e não-captação de EOAT e de EOAPD; 2. Em condições de normalidade de orelha média a proporção de captação de EOAT foi maior em jovens do que em idosos, e a proporção de captação de EOAPD foi semelhante em ambos os grupos; 3. Em condições de normalidade de orelha média, a proporção de captação de EOAPD foi maior que de EOAT tanto em jovens como em idosos.

Laparoscopic cholecystectomy in Brazil: analysis of 33,563 cases.

The authors present the results obtained in 33,563 laparoscopic cholecystectomies performed in Brazil from 1990 to 1995. Data were obtained by mailing questionnaires to 220 Services, 118 of which responded. The features included the year when the service started its activities, patient distribution by sex and age, surgical indications, prophylaxis with antibiotics, use of nasogastric and vesical catheters, technique used to produce pneumoperitoneum, intraoperative cholangiography, management of choledocholithiasis, necessity and causes of conversion to open surgery, surgical time, intra and postoperative complications, time of hospitalization, mortality, patient return to normal activities, and laparoscopic cholecystectomy in pregnancy. Analysis of the results demonstrated that the data are equivalent to those obtained in leading world countries and at times even better in terms of lesion of the main bile duct, time of hospitalization, etc.

Estagio no campus avancado da USP um depoimento. / Practice at the campus of the Universidade de Sao Paulo in Maraba - a testimony

As autoras, academicas do sexto ano da Faculdade de Medicina da Universidade de Sao Paulo (1981), descrevem as experiencias usufruidas em um estagio de quatro semanas no Campus Avancado da Universidade de Sao Paulo, em Maraba, Estado do Para. Apos a apresentacao das atividades desempenhadas concluem pela validade do estagio em questao