High-risk psychotropic medications for US children with trauma sequelae.

Children exposed to trauma are predisposed to develop a number of mental health syndromes. They are prone to under-treatment with effective psychosocial interventions and over-treatment with high-risk psychotropic medications, especially polypharmacy and the use of antipsychotics for unapproved conditions. We review the evidence for psychosocial and pharmacological treatments for mental health problems associated with high exposure to childhood trauma - identifying those in foster care as an index group - and the frequency of high-risk pharmacological practices. We describe current efforts to reduce over-treatment of children with high-risk psychotropic medications and propose further recommendations to protect and provide effective care for these vulnerable children.

Laboratory-controlled Challenges of Nile Tilapia (Oreochromis niloticus) with Streptococcus agalactiae: Comparisons between Immersion, Oral, Intracoelomic and Intramuscular Routes of Infection.

Streptococcus agalactiae, the aetiological agent of streptococcosis in fish, is an important pathogen of cultured and wild fish worldwide. To gain a better understanding of the pathogenesis of streptococcosis in Nile tilapia (Oreochromis niloticus), and to identify the experimental route of infection that most closely mimics natural disease, fingerlings were challenged with S. agalactiae utilizing different delivery methods. Fingerlings were challenged via intracoelomic injection (ICinj), intramuscular injection (IMinj), orally or by immersion with serial dilutions of S. agalactiae. The dose lethal to 50% of test fish 15 days post challenge was 120 colony forming units (CFU)/fish after ICinj, and 105 CFU/fish after IMinj. Acute mortalities were present in both groups, but were higher in the fish challenged by ICinj. Very low mortalities were observed in the fish challenged via oral or immersion routes. Post-mortem evaluation of survivors revealed classical lesions associated with fish streptococcosis, including granulomatous or lymphohistiocytic epicarditis, splenitis, meningitis, myocarditis, choroiditis and exophthalmia. The information obtained improves our understanding of the pathogenesis of streptococcosis in fish, and provides useful information regarding controlled experimental infections in tilapia challenged with S. agalactiae. Results from this study suggest that IMinj challenge methods are not only suitable to induce streptococcosis in tilapia, but they may be the preferred method to study the pathogenesis of the naturally-occurring disease in this species.

The eggshell features and clutch viability of the broad-snouted caiman (Caiman latirostris) are associated with the egg burden of organochlorine compounds.

Organochlorine compounds (OCCs) are toxic and have been identified as endocrine-disrupting chemicals (EDCs). The broad-snouted Caiman (Caiman latirostris) is an oviparous species widely distributed in South America with potential to accumulate OCCs. The eggshell is formed during passage of the eggs through the oviduct. Since the oviduct is a target of hormone actions, exposure to OCCs could modify eggshell quality, thus affecting clutch viability. Eight clutches were collected from wetlands of Parana River tributaries, in north-eastern Argentina. Two to four eggs per clutch were used to establish the burden of OCCs, eggshell thickness and eggshell porosity. The remaining eggs were incubated in controlled conditions. Ten days after hatching, hatchling survival was assessed. Organochlorine pesticide residues (OCPs) were found in all clutches, while polychlorinated biphenyls (PCBs) were present in all but one clutch. The principal contributors to the OCP burden were members of the DDT family and oxychlordane. Eggshell thickness was 400.9±6.0 µm and, unexpectedly, no association between eggshell thickness and the OCC burden was found. The number of pores in the outer surface was 25.3±4.3 pores/cm². A significant inverse correlation between porosity and OCC burden was found (Pearson r= -0.81, p= 0.01). Furthermore, a decrease in caiman survival with decreased pore density was observed (Pearson r= 0.73, p= 0.04). Our findings highlight another potential negative impact of current and past use of OCCs on wildlife species.

Organochlorine compound residues in the eggs of broad-snouted caimans (Caiman latirostris) and correlation with measures of reproductive performance.

Organochlorine compounds (OCCs), like pesticides (OCPs) and polychlorinated biphenyls (PCBs), are persistent lipophilic chemicals classified as endocrine-disruptors. Caiman latirostris inhabits wetlands throughout north-eastern Argentina and may accumulate OCCs. The aims of this study were to determine OCC residues in the eggs of C. latirostris and to correlate OCC burden with clutch size, hatching success and hatchling survival as measures of reproductive performance. Fourteen caiman clutches were harvested from sites with different degrees of anthropogenic intervention on wetlands surrounding Paraná River tributaries. Two to four eggs by clutch were used to quantify OCCs. OCP residues were found in all clutches. The principal contributors to the OCPs burden were the DDT family (range BDL-153.0 ng g(-1) lipid) and oxychlordane (range BDL-34.3 ng g(-1) lipid). PCBs were present in 92.9% of the clutches (range BDL-136.6 ng g(-1) lipid). Both higher concentrations and higher diversity of pesticides, including endosulfan sulfate, were found in the nests harvested close to croplands. A negative correlation was found between clutch size and ∑OCCs (p=0.02, Pearson r=-0.53, r(2)=0.28), mainly due to the ∑OCPs (p=0.04, Pearson r=-0.54, r(2)=0.30). Since egg OCCs concentrations predict maternal burden, present findings suggest that higher OCCs exposure could lead to smaller clutches. Although, other factors like mother age could influence clutch size. Additionally, as caimans are a long-lived and non-migratory species, the maternal OCCs burden reflects the environmental status throughout their home range; thus, caiman eggs could be useful as a biomonitor of local contamination.

Megaesófago en un paciente con acalasia avanzada / No disponible

No disponible

Electrostatic tuning of the superconductor-insulator transition in two dimensions.

Superconductivity has been induced in insulating ultrathin films of amorphous bismuth using the electric field effect. The screening of the electron-electron interaction was found to increase with electron concentration in a manner correlated with the tendency towards superconductivity. This does not preclude an increase in the density of states being important in the development of superconductivity. The superconductor-insulator transition appears to belong to the universality class of the three dimensional XY model.

Ambipolar gate effect and low temperature magnetoresistance of ultrathin La0.8Ca0.2MnO3 films.

Ultrathin La(0.8)Ca(0.2)MnO(3) films have been measured in a field-effect geometry. The gate electric field produces a significant ambipolar decrease in resistance at low temperatures. This is attributed to the development of a pseudogap in the density of states and the coupling of localized charge to strain. Within a mixed phase scenario, the gate effect and magnetoresistance are interpreted in the framework of a "general susceptibility," which describes how phase boundaries move through a hierarchical pinning landscape.

[Anesthesia for carbon dioxide laser surgery to correct Zenker's diverticulum]. / Anestesia para la cirugía del divertículo de Zenker con láser CO2.

Two 48- and 62-year-old men, the latter with a history of ischemic heart disease, underwent endoscopic carbon dioxide laser surgery to correct Zenker's diverticulum. We provided total intravenous anesthesia, taking into consideration the special requirements of laser surgery. The pathogenesis of Zenker's diverticulum, the most common type of esophageal diverticulum, is poorly understood and the treatment approach depends on size and overall patient status. Patients with Zenker's diverticulum need a thorough preoperative assessment with special attention to airway permeability and the degree of difficulty of intubation. Anesthesia should be maintained in a manner that provides the safest, most effective surgical conditions.

Inhibition of rat lipoprotein lipid peroxidation by the oral administration of D003, a mixture of very long-chain saturated fatty acids.

Previous results have demonstrated that policosanol, a mixture of aliphatic primary alcohols isolated and purified from sugar cane wax, whose main component is octacosanol, inhibited lipid peroxidation in experimental models and human beings. D003 is a defined mixture of very long-chain saturated fatty acids, also isolated and purified from sugar cane wax, whose main component is octacosanoic acid followed by traicontanoic, dotriacontanoic, and tetracontanoic acids. Since very long-chain fatty acids are structurally related to their corresponding alcohols, we investigated the effect of oral treatment with D003 (0.5, 5, 50, and 100 mg/kg) over 4 weeks in reducing the susceptibility of rat lipoprotein to oxidative modification. The combined rat lipoprotein fraction VLDL + LDL was subjected to several oxidation systems, including those containing metal ions (CuSO4), those having the capacity to generate free radicals 2,2-azobis-2-amidinopropane hydrochloride (AAPH), and a more physiological system (resident macrophages). D003 (5, 50, and 100 mg/kg) significantly inhibited copper-mediated conjugated-diene generation in a concentration-dependent manner. D003 increased lag phase by 53.1, 115.3, and 119.3%, respectively, and decreased the rate of conjugate-diene generation by 16.6, 21.5, and 19.6%, respectively. D003 also inhibited azo-compound initiated and macrophage-mediated lipid peroxidation as judged by the significant decrease in thiobarbituric acid reactive substance (TBARS) generation. In all the systems the maximum effect was attained at 50 mg/kg. There was also a parallel attenuation in the reduction of lysine amino groups and a significant reduction of carbonyl content after oxidation of lipoprotein samples. Taken together, the present results indicate that oral administration of D003 protects lipoprotein fractions against lipid peroxidation in the lipid as well in the protein moiety.

Association of a CA repeat polymorphism upstream of the Fas ligand gene with multiple sclerosis.

We have analyzed a CA repeat polymorphism localized 46-kb upstream of the Fas ligand gene in Spanish and American populations that include 139 healthy controls and a cohort of 177 unrelated relapsing and remitting multiple sclerosis (MS) patients. The MS patients consisted of two groups, one with a family history of MS and one without. The frequency of the 13 CA repeats (allele B) was lower (p=0.01) in MS patients than in controls, 0.45 and 0.55 respectively. The odds ratio (BB vs. AB/AA) for MS patients vs. healthy controls was 0.51 (95% CI 0.3-0.9; p=0.01). The odds ratio (BB vs. AB/AA) for MS patients extracted from multiply affected families vs. healthy controls was 0.22 (95% CI 0.07-0.62; p=0.002). The HLA DRB1*1501-DQB1*0602 haplotype is associated with B allele with a relative frequency higher than A allele (0.52 and 0.48 in patients vs. 0.68 and 0.32 in controls). The results suggest that chromosomes with B allele have a genetic background that reduces susceptibility to MS, particularly in the familial forms.

Germline mutations in the CCM1 gene, encoding Krit1, cause cerebral cavernous malformations.

Mutations in the Kritl gene have been recently discovered as the cause of hereditary cerebral cavernous angioma. We sought the possibility that de novo, noninherited mutations of Kritl also cause cavernous angioma. A patient with two cerebral malformations carries a heterozygous deletion of two base pairs (741delTC) in exon VI of the Kritl gene. The deletion initiates a frameshift mutation that, 23 amino acids downstream, encodes a TAA stop triplet replacing a CAT triplet of histidine at exon VII (H271X). Magnetic resonance images of the parents were normal, neither parent carries the 741delTC mutation, and both bear the wild-type sequence of exon VI. These findings document a de novo germline mutation in Kritl gene that causes cerebral cavernous malformations.

Effects of policosanol treatment on the susceptibility of low density lipoprotein (LDL) isolated from healthy volunteers to oxidative modification in vitro.

AIMS: The aim of this study was to investigate the effect of policosanol on the susceptibility of LDL-C to in vitro lipid peroxidation in human healthy volunteers. METHODS: The effect of policosanol (5 and 10 mg day(-1) on LDL-C oxidation was studied in a double-blind, randomized, placebo-controlled trial conducted in 69 subjects. LDL-C samples isolated at baseline and after 8 weeks were subjected to in vitro tests of LDL-C oxidation. We tested the susceptibility of LDL-C to lipid peroxidation in a cell-free system by the addition of copper ions as well as in a more physiological system, macrophage-mediated oxidation. RESULTS: At baseline all groups were well matched regarding all variables. After 8 weeks of therapy policosanol administered at 5 and 10 mg, significantly and in a dose-dependent manner increased the lag phase of conjugated diene generation (mean +/- s.d.) from 83.79+/-29.16 min to 94.90+/-25.50 min (5 mg day(-1)) and from 82.74+/-17.16 min to 129.89+/-35.71 min (10 mg day(-1)), while in the placebo group LDL-C oxidation did not change significantly. Policosanol (10 mg day(-1)), but not placebo, significantly decreased the rate of conjugated diene generation. Comparison with placebo after therapy also showed significant differences. Macrophage mediated-oxidation was also inhibited by policosanol as evident by measuring thiobarbituric acid reactive substances (TBARS). Policosanol (10 mg day(-1)) significantly lowered malondialdehyde (MDA) generation from 8.50+/-0.91 to 5.76+/- 1.01 nmol mg(-1) protein. Comparison with placebo after 5 and 10 mg day(-1) showed significant differences. Policosanol significantly lowered total cholesterol by 10.5% (5 mg day(-1)) and 12.4% (10 mg day(-1)) and LDL-C by 16.7% and 20.2%, respectively. Also, policosanol (10 mg day(-1)) increased HDL-C by 15.2%. Five subjects withdrew from the study, none because of adverse experiences. No clinical or blood biochemical drug-related disturbances were found. CONCLUSIONS: The present study demonstrated that policosanol administered within its therapeutic dosage for lowering cholesterol (5 and 10 mg day(-1)), decreased the susceptibility of LDL-C to lipid peroxidation in vitro.

Importance of the CD3 marker for evaluating changes in rhesus macaque CD4/CD8 T-cell ratios.

BACKGROUND: Until recently, there were no CD3 antibodies that crossreacted with rhesus macaque T cells. Consequently, studies relying on CD8 counts or CD4/CD8 ratios enumerated this subpopulation on the basis of CD8+ or CD8bright+ staining. We used a rhesus-specific, anti-CD3 antibody to better define the CD8+ T-cell population, and to show the effects of better measurements on CD4/CD8 ratios and changes in T cells as macaques age. METHODS: We used three-color flow cytometry to measure CD4 and CD8 populations with and without CD3 costaining. Venous blood samples were obtained from 52 colony-bred macaques between 2 months and 9 years of age. RESULTS: The CD8+ T cells defined by CD3 and CD8 double staining were approximately 60% of all cells that were stained by CD8 alone. Improved detection of this lymphocyte subset showed that CD4/CD8 ratios were close to the range of 1.5-2.0. Declining CD4/CD8 ratios during aging are predominantly due to decreasing CD4+ T-cell counts. CONCLUSIONS: Better quantitation of the CD8+ T-cell population showed that the CD4/CD8 ratio was not inverted as had been reported, but is actually very similar to the values observed in human beings. Although the two species differ in the pattern of CD8 expression, the general immune system characteristics are very similar.

Serum endothelial adhesion molecules levels correlate with lesion burden in multiple sclerosis patients treated with interferon beta-1b.

The levels of serum-soluble intracellular adhesion molecule-1 and soluble endothelial-leukocyte adhesion molecule-1, and the Gadolinium-enhanced T1-weighted MRI were studied in a group of patients with relapsing-remitting multiple sclerosis treated with interferon beta-1b and compared to a non-treated control group. The levels of serum-soluble intracellular adhesion molecule-1 and soluble endothelial-leukocyte adhesion molecule-1 increased, after three months treatment, as compared to baseline and the non-treated MS patients. A significant correlation was found in the treated group between serum-soluble endothelial-leukocyte adhesion molecule-1 and the lesion area in the Gadolinium-enhancing (T2 weighted scan) MRI.

Gammadelta T cell receptor repertoire in blood and colonic mucosa of rhesus macaques.

Although their precise roles are not well defined, gammadelta T lymphocytes are recognized as regular components of immune responses. These cells express a limited T cell receptor repertoire and they can be stimulated by soluble ligands without conventional processing and presentation by major histocompatibility antigens. Progress in this area has been limited by the substantial differences between murine and human gammadelta T cells and the lack of knowledge about these cells in nonhuman primates. We used molecular analysis of T cell receptor diversity to characterize gammadelta T cell populations from peripheral blood and colon of rhesus macaques (Macaca mulatta). The gammadelta T cell receptor diversity was limited and distinct for these tissue compartments, particularly in the TCRGV2 family. Furthermore, the TCRDV1 + subset of peripheral blood gammadelta T cells showed signs of progressive oligoclonalization as a function of age. Similar observations have been reported for human tissue samples and our results validate rhesus macaques as an appropriate animal model for studying primate gammadelta T cell populations.

The oxidation-reduction state of serum proteins in multiple sclerosis patients: effect of interferon beta-1b.

The concentration of reduction equivalents in serum was studied in a cohort of healthy individuals, in a group of multiple sclerosis (MS) patients undergoing treatment with interferon beta-1b and another group of MS patients who refused treatment with interferon beta-1b. Two classes of sulfhydryl groups were detectable in serum: (1) the uncovered sulfhydryls, accessible to the oxidation-reduction substrate 5,5-dithiobis-(-2-nitrobenzoic acid) (DTNB); and (2) the hidden sulfhydryls that required previous heat denaturation of serum proteins to become accessible to DTNB. The concentration of the reduced form of both the uncovered- and hidden-type of sulfhydryls was higher in the serum of MS patients than in healthy individuals. Interferon beta-1b lowered the plasma concentration of the uncovered reduced sulfhydryls after 3 months of treatment. This was in contrast to a minor effect of interferon beta-1b in the hidden-form of sulfhydryl groups. The results suggest that the concentration of reduced sulfhydryls is a biochemical marker of the in vivo oxidation/reduction reactions in MS.