Tracking of cervical cancer in 7,519 patients: a study of the prevalence of altered cytologies.

PURPOSE: To evaluate the outcome and adherence of 535 patients with cytological changes. MATERIALS AND METHODS: Study of 7519 smear tests harvested in 2007. RESULTS: Of the 7,519 (100%) patients analyzed, 6,964 (92.6%) had cytology negative for intraepithelial lesion or malignancy, 535 (7.1%) abnormalities in epithelial cells, and 20 (0.3%) were unsatisfactory. Of these 535 (100%) patients, 511 (95.5%) were referred to the outpatient clinic and colposcopic exam submitted and 24 (4.5%) did not return to the clinic. The group participated in the ambulatory visits, 302 (59.1%) underwent colposcopy-guided biopsy, and the remaining 209 (40.9%) examinations were negative. CONCLUSION: The cytological examination remains the method of choice for cervical cancer screening. It includes low costs, is effective, and well-accepted. Early diagnosis minimises the cost of research. Universities have an important role in the training of health professionals and also in the development of research.

Occupational therapy and dementia: the experience of an Alzheimer special care unit.

This trial reports the outcomes of an occupational therapy (OT) program in a group of patients with moderately severe dementia, attending a day care center. Twenty-six patients were enrolled in this therapeutic program for a 12-month period. OT sessions were held for two hour a day, five days a week. The outcomes of the trial suggest that the introduction of OT and multidimensional assessment may improve management and mediate the psychophysical decline of persons with dementia. Indeed, the assessed performance indices remained relatively stable over time, as compared to the decline expected by the natural progression of disease. Moreover, behavioral disorders evaluated by the neuropsychiatric inventory (NPI) scores improved appreciably between treatment start and end. The day care center provides an opportunity for both the person with dementia and their family by optimizing therapy for the patient and providing medical assistance for morbid conditions that ensue during the course of disease and by lowering the burden of care and providing moral support for the family by a trained staff, with particular focus on behavioral disorders that are not amenable to pharmacological management.

[Diabetic foot: from diagnosis to therapy]. / Il piede diabetico: dalla diagnosi alla terapia.

Four percent of Italians are affected by diabetes mellitus. There are 120 million diabetics worldwide: it is expected that 15% of them will have wounds on their feet during their lifetime. In industrialized countries diabetes mellitus is the main cause of non-accidental amputation and this risk is approximately 15 times higher in diabetics than in any other population. The vasculopathy and/or the diabetic neuropathy represent the basic pathogenic elements in the development of diabetic foot: 15% of diabetics are affected by arteriopathy after 10 yrs of illness and just <50% of diabetics after 25 yrs; 25% of patients have neuropathy after 10 yrs of illness, >40% have neuropathy after 25 yrs. The infection is the third, and often, concomitant pathogenetic factor in the diabetic ulcera. The diagnostics of the vasculopathic diabetic foot makes use of a careful objective check; doppler ultrasonography and arteriography (with the therapeutic application of the PTCA). In addition to the objective check, EMG and the neuropathy autonomy test are fundamental in the neuropathic diabetic foot. Osteomyelitis represents the most fearful complication in the diabetic foot; it can often be solved only through surgical destructive therapy. Therapy of the diabetic foot must come from careful and synergic team work, in which dietician, vascular surgeon, orthopedist and dermatologist make available their own skill with humility and endless patience.

Gene elements that affect the longevity of rbcL sequence-containing transcripts in Chlamydomonas reinhardtii chloroplasts.

The chloroplast gene rbcL encodes the large subunit of the CO(2)-fixing enzyme ribulose-bisphosphate carboxylase. In previous work a target for photo-accelerated degradation of Chlamydomonas reinhardtii rbcL transcripts in vivo was found to lie within the first 63 nucleotides, and a sequence element required for increasing the longevity of transcripts of rbcL-reporter genes was found to occur between nucleotides 170 and 350. Photo-accelerated degradation of rbcL transcripts has been found to require nucleotides 21 to 41. Transcript nucleotides lying between 329 and 334 and between 14 and 27 are essential for stabilizing transcripts in vivo; mutations in either region reduce the longevity of transcripts. It is postulated that the effectiveness of photo-accelerated endonuclease attacks on the nucleotide 21 to 41 region is reduced by physical blockage or distortion of the target sequence by interacting proteins that associate with nucleotides in the 14 to 27 and 329 to 334 regions of the transcripts. Both the nucleotide +329 to +334 stabilizing sequence of rbcL and a transcription enhancing sequence that lies between +126 and +170 encode well conserved (cyanobacteria through angiosperms) amino acid sequences; the evolution of expression control elements within the protein coding sequence of rbcL is considered.

TRM1, a YY1-like suppressor of rbcS-m3 expression in maize mesophyll cells.

The genes rbcS and rbcL encode, respectively, the small and large subunits of the photosynthetic carbon dioxide fixation enzyme ribulose bisphosphate carboxylase/oxygenase. There is a single rbcL gene in each chloroplast chromosome; a family of rbcS genes is located in the nuclear genome. These two genes are not expressed in mesophyll cells but are in adjacent bundle-sheath cells of leaves of the C4 plant Zea mays. Two regions of the maize gene rbcS-m3 are required for suppressing expression in mesophyll cells. One region is just beyond the translation termination site in the 3' region, and the other is several hundred base pairs upstream of the transcription start site. A binding site for a protein with limited homology to the viral, yeast, and mammalian transcription repressor-activator YY1 (Yin-Yang I), has now been identified in the 3' region. A maize gene for a protein with zinc fingers homologous to those of YY1 has been isolated, characterized, and expressed in Escherichia coli. The gene is designated trm1 (transcription repressor-maize 1). The protein TRM1 binds to the YY1-like site and, in addition, TRM1 binds to two sequence regions in the 5' region of the gene that have no homology to the YY1 site. Mutagenesis or deletion of any of these three sequences eliminates repression of rbcS-m3 reporter genes in mesophyll cells.

Subpopulations of chloroplast ribosomes change during photoregulated development of Zea mays leaves: ribosomal proteins L2, L21, and L29.

Seedlings grown in darkness, i.e., etiolated seedlings, lack chlorophyll and most other components of the photosynthetic apparatus. On illumination, the plastids become photosynthetically competent through the production of chlorophylls and proteins encoded by certain chloroplast and nuclear genes. There are two types of photosynthetic cells in leaves of the C4 plant maize: bundle sheath cells (BSC) and adjacent mesophyll cells (MC). Some proteins of the maize photosynthetic machinery are solely or preferentially localized in MC and others in BSC. A particular gene may be photoregulated up in one cell type and down in the other. Transcripts of the nuclear gene rpl29, encoding the chloroplast ribosomal protein L29, increase in abundance about 17-fold during light-induced maturation of plastids. There is about 1.5 times more L29 protein in ribosomes of greening leaves than in ribosomes of unilluminated leaves; the L29 contents of MC and BSC are about the same. However, L21 is present about equally in plastid ribosomes of unilluminated and illuminated seedlings. In contrast to both L29 and L21, the fraction of the ribosome population containing L2 is about the same in MC and BSC of etiolated leaves but, on illumination, the proportion of the ribosome population with L2 increases in BSC but not in MC. The existence of different subpopulations of plastid ribosomes-e.g., those with and without L21 and/or L29 during development-evokes interesting, but as yet unanswered, questions about the roles of different types of ribosomes in differentiation.

[Productivity of teaching hospitals in the state of São Paulo,Brazil]. / Produtividade em hospitais de ensino no estado de São Paulo, Brasil.

Teaching hospitals can be defined as hospitals whose mission is both to provide health care to the population and to train qualified professionals. This represents high costs that need to be balanced by higher productivity and quality. The aim of the present study was to identify the level of productivity in five teaching hospitals in the state of São Paulo, Brazil. For that, we measured indicators such as patient length of stay, patient turnover rate, substitution interval, and number of employees per hospital bed. For a better understanding of the reality of these teaching hospitals, data regarding morbidity and geographic range of influence were also analyzed. Results were compared with the results from a previous study which analyzed private tertiary and secondary hospitals and public secondary hospitals. Productivity was defined as inversely proportional to length of stay, patient turnover rate, substitution interval, and number of employees per hospital bed. We observed that private hospitals have a higher productivity in terms of most indicators, which suggests that these hospitals make a more efficient use of their human, material, and financial resources. Teaching hospitals have a higher length of stay than the other hospitals (median = 7 days); lower turnover rate than private hospitals and similar to public hospitals (median = 3.70 days); higher employee per bed ratio than the private hospitals, and smaller than public hospitals (median = 7 employee/hospital bed). Substitution interval was different for each type of hospital; only public hospitals had a lower substitution interval than teaching hospitals (median = 1.70 days).

Autoradiographic localization of neurotransmitter binding sites in the hypoglossal and motor trigeminal nuclei of the rat.

The hypoglossal and motor trigeminal nuclei contain somatic motoneurons innervating the tongue, jaw, and palate. These two cranial motor nuclei are myotopically organized and contain neurotransmitter binding sites for thyrotropin-releasing hormone, substance P, and serotonin. Quantitative autoradiography was used to localize thyrotropin-releasing hormone, substance P, and serotonin-1A and serotonin-1B binding sites in the hypoglossal and motor trigeminal nuclei and to relate the relative distributions of these binding sites to the myotopic organizations of the two nuclei. In the hypoglossal nucleus, high-to-moderate concentrations of all four binding sites were present in the dorsal and ventromedial subnuclei, whereas low concentrations were noted in the ventrolateral subnucleus. In the motor trigeminal nucleus, high concentrations of serotonin-1B, moderate densities of thyrotropin-releasing hormone, and low levels of substance P and serotonin-1A binding sites were present in both the ventromedial and dorsolateral subnuclei. These observations demonstrate that neurotransmitter binding sites in the hypoglossal and motor trigeminal nuclei are heterogeneously localized and that their distributions correspond to the previously described myotopic organizations of each nucleus.

Prospective population survey: do centenarians change?

Two groups of centenarians (32 subjects) were evaluated, residing in the same geographic area, in two sampling periods (1988 and 1992). The characteristics of the groups were compared to see how this age class changed over a 4 year period. Significant differences were found for the number of centenarians, their level of dependency and the use of drugs.

Hormone levels in centenarians.

The serum profiles of total triiodothyronine (T(3)), free thyroxin (fT(4)), thyroid stimulating hormone (TSH), cortisol, prolactin (HPRL), parathormone (PTH), osteocalcin and growth hormone (GH) were measured in a group of 12 centenarians and compared to the values of a control group of twenty-nine subjects, aged 67-98 years. The study was aimed at revealing whether there are appreciable differences or age-related modifications in the hormone status of healthy control elderly and the centenarian population. In this series, the modifications in hormone levels were unremarkable, and the serum levels of the studied hormones in centenarians often fell within a range considered to be normal for the younger age classes.

Effects of vagotomy on neurotransmitter receptors in the rat dorsal vagal complex.

The dorsal vagal complex contains many different neurotransmitter receptors. The cyto-architectural localizations of some of these receptors remain largely unknown. In rats, vagotomy was performed to destroy vagal afferents terminating in the nucleus of the solitary tract and to produce chromatolysis of preganglionic motoneurons in the dorsal motor nucleus of the vagus. Quantitative receptor autoradiography was then employed to determine the effect of vagotomy upon the distribution of receptors for thyrotropin-releasing hormone, substance P, and serotonin within individual regions and subnuclei of the entire dorsal vagal complex. Vagotomy reduced the concentrations of thyrotropin-releasing hormone and substance P, but not serotonin1A, or serotonin1B, receptors in the dorsal motor nucleus of the vagus. Within the nucleus of the solitary tract, substance P receptors were reduced in only the medial and central subnuclei after vagotomy. In contrast, no effect was observed upon the concentrations of thyrotropin-releasing hormone, serotonin1A, or serotonin1B receptors in any subnuclei of the solitary tract following vagotomy. These results suggest that in the dorsal motor nucleus of the vagus, thyrotropin-releasing hormone and substance P receptors are localized upon vagal preganglionic motoneurons, while serotonin1A and serotonin1B receptors are present upon interneurons or other neuronal elements. These results also suggest that thyrotropin-releasing hormone, substance P, serotonin1A, and serotonin1B receptors in the nucleus of the solitary tract are localized upon internuncial neurons in the nucleus of the solitary tract.

Antinociception induced by systemic administration of local anaesthetics depends on a central cholinergic mechanism.

1 The antinociceptive effects of systemically-administered procaine, lignocaine and bupivacaine were examined in mice and rats by using the hot-plate, writhing and tail flick tests. 2 In both species all three local anaesthetics produced significant antinociception which was prevented by atropine (5 mg kg-1, i.p.) and by hemicholinium-3 (1 microgram per mouse, i.c.v.), but not by naloxone (3 mg kg-1, i.p.), alpha-methyl-p-tyrosine (100 mg kg-1, s.c.), reserpine (2 mg kg-1, i.p.) or atropine methylbromide (5.5 mg kg-1, i.p.). 3 Atropine (5 mg kg-1, i.p.) which totally antagonized oxotremorine (40 micrograms kg-1, s.c.) antinociception did not modify morphine (5 mg kg-1, s.c.) or baclofen (4 mg kg-1, s.c.) antinociception. On the other hand, hemicholinium, which antagonized local anaesthetic antinociception, did not prevent oxotremorine, morphine or baclofen antinociception. 4 Intracerebroventricular injection in mice of procaine (200 micrograms), lignocaine (150 microgram) and bupivacaine (25 micrograms), doses which were largely ineffective by parenteral routes, induced an antinociception whose intensity equalled that obtainable subcutaneously. Moreover, the i.c.v. injection of antinociceptive doses did not impair performance on the rota-rod test. 5 Concentrations below 10(-10) M of procaine, lignocaine and bupivacaine did not evoke any response on the isolated longitudinal muscle strip of guinea-pig ileum, or modify acetylcholine (ACh)-induced contractions. On the other hand, they always increased electrically-evoked twitches. 6 The same concentrations of local anaesthetics which induced antinociception did not inhibit acetylcholinesterase (AChE) in vitro. 7 On the basis of the above findings and the existing literature, a facilitation of cholinergic transmission by the local anaesthetics is postulated; this could be due to blockade of presynaptic muscarinic receptors.