Stimulant and relaxant drugs combined with stimulant and relaxant information: a study of active placebo

Rationale The active placebo hypothesis states that placebo effects are potentiated when an active drug is administered.Objective This hypothesis was tested in an experiment where information about the effect of a drug was combined with administration of an active drug or placebo.Methods Information that a drug acted as a relaxant, a stimulant, or as a placebo was crossed with oral administration of a relaxant drug (700 mg carisoprodol), a stimulant drug (400 mg caffeine) or placebo (lactose) in healthy volunteers (n=94). Dependent variables were subjective and physiological measures of arousal, as well as serum carisoprodol and caffeine levels. Data were collected from 15 to 280 min after administration of drug or placebo.Results Caffeine increased alertness, systolic and diastolic blood pressure, startle blink reflexes, and skin conductance responses. Subjects were calmer after carisoprodol, and heart rate was increased. There was a positive correlation between increased arousal and carisoprodol levels when stimulant information had been provided. However, this was only seen when carisoprodol levels were very low. There was no evidence that caffeine modulated the placebo response.Conclusions Active placebo responses were seen only transiently when carisoprodol levels were low, and only in the subjective arousal data. Caffeine did not support active placebo responses. The overall findings did not favour the active placebo hypothesis.     

Response to montelukast among subgroups of children aged 2 to 14 years with asthma

BACKGROUND: Determining who responds to asthma therapies, particularly leukotriene modifiers, continues to be explored. OBJECTIVE: We sought to identify patient characteristics predictive of response to montelukast. METHODS: We used data from 2 clinical trials in which children with asthma received either montelukast or placebo. Symptoms, beta-agonist use, and unanticipated health resource use caused by asthma were recorded in validated daily diaries for children 2 to 5 (n = 689) and 6 to 14 (n = 336) years old. We defined primary end points of days without asthma in 2- to 5-year-old patients (24 hours without symptoms, beta-agonist use, or asthma attack) and change in percent predicted FEV(1) in 6- to 14-year-old children. Asthma attack was defined by the use of rescue oral corticosteroids or by an unscheduled visit to a medical provider. Patients were grouped according to baseline characteristics, such as family history of asthma, personal history of allergy, frequency of asthma symptoms, eosinophilia, and concomitant use of inhaled corticosteroids or cromolyn. We examined the stratum-specific effects of montelukast on the percentage of days without asthma, change in percent predicted FEV(1), asthma attack, and a variety of secondary symptom and FEV(1) end points. RESULTS: We did not identify characteristics that predicted response to montelukast in either preschool or 6- to 14-year-old children. These findings were consistent across all symptom and FEV(1) outcomes. There was also no differential response to montelukast in either age group when asthma attack was the outcome. CONCLUSION: The patient characteristics studied do not appear to provide an indication of who will benefit most from treatment with montelukast.     

Detection of Gallibacterium spp. in chickens by fluorescent 16S rRNA in situ hybridization

Gallibacterium has recently been included as a new genus of the family Pasteurellaceae Pohl 1981, which encompasses bacteria previously reported as Pasteurella anatis, "Actinobacillus salpingitidis," and avian Pasteurella haemolytica-like organisms. So far, identification has exclusively relied on phenotypic characterization. We present a method based on a cyanine dye 3.18-labeled in situ hybridization probe targeting 16S rRNA to allow specific detection of bacteria belonging to the genus Gallibacterium. The probe, GAN850, showed no cross-reactivity to 25 other poultry-associated bacterial species, including members of the families Pasteurellaceae, Enterobacteriaceae, and Flavobacteriaceae, when cross-reactivities were evaluated by whole-cell hybridization. The probe was further evaluated by hybridization to formalin-fixed spleen and liver tissues from experimentally infected chickens, in which it proved to be useful for the detection of Gallibacterium. Additionally, determination of the spatial distribution and the host cell affiliation of Gallibacterium at various times during the infection process was possible. In conclusion, the in situ hybridization technique described may be of use as a diagnostic tool as well as for studies to elucidate the pathogenesis of Gallibacterium infections in chickens.     

Detection of malignant epithelial cells in effusions using flow cytometric immunophenotyping: an analysis of 92 cases

We compared the efficiency of immunophenotyping using flow cytometry (FCM) and a combination of morphologic and immunocytochemical studies for detecting malignant cells in 92 effusions. Cytologic results were as follows: carcinoma cells, 43 specimens; benign, 42 specimens; suggestive of nonepithelial malignancy, 7 specimens. After immunocytochemical analysis, 5 benign specimens were reclassified as malignant and 4 malignant epithelial specimens as benign. With FCM, cells positive for Ber-EP4, B 72.3, AH6, and HB-TN were detected in 28 to 36 (64%-82%) of 44 carcinomas but only 2 to 12 (5%-29%) of 41 benign specimens. Significant association was seen for coexpression. Ber-EP4 and AH6 were the most sensitive; Ber-EP4 was the most specific. The presence of cells positive for 3 of 4 markers strongly suggested malignancy (34/44 carcinoma specimens [77%]; 3/41 reactive specimens [7%]). The presence of cells positive for all 4 markers was diagnostic of malignancy (17/44 malignant specimens [39%]; 0/41 reactive effusions [0%]). FCM and immunocytochemical resultsfor Ber-EP4 expression showed excellent association. FCM is a powerful tool for diagnosing difficult effusions and can quantify coexpression of various markers in fresh specimens. By using established cellular markers coupled with biological markers, FCM also has great promise for experimental purposes.     

Rationalization of shape and related stress distribution in posterior teeth: a finite element study using nonlinear contact analysis

This study considered the loading configuration of intact teeth by using finite element analyses to rationalize the clinical and biologic advantage inherent to posterior tooth shape. The biomechanical behavior of opposing molars was investigated in consideration of different loadcases simulating working, nonworking, and vertical closing micromotions starting in a position close to maximum intercuspation. The resulting stress distribution was assessed in a numerical model, reproducing 2-D buccolingual cross sections of maxillary and mandibular molars. In each case (working/nonworking/closure), the stroke was applied to the mandibular tooth in a stepping procedure (nonlinear contact analysis) until a total external force of 200 N was attained on the contact nodes. The principal stress distribution and modified Von Mises stresses were extracted from the postprocessing files. Vertical loading of the teeth did not generate harmful concentrations of stress. More challenging situations were encountered during working and nonworking micromotions, both of which generated inverted stress patterns. Supporting cusps were generally well protected during both working and nonworking cases (mostly subjected to compressive stresses). Nonsupporting cusps tended to exhibit more tensile stresses. High stress levels were found in the central groove of the maxillary molar during nonworking micromotion and at the lingual surface of enamel of the mandibular tooth during single-contact working micromotion. The occlusal load configuration as well as geometry and hard tissue arrangement had a marked influence on the stress distribution within opposing molars. Additional computations demonstrated the essential role of enamel bridges and crests to protect the crown from harmful tensile stresses.     

Preoperative dexamethasone improves surgical outcome after laparoscopic cholecystectomy: a randomized double-blind placebo-controlled trial

OBJECTIVE: To determine the effects of preoperative dexamethasone on surgical outcome after laparoscopic cholecystectomy (LC). SUMMARY BACKGROUND DATA: Pain and fatigue are dominating symptoms after LC and may prolong convalescence. METHODS: In a double-blind, placebo-controlled study, 88 patients were randomized to intravenous dexamethasone (8 mg) or placebo 90 minutes before LC. Patients received a similar standardized anesthetic, surgical, and multimodal analgesic treatment. All patients were recommended 2 days postoperative duration of convalescence. The primary endpoints were fatigue and pain. Preoperatively and at several times during the first 24 postoperative hours, we measured C-reactive protein (CRP) and pulmonary function, pain scores, nausea, and number of vomiting episodes were registered. Analgesic and antiemetic requirements were recorded. Also, on a daily basis, patients reported scores of fatigue and pain before and during the first postoperative week and the dates for resumption of work and recreational activities. RESULTS: Eight patients were excluded from the study, leaving 40 patients in each study group for analysis. There were no apparent side effects of the study drug. Dexamethasone significantly reduced postoperative levels of CRP (P = 0.01), fatigue (P = 0.01), overall pain, and incisional pain during the first 24 postoperative hours (P < 0.05) and total requirements of opioids (P < 0.05). In addition, cumulated overall and visceral pain scores during the first postoperative week were significantly reduced (P < 0.05). Dexamethasone also reduced nausea and vomiting on the day of operation (P < 0.05). Resumption of recreational activities was significantly faster in the dexamethasone group versus placebo group (median 1 day versus 2 days) (P < 0.05). CONCLUSION: Preoperative dexamethasone (8 mg) reduced pain, fatigue, nausea and vomiting, and duration of convalescence in patients undergoing noncomplicated LC, when compared with placebo, and is recommended for routine use.     

Overweight, stunting, and anemia are public health problems among low socioeconomic groups in school adolescents (12-15 years) in the North Gaza Strip

The objective of the study was to describe sociodemographic differences in nutritional status among school adolescents aged 12 to 15 years in north Gaza Strip. A cross-sectional survey was conducted in 2002 comprising 1022 students from 10 schools in Gaza city, Jabalia village, and Jabalia refugee camp. Height, weight, and hemoglobin levels were measured to assess nutritional status. Self-administered questionnaires were administered to students and parents to obtain data on sociodemographic characteristics. The prevalence of overweight/obesity, stunting, and anemia in the total sample was 17.9%, 9.7%, and 49.6%, respectively. More overweight/obese girls than boys were found (20.2% vs 15.4%). In girls, being from a low-income residential area, having employed fathers, and having reached puberty had highest risk of overweight/obesity, whereas in boys, those with medium socioeconomic status (SES) had the lowest risk of overweight. The mean height-for-age percentile was generally low for both sexes compared with the National Center for Health Statistics/World Health Organization reference, but stunting was more common in boys than girls (13.7% vs 6.2%). Age was positively associated with risk of stunting in boys, whereas in girls, SES and mother's education were negatively associated with stunting. Anemia prevalence was high in both girls and boys (51.3% vs 47.9%). Age and onset of puberty had an independent negative effect on anemia among boys. Girls from nuclear families and from Jabalia village had higher risk of being anemic. In conclusion, undernutrition and overnutrition coexisted in the study area. Anemia, stunting, and overweight among the adolescents are public health problems, especially among low SES groups that merit attention.