Electroencephalographic evidence of brainstem recruitment during scorpion envenomation

Scorpion envenomation is a public health problem in Brazil, with most severe cases occuring in children under the age of 5 years (0.6% lethality). In fact, the toxic fractions of the Tityus serrulatus scorpion venom (TSSV) have greater permeability across the BBB of weanling rats when compared to adults. Although EEG alterations have been reported in up to 75% of pediatric severe cases, the role of the CNS in envenomation morbidity is still in debate. Our working hypothesis is that the neural substrates that play a major role in morbidity generate activity undetectable from EEG scalp leads. Twenty one-day-old rats (n=18) were injected s.c. with the deadliest toxic fraction of the TSSV, tityustoxin (TsTX; 2xDL50=6 mg/kg). EEG leads were stereotaxicaly implanted in the nucleus of the solitary tract (NTS) and left parietal cortex. EEG and ECG were continuously monitored by a video EEG system until death or for a maximum period of 240 min. An experimental group pre-treated with carbamazepine (CBZ) was added in order to better access the cause-effect relationship between neural discharges and the systemic ECG alterations. High amplitude discharges in the NTS, which correlated to cardiac alterations, were recorded soon after administration of TsTX. Abnormal electrographic activity spread throughout the cortex only later in the recording. As expected, the CBZ treatment increased the latency for the first epileptiform discharge, decreased EEG/ECG alterations and increased the general survival time. In summary: peripheral scorpion toxin inoculation recruits brainstem involved in cardiovascular control and initial electrographic activity was undetectable from the cortical electrode.     

Differential immune regulation of activated T cells between cutaneous and mucosal leishmaniasis as a model for pathogenesis

Cutaneous (CL) and mucosal leishmaniasis (ML) are characterized by a predominant type 1 immune response (IFN-gamma and TNF-alpha production) and strong inflammatory response in the lesions with few parasites. This exacerbated type 1 response is more evident in ML as compared to CL. Our main hypothesis is that a differential immune regulation of T cell activation leads to over reactive T cells in ML. In the present study, we investigated immunological factors that could explain the mechanisms behind it by comparing some immune regulatory mechanisms between ML and CL patients: frequency of cells expressing co-stimulatory molecules, apoptotic markers, T cell activation markers; and ability of neutralizing antibodies to IL-2, IL-12 and IL-15 do down-regulate IFN-gamma production in leishmania antigen-stimulated peripheral blood mononuclear cells (PBMC). Interestingly, in CL anti-IL-2 and anti-IL-15 significantly suppressed antigen-specific IFN-gamma production, while in ML only anti-IL-2 suppressed IFN-gamma production. Finally, higher frequency of CD4+ T cells expressing CD28-, CD69+ and CD62L(low) were observed in ML as compared to CL. These data indicate that an exacerbated type 1 response in ML is differentially regulated and not appropriately down modulated, with increased frequencies of activated effectors T cells, maintaining the persistent inflammatory response and tissue damage observed in ML.     

Obstructive sleep apnea and resistant hypertension: a case-control study

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) has been linked to resistant hypertension, but the magnitude of this association and its independence of confounding have not been established. METHODS: Case patients were 63 patients with resistant hypertension (BP >or= 140/90 mm Hg using at least three BP-lowering drugs, including a diuretic), and control subjects were 63 patients with controlled BP receiving drug treatment. The primary outcome was the frequency of OSAS (apnea-hypopnea index [AHI] >or= 10 episodes per hour) determined with a portable home monitor. The comparison of AHI episodes in patients truly normotensive, truly hypertensive, and in patients with white coat or masked hypertension, based on BP determined at office and by ambulatory BP monitoring (ABPM) was a secondary outcome. RESULTS: Case patients and control subjects were well matched for confounding factors. OSAS was present in 45 case patients (71%) and in 24 control subjects (38%) [p < 0.001]. In a logistic regression model, OSAS was strongly and independently associated with resistant hypertension (odds ratio, 4.8; 95% confidence interval, 2.0 to 11.7). The AHI of case patients with normal BP in ABPM (white coat hypertension) and control subjects with abnormal BP in ABPM (masked hypertension) was intermediate between the AHI of individuals with normal and abnormal BP measures in both settings (p < 0.001). CONCLUSIONS: The magnitude and independence of the risk of OSAS for resistant hypertension strengthen the concept that OSAS is a risk factor for resistant hypertension. Comorbid OSAS should be considered in patients with resistant hypertension.     

A new generation of women veterans: Stressors faced by women deployed to Iraq and Afghanistan

The extent of female service members' involvement in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), in terms of both the number of women deployed and the scope of their involvement, is unprecedented. While many of the mental health readjustment issues of female service members are likely to mirror those of the majority male Veteran population, this newest generation of women Veterans may also face unique threats to their mental health. The goal of this review it to highlight emerging issues relevant to the development of posttraumatic stress disorder (PTSD) among women deployed to Iraq and Afghanistan by reviewing the existing literature on gender-relevant issues among this cohort, as well as raising theoretically important issues that are worthy of further empirical investigation. Topics addressed include gender differences in combat experiences and in PTSD following combat exposure; sexual assault, sexual harassment and other interpersonal stressors experienced during deployment; women Veterans' experiences of premilitary trauma exposure; and unique stressors faced by women Veterans during the homecoming readjustment period. Given that most models of the impact of war zone deployment on PTSD are predicated on the experiences of male service members, women's expanding role in combat operations presents both an opportunity and a challenge to adapt these models to more effectively capture the experiences of female service members.     

An autochthonous case of hepatitis C virus genotype 5a in Brazil: phylogenetic analysis

Genotype 5 of hepatitis C virus (HCV) has been rarely identified in South America. A female of African descent who never left Brazil was found to be infected by this genotype in Mato Grosso state, Central Brazil. The patient denied drug injections and revealed that she had received blood transfusions several years before. One of her blood donors was identified and tested negative for anti-HCV and HCV RNA, as were her husband and offspring. Phylogenetic analysis of the E1 and NS5B regions confirmed that this HCV strain belonged to genotype 5a. However, the E1 region analysis indicates that our strain is not closely related to any sequences of genotype 5a from other geographical areas, diverging from the African and European subclades known so far. These data suggest that genotype 5a HCV might have been circulating at a low level in Brazil longer than previously supposed.     

Influence of the degree of dentine mineralization on pulp chamber temperature increase during resin-based composite (RBC) light-activation

Objectives

To analyse the influence of the degree of dentine mineralization on the pulp chamber temperature increase during composite light-activation.

Methods

Dentine discs (2 mm thick) obtained from recently extracted teeth or those with extensive dentine sclerosis were analysed by FT-IR spectrometry in order to choose the two discs with the greatest difference in the degree of mineralization. A model tooth was set up with the dentine discs between a molar with the pulp chamber exposed and a crown with a standardized class II cavity. A K-type thermocouple was introduced into the molar root until it came into contact with the dentine discs and the cavity was filled with P60 resin composite. The temperature rise was measured for 120 s after light-activation began: Standard (S) 600 mW/cm²/40 s; Ramp (R) 0 → 800 mW/cm²/10 s + 800 mW/cm²/10 s; Boost (B) 850 mW/cm²/10 s and LED (L) 1.300 mW/cm²/40 s (n = 10). The same protocol was repeated after grinding the dentine discs to 1.0 and 0.5 mm thickness.

Results

The temperature increase was significantly higher in dentine with high degree of mineralization (p < 0.05). With respect to the dentine thickness, the following result was found: 2 mm < 1 mm < 0.5 mm (p < 0.05). The light-activation mode also presented significant difference as follows: S > R = L > B (p < 0.05).

Conclusions

The higher the degree of dentine mineralization the greater the increase in pulp chamber temperature. The temperature increase was influenced by the light-polymerization mode and dentine thickness.     

A critical analysis of the degree of conversion of resin-based luting cements

Objective

This study analyzed the degree of conversion (DC%) of four resin-based cements (All Ceram, Enforce, Rely X ARC and Variolink II) activated by two modes (chemical and dual), and evaluated the decrease of DC% in the dual mode promoted by the interposition of a 2.0-mm-thick IPS Empress 2 disc.

Material and Methods

In the chemical activation, the resin-based cements were prepared by mixing equal amounts of base and catalyst pastes. In the dual activation, after mixing, the cements were light-activated at 650 mW/cm² for 40 s. In a third group, the cements were lightactivated through a 2.0-mm-thick IPS Empress 2 disc. The DC% was evaluated in a FT-IR spectrometer equipped with an attenuated total reflectance crystal (ATR). The data were analyzed by two-way ANOVA and Tukey''s HSD test.

Results

For all resin-based cements, the DC% was significantly higher with dual activation, followed by dual activation through IPS Empress 2, and chemical activation (p<0.05). Irrespective of the activation mode, Rely X presented the highest DC% (p<0.05). Chemically activated Variolink and All Ceram showed the worst results (p<0.05). The DC% decreased significantly when activation was performed through a 2.0-mm-thick IPS Empress 2 disc (p<0.05).

Conclusions

The results of the present study suggest that resin-based cements could present low DC% when the materials are dually activated through 2.0 mm of reinforced ceramic materials with translucency equal to or less than that of IPS-Empress 2.     

甲型H1N1流感病毒基因组序列分析及其特性研究

目的 分析甲型H1N1流感病毒的基因组序列特征,阐明该毒株的遗传变异及分子特性.方法 GenBank中获取流感病毒全序列,对各段基因与已知序列进行分析比较,绘制进化树,并分析和预测甲型毒株的致病性、药物敏感性和现有疫苗的预防保护作用.结果 甲型H1N1病毒的HA、PB2、PB1、PA、NP、NS基因与美国本土的猪流感病毒序列具有高度同源性,NA和M基因具有典型的欧亚株系猪流感病毒特征.该病毒具有人传人的分子基础,HA上HA1和HA2裂解位点序列为PSIQSR↓+GLFGAI,尚不具备高致病性流感病毒的特征.病毒对金刚烷胺类药物耐药,而对达菲和扎那米韦敏感.HA片段5个抗原决定区氨基酸序列与人用流感疫苗具有较大差异,推测现有疫苗对预防本次疫情基本无效.结论 甲型H1N1是一种北美和欧亚两种猪流感病毒的混合体,开发针对本病毒的流感疫苗有助于进一步控制疫情蔓延.