Hyperventilation response in the electroencephalogram and psychiatric problems in children with primary monosymptomatic nocturnal enuresis

OBJECTIVES: The aim of this study was to determine the frequency of an increased hyperventilation (HV) response in the electroencephalogram and to compare the results of psychometric assessments and electroencephalography (EEG) patterns in children with and without primary monosymptomatic nocturnal enuresis and in dry siblings of enuretics. We also compared the results of psychometric assessments and EEG patterns between enuretic and non-enuretic children. MATERIAL AND METHODS: The study included 89 children divided into three groups: 41 with primary monosymptomatic nocturnal enuresis, their 29 dry siblings and 19 with no history of voiding dysfunction (controls). Resting EEG changes were evaluated in all children. In addition to a psychiatric evaluation, the Maudsley Obsessive Compulsive Questionnaire, the Beck Child Depression Inventory and the State and Trait Anxiety Inventory for Children were used to assess obsessive-compulsive disorder, depression and anxiety, respectively. RESULTS: The time at which real words were first spoken occurred significantly later in enuretic children (p<0.01). The frequency of EEG abnormalities was significantly higher in the enuresis group and in their dry siblings than in the control group (p<0.01). Additionally, as an indicator of cortical dysmaturity, an increased HV response was observed more often in enuretic children and their dry siblings than in the control group (p<0.001). Anxiety scores for the enuretic children were higher than those for the controls (p<0.01). There was no significant difference in psychiatric problems between the enuresis and control groups (p>0.05). CONCLUSIONS: The increased frequency of a high-level HV response in resting-state EEG recordings and the anxiety scores suggested that delayed cortical maturity and high anxiety may be important factors in the pathogenesis of primary monosymptomatic nocturnal enuresis. The HV responses in the dry siblings of the enuretic children may emphasize the relationship between insufficient cerebral maturation and the genetic origin of nocturnal enuresis.     

Clinical risk factors for fatal diarrhea in hospitalized children

It is important to determine the specific factors for diarrheal deaths in infants & young children to enable the intervention and reduce the mortality rates. This study aimed to identify these factors in children under five years of age, hospitalized with diarrheal complaints. Four hundred diarrheal children were included in the study. Twenty-seven (6.75%) of them died and 373 (93.25%) survived. The nutritional status of the patients was determined using weight for height for age as percentage of Harward Standard. It was found that severe malnutrition (p=0.000 for weight for height ration <70% and p=0.036 for height for age <85%), co-existent sepsis (p=0.000), shigella infection (p=0.0014), hypoalbuminemia (p=0.0000), hypoglycemia (p=0.0002), hyponatremia (p=0.016), hypokalemia (p=0.0041) and metabolic acidosis (p=0.0069 for pH<7.35 and p=0.000 for HCO₃<20moL/l) were significant risk factors for diarrheal deaths in the univariate analysis. In the multivariate analysis, young age (under 6 months of age) {Odds ratio (OR) 10.49, 95% confidence interval (Cl) 1.75, 62.75)}, moderate or severe dehydration (OR 8.17, 95% Cl 1.53, 43.67), severe malnutrition (OR 0.04, 95% Cl 0.00, 0.22 of weight for height <70% and OR 0.03, 95% Cl 0.00, 0.36 for height for age<85%), co-existent sepsis (OR 37.26, 95% Cl 6.94, 200.06), shigella infection (OR 23.01, 95% Cl 3.08, 171.98), hypoalbuminemia (OR 0.11, 95% Cl 0.02, 0.54), metabolic acidosis (OR 0.03, 95% Cl 0.00, 0.33 of HCO3<20 mMol/L) were significant risk factors. It is concluded that, in addition to electrolyte and fluid treatments, prevention of malnutrition, continuation of feeding which lessens weight loss and may prevent fatal hypoglycemia, and early detection and treatment of probable sepsis are important in reducing diarrheal deaths.     

异常黑胆质载体动物模型的下丘脑-垂体-肾上腺轴功能紊乱的物质基础研究

目的:观察异常黑胆质载体动物模型下丘脑-垂体-肾上腺轴(HPAA)有关指标的变化,探求异常黑胆质载体动物模型HPAA功能紊乱的物质基础。方法:采用干寒饲养环境、干寒属性的饲料饲养、慢性间断足底电击等多因素复制小鼠异常黑胆质载体动物模型,用ELISA法检测血清ACTH、CORT和-βEP含量;采用高效液相-荧光检测分析法分析血清和脑去甲肾上腺素(NE)、多巴胺(DA)、5-羟色胺(5-HT)3、、4二羟基本乙酸(DOPAC)等单胺类神经递质含量。结果:血清ACTH、CORT和-βEP含量增加(P<0.05);异常黑胆质载体动物模型血清中NE含量明显增加(P<0.05),DA含量下降(P<0.05),5-HT(P<0.01)和DOPAC(P<0.01)含量减少;脑组织中NE含量明显增加(P<0.05),DA含量减少(P<0.05)和DOPAC含量降低(P<0.01),5-HT含量改变不明显(P>0.05)。结论:异常黑胆质载体动物模型实验动物下丘脑、垂体和肾上腺合成、分泌及调控功能紊乱,下丘脑-垂体-肾上腺轴(HPAA)处于应激激活状态,血清及脑组织单胺类神经递质存在异常。此可能是异常黑胆质载体动物模型存在HPAA紊乱的物质基础。     

Effects of reduced mucus oxygen concentration in airway Pseudomonas infections of cystic fibrosis patients

Current theories of CF pathogenesis predict different predisposing "local environmental" conditions and sites of bacterial infection within CF airways. Here we show that, in CF patients with established lung disease, Pseudomonas aeruginosa was located within hypoxic mucopurulent masses in airway lumens. In vitro studies revealed that CF-specific increases in epithelial O(2) consumption, linked to increased airway surface liquid (ASL) volume absorption and mucus stasis, generated steep hypoxic gradients within thickened mucus on CF epithelial surfaces prior to infection. Motile P. aeruginosa deposited on CF airway surfaces penetrated into hypoxic mucus zones and responded to this environment with increased alginate production. With P. aeruginosa growth in oxygen restricted environments, local hypoxia was exacerbated and frank anaerobiosis, as detected in vivo, resulted. These studies indicate that novel therapies for CF include removal of hypoxic mucus plaques and antibiotics effective against P. aeruginosa adapted to anaerobic environments.     

The Evaluation of CD99 Immunoreactivity and EWS/FLI1 Translocation by Fluorescence in situ Hybridization in Central PNETs and Ewing’s Sarcoma Family of Tumors

Ewing’s sarcoma family of tumors (ESFTs) are indicated by malignant, small, round and blue cell tumors of the bone and soft tissue. Gene rearrangements between EWS gene on chromosome 22q12 and members of the ETS gene family are common in and specific to ESFTs. Another defining characteristic of ESFTs is their membranous expression of the CD99. In contrast, such translocations and immunoreactivity are not found in central primitive neuroectodermal tumors (cPNETs). The aim of this study was to investigate the detection of EWS/FLI1 translocations and CD99 immunoreactivity in order to evaluate their clinicopathological features and their roles in the differential diagnosis of these tumors. In this study, we investigated CD99 immunoreactivity using immunohistochemistry and Ewing’s sarcoma / Friend leukaemia virus integration 1 (EWS/FLI1) translocation using the fluorescence in situ hybridization (FISH) method in 23 cases. CD99 expression was detected in 10/11 (90%) ESFT cases and 2/7 cPNET cases. In 18 cases EWS/FLI1 translocation was examined using the FISH method. The EWS/FLI1 translocations were detected in 7/8 (87.5%) ESFTs cases, whereas non of 8 cPNET cases were detected with this translocation. One case could not be classified as either central or peripheral, showed EWS/FLI1 translocation. There was a statistically significant difference in CD99 expression (p = 0.0013) and EWS/FLI1 translocation (p = 0,002) between cPNETs and ESFTs cases. In conclusion, CD99 expression and EWS/FLI1 translocation are specific and sensitive markers in the diagnosis of ESFTs. However, these were often not found in cases of cPNET. Therefore, in the diagnosis of ESFTs, clinical, radiological, histopathological and immunohistochemical parameters should always be evaluated together.     

Aspirin for primary thrombosis prevention in the antiphospholipid syndrome: a randomized, double-blind, placebo-controlled trial in asymptomatic antiphospholipid antibody-positive individuals

OBJECTIVE: To determine the efficacy of a daily dose of 81 mg aspirin in primary thrombosis prevention in asymptomatic, persistently antiphospholipid antibody (aPL)-positive individuals (those with positive aPL but no vascular and/or pregnancy events). METHODS: The Antiphospholipid Antibody Acetylsalicylic Acid (APLASA) study was a multicenter, randomized, double-blind, placebo-controlled clinical trial in which asymptomatic, persistently aPL-positive individuals were randomized to receive a daily dose of 81 mg of aspirin or placebo. In a separate observational and parallel study, asymptomatic, persistently aPL-positive individuals who were taking aspirin or declined randomization were followed up prospectively. RESULTS: In the APLASA study, 98 individuals were randomized to receive aspirin or placebo (mean +/- SD followup period 2.30 +/- 0.95 years), of whom 48 received aspirin and 50 received placebo. In the observational study, 74 nonrandomized individuals were followed up prospectively (mean +/- SD followup period 2.46 +/- 0.76 years); 61 received aspirin and 13 did not. In the APLASA study, the acute thrombosis incidence rates were 2.75 per 100 patient-years for aspirin-treated subjects and 0 per 100 patient-years for the placebo-treated subjects (hazard ratio 1.04, 95% confidence interval 0.69-1.56) (P = 0.83). Similarly, in the observational study, the acute thrombosis incidence rates were 2.70 per 100 patient-years for aspirin-treated subjects and 0 per 100 patient-years for those not treated with aspirin. All but 1 patient with thrombosis in either study had concomitant thrombosis risk factors and/or systemic autoimmune disease at the time of thrombosis. CONCLUSION: Our results suggest that asymptomatic, persistently aPL-positive individuals do not benefit from low-dose aspirin for primary thrombosis prophylaxis, have a low overall annual incidence rate of acute thrombosis, and develop vascular events when additional thrombosis risk factors are present.     

N-acetylcysteine improves intestinal barrier in partially hepatectomized rats

BACKGROUND: Translocating enteric bacteria play an important role in the development of infections following partial hepatectomy. The intestine itself is the first line of defence against bacterial translocation (BT). We investigated the effect of N-acetylcysteine (NAC) on BT and the intestinal wall. METHODS: We compared four groups of Sprague-Dawley male rats (eight in each group): sham, sham plus preoperative single dose of NAC, partial hepatectomy and partial hepatectomy plus preoperative single dose of NAC. Microorganism count in the tissues and the glutathione and malondialdehyte contents of the intestinal wall were studied at the end of the 24th hour. RESULTS: Bacterial growth was observed in the spleen and mesenteric lymph nodes in the sham group. There was bacterial growth in all the samples of the partial hepatectomy group. Differences were significant except in atrial and portal blood counts. In the partial hepatectomy plus NAC treatment group, counts were significantly low in all, except atrial and portal blood samples. The malondialdehyte level in the intestinal wall was 35.38 +/- 10.27 in the sham group, increasing significantly in the partial hepatectomy group (69.50 +/- 21.48), and decreasing in the partial hepatectomy plus NAC treatment group (35.63 +/- 14.12). Glutathione levels decreased significantly in the partial hepatectomy group and increased with preoperative single-dose NAC. CONCLUSION: Partial hepatectomy resulted in oxidative disturbances in intestinal wall, which in turn gave rise to BT. Parenteral NAC protects the intestinal wall from oxidative injury and attenuates BT.