Recurrence risk of a hypotonic hyporesponsive episode in two Australian specialist immunisation clinics

BackgroundA hypotonic hyporesponsive episode (HHE) is a well-described adverse event following immunisation (AEFI) in young children. There is limited data regarding recurrence post re-vaccination.MethodA retrospective analysis of HHEs reported to two tertiary paediatric hospitals in Australia: The Royal Children’s Hospital, Melbourne [2006–11] and the Children’s Hospital Westmead, Sydney [1997–2014].HHE definition level of confidence was allocated according to Brighton Collaboration (BC) criteria and defined immediate if within 30 min post vaccination. The Australian Immunisation Register (AIR) was utilised to document current immunisation status.Results235 HHE cases (135 Melbourne, 100 Sydney) were identified: 47% were female and 67% (157/235) occurred following the routine dose one vaccines at 6–8 weeks of age. Median time following immunisation was 120 min (range 1 min to 14 days) An immediate HHE occurred in 43% (102/235) and by BC criteria, 74% (173/235) were level 1 (definite). Subsequent vaccines were administered under supervision in hospital in 37% overall (86/235); 43% (58/135) in Melbourne and 28% (28/100) in Sydney. HHE recurrence rate was 3% (7/235) [95% confidence interval 1–6%]. AIR records were available in 94% (221/235). At a median age of 3.1 years, 84% (186/221) were up-to-date with recommended vaccines.ConclusionThis study highlights the importance of specialist immunization clinics in supporting the National Immunisation Program, through follow-up and management of serious adverse events following immunization.     

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目的了解福州市12岁学生龋病患病情况,为福州市口腔卫生保健工作及龋病的防治工作提供科学依据。方法于2010年10月,福州市第一医院口腔科按第六次全国学生体质健康调研工作的要求,随机抽调福州市城乡中小学12岁的学生共555名进行龋病的流行病学调查,以患龋率、龋均和龋齿充填率、显著性龋均指数为统计指标,采用SPSS17.0统计软件对结果进行统计分析。结果福州市12岁学生的患龋率为29.7%,受检者龋均为0.53,患龋者龋均为1.78,龋齿充填率为20.1%,显著性龋均指数为2.79。城区和乡镇的学生患龋率分别为25.3%和33.8%,差异有统计学意义(χ2=4.800,P=0.028);龋均分别为0.37和0.46,差异无统计学意义(t=-1.031,P>0.05);龋齿充填率分别为23.4%和17.5%,差异无统计学意义(χ2=1.605,P=0.205)。男生和女生的患龋率分别为26.9%和32.7%,差异无统计学意义(χ2=2.284,P=0.131);龋均分别为0.34和0.49,差异有统计学意义(t=-2.322,P<0.05);龋齿充填率分别为20.5%和19.8%,差异无统计学意义(χ2=0.023,P=0.879)。结论福州市12岁学生总体患龋率不高,但充填率低,乡镇学生的患龋率高于城区。今后预防保健工作应注意提高龋齿治疗率,特别是乡镇学生的龋齿预防和保健工作仍需加强。     

Effects of elemental mercury exposure at a thermometer plant

This study compares 84 mercury-exposed workers at a thermometer manufacturing facility with 79 unexposed workers for evidence of chronic mercury toxicity. Personal breathing-zone air concentrations of mercury ranged from 25.6 to 270.6 micrograms/m3 for thermometer workers. Urinary mercury levels in the study population ranged from 1.3 to 344.5 micrograms/g creatinine, with eight (10%) participants exceeding 150 micrograms/g creatinine and three workers exceeding 300 micrograms/g creatinine, which indicates increased absorption of mercury among the thermometer workers. All urine mercury levels in the comparison group were compatible with normal background levels in unexposed adults (less than 10 micrograms/g creatinine). Thermometer plant workers reported more symptoms than did controls; in general, these differences were not statistically significant and could not be specifically associated with mercury exposure. Static tremor, abnormal Romberg test, dysdiadochokinesia, and difficulty with heel-to-toe gait were more prevalent among thermometer workers than control workers, which could not be associated with recent mercury exposure; there was some suggestion of an association with chronic exposure. There were no intergroup differences for the standard clinical tests of renal function except for a significantly higher mean specific gravity among the thermometer workers. A positive correlation was found, however, between urinary N-acetyl-b-D-glucosaminidase (NAG) and urinary mercury. There was no consistent evidence for intergroup differences in proximal renal tubule function, as measured by urinary beta 2-microglobulin (B2M) or retinol binding protein (RBP).     

辽宁省12岁儿童龋病流行病学抽样调查分析

目的:了解辽宁省12岁儿童恒牙患龋状况,为龋病预防提供科学依据。方法:按照第三次全国口腔健康流行病学调查的要求,对辽宁省城乡6个地区36个调查点的792名12岁儿童进行了口腔检查。结果:在792名受检者中,患龋率和龋均分别为30.05%和0.51,农村和城市地区的患龋率分别为28.54%和31.57%,经统计学检验城乡无统计学意义(χ2=0.87,P>0.05),男女患龋率之间有统计学意义(χ2=10.6,P<0.01),显著性龋均指数为1.53。结论:辽宁省12岁儿童龋患明显低于十年前的状况,但患龋率仍达到30.05%,龋齿充填率也较低,龋齿主要集中于第一恒磨牙,仍应加大预防的力度,以降低龋病的发生。     

Modulation of the endogenous electrical activity of the bursting neuron in the snail Helix pomantia--III. A factor modulating the endogenous electrical activity of the bursting neuron.

A substance (modulating factor) which evokes the appearance of membrane potential waves in the bursting neuron RPa1 from an aestivating snail or an increase of the wave amplitude in the bursting neuron from an active snail (Helix pomatia) has been found in the snail's brain. This factor also modulates the activity of the bursting neuron V7. The modulating factor was eluted in the exchange volume on Sephadex G-25. The application of the factor led to the development of a depolarizing current at the holding potential ?55 mV under voltage clamp conditions. Hyperpolarization of the neuronal membrane from this holding potential by 7 mV for 2 s evoked an inward current before application of the modulating factor and an outward current after its application. No effect of the factor on the electrical activity of other silent or beating neurons were found.It is suggested that modulating factor may be the neurosecretory substance involved in interneuronal communication in the snail brain.     

A systematic review of the diagnosis of occupational asthma

Background:This study systematically reviews literature regarding the diagnosis of occupational asthma (OA) and compares specific inhalation challenge (SIC) testing with alternative tests.Methods:Electronic databases and trials registries were searched; additional references were identified from bibliographic searches of included studies, hand searches of conferences, and author contacts. Various study designs (clinical trials, cohorts, cross-sectional, or case series) were included involving workers with suspected OA. All diagnostic tests were compared to a “reference standard,” and two researchers independently extracted 2 × 2 data. Pooled sensitivities and specificities (95% confidence intervals [CIs]) were derived.Results:Seventy-seven studies were included. For high molecular weight (HMW) agents, the nonspecific bronchial provocation (NSBP) test, skin-prick test (SPT), and serum-specific IgE had sensitivities > 73% when compared to SIC. Specificity was highest for specific IgE vs SIC (79.0%; 95% CI, 50.5 to 93.3%). The highest sensitivity among low molecular weight asthmagens occurred between combined NSBP and SPT vs SIC (100%; 95% CI, 74.1 to 100%). When compared to SIC, specific IgE and SPT had similar specificities (88.9%; 95% CI, 84.7 to 92.1%; and 86.2%; 95% CI, 77.4 to 91.9%, respectively). For HMW agents, high specificity was demonstrated for positive NSBP tests and SPTs alone (82.5%; 95% CI, 54.0 to 95.0%) or when combined with specific IgE (74.3%; 95% CI, 45.0 to 91.0%) vs SIC. Sensitivity was somewhat lower (60.6% and 65.2%, respectively).Conclusions:In appropriate clinical situations when SIC is not available, the combination of a NSBP test with a specific SPT or specific IgE may be an appropriate alternative to SIC in diagnosing OA. While positive results of single NSBP test, specific SPT, or serum-specific IgE testing would increase the likelihood of OA, a negative result could not exclude OA.     

Novel rat model reveals important roles of β-adrenoreceptors in stress-induced cardiomyopathy

Background

Stress-induced cardiomyopathy (SIC), also known as Takotsubo cardiomyopathy, is an acute cardiac syndrome with substantial morbidity and mortality. The unique hallmark of SIC is extensive ventricular akinesia involving apical segments with preserved function in basal segments. Adrenergic overstimulation plays an important role in initiating SIC but the pathophysiological pathways and receptors involved are unknown.

Methods

Sprague Dawley rats (~ 300 g) were injected with a single dose of the β-adrenergic agonist isoprenaline (ISO, i.p.) and echocardiography was used to study cardiac function. The akinetic part of the left ventricle was biopsied in six SIC patients. Amount of intracellular lipid and glycogen as well as degree of permanent cardiac damage were assessed by histology.

Results

In rats, ISO at doses ≥ 50 mg/kg induced severe SIC-like regional akinesia that completely resolved within seven days. Intracellular lipid content was higher in akinetic, but not in normokinetic myocardium in both SIC patients and rats. β2-receptor blockade or Gi-pathway inhibition was associated with less widespread akinesia and low lipid accumulation but significantly increased acute mortality.

Conclusions

We provide a novel rat model of SIC that supports the hypothesis of circulating catecholamines as initiators of SIC. We propose that the β-adrenoreceptor pathway is important in the setting of severe catecholamine overstimulation and that perturbations of cardiac metabolism occur in SIC.     

Astrocytes and human cognition: Modeling information integration and modulation of neuronal activity

Recent research focusing on the participation of astrocytes in glutamatergic tripartite synapses has revealed mechanisms that support cognitive functions common to human and other mammalian species, such as learning, perception, conscious integration, memory formation/retrieval and the control of voluntary behavior. Astrocytes can modulate neuronal activity by means of release of glutamate, d-serine, adenosine triphosphate and other signaling molecules, contributing to sustain, reinforce or depress pre- and post-synaptic membranes. We review molecular mechanisms present in tripartite synapses and model the cognitive role of astrocytes. Single protoplasmic astrocytes operate as a “Local Hub”, integrating information patterns from neuronal and glial populations. Two mechanisms, here modeled as the “domino” and “carousel” effects, contribute to the formation of intercellular calcium waves. As waves propagate through gap junctions and reach other types of astrocytes (interlaminar, polarized, fibrous and varicose projection), the active astroglial network functions as a “Master Hub” that integrates results of distributed processing from several brain areas and supports conscious states. Response of this network would define the effect exerted on neuronal plasticity (membrane potentiation or depression), behavior and psychosomatic processes. Theoretical results of our modeling can contribute to the development of new experimental research programs to test cognitive functions of astrocytes.