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Probiotics, defined as live microorganisms that, when administered in adequate amounts, confer a health benefit on the host, are widely used despite uncertainty regarding their efficacy and discordant recommendations about their use. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Special Interest Group on Gut Microbiota and Modifications provides updated recommendations for the use of probiotics for the management of selected pediatric gastrointestinal disorders. All systematic reviews and/or meta-analyses, as well as subsequently published randomized controlled trials (RCTs) (until December 2021), that compared the use of probiotics in all delivery vehicles and formulations, at any dose, with no probiotic (ie, placebo or no treatment), were eligible for inclusion. The recommendations were formulated only if at least 2 RCTs on a similar well-defined probiotic strain were available. The modified Delphi process was used to establish consensus on the recommendations. Recommendations for the use of specific probiotic strains were made for the management of acute gastroenteritis, prevention of antibiotic-associated diarrhea, nosocomial diarrhea and necrotizing enterocolitis, management of Helicobacter pyloriinfection, and management of functional abdominal pain disorders and infant colic. Despite evidence to support the use of specific probiotics in some clinical situations, further studies confirming the effect(s) and defining the type, dose, and timing of probiotics are still often required. The use of probiotics with no documented health benefits should be discouraged.

Full manipulation of a quantum system requires controlled evolution generated by nonlinear interactions, which is coherent when the rate of nonlinearity is large compared with the rate of decoherence. As a result, engineered quantum systems typically rely on a bare nonlinearity much stronger than decoherence rates, and this hierarchy is usually assumed to be necessary. Here we challenge this assumption by demonstrating the universal control of a quantum system where the rate of bare nonlinear interaction is comparable to the fastest rate of decoherence. We introduce a noise-resilient protocol for the universal quantum control of a nearly harmonic oscillator that takes advantage of an in situ enhanced nonlinearity instead of harnessing a bare nonlinearity. Our experiment consists of a high-quality-factor microwave cavity with weak dispersive coupling to a superconducting qubit with much lower quality. By using strong drives to temporarily excite the oscillator, we realize an amplified three-wave-mixing interaction, achieving typical operation speeds over an order of magnitude faster than expected from the bare dispersive coupling. Our demonstrations include the preparation of a single-photon state with high fidelity, the generation of squeezed vacuum with large intracavity squeezing and measurement-free preparation of logical states for the binomial and Gottesman–Kitaev–Preskill quantum error-correcting codes.

Background: The association between Paget’s disease of bone (PDB) and increased cardiovascular (CV) risk has been suggested, but the literature is conflicting. Objective: Our study aimed to evaluate two markers of CV risk, namely, common carotid artery intimamedia thickness (cIMT) and the aortic pulse wave velocity (PWV) in patients with PDB. Methods: We enrolled 12 patients with PDB and 58 control subjects, matched for age. The diagnosis of PDB was based on clinical, radiological and biochemical parameters. Results: Patients with PDB showed higher PWV values than the controls, whereas cIMT was slightly but not significantly increased. Conclusion: These findings, although limited by the small study population, represent an original observation that deserves further study. The higher arterial stiffness in PDB could be related to the increased bone turnover or the high levels of oxidative stress that characterize this population.

Peripheral Artery Disease (PAD), a common vascular disease, has been associated with increased Cardiovascular (CV) morbidity and mortality as well as all-cause death. Type 2 Diabetes Mellitus (T2DM) predisposes to PAD development. In T2DM patients, PAD further increases the risk for CV disease and death as well as foot morbidity and microvascular complications. The present narrative review discusses the role of oxidative stress and inflammation in the pathophysiology of PAD with or without the presence of T2DM. The effects of lifestyle measures (i.e. diet, physical activity and smoking cessation) and drug treatment on markers of oxidative stress and inflammation are also considered. Further research should establish the clinical implications of such effects as well as the clinical use of antioxidants and anti-inflammatory drugs in PAD.

Los trastornos funcionales de dolor abdominal tienen una alta prevalencia en los niños. Estos trastornos pueden estar presentes por sí solos o en combinación con enfermedades orgánicas, tales como la enfermedad celíaca y las enfermedades inflamatorias intestinales. La inflamación intestinal (infecciosa y no infecciosa) predispone a los niños al desarrollo de hipersensibilidad visceral que puede manifestarse como trastornos funcionales de dolor abdominal, entre ellos el síndrome de intestino irritable. La aparición de síntomas de síndrome de intestino irritable en un paciente con una enfermedad orgánica subyacente, como la enfermedad inflamatoria intestinal, es un reto clínico, dado que la misma sintomatología puede representar un periodo de exacerbación de la enfermedad inflamatoria intestinal o un trastorno de dolor abdominal funcional sobrepuesto. Así mismo, puede ser que los síntomas del síndrome de intestino irritable en un niño con diagnóstico de enfermedad celíaca ocurran por un inadecuado control de la enfermedad celíaca o por la sobreposición con un trastorno de dolor abdominal funcional. Existe poca investigación acerca de la sobreposición de los trastornos funcionales abdominales y las enfermedades orgánicas en niños. Los estudios sugieren que la sobreposición entre los trastornos funcionales de dolor abdominal y la enfermedad inflamatoria intestinal es más común en adultos que en niños. Las causas de estas diferencias de prevalencia son aún desconocidas. Solo se han publicado unos cuantos estudios que tratan el tema de la sobreposición entre la enfermedad celíaca y los trastornos funcionales abdominales en niños. El presente artículo proporciona una revisión de la literatura acerca de la sobreposición entre la enfermedad celíaca, la enfermedad inflamatoria intestinal, y los trastornos funcionales de dolor abdominal en niños, además de establecer comparaciones con estudios realizados en adultos.

Functional abdominal pain disorders are highly prevalent in children. These disorders can be present in isolation or combined with organic diseases, such as celiac disease and inflammatory bowel diseases. Intestinal inflammation (infectious and non-infectious) predisposes children to the development of visceral hypersensitivity that can manifest as functional abdominal pain disorders, including irritable bowel syndrome. The new onset of irritable bowel syndrome symptoms in a patient with an underlying organic disease, such as inflammatory bowel disease, is clinically challenging, given that the same symptomatology may represent a flare-up of the inflammatory bowel disease or an overlapping functional abdominal pain disorder. Similarly, irritable bowel syndrome symptoms in a child previously diagnosed with celiac disease may occur due to poorly controlled celiac disease or the overlap with a functional abdominal pain disorder. There is little research on the overlap of functional abdominal disorders with organic diseases in children. Studies suggest that the overlap between functional abdominal pain disorders and inflammatory bowel disease is more common in adults than in children. The causes for these differences in prevalence are unknown. Only a handful of studies have been published on the overlap between celiac disease and functional abdominal pain disorders in children. The present article provides a review of the literature on the overlap between celiac disease, inflammatory bowel disease, and functional abdominal pain disorders in children and establish comparisons with studies conducted on adults.

Our aim is to show how materialistic monism, which is the dominant metaphysics of natural sciences, reduces the mental ambit to the brain's physical/biological substrate. We refer to two variants of this monism by pointing out the main reason for their failure, i.e. the hard problem of consciousness. For this reason, we think that a more effective alternative to materialistic monism is neutral monism, of which processual monism is one version that has its own strong specificity. Very brie y, our thesis is that body and mind have to be considered as cognitive domains working as systems of pertinentization, through which a certain form/component of the unique world is instantiated. As we explain below, pertinentization is the process by which a certain subset of components/qualities of reality is foregrounded, and in so doing a certain phenomenal domain i.e. a certain reality emerges.

PurposeThe aim of this study was to determine a sequence of structural changes in acute posterior multifocal placoid pigment epitheliopathy (APMPPE) using optical coherence tomography-angiography (OCT-A) and comparing with other imaging modalities.Patients and methodsPatients with a new diagnosis of acute-onset APMPPE referred to a regional specialist centre from October 2015 to October 2016 were included. Multimodal imaging employed on all patients from diagnosis included the following: fundus fluorescein angiography, indocyanine green angiography, fundus autofluorescence, spectral domain-OCT (SD-OCT), and OCT-A. All non-invasive imaging processes were repeated during follow-up.ResultsTen eyes of five patients were included in the study, three males and two females, with a mean age of 26.2 years (range: 21–32) and a mean follow-up of 6.4 months (range: 2.6–13.3). All patients presented with bilateral disease and macular involving lesions. OCT-A imaging of the choriocapillaris was supportive of hypoperfusion at the site of APMPPE lesions during the acute phase of this condition with normalisation of choroidal vasculature during follow-up. Multimodal imaging consistently highlighted four sequential phases from presentation to resolution of active disease.ConclusionsMultimodal imaging in patients with APMPPE in acute and long-term follow-up demonstrates a reversible choroidal hypoperfusion supporting the primary inciting pathology as a choriocapillaritis. The evolution shows resolution of the ischaemia through a defined sequence that results in persistent changes at the level of the retinal pigment epithelium and outer retina. OCT-A was able to detect preclinical changes and chart resolution at the level of the choriocapillaris.

Few correlation or calibration studies have been conducted to determine or validate sufficiency levels of N concentrations in the clippings of turfgrass for color and growth responses. In a series of field experiments conducted across six consecutive growing seasons (2007–2012) in Connecticut, clipping samples of Kentucky bluegrass (Poa pratensisL.) and tall fescue (Festuca arundinaceaSchreb.) lawns were used to estimate yields and then analyzed for N concentrations. Chlorophyll and normalized difference vegetative index (NDVI) meters were used to quantify turf color before sampling. Macy's concept of three nutritional zones of plant tissue nutrient concentration was used to identify minimum and critical concentrations of N in the clippings that define sufficiency ranges for color and growth responses, in addition to luxury consumption. Averaged across all variables and seasons (spring, summer, and fall), the sufficiency ranges of N concentration in the clippings were estimated to be 32 to 46 g kg–1for Kentucky bluegrass, and 28 to 42 g kg–1for tall fescue. Differences in minimum and critical concentrations among seasons and between species were thought to be due to demand‐driven nutrient uptake. Luxury consumption of N was observed in both species. When used in context with local conditions, tissue analysis for N concentrations in cool‐season turfgrass clippings can provide an objective basis for guiding N fertilization.

The aim of this study was to correlate the data obtained with multiple intraluminal esophageal impedance and pH (MII-pH) recordings in infants and children referred for suspected gastroesophageal reflux disease with esophageal histology. In a prospective study, results of esophageal biopsies and MII-pH recording obtained in 45 children (mean age ± SD: 69 ± 55 months) were analyzed. Regarding the MII-pH data, an automatic (Autoscan Bioview Analysis Software, version 5.3.4, Sandhill Scientific Inc, Highlands Ranch, CO) and a manual reading were performed; an automatic pH analysis (meal included) was also performed. Acidic, weakly acidic, and alkaline reflux episodes accounted, respectively, for 48.7%, 49.5%, and 1.8% of the total number of reflux episodes detected by MII-pH. Esophagitis was present in 25 (56%) children. Concordance between classic pH-study analysis (alone) and esophageal histology was found in 19 of 45 (42%) children. According to the MII-pH analysis, the mean and median value of the pH were significantly higher in the group with esophagitis than in the group with normal esophageal histology. A longer clearance time was found in the group with esophagitis than in subjects with normal histology. Gas reflux episodes represented 21% of the total reflux episodes and were comparable in both groups. Multiple intraluminal esophageal impedance and pH analysis does not provide a distinct parameter to predict esophageal mucosal injury in children. In our population, MII-pH shows comparable acidic, weakly acidic, alkaline, and gas reflux in children with and without esophagitis. Further research is needed to analyze clearance parameters.

The aim of this study was to correlate the data obtained with multiple intraluminal esophageal impedance and pH (MII-pH) recordings in infants and children referred for suspected gastroesophageal reflux disease with esophageal histology.

SUMMARY. Potential water quality impacts of agricultural production include runoff and leaching losses of nutrients, pesticides, and sediment. Stormwater runoff and soil water samples were collected from citrus (Citrus spp. ), avocado (Persea americana), and ornamental nursery sites in Ventura County, CA, across 19 months. Nitrate-nitrite-nitrogen concentrations in runoff ranged from 0.07 to 31.1 mg.L-1, with medians for groves and nurseries of 4.2 and 5.7 mg.L-1, respectively. Constituents in runoff exceeding benchmarks for surface waters included turbidity, chlorpyrifos, and some organochlorine pesticides. When detected, chlorpyrifos concentration was linearly related to sample turbidity (P = 0.0025, r² = 0.49). This suggests that the retention of waterborne sediments on-site may be an effective method for mitigating runoff of this pesticide. Bifenthrin, permethrin, and diazinon were also detected in runoff, but concentrations did not exceed water quality benchmarks. Nutrient concentrations in soil water were generally similar to nutrient concentrations in stormwater runoff, suggesting that potential groundwater contamination from leaching at citrus, avocado, and nursery sites may be as much of a concern as stormwater from these operations, particularly on sites with sandy or structured soil texture or flat topography. Nitrate-nitritenitrogen and orthophosphate concentrations in soil water were linearly related to nitrogen and phosphorus fertilizer application rates across sites, respectively (P < 0.0001, r² = 0.49 and 0.50, respectively), suggesting that proper nutrient management is important in reducing potential groundwater contamination at these operations. [ABSTRACT FROM AUTHOR]

Tissue N analysis a tool available for N management of turfgrass. However, peer‐reviewed calibration studies to determine optimum tissue N values are lacking. A field experiment with a mixed cool‐season species lawn and a greenhouse experiment with Kentucky bluegrass (Poa pratensisL.) were conducted across 2 yr, each with randomized complete block design. Treatments were N application rates between 0 and 587 kg N ha−1yr−1In the field experiment, clipping samples were taken monthly from May to September, dried, ground, and analyzed for total N. Clippings samples were collected one to two mowings after plots were fertilized. Linear plateau models comparing relative clipping yield, Commission Internationale de l‘ Eclairage hue, and CM1000 index to leaf N concentrations were developed. In the greenhouse experiment, clipping samples were taken every 2 wk from May to October and composited across sample dates for leaf N analysis. Color and clipping yields were related to leaf N concentrations using linear plateau models. These models indicated small marginal improvements in growth or color when leaf N exceeded 30 g kg−1, suggesting that a leaf N test can separate turf with optimum leaf N concentrations from turf with below optimum leaf N concentrations. Plateaus in leaf N concentrations with increasing N fertilizer rates suggest, however, that this test may be unable to identify sites with excess available soil N when turf has been mowed before tissue sampling.

Ideal nitrogen (N) management for turfgrass supplies sufficient N for high‐quality turf without increasing N leaching losses. A greenhouse study was conducted during two 27‐wk periods to determine if in situ anion exchange membranes (AEMs) could predict nitrate (NO3–N) leaching from a Kentucky bluegrass (Poa pratensisL.) turf grown on intact soil columns. Treatments consisted of 16 rates of N fertilization, from 0 to 98 kg N ha−1mo−1Percolate water was collected weekly and analyzed for NO3–N. Mean flow‐weighted NO3–N concentration and cumulative mass in percolate were exponentially related (pseudo‐R2= 0.995 and 0.994, respectively) to AEM desorbed soil NO3–N, with a percolate concentration below 10 mg NO3–N L−1corresponding to an AEM soil NO3–N value of 2.9 μg cm−2d−1Apparent N recovery by turf ranged from 28 to 40% of applied N, with a maximum corresponding to 4.7 μg cm−2d−1AEM soil NO3–N. Turf color, growth, and chlorophyll index increased with increasing AEM soil NO3–N, but these increases occurred at the expense of increases in NO3–N leaching losses. These results suggest that AEMs might serve as a tool for predicting NO3–N leaching losses from turf.

Scintigraphy is considered as the “gold standard” for measuring gastric emptying (GE). The 13C‐acetate breath test (13C‐ABT) offers an attractive alternative to measure GE of liquids as it is nonradioactive. The aim of this study was to assess the variability of the 13C‐ABT for GE of liquids in healthy children using nondispersive infrared spectrometry (NDIRS). The 13C‐ABT was repeated at least 2 times in 21 healthy children (6 girls and 15 boys), aged between 6.2 and 16.4 years, 2 to 7 days apart. After an overnight fast, a standardized milk drink, labeled with 50 or 100 mg 13C‐acetate according to weight, was administered. Breath samples were taken before feeding, at 5‐minute intervals for the first 40 minutes and at 10‐minute intervals for the following 140 minutes after feeding. Breath samples were analyzed using NDIRS, and 13C recovery was used to calculate values for gastric half‐emptying time (t1/2), time of peak 13C exhalation, or gastric lag phase (tlag) and gastric emptying coefficient (GEC). Intraindividual variabilities of the parameters t1/2, tlag, and GEC were expressed as coefficient of intrasubject variation (CV). The median CV of t1/2was 8.3% (CV range, 1.6%‐16.2%; t1/2interindividual range, 65‐112 minutes; and t1/2intraindividual range, 4‐33 minutes). The median CV of tlagwas 16.6% (CV range, 2.0%‐26.6%; tlaginterindividual range, 31‐76 minutes; and tlagintraindividual range, 1‐35 minutes). The median CV of GEC was 4.3% (CV range, 0.8%‐15.7%; GEC interindividual range, 3.81‐4.89; GEC intraindividual range, 0.08‐1.31). The CVs of t1/2, tlag, and GEC were independent of age, sex, weight, height, and measured values of t1/2, tlag, and GEC. The 13C‐ABT using NDIRS is an easy, noninvasive, and nonradioactive procedure with a large intraindividual variation for measuring GE of liquids in healthy children, but comparable to the variation reported with other techniques.

Scintigraphy is considered as the "gold standard" for measuring gastric emptying (GE). The 13C-acetate breath test (13C-ABT) offers an attractive alternative to measure GE of liquids as it is nonradioactive. The aim of this study was to assess the variability of the 13C-ABT for GE of liquids in healthy children using nondispersive infrared spectrometry (NDIRS).

Desirable nitrogen (N) management practices for turfgrass supply sufficient N for high quality turf while limiting excess soil N. Previous studies suggested the potential of anion exchange membranes (AEMs) for predicting turfgrass color, quality, or yield. However, these studies suggested a wide range of critical soil nitrate‐nitrogen (NO3–N) values across sample dates. A field experiment, in randomized complete block design with treatments consisting of nine N application rates, was conducted on a mixed species cool‐season turfgrass lawn across two growing seasons. Every 2 wk from May to October, turfgrass color was assessed with three different reflectance meters, and soil NO3–N was measured with in situ AEMs. Cate‐Nelson models were developed comparing relative reflectance value and yield to AEM desorbed soil NO3–N pooled across all sample dates. These models predicted critical AEM soil NO3–N values from 0.45 to 1.4 μg cm−2d−1Turf had a low probability of further positive response to AEM soil NO3–N greater than these critical values. These results suggest that soil NO3–N critical values from AEMs may be applicable across sample dates and years and may serve to guide N fertilization to limit excess soil NO3–N.

Baron Clemens von Pirquet, an Austrian paediatrician, proposed in 1903 the terms allergy and allergen after observing that some of his patients had “altered responses” to certain substances.1 Allergic symptoms are not necessarily accompanied by sensitization or vice versa. Recently, nomenclature for allergy has been revised.

Baron Clemens von Pirquet, an Austrian paediatrician, proposed in 1903 the terms allergy and allergen after observing that some of his patients had “altered responses” to certain substances.1 Allergic symptoms are not necessarily accompanied by sensitization or vice versa. Recently, nomenclature for allergy has been revised.

Fall season fertilization is a widely recommended practice for turfgrass. Fertilizer applied in the fall, however, may be subject to substantial leaching losses. A field study was conducted in Connecticut to determine the timing effects of fall fertilization on nitrate N (NO3−N) leaching, turf color, shoot density, and root mass of a 90% Kentucky bluegrass (Poa pratensisL.), 10% creeping red fescue (Festuca rubraL.) lawn. Treatments consisted of the date of fall fertilization: 15 September, 15 October, 15 November, 15 December, or control which received no fall fertilizer. Percolate water was collected weekly with soil monolith lysimeters. Mean log10NO3−N concentrations in percolate were higher for fall fertilized treatments than for the control. Mean NO3−N mass collected in percolate water was linearly related to the date of fertilizer application, with higher NO3−N loss for later application dates. Applying fall fertilizer improved turf color and density but there were no differences in color or density among applications made between 15 October and 15 December. These findings suggest that the current recommendation of applying N in mid‐ to late November in southern New England may not be compatible with water quality goals.

There is not extensive research on the potential of anion exchange membranes (AEMs) for determining available N in soils of turfgrass systems, nor on the use of reflectance meters for quantifying turfgrass color. The two objectives of this study were to determine relationships between (i) turfgrass color measurements and soil nitrate (NO3–N) desorbed from AEMs and (ii) reflectance meter measurements and turfgrass chlorophyll concentration. A field experiment was conducted on a 90% Kentucky bluegrass (Poa pratensisL.) stand across 2 yr. Anion exchange membranes were inserted into the soil and exchanged weekly. Desorbed NO3–N from the AEMs was quantified. Turfgrass color and chlorophyll measurements were taken monthly. Reflectance meter measurements were significantly related to chlorophyll concentration. Linear response plateau models suggested critical levels of AEM soil NO3–N, above which turfgrass color did not improve, from 0.31 to 0.43 μg cm−2d−1These models suggest that critical levels of soil NO3–N could be determined that maximize turfgrass quality without excessive N application. These findings suggest both AEMs and hand‐held reflectance meters could be useful tools for N management in turfgrass.

The aetiology of gastroparesis differs between children and adults. During childhood, gastroparesis is quite rare, and is mostly seen in preterm infants, with either immaturity of the gastrointestinal tract, or when allergic to cow’s milk protein. Acute, delayed gastric emptying may be observed following viral infections. In adults, most patients with gastroparesis are either idiopathic or of diabetic origin. As a consequence, approaches in the treatment of children and adults differ. Metoclopramide, domperidone, cisapride and erythromycin have all been studied. Evidence for benefit is strongest for the latter two drugs, although most studies have methodological shortcomings. From a paediatric perspective, it seems astonishing that more trials with erythromycin analogues have not been performed, as the few data available suggests that these analogues are more powerful, without the side effects of long-term, low-dose administration of antibiotics. Gastric electrical stimulation seems the most promising therapeutic option available at present.

Small-angle X-ray scattering (SAXS) was used to obtain solution parameters of a weak polyelectrolyte in water in the absence of any additives, such as neutralizing agents or salt. Poly(acrylic acid) (PAA) was used as a weak polyelectrolyte from which SAXS data were obtained in the dilute region of 1–10 mg cm⁻³. An intrinsic viscosity of 15.7 dL g⁻¹ was obtained from a plot of reciprocal reduced viscosities versus the concentration. The application of the SAXS data, that is, the contour length (L = 1.97 × 10⁴ Å), the persistence length (a* = 58.5 Å), and the molecular weight (M = 5.9 × 10⁵ Da), to the Yamakawa–Fujii equation suggested that PAA in water at 25 °C could be described as a wormlike chain having a cylindrical body of d = 6 Å. An end-to-end distance (r = 1.6 × 10³ Å) was calculated from r = 2a*L − 2(a*)². The nonisotropic expansion factor (α = 2.9) was calculated for PAA expanding from the random coil in dioxane at 30 °C (Θ temperature) to the wormlike chain in water at 25 °C. © 2003 Wiley Periodicals, Inc. J Polym Sci Part B: Polym Phys 41: 1263–1272, 2003

To determine levels of natriuretic peptides (NPs) in patients with end-stage renal disease (ESRD) and to examine the relationship of these cardiovascular pep-tides to left ventricular hypertrophy (LVH) and to cardiac mortality.

Histological detection of axillary lymph node metastases is still the most valuable prognostic parameter for breast cancer, but about 30% of node-negative patients relapse within five years, suggesting that current methods are inadequate for identifying metastatic disease. More sensitive, PCR-based methods for the detection of metastatic cells are now available, enabling the amplification of cancer cell-specific mRNA messages by the RT-PCR assay. An ideal tumour marker, consistently expressed in tumour samples and not at all in normal lymph nodes, remains to be identified. The present study first investigated the expression of seven mRNA markers, CEA, CK19, c-Met, mammaglobin, MUC-1, β1→GalNAc-T and p97, selected on the basis of their previously reported specificity for breast cancer cells. Eighteen lymph nodes were examined from patients without tumours. Only mammaglobin mRNA and CEA mRNA were not expressed in normal nodes. All of the other markers showed a band of expression in 17%-55% of cases, indicating that they are not breast cancer-specific. CEA mRNA and mammaglobin mRNA expression could be detected in 15/20 (75%) and 19/20 (95%) primary breast carcinomas, respectively. The expression of mammaglobin mRNA and CEA mRNA was then compared in axillary lymph nodes from 248 consecutive breast cancer patients, 89 with histologically documented lymph node metastasis and 159 without histological evidence of metastatic disease. Ninety-seven per cent of the patients with histologically involved nodes showed expression of mammaglobin mRNA, whereas CEA mRNA was expressed in 79% of these cases. In the group of patients with histologically negative lymph nodes, 46 (29%) and 32 (20%) were found to be positive for mammaglobin and CEA expression, respectively, indicating the presence of metastases not detected by routine histological examination of one lymph node section. These results show that both mammaglobin RT-PCR and CEA RT-PCR are useful tools for the detection of breast cancer metastases in axillary lymph nodes. The detection sensitivity of the mammaglobin RT-PCR is far superior to that of the CEA RT-PCR, allowing the diagnosis of occult metastases in nearly one-third of cases. Copyright © 2001 John Wiley & Sons, Ltd.

Objectives:To analyze the frequency and risk factors for urinary incontinence (UI) in Italy.Methods:Eligible for this cross–sectional study were men aged ≥50 years and women aged ≥40, randomly identified among registered subjects of a network of general practitioners during the period March–October 1997. All subjects were invited by telephonic interview to determine the presence of UI, reported by the subjects as loss of urine in the last year. The subjects with UI were further questioned at home for evaluation of the type, degree and frequency of UI episodes.Results:Of the 5,488 subjects interviewed (2,767 women and 2,721 men), 92 (3%) men and 316 (11%) women reported at least one episode of UI during the year before the interview. The frequence of UI increased with age both in men and women, being 2 and 11% in men and women, respectively, aged 50–60 years and 7 and 16% in those aged ≥70. Of the subjects with UI identified, 229 women and 64 men and a group of 289 subjects without UI were questionned at home using a detailed questionnaire. Six and 55% of men and women, respectively, reported stress incontinence, 20 and 12% urge incontinence and 20 and 24% mixed incontinence. The risk of UI increased with body mass index in women. A history of recurrent urinary infection was associated with UI in men and less markedly in women. No association emerged between education, smoking and alcohol or coffee consumption and risk of UI. Parity was directly associated with the risk of UI in women.Conclusions:The study offers a quantitative estimate of the prevalence of UI and its main risk factors in this Italian population.

The Practice Integrated Learning Sequence (PILS) is an office-based, practice-related Continuing Medical Education (CME) process that incorporates the practice of medicine into an educational program. In this research, the PILS process was used in an educational program for the management of hypertension involving 1,013 physicians. Program data suggest that the PILS process can help physicians assess their practice needs by evaluating their practice behaviors in comparison to objective criteria. The results suggest the importance of designing CME programs that facilitate physicians' use and development of self-directed learning skills, particularly self-evaluation.

Studies of electrocardiographic predictors of mortality in patients with chronic heart failure have reached varying conclusions. Differences in the characteristics of the patients studied may explain the conflicting results regarding both a prolonged QRS and an abnormal signal-averaged electrocardiogram (SAE). We therefore investigated the impact of the etiology of heart failure on the prognostic importance of a prolonged QRS and an abnormal SAE in 200 patients with heart failure. Patients were categorized according to etiology of heart failure and electrocardiographic parameters. The mortality of patients with a prolonged QRS was compared with mortality in those with both abnormal and normal SAEs. This was done for the entire group, and separately for those with ischemic and those with nonischemic cardiomyopathy. The mean follow-up was 18.8 months. Nonischemic patients with a prolonged QRS had significantly worse survival than other patients. However, nonischemic patients with an abnormal SAE did not have a worse prognosis than patients with a normal SAE. One-year survival of patients with a prolonged QRS was 71%, compared with 98% in patients with a normal and 87% in patients with an abnormal SAE (p < 0.05). In contrast, a prolonged QRS was not a predictor of poor prognosis in patients with ischemic cardiomyopathy (81% one year mortality). Patients with ischemic cardiomyopathy and an abnormal SAE tended to have a poorer survival than patients with a normal SAE (73% and 81% one year mortality, respectively). Thus, the etiology of heart failure affects the prognostic importance of both a prolonged QRS and an abnormal SAE.

Trisomy 7, trisomy 10 and loss of the Y chromosome have been found by some authors in presumptive normal parts of human kidneys. We describe cytogenetic findings in short-term cultures from 58 biopsies obtained from non-neoplastic and neoplastic (renal cell carcinoma, RCC) tissues from the same kidney, the same types of tissues from independent kidneys, and tissue from kidneys without neoplasia. The results indicate the following. Non-neoplastic tissue from kidneys involved in RCC have (in mosaics) trisomies 5, 7, 10, 18 and loss of the Y as non-random clonal changes. They are not the result of local metastasis but are also found in kidneys with non-tumoral chronic pathologies and should thus not be considered specific for RCC. They are neither culturing artefacts nor a general phenomenon found in cultured normal solid tissues, but are acquired abnormalities, possibily related to various reactive cellular states in the tissues that are histologically normal.

The radical anions of acrylamide, methacrylamide and 2-hydroxypropyl acrylate were produced by pulse radiolysis of moderately acidic aqueous solutions well below the pK_a of the radical anion. The rate coefficients of protonation were determined by UV kinetic spectroscopy at wavelengths where the protonated and ionic forms have considerably different absorbances. The rate coefficients of protonation were measured as (6.0±0.9)×10¹⁰, (6.6±1.0)×10¹⁰ and (5.0±1.0)×10¹⁰ mol^-1 d s^-1. Using these rate coefficients and the pK_a values of the radical anion, 7.9, 8.0 and 5.5, the rate coefficients of deprotonation were determined as 7.5×10², 6.6×10² and 1.6×10⁵ s^-1. The results clearly showed that in acidic solution the protonation occurred with H₃O⁺ and not with H₂O. The rate coefficients determined were discussed and compared with relevant data in the literature.