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Summary: CPK-BB (CK-BB) isoenzyme is an intracellular enzyme released in various neurologic conditions, including central nervous system (CNS) infections. Activity of CK-BB in cerebrospinal fluid (CSF) was determined in 80 [...]

Enteric perforations and fistulas are difficult to manage due to comorbidities, poor nutritional status, and anatomic challenges related to multiple interventions in those patients. The use of endoscopic methods as a nonsurgical approach is increasing. The aim of the present study was to describe the clinical experience with the use of the Ovesco Over-The-Scope Clip system in the closure of perforations, fistulas, and other indications in the digestive tract at a tertiary care hospital center.

Las perforaciones y fistulas enterales son de difícil manejo debido a las comorbilidades, mal estado nutricional y dificultades anatómicas relacionadas con múltiples intervenciones en estos pacientes. La utilización de métodos endoscópicos como abordaje no quirúrgico está incrementado. El objetivo del trabajo es describir la experiencia clínica con el uso del clip Ovesco en el cierre de perforaciones, fistulas y otras indicaciones en el tracto digestivo en un centro terciario.

Objective:: Post-hemorrhagic hydrocephalus (PHH) is associated with morbidity and mortality among very low birth weight (VLBW) infants. This study aimed to determine risk factors for PHH among VLBW infants with peri-intraventricular hemorrhage (PIVH). Study Design:: This is a population-based cohort of VLBW infants of 24 to 28 weeks gestation, born in Israel from 1995 to 2012. Infants in whom a brain ultrasound was not performed before 28 days or with major congenital malformations were excluded. Univariate and multivariable analyses identified risk factors associated with PHH. Results:: The final study cohort comprised 2811 infants with grade 2 or higher PIVH, of whom 610 (21.7%) developed PHH. PHH was independently associated with PIVH severity, with bilateral grade 3 PIVH and PIVH grade 3 and contralateral grade 4 having the highest risks (odds ratio (OR) 12.2, 95% confidence interval (CI) 8.56 to 17.4 and OR 13.7, 95% CI 9.4 to 20.1, respectively). Unilateral grade 3 or 4 PIVH's had moderately increased risks of PHH (OR 3.50, 95% CI 2.26 to 5.42 and OR 3.79, 95% CI 2.35 to 6.12, respectively). PHH was independently associated with increasing gestational age (GA) and with neonatal morbidities including patent ductus arteriosus (OR 1.47, 95% CI 1.15 to 1.88 if medically treated and OR 3.01, 95% CI 2.11 to 4.29 if surgically treated), sepsis (OR 1.79, 95% CI 1.44 to 2.22) and necrotizing enterocolitis (OR 1.60, 95% CI 1.18 to 2.17). Conclusions:: Among VLBW infants with PIVH, PHH was independently associated with PIVH severity group, increasing GA and acute neonatal morbidities. Unilateral grade 3 or 4 PIVH was associated with a moderate risk of developing PHH compared with bilateral severe hemorrhages.

The effects of two oral contraceptive combinations, dienogest 2.0 mg plus ethinyl estradiol 0.03 mg (Valette®) and desogestrel 0.15 mg plus ethinyl estradiol 0.02 mg (Lovelle®), on the human immune system were compared over one treatment cycle of 31 patients (n = 15 and n = 16, respectively).Lovelle but not Valette significantly increased the numbers of lymphocytes, monocytes and granulocytes. Valette decreased CD4 lymphocytes after 10 days' treatment; Lovelle had the opposite effect. Lovelle increased CD19 and CD23 after 21 days' treatment. Phagocytic activity was unaffected by either treatment.After 10 days' treatment, both contraceptives reduced serum IgA, IgG and IgM, which remained lowered at day 21 with Lovelle but returned to baseline with Valette. Secretory IgA was unaffected by either contraceptive.Neither treatment affected levels of interleukins, except for a significant difference between the treatment groups for interleukin-6 after 10 days' treatment that disappeared after 21 days' treatment.Levels of non-immunoglobulin serum components fluctuated; macroglobulin was increased with Valette. However, total protein and albumin levels were reduced more with Lovelle than with Valette. Complement factors also fluctuated.There was no evidence for any sustained immunosuppression with either Valette or Lovelle.

Background:In the last few years knowledge about periodontal infections has increased enormously, nevertheless practitioners are still seeking guidelines for suitable treatment concepts. Methods:The aim of this study was to examine the effect of doxycycline, metronidazole, and clindamycin used adjunctively in a 2‐step nonsurgical procedure in patients with rapidly progressive periodontitis (RPP). The first step included scaling, root planing, and polishing (SRP) in each quadrant using 4 to 5 visits. The second step included full‐mouth enhanced root planing (RP) and wound dressing in 1 or 2 visits after SRP and the beginning of antibiotic therapy. Forty‐eight patients (mean age 32.4 years) with generalized RPP, with an average of 16 sites with probing depths (PD) deeper than 8 mm, and high counts of Porphyromonas gingivaliswere randomly assigned to 4 different groups: group 1 (doxycycline) n = 12, group 2 (metronidazole) n = 15, group 3 (clindamycin) n = 11, and group 4 (control group; no antibiotic treatment) n = 10. Clinical evaluations, including plaque index (PI), sulcus bleeding index (SBI), probing depth (PD), clinical attachment level (CAL), and bacteriological and crevicular cell sampling, were done at baseline (BL), 3 weeks after SRP, and 6 and 24 months after RP. Results:After the first step (SRP), we observed an improvement of PI and SBI in all 4 groups, but did not see any statistically significant PD reduction 3 weeks after SRP compared to baseline. However, 6 and 24 months after the second step (RP) we observed a significantly greater reduction of PD in groups 2 and 3 and a significantly greater CAL gain in comparison to groups 1 and 4. After 24 months, the attachment level gain in group 1 and group 4 was less than 1.5 mm, and less than 1.0 mm in PD site categories 6 to 9 mm and >9 mm. PI showed no significant difference between the groups throughout the period after SRP until 24 months, compared to 3 weeks after SRP. SBI decreased most in the metronidazole and clindamycin groups. P. gingivalisand Actinobacillus actinomycetemcomitanswere almost completely eradicated in these 2 groups 24 months after RP. In addition, the phagocytotic capacity of crevicular polymorphonuclear neutrophils was increased in groups 2 and 3 after the second step. Conclusions:The present results show that metronidazole and clindamycin are effective antibiotics when used adjunctively in a 2‐step nonsurgical procedure of scaling and root planing in RPP patients. J Periodontol 2001;72:275‐283.

The influence of non-active ingredients in the manufacture of pellets on in-vitro dissolution rate and on bioavailability of hydrochlorothiazide has been studied. Pellets were formulated using either microcrystalline cellulose or microcrystalline cellulose-carboxymethylcellulose sodium blends as matrix, and hydrochlorothiazide as the active ingredient. In-vitro drug release from the different pellet formulations was retarded in comparison to a conventional tablet formulation and was dependent on the nature of the non-active ingredient and, for the microcrystalline cellulose-carboxymethylcellulose sodium blend, of the dissolution medium. In-vivo bioavailability of both pellet formulations was low compared with that of the conventional tablet and the plasma concentration-time profiles did not suggest slow release.

In this paper a single phase convertor circuit is described in which the a. c. current is kept within a given tolerance band of a sinusoidal current input. With a smoothed d. c. voltage on the secondary side d. c. power can be supplied to a constant voltage convertor for three-phase traction motors. It will be shown that the interactions between convertors and supply can be minimized by the optimum parallel operation of two independent convertors, i.e. by the simultaneous extinguishing and firing of different valve arms. Besides describing the control mechanisms, the operation of the convertor circuits and the results are illustrated by oscillograms. These oscillograms were obtained by simulation carried out on an analog computer combined with on actual control network.

Es wird gezeigt, wie sich ein Einphasenstromrichter mit harmonisch zeitabhängiger Übersetzung unter der Voraussetzung dynamisch steuern und regeln läβt, daβ Amplitude und Phasenwinkel der Übersetzung nur zeitdiskret beeinfluβt werden können. Das Mehrgröβenregelungssystem wird durch bestimmte Vorsteuerungsstrukturen annähernd entkoppelt, so daβ die Regelstruktur durch einschleifige Regelkreise aufgebaut werden kann. Die Steuer- und Regelstruktur ermöglicht es, Gleichspannung und Phasenlage der Wechselstromnulldurchgänge unabhängig von Netzspannungsschwankungen und Belastungsänderungen auch dynamisch innerhalb enger Toleranzen zu halten

PROBLEM: To investigate whether the mode of delivery or the drugs given to the mother during labor may affect the newborns' immune system.

We have identified a 16 bp deletion in the 3 untranslated region of the α2-globin gene, including the first nucleotide of the polyadenylation signal sequence. The propositus, her mother and one of her brothers, all heterozy-gotes for the above deletion, have mild microcytic anemia. This is the first description of a deletion in the a gene involving both the 3' untranslated region and the polyadenylation signal sequence, causing α-thalassemia.

In a controlled clinical trial, the elimination of caffeine was examined in 20 healthy women prior to and during one cycle of treatment with either of two oral contraceptive formulations, one containing 0.075 mg gestodene and 0.03 mg ethinylestradiol and one containing 0.125 mg levonorgestrel and 0.03 mg ethinylestradiol. In addition, caffeine clearance was determined 1 month after the last intake of the oral contraceptives. Compared with pretreatment values, the clearance of caffeine was reduced by about 54% and 55% after one treatment cycle with gestodene- and the levonorgestrel-containing oral contraceptive, respectively. Other pharmacokinetic parameters of caffeine, such as tmax and Cmax, were not affected. Clearance values returned to pretreatment values 1 month after the last administration of the oral contraceptives. There was no difference in the reduction of caffeine clearance between contraceptive formulations. A small, but significant difference in the AUC(0–24 h) values of ethinylestradiol was noted between both preparations. There was no correlation between the AUC(model) values of caffeine and the AUC(0–24 h) values of ethinylestradiol. In the present study, a somewhat more pronounced effect on the elimination of caffeine was observed than in previous investigations, where several contraceptive steroids were administered only for a period of 2 weeks.

Abstract: Objective: To investigate the influence of oral contraceptives on cytochrome P450 3A4 (P450NF) activity. Methods: In 23 healthy women, the pharmacokinetics of nifedipine and its main metabolite dehydronifedipine in plasma were assessed after a single oral dose, prior to and after intake of one of two oral contraceptive formulations, one containing 2 mg dienogest and 0.03 mg ethinylestradiol (group A) and the other containing 0.125 mg levonorgestrel and 0.03 mg ethinylestradiol (group B). Results: While the intake of two oral contraceptives for 21 days did not influence the plasma concentration-time curve of unchanged nifedipine, mean AUC0–23.5 h and the mean Cmax values of dehydronifedipine were significantly lower in both groups tested/(24% in group A and 25% in group B). This observation may indicate a reduced formation rate of metabolites and reflects an inhibition of cytochrome P450 3A4 activity. The activation of the same or other metabolic degradation mechanism(s) could explain this result. Conclusion: The investigation presented demonstrates the importance of metabolite measurement when in vivo studies are undertaken to investigate different influences on drug metabolizing ability.

There is growing evidencefor an important role of the immune system in the pathogenesis of periodontitis. To further characterize the possible immunoregulatory dysfunction of peripheral blood mononuclear cells (PBMC) in periodontitis patients, we investigated functional aspects of PBMC from patients with early‐onset periodontitis (EOP) and adult periodontitis (AP). Compared to controls, we observed decreased proliferative responses of PBMC from patients with EOP following stimulation with a mitogenic stimulus (phytohemagglutinin). To investigate whether this abnormality reflects a modulation in cytokine production, we measured the in vitro production of interleukin (IL)‐3, IL‐5, granulocyte macrophage colony‐stimulating factor (GM‐CSF), and interferon‐γ (IFN‐γ) by activated PBMC. PBMC in EOP patients expressed significantly decreased levels of IFN‐γ protein in response to mitogenic stimulation. Reduced IFN‐γ secretion was associated with decreased IFN‐γ and IL‐2 mRNA expression in these cells, as well as decreased HLA‐DR surface expression on monocytes. On the other hand, we observed significantly higher levels of IL‐5 and GM‐CSF in the same system using PBMC from AP patients. These were comparable to the levels observed for patients with allergic asthma. These data imply that EOP is associated with decreased Th1‐like cytokine expression, and that the PBMC response from patients with AP is predominantly Th2/Th0 in nature. J Periodontol 1998;69:1098–1104.

Phagocytes from the gingival crevice fluid(CF‐cells) of 11 patients with localized juvenile and post‐juvenile periodontitis (LJP/PJP), 14 with rapidly progressive periodontitis (RPP), 11 with adult periodontitis (AP), and 14 controls without periodontal disease were examined. Phagocytic activity in vitro was assessed. Crevicular washings were obtained from healthy sites of controls and diseased sites of patients after completion of the oral hygiene phase (professional and home care). The cells were carefully processed to avoid mechanical damage. The in vitro phagocytosis by uptake of opsonized C. albicanswas performed in a moist chamber (30 minutes, 37°C) and examined by light microscopy. CF‐cells were differentiated on the basis of their morphological appearance. The majority of cells in crevicular washings were PMNs, some macrophages, and few lymphocytes. Phagocytic activity in patients with LJP/PJP and RPP was significantly decreased in comparison with that from AP and the control group. The decreased percentage of cells phagocytosing opsonized C. albicanswas associated with the enhanced adherence of opsonized C. albicans. Moreover cell viability of CF‐cells from LJP/PJP sites was significantly reduced. The data from the present study suggest that the in vitro phagocytosis of crevicular phagocytes in juvenile and rapidly progressive periodontitis lesions is diminished. J Periodontol 1992; 63:496–501.

A letter to the editor from a reader couple sharing how they find "Forbes" magazine instructive, interesting and invaluable stimulant in a business, is presented.

It is difficult to maintain a proper balance between hyperoxemia and hypoxemia, and between hypocapnia and hypercapnia, when resuscitating severely asphyxiated infants. Hyperoxemia may be especially dangerous to the brain during reperfusion after severe asphyxia. Infants with postasphyxia hypoxic ischemic encephalopathy (HIE) frequently have episodes of hyperoxemia and/or hypocapnia in the first hours of life. A retrospective cohort study was planned to determine whether such episodes, occurring in the first 2 postnatal hours, heighten the risk of brain injury after intrapartum asphyxia. Adverse outcomes at age 2 years included death, severe cerebral palsy, or any degree or cerebral palsy accompanied by blindness, deafness, or delayed development. Severe and moderate hyperoxemia were defined as a Pa02greater than 200 and 100 mm Hg, respectively. Severe and moderate hypocapnia were defined as a PaCO2less than 20 and 25 mm Hg.

Differences in QT dispersion (a predictor for sudden death) were observed in a subgroup of patients in the ELITE heart failure study of losartan compared with captopril, and may explain improved survival with losartan.

Schlufolgerung: Dienogest stellt sich nach diesen Untersuchungen als ein Gestagen mit fehlender Androgenitt und weitgehender metabolischer Vertrglichkeit dar, das als eine Erweitwerung des verfgbaren Spektrums begrt werden kann.