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Although often overlooked in our daily lives, saliva performs a host of necessary physiological functions, including lubricating and protecting the oral cavity, facilitating taste sensation and digestion and maintaining tooth enamel. Therefore, salivary gland dysfunction and hyposalivation, often resulting from pathogenesis of the autoimmune disease Sjogren’s syndrome or from radiotherapy of the head and neck region during cancer treatment, severely reduce the quality of life of afflicted patients and can lead to dental caries, periodontitis, digestive disorders, loss of taste and difficulty speaking. Since their initial discovery in the 1970’s, P2 purinergic receptors for extracellular nucleotides, including ATP-gated ion channel P2X and G protein-coupled P2Y receptors, have been shown to mediate physiological processes in numerous tissues, including the salivary glands where P2 receptors represent a link between canonical and non-canonical saliva secretion. Additionally, extracellular nucleotides released during periods of cellular stress and inflammation act as a tissue alarmin to coordinate immunological and tissue repair responses through P2 receptor activation. Accordingly, P2 receptors have gained widespread clinical interest with agonists and antagonists either currently undergoing clinical trials or already approved for human use. Here, we review the contributions of P2 receptors to salivary gland function and describe their role in salivary gland dysfunction. We further consider their potential as therapeutic targets to promote physiological saliva flow, prevent salivary gland inflammation and enhance tissue regeneration.

ObjectiveTo describe the introduction of complementary foods in a population-based cohort in relation to recommendations and explore the possible impact of maternal education on infant feeding practices.DesignProspective data from the All Babies in Southeast Sweden (ABIS) cohort study were used. The ABIS study invited all infants born in south-east Sweden during October 1997–October 1999 (n 21 700) to participate. A questionnaire was completed for 16 022 infants. During the infants’ first year parents continuously filed in a diary covering introduction of foods.SettingSweden.SubjectsInfants (n 9727) with completed food diaries.ResultsPotatoes, vegetables, fruits/berries and porridge were the foods first introduced, with a median introduction between 19 and 22 weeks, followed by introduction of meat, cow’s milk, follow-on formula and sour milk/yoghurt between 24 and 27 weeks. Early introduction of any food, before 16 weeks, occurred for 27 % of the infants and was more common in infants of mothers with low education. Overall, potatoes (14·7 %), vegetables (11·1 %), fruits/berries (8·5 %), porridge (7·4 %) and follow-on formula (2·7 %) were the foods most frequently introduced early. The majority of infants (≥70 %) were introduced to potatoes, vegetables, fruits/berries and porridge during concurrent breast-feeding, but introduction during concurrent breast-feeding was less common in infants of mothers with low education.ConclusionsMost infants were introduced to complementary foods timely in relation to recommendations. Low maternal education was associated with earlier introduction of complementary foods and less introduction during concurrent breast-feeding. Still, the results indicated exposure to fewer foods at 12 months in infants of mothers with low education.

BACKGROUND Fever of unknown origin and high sedimentation rate are common clinical problems. MATERIAL AND METHODS A middle-aged man with fever of unknown origin, night sweats and high sedimentation rate was referred to our hospital for investigation. RESULTS AND INTERPRETATION The patient was suspected to have mononucleosis or reactivation of infectious mononucleosis because of mild anaemia and thrombocytopenia, a weakly positive IgM antibody test for Epstein-Barr virus and monocytosis (in peripheral blood). Because monocytosis, elevated sedimentation rate and fever persisted, bone marrow smears were prepared and biopsies taken.The third biopsy showed that morphology was consistent with chronic myelomonocytic leukemia (CMML), which was confirmed by two later biopsies. However, a malignant cell population (consisting of blasts in peripheral blood) was only found in one of several flow cytometry assessments of peripheral blood and bone marrow aspirate and cytogenetic analyses of bone marrow cells were normal. The patient's clinical situation has been stable for some years and treatment has not been necessary.

The objectives of the study were to determine the profile of mothers who join the prevention of mother to child transmission (PMTCT) of HIV programme and to describe the factors that motivate or de-motivate the mothers to stick to or drop out of the PMTCT programme. Qualitative and quantitative research designs were used with exploratory and descriptive strategies. The study population included all the HIV/AIDS-positive mothers registered with the PMTCT programme at Katutura State Hospital and who delivered at the same hospital between March 2002 and December 2003. A total of 30 mothers were conveniently selected and interviewed as they came for their follow-up visits. A questionnaire was used for the data collection. In-depth interview was conducted with two cases (both mothers who did not keep to the follow-up visits given). The results show that factors motivating mothers to stick to the programme included the health of their children, ensuring they stand a chance of receiving antiretroviral treatment and wanting their children to live longer. Factors identified as de-motivating mothers included family members who are still in denial that HIV/AIDS exists, stigma attached to people living with the disease, financial problems and domestic violence. All mothers stated that the counselling and education given during antenatal care influenced their decision about whether to adhere to the programme. Most of the respondents stated that the support groups available for HIV/AIDS-infected persons are few, and there is no proper channel of communication and referral between the hospital and these groups. The researchers concluded that the factors influencing the adherence of mothers to the follow-up visits are both sociocultural and health related. The Ministry of Health and Social Services also needs to formalize the referral system with all local organizations working in the HIV/AIDS areas.

Purpose To develop a method for the measurement of brain perfusion based on dynamic contrast-enhanced T1-weighted MR imaging. Materials and Methods Dynamic imaging of the first pass of a bolus of a paramagnetic contrast agent was performed using a 3T whole-body magnet and a T1-weighted fast field echo sequence. The input function was obtained from the internal carotid artery. An initial T1 measurement was performed in order to convert the MR signal to concentration of the contrast agent. Pixelwise and region of interest (ROI)-based calculation of cerebral perfusion (CBF) was performed using Tikhonov's procedure of deconvolution. Seven patients with acute optic neuritis and two patients with acute stroke were investigated. Results The mean perfusion value for ROIs in gray matter was 62 mL/100g/min and 21 mL/100g/min in white matter in patients with acute optic neuritis. The perfusion inside the infarct core was 9 mL/100g/min in one of the stroke patients. The other stroke patient had postischemic hyperperfusion and CBF was 140 mL/100g/min. Conclusion Absolute values of brain perfusion can be obtained using dynamic contrast-enhanced MRI. These values correspond to expected values from established PET methods. Furthermore, at 3T pixelwise calculation can be performed, allowing construction of CBF maps. J. Magn. Reson. Imaging 2008;27:754–762. © 2008 Wiley-Liss, Inc.

An industrial separation system consisting of four pressure-staged distillation columns has been studied to see if multi-effect integration can be applied to any two columns in the sequence. Shortcut equations and Vmin-diagrams have been used for screening purposes to find the columns with the highest potential for energy savings. The most promising case has then been further studied using rigorous simulation tools to verify the results from the shortcut approach. Three cases have been simulated: a non-integrated base case (existing), a multi-effect indirect split arrangement (ISF) and a multi-effect prefractionator arrangement (PF). The results showed that when considering the existing number of stages available the ISF arrangement was the best, however when considering infinite number of stages the PF arrangement was the best (as expected). © 2004 Elsevier B.V. All rights reserved.

The minimum energy requirements of six different heat-integrated multieffect and three nonintegrated distillation arrangements for separating a ternary mixture have been considered. The focus is on a heat-integrated complex distillation configuration, called a multieffect prefractionator arrangement. The comparison of the different arrangements is based on the minimum vapor flow rates at infinite number of stages, which are easily visualized and compared in a Vmin diagram. This tool can be used as a basis for screening and the best arrangement(s) can be studied further using more rigorous simulation methods. © 2005 American Institute of Chemical Engineers AIChE J, 51: 1714 –1725, 2005

A heat-integrated prefractionator arrangement is studied for a ternary separation of a propane–butane–pentane mixture. These types of integrated prefractionator arrangements have large energy savings compared with the best of the direct or indirect sequence with no heat integration. However, a heat-integrated distillation system can be more difficult to control than a non-integrated arrangement, so good control systems are essential. In this work, the focus is on selecting control variables that will ensure that the promised energy savings are achieved. The method of self-optimizing control (Skogestad, 2000) has been used to provide a systematic procedure for the selection of controlled variables, based on steady state economics. The results show that the integrated prefractionator arrangement can have large energy savings compared with non-integrated arrangements and that controlling the ratio of the distillate flow to the feed flow has good self-optimizing properties.

Although controversial, an amputation for longstanding and therapy-resistant Complex Regional Pain Syndrome Type I (CRPS-I) may improve quality of life and pain intensity. Resilience, the way people deal with adversity in a positive way may be related to these positive outcomes. This study focused on the relationship between resilience and post-amputation outcomes, i.e. quality of life, pain and recurrence of CRPS-I and psychological distress.Twenty-six patients with an amputation related to CRPS-I filled in the Connor-Davidson Resilience Scale (CD-RISC), World Health Organisation -- Quality of life Assessment (WHOQOL-Bref) and the Symptom Checklist-90 Revised (SCL-90-R). An interview was conducted and a physical examination performed. Results were compared with reference groups from literature and a control group from the outpatient rehabilitation clinic at our medical center.Resilience correlated significantly with all domains of the WHOQOL-Bref (ρ ranged from 0.41 to 0.72) and negatively with all domains of the SCL-90-R (ρ ranged from -0.39 to -0.68). Patients with an amputation because of CRPS-I have higher scores on resilience and quality of life than the control group. Resilience was lower in patients who reported CRPS-I symptoms compared to those who did not.The results confirmed our hypothesis that patients with an amputation because of CRPS-I who have a higher resilience also have a higher quality of life and experience lower psychological distress. The prognostic value of resilience in this patient group requires further research. Implications for Rehabilitation Until characteristics of patients with positive quality of life outcome have been further unraveled, amputation for CRPS-I should only be performed in expertise centers. Resilience, the process of adapting well in the face of adversity, should be further explored in Rehabilitation Medicine research in general. Measurement of resilience should be a standard procedure when patients with CRPS-I request an amputation. Improving resilience of patients in in- and outpatient rehabilitation clinics might be an additional treatment in rehabilitation care.

Background: Some patients with long-standing, therapy-resistant type-I complex regional pain syndrome consider an amputation. There is a lack of evidence regarding the risk of recurrence of the pain syndrome and patient outcomes after amputation. The goal of the present study was to evaluate the impact of an amputation on pain, participation in daily life activities, and quality of life as well as the use of a prosthesis and the risk of recurrence of the pain syndrome in patients with long-standing, therapy-resistant type-I complex regional pain syndrome. Methods: From May 2000 to October 2008, twenty-two patients underwent an amputation of a nonfunctional limb at our institution because of long-standing, therapy-resistant type-I complex regional pain syndrome. Twenty-one of these patients were included in our study. The median age was forty-six years (interquartile range [IQR], thirty-seven to fifty-one years), the median duration of the complex regional pain syndrome was six years (IQR, two to ten years), and the median interval between the amputation and the study was five years (IQR, three to seven years). A semistructured interview was conducted, physical examination of the residual limb was performed, and the patients completed two questionnaires. Results: Twenty patients (95%) reported an improvement in their lives. Nineteen patients (90%) reported a reduction in pain, seventeen patients (81%) reported an improvement in mobility, and fourteen (67%) reported an improvement in sleep. Eighteen of the twenty-one patients stated that they would choose to undergo an amputation again under the same circumstances. Ten of the fifteen patients with a lower-limb amputation and one of the six with an upper-limb amputation regularly used a prosthesis. The type-I complex regional pain syndrome recurred in the residual limb of three patients (14%) and symptoms recurred in another limb in two patients (10%). Conclusions: Amputation may positively contribute to the lives of patients with long-standing, therapy-resistant type-I complex regional pain syndrome. Patients were likely to use a prosthesis after a lower-limb amputation. The risk of recurrence of the type-I complex regional pain syndrome was 24%. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

A heat-integrated prefractionator arrangement is studied for a ternary separation of a propane–butane–pentane mixture. These types of integrated prefractionator arrangements have large energy savings compared with the best of the direct or indirect sequence with no heat integration. However, a heat-integrated distillation system can be more difficult to control than a non-integrated arrangement, so good control systems are essential. In this work, the focus is on selecting control variables that will ensure that the promised energy savings are achieved. The method of self-optimizing control (Skogestad, 2000) has been used to provide a systematic procedure for the selection of controlled variables, based on steady state economics. The results show that the integrated prefractionator arrangement can have large energy savings compared with non-integrated arrangements and that controlling the ratio of the distillate flow to the feed flow has good self-optimizing properties. © 2004 Elsevier Ltd. All rights reserved.

The plasticity of endothelin ETB receptor activity and the influence of pro-inflammatory cytokines was examined in cerebral artery. In fresh rat basilar artery, the selective ETB receptor agonist, sarafotoxin S6c, induced negligible contractions. However, after 1 day of organ culture, fully defined concentration-response curves were obtained in artery segments exposed to sarafotoxin S6c. Organ culture in the presence of either interleukin-1 beta or tumour necrosis factor-alpha, but not interleukin-2 or interleukin-6, further amplified the maximal contraction to sarafotoxin S6c. The plasticity of ETB receptor expression in cerebral arteries and sensitivity for pro-inflammatory cytokines, suggest a role in inflammatory cerebral diseases such as stroke.

Monitoring of the heart rate of five healthy well-conditioned women during an aerobic dance routine showed that maximum rates were within acceptable limits for exercise tachycardia except in one subject, who had paroxysmal supraventricular tachycardia that subsequently converted to sinus tachycardia. Thus, although aerobic dance seems a benign form of exercise, it can be intense enough to trigger dysrhythmias. Before recommending or approving it for any patient, the physician should take into consideration the person's age, health, and physical fitness level.