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Diabetes mellitus (DM) is a disease with increasing incidence worldwide, according to data from the International Diabetes Federation (IDF) and the World Health Organization (WHO) An essential role in prophylaxis, early diagnosis and monitoring is played by the healthcare providers, such as medical doctors, pharmacists, and nurses, and by conducting public information campaigns It also matters the way in which the information is understood and perceived effectively, as well as the preferences and information needs of the population In this paper, instrumental marketing research was conducted, based on a prospective observational study on the incidence of diabetes and on effective information methods among the population The purpose was to assess the role of pharmacists and pharmaceutical companies in information campaigns in the field and the need for such campaigns The research results showed that in order to improve the level of education and information of the population, but also to improve the health of the population, it is considered necessary and appropriate, the active involvement of pharmacists and pharmaceutical companies in initiating and conducting health campaigns on diabetes and other current public health issues © 2020 Polish Pharmaceutical Society All rights reserved

Burns in neonates is a unique pathology that poses management challenges, as, besides treating the burn injury, the medical team needs to be familiar with the unique physiology of the newborn. This study aimed to review our center's experience with the management of neonatal burns. A 7-year retrospective study of neonatal burns managed at a tertiary national referral unit in Bucharest, Romania, was performed. Patients were divided into two groups, preterm and term, based on gestational age. Collected data included demographics, treatment, complications and follow-up. Our center managed 13 neonates with burns (5 term and 8 preterm), with a mean age at injury of 8.6 days. All neonatal burns were thermal injuries. For preterm babies, all burns were iatrogenic, consisting of victims of a fire in a Maternity Hospital, while for the term group only one was iatrogenic. Burns were more extensive in the premature group (65% vs. 20% mean TBSA, p=0.0001). All premature patients had associated inhalation injuries. Surgical treatment was indicated for two term patients. Survival rate was 77% and was negatively influenced by inhalation injury, burn shock and TBSA50%. In conclusion, the majority of hospitalized neonatal burns in Romania were the result of a fire disaster secondary to an infrastructure deficiency. Their management is complex, posing specific challenges, and needs to be led by a multidisciplinary team that can ensure an individualized continuum of acute burn care and recovery.Les brûlures du nouveau- né (NN) posent une problème physiopathologique spécifique, tenant non seulement aux conséquences de la brûlure mais aussi à la physiologie particulière du NN. Cet article décrit notre expérience. Il s’agit d’une étude rétrospective reprenant les 13 NN pris en charge dans un CTB de référence de Bucarest, pour une brûlure survenue en moyenne à 8,6J. Les patients ont été répartis entres prématurés (P,8) et à terme (T,5). Toutes les brûlures étaient thermiques, toutes iatrogènes dans le groupe P, consécutives à un incendie à la maternité quand une seule était iatrogène dans le groupe T. Elles étaient plus étendues dans le groupe P (65% SCT) que dans le groupe T (20%, p= 0,0001). Tous les P avaient des lésions d’inhalation. Une greffe a été nécessaire pour 2 T. La mortalité était de 23%, influencée par la surface brûlée, l’inhalation et une surface atteinte50 %. En conclusion, la plupart des brûlures de NN roumains ayant nécessité une hospitalisation étaient dues à l’incendie d’une maternité à l’architecture déficiente. Leur prise en charge est complexe et spécifique, ce qui nécessite une équipe entraînée, à même de proposer des soins adaptés, de la phase aiguë à la rééducation.

BACKGROUND: Acute appendicitis is the most common surgical emergency in children. Differentiation of acute appendicitis from conditions that do not require operative management can be challenging in children. This study aimed to identify the optimum risk prediction model to stratify acute appendicitis risk in children. METHODS: We did a rapid review to identify acute appendicitis risk prediction models. A prospective, multicentre cohort study was then done to evaluate performance of these models. Children (aged 5-15 years) presenting with acute right iliac fossa pain in the UK and Ireland were included. For each model, score cutoff thresholds were systematically varied to identify the best achievable specificity while maintaining a failure rate (ie, proportion of patients identified as low risk who had acute appendicitis) less than 5%. The normal appendicectomy rate was the proportion of resected appendixes found to be normal on histopathological examination. FINDINGS:15 risk prediction models were identified that could be assessed. The cohort study enrolled 1827 children from 139 centres, of whom 630 (34·5%) underwent appendicectomy. The normal appendicectomy rate was 15·9% (100 of 630 patients). The Shera score was the best performing model, with an area under the curve of 0·84 (95% CI 0·82-0·86). Applying score cutoffs of 3 points or lower for children aged 5-10 years and girls aged 11-15 years, and 2 points or lower for boys aged 11-15 years, the failure rate was 3·3% (95% CI 2·0-5·2; 18 of 539 patients), specificity was 44·3% (95% CI 41·4-47·2; 521 of 1176), and positive predictive value was 41·4% (38·5-44·4; 463 of 1118). Positive predictive value for the Shera score with a cutoff of 6 points or lower (72·6%, 67·4-77·4) was similar to that of ultrasound scan (75·0%, 65·3-83·1). INTERPRETATION: The Shera score has the potential to identify a large group of children at low risk of acute appendicitis who could be considered for early discharge. Risk scoring does not identify children who should proceed directly to surgery. Medium-risk and high-risk children should undergo routine preoperative ultrasound imaging by operators trained to assess for acute appendicitis, and MRI or low-dose CT if uncertainty remains. FUNDING: None.

Chronic midgut volvulus is a rare condition and the diagnosis can pose a serious challenge. We present the case of an 8 year old girl, with a long-standing history of atypical gastrointestinal symptoms. Although extensive evaluation was performed, the diagnosis of intestinal malrotation with chronic volvulus was only established after 5 years. Her symptoms resolved after corrective surgery. This case report underlines the importance of considering malrotation in the differential diagnosis of patients that present beyond infancy with vague nonspecific gastrointestinal complaints, as a misdiagnosis can result in a catastrophic outcome.

Xanthogranulomatous pyelonephritis (XGP) is an uncommon chronic destructive granulomatous inflammation of the kidney that can sometimes mimic other renal pathologies like tumours or infections. For this reason, it is also called “the great imitator”.This is the case of a 7-year old girl that presented to the hospital with right hip pain and a suspicious right sided abdominal lesion, thought initially to be a Wilms’ tumour and then an appendiceal mass with a psoas abscess. The abscess was percutaneously drained and the patient was treated with intravenous antibiotics. At 6 weeks interval, the interval appendicectomy was negative. On subsequent follow-up imaging, an abnormally structured kidney was shown, surrounded by a calcified rim and a remnant psoas abscess, which suggested XGP or tuberculous (TB) pyelonephritis as differentials. A DMSA scan showed no function in the affected kidney and the patient underwent a nephroureterectomy. The histopathology showed features that prompted consideration of tuberculosis but ultimately allowed a diagnosis of XGP.XGP can be a confounding pathology as in the present case, where there remained multiple clinical, radiological and histological differentials throughout the course of the patients care, right up to the final diagnosis. Keywords: Xanthogranulomatous pyelonephritis, Wilms' tumor, Appendicitis, Renal tuberculosis, Mimic

Wind tunnel campaigns are negotiated between the operator and customer, regardless if the customer belongs to the wind tunnel owner or if it is external. Customer issues a test matrix, sometimes the scale of the model and some instrumentation requirements. All these elements must be optimized/tailored in order to guarantee a successful campaign, while minimizing the compromises. A tradeoff or optimization is required in an early stage of a project, when feasibility is questioned. Optimization of the experimental setup considers as variables scale of the model, stagnation pressure and sweep rate for all wind tunnel runs, selection of the most suitable balance and sting. The wind tunnel operating diagram is introducing the correlation among Mach number, stagnation pressure and blow-down duration. These parameters must be optimally set in order to achieve the best Reynolds matching with respect to customer requirements in a minimum time per run, corresponding to the minimization of the wind tunnel power consumption.Wind tunnel campaigns are negotiated between the operator and customer, regardless if the customer belongs to the wind tunnel owner or if it is external. Customer issues a test matrix, sometimes the scale of the model and some instrumentation requirements. All these elements must be optimized/tailored in order to guarantee a successful campaign, while minimizing the compromises. A tradeoff or optimization is required in an early stage of a project, when feasibility is questioned. Optimization of the experimental setup considers as variables scale of the model, stagnation pressure and sweep rate for all wind tunnel runs, selection of the most suitable balance and sting. The wind tunnel operating diagram is introducing the correlation among Mach number, stagnation pressure and blow-down duration. These parameters must be optimally set in order to achieve the best Reynolds matching with respect to customer requirements in a minimum time per run, corresponding to the minimization of the wind tunnel power cons...

Ptpn6 is a cytoplasmic phosphatase that functions to prevent autoimmune and interleukin-1 (IL-1) receptor-dependent, caspase-1-independent inflammatory disease. Conditional deletion of Ptpn6 in neutrophils (Ptpn6∆PMN) is sufficient to initiate IL-1 receptor-dependent cutaneous inflammatory disease, but the source of IL-1 and the mechanisms behind IL-1 release remain unclear. Here, we investigate the mechanisms controlling IL-1α/β release from neutrophils by inhibiting caspase-8-dependent apoptosis and Ripk1-Ripk3-Mlkl-regulated necroptosis. Loss of Ripk1 accelerated disease onset, whereas combined deletion of caspase-8 and either Ripk3 or Mlkl strongly protected Ptpn6∆PMN mice. Ptpn6∆PMN neutrophils displayed increased p38 mitogen-activated protein kinase-dependent Ripk1-independent IL-1 and tumor necrosis factor production, and were prone to cell death. Together, these data emphasize dual functions for Ptpn6 in the negative regulation of p38 mitogen-activated protein kinase activation to control tumor necrosis factor and IL-1α/β expression, and in maintaining Ripk1 function to prevent caspase-8- and Ripk3-Mlkl-dependent cell death and concomitant IL-1α/β release.

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Recent progress in medical imaging allowed higher accuracy in diagnosis of acute diverticulitis. Contrast enhanced Computed Tomography (CT) has a high sensitivity and specificity, reaching a diagnostic accuracy over 95%. Although abdominal X-ray and ultrasonography are still used, their utility is limited in this pathology. Retrospective study including patients admitted for acute diverticulitis in the Surgery Clinic of Bucharest Clinical Emergency Hospital between January 2012 and July 2014. From the total number of 29508 admissions, 156 patients were diagnosed with acute diverticulitis staged Hinchey I to IV. The imagistic investigations on admission were plain abdominal X-ray (128 cases), which identified 6 cases of pneumoperitoneum; abdominal ultrasound (112 cases) which identified colonic wall thickening and/or free peritoneal fluid in 29.4% cases. Contrast enhanced CT was performed in 97 cases, successfully establishing the diagnostic in 80% of cases. The mean waiting time interval until CT scan was under 24 hours for the patients with acute complicated diverticulitis. Patients with acute diverticulitis staged Hinchey II-III needed CT reevaluation both for monitoring the response to conservative treatment and identification of postoperative complications. Due to its high diagnostic accuracy and short waiting interval, in the studied cohort, contrast enhanced CT represents the investigation of choice in diagnosing acute diverticulitis. Abdominal ultrasound remains an alternative only in cases where CT scan is unavailable or contraindicated, having a lower accuracy in diagnosis and evaluation of diverticular disease complications.

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Affordable space access requires partial or ideally full launch vehicle reuse, which is in line with clean environment requirement. Although the idea is old, the practical use is difficult, requiring very large technology investment for qualification. Rocket gliders like Space Shuttle have been successfullyoperated but the price and correspondingly the energy footprint were found not sustainable. For medium launchers, finally there is a very promising platform as Falcon 9. For very small launchers the situation is more complex, because the performance index (payload to start mass) is already small, versus medium and heavy launchers. For partial reusable micro launchers this index is even smaller. However the challenge has to be taken because it is likely that in a multiyear effort, technology is going to enable the performance recovery to make such a system economically and environmentally feasible. The current paper is devoted to a small unitary glide back booster which is foreseen to be assembled in a number of possible configurations. Although the level of analysis is not deep, the solution is analyzed from the aerodynamic point of view. A wind tunnel model is designed, with an active canard, to enablea more efficient wind tunnel campaign, as a national level premiere.

This paper presents the GlidArc plasma effects on some metallic surfaces often used in dentistry: zirconium, titanium and nickel – chromium alloy plates. For the experiments performed, a GlidArc reactor with two planar electrodes has been used. During the tests, the gas flow has been kept constant while the treatment time and the distance between the plasma and the sample were modified. The surfaces were analyzed using atomic force microscopy (AFM) in order to determine the surface morphological modifications induced by the plasma treatment.

In this work an electrochemical immunoassay, based on a direct competitive assay, was developed using magnetic beads as solid phase and carbon screen-printed arrays as transducers for the detection of sulfonamides in food matrices such as honey. Magnetic beads coated with protein A were modified by immobilisation of specific antibodies and then the competition between the target analyte and the corresponding analyte-labelled with an enzyme was carried out; after the immunosensing step, beads were captured by a magnet onto the working surfaces of a screen-printed eight-electrodes array for a multiple electrochemical detection. Screen-printed eight-electrodes arrays were chosen as transducers due to the possibility to repeat multiple analysis and to test different samples simultaneously. Alkaline Phosphatase (AP) was used as enzyme label and Differential Pulse Voltammetry (DPV) as fast electrochemical technique. Calibration curves demonstrate that the developed electrochemical immunoassay was able to detect this class of drugs in standard solutions at low concentrations (ng/mL levels). The short incubation times (25 min) and the fast electrochemical measurement (10 sec) make of these systems a possible alternative to classic ELISA tests.

Summary Background Xanthogranulomatous pyelonephritis (XGP) is an uncommon chronic destructive granulomatous inflammation of the kidney. It was first described in 1916, and is thought to affect 6/1000 cases of pyelonephritis. Its manifestations are varied, and with a limited number of cases in the literature, the optimal diagnosis and management of XGP in the paediatric cohort is still unknown. Material and methods The medical records of children who were diagnosed and treated for XGP at the current unit during the period 1963–2016, inclusive, were retrospectively reviewed. Information pertaining to each patient was recorded, including: demographic data, past medical history, clinical and biochemical characteristics, diagnostic procedures, treatment methods, histopathologic diagnosis of the removed specimen, and outcome. Results A total of 66 children with a median age of 4.84 years (range 1.1–14.81), with an M:F ratio 1.35:1 underwent nephrectomy for XGP and had a median follow-up of 7.19 years (range 0.11–17.45). The most common presentations were systemic illness (62.1%), pain (60.6%), urinary tract infections (54.5%) and an abdominal mass (39.4%); pyrexia was present in 53%. Biochemical abnormalities included anaemia (86.3%), thrombocytosis (80.3%) and hypomagnesemia (65.1%). There was an 83.3% concordance between intraoperative cultures and positive mid-stream urines. Index kidneys were significantly larger than the contralateral side (mean 1.32 cm; P = 0.002). Staging of XGP demonstrated extension beyond the kidney in 79% of kidneys. Computed tomography (CT) was performed in 11 cases (Summary figure). Dimercaptosuccinic acid (DMSA) scan showed 0–10% function in 90.47% of cases. Surgical procedures included nephrectomy (n = 63) and partial nephrectomy (n = 3). Perioperative complications included colonic resections (n = 5) and abscess formation in 18%. Conclusions This is the largest series to date of XGP in a paediatric cohort. XGP should be included in the differential diagnosis of all children presenting with perirenal or psoas abscesses, renal masses and/or non-functioning kidneys with/or without associated urolithiasis. Clinical awareness and a high index of suspicion is required to achieve the correct pre-operative diagnosis and appropriate management. Download : Download high-res image (369KB) Download : Download full-size image Summary Figure . Pathognomonic CT feature of xanthogranulomatous pyelonephritis: ‘bear-paw’ sign.

This article considers some of the problems of the interpretation of information from other national arthroplasty registers when setting up a new register. In order for the most useful information to be available from registers much international co-operation is required between all those responsible for the design of registers as well as those who gather, assess and publish the data.

Near total colonic aganglionosis is one of the rarest forms of Hirschsprung's disease and until recent years it has been considered deadly. Establishing a correct diagnosis has proven to be challenging, because while the clinical and radiological features can be useful, they are not pathognomonic. Chronic intestinal obstruction and long-term parenteral nutrition dependency are associated with a high mortality risk for these patients. While there is no current consensus with regards to a superior operative method, the patients benefit from surgical techniques aimed at lengthening the intestine, as well as from intestine transplant. We report the case of a newborn baby girl who was admitted to our clinic for abdominal distension,biliary and fecaloid vomiting. With an initial suspicion of digestive tract malformation, the diagnosis of near total congenital megacolon was established with great difficulty and the infant underwent serial surgeries, ending up with an extended myotomy-myectomy (Ziegler's procedure) as a curative approach, with favorable immediate postoperative evolution.However, the patient developed sepsis and although the infection was treated accordingly, the baby's general condition kept deteriorating and exitus was recorded 77 days after admission.

The cold plasma reactors are more often used in the last decades in surface treatment and bio-decontamination. The aim of this paper is to present the GlidArc plasma effects on the material surfaces used in dentistry (zirconium and titanium plates). For the conducted tests two GlidArc reactors were used: the first one having two electrodes, producing a planar electrical discharge and the second one with three electrodes and volumic discharge. Keeping the treatment time constant (60 seconds) the nature of the blowing gas used (humid and dry air) and the distance between the plasma and the treating samples was modified. The surfaces were analyzed performing atomic force microscopy (AFM) in air at room temperature. Both topographical and adhesion force measurements were considered as parameters used for characterizing the morphological modifications of the surfaces induced by the plasma treatment.

OBJECTIVESWe sought to evaluate whether oral anticoagulant (AC) therapy given for five months was superior to standard (control) therapy in patients with unstable angina receiving aspirin.BACKGROUNDThe long-term risk of myocardial infarction (MI) or death remains high in patients with unstable angina, despite the use of aspirin. Therefore, additional treatments are necessary.METHODSOf the 10,141 patients entering the main trial, 3,712 were randomized 12 to 48 h later to receive oral AC therapy (n = 1,848) or standard therapy (n = 1,864).RESULTSOne-hundred forty patients (7.6%) suffered from cardiovascular death, MI or stroke while receiving oral AC, compared with 155 patients (8.3%) on standard therapy (relative risk [RR] 0.90, 95% confidence interval [CI] 0.72 to 1.14; p = 0.40). The rates of the primary outcomes plus refractory angina were 16.7% (n = 308) versus 17.5% (n = 327) (RR 0.95, 95% CI 0.81 to 1.11; p = 0.53). Countries were divided into good or poor compliers (based on the use of oral AC above or below 70% at 35 days), without knowledge of results by country. In good-complier countries, oral AC was discontinued in only 10.4% of patients at seven days and in 23.6% by five months, compared with 27.6% and 44.9%, respectively, in poor complier countries. There were significant reductions in the risks of both the primary (6.1% vs. 8.9%; RR 0.68, 95% CI 0.48 to 0.95; p = 0.02) and secondary outcomes (11.9% vs. 16.5%; RR 0.70, 95% CI 0.55 to 0.90; p = 0.005) with oral AC in the good-complier countries. There was little difference in the poor-complier countries (9.0% vs. 7.8% for the primary and 21.3% vs. 18.5% for the secondary outcomes, tests for interactions comparing the RRs for the primary and secondary outcomes were p < 0.02 and p = 0.002, respectively, between the two sets of countries). In the overall study, there was an excess of major bleeding (2.7% vs. 1.3%; p = 0.004), which was larger in the good-complier countries (RR 2.71) compared with the poor-complier countries (RR 1.58). There were also reductions in cardiac catheterization (RR 0.80; p = 0.004) and coronary revascularization procedures (RR 0.82; p = 0.06) in the good-complier countries, but not in the poor-complier countries (RR 0.98 and 1.06, respectively, p for interaction of 0.06 and 0.04, respectively).CONCLUSIONSOverall, oral AC led to a small, nonsignificant reduction in the risk of the primary and secondary outcomes. Stratifying the countries or centers by their rates of compliance to oral AC suggested that good compliance to oral AC could potentially lead to clinically important reductions in major ischemic cardiovascular events.

Multiple intestinal atresia (MIA) is a complex congenital defect which represents a challenge for the pediatric surgeon,especially in the rare event of encountering type IIIb or apple peel atresia, which has a high mortality rate. The surgeon’s aim is to preserve as much bowel length as possible, to avoid postoperative sepsis and to prevent long-term complications such as short bowel syndrome. Access to a good neonatal intensive care unit and to parenteral nutritional support is crucial in the survival of these children. We report a rare case of multiple intestinal atresia associated with an apple peel atresia, which was managed by multiple intestinal resections and anastomosis without the placement of transanastomotic tubes or stomas.

In recent years investigations have been made to study the electric Pygmy Dipole Resonance (PDR) systematically, mainly in semi‐magic nuclei. For this purpose the well understood high resolution (γ,γ′) photon scattering method is used. In complementary (α,α′γ) coincidence experiments at Eα = 136 MeV a similar γ‐energy resolution and a high selectivity to E1 transitions can be obtained at the Big‐Bite Spectrometer (BBS) at KVI, Groningen. In comparison to the (γ,γ′) method a structural splitting of the PDR is observed in the N = 82 nuclei 138Ba and 140Ce and in the Z = 50 nucleus 124Sn. The low energy part is excited in (γ,γ′) as well as in (α,α′γ) while the high energy part is observed in (γ,γ′) only. The experimental results together with theoretical QPM and RQTBA calculations on 124Sn which are able to reproduce the splitting of the PDR qualitatively are presented. The low‐lying group of Jπ = 1− states seem to represent the more isoscalar neutron‐skin oscillation of the PDR while the energetically higher‐lying states seemingly belong to the transitional region between the PDR and the isovector Giant Dipole Resonance (IVGDR).

The reorganization processes at submicron level of the polymeric materials have been investigated because of their applications in optoelectronics and bio‐science. We have obtained surface relief modulation in single step processing on the photo resist and polysiloxane films. But for technical applications the time evolution and stability of the induced surface structure is an important parameter and is a problem to be discussed. In case of single step surface relief formation on polymeric materials the process is connected with the photochromic behavior of the materials. As it is known the UV light induced effects on the material structure are reversible under the action of visible light, but with different speeds. In this report is analyzed the time evolution of the surface modulation obtained under the action of the UV light for azopolymers with different structures.

The reorganization processes at submicron level of the polymeric materials have been investigated because of their applications in optoelectronics and bio-science. We have obtained surface relief modulation in single step processing on the photo resist and polysiloxane films. But for technical applications the time evolution and stability of the induced surface structure is an important parameter and is a problem to be discussed. In case of single step surface relief formation on polymeric materials the process is connected with the photochromic behavior of the materials. As it is known the UV light induced effects on the material structure are reversible under the action of visible light, but with different speeds. In this report is analyzed the time evolution of the surface modulation obtained under the action of the UV light for azopolymers with different structures.

Chord routing is greedy and non-symmetric, and is based on a skiplist-like data structure, whose entries are known as fingers. This work explores the benefits arising from a modified greedy lookup strategy that, without introducing any additional communication overhead, simply exploits the implicit symmetry knowledge intrinsic to the highly structured Chord ring. Through extensive simulation on a dynamic peer environment, we show a practical and feasible solution that actually boosts DHT lookup performance under a wide range of scenarios.

Cortical sensory maps in mammalian brain exhibit various kinds of asymmetry and lateralization, the causes and mechanisms of which are not well understood and are a subject of controversy. This study uses a neural network model of left and right cortical regions connected via a corpus callosum to examine possible factors involved an the development of map lateralization and asymmetries. Competitive distribution of activation and competitive learning rules are used. The effects of varying callosal connection strength (both excitatory and inhibitory) in the symmetric case and in the presence of some model asymmetries are studied along with the effects of varying training input overlap. The results may provide some insight into how underlying cortical asymmetries and callosal influences can interact to cause hemispheric map asymmetries.

ObjectivesThe purpose of this study is to evaluate the clinical and socio-professional functioning status after two years of evolution, on a sample of patients with first episode of psychosis, admitted in the Psychiatric Clinic in Timisoara in 2006.MethodsThe initial sample was formed of 41 patients, but at the follow-up point (2008) only 28 patients were still in evidence. Diagnosis was made after ICD 10, BPRS and GAF were used as evaluation tools.ResultsOn the initial evaluation 32 % had a diagnosis of persistent delusional disorder, 25 % of short and transitory psychosis, 18% schizophrenia and 25% other psychosis. After 2 years of evolution 46% had a diagnosis of persistent delusional disorder, 25% schizophrenia and only 7 % had acute and transitory psychosis. In 28% of the cases the diagnosis was changed, most of the cases being the ones initially diagnosed with acute and transitory psychosis. The most stabil diagnosis was the persistent delusional disorder. In the majority of the cases we observed a lower socio-professional and family functioning.ConclusionsThe results of this study sugests that the diagnosis of first episode of psychosis is partially predictive for the type of illnes, because a first episode of psychosis can evolve in different pathologies. The socio-professional and family functioning is lower in the majority of cases without a clear connection with the initial diagnosis.

ObjectiveTo create an image of therapeutic options available for the first episode psychsis and the way these options influence the evolution of patients.Material and methodsThe present study is part of a larger follow-up study on a number of 121 patients with a diagnostic of first episode psychosis admitted in the Timisoara Psychiatric Clinic and The Day Clinic in the Timisoara Mental Health Center between 2003-2006 and prospectively monitored from the moment of their first contact with psychiatric services.ResultsThe average calculated duration of prodrome period and average Duration of Untreated Psychosis (DUP) are similar to the results indicated by most other studies. The results of statistical tests show that: the longest the prodrome, the worse the improvement of illness during course; a longer prodrome is correlated with a higher number of relapses during the patient's illness course and a longer Duration of Untreated Psychosis is likely to lead to an increased severity of illness. Patients’ adherence to treatment is influenced both by the traits of the first psychotic episode and the way the patients perceive the side effects and the general utility of the administered medication.ConclusionsPsychiatrists have to dedicate more time and interest to establishing a therapeutic alliance with their patients with first episode psychosis; an individualized strategy is required to establish the adequate means and ways of intervention before initiating any type of therapy.

UMMARY A study was carried out on two cases of reflex epilepsy with hemiconvulsive seizures induced by proprioceptive stimulations (tuning fork vibrations and active and/or passive movements). A proprioceptive dissociation is shown to exist in reflex epilepsy, i.e. the seizures are induced only by certain proprioceptive stimuli (vibration or movement). It is assumed that the proprioceptive stimuli generated during the convulsive seizure intervene by a feedback mechanism. By means of this feedback mechanism the afferent proprioceptive impulses in the course of the seizure facilitate the cortical mechanisms of clonic transformation of the convulsive fit. Interruption of this mechanism in the clonic phase of the paroxysm by immobilization of the parts showing myoclonic jerks brought about immediate arrest of the seizure in the first case and temporary disappearance of the spontaneous focal discharges during the seizure in the second case. RESUME Les auteurs presentent deux cas d'epilepsie reflexe avec des crises hemiconvulsives provoquees par des stimulations proprioceptives (les vibrations d'un diapason et les mouvements passifs ou actifs). On a observe une dissociation proprioceptive au cours des crises, provoquees seulement par certaines stimulations proprioceptives (vibrations ou mouvements). On suppose que les stimulations proprioceptives apparaissant au cours des crises interviennent par un mecanisme de feedback. Par ce mecanisme les impulsions afferentes proprioceptives interviennent au niveau cortical, facilitant la transformation clonique des crises convulsives. L'interruption de ces mecanismes dans sa phase clonique par l'immobilisation du segment anime de mouvements myocloniques a provoque un arret immediat de la crise dans notre premier cas et une disparition de courte duree des decharges focales spontanees dans notre deuxieme cas.

SUMMARY Activations were performed by means of natrium-evipan (Bayer). Small doses (0.10–0.20 g) of evipan were administered intravenously. The drug was injected slowly, concomitantly with continuous recording of the EEG. In all the cases solutions of 0.05 g evipan/ml normal saline or distilled water were injected. The rate of administration was, on the average, 1 ml solution every 10 sec. Evipan-induced EEG activation was achieved following standard bipolar recordings with 3 min of hyperventilation. Eighty-three patients and 4 normal controls underwent evipan EEG activation. The patients were studied in the following groups: 41 with epileptic seizures ascertained clinically; 14 with non-epileptic paroxysmal manifestations (8 with seizures indefinite in clinical aspect, 3 with syncopal seizures, 1 with migrainous attacks and 2 with paroxysmal vertigo (Meniere)); 21 neurotic cases; 7 focal cerebral lesions (2 tumors and 5 cerebrovascular accidents). The bioelectric changes produced by administration of small doses of evipan were not accompanied by disagreeable subjective sensations nor by sleep. The main duration of an activation is 20 min at the maximum. After this time interval the patient can leave the laboratory room without any risk whatsoever. The results obtained show that evipan constantly induces bioelectric changes such as: diffuse synchronization or resynchronization of the background activity, increase in tracing amplitude and appearance of focal anomalies or diffuse, lesional or irritative anomalies. The latter were particularly conspicuous in patients clinically showing epileptic seizures. It is worth noting that the increase in amplitude occurring in epileptics with evipan exceeds 2–3 times the amplitude of the initial EEG tracings. The increase is very early in epileptics following very small doses of evipan and lasts longer than with the other categories of patients. This high voltage amplitude of bioelectric tracings was interpreted as a functional reorganization phenomenon, diffuse or restricted to particular epileptogenic circuits and systems of the brain. The amplitude increase was regarded as pathognomonic for epilepsy, as it only occurred in patients with clinical epilepsy and was constantly associated with comitial, diffuse or focal anomalies. On the basis of data obtained, the amplitude increase was estimated as an electro-encephalographic equivalent of the convulsive predisposition of the brain. In a great number of cases evipan activation induces electroencephalographically a delimitation of lesional or epileptogenic foci. The setting off of foci is accounted for by the absence of bioelectric resynchronization induced by evipan at the level of the damaged cerebral areas. RESUME Des activations ont ete effectuees avec l'Evipan sodique (Bayer) en solution de 0.05 g/ml dans du serum physiologique. De petites doses du produit (0.10 a 0.20 g) ont ete utilisees en injection intra-veineuse lente (1 ml de solution en 10 secondes) pendant un enregistrement continu de l'E.E.G. Quatre-vingt trois malades et 4 temoins normaux ont eteetudies dont on avait prealablement enregistre l'E.E.G. standard comportant une epreuve de l'hyperpnee de 3 minutes. Les malades se groupaient de la facon suivante: 41 epileptiques; 14 sujets souffrant de crises non epileptiques (crises de nature indeterminee, 8 cas; syncopes, 3 cas; migraine, 1 cas; vertiges paroxystiques, 2 cas); 21 nevrotiques; 7 sujets souffrant de lesions cerebrales en foyer (tumeur, 2 cas; foyer vasculaire, 5 cas). L'activation de ces sujets par l'Evipan sodique s'est effectuee en 20 minutes au maximum et ne s'est accompagnee d'aucune sensation subjective desagreable. Cette activation s'exprime par une synchronisation ou une resynchronisation diffuse de l'activite fondamentale de l'E.E.G., phenomene qui est particulierement precoce, important et durable chez les epileptiques dont l'amplitude des traces est doublee ou meme triplee. Chez les sujets souffrant de crises epileptiques focalisees et chez ceux porteurs d'une lesion focalisee non epileptogene, l'activation fait apparaitre des anomalies E.E.G. focales de type irritatif ou non irritatif ou augmente l'amplitude dc telles anomalies lorsqu'elles preexistaient. Pareilles modifications des traces sont interpretees par les auteurs comme la manifestation d'un phenomene de reorganisation fonctionnelle, diffuse ou localisee, de certains circuits et systemes epileptogenes du cerveau; elles sont considerees comme pathognomoniques de l'epilepsie et representeraient un equivalent electroencepha-lographique de la predisposition convulsivante du cerveau.

SummaryThe efficiency of utilization of the energy of food by weaned pigs of the Large White breed was measured. Three diets based on maize (40–60%) had a metabolizable energy of 75·8±1·2% of the gross energy, and 78·2 ±3·4% of the metabolizable energy was present as net energy.The maintenance requirement of metabolizable energy of pigs weighing 14·3 ± 2·1 kg was 143·6 kcal/kg°0·75/24 h (601 kJ/kg0·75/24 h).The energy cost per g protein and fat synthesized by piglets was estimated to be 7·43 and 12·05 kcal (31·1 and 50·4 kJ) metabolizable energy, respectively.Equations for calculation of metabolizable energy (Yl, kcal) and of the net energy (Y2, kcal), based on digested nutrients, were:Y1 = 4·64×1 + 9·12×2 + 4·25×3'CV = ± 1·2%,Y2 = 3·84×1 + 7·09×2 + 3·28×3'CV = ± 1·4%,where X1 = g protein digested, X2 = g fat digested, X3= g carbohydrate digested (crude fibre × N-free extracts).