Long-Term Follow-up of the Italian Flexible Sigmoidoscopy Screening Trial

BACKGROUND

Recent reports showed that the protective effect of flexible sigmoidoscopy (FS) screening was maintained up to17 years, although differences were reported by sex.

OBJECTIVE

To assess long-term reduction of colorectal cancer (CRC) incidence and mortality after a single FS screening.

DESIGN

Parallel randomized controlled trial. (ISRCTN registry number: 27814061).

SETTING

6 centers in Italy.

PARTICIPANTS

Persons aged 55 to 64 years expressing interest in having FS screening if invited, recruited from 1995 to 1999 and followed until 2012 (incidence) and 2014 to 2016 (mortality).

INTERVENTION

Eligible persons were randomly assigned (1:1 ratio) to either the once-only FS screening group or control (usual care) group.

MEASUREMENTS

Incidence and mortality rate ratios (RRs) and rate differences.

RESULTS

A total of 34 272 persons (17 136 in each group) were included in the analysis; 9911 participants had screening in the intervention group. Median follow-up was 15.4 years for incidence and 18.8 years for mortality. Incidence of CRC was reduced by 19% (RR, 0.81 [95% CI, 0.71 to 0.93]) in the intention-to-treat (ITT) analysis, comparing the intervention with the control group, and by 33% (RR, 0.67 [CI, 0.56 to 0.81]) in the per protocol (PP) analysis, comparing participants screened in the intervention group with the control persons. Colorectal cancer mortality was reduced by 22% (RR, 0.78 [CI, 0.61 to 0.98]) in the ITT analysis and by 39% (RR, 0.61 [CI, 0.44 to 0.84]) in the PP analysis. Incidence of CRC was statistically significantly reduced among both men and women. Colorectal cancer mortality was statistically significantly reduced among men (ITT RR, 0.73 [CI, 0.54 to 0.97]) but not among women (ITT RR, 0.90 [CI, 0.59 to 1.37]).

LIMITATION

Self-selection of volunteers from the general population sample targeted for recruitment may limit generalizability.

CONCLUSION

The strong protective effect of a single FS screening for CRC incidence and mortality was maintained up to 15 and 19 years, respectively.

PRIMARY FUNDING SOURCE

Italian Association for Cancer Research, Italian National Research Council, Istituto Oncologico Romagnolo, Fondo "E. Tempia," University of Milan, and Local Health Unit ASL-Torino.

Feed-out rate used as a tool to manage the aerobic deterioration of corn silages in tropical and temperate climates

There is an increasing recognition throughout the world that many of the feeding problems of dairy herds are linked to the presence of aerobically deteriorated parts on a silo face, causing farmers to pose questions on what amount of silage should be removed daily to feed their animals. Since an adequate feed-out rate helps to prevent silage spoilage, a simple tool is needed to manage the aerobic deterioration of corn silages during feed-out. The aims of this study were to develop an unloading rate index, which we have called the mass feed-out rate (MFR), expressed in kilograms of fresh matter silage unloaded daily per square meter of silo face, to better predict the aerobic deterioration of silage and to offer management solutions to help prevent spoilage, through a survey on 97 commercial dairy farms in Italy and Brazil. Silages were sampled and analyzed for their main microbial, fermentative, and nutritional characteristics, whereas silage temperatures were measured in the core and peripheral areas of the silo working face. Moreover, a detailed questionnaire on silo management and silage utilization was administered to the farmers during each farm visit. The size and silage density of the silos presented a wide variability in the 2 countries, thus indicating that different management practices were adopted during corn harvesting, silo filling, and silage compaction. The differences between pH and temperature in the peripheral areas and in the core of the silage (dpH and dT, respectively) were tested as a single indicator to identify any aerobic deteriorated areas on the silo face, associated with the yeast and mold counts. Both indicators correctly identified aerobic deterioration in 86.6% and 93.8% of the studied silos, respectively. The lactic acid and ethanol increased as the MFR increased, whereas the starch, dT, and the yeast and mold counts decreased with increasing MFR. A daily removal rate of over 250 kg of silage/m² markedly reduced the risk of spoilage in corn silages at a farm level in both temperate and tropical environments. The new MFR index can substitute for the commonly used linear feed-out rate as it includes the silage density and can be obtained from 1 single recording.

Dairy farm management practices and the risk of contamination of tank milk from Clostridium spp. and Paenibacillus spp. spores in silage, total mixed ration, dairy cow feces, and raw milk

The occurrence of Paenibacillus and Clostridium spores in silage is of great concern for dairy producers because their spores can contaminate milk and damage processed milk and semi-hard cheeses. Spoiled silage is considered to be the main contamination source of the total mixed ration (TMR), feces of dairy cows, and consequently bulk tank milk via the contamination of cow teats by dirt during milking. The presence of an anaerobic and facultative anaerobic sporeformer population in different matrices (soil, corn silage, other feeds, TMR, feces, and milk) and its transmission pathway has been studied on 49 dairy farms by coupling plate count data with 16S-DNA identification. The different matrices have shown a high variability in the anaerobic and facultative anaerobic spore count, with the highest values being found in the aerobically deteriorated areas of corn silages. Clostridium tyrobutyricum, Paenibacillus macerans, and Paenibacillus thermophilus were detected in all the matrices. The TMR spore count was influenced by the amount of spoiled corn silage in the TMR and by the care taken when cleaning the spoiled silage before feed-out. Most of the farms that prevent the presence of visible moldy silage in the silo and carefully clean to remove molded spots were able to maintain their TMR spore counts below 4.0 log spores/g. When a level of 4.5 log spores/g of TMR was exceeded, the feces presented a greater contamination than 3.0 log spores/g. Moreover, the higher the number of spores in the feces was, the higher the number of spores in the milk. Most of the farms that presented a feces contamination greater than 5.0 log spores/g had a higher milk spore contamination than 1,000 spores/L. Careful animal cleaning and good milking practices have been found to be essential to maintain low levels of contamination in bulk tank milk, but it has emerged that only by coupling these practices with a correct silage management and cleaning during TMR preparation can the contamination of milk by spores be kept at a low level. It has been found that aerobically deteriorated silage has a great capacity to contaminate TMR and consequently to increase the risk of milk spore contamination, even when routine milking practices are adopted correctly.

Prescriptive appropriateness using inhalant and food allergen panels: a comparison between General Practitioners' and Allergists' prescription in Genoa (Italy)

Background. Prescriptive appropriateness is an actual claim in healthcare, and it also concerns in vitro tests used in the allergy work-up, such as the serum allergen-specific IgE (sIgE) assay. In the Liguria Region, two panels were defined (for inhaled and food allergens) including 12 allergens. Their composition changed over time. Objectives. The aims of the present retrospective study were: i) to evaluate the percentage of positive tests, and ii) to compare the findings of sIgE assay on the basis of the general practictioners' (GPs) or specialist' prescription, considering both the old panels and the new panels. Methods. This retrospective study considered a population of adult patients, which consisted of 2368 subjects (68% females; mean age 50 years; age range: 10-103 years). Serum sIgE were measured by ImmunoCap system. Results. The percentages of positive tests were very low for food allergens and low for inhaled ones (ranging between 5% to 35%). There was change of prevalent prescriptor with new panels. Conclusions. This study underlines the relevance of prescriptive appropriateness in the allergy work-up. The sIgE assay should be limited to those allergens that have a clinical relevance, based on clinical history.

Serum allergen-specific IgE, allergic rhinitis severity, and age

BACKGROUND

Allergic rhinitis (AR) is characterized by an IgE-mediated reaction. Aging usually induces a progressive decline of immune system function. There is common belief that both allergic symptoms severity and serum IgE production decline during aging.

OBJECTIVE

This study aimed to evaluate the possible impact of age on: i) serum allergen-specific IgE levels in a large sample of subjects, and ii) AR symptom severity in a group of mono-allergic patients.

METHODS

Serum allergen-specific IgE to birch, Bet v 1, Parietaria, and Dermatophagoides pteronyssinus were measured by immunofluorometric assay (IFMA) in a sample of 8098 subjects. AR symptom severity was assessed by visual analogue scale (VAS) in a sub-group of 531 mono-allergic patients.

RESULTS

The analysis of variance showed that IgE to Bet v 1, birch, and Dermatophagoides pteronyssinus significantly decreased considering the age, whereas IgE to Parietaria did not significantly decline in respect of the age. Considering the global sample of mono-allergic patients, elderly subjects (over 65 years old) tended to have lower IgE levels, but had significantly lower VAS rating, and significantly less sensitizations than adult subjects (18-65 years old). In both adult and elderly patients VAS strongly correlated with IgE values.

CONCLUSIONS

Allergen-specific IgE levels tend to reduce with aging, but with differences between types of allergy. The IgE decrease is usually associated with reduced AR symptom severity. Elderly AR patients seem to have a different phenotype/endotype in comparison with adult AR ones, characterized by milder symptoms, lower IgE production, and less sensitizations. However, a close positive relationship between IgE values and VAS scores is shared by both adult and elderly AR patients, confirming the close link between allergy and symptoms that persists also in the elderly.

Hypertonic saline monotherapy in children with perennial allergic rhinitis: a pilot study

Perennial allergic rhinitis (PAR) is very common in children and has a relevant impact on their families. House dust mites (HDM) are the most relevant cause of PAR. The present pilot study aimed to evaluate whether hypertonic saline (3%) nasal spray as monotherapy is able to improve: nasal symptom severity and parental perception of rhinitis control, sleep, and school performance in HDM-mono-sensitized children with PAR. Globally, 25 children (13 males and 12 females; mean age 9.5±3.1 years) were treated for 3 weeks. They were visited at baseline, at the end of treatment, and after a 2-week follow-up. Hypertonic saline significantly reduced total symptom score, and improved the perception, according to their parents, of rhinitis control, sleep, and school performance. In conclusion, the present pilot study provided the first evidence that 3% hypertonic saline monotherapy was able to relieve nasal symptoms and parental perception of PAR impact as well as being safe and well tolerated.

Update of recommendations for Analgosedation in pediatric intensive care unit

Effective and adequate therapy to control pain and stress are essential in managing children in Pediatric Intensive Care Unit (PICU) undergoing painful invasive procedures, this should be, but is not yet, one of our main aims. Aware that this difficult mission must be pursued in a systematic, multimodal and multitasking way, the Studying Group on Analgosedation in PICU from the Italian Society of Neonatal and Paediatric Anesthesia and Intensive Care (SARNePI) is providing its recommendations.

Ultrasound-assisted dyeing of cellulose acetate

The possibility of reducing the use of auxiliaries in conventional cellulose acetate dyeing with Disperse Red 50 using ultrasound technique was studied as an alternative to the standard procedure. Dyeing of cellulose acetate yarn was carried out by using either mechanical agitation alone, with and without auxiliaries, or coupling mechanical and ultrasound agitation in the bath where the temperature range was maintained between 60 and 80 °C. The best results of dyeing kinetics were obtained with ultrasound coupled with mechanical agitation without auxiliaries (90% of bath exhaustion value at 80 °C). Hence the corresponding half dyeing times, absorption rate constants according to Cegarra-Puente modified equation and ultrasound efficiency were calculated confirming the synergic effect of sonication on the dyeing kinetics. Moreover the apparent activation energies were also evaluated and the positive effect of ultrasound added to mechanical agitation was evidenced by the lower value (48 kJ/mol) in comparison with 112 and 169 kJ/mol for mechanical stirring alone with auxiliaries and without, respectively. Finally, the fastness tests gave good values for samples dyed with ultrasound technique even without auxiliaries. Moreover color measurements on dyed yarns showed that the color yield obtained by ultrasound-assisted dyeing at 80 °C of cellulose acetate without using additional chemicals into the dye bath reached the same value yielded by mechanical agitation, but with remarkably shorter time.

Adsorption of chromate and cupric ions onto chitosan-coated cotton gauze

A chitosan-coated cotton gauze was prepared by UV-curing and tested as adsorbent to remove copper (II) and chromium (VI) ions from water solutions. The adsorbent characterization was carried out by Scanning Electron Microscopy (SEM), Energy Dispersive X-ray Spectroscopy (EDX) and Fourier Transform Infrared Spectroscopy in Attenuated Total Reflection (FTIR-ATR). Adsorption of copper and chromium ions onto the gauze was tested in batch process at different experimental conditions. The effects of pH, temperature, contact time and metal ion concentration were investigated. The optimum adsorption took place at pH 3 for Cr(VI) and pH 5 for Cu(II) ions respectively, while the temperature did not affect the adsorption process. Pseudo-first and pseudo-second order models were used to investigate the adsorption kinetics which was found very fast and better described by the pseudo-second order model for both metal ions. The adsorption of Cr(VI) ions was satisfactory described by the Langmuir isotherm, while that of Cu(II) ions showed a better agreement with the Freundlich model.

The error in neonatal intensive care: a multicenter prospective study

AIM

During a nursing conference of the Northeaster Piedmont Neonatal Intensive and Subintensive Neonatal Units the error in pediatrics and neonatology was discussed and a follow-up work was proposed with the aim to understand how many, what type of errors and what kind of adverse event they cause in our clinical practice.

METHODS

Through an anonymous "detection sheet" we detected the errors made between March 1 and April 30, 2010 in a NICU and 2 Subintensive therapies. The total number of patients was 166 for 2398 days of hospitalization.

RESULTS

The total number of errors was 72, with a error of 0.43/patient. Forty-six patients had experienced at least 1 error (28% of patients) and more than a 16 (10% of our patients). There is a statistically significant correlation between days of hospitalization and the number of errors occurred (r=0.63 Sperman's correlation, P<0.01); 48% and 53% of the errors in the NICU and Subintensive CU were related to medication administration.

CONCLUSION

The severe damage in the NICU was caused by errors more frequently related to vascular access while the only mistake that led to a serious incident in subintensive CU was determined by a monitoring error. Errors were most frequently attributed to inattention-distraction, less frequently have been attributed to a lack of experience or a state of excessive fatigue. The data of our study were made available to all staff in order to make operators more aware of the importance of working safely.

[An unusual case of "complicated" adrenal hemorrhage]

This case report concerns a newborn with bilateral adrenal massive hemorrhage complicated by inferior cava vein thrombosis, hypertension and encephalopathy to elaborate diagnostic and therapeutic problem of neonatal thromboembolic events. Increasing of risk population (extreme prematurity), improvement of imaging, laboratory and neonatologist care enhanced in recent years the diagnosis of this group of diseases. Even if literature about this subject is poor, we remark the significant effort of neonatologist to revise and update neonatal guidelines and the relevance of the institution of the National Registry of Neonatal Thrombosis (RITI).

Multifunctional finishing of wool fabrics by chitosan UV-grafting: an approach

The aim of this study was the surface modification of wool fibers to confer a multifunctional finishing to the fabrics, improving the textile value and its applications without damage of comfort properties. The attention was focused on an economical and environmental friendly process to obtain an effective treatment with good durability to washing. Chitosan in acetic acid solution was applied by padding, and grafted by ultraviolet radiation, through radical reactions promoted by a photoinitiator. 2% chitosan grafted was enough to confer satisfactory antimicrobial activity (67% reduction of Escherichia coli) after an oxidative wool pre-treatment and 1h impregnation at 50 °C. Moreover treated wool fabrics showed a strong dyeability increase toward acid dye. However the evaluation of the treatment durability to laundering showed different behavior depending on the nature of the surfactants. Finally, anti-felting properties with respect to untreated fabrics were revealed, while no effect was shown toward anti-pilling properties.

Antimicrobial finish of textiles by chitosan UV-curing

The purpose of this research work was to develop a textile finish based on the radical UV-curing of chitosan on textiles to confer antimicrobial properties. Chitosan is a biopolymer with unique properties such as biodegradability, non-toxicity, antimicrobial activity. In this work cotton or silk fabrics and synthetic filter fabrics were impregnated with an acid solution of chitosan added of the photoinitiator in the proper amount and cured at room temperature by exposure to UV lamp. Process conditions such as percentage add-on, dilution, chitosan-fabric contact time, irradiation time and power, were optimized. The antimicrobial activity of finished fabrics was tested according to ASTM E 2149-01 standard test performed with Escherichia Coli ATCC 8739. Moreover dyeing test with Turquoise Telon dye were carried out to evaluate the treatment homogeneity while the amino group content was determined by ninhydrin assay. Moreover on cotton and silk fabrics the treatment fastness to domestic laundering was tested, according to UNI EN ISO105-C01. Obtained results showed a strong antimicrobial activity conferred by the treatment, homogeneous on fabric surface. It is evident already at low add-on, without affecting the hand properties of natural fabrics and the filtration characteristics of the synthetic filter fabrics. Finally, washing fastness was better for samples prepared with a better penetration of chitosan inside the fibers.

Ultrasound for low temperature dyeing of wool with acid dye

The possibility of reducing the temperature of conventional wool dyeing with an acid levelling dye using ultrasound was studied in order to reach exhaustion values comparable to those obtained with the standard procedure at 98 °C, obtaining dyed samples of good quality. The aim was to develop a laboratory method that could be transferred at industrial level, reducing both the energy consumption and fiber damage caused by the prolonged exposure to high temperature without the use of polluting auxiliary agents. Dyeings of wool fabrics were carried out in the temperature range between 60 °C and 80 °C using either mechanical or ultrasound agitation of the bath and coupling the two methods to compare the results. For each dyeing, the exhaustion curves of the dye bath were determined and the better results of dyeing kinetics were obtained with ultrasound coupled with mechanical stirring. Hence the corresponding half dyeing times, absorption rate constants according to Cegarra-Puente modified equation and ultrasonic efficiency were calculated in comparison with mechanical stirring alone. In the presence of ultrasound the absorption rate constants increased by at least 50%, at each temperature, confirming the synergic effect of sonication on the dyeing kinetics. Moreover the apparent activation energies were also evaluated and the positive effect of ultrasound was ascribed to the pre-exponential factor of the Arrhenius equation. It was also shown that the effect of ultrasound at 60 °C was just on the dye bath, practically unaffecting the wool fiber surface, as confirmed by the results of SEM analysis. Finally, fastness tests to rubbing and domestic laundering yielded good values for samples dyed in ultrasound assisted process even at the lower temperature. These results suggest the possibility, thanks to the use of ultrasound, to obtain a well equalized dyeing on wool working yet at 60°C, a temperature process strongly lower than 98°C, currently used in industry, which damages the mechanical properties of the fibers.

Acceptability and side-effects of colonoscopy and sigmoidoscopy in a screening setting

OBJECTIVE

Quantitative information on adverse reactions associated with colorectal cancer (CRC) screening tests is useful to estimate the balance between benefit and risk in different strategies.

SETTING

Six Italian screening centres.

METHODS

Thirty-day active follow-up (interview about side-effects and acceptability of the screening procedure and review of hospital admissions) among average-risk people undergoing flexible sigmoidoscopy (FS), total colonoscopy (TC), fecal immunochemical test (FIT) in a multicentre randomized trial of CRC screening. Multivariable logistic models were used to assess determinants of completion rate and self-reported pain.

RESULTS

The attendance rate following the first invitation and mail reminder was 28.2% (1696/6018) in the FS and 23.0% (1382/6021) in the TC arm. Response rate to the 30-day follow-up questionnaire was 88.6% (1502/1696) among people undergoing FS, and 86.7% (1198/1382) among those undergoing TC. The proportion of people complaining of serious reactions following bowel preparation (odds ratio [OR], 5.17; 95% confidence interval [CI] 3.70-7.24) or reporting severe pain immediately after the exam (OR, 1.86; 95% CI 1.47-2.34) was higher for TC than for FS. The most common post-procedural complaints were abdominal distension and pain. People mentioning pain or bowel distension following preparation were more likely to report severe pain both after FS (OR, 2.13; 95% CI 1.52-2.97) and TC (OR: 2.03; 95% CI 1.41-2.90). The 30-day hospitalization rate was similar after FS, TC and FIT.

CONCLUSIONS

Screenees reported higher pain levels after TC than FS. The proportion of people complaining of severe side effects after discharge was similar. Bowel preparation was poorly tolerated by people undergoing TC. Subjects' reactions to the bowel preparation was predictive of post-procedural discomfort. A commitment of at least 48 hours was required of people undergoing TC, compared with 3-4 for FS.

Ultraviolet curing for surface modification of textile fabrics

In this study, cotton, polyester and polyamide fabrics were treated by radical or cationic ultraviolet curing of different commercial products conferring water and oil repellency. Moreover, radical ultraviolet curing of chitosan was applied to confer antimicrobial properties. The advantages of this technology are well known making it very interesting for industrial applications: energy savings, low environmental impact, simple, cheap and small equipment, high treatment speed. The polymerization was controlled through weight gain and gel content measurements, while the properties of hydro and oil repellency were determined in terms of contact angle, moisture adsorption and water vapor permeability. The polymer distribution on fabric surfaces was investigated by scanning electron microscopy and atomic force microscopy. However the fabrics treated with chitosan were subjected to the standard test for determining the antimicrobial activity. Finally the finished cotton samples were subjected to washing fastness tests.

Once-only sigmoidoscopy in colorectal cancer screening: follow-up findings of the Italian Randomized Controlled Trial--SCORE

BACKGROUND

A single flexible sigmoidoscopy at around the age of 60 years has been proposed as an effective strategy for colorectal cancer (CRC) screening.

METHODS

We conducted a randomized controlled trial to evaluate the effect of flexible sigmoidoscopy screening on CRC incidence and mortality. A questionnaire to assess the eligibility and interest in screening was mailed to 236,568 men and women, aged 55-64 years, who were randomly selected from six trial centers in Italy. Of the 56,532 respondents, interested and eligible subjects were randomly assigned to the intervention group (invitation for flexible sigmoidoscopy; n = 17,148) or the control group (no further contact; n = 17,144), between June 14, 1995, and May 10, 1999. Flexible sigmoidoscopy was performed on 9911 subjects. Intention-to-treat and per-protocol analyses were performed to compare the CRC incidence and mortality rates in the intervention and control groups. Per-protocol analysis was adjusted for noncompliance.

RESULTS

A total of 34,272 subjects (17,136 in each group) were included in the follow-up analysis. The median follow-up period was 10.5 years for incidence and 11.4 years for mortality; 251 subjects were diagnosed with CRC in the intervention group and 306 in the control group. Overall incidence rates in the intervention and control groups were 144.11 and 176.43, respectively, per 100,000 person-years. CRC-related death was noted in 65 subjects in the intervention group and 83 subjects in the control group. Mortality rates in the intervention and control groups were 34.66 and 44.45, respectively, per 100,000 person-years. In the intention-to-treat analysis, the rate of CRC incidence was statistically significantly reduced in the intervention group by 18% (rate ratio [RR] = 0.82, 95% confidence interval [CI] = 0.69 to 0.96), and the mortality rate was non-statistically significantly reduced by 22% (RR = 0.78; 95% CI = 0.56 to 1.08) compared with the control group. In the per-protocol analysis, both CRC incidence and mortality rates were statistically significantly reduced among the screened subjects; CRC incidence was reduced by 31% (RR = 0.69; 95% CI = 0.56 to 0.86) and mortality was reduced by 38% (RR = 0.62; 95% CI = 0.40 to 0.96) compared with the control group.

CONCLUSION

A single flexible sigmoidoscopy screening between ages 55 and 64 years was associated with a substantial reduction of CRC incidence and mortality.

Radiographic findings among children hospitalized with severe community-acquired pneumonia

BACKGROUND

Community-acquired pneumonia (CAP) is a leading cause of childhood death. There are few published reports of radiographic findings among children with severe CAP.

OBJECTIVE

To describe chest X-ray (CXR) findings and assess association between these radiographic findings and pneumococcal isolation in children with severe CAP.

METHODS

A prospective, multicenter, observational study was conducted in 12 centers in Argentina, Brazil, and the Dominican Republic. Children aged 3-59 months, hospitalized with severe pneumonia, were included. On admission, blood and pleural effusion cultures were performed. Streptococcus pneumoniae was identified according to standard procedures in the respective national reference laboratory. Chest X-rays were taken on admission and read before the culture results were reported.

RESULTS

Out of 2,536 enrolled patients, 283 (11.2%) had S. pneumoniae isolated, in 181 cases (7.1%) from blood. The follow radiographic patterns were observed: alveolar infiltrate (75.2%), pleural effusion (15.6%), and interstitial infiltrate (9.2%). Overall, pleural effusion was associated with pneumococcal isolation and pneumococcal bacteremia (P < 0.001). Infiltrates were unilateral (78.7%) or bilateral (21.3%), right-sided (76%) or left-sided (24%), in the lower lobe (53.6%) or the upper lobe (46.4%). Multivariate analysis including patients with affection of only one lobe showed that upper lobe affection and pleural effusion were associated with pneumococcal isolation (OR 1.8, 95% CI, 1.3-2.7; OR 11.0, 95% CI, 4.6-26.8, respectively) and with pneumococcal bacteremia (OR 1.7, 95% CI, 1.2-2.6; OR 3.1, 95% CI, 1.2-8.0, respectively).

CONCLUSIONS

Three-quarters of the patients studied had alveolar infiltrates. Upper lobe compromising and pleural effusion were associated with pneumococcal invasive disease.

Adsorption of Methylene Blue on magnesium silicate: kinetics, equilibria and comparison with other adsorbents

Batch adsorption from aqueous solutions in a slightly basic medium of Methylene Blue, up to 2500 mg/L, onto synthetic magnesium silicate (Florisil) of three particle size ranges (mean diameters of 112, 200 and 425 microm) was compared to the corresponding adsorption onto activated carbon and Amberlite XAD-2. The best fit of the kinetic results was achieved by a pseudo second-order equation. The equilibrium data were found to be well represented by the Langmuir isotherm equation. Amberlite XAD-2, an unspecific adsorbent capable of adsorbing exclusively through a surface effect, exhibited a poor dye uptake, confirming that the adsorption mechanism on Florisil was due to electrostatic attraction and ion exchange. Moreover, the comparison between Florisil and the other adsorbents was performed on the basis of the evaluation of the surface area and pore volume occupied by the adsorbed dye.

[Current topics in pharmacokinetics and pharmacogenetics of antidepressant drugs]

For antidepressants as well as for other drugs, personalized prescription has become a major challenge, provided the large interindividual variability encountered both at the pharmacokinetic and the efficacy and tolerance levels. Better identification of the numerous relevant factors and quantification of their effects are prerequisites to progress in that direction. On the basis of recent literature, genetic factors are first reviewed, including polymorphisms of genes coding for drug-metabolizing enzymes, transporters and pharmacodynamic target molecules. Current recommendations with respect to therapeutic drug monitoring of antidepressants and use of pharmacogenetic testing are then summarized.

Familial Risk Factors for the Course of Bipolar Disorder

Aims:

The major aims of the present paper were to:1.

Methods:

A family study including 125 bipolar-I patients and all available first-degree relatives has been conducted at two Swiss sites. All participants were evaluated using the Diagnostic Interview for Genetic Studies. Assessed course variables included the age of onset, the number of episodes and social functioning in terms of GAF scores. Among the 237 interviewed relatives of bipolar probands, 32 also exhibited bipolar disorder.

Results:

The occurrence of bipolar disorders in relatives was not associated with course variables in bipolar probands, whereas the occurrence of unipolar depression in relatives was associated with a more favorable course in probands in terms of higher lifetime GAF scores. Regarding the expression of symptoms during episodes, associations between disorders in probands and relatives were observed for dysphoric and psychotic rather than for typical manic symptom patterns.

Conclusion:

Our data did not provide support for a significant association between the course of bipolar disorder and the presence or the course characteristics of bipolar disorders in relatives. Surprisingly, the presence of unipolar depression in relatives was even associated with a better course of the bipolar disorder in probands. Nevertheless, bipolar disorder revealed some degree of similarity across family members, particularly regarding the expression of dysphoric and psychotic symptom patterns.

Prevalence of pathological gambling in Switzerland after the opening of casinos and the introduction of new preventive legislation

OBJECTIVE

This survey aimed to evaluate the prevalence of pathological gambling (PG) in the Swiss population in 2005 and the link between PG and alcohol abuse. This replication study made it possible to compare the prevalence rates of PG measured before and after the introduction of casinos and new preventive legislation.

METHOD

A total of 2803 telephone interviews were completed using standardized assessment instruments for identifying gamblers (South Oaks Gambling Screen) and alcohol abuse (CAGE).

RESULTS

The past-year prevalence rates were 0.8% for problem and 0.5% for PG. No relationship was found between alcohol abuse and gambling behaviour. The past-year prevalence of disordered gambling did not change between 1998 and 2005.

CONCLUSION

Despite widespread openings of casinos in Switzerland since 2002, the prevalence estimates of past-year disordered gambling have remained stable. The discussion focuses on different factors (social measures, legal obligations and social adaptational capacities) that may account for the stabilization of prevalence estimates.

Inter-informant agreement and prevalence estimates for substance use disorders: direct interview versus family history method

OBJECTIVES

Family studies typically use multiple sources of information on each individual including direct interviews and family history information. The aims of the present study were to: (1) assess agreement for diagnoses of specific substance use disorders between direct interviews and the family history method; (2) compare prevalence estimates according to the two methods; (3) test strategies to approximate prevalence estimates according to family history reports to those based on direct interviews; (4) determine covariates of inter-informant agreement; and (5) identify covariates that affect the likelihood of reporting disorders by informants.

METHODS

Analyses were based on family study data which included 1621 distinct informant (first-degree relatives and spouses) - index subject pairs.

RESULTS

Our main findings were: (1) inter-informant agreement was fair to good for all substance disorders, except for alcohol abuse; (2) the family history method underestimated the prevalence of drug but not alcohol use disorders; (3) lowering diagnostic thresholds for drug disorders and combining multiple family histories increased the accuracy of prevalence estimates for these disorders according to the family history method; (4) female sex of index subjects was associated with higher agreement for nearly all disorders; and (5) informants who themselves had a history of the same substance use disorder were more likely to report this disorder in their relatives, which entails the risk of overestimation of the size of familial aggregation.

CONCLUSION

Our findings have important implications for the best-estimate procedure applied in family studies.

Study on the structure and properties of wool keratin regenerated from formic acid

Structural characteristics of keratin regenerated from water (KW) and from formic (KF) acid solutions were compared. Amino acid composition and molecular weight distribution of KW and KF samples were studied by high performance liquid chromatography (HPLC) and SDS-PAGE electrophoresis. Turbidity measurement showed that keratin dissolved in formic acid forms transparent and stable solutions and no flocculation occurs. In addition, because of its good solvation properties, studied by viscosity measurements, formic acid can be used as a co-solvent to prepare keratin-based blend solutions. Structural studies carried out by X-ray diffraction (XRD), Fourier transform infrared (FT-IR) and near infrared (NIR) suggest that formic acid stabilizes the beta-sheet structure. Thermogravimetric analysis (TGA) reveals a higher thermal stability of keratin regenerated from formic acid with respect to keratin regenerated from water.

Comparing attendance and detection rate of colonoscopy with sigmoidoscopy and FIT for colorectal cancer screening

BACKGROUND & AIMS

We conducted a study to estimate population coverage and detection rate (DR) achievable through different strategies of colorectal cancer (CRC) screening.

METHODS

A population-based multicenter randomized trial comparing 3 strategies was used: (1) biennial immunologic fecal occult blood test (FIT), (2) "once only" sigmoidoscopy (FS), and (3) "once only" colonoscopy (TC). A random sample of men and women, aged 55 to 64 years, was drawn from general practitioners' (GP) rosters. Eligible subjects, randomized within GP, were mailed a personal invitation. Nonresponders in groups 2 and 3 were invited again at 12 and 24 months. Screenees with "high-risk" distal polyps (villous component >20%, high-grade dysplasia, CRC, size >or=10 mm, >2 adenomas) at FS, or with positive FIT, were referred for TC.

RESULTS

The attendance rate was 32.3% (1965/6075) for FIT, 32.3% (1944/6018) for FS, 26.5% (1597/6021) for TC. FIT detected 2 patients with CRC (0.1%) and 21 with an advanced adenoma (1.1%). The corresponding figures were as follows: 12 (0.6%) and 86 (4.5%) patients, respectively, for FS; 13 (0.8%) and 100 (6.3%) patients, respectively, for TC. To detect 1 advanced neoplasm, it would be necessary to invite 264 people with FIT, 60 with FS, 53 with TC. FS would have detected 27.3% of the proximal advanced neoplasms detected at TC. Assuming the same participation rate at TC as at FS, 48 TCs would be necessary to detect 1 additional advanced neoplasm missed by FS.

CONCLUSIONS

When participants are offered 1 screening test, participation is lower in a TC than in an FS program. However, DR of advanced neoplasia is higher with TC.

Dye removal by low cost adsorbents: hazelnut shells in comparison with wood sawdust

Batch adsorption of Methylene Blue, up to 1000 mg L(-1), and Acid Blue 25, up to 500 mg L(-1), onto ground hazelnut shells was studied in comparison with sawdust of various species of wood, in order to explore the potential use of this material as low cost adsorbent for dye removal in dyehouse effluents. The adsorption kinetics was investigated according to Lagergren's model, but the best fit was achieved by a second order equation. The equilibrium data were processed according to Langmuir's model and higher adsorption capacity values towards both dyes were shown by hazelnut shells than wood sawdust. Moreover, fixed bed adsorption of Methylene Blue was performed on hazelnut shell columns and the breakthrough curves were determined by varying bed depth, flow rate and influent concentration. The data were processed according to Bohart-Adams model and the column performances could be predicted by the bed depth service time (BDST) approach.

Risk factors in newborns with severe acidosis at birth

AIM

The identification of pre and postnatal risk factors as responsible of hypoxic-ischemic brain injury damage results very important in predicting the neurological outcome of newborns. The aim of this study was to investigate a possible correlation between pre and postnatal risk factors and severe acidosis at birth.

METHODS

We collected all data of 559 newborns in our Hospital with risk factors. Risk factors have been subdivided in: maternal, placental, fetal, umbilical and obstetrical risk factors.

RESULTS

Of 559 newborns we collected umbilical cord pH and base excess (BE) in 411. Of these, 32 showed severe acidosis at birth: 29 full-term and 3 preterm. Fourteen out of 32 had almost one obstetric risk factor. Among all obstetric risk factors the application of the vacuum was statistically significant (9/59 applications of vacuum; P 0.003). No signs of brain injury were seen at cerebral echography in 29 cases of acidosis at birth. In all 3 premature neonates we found intraventricular hemorrhage, but without apparent neurological consequences at follow-up. Of 559 newborns with risk factors 21 have been intubated at birth. Only in premature deliveries a significant correlation between intubation at birth and acidosis was found.

CONCLUSION

The only factor which seems to play a significant role in developing a severe acidosis at birth is the use of vacuum in full-term deliveries. Umbilical cord pH and BE are related to intraventricular hemorrhage and need of intubation in delivery room for preterm infants. However, in both groups, no significant effect of acidemia on neurological outcome could be demonstrated.