Comparison of Two Extubation Techniques in Critically Ill Adult Subjects: The ExtubAR Randomized Clinical Trial

BACKGROUND

Two orotracheal extubation techniques are described in the literature: the traditional technique and the positive-pressure technique. Although prior studies reported better clinical outcomes with the positive-pressure extubation technique, its superiority has not been extensively studied yet. This study was to determine whether the positive-pressure orotracheal extubation technique, compared with the traditional orotracheal extubation technique, reduces the incidence of major postextubation complications (up to 60 min) in critically ill adult subjects.

METHODS

This was a multi-center randomized clinical trial. Subjects age > 18 y, requiring invasive mechanical ventilation through an endotracheal tube, who met the orotracheal extubation criteria were included and randomized to traditional extubation group (removing the endotracheal tube by applying continuous endotracheal suctioning during the entire procedure) or positive-pressure group (application of pressure support mode at 15/10 cm H₂O during cuff deflation and extubation). The primary measure was postextubation major complications, defined as the clinical evidence of at least one of the following: desaturation, upper-airway obstruction, or vomiting.

RESULTS

A total of 725 subjects was randomly assigned to the traditional extubation group (n = 358) and positive-pressure group (n = 367). Seventeen subjects were eliminated and not included in the per-protocol analysis. Of 708 subjects, 185 (26.1%) developed at least one major complication. The incidence was 27.8% (96/345) in the traditional group compared with 24.5% (89/363) in the positive-pressure group. No statistically significant differences were observed between the 2 groups (absolute risk 3% [95 CI -3 to 10]; relative risk, 0.88 [95 CI 0.69-1.13], P = .32).

CONCLUSIONS

Despite the trend toward the positive-pressure group, no statistically significant differences were observed. Our findings agree with the literature in that positive-pressure extubation is a safe procedure; therefore, both techniques may be used during extubation in critically ill adult patients.

ABCB1 c.-6-180T>G polymorphism and clinical risk factors in a multi-breed cohort of dogs with refractory idiopathic epilepsy

Epilepsy is the most common chronic neurological disorder in dogs. Approximately 20-30% of dogs do not achieve satisfactory seizure control with two or more anti-epileptic drugs at appropriate dosages. This condition, defined as refractory epilepsy, is a multifactorial condition involving both acquired and genetic factors. The P glycoprotein might play and important role in the pathophysiological mechanism and it is encoded by the ABCB1 gene. An association between a single nucleotide variation of the ABCB1 gene (c.-6-180T>G) and phenobarbital resistance has previously been reported in a Border collie population with idiopathic epilepsy. To date, the presence and relevance of this polymorphism has not been assessed in other breeds. A multicentre retrospective, case-control study was conducted to investigate associations between ABCB1 c.-6-180T>G, clinical variables, and refractoriness in a multi-breed population of dogs with refractory idiopathic epilepsy. A secondary aim was to evaluate the possible involvement of the ABCB1 c.-6-180T>G single nucleotide variation this population. Fifty-two refractory and 50 responsive dogs with idiopathic epilepsy were enrolled. Of these, 45 refractory and 50 responsive (control) dogs were genotyped. The G allele was found in several breeds, but there was no evidence of association with refractoriness (P=0.69). The uncertain role of the c.-6-180T>G variation was further suggested by an association between the T/T genotype with both refractoriness and responsiveness in different breeds. Furthermore, high seizure density (cluster seizure) was the main clinical risk factor for refractory idiopathic epilepsy (P=0.003).

Experimental Observation of Proton Bunch Modulation in a Plasma at Varying Plasma Densities

We give direct experimental evidence for the observation of the full transverse self-modulation of a long, relativistic proton bunch propagating through a dense plasma. The bunch exits the plasma with a periodic density modulation resulting from radial wakefield effects. We show that the modulation is seeded by a relativistic ionization front created using an intense laser pulse copropagating with the proton bunch. The modulation extends over the length of the proton bunch following the seed point. By varying the plasma density over one order of magnitude, we show that the modulation frequency scales with the expected dependence on the plasma density, i.e., it is equal to the plasma frequency, as expected from theory.

Experimental Observation of Plasma Wakefield Growth Driven by the Seeded Self-Modulation of a Proton Bunch

We measure the effects of transverse wakefields driven by a relativistic proton bunch in plasma with densities of 2.1×10^{14} and 7.7×10^{14}  electrons/cm^{3}. We show that these wakefields periodically defocus the proton bunch itself, consistently with the development of the seeded self-modulation process. We show that the defocusing increases both along the bunch and along the plasma by using time resolved and time-integrated measurements of the proton bunch transverse distribution. We evaluate the transverse wakefield amplitudes and show that they exceed their seed value (<15  MV/m) and reach over 300  MV/m. All these results confirm the development of the seeded self-modulation process, a necessary condition for external injection of low energy and acceleration of electrons to multi-GeV energy levels.

Acceleration of electrons in the plasma wakefield of a proton bunch

High-energy particle accelerators have been crucial in providing a deeper understanding of fundamental particles and the forces that govern their interactions. To increase the energy of the particles or to reduce the size of the accelerator, new acceleration schemes need to be developed. Plasma wakefield acceleration^1–5, in which the electrons in a plasma are excited, leading to strong electric fields (so called ‘wakefields’), is one such promising acceleration technique. Experiments have shown that an intense laser pulse^6–9 or electron bunch^10,11 traversing a plasma can drive electric fields of tens of gigavolts per metre and above—well beyond those achieved in conventional radio-frequency accelerators (about 0.1 gigavolt per metre). However, the low stored energy of laser pulses and electron bunches means that multiple acceleration stages are needed to reach very high particle energies^5,12. The use of proton bunches is compelling because they have the potential to drive wakefields and to accelerate electrons to high energy in a single acceleration stage¹³. Long, thin proton bunches can be used because they undergo a process called self-modulation^14–16, a particle–plasma interaction that splits the bunch longitudinally into a series of high-density microbunches, which then act resonantly to create large wakefields. The Advanced Wakefield (AWAKE) experiment at CERN^17–19 uses high-intensity proton bunches—in which each proton has an energy of 400 gigaelectronvolts, resulting in a total bunch energy of 19 kilojoules—to drive a wakefield in a ten-metre-long plasma. Electron bunches are then injected into this wakefield. Here we present measurements of electrons accelerated up to two gigaelectronvolts at the AWAKE experiment, in a demonstration of proton-driven plasma wakefield acceleration. Measurements were conducted under various plasma conditions and the acceleration was found to be consistent and reliable. The potential for this scheme to produce very high-energy electron bunches in a single accelerating stage²⁰ means that our results are an important step towards the development of future high-energy particle accelerators^21,22.

Electron acceleration to very high energies is achieved in a single step by injecting electrons into a ‘wake’ of charge created in a 10-metre-long plasma by speeding long proton bunches.

Intradural extramedullary granular cell tumour in a cat

A 7-year-old domestic shorthair cat was evaluated for progressive paraparesis, inability to jump, a paralysed tail and inability to void the bladder. Neurologic examination was consistent with a L4-S3 localisation. Survey radiographs of the lumbar vertebral column revealed L4-L7 vertebral body remodelling. A pre-contrast T1-weighted hyperintense, diffusely enhancing intradural lesion extending from L4 to S1 vertebral bodies was detected by MRI. Large, mesenchymal, round-to-polygonal cells arranged in nests or sheets were found on histologic examination at post mortem. These cells were characterised by abundant intracytoplasmic PAS-positive, diastase-resistant granules and positive immunoexpression of vimentin, S-100, neuron-specific enolase and desmin. This is the first report of a spinal granular cell tumour in a cat.

Prevalence and Risk Factors for Presumptive Ascending/Descending Myelomalacia in Dogs after Thoracolumbar Intervertebral Disk Herniation

Background

Ascending/descending myelomalacia (ADMM) is a severe complication of thoracolumbar intervertebral disk herniation (TL‐IVDH) in dogs.

Hypothesis/Objectives

To investigate the prevalence and risk factors for ADMM in nonambulatory dogs with surgically treated TL‐IVDH.

Animals

Six‐hundred and fifty‐two client‐owned dogs evaluated for TL‐IVDH that underwent decompressive spinal surgery.

Methods

Retrospective medical record review from February 2007 through December 2015.

Results

Thirteen dogs developed ADMM, with an overall prevalence of 2.0%. The prevalence of ADMM was 0% in dogs with neurological signs graded 1 or 2 at admission or before magnetic resonance imaging (MRI) or surgical procedures, 0.6% in dogs with neurological signs graded 3, 2.7% in dogs with neurological signs graded 4, and 14.5% in dogs with neurological signs graded 5. Age (<5.8 years), neurological status (grade 5), site of disk herniation (L5‐L6), duration of clinical signs before becoming nonambulatory (<24 hours), detection of intramedullary T2‐weighted (T2W) hyperintensity, and a T2 length ratio >4.57 were significant risk factors in the univariate analysis for development of ADMM.

Conclusions and Clinical Importance

The factors identified in this study may be useful for the prediction of ADMM. Multicenter studies with a higher number of dogs with ADMM are required to confirm these data.

Activation of P2X7 and P2Y11 purinergic receptors inhibits migration and normalizes tumor-derived endothelial cells via cAMP signaling

Purinergic signaling is involved in inflammation and cancer. Extracellular ATP accumulates in tumor interstitium, reaching hundreds micromolar concentrations, but its functional role on tumor vasculature and endothelium is unknown. Here we show that high ATP doses (>20 μM) strongly inhibit migration of endothelial cells from human breast carcinoma (BTEC), but not of normal human microvascular EC. Lower doses (1–10 mm result ineffective. The anti-migratory activity is associated with cytoskeleton remodeling and is significantly prevented by hypoxia. Pharmacological and molecular evidences suggest a major role for P2X7R and P2Y11R in ATP-mediated inhibition of TEC migration: selective activation of these purinergic receptors by BzATP mimics the anti-migratory effect of ATP, which is in turn impaired by their pharmacological or molecular silencing. Downstream pathway includes calcium-dependent Adenilyl Cyclase 10 (AC10) recruitment, cAMP release and EPAC-1 activation. Notably, high ATP enhances TEC-mediated attraction of human pericytes, leading to a decrease of endothelial permeability, a hallmark of vessel normalization. Finally, we provide the first evidence of in vivo P2X7R expression in blood vessels of murine and human breast carcinoma. In conclusion, we have identified a purinergic pathway selectively acting as an antiangiogenic and normalizing signal for human tumor-derived vascular endothelium.

Giant Cell Osteosarcoma in the Calvarium of a Cat

Feline primary osteosarcomas involving the skull are extremely rare. When they occur, orbit, mandible, and maxilla are the most common sites. Microscopically, scattered multinucleated giant cells (MGCs) are not an uncommon occurrence in osteosarcoma (OSC), but they are generally in low number. Only in a rare variant, the giant cell-rich OSC, are MGCs the prevalent cell type. Although osteoclast and osteoblast origin have been postulated in human and veterinary literature, the origin of MGCs in osteosarcomas is poorly understood. This report describes a giant cell-rich OSC in the calvarium of a 13-year-old spayed female shorthair cat. The animal exhibited a range of neurologic signs, including left circling, compulsive gait, lack of proprioception, and bilateral absence of menace reaction, with indication of left forebrain involvement. Gross lesions were characterized by a multilobate, spherical mass located in the left calvarium, compressing the left forebrain. Histologically, the tumor was characterized by scattered nests of MGCs separated by small bundles of pleomorphic, fusate to polygonal cells. Between spindle cells, osteoid was very sparse and arranged in thin strands. immunohistochemical stains for vimentin were positive, with no detectable cellular staining for cytokeratin, S-100 protein, or Class II major histocompatibility complex. Ultrastructurally, MGCs contained profiles of rough endoplasmic reticulum; no lysosomes were observed. The origin of MGCs in osteosarcoma remains obscure, and our results confirm their ambiguous identity.

Role of internal medicine in a new model of hospital: a proposal of Tuscany’s FADOI

BACKGROUND The Tuscany’s FADOI society proposes the role of internal medicine in a new model of hospital care. The cornerstones of this new model are the “care intensity” and the “department”. We propose that hospital care should be organized so that the patient and his needs represent the core of this care system, in accordance with the idea of the progressive patient care. This aim can be obtained by dividing the hospital’s areas for intensity of care and, therefore, going beyond the present model of hospital care, where the patients are treated in specialty divisions. This new model of care may find its own execution within the department. For medical area, the department of medicine undoubtedly offers a strong multidisciplinary integration and favours the organization for intensity of care. The management of a large amount of patients should be left to the internist. In fact, because of his olistic formation, this clinician seems more appropriate than the other specialists to play this role. The specialists will take care of those patients who suffer from disturbances with a strong specialistic characterization, and in other cases acting as consultants. CONCLUSIONS In Tuscany we can now view various experiences which are trying to experiment this model. Results are encouraging. Starting from these results and greatly believing in them, we offer this contribute to the internists who work in hospital, persuaded to draw from them useful matters for discussion.

Family relations and eating disorders. The effectiveness of an integrated approach in the treatment of anorexia and bulimia in teenagers: results of a case-control systemic research

This article presents the results of a broader clinical research into the effectiveness of integrated treatments in teenage eating disorders, carried out at the Complex Operative Unit of Psychotherapy (Unità Operativa Complessa or U.O.C.) of the Department of Psychiatric Sciences and Psychological Medicine in collaboration with the Department of Neuropsychiatric Science for Child Development (Dipartimento di Scienze Neuropsichiatriche dell'Età Evolutiva), both at the "La Sapienza" University of Rome. The hypothesis of this research project is that in diagnosticable situations such as anorexia or bulimia, an integrated and multidisciplinary treatment, which combines medical-nutritional interventions and family psychotherapy, allows better results than a single kind of treatment, which is the usual medical- nutritional intervention supported by psychiatric counselling. Twenty-eight cases (16 of bulimia and 12 of anorexia) were selected and then subdivided, with a randomized distribution, into two (experimental and control) homogeneous groups of 14 patients. The grouping variables were the diagnosis, the disorder's seriousness and duration, BMI, gender, age, family composition and social status. The variables which have been examined in this article are the clinical parameters, which were valuated in accordance with the DSM IV-TR criteria, and relational parameters which were explored through the use of the W.F.T. Test (Wiltwyck Family Tasks). These parameters were tested at beginning as well as at the end of the therapies, in both the experimental group and the control group. Statistical analysis has shown that the experimental group, which was followed with the integrated treatment, experienced a significant improvement of the parameters as related to dysfunctional family interaction modalities, and that this improvement was correlated to the positive evolution of the clinical parameters. This improvement was not present or not of the same degree in the control group. The results, moreover, demonstrate the effectiveness of an integrated systemic treatment based on a complex approach compared to a reductionist approach.

[Occupational medicine and communication: which role for print media?]

The diffusion of recent regulations on work safety has captured mass-media's interest on work accidents. The present work aims to highlight the role of print media in building a social representation of work safety, by performing a qualitative analysis of articles published between 2009 and 2010 in three of the main national newspapers. Results showed that print media are accurate in reporting news, but they do not serve as source of education in work safety's issues. Information is mainly focused around catastrophic events, with headlines inducing negative emotions. Very few articles contain a critical discussion of methods and operational proposals tested around the Country. A possible transformation of media's role in promoting work safety is discussed.

[Psychopathology, quality of life and social functioning in dialysis treatment and kidney transplantation patients]

OBJECTIVES

Psychiatric evaluation of organ transplant candidates is now routinely proposed also in Italy. This study purposed to assess the psychological status in patients on hemo-dialysis, peritoneal dialysis and renal transplantation; moreover other purpose is to investigate the possible differences among the three groups.

MATERIALS AND METHODS

157 subjects were consecutively enrolled, to the service of U.O. Trapianti d'Organo of San Salvatore Hospital in L'Aquila (Italy), between October 2007 and August 2009; 127 were in dialysis (80.9%), of which 101 were in hemodialysis (64.3%) (HD group) and 26 in peritoneal dialysis (16.6%) (PD group) and 30 (19.1%) Kidney transplant (PT group). The subjects were examined with clinical evaluation and through the following psychometric instruments: HAM-D, HAM-A, Jalowiec Coping Scale, STAI-Y1, STAI-Y2, DISS, SF-36.

RESULTS

30% out of our sample showed the presence of some psychopathological signs and symptoms, especially depression and anxiety. At HAM-D there were no differences between HD group (6.73; DS + 5.58) and PD group (5.27, DS + 5.63); the mean value at HAM-D in PT group was 4.4 (DS + 3.16) (p < 0.05). At HAM-A there were no differences between three groups. The HD group showed an higher value at STAI-Y1 (38.61; DS + 10.64) than PD (34.95; DS + 6.75) and PT (33.89; DS + 6.14) groups (p < 0.05). The quality of life (physical role, general health, vitality and role emotional) was lower in HD and PD groups, higher in group PT. The HD e PD groups showed a higher level of disability than PT group (p < 0.05). All subjects used "positive: coping styles.

CONCLUSIONS

We consider essential to investigate the issues observed in this study, with the need to integrate psychosocial and functional needs assessment within a course of diagnosis and treatment for people who are undergoing dialysis procedures, or after waiting for a transplantation. Dialysis affects the quality of life, leading to limitations in activities and high level of disability. The PT group showed better quality of life and less impairment in functioning in the investigated areas. If the impact of psychological and/or psychiatric aid remains difficult to appraise, these results emphasize the impact of psychological status and the appropriateness of psychosocial support intervention on patients facing the transplant process or in dialysis treatments.

What is the optimal strategy to confirm the diagnosis of epithelial ovarian carcinoma (EOC) prior to neoadjuvant chemotherapy (NAC)?

5511

Background: NAC has been increasingly utilized in clinical practice yet no standard diagnostic strategy has been defined for EOC prior to the administration of NAC. We reviewed the diagnostic process for patients receiving NAC at our centre to determine if an optimal diagnostic strategy could be determined. Methods: A retrospective chart review of all patients known to receive NAC followed by cytoreductive surgery for presumed EOC between 1994 and 2007 was performed. Diagnostic strategies were defined as histology, cytology, and clinical. Performance of these strategies in predicting final pathology, based on expert pathology review of surgery specimens, was compared using Fisher's exact test. Results: 152 patients were included. Initial diagnosis was made on the basis of: cytology (paracentesis/thoracentesis)- 89 (59%); percutaneous biopsy- 40 (26%), radiology and CA-125–18 (12%), surgical biopsy -5 (3%). The final diagnosis was consistent with invasive EOC in 145 patients (95%). The remaining 7 were ovarian LMP (4), ovarian carcinosarcoma (1), endometrial serous cancer (1), and GI tumor (1). The diagnostic accuracies of the 3 strategies differed: histology (43/45), cytology (87/89), and clinical (15/18), p = 0.039. 17% of patients had an alternate final diagnosis when clinical parameters were the only basis for the diagnosis of EOC prior to NAC. A specific EOC subtype was identified pre-op in 82 patients (histology-31 cases, cytology-51 cases). Subtype differed between pre- and post-treatment samples in 13% of histology and 8% of cytology cases. Conclusions: Diagnosis of EOC based on cytology or histology-based strategies are superior to clinical factors alone. Even in a centre with trained gynecologic cytopathologists, cytology and biopsy strategies preclude accurate subtype diagnosis in a significant number of patients. These data are important for clinical practice and the design of future clinical trials.

No significant financial relationships to disclose.

[Comparative evaluation of the Joel-Cohen cesarean section versus the transrectal incision]

OBJECTIVE

The aim of this study was to compare the Joel-Cohen method for cesarean section to the traditional transrectal incision.

METHOD

Fifty-two patients requiring a caesarean section were enrolled in this prospective study. Overall morbidity and post-operative pain was assessed. Four surgeons participated to this study, each included 13 patients. The main judgement criterion was post-operative pain on the first day.

RESULTS

Post-operative pain on the first day was less important (50 vs 23% p=0.04) in Joel-Cohen's. This method was shorter compared to the transrectal incision (33.6+6.4 min vs 51.2+8 min p<0.0001). There was no difference in overall morbidity between the two groups.

CONCLUSION

Joel-Cohen's method decrease post-operative pain and is a shorter procedure compared to the transrectal incision.

The use of cytogenetics in understanding ovarian cancer

The future of cancer research is no longer limited to epidemiological data and clinical management, but rather encompasses a new dimension of understanding, that involves genetics of the tumors themselves. This has been exemplified most prominently in hematological tumors where alterations at the DNA level have been found to play key roles in the pathophysiology, diagnosis, monitoring and prognosis of these tumors. It has been shown over the last 20 years that recurrent chromosomal rearrangements are strongly associated with the activation of oncogenes, acquisition of drug resistance and loss of tumor suppressor gene function. Chromosomal alterations have also been shown to characterize many solid tumors, including epithelial ovarian cancer [Cancer Res. 62 (2002) 3466; Cancer 91 (2001) 534; Genes Chromosomes Cancer 25 (1999) 290]. Despite these findings, however, there are currently few examples of specific cytogenetic studies that have contributed to the clinical management of solid tumors such as ovarian cancer. The limiting factor to date is the resolution of available techniques. With time, as the technology improves, so will our ability to focus on specific findings that may be applicable to future clinical management. The intention of this report is to familiarize the reader with the evolution of cytogenetic and molecular cytogenetic techniques used in the study of ovarian cancer, the early formulations from these studies and their use in answering specific clinical questions such as association with pathologic subtype, the relevance of drug resistance, the impact of BRCA mutations, and finally to guide the reader into the future of this ever growing field.

[Balance disorders in the elderly]

In the elderly patient, instability is a syndrome in which a loss of balance, during ambulation or while standing, can give rise to falls, with consequent disability and morbidity. Maintaining the correct static and dynamic balance is known to be the result of the synergetic functioning of different systems. In old age, however, the efficiency of these mechanisms is impaired because of the physiological process of aging, which affects all of the organs and systems of the human body. Besides that, different concomitant causes such as cardiovascular and dysmetabolic pathologies, chronic pharmacological therapies etc. contribute to the aging of our organism. The object of this study was to evaluate 40 subjects, 21 males and 19 females, aged between 70 and 86, who were referred to us with craniofacial trauma consequent to a fall. Upon hospitalization, all of the patients were asked to fill in a questionnaire evaluating the incidence of the vertigo symptom as a possible cause of the falls. All of the subjects underwent the following clinicoinstrumental examinations: standard audiometric evaluation, vestibular tests, neurological and ophthalmic examination. Careful appraisal of the results obtained enabled us to conclude that balance disorders in the elderly patient are due to the synergetic action of three factors: aging, concomitant diseases and environmental factors. In conclusion, we can affirm that balance disorders giving rise to a fall in the elderly are attributable to the concomitance of different factors that determine a clinical state of imbalance, defined by some Authors with the term "presbivertigo". It follows that a suitable diagnostic protocol must be employed, comprising a detailed medical, pharmacological and functional history, a study both of the environmental conditions in which the patient lives and the modalities according to which the traumatic event occurred. It is, last of all, indispensable that steps be taken to improve these environmental conditions, such as choosing flooring materials, light fixtures, stairs, bathroom furnishings and suitable footwear promoting proper foot placement and support on the ground.

Adrenarche, pubertal development, age at menarche and final height of full-term, born small for gestational age (SGA) girls

Children born small for gestational age (SGA) may present advanced bone maturation in childhood and reduced final height. The objectives of the study were to evaluate adrenarche, pubertal development, age at menarche and final height in full-term born-SGA girls. Twenty-four girls (12 born-SGA and 12 matched controls) were evaluated at 6-7.5 years of age for clinical signs of puberty and dehydroepiandrosterone sulfate (DHEAS) levels, as a marker of adrenarche. Thirty-eight girls (19 born-SGA and 19 matched controls) were evaluated at 17.5-18.5 years of age to assess final height, sexual maturation and age at menarche. SGA girls had a mean final height (160.1 cm vs 165.8 cm, p < 0.01) and mean weight (52.1 kg vs 56.5 kg, p < 0.05) significantly lower than controls. Controls had a mean final height significantly higher than their mean target height. Sexual maturation was at stage 5 of Tanner's staging in SGA girls and control subjects. SGA girls had a slightly anticipated puberty (9.9 vs 10.4 years for initial breast development) and a lower age at menarche (11.9 vs 12.3 years). At 6-7.5 years of age, SGA females and controls did not show any difference for clinical signs of puberty; however, DHEAS levels (0.75 + 0.18 microgram/ml vs 0.57 + 0.22 microgram/ml, p < 0.05) were significantly higher in SGA girls than in control subjects. We concluded that full-term born-SGA females have impaired final height and weight in adolescence but substantially normal sexual maturation and age at menarche. Increased DHEAS levels before puberty in born-SGA girls may predispose to increased bone maturation in childhood with a reduced final height. In our population a progressive increment in final stature is evident.

Effect of dietary alpha-tocopheryl acetate and ascorbic acid on rabbit semen stored at 5 degrees C

The objective of this research was to verify the effects of dietary alpha-tocopheryl acetate (50 vs. 200 mg/kg diet) and ascorbic acid (0 vs. 1 g/L water) on the relative amounts on semen and motion characteristics, oxidative stability and fertilizing ability of rabbit spermatozoa stored for 24 h at 5 degrees C. A high amount of dietary (alpha-tocopheryl acetate significantly increased the level of Vitamin E in the semen (0.90 vs. 0.41 micromol/L) and its oxidative stability after storage (Thiobarbituric Acid Reactive Substances-- TBARS 15.88 vs. 20.90 nmol Malondialdehyde--MDA/mL). Ascorbic acid showed a different effect in relation to the Vitamin E status of animals: when associated with the higher level of Vitamin E it increased the (alpha-tocopherol and the oxidative stability of semen (2.67 micromol/L and 12.25 nmol MDA/mL, respectively), whereas both parameters were reduced with lower Vitamin E (0.13 micromol/L and 21.20 nmol MDA/mL). Semen traits were not modified by the separate supplementation of supranutritional levels of vitamins, whereas their combination significantly improved the viability and the kinetics of spermatozoa (e.g. track speed: 95.13 vs. 71.31 microm sec(-1)) with an increase in fertility rate (70.0 vs. 63.3; P=0.06) that could be considered almost significant.

Symptomatic hypercalcemia in the first months of life: calcium-regulating hormones and treatment

Neonatal hypercalcemia is a rare condition often of unclear pathogenesis. If unrecognized and untreated it may result in central nervous system and renal damage. We studied three infants with symptomatic neonatal hypercalcemia pointing out pathogenetic and therapeutic aspects. One infant was found to have transient hyperparathyroidism with high intact parathyroid hormone (iPTH) levels. One infant had an incomplete form of Williams syndrome with hypercalcemia and an elfin facies. The pathogenesis is unclear in this case. A reduced secretion of calcitonin or an hypersensitivity to vitamin D might be the underlying defect. The third case was found to have subcutaneous fat necrosis and hypercalcemia associated with high 1,25(OH)2D levels and suppressed iPTH levels. These findings suggest an unregulated extrarenal 1,25(OH)2D production. These infants were treated with hydratation, furosemide, corticosteroids and low calcium diet. Symptomatic neonatal hypercalcemia should be treated promptly. However blood has to be taken before starting treatment to study calcium-regulating hormones and clarify pathogenesis.

Effect of postweaning feeding on the performance and energy balance of female rabbits at different physiological states

The feeding of a high-fiber and low-energy diet to young rabbit does from weaning to the first kindling was used to modify their body reserves, stimulate their energy intake, and reduce the energy deficit during the first lactation. Rabbits (53 per group) were given ad libitum access to either a control or high-fiber diet (CP, 17.6 vs 15.8% of DM; crude fiber, 15.5 vs 19.9% of DM; digestible energy, 2,565 vs 2,261 kcal/kg of DM, respectively) from weaning to their first kindling. During lactation, both groups received the same diet, which contained 19.3% CP, 16.5% crude fiber, and 2,634 kcal/kg digestible energy (dry matter basis). Four comparative slaughters were performed to estimate the chemical and energy balance of rabbit does at different physiological states: at the beginning of the trial (12 rabbits, 45 d of age), at mating (10 rabbits per group, 136 d), at kindling (10 rabbits per group, 167 d), and at the end of lactation (12 and 11 rabbits for the control and the high-fiber group, 197 d). Large changes in body weight and composition were observed between slaughters. From 45 d to mating, doe body fat and energy increased 7.93 and 4.64 times the initial content, respectively. During pregnancy, body protein concentration decreased from 203 to 186 g/kg. At the end of lactation, body fat and energy concentration were reduced to values close to those measured at 45 d of age. Dietary treatment affected body chemical and energy balance during pregnancy and lactation but not reproductive and lactational performance. The high-fiber diet stimulated feed intake from weaning to the first kindling but not dietary energy intake. During lactation, the rabbits fed the high-fiber diet ate 10 kcal x d(-1) x kg live weight(-.75) more and lost less body fat (-405 vs -504 g) and body energy (-3,628 vs -4,294 kcal) than the does fed the control diet (P < .001). In the same period, all does showed water and protein retention (185 and 45 g, on average) regardless of dietary treatment. In conclusion, feeding young does a high-fiber diet until their first kindling reduced the chemical and energy body deficit at the end of the first lactation.

Idiopathic epilepsy in 125 dogs: a long-term study. Clinical and electroencephalographic findings

Well-documented cases of confirmed idiopathic epilepsy in 125 dogs were evaluated retrospectively. Forty-six breeds (each with no sex predisposition) were examined. Although dogs of all ages were affected, the peak value for the onset of first seizure was between one and five years. Approximately 75 per cent of animals had generalised grand mal type seizures with loss of consciousness. Preictal and postictal phases were present in the majority of dogs. Interictal electroencephalographic recordings of 37 anaesthetised dogs were statistically analysed. High frequency and low amplitude paroxysmal discharges with either a focal or generalised distribution were found in the majority of these dogs. Possible causes for this variation from dog to dog were analysed. It was concluded that, despite anaesthesia, electroencephalographic features were consistent and unique in dogs with idiopathic epilepsy.

[The neonatal respiratory insufficiency syndrome: the role of the chest radiogram]

INTRODUCTION

Chest radiography is considered the most reliable diagnostic tool to study the respiratory distress syndrome in newborns and one of the few diagnostic investigations which can be used considering the clinical situation of these patients and the need of a prompt diagnosis.

MATERIALS AND METHODS

We examined 124 newborns (56 males and 68 females) submitted to chest radiography at least once. Two radiologists analyzed the images investigating: a) chest expansion, b) reticulonodular opacities, c) aerial bronchograms, d) parenchymal consolidation, e) atelectasis, f) pneumothorax. The clinical diagnosis was made by neonatologists on the basis of clinical and instrumental data and of the clinical evolution of the patients.

RESULTS

Twenty of 23 clinically negative patients had negative chest radiographs and 3 were false positives. Transient tachypnea was diagnosed in 14 newborns where chest radiography showed reticulonodular opacities. Ten of 62 patients with hyaline membrane disease had a negative chest radiograph, 26 had fine granular opacities, 16 marked hypoexpansion with reticulonodular opacities and aerial bronchogram, and 10 diffuse parenchymal consolidations with aerial bronchogram also in the peripheral lung. Eleven patients had a clinical and radiological diagnosis of segmental or lobar atelectasis; 5 newborns had an aspiration syndrome and radiography showed parenchymal consolidations in 4 and was negative in one. Five patients had pneumothorax, 3 diaphragmatic hernia and 1 infective pneumonia; radiology confirmed the diagnosis in all cases. We had three false positives and 11 false negatives at conventional radiography--i.e., 10 had MMI and one the meconium aspiration syndrome. Diagnostic sensitivity was 89.1%, specificity 86.9% and diagnostic accuracy 88.7%.

CONCLUSIONS

Our results are partially limited by the lack of a reference gold standard. Nevertheless, if we consider the clinical condition and the respiratory distress syndrome evolution as a valid reference, the diagnostic accuracy of radiography is good.

Final height in girls with slowly progressive untreated central precocious puberty

A group of six girls with slowly progressive idiopathic precocious puberty (IPP) and a good initial height prognosis was followed without treatment. At first observation the girls had a bone age advance over chronological age of no more than 18 months, a delta height age (delta HA): delta bone age (delta BA) ratio higher than 0.9 and height prognosis was unimpaired after 6 months. During the first two years of follow-up the girls maintained an acceptable height potential. The delta HA:delta BA ratio remained constant at greater than 0.9. Predicted height showed a slight increase or decrease (+/- 4 cm). The girls were reevaluated after the age of 14 years and followed-up until they reached their final height (FH). The mean FH (155.4 +/- 2.8 cm) was below the mean target height (159.3 +/- 4.2 cm) by 3.9 cm (range -2.1 to -6.7 cm); this difference was not statistically significant. The FH was more than 5 cm below the target height in only one case; this girl had the most precocious onset of puberty, at 6 years of age. In three cases FH was between the 3rd and 10th centiles. These three girls had a target height below 158 cm (< 25th centile). Girls with slowly progressive IPP and a good initial height prognosis preserved height potential with an acceptable final height without therapy.