Terapia pulpar em dentes decíduos: possibilidades terapêuticas baseadas em evidências

Introduction: Pulpotomy of primary teeth has been the treatment of choice in cases of inflammation of the coronal pulp caused by caries or trauma with no involvement of the radicular pulp, thus avoiding the premature loss of the teeth. Not only is the diagnosis of the inflamed dental pulp required for this therapy to succeed, but also the selection of an effective and biocompatible medicament. However, none of the drugs available and recommended for pulpotomy therapy present all the requirements of an ideal pulp capping agent. Objective: Through a systematic literature review, between the years of 2000 and 2011, focusing in randomized clinical trials, systematic reviews and meta-analysis, aiming to analyze and discuss based on alternatives for the treatment of pulpotomy in human deciduous teeth. Conclusion: Scientific evidences showed that the medicaments and techniques influence were few. Thus, further and well-designed studies are suggested for clarification. The information generated in such experiments may contribute to a better understanding of the mechanisms of pulp therapy to new therapeutic approaches aimed at improving pulp therapy in deciduous teeth.

Avaliação da qualidade de vida em crianças com implante coclear: revisão sistemática

The use of cochlear implant (CI) in children enables the development of listening and communication skills, allowing the child's progress in school and to be able to obtain, maintain and carry out an occupation. However, the progress after the CI has different results in some children, because many children are able to interact and participate in society, while others develop limited ability to communicate verbally. The need for a better understanding of CI outcomes, besides hearing and language benefits, has spurred the inclusion of quality of life measurements (QOL) to assess the impact of this technology. OBJECTIVE: Identify the key aspects of quality of life assessed in children with cochlear implant. METHOD: Through a systematic literature review, we considered publications from the period of 2000 to 2011. CONCLUSION: We concluded that QOL measurements in children include several concepts and methodologies. When referring to children using CI, results showed the challenges in broadly conceptualizing which quality of life domains are important to the child and how these areas can evolve during development, considering the wide variety of instruments and aspects evaluated.

Le società pubbliche a partecipazione regionale e locale operanti nei settori dei servizi pubblici locali e dei servizi “strumentali” e quelle con scopo lucrativo: la recente evoluzione legislativa, gli ambiti di attività ed i relativi limiti, le prospettive future.

Con la prima parte, si intende fornire un quadro pressoché esaustivo delle principali disposizioni in materia di società a partecipazione pubblica regionale e locale operanti nel campo dei servizi pubblici locali e della loro interpretazione giurisprudenziale e dottrinale, prendendo le mosse dagli ultimi interventi legislativo. Nella seconda parte, si affronta, invece, il tema dei limiti legislativi alla capacità di azione delle società a partecipazione pubblica e dei connessi dubbi interpretativi, anche alla luce degli orientamenti giurisprudenziali e dottrinali. In particolare, l’analisi riguarda l’art. 13 del decreto”Bersani” e il comma 9 dell’art. 23 bis (ora pedissequamente trasfuso nel comma 33 dell’art. 4 del d.l. n. 138/2011), ossia le principali disposizioni che definiscono, rispettivamente, la capacità di azione delle società (a partecipazione pubblica) strumentali e di quelle operanti nel campo dei servizi pubblici locali titolari di affidamenti diretti (assentiti con modalità diverse dall’evidenza pubblica). Vengono forniti cenni di inquadramento in relazione al cd. procedimento di riordino delle partecipazioni societarie pubbliche previsto dalla legge finanziaria del 2008 (art. 3, commi 27 – 32). Dal combinato disposto delle suddette norme, così come interpretate dalla giurisprudenza costituzionale ed amministrativa, si ricavano, poi, utili indicazioni in ordine alla possibilità, per gli enti pubblici territoriali, di costituire società con scopo meramente lucrativo (ossia, soggetti societari privi del rapporto di strumentalità con gli enti costituenti o partecipanti, chiamati ad operare, in regime di concorrenza, in settori completamente liberalizzati) e società cd. multiutilities (aventi oggetto sociale complesso, la cui attività si estrinseca tanto nel campo dei servizi strumentali, quanto in quello dei servizi pubblici locali), nonché in relazione alla disciplina applicabile all’attività di detti soggetti societari. La finalità ultima del contributo consiste nell'individuazione delle linee guida finalizzate alla classificazione delle società pubbliche in funzione della loro attività.

Isolierung und Identifizierung von wachstumsfördernden Substanzen für das weinrelevante Bakterium Oenococcus oeni aus Fruchtsäften und Blattextrakten

Neben Tomatensaft wurde eine Vielzahl von Säften und Blattextrakten als Medienzusätze auf Wachstumsförderung bei 30 verschiedenen Oenococcus oeni-Stämmen getestet. Es zeigte sich eine breite Wachstumsförderung bei allen Zusätzen mit Ausnahme von Zitronensaft, sodass die Wachstumsfaktoren keine tomatenspezifischen Inhaltsstoffe sein können und eher ubiquitär in der Pflanzenwelt vorkommen. Das Ausmaß der Wachstumsförderung war stammabhängig sehr unterschiedlich und Tomatensaft stellte keineswegs für alle Stämme den optimalen Medienzusatz dar. Durch Schälen der Früchte war eine für die Analytik hilfreiche Abtrennung schalenspezifischer Inhaltsstoffe möglich, wobei auch die Schalenextrakte großes Potential für die Suche nach Wachstumsfaktoren offenbarten und die Wichtigkeit einer Auftrennung der Frucht in die verschiedenen Fruchtbereiche betonte. Aus Tomatensaft konnte analytisch der anorganische Wachstumsfaktor Mangan identifiziert werden. Die größten Zelldichten der Oenokokken-Stämme wurden hierbei bei 67 µM und 34 mM Manganzusatz erreicht. Bei 13 von 20 getesteten Oenokokkenstämmen konnte bei Zusatz von 34 mM Mangan der Tomatensaft ersetzt werden, bei 4 Stämmen (z. B. Stamm B2) fehlten jedoch noch weitere Wachstumsfaktoren und bei 3 Stämmen (z. B. Stamm B120) kam es zu einem verfrühten Absterben. Da weitere Mineralstoffe sowie veraschte Säfte und Blattextrakte keinen positiven Einfluß auf die Oenokokken-Zelldichte hatten, wurde mittels semipräparativer HPLC nach zusätzlichen organischen Wachstumsfaktoren für den Stamm B2 gesucht. Hierzu wurde der nachfolgende Wachstums-Assay miniaturisiert und erfolgreich auf Microtiterplatten etabliert. Es gelang die Isolierung und Identifizierung eines wachstumsfördernden Trisaccharides aus Mangoschalen-Extrakt, das aus den Zuckern Glucose, Rhamnose und Arabinose bestand. Von den monomeren Zuckern erhöhte lediglich die Arabinose die Zelldichte, das Optimum lag bei 1,5 g/l. Auch aus Zitronenmesokarp-Extrakt war die Isolierung eines wachstumsfördernden arabinosehaltigen Disaccharides möglich, die Menge reichte jedoch noch nicht für eine genaue Identifizierung aus. Desweiteren erwies sich 1,5 g/l Cystein als wachstumsstimulierend. Ein Zusatz aller gefundenen Wachstumsfaktoren (34 mM Mangan, 1,5 g/l Arabinose und 1,5 g/l Cystein) ersetzte den Tomatensaft bei weiteren Oenokokken-Stämmen (z.B. Stamm B120) komplett, wobei bei allen Stämmen sogar eine schnellere Anzucht erfolgte. Neben dem Tomatensaft war auch der Zusatz von Hefeextrakt zum Grundmedium nicht mehr nötig, sodass ein neues vereinfachtes Medium für die Anzucht von Oenokokken mit komplexen Nährstoffansprüchen vorgeschlagen werden konnte. Lediglich beim Stamm B2 zeigte sich noch ein OD-Unterschied von 0,2 in der stationären Phase, der nach Adsorptionsversuchen an Polyvinylpolypyrrolidon auf noch unidentifizierte Polyphenole im Tomatensaft zurückzuführen ist. Aus grünem Tee erwies sich das Polyphenol Epigallocatechingallat (EGCG) konzentrationsabhängig sowohl als Hemmstoff (>550 mg/l EGCG) als auch Wachstumsfaktor (400-500 mg/l EGCG) für den Oenokokken-Stamm B2. Der hemmende als auch der fördernde Einfluss auf das Wachstum wurde mittels Sytox/DAPI-Färbung bestätigt. Der sogenannte „Tomatensaft-Faktor“ ist also nicht eine spezielle Substanz, sondern das synergistische Zusammenwirken mehrerer einfacher Substanzen wie Mineralstoffe, Aminosäuren, Kohlenhydrate und Polyphenole. Auch sind die Oenokokken-Stämme bezüglich ihres Nährstoffbedarfes sehr unterschiedlich, sodass für jeden Stamm einzeln das optimale Substratspektrum ermittelt werden muss.

Virus oncogeni a dna in tumori umani: studio delle infezioni da papillomavirus e poliomavirus in neoplasie di diversa origine.

I virus tumorali inducono oncogenesi nel loro ospite naturale o in sistemi animali sperimentali, manipolando diverse vie cellulari. Ad oggi, sono stati identificati sette virus capaci di causare specifici tumori umani. Inoltre HPV, JCV ed SV40, sono stati associati con un grande numero di tumori umani in sedi corporee non convenzionali, ma, nonostante molti anni di ricerca, nessuna eziologia virale è stata ancora confermata. Lo scopo di questo studio è stato di valutare la presenza ed il significato sia di JCV ed SV40 in tumori ossei umani, e di HPV nel carcinoma della mammella (BC), galattoforectomie (GF), secrezioni mammarie patologiche (ND) e glioblastoma multiforme (GBM). Tecniche di biologia molecolare sono state impiegate per esaminare campioni di tessuto tumorale di 70 tumori ossei (20 osteosarcomi [OS], 20 tumori a cellule giganti [TCG], 30 condrosarcomi [CS]), 168 BCs , 30 GFs, 59 GBM e 30 campioni di ND. Il genoma di SV40 e JCV è stato trovato nel 70% dei CS + 20% degli OS, e nel 13% dei CS +10% dei TCG, rispettivamente. Il DNA di HPV è stato rilevato nel 30% dei pazienti con BC, nel 27% dei campioni GF e nel 13% dei NDs. HPV16 è stato il genotipo maggiormente osservato in tutti questi campioni, seguito da HPV18 e HPV35. Inoltre, il DNA di HPV è stato trovato nel 22% dei pazienti con GBM, in questo tumore HPV6 era il tipo più frequentemente rilevato, seguito da HPV16. L’ ISH ha mostrato che il DNA di HPV è situato all’interno di cellule tumorali mammarie e di GBM. I nostri risultati suggeriscono un possibile ruolo di JCV, SV40 e HPV in questi tumori, se non come induttori come promotori del processo neoplastico, tuttavia diversi criteri devono ancora essere soddisfatti prima di chiarirne il ruolo.

Methodische Untersuchung zur Diagnostik der bronchialen Hyperreagibilität mit Hilfe eines inhalativen Methacholin-Provokationstests

Die unspezifische Provokation mit Methacholin ist die am weitesten verbreitete und akzeptierte Methode zur Diagnose bzw. zum Ausschluss der bronchialen Hyperreagibilität bei Patienten mit Verdacht auf ein Asthma bronchiale und zu dessen Therapiekontrolle. Um die Sicherheit und die Genauigkeit der Methode weiter zu verbessern, wurde daher ein Dosimeterprotokoll entwickelt, das die inhalierte Methacholin-Dosis anstatt durch die Erhöhung, d.h. in der Regel Verdoppelung, der Methacholinkonzentrationen nur durch Erhöhung der Anzahl der Inhalationen bei konstanter, niedriger Konzentration der Methacholinlösung steigert. Dieses neue Protokoll wurde verglichen mit anderen weit verbreiteten Methacholin-Provokationsprotokollen. Die Methacholinchlorid-Lösung (1,75 mg/ml) wurde mit Hilfe des Dosimetersystems ZAN 200 ProvAir II sowie des Verneblertopfes DeVilbiss 646 vernebelt. 15 Asthmapatienten mit einer vor der Provokation normalen Lungenfunktion (FEV1 98 +/- 9 % PN) und 18 Lungengesunde (FEV1 110 +/- 12 % PN) nahmen an der Testreihe teil. Begonnen wurde mit einer Dosis von 20 μg Methacholinchlorid (= eine Inhalation); beendet wurde der Versuch bei einer Kumulativdosis von 2000 μg Methacholinchlorid, wenn nicht vorher ein Kriterium für einen positiven Test und damit für einen Versuchsabbruch erfüllt wurde. Abbruchkriterien waren entweder ein Abfall der FEV1 um 20 % des Ausgangswertes oder ein Anstieg des totalen Atemwegswiderstandes auf ≥ 0,5 kPa*s/l. Mittels linearer Regression wurden die Provokationsdosen PD 20 FEV1 und PD Rtot ≥ 0,5 berechnet. Im Vergleich mit anderen Protokollen zeigte sich, dass auch das neue Protokoll zuverlässig und sicher zwischen gesund und krank unterscheidet. Der Median der PD 20 FEV1 liegt in der Gruppe der Asthmatiker bei 222 μg, bei den Lungengesunden bei 2000 μg; daraus ergibt sich ein p-Wert von < 0,001. In Bezug auf die PD Rtot ≥ 0,5 liegt der Median bei den Asthmatikern bei 122 μg, in der Gruppe der Lungengesunden bei 2000 μg; hieraus errechnet sich ebenfalls ein p-Wert von < 0,001. Sensitivität und Spezifität der Methode wurden mittels ROC-Kurven untersucht. Basierend auf der PD 20 FEV1 liefert die Methode für die Diagnose einer bronchialen Hyperreagibilität bei einer Enddosis von 1000 μg Methacholinchlorid eine Sensitivität von über 93 % und eine Spezifität von 83 %; basierend auf der PD Rtot ≥ 0,5 liegt die Sensitivität bei einer Dosis von 1000 μg bei 90 %, die Spezifität bei 89 %. Für die gemeinsame Betrachtung der parameterspezifischen Provokationsdosen PD 20 FEV1 und PD Rtot ≥ 0,5, der PD Minimal, bei 1000 μg liegt die Sensitivität bei über 93 % und die Spezifität bei 83 %. Daher können 1000 μg als Schwellendosis für den Ausschluss einer bronchialen Hyperreagibilität zum Untersuchungszeitpunkt angesehen werden, und der Test darf an diesem Punkt abgebrochen werden. Grundsätzlich ist festzustellen, dass die Diagnostik der bronchialen Hyperreagibilität sicher und genau mit Hilfe eines Dosimeterprotokolls erfolgen kann, das die Methacholin-Dosis nur durch die Steigerung der Inhalationen bei gleichbleibender Konzentration der Methacholinlösung erhöht. Die Schwellendosis zwischen normaler und pathologischer bronchialer Reaktion, Sensitivität und Spezifität sowie die Trennschärfe der Methode sind sehr gut vergleichbar mit anderen bisher etablierten Protokollen.

Aircraft noise, air pollution, and mortality from myocardial infarction

Objective: Myocardial infarction has been associated with both transportation noise and air pollution. We examined residential exposure to aircraft noise and mortality from myocardial infarction, taking air pollution into account. Methods: We analyzed the Swiss National Cohort, which includes geocoded information on residence. Exposure to aircraft noise and air pollution was determined based on geospatial noise and air-pollution (PM10) models and distance to major roads. We used Cox proportional hazard models, with age as the timescale. We compared the risk of death across categories of A-weighted sound pressure levels (dB(A)) and by duration of living in exposed corridors, adjusting for PM10 levels, distance to major roads, sex, education, and socioeconomic position of the municipality. Results: We analyzed 4.6 million persons older than 30 years who were followed from near the end of 2000 through December 2005, including 15,532 deaths from myocardial infarction (ICD-10 codes I 21, I 22). Mortality increased with increasing level and duration of aircraft noise. The adjusted hazard ratio comparing ≥60 dB(A) with <45 dB(A) was 1.3 (95% confidence interval = 0.96-1.7) overall, and 1.5 (1.0-2.2) in persons who had lived at the same place for at least 15 years. None of the other endpoints (mortality from all causes, all circulatory disease, cerebrovascular disease, stroke, and lung cancer) was associated with aircraft noise. Conclusion: Aircraft noise was associated with mortality from myocardial infarction, with a dose-response relationship for level and duration of exposure. The association does not appear to be explained by exposure to particulate matter air pollution, education, or socioeconomic status of the municipality.

Sacral neuromodulation for neurogenic lower urinary tract dysfunction: systematic review and meta-analysis

Context Treatment of neurogenic lower urinary tract dysfunction (LUTD) is a challenge, because conventional therapies often fail. Sacral neuromodulation (SNM) has become a well-established therapy for refractory non-neurogenic LUTD, but its value in patients with a neurologic cause is unclear. Objective To assess the efficacy and safety of SNM for neurogenic LUTD. Evidence acquisition Studies were identified by electronic search of PubMed, EMBASE, and ScienceDirect (on 15 April 2010) and hand search of reference lists and review articles. SNM articles were included if they reported on efficacy and/or safety of tested and/or permanently implanted patients suffering from neurogenic LUTD. Two reviewers independently selected studies and extracted data. Study estimates were pooled using Bayesian random-effects meta-analysis. Evidence synthesis Of the 26 independent studies (357 patients) included, the evidence level ranged from 2b to 4 according to the Oxford Centre for Evidence-Based Medicine. Half (n = 13) of the included studies reported data on both test phase and permanent SNM; the remaining studies were confined to test phase (n = 4) or permanent SNM (n = 9). The pooled success rate was 68% for the test phase (95% credibility interval [CrI], 50–87) and 92% (95% CrI, 81–98%) for permanent SNM, with a mean follow-up of 26 mo. The pooled adverse event rate was 0% (95% CrI, 0–2%) for the test phase and 24% (95% CrI, 6–48%) for permanent SNM. Conclusions There is evidence indicating that SNM may be effective and safe for the treatment of patients with neurogenic LUTD. However, the number of investigated patients is low with high between-study heterogeneity, and there is a lack of randomised, controlled trials. Thus, well-designed, adequately powered studies are urgently needed before more widespread use of SNM for neurogenic LUTD can be recommended.

Pregnancy outcome following exposure to angiotensin-converting enzyme inhibitors or angiotensin receptor antagonists: a systematic review

The objective was to analyze the outcome following prenatal exposure to angiotensin-converting enzyme inhibitors (ACE-Is) or angiotensin receptor antagonists (ARBs). For this purpose, a systematic review of published case reports and case series dealing with intrauterine exposure to ACE-Is or to ARBs using Medline as the source of data was performed. The publications retained for analysis included patients who were described individually, revealing, at minimum, the gestational age, substance used, period of medication intake, and the outcome. In total, 72 reports were included; 37 articles (118 well-documented cases) described the prenatal exposure to ACE-Is; and 35 articles (68 cases) described the prenatal exposure to ARBs. Overall, 52% of the newborns exposed to ACE-Is and 13% of the newborns exposed to ARBs did not exhibit any complications (P<0.0001). Neonatal complications were more frequent following exposure to ARBs and included renal failure, oligohydramnios, death, arterial hypotension, intrauterine growth retardation, respiratory distress syndrome, pulmonary hypoplasia, hypocalvaria, limb defects, persistent patent ductus arteriosus, or cerebral complications. The long-term outcome is described as positive in only 50% of the exposed children. Fetopathy caused by exposure to ACE-Is or ARBs has relevant neonatal and long-term complications. The outcome is poorer following exposure to ARBs. We propose the term "fetal renin-angiotensin system blockade syndrome" to describe the related clinical findings. Thirty years after the first description of ACE-I fetopathy, relevant complications are, at present, regularly described, indicating that the awareness of the deleterious effect of prenatal exposure to drugs inhibiting the renin-angiotensin system should be improved.

Treating open carious lesions in anxious children with ozone. A prospective controlled clinical study

PURPOSE: To determine whether the treatment of dental caries with ozone was possible in apprehensive children and to ascertain whether ozone reverses caries in open single-surface lesions. Further, the influence of ozone on laser fluorescence was investigated. METHODS: 82 lesions in 28 children with at least two open single-surface lesions were assessed. The children were anxious and were judged by the referring dentist as non-treatable. For each test lesion, which was treated with ozone, a control lesion was left without ozone treatment. Hardness and laser fluorescence values were assessed and the changes for hardness and laser fluorescence values in the test lesion were compared with the values in the control lesion after 2, 4, 6, and 8 months. RESULTS: 94 percent of the children were treatable and 93% lost their dental anxiety. The hardness values improved significantly in the ozone-treated test lesions after 4, 6, and 8 months (P< 0.05) compared with baseline while the control lesions had no significant change in hardness at any recall interval. Comparing the differences between test and control teeth over time, the laser fluorescence values improved, however the improvement was not statistically significant (P> 0.05). The use of ozone resulted in an average reduction of 13% of the laser fluorescence values immediately after the ozone treatment.

Learning real-world stimuli in a neural network with spike-driven synaptic dynamics

We present a model of spike-driven synaptic plasticity inspired by experimental observations and motivated by the desire to build an electronic hardware device that can learn to classify complex stimuli in a semisupervised fashion. During training, patterns of activity are sequentially imposed on the input neurons, and an additional instructor signal drives the output neurons toward the desired activity. The network is made of integrate-and-fire neurons with constant leak and a floor. The synapses are bistable, and they are modified by the arrival of presynaptic spikes. The sign of the change is determined by both the depolarization and the state of a variable that integrates the postsynaptic action potentials. Following the training phase, the instructor signal is removed, and the output neurons are driven purely by the activity of the input neurons weighted by the plastic synapses. In the absence of stimulation, the synapses preserve their internal state indefinitely. Memories are also very robust to the disruptive action of spontaneous activity. A network of 2000 input neurons is shown to be able to classify correctly a large number (thousands) of highly overlapping patterns (300 classes of preprocessed Latex characters, 30 patterns per class, and a subset of the NIST characters data set) and to generalize with performances that are better than or comparable to those of artificial neural networks. Finally we show that the synaptic dynamics is compatible with many of the experimental observations on the induction of long-term modifications (spike-timing-dependent plasticity and its dependence on both the postsynaptic depolarization and the frequency of pre- and postsynaptic neurons).

Functional respiratory morphology in the newborn quokka wallaby (Setonix brachyurus)

A morphological and morphometric study of the lung of the newborn quokka wallaby (Setonix brachyurus) was undertaken to assess its morphofunctional status at birth. Additionally, skin structure and morphometry were investigated to assess the possibility of cutaneous gas exchange. The lung was at canalicular stage and comprised a few conducting airways and a parenchyma of thick-walled tubules lined by stretches of cuboidal pneumocytes alternating with squamous epithelium, with occasional portions of thin blood-gas barrier. The tubules were separated by abundant intertubular mesenchyme, aggregations of developing capillaries and mesenchymal cells. Conversion of the cuboidal pneumocytes to type I cells occurred through cell broadening and lamellar body extrusion. Superfluous cuboidal cells were lost through apoptosis and subsequent clearance by alveolar macrophages. The establishment of the thin blood-gas barrier was established through apposition of the incipient capillaries to the formative thin squamous epithelium. The absolute volume of the lung was 0.02 +/- 0.001 cm(3) with an air space surface area of 4.85 +/- 0.43 cm(2). Differentiated type I pneumocytes covered 78% of the tubular surface, the rest 22% going to long stretches of type II cells, their precursors or low cuboidal transitory cells with sparse lamellar bodies. The body weight-related diffusion capacity was 2.52 +/- 0.56 mL O(2) min(-1) kg(-1). The epidermis was poorly developed, and measured 29.97 +/- 4.88 microm in thickness, 13% of which was taken by a thin layer of stratum corneum, measuring 4.87 +/- 0.98 microm thick. Superficial capillaries were closely associated with the epidermis, showing the possibility that the skin also participated in some gaseous exchange. Qualitatively, the neonate quokka lung had the basic constituents for gas exchange but was quantitatively inadequate, implying the significance of percutaneous gas exchange.

Sporadic bloody diarrhoea-associated thrombotic thrombocytopenic purpura-haemolytic uraemic syndrome: an adult and paediatric comparison

Although diarrhoea-associated haemolytic uremic syndrome (HUS) in children is well described, the clinical features of bloody diarrhoea-associated thrombotic thrombocytopenic purpura (TTP)-HUS in adults are not documented. Twenty-one adults, 6.5% of the 322 adults in The Oklahoma TTP-HUS Registry, 1989-2006, have presented with bloody diarrhoea. There were no case clusters. Escherichia coli O157:H7 was identified in five patients, but many patients did not have appropriate studies. The annual incidence was 0.68/10(6), 10-fold less than the incidence of diarrhoea-associated HUS in children in Oklahoma. Two (13%) of 16 patients in whom ADAMTS13 (A Disintegrin And Metalloproteinase with a ThromboSpondin type 1 motif, member 13) was measured had <10% activity. Severe neurological abnormalities (67%) and renal failure (62%) were common; seven patients (33%) died; no survivors have relapsed. Compared to the 38 other Oklahoma Registry patients with ADAMTS13 <10%, frequency of severe neurological abnormalities and death was not different; frequency of renal failure was greater; frequency of relapse was less. Compared to 5999 children with sporadic diarrhoea-associated HUS in published reports, frequency of renal failure and relapse was not different; frequency of severe neurological abnormalities and death was greater (P < 0.05 for all differences). Awareness of the continuous occurrence of sporadic bloody diarrhoea-associated TTP-HUS in adults is important for prompt diagnosis and appropriate management.

His-Purkinje system re-entry in patients with clustering ventricular tachycardia episodes

AIMS: Multiple arrhythmia re-inductions were recently shown in His-Purkinje system (HPS) ventricular tachycardia (VT). We hypothesized that HPS VT was a frequent mechanism of repetitive or incessant VT and assessed diagnostic criteria to select patients likely to have HPS VT. METHODS AND RESULTS: Consecutive patients with clustering VT episodes (>3 sustained monomorphic VT within 2 weeks) were included in the analysis. HPS VT was considered plausible in patients with (i) impaired left ventricular function associated with dilated cardiomyopathy or valvular heart disease; or (ii) ECG during VT similar to sinus rhythm QRS or to bundle-branch block QRS. HPS VT was plausible in 12 of 48 patients and HPS VT was demonstrated in 6 of 12 patients (50%, or 13% of the whole study group). Median VT cycle length was 318 ms (250-550). Catheter ablation was successful in all six patients. CONCLUSION: His-Purkinje system VT is found in a significant number of patients with repetitive or incessant VT episodes, and in a large proportion of patients with predefined clinical or electrocardiographic characteristics. Since it is easily amenable to catheter ablation, our data support the screening of all patients with repetitive VT in this regard and an invasive approach in a selected group of patients.

Testing the GlaaS algorithm for dose measurements on low- and high-energy photon beams using an amorphous silicon portal imager

The GLAaS algorithm for pretreatment intensity modulation radiation therapy absolute dose verification based on the use of amorphous silicon detectors, as described in Nicolini et al. [G. Nicolini, A. Fogliata, E. Vanetti, A. Clivio, and L. Cozzi, Med. Phys. 33, 2839-2851 (2006)], was tested under a variety of experimental conditions to investigate its robustness, the possibility of using it in different clinics and its performance. GLAaS was therefore tested on a low-energy Varian Clinac (6 MV) equipped with an amorphous silicon Portal Vision PV-aS500 with electronic readout IAS2 and on a high-energy Clinac (6 and 15 MV) equipped with a PV-aS1000 and IAS3 electronics. Tests were performed for three calibration conditions: A: adding buildup on the top of the cassette such that SDD-SSD = d(max) and comparing measurements with corresponding doses computed at d(max), B: without adding any buildup on the top of the cassette and considering only the intrinsic water-equivalent thickness of the electronic portal imaging devices device (0.8 cm), and C: without adding any buildup on the top of the cassette but comparing measurements against doses computed at d(max). This procedure is similar to that usually applied when in vivo dosimetry is performed with solid state diodes without sufficient buildup material. Quantitatively, the gamma index (gamma), as described by Low et al. [D. A. Low, W. B. Harms, S. Mutic, and J. A. Purdy, Med. Phys. 25, 656-660 (1998)], was assessed. The gamma index was computed for a distance to agreement (DTA) of 3 mm. The dose difference deltaD was considered as 2%, 3%, and 4%. As a measure of the quality of results, the fraction of field area with gamma larger than 1 (%FA) was scored. Results over a set of 50 test samples (including fields from head and neck, breast, prostate, anal canal, and brain cases) and from the long-term routine usage, demonstrated the robustness and stability of GLAaS. In general, the mean values of %FA remain below 3% for deltaD equal or larger than 3%, while they are slightly larger for deltaD = 2% with %FA in the range from 3% to 8%. Since its introduction in routine practice, 1453 fields have been verified with GLAaS at the authors' institute (6 MV beam). Using a DTA of 3 mm and a deltaD of 4% the authors obtained %FA = 0.9 +/- 1.1 for the entire data set while, stratifying according to the dose calculation algorithm, they observed: %FA = 0.7 +/- 0.9 for fields computed with the analytical anisotropic algorithm and %FA = 2.4 +/- 1.3 for pencil-beam based fields with a statistically significant difference between the two groups. If data are stratified according to field splitting, they observed %FA = 0.8 +/- 1.0 for split fields and 1.0 +/- 1.2 for nonsplit fields without any significant difference.