S
treptococcus pneumoniae
is a major cause of morbidity and mortality and results in expenditures of over $4 billion yearly in the United States for the treatment of pneumonia, meningitis, ...bacteremia, sinusitis, and otitis media.
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The emergence of drug-resistant
S. pneumoniae
will make these common infections more difficult to treat.
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Most reports regarding drug-resistant pneumococcus in the United States have focused on infections in children, in which the spread of drug-resistant organisms has been linked to day-care centers and the indiscriminate use of antibiotics.
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To characterize the epidemiology of drug-resistant
S. pneumoniae,
we conducted population-based surveillance for . . .
Effective Haemophilus influenzae type b (Hib) conjugate vaccines were first licensed for use in US children at least 18 months old in December 1987 and for infants at least 2 months old in October ...1990. We evaluated trends in Hib disease associated with licensure of Hib conjugate vaccines.
Data from two sources, an intensive laboratory-based active surveillance system and the National Bacterial Meningitis Reporting System (NBMRS), were used separately to evaluate disease incidence. Data from vaccine manufacturers on Hib vaccine doses distributed in the United States were compared with trends in Hib disease incidence.
The age-specific incidence of Hib disease among children less than 5 years old decreased by 71% from 37 per 100,000 persons in 1989 to 11 per 100,000 persons in 1991 (active surveillance data). Haemophilus influenzae meningitis incidence decreased by 82% between 1985 and 1991 (NBMRS data). Increases in doses of Hib vaccine distributed in the United States coincided with steep declines in Hib disease. Both surveillance systems showed decreased rates of Hib disease in infants less than 1 year old before vaccine was licensed for use in this age group. Haemophilus influenzae type b disease incidence in persons at least 12 years old and pneumococcal meningitis incidence in children less than 5 years old did not change substantially during the same period; therefore, decreased Hib disease in children less than 5 years old is not likely to be explained solely by changes in surveillance sensitivity or decreases in bacterial disease due to changes in medical practice.
Our data suggest that conjugate vaccines have already had a marked impact on the incidence of Hib disease in the United States, preventing an estimated 10,000 to 16,000 cases of Hib disease in 1991. The decline of disease in infants less than 1 year old before licensure for this age group warrants further investigation.
To evaluate the effectiveness and safety of samarium-153 (153Sm) lexidronam (EDTMP) in a double-blind, placebo-controlled study.
Patients with painful bone metastases secondary to a variety of ...primary malignancies were randomized to receive 153Sm-EDTMP 0.5 or 1.0 mCi/kg, or placebo. Treatment was unblinded for patients who did not respond by week 4, with those who had received placebo eligible to receive 1.0 mCi/kg of active drug in an open-label manner. Patient and physician evaluations were used to assess pain relief, as was concurrent change in opioid analgesia.
One hundred eighteen patients were enrolled onto the study. Patients who received 1.0 mCi/kg of active drug had significant reductions in pain during each of the first 4 weeks in both patient-rated and physician-rated evaluations. Pain relief was observed in 62% to 72% of those who received the 1.O-mCi/kg dose during the first 4 weeks, with marked or complete relief noted in 31% by week 4. Persistence of pain relief was seen through week 16 in 43% of patients who received 1.0 mCi/kg, of active drug. A significant correlation (P = .01) was observed between reductions in opioid analgesic use and pain scores only for those patients who received 1.0 mCi/kg 153Sm-EDTMP. Bone marrow suppression was mild, reversible, and not associated with grade 4 toxicity.
A single dose of 1.0 mCi/kg of 153Sm-EDTMP provided relief from pain associated with bone metastases. Pain relief was observed within 1 week of administration and persisted until at least week 16 in the majority of patients who responded.
Rates of invasive Haemophilus influenzae type b (Hib) disease in children decreased very rapidly after licensure of Hib conjugate vaccines. A role for a vaccine-related reduction in nasopharyngeal ...carriage of Hib has been suggested. We studied oropharyngeal carriage of Hib and vaccination rates in a population of 2− to 5-year-old children in metropolitan Atlanta. Among 584 children 75% were vaccinated with an Hib conjugate vaccine, 17% had not been vaccinated and 8% had no vaccination records available. Forty-one percent of the children were colonized with H. influenzae. One child was colonized with Hib. Hib carriage (0.17%; upper 95% confidence interval boundary, 0.97%) was substantially lower than the estimates of Hib carriage from prior studies of children who had not received Hib conjugate vaccines. Our data are consistent with a decline in Hib carriage induced by widespread use of conjugate Hib vaccines, which may have contributed to the decline of Hib disease in United States children.
•The fly ash source has significant effect on FGC compressive strength.•The type of activating solution has a significant effect on FGC compressive strength.•Curing conditions play a significant role ...in compressive strength gain.
Development of sustainable construction materials has been the focus of research efforts worldwide in recent years. Concrete is a major construction material; hence, finding alternatives to ordinary Portland cement is of extreme importance due to high levels of carbon dioxide emissions associated with its manufacturing process. This study investigates the effects of activating solution type, curing procedure, and source of fly ash in relation to the resulting compressive strength of fly ash-based geopolymer concrete. The fly ash-based geopolymer paste microstructure was observed and density, absorption and voids were measured. Two activating solutions were used: a) a mixture of sodium hydroxide, silica fume, and water; and b) a mixture of sodium hydroxide solution, sodium silicate, and water. Test results indicate that the resulting concrete has the potential for high compressive strength and the compressive strength is directly affected by the source of fly ash. Results further indicate that compressive strength is not significantly affected by the curing condition when silica fume is used in the activating solution in comparison to the use of sodium silicate.
During the past 15 years, many investigators have examined the effects of somatotropin (ST) on growth and lactation in farm animals. Throughout this period, concerns about potential effects of ST on ...reproduction have been expressed. The objective of the present review will be to focus on the effects of exogenous ST on the hypothalamic-pituitary-gonadal axis. Plasma progesterone is increased when recombinant bovine (rb)ST is given to cattle, early in lactation, and also to sheep. Also, the release of progesterone from cultured swine and human luteal cells is increased by ST. Treatment with rbSt increases the numbers of small follicles, but does not increase the ovulatory rate of ruminants. Doses of ST similar to those used to increase milk production do not affect the secretion of testosterone or spermatogenesis in rams or bulls. Stimulatory and inhibitory effects of exogenous ST on reproductive function of gilts have been reported. Daily injections of porcine ST (pST) delayed puberty and expression of estrus after puberty. Daily administration of pST increased the number of small follicles, but not of medium follicles, whereas administration of pST by using a sustained release implant increased the number of medium follicles. Size and weight of reproductive organs and concentration of testosterone are not affected when pST is administered for at least 42 d. However, pST enhanced testicular development and spermatogenesis when given to neonatal boars. In summary, administration of exogenous ST at doses known to alter milk production and carcass composition may have subtle positive and/or negative effects on the reproductive systems of cattle and swine; however, these effects appear to be transient.
Objective. To identify dietary risk factors for sporadic listeriosis. Design. Case-control study with blinded telephone interviews. Setting. Multistate population of 18 million persons, November 1988 ...through December 1990. Participants. One hundred sixty-five patients with culture-confirmed listeriosis and 376 control subjects matched for age, health care provider, and immunosuppressive condition. Results. The annual incidence of invasive listeriosis was 7.4 cases per million population; 23% of the infections were fatal. Cases were more likely than matched controls to have eaten soft cheeses (odds ratio OR, 2.6; 95% confidence interval CI, 1.4 to 4.8; P = 0.002) or food purchased from store delicatessen counters (OR, 1.6; 95% CI, 1.0 to 2.5; P = 0.04); 32% of sporadic disease could be attributed to eating these foods. Sixty-nine percent of cases in men and nonpregnant women occurred in cancer patients, persons with the acquired immunodeficiency syndrome, organ transplant recipients, or those receiving corticosteroid therapy. Among these immunosuppressed patients, eating undercooked chicken also increased the risk of listeriosis (OR, 3.3; 95% CI, 1.2 to 9.2; P = 0.02). Conclusions. Foodborne transmission may account for a substantial portion of sporadic listeriosis. Prevention efforts should include dietary counseling of high-risk patients and continued monitoring of food production
The Halogen Occultation Experiment (HALOE) experiment on Upper Atmosphere Research Satellite (UARS) performs solar occultation (sunrise and sunset) measurements to infer the composition and structure ...of the stratosphere and mesosphere. Two of the HALOE channels, centered at 5.26 μm and 6.25 μm, are designed to infer concentrations of nitric oxide and nitrogen dioxide respectively. The NO measurements extend from the lower stratosphere up to 130 km, while the NO2 results typically range from the lower stratosphere to 50 km and higher near the winter terminator. Comparison with results from various instruments are presented, including satellite‐, balloon‐, and ground‐based measurements. Both NO and NO2 can show large percentage errors in the presence of heavy aerosol concentrations, confined to below 25 km and before 1993. The NO2 measurements show mean differences with correlative measurements of about 10 to 15% over the middle stratosphere. The NO2 precision is about 7.5 × 10−13 atm, degrading to 2 × 10−12 atm in the lower stratosphere. The NO differences are similar in the middle stratosphere but sometimes show a low bias (as much as 35%) between 30 and 60 km with some correlative measurements. NO precision when expressed in units of density is nearly constant at 1 × 10−12 atmospheres, or approximately 0.1 ppbv at 10.0 mb or 1.0 ppbv at 1.0 mb, and so forth when expressed in mixing ratio. Above 65 km, agreement in the mean with Atmospheric Trace Molecule Spectroscopy (ATMOS) NO results is very good, typically ±15%. Model comparisons are also presented, showing good agreement with both expected morphology and diurnal behavior for both NO2 and NO.
Approximately two-thirds of major depressive disorder (MDD) patients do not respond adequately to current therapies. BUP/SAM (ALKS 5461), a combination of buprenorphine (BUP) and samidorphan (SAM), ...is a novel opioid system modulator in development as an adjunct treatment for MDD. Using a rat strain (Wistar Kyoto rat) that is predisposed to stress and has an inadequate response to selective serotonin reuptake inhibitors (SSRIs), we investigated the effect of BUP and SAM, individually and in combination, in established nonclinical assays used to study antidepressants (the forced swim test, FST) and anxiolytics (marble burying test). As opioids and their receptors are expressed in mesocorticolimbic regions of the brain, we analyzed extracellular concentrations of dopamine, serotonin, and/or their metabolites in brain areas associated with mood and motivation. BUP alone and in combination with SAM significantly reduced immobility in the FST. Similarly, the BUP/SAM combination significantly reduced immobility in SSRI (escitalopram)-treated rats. BUP/SAM also decreased burying behavior. SAM attenuated BUP-induced changes of extracellular levels of serotonin and dopamine in the medial prefrontal cortex and nucleus accumbens shell. The latter suggests that the addition of SAM to BUP may limit activation of the mesolimbic dopamine reward pathway and thereby reduce BUP's reinforcing properties. SAM alone had no effect on neurochemistry or immobility in the FST. Collectively, these data indicate that opioid system modulation may offer an alternative mechanism that does not rely on enhanced serotonergic neurotransmission in neurocircuits associated with antidepressant and anxiolytic activity in nonclinical models.
•WKY rats are insensitive to both acute and chronic SSRI treatment as measured by immobility in the FST.•The BUP/SAM combination reduces immobility in the FST and burying behavior in the MBT for at least 1 week in WKY rats after a single administration.•SAM attenuated BUP-induced neurochemical changes suggesting that the addition of SAM reduces BUP's deleterious properties.
The authors presented the cases of two children with inflammatory myofibroblastic (IMF) tumor and reviewed the literature to facilitate the preoperative recognition, delineate the clinical features, ...and describe the natural history of this entity. The first child had IMF tumor arising from the mesentery of the small intestine. He presented with an abdominal mass associated with severe inflammatory response manifested by fever, impaired growth, thrombocytosis, and microcytic, hypochromic anemia. After surgical resection, his fever resolved and his growth rate and the laboratory abnormalities normalized. Five months after initial diagnosis, the fever, anemia, and thrombocytosis recurred along with two tumors arising from the omentum and the abdominal soft tissue. After the second surgery, he remains free of recurrent disease for 30 months. The second child presented with a lung mass that was radiologically indistinguishable from pulmonary sequestration. After surgical resection, she remains free of recurrent disease for 18 months.
IMF tumor should be considered in any solid tumor that occurs in association with a chronic inflammatory response. IMF tumor should also be considered in the differential diagnosis of pulmonary sequestration.
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