The case of a 3-year-old female with an atypical presentation of foreign body aspiration is described. Resistance to the therapy, mild radiological signs and a high index of suspicion of the ...clinician could lead to the right diagnosis.
In the first half of the 20th century, visceral leishmaniasis (VL) was a common infantile syndrome in coastal territories of the Campania region of Italy. After World War II, the incidence dropped to ...a few cases/year for three decades; in late 1980s the disease reemerged among both children and adults. To face the VL recrudescence, a Paediatric Reference Centre was established at the Santobono-Pausilipon hospital in Naples, for the clinical diagnosis, care and drug treatment of all infantile VL cases occurred in the Campania region. Rapid laboratory diagnosis was secured by a Diagnostic Reference Centre established at the Istituto Superiore di Sanità. Here, we report on the epidemiological and parasitological features of all cases referred to the Centre in the past 15 years. From 1990 to March 2004, a total of 255 cases were diagnosed and treated at the Centre. The Figure shows the yearly trend of patients (min. 3 cases in 1990 and 1991, max. 30 cases in 2000). There were 135 males (52.9%); the age ranged 4 months-14 years, but 189 patients (74.1%) were < or = 3 years old. The majority of the patients (189, 74.1%) were from the Naples province, with a cluster of 102 cases (40% of total patients) from the towns and districts surrounding Vesuvius. Twenty-seven cases (10.6%) were from the town of Maddaloni, Caserta province, whereas 15 cases (5.9%) were from coastal villages of the Salerno province. Only 1 and 2 cases were from Benevento and Avellino provinces, respectively. All patients but seven, who have been treated with antimonial drugs in the 1990-1993 period, were successfully treated with a liposomal amphotericin B regimen. From bone-marrow aspirate samples, 138 Leishmania cultures were obtained in EMTM and Sloppy Evans' media, of which 134 have been typed by the electrophoretic analysis of 13 isoenzymes. Two zymodemes (Z) of L. infantum were routinely identified over the study period, ZMON-1 (the commonest zymodeme in the Mediterranean area) and ZMON-72, variant from MON-1 in PGM mobility and detected only in our region. The latter, identified in 61 patients (45.5%), was found exclusively distributed in towns of the Vesuvius area and in Maddaloni until 1996, but in recent years it appears to have spread to other areas of the Naples (including the island of Ischia) and Caserta provinces, but not to Salerno province. In conclusion, the VL macrofocus of the Naples-Caserta area is probably responsible for the highest number of infantile cases among any VL macrofoci described in southern Europe. Considering the limited efforts paid to control the canine reservoir, rapid diagnosis and appropriate treatment of patients still remain the first-line control measures aimed at reducing the health impact of the disease.
Security is today a relevant requirement for any distributed application, and in particular for these enabled by the Web such as e-health, e-commerce, and e-learning. It is thus crucial that the use ...of Web services, stand-alone or composed, provide strong security guarantees. Web services security encompasses several requirements that can be described along the well known security dimensions, that is: integrity, whereby a message must remain unaltered during transmission; confidentiality, whereby the contents of a message cannot be viewed while in transit, except by authorized services; availability, whereby a message is promptly delivered to the intended recipient, thus ensuring that legitimate users receive the services they are entitled to. Moreover, each Web service must protect its own resources against unauthorized access. This in turn requires suitable means for: identification, whereby the recipient of a message must be able to identify the sender; authentication, whereby the recipient of a message needs to verify the claimed identity of the sender; authorization, whereby the recipient of a message needs to apply access control policies to determine whether the sender has the right to use the required resources. In the tutorial we will first discuss the main security requirements underlying the interactions between clients and Web services and among the Web services themselves. Then we will describe how such security requirements are addressed by standards for Web services security recently developed or under development by various standardizations bodies. Standards that are covered include: WSS, that encompasses a large number of components addressing various security aspects; XACML, that is related to access control and has been recently extended with a profile for Web services access control; WS-Federation, Liberty Alliance and Shibboleth, that address the important problem of identity management in federated organizations. Issues related to the use of these standards are discussed. Then, research approaches to the problem of Web service security will be surveyed, including negotiation-based access control for Web services, and access control for conversation-based Web services
The virus-specific CD8 super(+) T cell responses of 21 HIV-infected patients were studied including a unique cohort of long-term nonprogressors with low levels of plasma viral RNA and strong ...proliferative responses to HIV Ags. HIV-specific CD8 super(+) T cell responses were studied by a combination of standard cytotoxic T cell (CTL) assays, MHC tetramers, and TCR repertoire analysis. The frequencies of CD8 super(+) T cells specific to the majority of HIV gene products were measured by flow cytometric detection of intracellular IFN- gamma in response to HIV-vaccinia recombinant-infected autologous B cells. Very high frequencies (0.8-18.0%) of circulating CD8 super(+) T cells were found to be HIV specific. High frequencies of HIV-specific CD8 super(+) T cells were not limited to long-tern nonprogressors with restriction of plasma virus. No correlation was found between the frequency of HIV-specific CD8 super(+) T cells and levels of plasma viremia. In each case, the vast majority of cells (up to 17.2%) responded to gag-pol. Repertoire analysis showed these large numbers of Ag-specific cells were scattered throughout the repertoire and in the majority of cases not contained within large monoclonal expansions. These data demonstrate that high numbers of HIV-specific CD8 super(+) T cells exist even in patients with high-level viremia and progressive disease. Further, they suggest that other qualitative parameters of the CD8 super(+) T cell response may differentiate some patients with very low levels of plasma virus and nonprogressive disease.
Serine hydroxymethyltransferase purified from rabbit liver cytosol has at least two Asn residues (Asn5 and Asn220) that are 67 and 30% deamidated, respectively. Asn5 is deamidated equally to Asp and ...isoAsp, while Asn220 is deamidated only to isoAsp. To determine the effect of these Asn deamidations on enzyme activity and stability a recombinant rabbit liver cytosolic serine hydroxymethyltransferase was expressed in Escherichia coli over a 5-h period. About 90% of the recombinant enzyme could be isolated with the two Asn residues in a nondeamidated form. Compared with the enzyme isolated from liver the recombinant enzyme had a 35% increase in catalytic activity but exhibited no significant changes in either affinity for substrates or stability. Introduction of Asp residues for either Asn5 or Asn220 did not significantly alter activity or stability of the mutant forms. In vitro incubation of the recombinant enzyme at 37°C and pH 7.3 resulted in the rapid deamidation of Asn5 to both Asp and isoAsp with a t1/2 of 50–70 h, which is comparable to the rate found with small flexible peptides containing the same sequence. The t1/2 for deamidation of Asn220 was at least 200 h. This residue may become deamidated only after some unfolding of the enzyme. The rates for deamidation of Asn5 and Asn220 are consistent with the structural environment of the two Asn residues in the native enzyme. There are also at least two additional deamidation events that occur during prolonged incubation of the recombinant enzyme.
A 4-Mb toggle MRAM, built in 0.18-mum five level metal CMOS technology, uses a 1.55 mum/sup 2/ bit cell with a single toggling magneto tunnel junction to achieve a chip size of 4.5 mm x 6.3 mm. The ...memory uses unidirectional programming currents controlled by locally mirrored write drivers to apply a robust toggle write sequence. An isolated read architecture driven by a balanced three input current mirror sense amplifier supports 25-ns cycle time asynchronous operation.
The ability of human breast carcinomas to convert pregnenolone to progesterone and dehydroepiandrosterone to delta 4-androstene-3,17-dione (delta 4) was investigated as a potential aid for prognosis, ...and the following observations were recorded. 1. Neither the amounts of progesterone or delta 4 synthesized nor delta 4/progesterone ratios correlated with tumour size or lymph node involvement. 2. delta 4 synthesis was lower in carcinomas from patients who had recurrences within 2 years of mastectomy than in carcinomas from those who remained free of metastases. 3. Life table analysis of the results indicated that these parameters appeared unlikely to be useful aids for prognosis.
The empirical use of antibiotic therapy is widely accepted for patients with fever and neutropenia during cancer chemotherapy. The use of intravenous monotherapy with broad-spectrum antibiotics in ...patients at high risk for complications is an appropriate alternative. However, few data are available for pediatric patients. The aim of this study was to compare the efficacy and safety of cefepime (CFP) monotherapy with ceftriaxone plus amikacin (CFT+AK) in children and adolescents with febrile neutropenia (FN).
A prospective randomized open study of patients with lymphoma or leukemia who had fever and neutropenia during chemotherapy was conducted. Patients were randomized to receive CFP or CFT+AK. The randomization was based on number lists.
Fifty seven patients with 125 episodes of fever and neutropenia were evaluated (CFP, 62 episodes; CFT+AK, 63 episodes). The mean neutrophil count at admission to hospital was 118.6 cells/mm(3) for patients in the CFP group and 107 cells/mm(3) for patients in the CFT+AK group. The mean duration of neutropenia was 9 days for the CFP group and 8 days for the CFT+AK group. Analysis of only the first episodes for each patient showed that CFP treatment was successful for 65.5% of episodes and CFT+AK was successful for 64.3% of episodes. The overall rates of success with modification were 90% for the CFP group and 89% for the CFT+AK group. No major treatment-emergent toxicity was reported.
Monotherapy with CFP seems to be as effective and safe as CFT+AK for initial empirical therapy in children and adolescents with FN.
