Primary focal segmental glomerulosclerosis: clinical course and response to therapy

Primary focal segmental glomerulosclerosis (FSGS) is a lesion associated with a poor prognosis and results in end-stage renal disease after 5 to 10 years. Based on past experience, many nephrologists have considered primary FSGS a lesion that is steroid resistant and therefore are reluctant to offer steroids as treatment. Recent data, however, have demonstrated that patients with primary FSGS have a response to steroid therapy that is considerably better than had been described. Thus, it may be that nephrologists have been more "steroid reluctant" than the lesion is steroid resistant. To better understand this issue we review the clinical course and response to therapy in patients with primary FSGS.     

The genome of Treponema pallidum: new light on the agent of syphilis

Covert brain activity related to task-free, spontaneous (i.e. unrequested), emotional evaluation of human face images was analysed in 27-channel averaged event-related potential (ERP) map series recorded from 18 healthy subjects while observing random sequences of face images without further instructions. After recording, subjects self-rated each face image on a scale from "liked" to "disliked". These ratings were used to dichotomize the face images into the affective evaluation categories of "liked" and "disliked" for each subject and the subjects into the affective attitudes of "philanthropists" and "misanthropists" (depending on their mean rating across images). Event-related map series were averaged for "liked" and "disliked" face images and for "philanthropists" and "misanthropists". The spatial configuration (landscape) of the electric field maps was assessed numerically by the electric gravity center, a conservative estimate of the mean location of all intracerebral, active, electric sources. Differences in electric gravity center location indicate activity of different neuronal populations. The electric gravity center locations of all event-related maps were averaged over the entire stimulus-on time (450 ms). The mean electric gravity center for disliked faces was located (significant across subjects) more to the right and somewhat more posterior than for liked faces. Similar differences were found between the mean electric gravity centers of misanthropists (more right and posterior) and philanthropists. Our neurophysiological findings are in line with neuropsychological findings, revealing visual emotional processing to depend on affective evaluation category and affective attitude, and extending the conclusions to a paradigm without directed task.     

The dental status of asthmatic British school children

Pancreatic cancer is a dismal disease. The 5-year overall survival ranges from 1% to 5%. Surgery is the only curative treatment available for this cancer, but it is indicated only in selected patients with a less than 4 cm tumor. In these patients, survival rate is about 30%. We have considered several aspects: the very difficult early diagnosis, the correct diagnostic flow chart, actual surgical procedures and new trends in biologic and genetic research. It is likely that better results can be achieved by defining an "early pancreatic cancer" and establishing how to detect it. This could be the wrigth one way is to significantly improve the survival of these patients.     

Fetal heart rate patterns in postasphyxiated fetal lambs with brain damage

OBJECTIVE: We previously showed that in asphyxiated fetal lambs the duration of hypotension correlated well with the severity of histologic damage to the brain, whereas the duration of bradycardia did not. This study compares fetal heart rate patterns with the degree of histologic damage to the brain. STUDY DESIGN: Twelve chronically instrumented near-term fetal lambs were subjected to asphyxia by umbilical cord occlusion until fetal arterial pH was <6. 9 and base excess was <-20 mEq/L. An additional 4 fetuses served as sham-asphyxia controls. Fetal heart rate (from electrocardiogram), arterial blood pressure, fetal breathing movements, and electrocorticogram were continuously monitored before, during, and for 72 hours after asphyxia. Fetal brain histologic features were categorized as mild (group 1, n = 5), moderate (group 2, n = 4), and severe (group 3, n = 3). Long-term fetal heart rate variability expressed as amplitude range was assessed visually every 5 minutes from 30 minutes before asphyxia until 2 hours of recovery and at 6, 12, 24, 48, and 72 hours of recovery. RESULTS: Long-term fetal heart rate variability amplitude decreased from 32 +/- 17 beats/min (mean +/- SEM) preocclusion to 4 +/- 13 beats/min at the end of occlusion (P <.001) without significant differences among the 3 groups. During 10 to 45 minutes of recovery, the long-term variability of group 1 was significantly greater than that of groups 2 and 3. At 24 to 72 hours of recovery, the long-term variability of groups 1 and 2 was significantly higher than that of group 3, which was almost 0. The "checkmark" and sinusoidal fetal heart rate patterns were observed during the recovery period in groups 2 and 3. CONCLUSIONS: Decreased long-term fetal heart rate variability and the "checkmark" and sinusoidal fetal heart rate patterns were indicators of the severity of asphyxial histologic damage in the fetal brain.     

Functional correction of renal defects in a mouse model for ARPKD through expression of the cloned wild-type Tg737 cDNA

Autosomal recessive polycystic kidney disease (ARPKD) is characterized by the formation of large collecting tubule and ductular cysts that often result in renal insufficiency within the first decade of life. Understanding the process leading to cyst formation will require the identification and characterization of genes involved in the etiology of this disease. In this regard, we previously described the generation of a mouse model (TgN737Rpw) for ARPKD and the cloning of a candidate gene. Here we show direct involvement of the Tg737 gene in collecting duct cyst formation by expressing the wild-type Tg737 cDNA as a transgene in TgN737Rpw mutants. In contrast to TgN737Rpw mutants, the "rescued" animals survive longer, have normal renal function and normal localization of the EGFr to the basolateral surfaces of collecting duct epithelium.     

The effect of soft cervical collars on persistent neck pain in patients with whiplash injury

Thirty-five male patients, aged 34-79 yr, with definite rheumatoid arthritis (RA) were recruited from out-patient clinics and randomized to receive monthly injections of testosterone enanthate 250 mg or placebo as an adjunct therapy for 9 months. Endpoints included disease activity parameters and bone mineral density (BMD). At baseline, there were negative correlations between the ESR and serum testosterone (r = -0.42, P < 0.01) and BMD (hip, r = -0.65, P < 0.01). A total of 29.6% of all patients had at least one vertebral fracture, most having multiple fractures. Back pain, however, was not more prevalent in fracture patients (55% vs 50%). Disease activity was significantly higher in the fracture group (joint score P < 0.05, rheumatoid factor P < 0.01). Thirty patients completed the trial, 15 receiving testosterone and 15 receiving placebo. There were significant rises in serum testosterone, dihydrotestosterone and oestradiol in the treatment group. There was no significant effect of treatment on disease activity overall, five patients receiving testosterone underwent a "flare'. Differences in mean BMD following testosterone or placebo were non-significant (spine: +1.2% vs -1.1%; femur: -0.3% vs +0.3%). There was no suggestion of a positive effect of testosterone on disease activity in men with RA.     

Thermal comfort and sensation in men wearing a cooling system controlled by skin temperature

OBJECTIVE: The study was done to determine whether thermal comfort (TC), thermal sensation (TS), and subjective factors gauging environmental stress were negatively affected with different cooling methods in men exercising in chemical protective clothing. BACKGROUND: Previous studies have reported that intermittent regional cooling improved the efficacy of cooling as compared with constant cooling (CC), but no studies have addressed whether there is any improvement in thermal comfort. METHODS: Eight male volunteers exercised at moderate work intensity (425 W) in three microclimate cooling tests. The circulating fluid in the cooling garment was provided during exercise to the head (6% body surface area [BSA]), torso (22% BSA), and thighs (44% BSA) and manipulated under three methods: (a) CC, (b) pulsed cooling (PC), and (c) PC activated by mean skin temperature (T(sk)) control (PC(skin)). TC and TS ratings were recorded every 20 min during the 80-min test. RESULTS: TC and TS ratings were not different for PC(skin) and CC; thus the participants perceived PC(skin) as being similar to CC. TS was significantly warmer with PC than with PC(skin) and CC (p < .001). In PC(skin), T(sk) was significantly higher than in PC and CC (p < .001), and PC(skin) was rated as being not as warm as PC according to TS. CONCLUSION: This indicates that the PC(skin) method was perceived as being as cool as CC and cooler than PC. APPLICATION: These findings indicate that the PC(skin) cooling method is an acceptable alternative to CC and PC based on human perceptions.     

Intermittent microclimate cooling during exercise-heat stress in US army chemical protective clothing

The effectiveness of intermittent, microclimate cooling for men who worked in US Army chemical protective clothing (modified mission-oriented protective posture level 3; MOPP 3) was examined. The hypothesis was that intermittent cooling on a 2 min on-off schedule using a liquid cooling garment (LCG) covering 72% of the body surface area would reduce heat strain comparably to constant cooling. Four male subjects completed three experiments at 30 degrees C, 30% relative humidity wearing the LCG under the MOPP 3 during 80 min of treadmill walking at 224 +/- 5 W . m(-2). Water temperature to the LCG was held constant at 21 degrees C. The experiments were; 1) constant cooling (CC); 2) intermittent cooling at 2-min intervals (IC); 3) no cooling (NC). Core temperature increased (1.6 +/- 0.2 degrees C) in NC, which was greater than IC (0.5 +/- 0.2 degrees C) and CC (0.5 +/- 0.3 degrees C) ( p < 0.05). Mean skin temperature was higher during NC (36.1 +/- 0.4 degrees C) than IC (33.7 +/- 0.6 degrees C) and CC (32.6 +/- 0.6 degrees C) and mean skin temperature was higher during IC than CC ( p < 0.05). Mean heart rate during NC (139 +/- 9 b . min(-1)) was greater than IC (110 +/- 10 b . min(-1)) and CC (107 +/- 9 b . min(-1)) ( p < 0.05). Cooling by conduction (K) during NC (94 +/- 4 W . m(-2)) was lower than IC (142 +/- 7 W . m(-2)) and CC (146 +/- 4 W . m(-2)) ( p < 0.05). These findings suggest that IC provided a favourable skin to LCG gradient for heat dissipation by conduction and reduced heat strain comparable to CC during exercise-heat stress in chemical protective clothing.