Four-graded Scale Research Articles

Impact of COVID-19 and COVID-19 vaccination on high-risk patients with antiphospholipid syndrome: a nationwide survey.

ObjectivesPatients with antiphospholipid syndrome (APS) and triple-positive for antiphospholipid antibodies (aPL) are at high-risk of recurrent events. As COVID-19 and COVID-19 vaccination may induce thrombotic complications, the objective of the study was to assess the course of COVID-19 and adverse events after vaccination in these patients.MethodsThis is a nationwide multicentre survey conducted in nine APS referral centres by means of a questionnaire. Included patients are thrombotic APS with triple-positive aPL confirmed 12 weeks apart. Reference specialist physicians used a four-graded scale of severity for COVID-19 [from 0 (asymptomatic) to 3 (hospitalization in intensive care unit)] and a six-graded scale for adverse reactions to vaccination [from 0 (transient local injection site sign/symptoms) to 5 (potentially life-threatening reactions)]. Outcomes were considered within a 30-days period.ResultsOut of 161 patients interviewed, 18 (11%) had COVID-19. All of them fully recovered without any progression to severe disease nor thromboembolic event. One-hundred-forty-six patients received the first (92%) and 129 (80%) the second dose of vaccine; side effects were minimal and, in most cases, (83% after the first and 68% after the second shot) limited to a sore arm. Fifteen patients (9%) were unvaccinated. Most of them raised doubts on the need for vaccination, complained for poor safety and in general were reluctant on COVID-19 vaccination.ConclusionPatients with triple-positive thrombotic APS did not suffer from severe COVID-19 outcomes. Importantly, COVID-19 vaccination was well tolerated. These data may reassure patients and physicians and contribute in reducing hesitancy in unvaccinated patients.

Men with impaired glucose tolerance have lower self-rated health than men with impaired fasting glucose

AimPrevious studies have shown that individuals with impaired glucose tolerance (IGT) have lower self-rated health than normoglycaemic individuals. The aim of this study was to examine differences in self-rated health between individuals with IGT and those with impaired fasting glucose (IFG) and to consider the potentially mediating effect of physical activity. MethodsIn 2002–2005, a total of 2816 individuals were randomly selected for a population-based study in Sweden. All participants performed an oral glucose tolerance test (OGTT). Fasting venous blood samples were drawn, and questionnaires concerning lifestyles were completed. Self-rated health (SRH) and leisure time physical activity (LTPA) were reported on a five-graded and four-graded scale, respectively. A total of 213 individuals with IGT and 129 with IFG were detected. ResultsIGT, but not IFG, was associated with low self-rated health. The difference in self-rated health was seen particularly in men when adjusted for age and BMI (OR = 2.13, CI: 1.13–4.02, p = 0.020). The results became insignificant when including physical activity in the model (OR = 1.8, CI: 0.91–3.58, p = 0.094). ConclusionThe low self-rated health adds further weight to the risk profile in men with IGT and stresses the importance of early detection and lifestyle interventions.

Прогнозування ризику біфентринових інсектицидів для здоров'я людини при споживанні сільськогосподарських продуктів, вирощених з їх використанням (англійською мовою)

The assessment of the health risks of pesticides is an integral part of their monitoring. The Purpose of the Work was to predict the risk of bifenthrin-based insecticides for human health when consuming agricultural products grown in their application for the public health preservation. Materials and Methods of Research. The bifenthine stability parameters in agricultural crops were studied in the field experiments in soil and climatic conditions of Ukraine. For the integrated assessment of the potential hazard of pesticide exposure to the human body when contaminated agricultural products were used, a methodology developed by specialist of Hygiene and Ecology Institute was used. Allowable daily dose (ADD), half-life period (DT50) and average daily consumption of the product were estimated on a four-graded scale. Results and Discussion. By degree of hazard according to State Standards 8.8.1.002-98 bifenthrin pertains to the 2nd class of hazard (moderately stable) by resistance in vegetative agricultural crops. The active ingredient pertains to the 2nd class of hazard by the value of the integral index of hazard when consuming products — dangerous compound. Conclusion. Integral assessment of the potential risk of bifenthrin exposure to humans using contaminated agricultural products showed that the substance pertains to the 2nd class of hazard (dangerous compounds). The obtained parameter should be taken into account when deciding on bifenthrin-based formulations expansion of the scope.

Порівняльна оцінка небезпеки для дітей та підлітків різного віку вживання сільськогосподарських продуктів, контамінованих фунгіцидами класу амідів та триазолів

Annually more than 2 million tons of chemical plant protection products are introduced into the fields of the planet due to the need to preserve the crop. However, with multiple introduction of persistent pesticides, soil can become a source of pollution of crop production. The Purpose of our work was to predict the danger for children of all ages when consuming agricultural products contaminated with fungicides of the amides and triazoles classes. Materials and Methods. For an integrated assessment of the potential hazard on a four-graded scale, the allowable daily intake, the half-life in plants, and the average daily consumption of the product were estimated. When estimating the average daily consumption of products for children under the age of 18, the safety coefficients were used. Results. According to the persistence in agricultural cultures, fungicides cyflufenamide and difenoconazole were classified as hazard classes 3 (moderately stable). By the integral indicator of the danger when consuming pesticide-contaminated products for adults, difenoconazole is very dangerous (grade 4), cyflufenamide —moderately dangerous (grade 3). Conclusion. It has been established that for children, depending on their age, both studied active substances can be from extremely dangerous for infants and children of preschool age to a low or moderately dangerous for adolescents. Key Words: risk, pesticides, food products, children.

FORECASTING OF TRIAZOLE, AMIDE, PIPEREDINYLE THIAZOL ISOXAZOLINE, OXAZOLE FUNGICIDES HAZARDOUS EFFECT ON HUMAN HEALTH IN CONSUMPTION OF VEGETABLES GROWED IN THEIR APPLICATION

The chemical plant protection products application is an integral part of intensive crop production technologies. However, scientists have proven that the increase in chemical pollution of the environment in 2 times increases the general level of morbidity of the adult population by 25%. That is why the risk assessment of pesticide-contaminated products consumption is an important part of the regulatory process. Methods. The parameters of fungicides difenoconazole, tebuconazole, cyflufenamid, oxathiapiprolin, famoxadone persistence in agricultural crops were studied in the field experiments. For the integrated assessment of the potential risk of pesticide-contaminated products consumption for human (RPCPC), a methodology developed on the basis of the Institute of Hygiene and Ecology was used. The acceptable daily intake (ADI), the half-life period (τ50) in plants and the average daily consumption of the product have been evaluated using four-graded scale. Results. According to the persistency in tomatoes and potatoes, fungicides difenoconazole, cyflufenamid, famoxadone are pertained to 3 classes of hazard (5-14 days); tebuconazole - to 2 class (15-30 days); oxathiapiprolin - to 4 class (less than 5 days). After the addition of all the obtained points, the RPCPC value (tomatoes and potatoes) for difenoconazole, cyflufenamid, famoxadone amounted 8 points (2+2+2× 2 and 2+2+4, respectively); tebuconazole - 8 points (3+1+2×2 or 3+1+4, respectively); oxathiapiprolin - 6 points (1+1+2×2 or 1+1+4, respectively). Discussion. Thus, the studied compounds belong to the 3rd class of hazard according to pesticide-contaminated products consumption for human index value. The results obtained by us correlate with the studies carried out in the previous stage. The exception was only difenoconazole, which was classified as hazard class 2 due to its high toxicity for human.

Psychometric evaluation of the Swedish version of Rosenberg’s self-esteem scale

Background: The widely used Rosenberg’s self-esteem scale (RSES) has not been evaluated for psychometric properties in Sweden.Aims: This study aimed at analyzing its factor structure, internal consistency, criterion, convergent and discriminant validity, sensitivity to change, and whether a four-graded Likert-type response scale increased its reliability and validity compared to a yes/no response scale.Methods: People with mental illness participating in intervention studies to (1) promote everyday life balance (N = 223) or (2) remedy self-stigma (N = 103) were included. Both samples completed the RSES and questionnaires addressing quality of life and sociodemographic data. Sample 1 also completed instruments chosen to assess convergent and discriminant validity: self-mastery (convergent validity), level of functioning and occupational engagement (discriminant validity). Confirmatory factor analysis (CFA), structural equation modeling, and conventional inferential statistics were used.Results: Based on both samples, the Swedish RSES formed one factor and exhibited high internal consistency (>0.90). The two response scales were equivalent. Criterion validity in relation to quality of life was demonstrated. RSES could distinguish between women and men (women scoring lower) and between diagnostic groups (people with depression scoring lower). Correlations >0.5 with variables chosen to reflect convergent validity and around 0.2 with variables used to address discriminant validity further highlighted the construct validity of RSES. The instrument also showed sensitivity to change.Conclusions: The Swedish RSES exhibited a one-component factor structure and showed good psychometric properties in terms of good internal consistency, criterion, convergent and discriminant validity, and sensitivity to change. The yes/no and the four-graded Likert-type response scales worked equivalently.

Evaluation of different low-dose multidetector CT and cone beam CT protocols in maxillary sinus imaging: part I—anin vitrostudy

This in vitro study aimed to assess radiation dose and image quality of different low-dose multidetector CT (MDCT) and CBCT imaging protocols in comparison with the standard MDCT protocol for maxillary sinus imaging. Effective dose (E) and image quality of 10 MDCT (changing effective milliampere second starting from 141.3 EmAs to 20 EmAs) and 3 CBCT protocols (changing milliampere second and voxel size) were assessed throughout scanning an anthropomorphic head and neck Alderson Rando phantom. E values were calculated using thermoluminescent dosemeters (TLDs) fixed at 6 sensitive organs (14 sites) on the Rando phantom. Image quality was assessed objectively (by calculating the standard deviation values of the radiographic density of water) and subjectively (by assessing the diagnostic image quality using a four-graded scale: 1 = very good, 2 = good, 3 = acceptable and 4 = unacceptable). Two MDCT protocols (120 kV/32 EmA and 120 kV/25 EmA) had lower radiation doses with statistically significant differences (p < 0.001) compared with that of the standard MDCT protocol (120 kV/141.3 EmA), and they preserved a good diagnostic image quality. One CBCT protocol (120 kV/20 mA) had a reasonable radiation dose and good image quality. There were no statistically significant differences between the above-mentioned lower dose MDCT and CBCT protocols (p > 0.05) with respect to the radiation dose and image quality. The low-dose MDCT and CBCT protocols are viable methods for maxillary sinus examination as evaluated using the above-mentioned phantom that yield a good diagnostic image quality using E approximately 7 and 11 times lower than that of the standard MDCT, respectively. These findings were evaluated in the in vivo part of this project.

Abstract P058: Men with Impaired Glucose Tolerance Have Lower Self-rated Health Than Men with Impaired Fasting Glucose, an Association Mediated by Physical Activity

Aim: Previous studies have shown that individuals with type 2 diabetes (T2D) and impaired glucose tolerance (IGT) have lower self-rated health than normoglycemic individuals. Less is known about individuals with impaired fasting glucose (IFG). The aim of this study was to examine differences in self-rated health between individuals with IGT and those with IFG, taking into account the mediating effect of lifestyle. Methods: In 2002-2005, a total of 2816 individuals 35-74 years were randomly selected for a population-based study in the southwest of Sweden (The Skaraborg Project). All participants performed an oral glucose tolerance test (OGTT) and had anthropometric measurements and blood pressure taken. Fasting venous blood samples were drawn and validated questionnaires on lifestyles were completed. Self-rated health (SRH) was ranked on a five-graded scale, and dichotomized into “good or very good” (1-2) or “fair, bad or very bad” (3-5). Leisure time physical activity (LTPA) was reported on a four-graded scale and dichotomized into sedentary/low LTPA or moderate/high LTPA. At baseline, 213 individuals with IGT and 129 with IFG were detected and used for further analyses in this cross-sectional study. Results: Individuals with IGT were found to have lower self-rated health than individuals with IFG (OR=1.62, CI: 1.01-2.60, p=0.047). There was a borderline interaction between sex and IGT/IFG considering self-rated health (p=0.055) and the difference in self-rated health was seen particularly in men when adjusted for age and BMI (OR=2.13, CI: 1.13-4.02, p=0.020). The results remained significant when also adjusting for smoking, history of CVD and lack of sleep, but became insignificant when including physical activity in the model (OR=1.8, CI: 0.91-3.58, p=0.094). Individuals with IGT reported a lower level of physical activity than those with IFG (OR=2.2, CI: 1.30-3.75, p=0.004) when adjusting for age, BMI and history of CVD. No significant differences were seen in alcohol consumption (P=0.209) or smoking (p=0.150). Conclusion: This study shows that individuals with IGT had significantly worse self-rated health than individuals with IFG and also a less physically active lifestyle. These results indicate that physical inactivity might be an important explanatory factor behind the observed association between low self-rated health and IGT. These findings are important to consider in care-taking and treatment of patients with IGT and IFG in primary care.

Propranolol for proliferating hemangioma: therapeutic efficacy and expressions of vascular endothelial growth factor-A and hypoxia-inducible factor 1α in patients before and after treatment

Objective To evaluate the clinical efficacy of propranolol in treating proliferating infantile haemangiomas,and to measure the expression levels of vascular endothelial growth factor-A (VEGF-A) and hypoxiainducible factor 1α (HIF-1α) in sera and urine of patients during the treatment.Methods Thirty infants with proliferating haemangiomas were treated with propranolol at doses of 0.5-2 mg/kg per day.The radius of haemangiomas was measured,and blood and urine samples were obtained from these patients before,and at 4 and 12 weeks after the beginning of treatment.Clinical efficacy was estimated according to a four-graded scale as well as the feedback from parents of these patients.Enzyme-linked immunosorbent assay (ELISA) was performed to determine the serum and urine concentrations of VEGF-A and HIF-1α.Thirty check-up infants collected from the Department of Child Health Care served as the healthy controls.Statistical analysis was done by two-way analysis of variance followed by the least significant difference (LSD) test.Results After 12 weeks of treatment,clinical response was excellent in 2 patients,good in 11,moderate in 14,and poor in 3.The serum levels of VEGF-A and HIF-1α were (268.174 ± 95.056) μg/L and (10.809 ± 1.686) mg/L respectively in the control group,sequentially decreased in the patients from baseline to 4 and 12 weeks after the beginning of treatment (VEGF-A:(385.692 ± 136.146) vs.(264.853 ± 122.12) vs.(211.345 ± 104.035) μg/L; HIF-1α:(31.462 ± 7.458) vs.(21.454 ± 5.489) vs.(12.052 ± 3.623) mg/L).The trend in expression changes of VEGF-A and HIF-1α in urine samples was similar to that in blood samples in these patients.Positive correlation was observed between the expression level of VEGF-A and HIF-1α in sera (r=0.730,P＜ 0.05) and urine (r=0.667,P＜ 0.05) of these patients.Moreover,the levels of serum VEGF-A,urine VEGF-A,serum HIF-1α and urine HIF-1α were all negatively correlated with the time course following propranolol administration (r =-0.390,-0.689,-0.806,-0.683,P ＜ 0.05,0.01,0.05,0.01 respectively).Conclusion Propranolol is effective for the treatment of proliferating infantile haemangiomas,likely by reducing serum and urinary concentrations of VEGF-A and HIF-lα in children. Key words: Propranolol; Hemangioma; Vascular endothelial growth factor A; Hypoxia-inducible factor 1α

Preemptive dexmedetomidine to prevent propofol injection pain in children.

The incidence of propofol injection pain is high in children, but no methods have been found to suppress it completely. This study intends to evaluate the efficacy of dexmedetomidine-midazolam in preventing propofol injection pain in children. One-hundred ASA I patients, aged 3-12 years, weighing 15-53 kg, undergoing elective surgery were randomized into two groups of 50 each, using computer-generated random numbers. Normal saline 0.15 ml/kg in Group C or dexmedetomidine 0.6 μg/kg in Group D was infused IV over 10 min. Then midazolam 0.06 mg/kg was administered immediately; 2 min after aforementioned treatments in each group, all patients received propofol 2 mg/kg (propofol was mixed with lidocaine 1 mg/ml in Group C) at an average rate of 0.2 ml per 1 s. Another anesthesiologist, blind to the pretreatment, recorded the occurrence of injection pain using a four-graded pain scale: 1 = no pain (no reaction to injection), 2 = slight pain (minor verbal/facial response or motor reaction to injection), 3 = moderate pain (clear verbal/facial response or motor reaction to injection) and 4 = severe pain (the patient both complained of pain and withdrew the arm). Forty (80 %) patients in Group C (control) had injection pain; however, none of patients in Group D had any injection pain. The total incidence of profol-induced pain in Group C was significantly higher (P < 0.01). There were no instances of bradycardia or low blood pressure with either treatment in this study. Pretreatment with dexmedetomidine 0.6 μg/kg, then midazolam 0.06 mg/kg could suppress propofol injection pain in children.

The Distribution of Macrophages with a M1 or M2 Phenotype in Relation to Prognosis and the Molecular Characteristics of Colorectal Cancer

High macrophage infiltration has been correlated to improved survival in colorectal cancer (CRC). Tumor associated macrophages (TAMs) play complex roles in tumorigenesis since they are believed to hold both tumor preventing (M1 macrophages) and tumor promoting (M2 macrophages) activities. Here we have applied an immunohistochemical approach to determine the degree of infiltrating macrophages with a M1 or M2 phenotype in clinical specimens of CRC in relation to prognosis, both in CRC in general but also in subgroups of CRC defined by microsatellite instability (MSI) screening status and the CpG island methylator phenotype (CIMP). A total of 485 consecutive CRC specimens were stained for nitric oxide synthase 2 (NOS2) (also denoted iNOS) as a marker for the M1 macrophage phenotype and the scavenger receptor CD163 as a marker for the M2 macrophage phenotype. The average infiltration of NOS2 and CD163 expressing macrophages along the invasive tumor front was semi-quantitatively evaluated using a four-graded scale. Two subtypes of macrophages, displaying M1 (NOS2+) or M2 (CD163+) phenotypes, were recognized. We observed a significant correlation between the amount of NOS2+ and CD163+ cells (P<0.0001). A strong inverse correlation to tumor stage was found for both NOS2 (P<0.0001) and CD163 (P<0.0001) infiltration. Furthermore, patients harbouring tumors highly infiltrated by NOS2+ cells had a significantly better prognosis than those infiltrated by few NOS2+ cells, and this was found to be independent of MSI screening status and CIMP status. No significant difference was found on cancer-specific survival in groups of CRC with different NOS2/CD163 ratios. In conclusion, an increased infiltration of macrophages with a M1 phenotype at the tumor front is accompanied by a concomitant increase in macrophages with a M2 phenotype, and in a stage dependent manner correlated to a better prognosis in patients with CRC.

Endotracheal tube size and sore throat following surgery: a randomized‐controlled study

Sore throat following endotracheal intubation is a common problem following surgery and one of the factors that affects the quality of recovery. This study was carried out with the primary aim of assessing whether the size of the endotracheal tube (ETT) affects the risk of sore throat in women following anaesthesia. One hundred healthy adult women undergoing elective surgery were randomly allocated to oral intubation with either ETT size 6.0 or 7.0. Anaesthesia was based on either inhalation or total intravenous anaesthesia according to standardized routines. Pre- and post-operatively, sore throat and discomfort were assessed on a four-graded scale and for hoarseness on a binary scale (yes or no). Post-operatively, the assessments were performed after 1-2 and 24 h, and if there was discomfort at 24 h, a follow-up call was made at 72 and 96 h. After 1-2 h post-operatively, there were a higher proportion of patients with sore throat in ETT 7.0 vs. ETT 6.0 (51.1% vs. 27.1%), P=0.006. This difference between the groups was also evident, P=0.002, when comparing changes between the pre- and the post-operative values. The severity of discomfort from sore throat was also higher in ETT 7.0 (38.8%) compared with ETT 6.0 (18.8%), P=0.02. No differences were found in the incidence of hoarseness between the groups. The remaining symptoms lasted up to 96 h post-operatively in 11%, irrespective of the tube size. Use of a smaller-sized ETT can alleviate sore throat and discomfort in women at the post-anaesthesia care unit.

Bright liver, body composition and insulin resistance changes with nutritional intervention: a follow‐up study

Nonalcoholic fatty liver disease (NAFLD) because of its association with obesity, diabetes and insulin resistance (IR), is the hepatic expression of metabolic syndrome. Exercise and nutritional intervention can improve and prevent these inter-related conditions; the relationships between the degree of IR and ultrasound (US) morphological post-interventional changes are not defined. The aim of our study was to assess the relationship, if any, in NAFLD patients, among IR, BMI and degree of bright liver, before and after 6 months of a moderately hypocaloric/balanced dietary/lifestyle treatment. Fifty outpatients with a clinical and US diagnosis of NAFLD were studied. Liver echogenicity [Bright Liver Score (BLS)] was scored on a four-graded scale. IR was assessed by homoeostasis model-insulin resistance (HOMA-IR). Body composition was assessed by bioimpedance assessment and skinfold measurements. A significant decrease of BLS was observed, with a concurrent decrease of body weight, body mass index (BMI) and HOMA-IR. Bright liver decrease has a trend parallel to IR, much less steep than the trend of bright liver reduction against US liver dimensions, body weight and BMI decrease. HOMA-IR is the only baseline variable that enters significantly in the multiple regression and, alone, explains 21.4% of variance in predicting bright liver degree. After dietary interventions, both HOMA-IR and BMI are significantly involved in the multiple regression and explain, together, 42.3% of variance in predicting bright liver degree; variation in BLS can be predicted by variation of body weight and of US longitudinal measurement of the liver. Liver US BLS appears to be a useful tool, both alone and along with other US measurements and body weight changes, for the assessment of clinical-metabolic amelioration in patients treated with dietetic interventions. The clinical-diagnostic role, if any, of other assessed laboratory analyses, in the subset of NAFLD, does not appear to be definite.

Validation of a Four-Graded Scale for Severity of Heartburn in Patients with Symptoms of Gastroesophageal Reflux Disease

Objectives To evaluate the reliability, responsiveness, and validity of a four-graded symptom severity scale (none, mild, moderate, severe) and an eight-graded frequency scale (number of days with symptoms during past week) for assessment of heartburn severity and frequency in patients with symptoms of heartburn but without esophagitis. Methods Data were taken from two 4-week clinical trials comparing esomeprazole 20 mg and/or 40 mg to omeprazole 20 mg. Both scales were analyzed in terms of mean scores and treatment success rates, after dichotomization to “treatment success” variables. Results Heartburn severity reliability was higher when assessed by patient diary cards than by the investigator (intraclass correlation coefficients were 0.79 and 0.59, respectively; corresponding figures for heartburn frequency were 0.77 and 0.78). There was good agreement between investigator and diary card assessments for the dichotomized variables “complete resolution” and “adequate relief” from heartburn. High correlation between investigator- and diary card-assessed heartburn severity and frequency was apparent. Responsiveness was high, as shown by comparing 4-week treatment success rates to the patients' perception of treatment effect according to the Overall Treatment Effect questionnaire. Construct validity was good (kappa values approximately 0.70 for agreement between complete resolution and the dichotomized Gastrointestinal Symptom Rating Scale [GSRS] Heartburn item). Correlations between heartburn severity and frequency and the GSRS Heartburn item were similarly high. Conclusion The four-graded heartburn severity and eight-graded frequency scales are reliable, responsive, and valid when used in clinical trials of patients with symptoms of gastroesophageal reflux disease, irrespective of the type of assessment (investigator assessment or patient diary cards).

Semiquantitative evaluation overestimates the degree of steatosis in liver biopsies: a comparison to stereological point counting

The degree of steatosis in liver biopsies is usually assessed by a morphological semiquantitative approach in which the histopathologist uses a four-graded scale: 0–3 or none, slight, moderate and severe. Scores 1–3 are considered to correspond to fat deposition in <33, 33–66 and >66% of the hepatocytes. There is a considerable inter- and intra-individual variation in such scoring methods and a more standardized and quantitative approach is preferable. In the present study, we compare the semiquantitative technique with the stereological point counting method in the assessment of hepatic steatosis. A total of 75 archived liver needle biopsies were used. They were selected according to the original routine diagnosis of slight, moderate or severe steatosis. In all, 10 randomly selected images from each biopsy were digitized into a computer, a point grid lattice was superimposed and the number of hits on fat globules was counted. A pathologist scored the specimens in a four-graded scale as described above. The mean liver biopsy area (volume) with fat in hepatocytes was 2.2% for grade 1, 9.2% for grade 2 and 23.1% for grade 3. The kappa value for the semiquantitative estimates was 0.71 for the unweigthed kappa and 0.87 for weighted kappa. The intraclass correlation coefficient (ICC) was 0.99 for images counted twice and 0.95 when two sets of images were captured from the same biopsy. These ICCs indicate excellent agreement and above that of the semiquantitative estimates. In conclusion, the area/volume of fat content of the hepatocytes is greatly overemphasized in semiquantitative estimation. Furthermore, the point counting technique has a better reproducibility than visual evaluation and should be preferred in estimates of liver steatosis in scientific studies and in clinical contexts when the amount of steatosis is important for treatment and prognosis, such as liver transplantation.

Pharmacokinetics and efficacy of ropivacaine for continuous epidural infusion in neonates and infants

The primary objective of this noncomparative study was to evaluate the pharmacokinetics of ropivacaine during a 48-72-h continuous epidural infusion of ropivacaine in children under 1 year. The secondary objectives were to assess efficacy and safety. Neonates and infants (ASA I-III, gestational age > or =37 weeks, > or =2.5 kg, scheduled for major abdominal or thoracic surgery) were included and separated into age groups: 0-30 (neonate), 31-90, 91-180, and 181-365 days. Ethics committee approval and informed parental consent were obtained before inclusion. An epidural catheter was introduced under general anesthesia at the appropriate dermatomal level. An initial bolus dose (0.9-2.0 mg.kg(-1) of ropivacaine 0.2%) was followed by an epidural infusion (0.2 mg.kg(-1).h(-1) for infants <180 days or 0.4 mg.kg(-1).h(-1) for infants >180 days). Plasma samples were collected every 12 h from 24 h, and on termination of the epidural infusion. Postoperative pain was evaluated using both the Objective Pain Scale and a four-graded descriptive scale. Forty-five infants, median age 116 (0-362) days, were included. Forty-three and 19 patients received an infusion for at least 48 and 72 h, respectively. Satisfactory analgesia was provided in the majority, only 20 patients were given supplementary medication during the infusion. In all age groups, plasma concentrations of unbound ropivacaine leveled at 24 h, without any further increase at 48 and 72 h. Because of lower clearance of unbound ropivacaine in neonates (mean 33 ml.min(-1).kg(-1)) than in infants above the age of 30 days (80, 124, and 163 ml.min(-1).kg(-1), respectively, in the age groups 31-90, 91-180, and 180-365 days), unbound ropivacaine concentrations at the end of infusion were higher in neonates [median 0.10 mg.l(-1) (0.04-0.21 mg.l(-1))] than in infants >30 days [median 0.03 mg.l(-1) (0.003-0.10 mg.l(-1))]. Epidural infusions (0.2-0.4 mg.kg(-1).h(-1) ropivacaine) provided satisfactory pain relief in neonates and infants under 1 year. As plasma concentrations of unbound ropivacaine were not influenced by the duration of the infusion, ropivacaine can be safely used for postoperative epidural infusion for 48-72 h. Levels of unbound ropivacaine were higher in the neonates than in the infants, but were below threshold concentrations for CNS toxicity in adults (> or =0.35 mg.l(-1)). This should not preclude the use of ropivacaine infusions in neonates but suggests a need for caution during the first weeks of life.

Validation of a six‐graded faces scale for evaluation of postoperative pain in children

The faces pain scales are often used for self-report assessment of paediatric pain. The aim of this study was to evaluate the validity of a six-graded faces pain scale after surgery by comparing the level of agreement between the children's report of faces pain scores and experienced nurses' assessment of pain by observation of behaviour. The faces pain scores before, at and after administration of analgesics were analysed. The study was performed in two South African hospitals, one with a mainly rural population and the other with an urban population. A total of 110 children aged 4-12 years, scheduled for inguinal surgery in the two South African hospitals, were included in the study. The anaesthetic technique was standardized. All patients received a caudal block preoperatively. Postoperative pain assessments were made every hour for 8 h after the caudal block was performed. A designated nurse assessed pain by using a four-graded descriptive scale (no, mild, moderate or severe pain) and thereafter the child reported pain by using the six-graded faces pain scale. A high correlation was found between the two methods of assessment (tau = 0.76, P < 0.0001). The correlation between methods was high in both hospital populations and in all age groups. The weakest correlation was found in children aged 8-12 years (tau = 0.56, P < 0.01). Significantly lower faces pain scores were found after administration of analgesics compared with pain rating before analgesics (P < 0.0001). The proportion of patients with pain scores above 2 decreased from 86% to 31% (P < 0.001). The findings support this six-graded faces pain scale as a useful and valid instrument for measuring pain in the postoperative period in children aged 4-12 years.

Azithromycin Compared with Minocycline in the Treatment of Acne Comedonica and Papulo-Pustulosa

This open study was conducted in 72 outpatients with acne vulgaris, to compare the clinical efficacy and tolerability of azithromycin and minocycline. Azithromycin was administered as a single oral dose (500 mg/day) for 4 days in four cycles every 10 days and minocycline was administered 100 mg daily for 6 weeks. Improvement was assessed 6 weeks after initiation of treatment with a four-graded scale. A satisfactory clinical response was observed in 75.8% of the patients treated with azithromycin and in 70.5% of those treated with minocycline. There were no significant differences between these two acne treatments in terms of reduction of the number of lesions (p> 0.05). Both agents were well tolerated and mild side effects were reported in 10.3% of azithromycin and 11.7% of minocycline treated patients. We conclude that azithromycin is at least as clinically effective and well tolerated as minocycline as treatment of facial comedonic and papulopustular acne.

The human leucocyte antigen (HLA) DR expression and the distribution of T-lymphocytes in the fimbriae of the normal fallopian tube and during pelvic adhesion disease.

Systematically to investigate the expression of human leucocyte antigen (HLA) DR on the columnar epithelium and the content of T-lymphocytes in the fimbriae specimens of the fallopian tube from healthy women and from women with infertility and pelvic adhesions. The staining of HLA-DR expression on the columnar epithelium was judged on a four-graded scale according to the distribution of HLA-DR expression. The amount and distribution of T-lymphocytes were registered. The biopsies from normal fimbriae contained sparsely infiltrating T-lymphocytes. On the columnar epithelial cells a patchy HLA-DR expression was observed that was more widespread in preovulatory cases. In some biopsies from sactosalpinx, the HLA-DR expression was found completely to cover the columnar epithelial cells and was associated with a heavy infiltration of T-lymphocytes. CD4+ T-lymphocytes dominated in all but one adhesion biopsies. The findings indicate an ongoing immunological activity in pelvic adhesions that might immunologically influence fertility.

Dynamic neck strength training effect on pain and function.

This study examined whether neck resistance training could increase strength and reduce pain in workers with a high prevalence of neck disorders. Middle-aged women workers (n = 17) exercised twice weekly for 8 weeks. Each session (12min) consisted of three sets of 12 repetitions of resisted rotation, flexion, and extension muscles using hydraulic dampers. Resistance was set individually and progressively increased every second week. Angle-specific maximal isometric rotator, extensor, and flexor torque was measured before and after training. Torque during rotation, flexion and extension increased (p < .05) on average 35%, 27%, and 19%, respectively, after training. Perceived pain, assessed using a four-graded scale, was reduced (p < .05) after training. It is suggested that 12 minutes of specific neck strength training twice weekly for 8 weeks increases strength of rotator, extensor, and flexor muscles of the neck. Also all individuals who had pain reported reduced perceived neck pain after training.