Prevalence of positive skin-prick tests results is not enhanced in children with OME. Nevertheless, the association of OME with symptoms associated with atopy suggests that such concomitant diseases may play a part in the pathogenesis of the disorder. Children with allergic rhinitis or atopic eczema should be investigated by tympanometry for OME.

BackgroundThe independent prognostic impact of diabetes mellitus (DM) and prediabetes mellitus (pre‐DM) on survival outcomes in patients with chronic heart failure has been investigated in observational registries and randomized, clinical trials, but the results have been often inconclusive or conflicting. We examined the independent prognostic impact of DM and pre‐DM on survival outcomes in the GISSI‐HF (Gruppo Italiano per lo Studio della Sopravvivenza nella Insufficienza Cardiaca‐Heart Failure) trial.Methods and ResultsWe assessed the risk of all‐cause death and the composite of all‐cause death or cardiovascular hospitalization over a median follow‐up period of 3.9 years among the 6935 chronic heart failure participants of the GISSI‐HF trial, who were stratified by presence of DM (n=2852), pre‐DM (n=2013), and non‐DM (n=2070) at baseline. Compared with non‐DM patients, those with DM had remarkably higher incidence rates of all‐cause death (34.5% versus 24.6%) and the composite end point (63.6% versus 54.7%). Conversely, both event rates were similar between non‐DM patients and those with pre‐DM. Cox regression analysis showed that DM, but not pre‐DM, was associated with an increased risk of all‐cause death (adjusted hazard ratio, 1.43; 95% CI, 1.28–1.60) and of the composite end point (adjusted hazard ratio, 1.23; 95% CI, 1.13–1.32), independently of established risk factors. In the DM subgroup, higher hemoglobin A1c was also independently associated with increased risk of both study outcomes (all‐cause death: adjusted hazard ratio, 1.21; 95% CI, 1.02–1.43; and composite end point: adjusted hazard ratio, 1.14; 95% CI, 1.01–1.29, respectively).ConclusionsPresence of DM was independently associated with poor long‐term survival outcomes in patients with chronic heart failure.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00336336.

The pathogenesis of sarcoidosis is not yet known. On the basis of seroepidemiological data, an association between Chlamydia pneumoniae infection and sarcoidosis has been suggested, but so far no study has addressed the direct detection of this agent in the affected tissues. The aim of the present study was to detect C. pneumoniae deoxyribonucleic acid (DNA) within sarcoid tissue specimens by means of a two-step polymerase chain reaction.Lung biopsy specimens of 33 patients with histologically confirmed pulmonary sarcoidosis and 21 control lung biopsies or pathology specimens of patients with pulmonary carcinoma or emphysema were retrospectively analysed. A nested polymerase chain reaction was applied using two sets of primers designed to detect a fragment of the 16 strand ribosomal ribonucleic acid (rRNA) gene of C. pneumoniae. The results of the study failed to demonstrate the presence of C. pneumoniae in biopsy specimens of sarcoid tissue and in the control lung biopsies or pathology specimens.Our results, therefore, tend to rule out the possibility of a direct involvement of Chlamydia pneumoniae in the pathogenesis of sarcoidosis.

Although nicotine gives its name to one of the principal actions of acetylcholine-the " nicotinic" action on skeletal muscle-the effects of nicotine on mammalian muscle (as distinct from amphibian or avian muscle) have been studied relatively rarely. The most recent analysis was that by Bacq & Brown (1937) who showed that arterial injections of nicotine into the gastrocnemius of the cat produced a contraction of the muscle followed by a prolonged depression of the response to nerve stimulation. They also noted that repetitive stimulation of the nerve relieved the depression of the twitch. There is no information, however, which allows a confident comparison between the effects produced by nicotine and those produced by, for instance, decamethonium or d-tubocurarine. The experiments described here analyse, on cat muscle, some of the characteristics of the action of nicotine in the light of recent knowledge. METHODSCats anaesthetized with chloralose after induction by ethyl chloride and ether were used in all experiments. A tracheal cannula was inserted, and a venous cannula in either the femoral or jugular vein. For injecting into the iliac artery of one leg, the opposite iliac artery and the descending pelvic artery were ligated and a Gordh needle was inserted into the ligated iliac artery pointing centrally so that injections were carried into the open artery on the other side. Some minutes after each injection, an injection of saline 0.5 ml. was made to wash out the needle and arterial deadspace. The contractions of tibialis, soleus or gastrocnemius were recorded using a flat spring myograph writing with a light lever on a smoked drum. The sciatic nerve in the thigh was tied close to the hip; shielded platinum stimulating electrodes were placed on it during its course through the hamstrings. For stimuli, square wave maximal shocks of 0.5 msec duration were used. For close arterial injections into the tibialis muscle, the technique of Brown (1938) was followed.

The high pharmacological activity of 5-hydroxytryptamine (5-HT) and its wide distribution in the body suggest that it may play a part in normal physiological processes, but this is still a matter for speculation. Very small amounts of 5-HT cause vasoconstriction in the perfused ear of a rabbit, and this tissue was used in the work which first led to the isolation of 5-HT. It has been suggested that an important action of 5-HT may be to modify the responses of tissues to other active substances. The effects on the rabbit's ear of 5-HT combined with various other drugs have been studied by Gaddum and Hameed (1954). The experiments described below are an extension of this work. METHODSRabbits were killed by a blow on the head and bled out. Both ears were removed with a sharp scalpel. The central auricular artery was cleaned and cannulated as described by Page and Green (1948). The ears were perfused at room temperature through a polythene cannula. Two reservoirs were used so that alternative fluids could be perfused by adjusting a two-way stopcock. The ear was fixed on a tilted draining board and perfusate was collected in a glass tube from which it ran to the drop timer (Gaddum and Kwiatkowski, 1938). In the tracings the height of the record indicates the time interval between drops.The perfusion fluid was that recommended by Page and Green (1948) for the study of vasoconstrictors and had the following composition (g./l.): NaCl 8.2, KCl 0.84, CaCl2.2H20 0.04, MgCl2.6H20 0.06, NaHCO3 0.4, glucose 1. To each litre was added 10 ml. of phosphate containing 4 parts of M-K2HPO4 to 1 part of M-KH2PO4.The ears were more sensitive on the second and third days than on the first day, after being left overnight in the refrigerator. The doses, which, owing to a misunderstanding and contrary to the usual custom, are given in terms of the weights of the salts, were injected in a uniform volume of 0.1 ml. at regular time intervals. The injections were made slowly through the rubber cap of an injection tube similar to that described by Gaddum and Kwiatkowski (1938) and connected with the polythene cannula. The perfusion fluid entered the air space in this tube in drops, and the rate of injection was regulated so as to keep the size of the drop approximately constant. In this way changes in flow due to changes of pressure in the cannula can be avoided. The " dose-ratio " is the ratio of the dose of 5-HT producing an effect in the presence of the antagonist to the dose producing the same effect in its absence. REsULTSThe doses were kept small in order to avoid changes in the sensitivity of the preparation. The intervals between injections were 5-10 min. in order to avoid tachyphylaxis, which was particularly liable to occur with 5-HT and tryptamine. When these precautions were taken the sensitivity was reasonably constant and suitable effects were produced by the following doses: adrenaline, 0.5-1 ng.; noradrenaline, 1-2 ng.; 5-HT, l-10 ng.; tryptamine, 10-100 ng.; pitressin, 1 mU.; and angiotonin, 0.1 unit. PotentiationWhen 5-H...