Dualism and uniformism in sleep

The phenomenological evidence for distinguishing between REM and NREM sleep is overwhelming. However, this difference has only been found thanks to electrophysiological analytical methods, and is practically non existent in phenotypic terms, i.e., observable with the naked eye. It is well accepted that the selective pressure determining evolutionary changes can only work upon phenotypic differences. Hence, it follows that the differences between REM and NREM could not have been selected through evolution and this implies that, in functional terms, both states could be equivalent.

[Acoustic voice analysis: reliability of a set of multi-dimensional parameters]

A correlational study of the reliability of acoustic voice parameters was made of 148 healthy adults. Acoustic analysis was performed with MDVP-Multi-Dimensional Voice Program implemented in a CSL-Computerized Speech Lab of Kay Elemetrics. A set of 29 voice parameters were obtained from two samples of sustained vowel /a/ recorded from each subject. General results separated by sex are showed and the test-retest reliability in each pair of measures was calculated. Data show a high intra-subject stability of Frequency Fundamental parameters; acceptable stability in parameters of Frequency and Amplitude Perturbation, Noise, Subharmonics and Voice irregularities; and a very low consistency in Tremor parameters. Parameters related with shimmer were more reliable than parameters related with jitter. According to results several conclusions are reported.

Microscopic model of superconductivity in carbon nanotubes

We propose the model of a manifold of one-dimensional interacting electron systems to account for the superconductivity observed in ropes of nanotubes. We rely on the strong suppression of single-particle hopping between neighboring nanotubes in a disordered rope and conclude that the tunneling takes place in pairs of electrons, which are formed within each nanotube due to the existence of large superconducting correlations. Our estimate of the transition temperature is consistent with the values that have been measured experimentally in ropes with about 100 metallic nanotubes.

Clinical features of late onset psoriatic arthritis

The aim of this work is to compare the clinical and radiological manifestations of patients presenting late onset psoriatic arthritis (PsA) with early onset PsA. An overall of 96 consecutive PsA patients were studied over an 8-month-period. Clinical, laboratory and radiographic signs were assessed. Of the 96 patients studied, 84 had their earliest symptoms before the age of 60 (Group I) and 12 after it (Group II). In Group II the mean age was 65.7 years (range 60-73), the sex ratio (male/female) was 9/3. All patients were HLA-B27 negative; the clinical forms observed were: polyarticular (6 patients; 50%), oligoarticular (4 patients; 33%) and spondyloarthropathy (SpA) (2 patients; 17%). Only two patients had asymmetric sacroiliitis and three had history of dactylitis episodes. In conclusion, we found distinct clinical manifestations in late onset PsA. Peripheral affection was found predominant. The male/female ratio was higher than other age groups.

[Cytomegalovirus sensitivity to anti-retroviral agents in patients infected with the human immunodeficiency virus with chorioretinitis in Spain]

OBJECTIVES

To determine the prevalence of the in vitro resistance rate of cytomegalovirus (CMV) to gancyclovir (GCV) and foscarnet (FOS) among patients with AIDS and chorioretinitis. Furthermore, in vitro sensitivity results were compared with the clinical response to therapy.

PATIENTS AND METHODS

Thirty-six patients with the diagnosis of CMV retinitis and AIDS were included in the study. Antiviral sensitivity testing was performed to 51 clinical CMV strains from these patients. The in vitro sensitivity was compared with the clinical response to therapy. The resistance criteria were the inhibitory dose50 (ID50) GCV > 5 M and ID50 FOS > 400 M.

RESULTS

None of the CMV tested strains was resistant to GCV or FOS; however, six patients who had relapses of chorioretinitis while on maintenance therapy and isolation during the condition had mean ID50 of strains (n=8) of 1,95 M for GCV (standard deviation [SD] of 0.71) and 115.2 for FOS (SD, 34.7). These patients responded well when drugs were used at induction doses.

CONCLUSION

The in vitro sensitivity testing is not a good predictor of infection control when the drug is used at maintenance doses. This suggests that these strains should be classified in the intermediate resistant category.

Impairment of renal vasodilation with l-arginine is related to more severe disease in untreated hypertensive patients

Data remain insufficient to place the decreased response to L-arginine in hypertensive patients within a consistent pathophysiological sequence. The aim of the present study in patients with essential hypertension was to assess the relationships between the response to L-arginine and a set of relevant clinical and laboratory parameters. In this prospective, interventional study, we administered L-arginine to untreated hypertensive individuals and healthy control subjects and measured the clearance of inulin and of para-aminohippurate and a set of biochemical and clinical variables. L-Arginine infusion revealed major differences between control subjects and 1 subgroup (group B) of hypertensive individuals. Group B hypertensives (n=18) had no increase in inulin clearance and no decrease in renal vascular resistance with L-arginine; however, in another subset of hypertensive patients (group A, n=27), the insulin clearance increased and renal vascular resistance decreased similar to the control group (group C, n=11). The ambulatory blood pressure monitoring in group B showed both an increased mean diastolic pressure and a "nondipper" pattern in the nocturnal regulation of arterial pressure. These findings in group B were accompanied by significant alterations in optic fundus and left ventricle hypertrophy and increased microalbuminuria (all, P<0.05). Furthermore, group B individuals had significantly lower values of HDL cholesterol and a higher baseline atherogenic index, plasma insulin level, and glucose/insulin index. We disclose a previously undescribed relationship between end organ repercussion and decreased renal hemodynamic response to L-arginine. Our results may help to understand the mechanisms that lead to target organ damage in hypertension.

[Precut Vater's papilla. Prospective evaluation of frequency of use, effectiveness, complication and mortality. Cooperative study in the northwest of the province of Buenos Aires]

INTRODUCTION

Precut papillotomy, has been considered a potentially dangerous procedure. In spite of this, numerous national and foreign referral centers have reported good results with the use of this technique that increases the cannulation rate and permits additional therapeutic procedures.

OBJECTIVES

We evaluated the procedure in terms of frequency of use, effectiveness, complications and mortality.

PATIENT AND METHODS

Between January 1, 1996 and December 31, 1999, 419 ERCP were performed in our centers. We used precut papillotomy in 51 patients. Inclusion criteria for precut papillotomy protocol were: 1 precut papillotomy indication. 1-1 failure to cannulate the papilla, 1-2 appropriate indication, 1-3 Expert endoscopist, 2 complete follow up, 3 informed consent. The experimental design of the study was prospective. When the patients entered into the protocol, they underwent a needle-knife sphincterotomy according to Huibregise's technique. The follow up was done during 30 days, with a clinical examination, laboratory test and ultrasonography all of them weekly, to determine the possible complications according to Cotton's criteria and the mortality.

RESULTS

4-1) Precut frequency: 51 patients (pts.) (12.1%). 4-2) Follow up: 49 pts. (96.1%) fulfilled the weekly controls; 2 pts. (3.9%) did not come for the controls. 4-3) Sex and Age: Women 29 pts. (56.9%). Age 62.5 +/- 1.74 years. Men: 22 pts. (43.1%) Age +/- 3.35 years. 4-4) INDICATIONS: Jaundice, diagnosis and treatment: 44 pts. (86.3%), post-cholecystectomy pain; 4 pts. (7.8%), and idiopathic abdominal pain: 3 pts. (5.9%). 4-5) Effectiveness: First attempt 35 pts. (71.4%), second attempt: 10 pts (20.4%). Definite effectiveness: 45 pts. (98.1%), failure: 4 pts. (8.1%). 4-6) Complementary treatment: in 43 pts. we performed the following procedures: papillotomy and stone extraction: 26 pts. (53%), papillotomy and prosthesis: 9 pts. (18.4%), Prosthesis: 8 pts. (16.3%, only pre-cut papillotomy: 6 pts. (12.2%). 4-7 Final diagnoses: Coledocholithiasis 41 pts. (83.6%); Malignant obstruction of biliary duct: 4 pts. (8.2%), Pancreatic Cancer: 1 pts. (2%); Ampullary Cancer 1 pts. (2%). Oddi sphyncter dysfunction: 1 pts. (2%). 4-8.

COMPLICATIONS

Total 9 pts. (18.4%). mild Haemorrhage: 7 pts. (14.4%). Acute pancreatitis: 2 pts. (4%), mild: 1 pts. (2%), severe: 1 pts. (2%) 4-9-Mortality: not recorded.

CONCLUSIONS

5-1 Precut papillotomy is used by us with the same frequency native authors use it, but less than foreign authors. 5-2 Age, sex, indications, complementary treatment and final diagnoses are similar to those repo. 5-3 reported by other authors. 5-3- High rate of follow up. 5-4- High percentage of effectiveness which coincide with consulted studies. Precut papillotomy was the only therapy in 12.2% of the cases. 5-5 Low percentage of complications and, when present, of minor importance coinciding with other authors. 5-6 No mortality. 5-7 In our experience, precut papillotomy was a safe and effective technique to cannulate the papilla.

[Study of renal transplant by deconvoluted renogram with 99m Tc-mercaptoacetyltriglycine (Mag3)]

AIM

To evaluate the usefulness of the 99mTc-MAG3 renogram deconvolution and its derived parameters in kidney graft function monitoring.

MATERIAL AND METHOD

221 renograms were studied: 64 were diagnosed as functioning graft (FG), 37 as functioning graft with elevated serum creatinine (FG2), 59 as acute tubular necrosis (ATN), 30 as acute rejection (AR), 20 as urinary tract obstruction (OBS) and 11 as cyclosporine nephrotoxicity (TNX). The parameters evaluated were: maximal activity of conventional renogram and mean transit time (MTT), time to reach 20% (T20) and 80% (T80) of the height of the RRF and initial uptake (IU) from the deconvoluted renal retention function (RRF).

RESULTS

MTT and T20 were significantly longer and IU significantly lower in non-functioning grafts. However, MTT and T20 became shorter than in FG when graft function is severely impaired.

CONCLUSION

IU, MTT and T20 are more useful than maxim activity of renogram in monitoring kidney graft function and in evaluating renal dysfunction severity. IU is a very sensitive and early parameter.

Consistency of superconducting correlations with one-dimensional electron interactions in carbon nanotubes

We show that a model of interacting electrons in one dimension is able to explain the order of magnitude as well as the temperature dependence of the critical supercurrents recently measured in nanotube samples placed between superconducting contacts. We use bosonization methods to deal with the long-range Coulomb interaction, ending up with a picture in which the critical current does not follow the temperature dependence of the gap in the contacts. Our results also reveal the presence of a short-range attractive interaction in the nanotubes, which accounts for a significant enhancement of the critical supercurrents.

Spiro beta-lactams as beta-turn mimetics. Design, synthesis, and NMR conformational analysis

Molecular modeling calculations using high-level ab initio methods (MP2/6-31+G) of a new type of spiro beta-lactams predict that these systems could adopt a beta-turn secondary structure in solution. Strong intramolecular hydrogen bonds stabilize the beta-turn conformation with a geometry that is very close to the ideal type II beta-turns. The synthesis of the spiro beta-lactams is achieved by Staudinger reaction of a cyclic ketene derived from N-bencyloxycarbonyl-L-proline acid chloride with an imine. This reaction allows the formation of the spiranic backbone in a single-step with high diastereoselectivity and good yields. The new spiro beta-lactams obtained are the core for the preparation of different types of peptidomimetics using well-established peptide chemistry. The NMR conformational analysis shows that these compounds adopt beta-turn conformation as predicted by the theoretical studies.

Effects of stage of harvest on the protein value of fresh lucerne for ruminants

The ruminal degradation of dry matter (DM) and crude protein (CP) and the intestinal availability of CP of four fresh lucerne (Medicago sativa L.) samples, corresponding to a 3rd growing cycle and harvested at 2-week intervals, were determined. Rumen degradability, measured by the nylon bag technique, and rumen outflow rates were determined on three rumen-cannulated wethers. Intestinal digestibility was determined by the mobile bag technique on three duodenal fistulated wethers. Both groups of animals were fed a 2:1 lucerne hay to concentrate diet at an intake level of 40 g DM x kg(-1) BW0.75. The effective degradability (ED) of DM decreased with maturity in linear and quadratic form, as a consequence of a decrease in the soluble fraction and a similar increase in the undegradable materials. The resultant values were 0.795, 0.661, 0.600, and 0.576 for harvests at 2, 4, 6, and 8 weeks. The ED of CP showed the same trend. However, the variations (values of 0.896, 0.832, 0.791, and 0.817, respectively), were moderate and mainly due to the reduction of the proportion of soluble CP. The intestinal digestibility of CP of all samples showed a downward trend with the increase in the ruminal incubation time, as modelled according to a logistic function. The undegraded CP digested in the gut (Di) and therefore the effective intestinal digestibility (EID) were derived from this function according to the rumen outflow of undegraded CP. The effects of maturity on the mean values of Di, expressed as a proportion of the original CP content, were the opposite of those recorded for the ED of CP. These values were 0.067, 0.102, 0.115, and 0.089 for samples harvested at 2, 4, 6, and 8 weeks, respectively. Nevertheless, when Di was expressed as g CP x kg(-1) DM, these values (18.0, 17.4, 17.1, and 14.3, respectively) decreased in linear form. The same trend was observed for EID values, which represent 0.641, 0.609, 0.549, and 0.488, respectively. The change of the digestion site produced by the reduction of ED of CP was also associated with an increase in the undigested CP (values of 0.037, 0.066, 0.094, and 0.094, at the four harvesting times).

Detection of unsuspected cases of nosocomial transmission of tuberculosis by use of a molecular typing method

The aim of this study was to use restriction fragment length polymorphism to detect unsuspected cases of nosocomial transmission of tuberculosis (TB) among patients who had been admitted to a university hospital. One hundred fifty-one samples of Mycobacterium tuberculosis isolated from patients with pulmonary TB were studied. The isolates from 37 patients (24.5%) defined 11 clusters. None of the patients infected with these cluster isolates had hospital stays that coincided with one another, and for 5.4% of the patients, the epidemiological link was clearly outside the hospital. Previous incarceration was associated with infection with cluster isolates. In addition, 109 patients without TB (41 of whom were infected with human immunodeficiency virus) who shared a room with patients who had TB were followed for 18-60 months. Among the patients who survived, secondary cases of TB due to nosocomial transmission were not detected.

[Tetralogy of Fallot complicated by severe hemoptysis in the adult]

Fallot tetralogy with pulmonary artery atresia is a special situation in which the patient can survive up to middle-age. In these cases some complications such as hemoptysis can appear with difficult treatment that endangers the life of the patient. When the cause of bleeding is the arteriovenous shunts, which are frequent in the multiple vascular malformations originated in this congenital cardiopathy, the selective embolization of these malformations can be an effective option of treatment.

Potential role of a new anti-beta3 integrin antibody in the development of intimal hyperplasia after vascular surgery: an in vitro smooth muscle cell model

The occurrence of intimal hyperplasia after vascular surgery is an ongoing concern in current clinical practice. Among the many factors involved in the development of this pathology, platelet adhesion and myointimal proliferation play a major role. Both these processes are mediated by integrins (mainly alphavbeta3 integrins). Over the past years, several substances have been designed to delay or inhibit the cell proliferation that leads to hyperplasia and mainly include monoclonal antibodies directed against integrins. The aim of the present study was to evaluate the effects of an antibody denoted P37 (anti beta3 integrin) on human smooth muscle cells (SMC) and its role in blocking the B3 subunit. To this end, SMC from human umbilical artery were cultured in the presence or absence of the cell substrate vitronectin (VN) and incubated with P37. After 4 days of treatment, determination was made of cell proliferation and migration. Smooth muscle cells grown on VN showed increased proliferation and migration compared to control VN-free cultures. However, the presence of P37 in the culture medium inhibited proliferation and reduced migration. Combined treatment with VN and P37 led to improved proliferation but VN was unable to reverse the effects on migration observed in the former cultures. Results suggest that in vitro, P37 is capable of blocking human SMC beta3 integrins and thus impedes cell proliferation and migration These findings may have clinical implications related to modulation of the development of hyperplasia.

Analysis of IgG response to experimental infection with RH Toxoplasma gondii in goats

The IgG response of goats experimentally infected with RH Toxoplasma gondii has been analysed using an indirect ELISA and Western-blot analysis. Specific IgG antibodies were first detected at 14 days post-inoculation (p.i.), reaching a peak by day 35 p.i. and showing slight fluctuations until the end of the experiment (91 p.i.). Specific IgG showed a reactivity over a whole range of peptides (125-24 kDa approximately), but the highest reactivity was observed against a group of antigens with a molecular weight between 34 and 28 kDa, in particular against a 30 kDa fraction which is considered to represent the major surface protein of T. gondii named p30 or SAG-1.

Dextranase (alpha-1,6 glucan-6-glucanohydrolase) from Penicillium minioluteum expressed in Pichia pastoris: two host cells with minor differences in N-glycosylation

Differences in glycosylation between the natural alpha-1,6 glucan-6-glucanohydrolase from Penicillium minioluteum and the heterologous protein expressed in the yeast Pichia pastoris were analyzed. Glycosylation profiling was carried out using fluorophore-assisted carbohydrate electrophoresis and amine absorption high-performance liquid chromatography (NH(2)-HPLC) in combination with matrix-assisted laser desorption-time of flight-mass spectrometry. Both microorganisms produce only oligomannosidic type structures, but the oligosaccharide population differs in both enzymes. The native enzyme has mainly short oligosaccharide chains ranging from Man(5)GlcNAc(2) to Man(9)GlcNAc(2), of which Man(8)GlcNAc(2) was the most represented oligosaccharide. The oligosaccharides linked to the protein produced in P. pastoris range from Man(7)GlcNAc(2) up to Man(14)GlcNAc(2), with Man(8)GlcNAc(2) and Man(9)GlcNAc(2) being the most abundant structures. In both enzymes the first glycosylation site (Asn(5)) is always glycosylated. However, Asn(537) and Asn(540) are only partially glycosylated in an alternate manner.

[Instruments of depression assessment in schizophrenia]

Lately, numerous reports have focused on the evaluation of depressive symptoms of schizophrenia. This assessment has been hampered by the temporal variability of the depressive symptoms and by their overlap with both the negative symptoms of schizophrenia and the extrapyramidal effects of the antipsychotic treatment. So far, classical assessment instruments such as the Hamilton Depression Rating Scale (HDRS) or the Montgomery-Asberg Rating Depression Scale (MARDS) have been used in those patients suffering from schizophrenia with depressive symptomatology, despite the important limitations concerning their use in subpopulations other than the one they have been developed for. New specific depression scales for schizophrenia such as the Calgary Depression Scale for Schizophrenics (CDSS) seems to have more efficiency and ability to distinguish between depression, negative and extrapyramidal symptoms. The present paper reviews the instruments used so far on the assessment of depressive symptomatology in schizophrenic patients.

Adjuvant radiochemotherapy in the treatment of completely resected, locally advanced gastric cancer

PURPOSE

To analyze the efficacy and toxicity of adjuvant whole abdomen irradiation (WAI) and concomitant chemotherapy in the treatment of completely resected, high-risk gastric cancer.

METHODS AND MATERIALS

Between October 1990 and September 1997, 52 patients with completely resected gastric cancer, with lymph node and/or serosal involvement, were treated. Ages were 16-78 (median, 53.5) years. Treatment was either total- or sub-total gastrectomy, followed by WAI, 2100 cGy/21 fractions plus a 2400 cGy/16 fractions boost to the tumor bed. Chemotherapy consisted of either 5-fluorouracil (5-FU) 450-500 mg/m(2) i.v. for 5 days first and 5th week or 200-300 mg/m(2) continuous infusion during irradiation. No further chemotherapy was given.

RESULTS

With a minimum follow-up of 30 months and a median follow-up of 43.5 months, 25 of the 52 patients have died. Overall 5-year survival rate is 54%. Three patients sustained Grade 3-5 complications. Two patients with Grade 5 complications (malabsorption syndrome) died 31 and 56 months after the beginning of the treatment, respectively, with no evidence of recurrent tumor. For patients with involvement of the lymph nodes alone (n = 19) the 5-year survival was 69%, which was significantly better than the 36% 5-year survival observed for those patients with both serosal and lymph node involvement (n = 26, p = 0.004).

CONCLUSION

Adjuvant radiochemotherapy, WAI, and concomitant 5-FU, is a feasible and a fairly well-tolerated treatment for patients with locally advanced (involvement of the lymph nodes or serosa) gastric carcinoma who undergo complete resection. The 54% overall 5-year survival compares favorably with the survival reported after surgery alone for those patients.

A small outbreak of Legionnaires' disease in a cargo ship under repair

It was reported that two mechanics working on a cargo ship under repair in the port of Barcelona had died after having fever. An investigation was made into the possibility of any additional cases and the presence of Legionella pneumophila in the ship they were repairing and in their hotel. The contaminated water system was treated with sodium hypochlorite. Both patients died after having been repeatedly diagnosed as having influenza. The two cases occurred among those who had been working with the pump of the ship's water system, while no cases were observed among the other workers (p = 0.02). Various serogroups of L. pneumophila were isolated from the ship's water pump and distribution system. However, organism of serogroup 1, subgroup Pontiac (Knoxville) were identified with identical deoxyribonucleic acid (DNA) patterns in the lung tissue of one patient and in the cooling water circuit valve of the ship's water pump. The first postintervention control water samples showed no further growth of legionella, but serogroups 4 and 8 were identified 8 months later. This legionellosis outbreak, although small, was highly lethal, probably due to the high levels of bacteria to which the patients were exposed and also because of the failure of correct diagnosis. International recommendations on prevention and control of legionellosis, which include ships under repair, are required.