Riparian proper functioning condition assessment to improve watershed management for water quality

Pollutants can be reduced, ameliorated, or assimilated when riparian ecosystems have the vegetation, water, and soil/landform needed for riparian functions. Loss of physical form and ecological function unravels assimilation processes, increasing supply and transport of pollutants. Water quality and aquatic organisms are response measures of accumulated upstream discharges, and ultimately of changes in riparian functions. Thus, water quality monitoring often fails to identify or lags behind many causes of pollution or remediation from riparian degradation. This paper reviews the interagency riparian proper functioning condition (PFC) assessment for lotic (running water) riparian ecosystems and outlines connections between PFC and water quality attributes (sediment, nutrients, temperature, and dissolved oxygen [DO]). The PFC interaction of hydrology, vegetation, and soils/landforms influences water quality by dissipating energy associated with high waterflow, thereby reducing vertical instability and lateral erosion while developing floodplains with captured sediment and nutrients. Slowing flood water enables aquifer recharge, deposition, and plant nutrient uptake. Water-loving, densely rooted streambank stabilizing vegetation and/or wood helps integrate riparian functions to maintain channel pattern, profile, and dimension with characteristics for a diversity of habitats. A complex food web helps slow the nutrient spiral with uptake and storage. Temperature fluctuations are dampened by delayed discharges, narrower and deeper active channels, coarser substrates that enhance hyporheic interchange, and shade from riparian vegetation. After assessment and implementation, monitoring recovery of impaired riparian function attributes (e.g., streambank plant species) naturally focuses on persistent drivers of water quality and aquatic habitat. This provides timely environmental indicators of stream ecological health and water quality remediation projects or land management.

Ultrasound Practitioner Master's Degree Curriculum and Questionnaire Response by the SDMS Membership

Following publication of the ultrasound practitioner (UP) master's degree educational proposal in August 1999, the UP Commission published a questionnaire to obtain feedback from SDMS membership to the UP concept. This article contains the results of that data collection. Additionally, as progress has been made in the development of UP programs around the country, refinement of the curriculum, as originally proposed, has begun. This article contains a breakdown of required didactic and clinical education for the midlevel provider in diagnostic ultrasound.

Evaluation of liquid aerosol transport through porous media

Application of remediation methods in contaminated vadose zones has been hindered by an inability to effectively distribute liquid- or solid-phase amendments. Injection as aerosols in a carrier gas could be a viable method for achieving useful distributions of amendments in unsaturated materials. The objectives of this work were to characterize radial transport of aerosols in unsaturated porous media, and to develop capabilities for predicting results of aerosol injection scenarios at the field-scale. Transport processes were investigated by conducting lab-scale injection experiments with radial flow geometry, and predictive capabilities were obtained by developing and validating a numerical model for simulating coupled aerosol transport, deposition, and multi-phase flow in porous media. Soybean oil was transported more than 2m through sand by injecting it as micron-scale aerosol droplets. Oil saturation in the sand increased with time to a maximum of 0.25, and decreased with radial distance in the experiments. The numerical analysis predicted the distribution of oil saturation with only minor calibration. The results indicated that evolution of oil saturation was controlled by aerosol deposition and subsequent flow of the liquid oil, and simulation requires including these two coupled processes. The calibrated model was used to evaluate field applications. The results suggest that amendments can be delivered to the vadose zone as aerosols, and that gas injection rate and aerosol particle size will be important controls on the process.

The Management of Prolactin-Secreting Pituitary Adenomas

Advances in the investigation and treatment of pituitary tumours over the past decade have necessitated a major reappraisal of the management of these lesions. The recognition that prolactin-secreting pituitary adenomas (prolactinomas) not only represent a further sub-group of secretory tumours but may in fact be the commonest type of pituitary tumour has come at an appropriate time. Refinements in neuroradiological techniques and transphenoidal surgery and the introduction of the dopamine-agonist bromocriptine now offer prospects for early detection and effective treatment, either by selective adenomectomy or by non-invasive therapy with bromocriptine. In a study of 67 patients with large prolactin-secreting pituitary adenomas, 33 have undergone computerised tomography and metrizamide cisternography for assessment of tumour size. In ten of these patients repeat scans following bromocriptine therapy have shown reduction in prolactinoma size in eight. The two patients with no change in tumour size differed from the rest, having received a lower dose of bromocriptine and had prolactinomas as part of the multiple endocrine adenomatosis syndrome (Type I).

Clinical evaluation of the intestinal microcirculation using sidestream dark field imaging--recommendations of a round table meeting

INTRODUCTION

In clinical setting, Sidestream Dark Field (SDF) imaging has provided unprecedented insights into the gut microcirculation mainly by studying the intestinal mucosa of patients with ileostomies. Visualizing microvascular structure and function of ileal mucosa at the bedside brings unique opportunity for clinical research, particularly in critically ill patients. Several papers that were focused on intestinal microcirculation, used different methods of assessment because an accepted scoring systems does not exist so far and it is no surprise that it is rather difficult to compare the results from these studies. The present paper presents recommendations concerning specific aspects of image acquisition and proposes some parameters for the description of the intestinal microcirculation in human studies, as suggested by the participants of a round table meeting.

METHODS

The round table meeting participants reviewed all relevant literature, discussed various aspects of image acquisition by SDF technology in patients with ileostomy and parameters for the description of intestinal mucosa microcirculation. Selected key conditions for high quality and reproducible image recordings were identified. To evaluate quality of intestinal microcirculation, selected parameters and scoring system were suggested and described.

RESULTS

For image acquisition in ileostomies, five key points were proposed: optimal timing, optimal SDF device probe positioning, optimal stabilization, optimal number and length of acquired video recordings, and optimal avoidance of pressure artefacts. With regard to image analysis, simplified set of quantitative and qualitative parameters for the description of the intestinal mucosa microcirculation for the clinical studies has been proposed: vessels per villus, microvascular flow index, proportion of perfused villi, and borders of villi. The proposed parameters can be included in a semi-quantitative scoring system; however, this scoring system needs further validation. This simplified analysis does not require sophisticated software and can be performed manually on the video screen.

CONCLUSION

We propose a simple methodology for image acquisition and suggest specific microvascular parameters to analyze SDF imaging studies of the intestinal mucosa microcirculation in patients with ileostomy. Proposed scoring system needs to be validated in further clinical studies.

Randomized phase II trial of pemetrexed/cisplatin with or without CBP501 in patients with advanced malignant pleural mesothelioma

BACKGROUND

CBP501, a synthetic duodecapeptide, increases cisplatin influx into tumor cells through an interaction with calmodulin enhancing cisplatin cytotoxicity, and effects cell cycle progression by abrogating DNA repair at the G2 checkpoint. In phase I clinical trials of CBP501 alone or in combination with cisplatin, the most common toxicity was infusion-related urticaria. Activity of CBP501 plus cisplatin was observed in patients with ovarian cancer and mesothelioma, including some patients previously treated with cisplatin.

METHODS

Chemotherapy naïve patients with unresectable MPM were stratified by histology and performance status, and randomized 2:1 to pemetrexed/cisplatin plus CBP501 25mg/m(2) IV (Arm A) or pemetrexed/cisplatin alone (Arm B). The primary endpoint was progression free survival (PFS) at 4 months.

RESULTS

65 patients were randomized, and 63 were treated. Patient characteristics in the two arms were balanced. Based on independent radiology review of the treated population, 25/40 patients (63%) in Arm A and 9/23 (39%) in Arm B had PFS≥4mo; the median PFS was 5.1mo (95% CI, 3.9, 6.5) vs 3.4mo (2.5, 6.7). Median OS was 13.3mo (9.2, 16.3) in Arm A and 12.8 (6.5, 16.1) in Arm B. Adverse events were not different than expected from standard chemotherapy, and comparable in the two arms, aside from infusion reactions which occurred in 70% of patients treated with CBP501.

CONCLUSIONS

While this randomized phase II trial met its primary endpoint of PFS at 4 months, other parameters such as response rate and overall survival suggest that the addition of CBP501 does not improve the efficacy of standard chemotherapy for MPM.

Magnetic resonance imaging of fixed post mortem brains reliably reflects subcortical vascular pathology of frontal, parietal and occipital white matter

AIMS

Subcortical vascular pathology of the white and deep grey matter (WM and DGM) is associated with cognitive impairment. Routine neuropathological assessment of subcortical vascular pathology is based on semiquantitative scoring of characteristic lesions in a limited number of histological slides from selected WM and DGM areas. Clinically, WM and DGM lesions are visualized as hyper-intensities on magnetic resonance imaging (MRI). The aim of this study was to evaluate the feasibility of MRI on fixed post mortem brain hemispheres to complement routine neuropathological assessment of subcortical vascular pathology.

METHODS

We assessed subcortical vascular pathology in 40 post mortem brain hemispheres from demented (n = 26) and nondemented (n = 14) individuals (mean age 83.2 ± 14.8 years; 62.5% female) using (i) routine histological assessment; (ii) extensive histological assessment of the entire hemisphere at 7-mm intervals; and (iii) full T2-weighted MRI performed on fixed post mortem brain hemispheres.

RESULTS

In both WM and DGM routine histological scores for subcortical vascular pathology were significantly lower (P < 0.01) than the corresponding scores obtained by extensive histological assessment. In contrast, no significant differences were seen between scores obtained by MRI and extensive histological assessment in frontal, parietal and occipital lobes while MRI scores were significantly lower in the temporal WM and DGM (P < 0.01).

CONCLUSIONS

The results of our study indicate that routine histological assessment underrates subcortical vascular pathology and we conclude that MRI could be used in addition to complement neuropathological post mortem assessment of subcortical vascular pathology of the WM.

Electrical activity of the diaphragm (Edi) values and Edi catheter placement in non-ventilated preterm neonates

OBJECTIVE

The electrical activity of the diaphragm (Edi) reflects neural respiratory drive. Edi peak correlates with inspiratory drive and Edi minimum (Edi min) correlates with the tonic activity of the diaphragm. Edi data in non-ventilated preterm neonates have not been determined.The primary aim of this study was to determine Edi values in non-ventilated preterm neonates throughout postnatal maturation and with various types of noninvasive respiratory support. The secondary aim was to evaluate the success or complications of placement of the Edi catheter in premature neonates.

STUDY DESIGN

This was a prospective observational study of non-ventilated neonates <33 weeks gestation. Data were collected weekly using an Edi catheter placed in neonates on highflow nasal cannula (HFNC), nasal cannula (NC) or room air (RA). Clinical stability was determined by measuring heart rate (HR), respiratory rate (RR) and oxygen saturation (Sats). Success and adverse events of Edi catheter placement was monitored. Statistics were obtained by analysis of variance, P<0.05 was considered significant.

RESULT

Seventeen neonates were enrolled at 26 to 33 weeks postmenstrual age and studied from 1 to 10 weeks in duration. Overall Edi peak was 10.8±3.7 mcV (range 3.7 to 18.7) and Edi min was 2.8±1.1 mcV (range 0.8 to 7.6). There was no difference in Edi peak and min over postmenstrual ages within or between neonates, and no difference between those neonates on HFNC, NC or RA. HR, RR and Sats were not different over postmenstrual age or between any groups. The Edi catheter was placed successfully in 100% of these neonates. There were no adverse events noted.

CONCLUSION

In clinically stable neonates, the inspiratory drive (Edi peak) and tonic activity (Edi min) do not change with postnatal maturation or with the level of noninvasive respiratory support. The Edi catheter can be placed successfully in these premature neonates. These Edi data have the potential to guide ventilatory management of premature neonates.