Large area nanoscale patterning of silicon surfaces by parallel local oxidation

The homogeneity and the reproducibility of parallel local oxidation have been improved by introducing a thin film of polymethylmethacrylate (PMMA) between the stamp and the silicon surface. The flexibility of the polymer film enables a homogeneous contact of the stamp with the silicon surface to be achieved. The oxides obtained yield better aspect ratios compared with the ones created with no PMMA layer. The pattern is formed when a bias voltage is applied between the stamp and the silicon surface for 1 min. The patterning can be done by a step and repeat technique and is reproducible across a centimetre length scale. Once the oxide nanostructures have been created, the polymer is removed by etching in acetone. Finally, parallel local oxidation is applied to fabricate silicon nanostructures and templates for the growth of organic molecules.

Phylogenetic analysis of New World screwworm fly, Cochliomyia hominivorax, suggests genetic isolation of some Caribbean island populations following colonization from South America

Larval infestations of the New World screwworm (NWS) fly, Cochliomyia hominivorax, cause considerable economic losses through the direct mortality and reduced production of livestock. Since the 1950s, NWS populations in North and Central America have been the target of virtually continuous eradication attempts by sterile insect technique (SIT). Nevertheless, in some areas, such as Jamaica, SIT-based control programmes have failed. Reasons for the failure of SIT-based programmes in some locations are unknown, but it is hypothesized that failure may be related to the mating incompatibility between sterile and wild flies or to the existence of sexually incompatible cryptic species. Accordingly, the current research investigates intraspecific phylogenetic relationships and associated biogeographic patterns between NWS populations from the Caribbean and South America, which represent those populations involved in, or earmarked for, forthcoming SIT programmes. Uniquely, this study also includes analyses of two North American samples, collected in Texas in 1933 and 1953 prior to initiation of the SIT-based eradication programme. The study utilizes three nucleotide datasets: elongation factor-1alpha (nuclear); cytochrome oxidase subunit 1 (mitochondrial), and 12S rRNA (mitochondrial). Phylogenetic analysis of these data, representing populations from across the Caribbean, South America and Texas, indicates sub-structuring of fly populations on several of the larger Caribbean islands, suggesting a period of isolation and/or founder effects following colonization from South America; significantly, our findings do not support a North American origin for Cuban flies. The importance of these findings in the light of proposed SIT programmes in the region is discussed.

Lesiones del nervio cubital en el canal de Guyon: a propósito de 6 casos

La compresión del nervio cubital en el canal de Guyon es mucho menos frecuente que la compresión del nervio mediano en el canal carpiano o del nervio cubital en el codo, ocupando el tercer lugar dentro de los síndromes canaliculares del miembro superior, pero no por ello es rara. A diferencia de estos síndromes, es raro que aparezca de forma idiopática, siendo más frecuente que aparezca de forma secundaria a causas locales, por lo que, a parte del EMG, es más frecuente la utilización de otras pruebas complementarias (RM, TAC, Doppler) para completar el diagnóstico. También puede aparecer como consecuencia de microtraumatismos profesionales, y, dentro de las formas traumáticas, es muy rara la lesión aislada de la rama motora debido a un traumatismo penetrante.

Es fundamental conocer la anatomía de esta zona porque esto nos permitirá hacer un diagnóstico clínico relativamente fácil y precisar el lugar de la compresión, porque anatómicamente este canal se divide en tres zonas, pero además porque es preciso conocer las relaciones anatómicas de este espacio para evitar complicaciones o lesiones iatrogénicas del nervio cubital tras la cirugía del canal carpiano, que se pueden producir a través de la zona central de su pared interna que sólo está ocupada por tejido adiposo, pues el canal de Guyon no es un canal rígido sino de un conducto osteofibroso, tal como lo describió Guyon en 1861.

Comparison of the sensitivity of different toxicity test endpoints in a microalga exposed to the herbicide paraquat

The use of herbicides constitutes the principal method of weed control but the introduction of these compounds into the aquatic environment can provoke severe consequences for non-target organisms such as microalgae. Toxic effects of these pollutants on microalgae are generally evaluated using phytotoxicity tests based on growth inhibition, a population-based parameter. However, physiological cellular endpoints could allow early detection of cell stress and elucidate underlying toxicity mechanisms. Effects of the herbicide paraquat on the freshwater microalga Chlamydomonas moewusii were studied to evaluate growth rate and cellular parameters such as cellular viability and metabolic activity assayed by flow cytometry and DNA damage assayed by the comet assay. Sensitivity of growth and parameters assayed by flow cytometry were similar, showing a significant effect in cultures exposed to a paraquat concentration of 0.1 microM or higher, although in cultures exposed during 48 h to 0.05 microM, a significant stimulation of cellular fluorescein fluorescence was observed, related to cellular metabolic activity. After only 24 h of herbicide exposure significant DNA damage was observed in microalgal cells exposed to all paraquat concentrations assayed, with a 23.67% of comets in cultures exposed to 0.05 microM, revealing the genotoxicity of this herbicide. Taking into account the results obtained, comet assay provides a sensitive and rapid system for measuring primary DNA damage in Chlamydomonas moewusii, which could be an important aspect of environmental genotoxicity monitoring in surface waters.

Online monitoring of OUR, K(L)a and OTE indicators: practical implementation in full-scale industrial WWTPs

Based on on/off aeration strategies, this paper describes all the steps involved in the development and implementation of three identification algorithms aimed at monitoring the oxygen uptake rate (OUR), the oxygen mass-transfer coefficient (K(L)a), and oxygen transfer efficiency (OTE) in aerated biological reactors. Firstly, a detailed explanation of the theoretical background behind every algorithm is given. In addition, practical issues have also been taken into account in order to guarantee the quality of estimations. Finally, the three algorithms have been implemented and validated in a full-scale industrial wastewater treatment plant with satisfactory results. Although short-term noise has been observed in the estimated data (especially at high OURs), the medium and long-term data trajectories have been correctly reproduced.

Maghemite-silica nanocomposites: sol-gel processing enhancement of the magneto-optical response

The preparation and processing of maghemite-silica gel nanocomposites have been investigated in order to maximize their magneto-optical response for magnetic field sensing applications. In situ precipitation of maghemite nanoparticles from an iron salt precursor during the sol-gel processing of the silica matrix has been carried out while controlling the time, temperature, and environment at each step of the whole process. In this paper, the nanostructural, magnetic, and magneto-optical properties of these materials are correlated with the processing path followed, from the starting sol to the partially densified monolith. Results demonstrate that introducing a washing treatment prevents the formation of hematite phase as well as an excessive particle agglomeration. Different processing conditions of identical sols may lead to nanocomposites with a Verdet constant at low magnetic fields (0.01 T) ranging from 200 to 950 rad T(-1) m(-1), which is the typical value of commercial terbium gallium garnets used in Faraday rotators.

[Apolipoprotein E4 in dementia with Lewy bodies]

INTRODUCTION

There is a strong association between the e4 allele of apolipoprotein E (APOE) and Alzheimer's disease (AD). This converts this allele into a risk factor for the development of AD. The association between APOE4 and dementia with Lewy bodies (DLB) is under discussion. In DLB, the presence of APOE4 has been related with a greater amount of senile plaques and neurofibrillary tangles.

METHOD

This is a case-control study in which the APOE genotype was determined using the modified PCR technique of Wenham in 306 patients with diagnosis of probably AD, NINCDS-ADRDA criteria, 58 cases of probably DLB, McKeith et al. consensus criteria (1996), all of them with SPECT with pathological 123I-FP-CIT and 80 normal controls (NC) having similar age and gender distribution.

RESULTS

The frequency of alleles was: DLB group epsilon4: 16%; epsilon3: 75%; epsilon2: 9%; AD: epsilon4: 32%; epsilon3: 67%; epsilon2: 1%; and in the normal control group: epsilon4: 12%; epsilon3: 83%; epsilon2: 5%. The percentage of alleles in both genders was similar in the three groups.

CONCLUSIONS

APOE4 percentage in DLB group (16%) was lower than in AD group (32%), and similar to the control group (12%). Considering that the presence of morphopathological Alzheimer type alterations in DBL, essentially neurofibrillary tangles, is inversely correlated with the presence of Parkinsonian signs, this group may represent pure forms of the disease, although the lack of neuropathological demonstration does not make it possible to confirm this hypothesis.

Cadmium accumulation and its effect on the in vitro growth of woody fleabane and mycorrhized white birch

The effect of Cd on woody fleabane (Dittrichia viscosa (L.) Greuter) and white birch (Betula celtiberica Rothm. & Vasc.) was examined. Woody fleabane and white birch were grown in vitro in Murashige, T., Skoog, F., [1962. A revised medium for rapid growth and bioassays with tobacco tissue cultures. Physiol. Plant. 15, 473-479] (MS) plus Cd (10 mg Cd kg(-1)) and except for root length in white birch, plant development was inhibited when Cd was added. Cd accumulation in above-ground tissues showed differences among clones, reaching 1300 and 463 mg Cd kg(-1) dry wt. in selected clones of woody fleabane and white birch, respectively. Tolerance of Paxillus filamentosus (Scop) Fr. to Cd was also examined before mycorrhization. Plants of mycorrhized white birch grown in the presence of Cd had a better development and accumulated more Cd in their shoots than the non-mycorrhized ones. The use of selected clones of woody fleabane and the mycorrhization of white birch enhance extraction efficiency from contaminated soils in phytoremediation programs.

Emergency contraception in Cuba with 10 mg of mifepristone

BACKGROUND

Mifepristone in a dose of 10 mg is an effective emergency contraceptive when administered up to 120 hours after unprotected coitus.

METHODS

Between May 2003 and February 2005, we conducted in Cuba a single-arm trial to evaluate the effectiveness of 10 mg mifepristone for emergency contraception up to 6 days after unprotected coitus. A total of 635 women who requested emergency contraception after a single act of unprotected intercourse were included in the study.

RESULTS

After treatment there were 7/635 (1.1%) pregnancies (95% CI 0.4-2.3%). Pregnancy that might have occurred was prevented in 88.0% of the cases (95% CI 77.1-95.1%). The most common side effects reported by participants were fatigue (10.7%), dizziness (6.1%) and nausea (4.9%); vomiting was only reported by 0.6%. In 38/635 (6.0%) women menstruation was delayed more than 7 days.

CONCLUSIONS

Mifepristone 10 mg administered is an effective emergency contraceptive with an acceptable profile of side effects up to five days, but greater studies are necessary to verify its efficacy up to 6 days after unprotected intercourse.

[Treatment of antiphospholipid syndrome]

The antiphospholipid syndrome (APS) is a disorder of recurrent thrombosis and/or pregnancy loss associated with the presence of antiphospholipid antibodies and persistently positive lupus anticoagulant, anticardiolipin or anti beta2-glycoprotein1. Oral anticoagulants are the best available and most effective treatment for the secondary prevention of recurrent venous or arterial thrombosis. Patients with APS are treated with long-term therapy to prolong the INR to 2.0-3.0. Low-molecular-weight heparin in combination with low-aspirin dose is a reasonable strategy to avoid pregnancy loss in women with this syndrome.

Development of a web-based support system for both homogeneous and heterogeneous air quality control networks: process and product

The Environmental Laboratories Automation Software System or PALMA (Spanish abbreviation) was developed by a multidisciplinary team in order to support the main tasks of heterogeneous air quality control networks. The software process for PALMA development, which can be perfectly applied to similar multidisciplinary projects, was (a) well-defined, (b) arranged between environmental technicians and informatics, (c) based on quality guides, and (d) clearly user-centred. Moreover, it introduces some interesting advantages with regard to the classical step-by-step approaches. PALMA is a web-based system that allows 'off-line' and automated telematic data acquisition from distributed inmission stations belonging not only to homogeneous but also to heterogeneous air quality control networks. It provides graphic and tabular representations for a comprehensive and centralised analysis of acquired data, and considers the daily work that is associated with such networks: validation of the acquired data, alerts with regard to (periodical) tasks (e.g., analysers verification), downloading of files with environmental information (e.g., dust forecasts), etc. The implantation of PALMA has provided qualitative and quantitative improvements in the work performed by the people in charge of the considered control network.

Initial safety results of an open-label phase II trial of erlotinib in non-small cell lung carcinoma (NSCLC)

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Background: Erlotinib is an orally selective and reversible inhibitor of HER1/EGFR tyrosine kinase. Erlotinib has demonstrated to be effective in the treatment of advanced non-small-cell lung cancer, in terms of longer survival, better quality of life and delayed symptom progression. The TargeT trial is a large open-label, non-randomized, phase II study carried out in 101 Spanish institutions. Methods: Eligibility criteria included stage IIIB-IV previously treated patients (p) with confirmed NSCLC. Patients harboring mutations in EGFR gene or p unsuitable for chemotherapy were also allowed to enter the study and received erlotinib as first line treatment. Subjects were treated with 150 mg/day po until disease progression or unacceptable toxicity. Dose reductions were allowed. Primary end-point was time to progression. Results: By the time of this analysis, data from 1,522 p were available. Median age: 65 y (range 26–95); most p were male (71.9%); active/former a smoker (78.3%). Around half of the p had adenocarcinoma histology, including bronchioloalveolar carcinoma (53%) and 81.8% exhibited stage IV. ECOG PS 0/1/2 were (%) 21/54/25. The % p receiving erlotinib as 1st/2nd/3rd-line treatment were 29/38/33. Safety data were available for 1,255 p. 6.9% p did not experience any adverse event. As expected most common adverse events were rash (any grade: 61%; gr. 3/4: 11%), and diarrhea (any gr.: 31%; gr. 3/4: 4%) 5.6% p withdrew prematurely the trial due to AE. Erlotinib-related AEs leading to treatment discontinuation were cutaneous toxicity in 21 p (17 gr. 3/4), diarrhea in 6 p (4 gr. 3/4), hepatic toxicity in 1 p, cholestasis in 1 p, and interstitial pneumonitis in 1 p. No unexpected toxicities were reported. 10% of p had dose reductions mainly due to rash and diarrhea. Response rate in these p was 18.7%; time to progression 3.8 months (95% CI: 3.5–4.2); and overall survival 6.0 months (95% CI: 5.5–6.4). Conclusions: These initial interim safety results of erlotinib in real-life clinical setting in a large number of unselected patients with advanced non-small-cell lung cancer confirm the favorable toxicity profile and good tolerability of erlotinib.

No significant financial relationships to disclose.

Concomitant chemoradiation plus induction (I) or consolidation (C) chemotherapy (CT) with docetaxel (D) and gemcitabine (G) for unresectable stage III non-small cell lung cancer (NSCLC) patients (p). Results of the randomized SLCG 0008 phase II trial

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Background: Neither the optimal sequence of treatment nor the best combination CT is yet well-defined in p receiving concomitant therapy Methods: P with unresectable stage III NSCLC with IK ≥ 70 and weight loss < 5% were initially randomized to sequential treatment (arm A), concurrent CT/TRT followed by consolidation CT (arm B) or induction CT followed by CT/TRT (arm C). Based on RTOG 9410 results, arm A was closed and the study continues with two concomitant arms (B, C). All p receive 2 cycles of D 40 mg/m2 d1, 8 plus G 1,200 mg/m2 d1, 8 as I or C therapy. Concomitant treatment includes D 20 mg/m2 and carboplatin (Cb) AUC 2 weekly plus 60 Gy TRT. Results: From May 01 to Jun 06, 151 p were included (A: 19, B: 66, C: 66). Due to the early closing of arm A, only data of evaluable arms B and C p are shown: toxicity 127 p (B: 63, C: 64) and response 110 p (B: 53, C: 57). All groups are well-matched for baseline disease characteristics. Toxicity grade 3–4 by CTC and RTOG criteria was: esophagitis 19.5% (arm B) and 14.2% (arm C); pneumonitis 8.8 % (arm B) and 10% (arm C). Neutropenia during I or C therapy: 22% (B) and 6.2% (C). Thrombocytopenia 8% (B) and 3% (C). Neutropenia during concomitant therapy: 6.3% (B) and 6% (C). No thrombocytopenia or severe anemia was found during CT/TRT. The reduction CT rate was superior in consolidation (35%) than in induction (15%) and in arm C during concomitant therapy (22.4% C, 6.5% B). Delay of CT dose was similar in B and C arms during I or C (22% B, 20% C) but superior in arm C during concurrent treatment (19.6% B, 30.6% C). The final response rates were 57% (B) and 56.9% (C). A trend for longer time to progression (TTP) was found (B: 7.6 months (m) and C: 9.2 m; p= 0.12) but with similar overall survival (B: 14.3 m and C: 14.7 m; p=0.38). Conclusions: Non- platinum CT plus concomitant chemoradiation offer similar response rate and a favorable hematological toxicity profile in unresectable stage III NSCLC p. No differences in OS but a trend for longer TTP in the arm C (I followed by concurrent approach) has been found. Final data are pending in order to select the best sequence for further studies.

No significant financial relationships to disclose.

Bone mineral density in women with non-metastatic breast cancer: Effect of intravenous bisphosphonates given before adjuvant therapies

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Background: Adjuvant therapies shown survival improve of non-metastatic breast cancer (NMBC) patients, but they also decrease bone mineral density (BMD). Bisphosphonates are effective agents for the management of osteoporosis. Intravenous zoledronate, which is approved for the treatment of malignant hypercalcemia, multiple myeloma, and skeletal metastases, can suppress bone resorption and are often considered first-line therapy for the treatment of osteoporosis. We have analyzed the effects of chemotherapy on BMD of women with NMBC who received before adjuvant therapies intravenous bisphosphonates (zoledronic acid). Methods: We prospectively studied the effects of a single intravenous zoledronic acid dose (4 mg), on BMD of 74 women with NMBC (stage I-III), administred previous to the adjuvant therapies. The patients were referred to the Medical Oncology Service of University Hospital of Canary Islands between 2003 y 2006. Lumbar and hip BMD (g/cm2) was measured at diagnosis and after chemotherapy. The results were compared with a group of 80 patients with NMBC who received adjuvant therapy without intravenous bisphosphonates. Results: Breast cancer patients the median age was 52 ± 10 years old and the body mass index was 28,2 ± 5.5 kg/m2. At baseline there were not differences in BMD between the group that received bisphosphonates and the group with only chemotherapy at any of lumbar or femoral bone sites. In our study, the BMD after chemotherapy and intravenous bisphosphonates (n=74) significantly increased at femoral neck (0.805 ± 0.01, 0,826± 0.12; p=0.002) and trochanter (0.709 ± 0.01, 0.724 ± 0.01; p=0.002) and remained stable at lumbar, intertrochanter, total hip and Ward’s triangle; whether the group without bisphosphonates significantly decreased at lumbar (1.014 ± 0; 0.995 ± 0, p=0.0001), trochanter (0.701± 0; 0.690 ± 0, p=0,046), intertrochanter (1,095 ± 0; 1.078 ± 0, p=0.0001) and total hip (0,924 ± 0; 0.915 ± 0, p=0.046) areas (table). Conclusions: Women with NMBC are affected by early bone loss after adjuvant chemotherapy. Bisphosphonates intravenous (zoledronic acid) given before adjuvant therapy might be an effective treatment for this bone loss, increasing BMD or remaining stable.

No significant financial relationships to disclose.

Thymoglobulin and rate of infectious complications after transplantation

Thymoglobulin is used as an induction agent in kidney transplantation, but the optimal dose is not well established. However, its use may be associated with increased infectious complications after transplantation.

METHODS

This retrospective study of 61 high-risk renal recipients of transplants from deceased donors performed between June 2001 and April 2004 included patients treated with thymoglobulin. Patients were divided into two groups according to the total thymoglobulin dose (G1, n = 30, <7 mg/kg; G2, n = 31, >7 mg/kg) and followed for at least 1 year.

RESULTS

Mean recipient age was 43 +/- 14 years; 41% were males; 63% non-Whites. Mean cold ischemia time was 26.3 +/- 7 hours. Mean PRA was 23% (0-100%). Second transplantation was performed in 18 (29.5%) patients. Mean donor age was 42.1 +/- 16 years, and 59% had a cerebral vascular accident as the cause of death. Patient- and death-censored graft survival at 12 months were 86% and 88%, respectively. There were 149 infectious episodes among 47 (78%) patients. The incidence of infection was 1.7 +/- 0.24 infections per patient per year in G1 (lower dose) vs 3.12 +/- 0.23 in G2 (P < .001). Bacterial (0.66 +/- 1.0 vs 1.48 +/- 1.26 infections per patient per year, P = .009) and viral infections (0.9 +/- 0.71 vs 1.41 +/- 0.71; P = .006) were more frequent in the higher dose group.

CONCLUSION

This study suggested that a greater number of infectious episodes were present when the total dose of thymoglobulin was higher than 7 mg/kg.

DNA microdevice for electrochemical detection of Escherichia coli 0157:H7 molecular markers

An electrochemical DNA sensor based on the hybridization recognition of a single-stranded DNA (ssDNA) probe immobilized onto a gold electrode to its complementary ssDNA is presented. The DNA probe is bound on gold surface electrode by using self-assembled monolayer (SAM) technology. An optimized mixed SAM with a blocking molecule preventing the nonspecific adsorption on the electrode surface has been prepared. In this paper, a DNA biosensor is designed by means of the immobilization of a single stranded DNA probe on an electrochemical transducer surface to recognize specifically Escherichia coli (E. coli) 0157:H7 complementary target DNA sequence via cyclic voltammetry experiments. The 21 mer DNA probe including a C6 alkanethiol group at the 5' phosphate end has been synthesized to form the SAM onto the gold surface through the gold sulfur bond. The goal of this paper has been to design, characterise and optimise an electrochemical DNA sensor. In order to investigate the oligonucleotide probe immobilization and the hybridization detection, experiments with different concentration of DNA and mismatch sequences have been performed. This microdevice has demonstrated the suitability of oligonucleotide Self-assembled monolayers (SAMs) on gold as immobilization method. The DNA probes deposited on gold surface have been functional and able to detect changes in bases sequence in a 21-mer oligonucleotide.

DNA profiling analysis of 100 consecutive de novo acute myeloid leukemia cases reveals patterns of genomic instability that affect all cytogenetic risk groups

We have carried out a high-resolution whole genome DNA profiling analysis on 100 bone marrow samples from a consecutive series of de novo acute myeloid leukemia (AML) cases. After discarding copy number changes that are known to be genetic polymorphisms, we found that genomic aberrations (GA) in the form of gains or losses of genetic material were present in 74% of the samples, with a median of 2 GA per case (range 0-35). In addition to the cytogenetically detected aberration, GA were present in cases from all cytogenetic prognostic groups: 79% in the favorable group, 60% in the intermediate group (including 59% of cases with normal karyotype) and 83% in the adverse group. Five aberrant deleted regions were recurrently associated with cases with a highly aberrant genome (e.g., a 1.5 Mb deletion at 17q11.2 and a 750 kb deletion at 5q31.1). Different degrees of genomic instability showed a statistically significant impact on survival curves, even within the normal karyotype cases. This association was independent of other clinical and genetic parameters. Our study provides, for the first time, a detailed picture of the nature and frequency of DNA copy number aberrations in de novo AML.

[Antiplatelets and anticoagulants in acute coronary syndromes: levels of evidence]

Management of acute coronary syndromes (ACS) has moved rapidly in parallel with our understanding of the pathophysiological basis of the disease. In the eighties, the demonstration of the pivotal role of coronary thrombosis in the etiology of a ACS led to administration of aspirin and unfractionated heparin. In recent years, new medical and invasive therapies have been developed: anti-platelets (thienopyridines and glycoprotein Ilb/IlIa inhibitors), antithrombins (low molecularweight heparins) and most recently, factor Xa inhibitors (pentasaccharides). As new treatments are rapidly added, clinicians are constantly challenged to incorporate new information and guidelines into their practices in a timely fashion.

[Diagnosis and management of deep venous thrombosis]

Deep-vein thrombosis (DVT) is a common condition that can lead to complications such as postphlebitic syndrome, pulmonary embolism and death. Currently, an algorithm strategy combining pretest probability, D-dimer testing and compression ultrasonography imaging allows for safe and convenient estimation of suspected lower-limb thrombosis. The mainstay of treatment is anticoagulation therapy. The use of low-molecular-weight heparin or pentasaccharide (fondaparinux) allows for outpatient management of most patients with DVT. The duration of anticoagulation depends on whether the primary event was idiopathic or secondary to a transient risk factor. Interventions such as thrombolysis and placement of inferior vena cava filter are reserved for special situations.

[Study of diastolic function in peritoneal dialysis patientes. Comparison between pulsed and Tissue Doppler]

INTRODUCTION

Left ventricular hypertrophy (LVH) is the main expression of uremic cardiomyopathy. Alteration of the diastolic function is frequently associated with LVH, indicating future cardiovascular events. Recent studies suggest that the Tissue Doppler (TID) of the mitral annulus obtains parameters of diastolic function that are not influenced by other factors, unlike what occurs with the pulsed Doppler (PD), and that the relationship between the velocity of the proto-diastolic waves of both techniques (E/E') would be the most important datum to diagnose a diastolic malfunction. The objective of this study is to verify LVH prevalence in a population of End Stage Renal Disease patients (ESRD) in peritoneal dialysis (CAPD), and to study diastolic function, comparing the results of both techniques (PD/TID), as well as the possible causes that determine the appearance of diastolic malfunction in these patients.

PATIENTS AND METHODS

We carried out a cross-section study with 42 patients in peritoneal dialysis. All patients had an ejection fraction of over 50% and had no clinical signs of heart failure, valvular heart disease or arrhytmia. A basic biochemistry, residual renal function, C-reactive protein and an ultrasonic study with M-mode doppler, pulsed doppler and tissue doppler of the mitral annulus, were performed in all patients.

RESULTS

26.2% of the patients had a concentric LVH, 14.3% an asymmetric LVH and 23.8% a concentric growth. The PD showed an E/A ratio under 0.75 in 20 cases (which would indicate an alteration of ventricular relaxation), an E/A between 0.75 and 1.5 in 22 (normal or pseudonormal pattern) and none with an E/A over 1.5. On the other hand, the TID showed: 24 patients with an E/A < 0.75, 16 between 0.75 and 1.5, and 2 with an E/A > 1.5. The E/E' proportion was normal in 13 cases(< 8), intermediate in 12 (8-10), and greater than 10 in 17, expressing a clear diastolic malfunction. Twelve of the 17 with diastolic malfunction had a pseudo-normal pattern with the PD. A relationship was observed between the E/A and age and hs-CRP. A relationship was also found between RRF, ejection fraction and diastolic pressure (p = 0.03, r = 0.32 and p = 0.006, r = 0.29), while, in the multivariant study, the presence of LVH was the only variable with enough significance to influence the diastolic malfunction (odds ratio of 7.6).

CONCLUSIONS

Patients in CAPD have a high incidence of diastolic malfunction. LVH, present in a high percentage of patients, is one of the factors that favours its appearance. The non-invasive TID technique and the E/E' ratio have shown to be more sensitive than the PD in diagnosing a diastolic malfunction.

[Implementation of a protocol of management of chronic kidney disease between Nephrology and Primary Health Care. Preliminary results]

During the last years there has been an important advance in the knowledge of chronic kidney disease (CKD). In order to adapt our clinical practice to these new data, a protocol of management of CKD between Nephrology and Primary Health Care has been developed. The protocol includes several items like cardiac and renal protection strategies, diagnosis and treatment of complications, use of drugs and clear derivation criteria. Implementation of the protocol has been only partial and has implied, for the Renal Unit, an increase in the number of patients,specially the oldest ones, but a clear improve in the quality of the information too,and a first positive step in the right way to face the challenge of CKD. In view of analysed data we propose some modifications for the protocol.

Tegafur and 5-fluorouracil pelvic tissue concentrations in rectal cancer patients receiving preoperative chemoradiation

BACKGROUND AND PURPOSE

To investigate the presence of 5-Fluorouracil (5-FU) in pelvic tissue after oral administration of tegafur. To measure tegafur and 5-FU concentrations in normal rectal mucosa, perirectal fat and residual tumor in rectal cancer patients receiving preoperative chemoradiation. To correlate drug concentrations with cancer downstaging effects.

PATIENTS AND METHODS

Three tissue samples taken from 16 surgical specimens after recto-sigmoid resection were analyzed. Tegafur and 5-FU concentrations were measured using high-performance liquid chromatography. 16 patients with locally advanced rectal cancer were treated with preoperative pelvic irradiation (45-50 Gy) sensitized with oral tegafur (400 mg for every 8 hours daily). Seven patients received a precharge dose of tegafur (400 mg oral every 8 hours) 24 hours before surgery.

RESULTS

In 8 of the 9 patients who did not receive a precharge dose, detectable levels of tegafur were observed in fat tissue, normal mucosa and tumor, but detectable 5-FU levels were only observed in one patient. Mean concentrations (ranges) for tegafur in fat, normal mucosa and tumor in patients without the precharge dose were 72.19 (12.1-205.6), 179.53 (11.30-727.7) and 252.35 (27.9-874.6) ng/g, respectively; mean concentrations for 5-FU in the same samples were 0.95, 1.92 and 2.68 ng/g (1 patient), respectively. In patients receiving a tegafur precharge, both tegafur and 5-FU were present in all tissue samples with the exception of 2 fat samples, in which drug concentrations were undetectable. 5-FU levels were higher in tumor than other sites, with a median value of 68.24 ng/g (range 3.8-283.05 ng/g). Tegafur levels were also higher in tumor samples than other sites (mean 3446.53 ng/g, range 1044.5-7847.0 ng/g), except in 2 patients who had higher levels of tegafur in normal mucosa.

CONCLUSIONS

Tegafur and 5-FU are not always present in pelvic tissues 5 to 6 weeks after oral administration of tegafur. Both drugs were present in the tissues analyzed, in relevant concentrations, 24 hours after oral administration of tegafur. The data obtained suggest a tendency (not significant) toward a correlation between levels of 5-FU present in the residual tumor and cancer downstaging.

Elderly advanced non-small-cell lung cancer (NSCLC) patients (p) treated with vinorelbine (vrb) plus gemcitabine (gem): Molecular correlates

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Background: The clinical benefit of non-cisplatin doublets (vrb/gem) vs a single agent (vrb or gem) in elderly p is still controversial. The present study focuses on clinical outcome with vrb/gem in the elderly and the role of functional status. Genetic predictive markers of response to vrb/gem will also be examined in genomic and cDNA from tumor and circulating tumor DNA. Methods: NSCLC p with stage IIIB (pleural effusion or supraclavicular lymph nodes)-IV or recurrent disease and age ≥ 70 years were treated with vrb (25 mg/m2 iv or 60–80 mg/m2 oral) plus gem 1200 mg/m2, days 1,8 every 21 days. Activities of daily living (ADL), instrumental activities of dalily living (IADL) and comorbidities were evaluated. Primary tumor and baseline serum DNA were collected for assessment of microtubule associated protein 4 (MAP4) in tumor and checkpoint with forkhead-associated and ring finger (CHFR) methylation in serum. A preliminary analysis of response and toxicity was performed on 51 p. Results: From April 2004 to December 2005, 145 p were included. Data on 68 p is available: median age 74.5 years (70–83); stage IIIB: 21.2%, IV: 78.7%; PS 0: 23.4%, 1: 54.6%, 2: 21.8%. Self-sufficiency in ADL and IADL was 56.2% and 25% of the p analyzed. All p but 8 had comorbidities. Response rate for 51 p: partial response, 12% (95% CI, 8.9–20%); stable disease, 32% (95% CI, 19.2–44.8%). Main hematological toxicities: grade 3/4 neutropenia, 8.3/4.1%; grade 3 thrombocytopenia, 4.1%; grade 3 anemia, 4.1% of the p respectively. Conclusions: Preliminary findings indicate that vrb/gem is feasible in elderly p with acceptable toxicity. Complete data on response, survival and genetic markers will be presented.

No significant financial relationships to disclose.

Diversity of metabolic syndrome risk factors in obese children and adolescents

The aim of this study was to investigate the frequency of metabolic syndrome (MS) variables in a group of spanish obese children and adolescents, to asses MS prevalence in this population and to describe it's relationship with other metabolic risk factors. 103 children were studied : 54 male and 49 female, mean age 10.08+/-2.3 with exogenous obesity. Obesity was defined when BMI was higher than the age and sex specific equivalent to 30 kg/m(2) in adults. MS variables considered were waist circumference, blood pressure, fasting blood triglycerides, fasting glucose/insulin and HDL-cholesterol. The children were considered as having the MS when three or more characteristics showed abnormal values according to Cook and De Ferranti definitions. HOMA index, ApoB and ApoA1 were studied too. The most frequent features of the metabolic syndrome were excess waist circumference and hypertension. The MS markers with the lowest frequency were dyslipidemia and fasting hyperglicemia. MS prevalence was 29,9% (Cook et al. criteria) and 50% (De Ferranti et al. criteria). Fasting insulin and HOMA index values increased significantly (p < 0.05) when three or more abnormalities of the MS variables were present. Apo B increased significantly only in females (p < 0.05) and Apo Al decreased significantly (p < 0.05) in both sexes when MS was present. Adequate metabolic syndrome risk factors criteria, mainly cut-off values, need to be defined in the European paediatric population.

Relation between pp65 antigenemia, RT-PCR and viruria for cytomegalovirus detection in kidney transplant recipients

INTRODUCTION

We compared the efficiency of detection using pp65 antigenemia, reverse transcription-polymerase chain reaction (RT-PCR), and viruria for the diagnosis of cytomegalovirus (CMV) infections after kidney transplantation.

PATIENTS AND METHODS

We evaluated 40 renal transplant recipients between weeks 5 and 12 after transplantation, including 179 blood and 181 urine specimens.

RESULTS

All positive samples by antigenemia were also positive by PCR. However, in 52 cases only PCR was positive (kappa = 0.134 [P < .001]). Viruria was positive in 66 cases, but only 26 were CMV PCR positive. In 34 cases, viruria was negative and PCR positive (P = .192).

CONCLUSION

Detection of DNA in serum is a more sensitive method than antigenemia for the diagnosis of CMV infection. Viruria was not related to the presence of CMV in blood.

[Quality improvement of the filling medication trolleys process, for an unit-dose drug distribution system]

OBJECTIVE

To assess the quality of filling medication trolleys process for an unit-dose drug distribution system, after the implantation of a protocol.

METHOD

Five criteria were defined: four were related to the medication given to the patient, and one criterion was related to the patient's identification. At the same time, it was designed a standardized protocol of filling medication trolleys process and it was evaluated the degree of compliance with the criteria on all the hospitalized patients medication drawers in two clinical units. The fulfilment of the criteria was measured both before and after the implantation of the protocol, for fourteen and seven days respectively.

RESULTS

In the first evaluation the number of errors was 0.84/medication drawer. After the implantation of the protocol, the total number of errors after correction for sample size decreased at 0.22/medication drawer. The degree of compliance improved for all the criteria, and differences were statistically significant for the criteria with most errors.

CONCLUSIONS

The implantation of a protocol significantly improved two of the five quality criteria studied in the filling medication trolleys process. The patient's identification has been revealed as a fundamental aspect of intervention in the dispensation quality.

Therapy of paraneoplastic pemphigus with Rituximab: a case report and review of literature

Paraneoplastic pemphigus (PNP) is an autoimmune blistering disease with poor prognosis when associated with malignant neoplasm. We report the case of a patient with PNP associated with a CD20+ non-Hodgkin follicular lymphoma who was treated with Rituximab plus corticosteroids and short courses of cyclosporin. One and a half years after Rituximab therapy, oral ulcerations had cleared and oral methylprednisolone was slowly tapered down without further recurrences. In the course of the disease, the patient developed sepsis due to Listeria monocytogenes and viral infections by human herpes virus 1 and 3. At the end-stage of the disease she developed a cutaneous infection from Mycobacterium chelonae. The patient died 2 years and 7 months after the onset of PNP. Rituximab may be useful for PNP therapy, but further studies are necessary to confirm this hypothesis.

[Hypovolemic shock during surgery caused by a rectus sheath hematoma]

Prophylactic treatment with low molecular weight heparins (LMWH) is currently widely used to prevent thromboembolic events. However, such treatment is not free of risk. Among the possible complications described is rectus sheath hematoma. We report the case of a patient undergoing surgery for a hypophysial adenoma approached by the transsphenoidal route. He received LMWH prophylaxis for thromboembolism and showed a tendency to hypotension during surgery. The patient's condition deteriorated to hypovolemic shock accompanied by episodes of atrial fibrillation with rapid ventricular response. With the transfusion of medications, blood products and plasma volume expanders, the patient was stabilized and surgery was completed. A computed tomography scan then revealed a hematoma occupying the greater part of the left anterior rectus muscle. With conservative wait-and-see treatment the abdominal symptoms disappeared and the hematoma gradually receded until fully resolved. Spontaneous rectus sheath hematoma is a rare condition. Presentation is quite nonspecific and computed tomography is needed for reaching a firm diagnosis. When a hematoma is large, the initial clinical picture may include hypovolemic shock, which may develop during surgery if the hematoma is not diagnosed early. Intraoperative management will be much more difficult than it would have been if diagnosis and treatment had taken place before the operation.

Mean hospital stay and treatment with electroconvulsive therapy

INTRODUCTION

The objective is to analyze if the mean hospital stay is less than the episodes or not in which electroconvulsive therapy (ECT) is applied.

METHODS

With a retrospective design, we studied a sample of 30 patients in whom ECT was applied between 1996 and 2001. These patients were suffering a disorder for which ECT has been shown to be effective (schizophrenia, bipolar disorder and major depression). Each one of the episodes (n = 185) of these patients was studied, comparing the length of stay in the hospital in these patients in which ECT was applied (n = 135) with those where it was not (n = 50). Statistical analysis was carried out by non-parametric Mann-Whitney-U tests. The descriptive level of statistical significance was established at p < 0.05.

RESULTS

This work shows statistically significant differences between the treatment groups (p = 0.000), the length of stay being longer when ECT is applied.

Alendronate in Kidney Transplant Patients: A Single-Center Experience

INTRODUCTION

Osteoporosis following a renal transplant is an important cause of morbidity. Several studies have demonstrated the efficiency of diphosphonates for the prevention and treatment of osteoporosis.

METHODS

We evaluated the effect of alendronate treatment on bone mineral density (BMD) in patients with osteoporosis (lumbar spine and/or hip t-scores < or = -2.5). Two study groups were established: group A (n = 13), patients treated orally with vitamin D, calcium, and alendronate (70 mg/week) and group B (n = 12) patients receiving only vitamin D and calcium. The immunosuppression regimen mostly used was steroids and cyclosporine. BMD was determined at the lumbar spine and hip using a Hologic 4500 QDR densitometer at the start of treatment and after 1 year.

RESULTS

The study groups showed no significant differences in age, sex, menopause, or transplant time. Group A received a mean of 1.80 +/- 1.3 microg vitamin D/week and 1.3 +/- 2.1 g calcium/d, compared to 1.1 +/- 1 microg and 1.25 +/- 2.3 g, respectively for group B (NS). After a mean of 411.15 +/- 107.75 days of treatment, a significant increase in BMD at the femoral neck was recorded in group A, but not at the level of the spine (+5.57% +/- 3.5%, P < .05 and -0.42% +/- 12%, NS, respectively). No significant changes were observed in group B (-1.45% +/- 8% femoral neck and +1.69% +/- 3.5% hip, NS). Dyspepsia was reported by 7% of patients.

CONCLUSIONS

In this preliminary analysis, alendronate produced, improvements are so far limited to an increased BMD in the hip.

Kidney-Pancreas Transplants: Is It So Difficult to Start a Program?

BACKGROUND

For selected patients with type 1 diabetes mellitus and end-stage renal failure, simultaneous kidney-pancreas (SKP) or pancreas after kidney (PAK) transplantation is the treatment of choice. However, it is frequently difficult to start a program for fear of serious intraabdominal complications in an immunosuppressed patient. We review our initial experience with these transplantations.

METHODS

Twenty-three patients (20 SKP, 3 PAK) with type 1 diabetes mellitus received transplants between June 2000 and October 2003. All received immunosuppression therapy with thymoglobulin, prednisone, tacrolimus, and mycophenolate mofetil. The operation included portal venous drainage and exocrine enteric drainage. Rejections were biopsy-proved. Cytomegalovirus prophylaxis with gancyclovir was administered.

RESULTS

The mean follow-up is 13 months (range, 1-30 months) for recipients of mean age 39 +/- 7 years (17 men, 6 women). Mean cold ischemia time for kidney was 10.2 +/- 3.9 hours, and for pancreas was 10.5 +/- 3 hours. The rate of initial graft function was 100%. Graft rejection rate was 8%. The repeat laparotomy rate was 53% (12 patients), with a mean of 0.8 procedures per patient (range, 0 to 5). At the end of follow-up, patient survival was 95%, kidney survival was 85%, and pancreas survival was 83%. Patients with a functioning graft were insulin-free, with a mean fasting glucose concentration of 79 +/- 7 mg/dL, hemoglobin A1C of 4.5% (range, 4% to 4.9%) C-peptide of 5.9 ng/mL (range, 2.1 to 12 ng/mL), and a mean serum creatinine level of 1.6 mg/dL (range, 0.9 to 4.6 mg/dL). There was 1 death, due to posttransplantation lymphoproliferative disease confined to the pancreatic graft and abdominal sepsis at 3 months posttransplantation.

CONCLUSIONS

Our results are similar to those of other series of SPK or PAK transplantations: low acute rejection rates, frequent requirement for repeat laparotomy, and good patient and graft survival, permitting an excellent quality of life.

Evaluation of capillary electrophoresis for determining the concentration of dissolved silica in geothermal brines

The determination of silica concentrations in geothermal brines is widely recognized as a difficult analytical task due to its complex chemical polymerization kinetics that occurs during sample collection and chemical analysis. Capillary electrophoresis (CE) has been evaluated as a new reliable analytical method to measure silica (as silicates) in geothermal brines. Synthetic and geothermal brine samples were used to evaluate CE methodology. A capillary electrophoresis instrument, Quanta 4000 (Waters-Millipore) coupled with a Waters 820 workstation was used to carry out the experimental work. The separation of silicates was completed in approximately 5.5 min using a conventional fused-silica capillary (75 microm i.d. x 375 microm o.d. x 60 cm total length). A hydrostatic injection (10 cm for 20 s at 25 degrees C) was employed for introducing the samples. The carrier electrolyte consisted of 10 mM sodium chromate, 3 mM tetradecyltrimethyl-ammonium hydroxide (TTAOH), 2 mM sodium carbonate, and 1 mM sodium hydroxide, adjusted to a pH 11.0 +/- 0.1. Silicates were determined using an indirect UV detection at a wavelength of 254 nm with a mercury lamp and with a negative power supply (-15 kV). A good reproducibility in the migration times (%R.S.D. approximately 1.6%) based on six non-consecutive injections of synthetic brine solutions was obtained. A linear response between silica concentration and corrected peak area was observed. Ordinary (OLR) and weighted (WLR) linear regression models were used for calculating silica concentrations in all samples using the corresponding fitted calibration curves. The analytical results of CE were finally compared with the most probable values of synthetic reference standards of silica using the Student's t-test. No significant differences were found between them at P = 0.01. Similarly, the atomic absorption spectrometry (AAS) results were also compared with the most probable concentrations of the same reference standards, finding significant differences at P = 0.01.

Outcome of children with B cell lymphoma in Venezuela with the LMB-89 protocol

BACKGROUND

We analyzed the results of the LMB-89 protocol performed in seven centers in Venezuela in 96 children having B-cell non-Hodgkin lymphoma treated from 1995 to 2002.

PROCEDURE

Mean age was 7.1 years with 71 (74%) been male. Eighty-two patients (85%) had diffuse small cell lymphoma Burkitt and Burkitt-like, and 14 (15%) had diffuse large B-cell lymphoma. Initial disease sites included the abdomen in 67%, peripheral nodes in 8%, and mediastinal in 4%. Treatment was directed to risk groups as described for LMB-89 protocol. Group A: seven patients (7%), group B: 80 patients (83%), and group C: nine patients (9%).

RESULTS

Mean follow-up was 35 +/- 31 months. Complete remission (CR) occurred in 70 patients (73%); four patients (6%) had relapse during the first year and ten patients (10%) had progressive disease. Overall survival (OS) and event free survival (EFS) were 85 and 80% at 1 year, and 82 and 75% at 2 years, respectively. The EFS by therapeutic groups at 3 years was A: 100%; B: 76%, and C: 56%.

TOXICITY

neutropenia in 75%, thrombocytopenia in 63%, febrile neutropenia in 39%. Viral infections: hepatitis B in 20%, hepatitis C in 2%, and Herpes zoster in 3%. Tumor lysis syndrome (TLS) occurred in 9% during induction phase with a high mortality of 44% (urate-oxidase was available only at the end of the study).

CONCLUSIONS

The high mortality rate during induction phase prohibited a better EFS. Prophylactic use of xantine-oxidase may improve future results. The high incidence of hepatitis B requires a vaccination program.