An evaluation of a macroalgal bioassay tool for assessing the spatial extent of nutrient release from offshore fish farms

In this study we develop and evaluate a macroalgal bioassay tool for monitoring the spatial extent of dissolved wastes loaded from offshore fish farms into the marine coastal ecosystem. This tool is based on the analysis of the nitrogen stable isotope ratio (delta(15)N) in tissues of several benthic primary producers (macroalgae and Posidonia oceanica epiphytes) incubated, by means of incubation devices, in the water column at increasing distances (from 0 m to 1000 m) from the fish cages. The bioassays were performed in three fish farms situated in different geographical locations (the Canary Islands, Murcia and Catalonia) and we test: the suitability of the different macroalgae species used in relation with their resistance to incubation and their sensitivity to fish farm wastes and the most appropriate incubation depth (5 m or approximately 20 m) and incubation time (2, 4 or 6 days) to detect the spatial distribution of delta(15)N around fish farms. In general terms, the results showed a significant increment of delta(15)N values toward the fish cages with respect to the reference (initial) and control values for all the species of macroalgae tested except for the red algae Asparagopsis taxiformis from Canary Islands. The magnitude and shape of the reported spatial responses varied as a function of the experimental settings analyzed as well as a function of the nutrient regime characteristics of each coastal area. The spatial gradient was more consistent in the shallow part of the water column (5 m depth), than in the deeper part ( approximately 20 m) and was statistically significant after an incubation period of four days. These results confirm the effectiveness and reliability of the method proposed, enabling the spatial extent of nutrients derived from fish farms to be assessed in an effective and simple manner, suitable for use in monitoring programs around offshore fish farms.

Monitoring influenza activity in Europe with Google Flu Trends: comparison with the findings of sentinel physician networks - results for 2009-10

The number of Internet searches has recently been used by Google to estimate the influenza incidence in the United States. We examined the correlation between the Google Flu Trends tool and sentinel networks estimates in several European countries during the 2009 influenza A(H1N1) pandemic and found a good correlation between estimates and peak incidence timing, with the highest peaks in countries where Internet is most frequently used for health-related searching. Although somehow limited, Google could be a valuable tool for syndromic surveillance.

Invasive filamentous fungal infections associated with renal transplant tourism

'Transplant tourism,' the practice of traveling abroad to acquire an organ, has emerged as an issue in kidney transplantation. We treated a patient who developed invasive aspergillosis of the allograft vascular anastomosis after receiving a kidney transplant in Pakistan, prompting us to review the literature of invasive mycoses among commercial organ transplant recipients. We reviewed all published cases of infections in solid organ transplant recipients who bought their organs abroad and analyzed these reports for invasive fungal infections. Including the new case reported here, 19 cases of invasive fungal infections post commercial kidney transplant occurring in 17 patients were analyzed. Infecting organisms were Aspergillus species (12/19; 63%), Zygomycetes (5/19; 26%), and other fungi (2/19; 5%). Invasive mold infections were present at the transplanted graft in 6/17 patients (35%) with graft loss or death in 13/17 (76%) of patients and overall mortality (10/17) 59%. Invasive fungal infections, frequently originating at the graft site, have emerged as a devastating complication of commercial renal transplant and are associated with high rates of graft loss and death.

Chemical burns: pathophysiology and treatment

Chemical burns continue to pose a variety of dilemmas to the clinician managing such cases. Assessment of burn depth is often difficult and the decision whether to excise the wound early is not always clear-cut. In this updated review, common agents are classified and the basic principles of management and specific recommendations are examined. The complications arising from exposure to these chemicals and the supportive measures needed during treatment are also described.

Real-time PCR with internal amplification control for detecting tuberculosis: method design and validation

Real-time PCR has been a major development in the diagnosis of tuberculosis. However, most tests do not include an internal amplification control (IAC), which therefore limits it clinical application. In this study a new, easy to perform real-time PCR test with IAC was designed and validated in clinical samples. The primers amplified a 163-bp fragment of IS6110 of Mycobacterium tuberculosis and the IAC was designed with a fragment of a different microorganism (Chlamydia trachomatis). The interassay and intraassay variation of this test were very low (0.45-1.65% and 0.18-1.80%, respectively). The detection accuracy was validated in 50 samples (25 urine, 25 sputum) with different concentrations of M. tuberculosis, 18 clinical isolates of non-tuberculous mycobacteria and 148 samples with clinical suspicion of pulmonary tuberculosis. The specificity was 100%. The detection limit of this PCR test without IAC was approximately 15 bacteria and with IAC approximately 32 bacteria. This real-time PCR with IAC assay can improve the detection of M. tuberculosis and contribute to standardization of this diagnostic technique.

[Resistant mutant prevention concentration of fluoroquinolones in clinical isolates of extended spectrum beta-lactamase (ESBL) producing and non-producing strains of Escherichia coli]

The aim of this job is to study the capacity of ciprofloxacin and levofloxacin in restricting the development of resistant mutants in strains of Escherichia coli by determining the mutant prevention concentration (MPC). Ninety-nine isolates of E. coli with different fluoroquinolone susceptibilities were studied and divided into ESBL-producing (n = 60) and non-ESBL producing (n = 36) groups. MPC values were determined using an inoculum of 1010 cfu/ml on Mueller-Hinton plates with serial dilutions of the antibiotics. No significative differences were detected in MIC of ESBL-producing and non-ESBL producing strains of E. coli. Ciprofloxacin susceptible ESBL-producing strains exhibit higher MPC for ciprofloxacin and levofloxacin than non-ESBL producing strains. Our study helps to explain the frequent fluoroquinolone resistance found in ESBL-producing strains. In this context, doubts emerge about the advisability of using fluoroquinolones to treat infections caused by ESBL-producing strains.

Implementation of local area network extension for instrumentation standard trigger capabilities in advanced data acquisition platforms

Synchronization mechanisms are an essential part of the real-time distributed data acquisition systems (DASs) used in fusion experiments. Traditionally, they have been based on the use of digital signals. The approach known as local area network extension for instrumentation (LXI) provides a set of very powerful synchronization and trigger mechanisms. The Intelligent Test Measurement System (ITMS) is a new platform designed to implement distributed data acquisition and fast data processing for fusion experiments. It is based on COMPATPCI technology and its extension to instrumentation (PXI). Hardware and software elements have been developed to include LXI trigger and synchronization mechanisms in this platform in order to obtain a class A LXI instrument. This paper describes the implementation of such a system, involving the following components: commercial hardware running a Linux operating system; a real-time extension to an operating system and network (RTAI and RTNET), which implements a software precision time protocol (PTP) using IEEE1588; an ad hoc PXI module to support hardware implementation of PTP-IEEE 1588; and the multipoint, low-voltage differential signaling hardware LXI trigger bus.

Self-adaptive sampling rate data acquisition in JET's correlation reflectometer

Data acquisition systems with self-adaptive sampling rate capabilities have been proposed as a solution to reduce the shear amount of data collected in every discharge of present fusion devices. This paper discusses the design of such a system for its use in the KG8B correlation reflectometer at JET. The system, which is based on the ITMS platform, continuously adapts the sample rate during the acquisition depending on the signal bandwidth. Data are acquired continuously at the expected maximum sample rate and transferred to a memory buffer in the host processor. Thereafter the rest of the process is based on software. Data are read from the memory buffer in blocks and for each block an intelligent decimation algorithm is applied. The decimation algorithm determines the signal bandwidth for each block in order to choose the optimum sample rate for that block, and from there the decimation factor to be used. Memory buffers are used to adapt the throughput of the three main software modules (data acquisition, processing, and storage) following a typical producer-consumer architecture. The system optimizes the amount of data collected while maintaining the same information. Design issues are discussed and results of performance evaluation are presented.

[In vitro generation of mutants of Klebsiella pneumoniae following exposure to fluorquinolones. Relationship with the presence of extended spectrum betalactamases]

In order to provide data that may help to explain the relationship between production of extended spectrum betalactamases and fluorquinolone resistance in Klebsiella pneumoniae, we have developed an in vitro model of exposure to sub-inhibitory concentrations of various fluorquinolones (ciprofloxacin, levofloxacin and moxifloxacin) in two strains, one of which is a producer of extended spectrum betalactamases (ESBL). Our data show that mutants with reduced fluorquinolone susceptibility appear in both cases, but that they appear earlier in ESBL-producing strains (13.3 days versus 14.4 days), especially following exposure to ciprofloxacin (12.5 days versus 14.9 days for levofloxacin and 14.2 days for moxifloxacin). Therefore, our data help explain the greater fluorquinolone resistance in ESBL-producing strains and confirm the need to administer the correct doses of fluoroquinolones, especially in the case of ciprofloxacin, in order to prevent the emergence of resistant mutants. This is particularly important if the strain is an ESBL-producer.

Bismuth recovery from acidic solutions using Cyphos IL-101 immobilized in a composite biopolymer matrix

Impregnated resins prepared by the immobilization of an ionic liquid (IL, Cyphos IL-101, tetradecyl(trihexyl)phosphonium chloride) into a composite biopolymer matrix (made of gelatin and alginate) have been tested for recovery of Bi(III) from acidic solutions. The concentration of HCl slightly influenced Bi(III) sorption capacity. Bismuth(III) sorption capacity increased with IL content in the resin but non-linearly. Maximum sorption capacity reached 110-130mgBig(-1) in 1M HCl solutions. The mechanism involved in Bi recovery was probably an ion exchange mechanism, though it was not possible to establish the stoichiometric exchange ratio between BiCl(4)(-) and IL. Sorption kinetics were investigated through the evaluation of a series of parameters: metal concentration, sorbent dosage, type and size of sorbent particles and agitation speed. In order to reinforce the stability of the resin particles, the IL-encapsulated gels were dried; this may cause a reduction in the porosity of the resin particle and then diffusion limitations. The intraparticle diffusion coefficients were evaluated using the Crank's equation. Additionally, the pseudo-first-order and pseudo-second-order equations were systematically tested on sorption kinetics. Metal can be desorbed from loaded resins using either citric acid or KI/HCl solutions. The sorbent could be recycled for at least three sorption/desorption cycles.

Design and validation of a scale to assess preferences of type 2 diabetic patients towards different nutritional supplements

OBJECTIVES

To design and validate a scale to evaluate preferences of type 2 diabetic patients towards nutritional supplements (Madrid scale) and to discover those taste attributes that are more discriminating.

CONTEXT

ambulatory patients with type 2 diabetes mellitus.

MATERIALS AND METHODS

18 controls and 106 type 2 diabetic patients received 2 of the 7 stimuli studied (6 nutritional supplements and a differential salty stimulus) and then completed both scales and a criterion question. Two weeks later, 30 diabetic patients received a retest. The psychometric properties of the Madrid scale were studied and the relative importance of each stimuli attribute was assessed.

RESULTS

Feasibility: The Madrid scale consists of 8 questions and is completed in less than five minutes; Dimensionality: A single dimension which explains 45.1% of the variance. Reliability: Cronbach's , 0.806; intraclass correlation coefficient, 0.835 (95% confidence interval: 0.653-0.922). Concurrent validity: Correlation indexes of the corrected total score with the criterion question and the Modified Wine-Tasting Scale, 0.731 (p < 0.0005) and 0.774 (p < 0.0005), respectively. The scale discriminated between subjects younger and older than 75 years and between supplements and the differential stimulus. Preferences: Glucerna SR chocolate, Glucerna SR strawberry, Glucerna SR vanilla, Diasip vanilla, Clinutren vanilla and Resource diabet vanilla.

CONCLUSION

The Madrid scale has adequate psychometric properties for its use in research and daily clinical practice.

Genotypes of the C677T and A1298C polymorphisms of the MTHFR gene as a cause of human spontaneous embryo loss

BACKGROUND Polymorphisms C677T and A1298C of the MTHFR gene have been implicated in fetal viability. In this study, we determined the allele and genotype frequencies of these polymorphisms in different populations, including spontaneous abortion (SA) fetal tissues, with the objective of evaluating their impact on fetal viability. METHODS 342 samples of fetal tissues, selected from SA occurring during the 1980s, 230 samples from subjects born in the 1980s and a third set of samples from 204 subjects born in the 1950s, were genotyped by using TaqMan probes. RESULTS The wild CC genotype of the C677T polymorphism showed a strong protective effect against abortion (0.03 in SA versus 0.47 in 1950s and 0.43 in 1980s) (P < 0.0001). Genotypes of three mutations in the combinations of polymorphisms for C677T and A1298C showed a very low frequency in the living population; however, the three mutations genotypes were over expressed in the SA group (0.02 in 1950s; 0.03 in 1980s and 0.17 in SA) (P < 0.0001). Samples with four mutations (n = 2) were found only in the SA group. CONCLUSIONS There is no linkage disequilibrium between C667T and A1298C polymorphisms. Fetal viability is directly related to the CC genotype as a protector while the three and four mutation MTHFR genotypes appear to be a determinant on fetal non-viability and SA.

Importance of the efflux pump systems in the resistance of Mycobacterium tuberculosis to fluoroquinolones and linezolid

OBJECTIVE

Our aim was to study the influence of efflux pump systems in the resistance of Mycobacterium tuberculosis to fluoroquinolones and linezolid.

METHODS

We studied the mutations in gyrA and gyrB genes and the influence of efflux pump systems with 2 inhibitors (reserpine and MC 207.110).

RESULTS

The effect of the active efflux system on the decrease in sensitivity to ciprofloxacin, moxifloxacin, levofloxacin, ofloxacin, gatifloxacin and linezolid was studied by investigating the variation in the in vitro activity of these compounds when assayed in association with reserpine and MC 207.110. These inhibitors exhibit activity both in strains that are resistant and in strains that are susceptible to these antibiotics. However, they are seen to be most active in resistant strains, since the minimum inhibitory concentration of the antibiotics studied in these strains was reduced between 2- and 6-fold.

CONCLUSIONS

Therefore, these mechanisms are involved in the resistance to both compounds. It would be of interest to carry out further studies to determine to what extent these active efflux systems influence resistance to the different groups of drugs used in the treatment of tuberculosis, with a view to the possibility of using the inhibitors of these systems in future therapeutic applications.

Cryoglobulinaemia associated with hepatitis C virus: influence of HCV genotypes, HCV-RNA viraemia and HIV coinfection

To determine whether the clinical and immunological expression of patients with cryoglobulinaemia associated with chronic hepatitis C virus (HCV) infection varied according to HCV-RNA load, HCV genotype or human immunodeficiency virus (HIV) coinfection. We studied 340 HCV patients (188 women and 152 men, with a mean age of 49 years) consecutively diagnosed with cryoglobulinaemia between 1993 and 2003 in our hospital. HCV infection was confirmed by serum HCV-RNA determination in all patients. Two hundred and forty-eight (73%) patients had asymptomatic cryoglobulinaemia and 92 (27%) presented cryoglobulinaemic symptoms. Patients with genotype 1 had a higher mean age at diagnosis of cryoglobulinaemia (48.2 vs 40.2 yrs, P < 0.001) and a higher prevalence of cryoglobulinaemic symptoms (25%vs 10%, P = 0.02), especially of vasculitic features (19%vs 5%, P = 0.014). In comparison with monoinfected HCV patients, those with HIV coinfection had a lower mean age at diagnosis of cryoglobulinaemia (40.4 vs 52.8 years, P < 0.001), a lower prevalence of cryoglobulinaemic symptoms (15%vs 34%, P < 0.001), vasculitis (10%vs 28%, P < 0.001), associated systemic autoimmune disease (3%vs 14%, P = 0.001), rheumatoid factor (30%vs 70%, P = 0.001) and hypocomplementaemia (50%vs 78%, P = 0.01). In HCV-HIV patients, a high viral load was associated with a high frequency of symptomatic cryoglobulinaemia, especially in patients with a high viral load of the two viruses (50%vs 7%, P = 0.001) A higher frequency of cryoglobulinaemic symptoms (especially vasculitis) was found in patients with HCV monoinfection and in those carrying HCV genotype 1. In contrast, patients with HIV coinfection presented a threefold lower prevalence of vasculitis. Associated HIV infection significantly attenuated the clinical and immunological expression of cryoglobulinaemia, except in coinfected patients with high viral loads for the two viruses.

High prevalence of carbapenem-hydrolysing oxacillinases in epidemiologically related and unrelated Acinetobacter baumannii clinical isolates in Spain

Carbapenem-hydrolysing oxacillinases are reported increasingly in Acinetobacter baumannii. This study investigated the role of these beta-lactamases in causing resistance to carbapenems in 83 epidemiologically related and unrelated imipenem-resistant A. baumannii clinical isolates. The isolates were also analysed for the presence of ISAba1 in the promoter region of the bla(OXA-51)-like gene in order to investigate the role of ISAba1 in OXA-51 expression. All clinical isolates contained a bla(OXA-51)-like gene, 20% contained a bla(OXA-58)-like gene, and 42% contained a bla(OXA-40)-like gene; bla(OXA-23)-like, bla(IMP) and bla(VIM) genes were not detected in any of the isolates investigated. ISAba1 was found in 24 (82.7%) of 28 pulsetypes, and was located in the promoter region of the bla(OXA-51)-like gene in five (20.8%) of these pulsetypes. Expression of bla(OXA-51) was detected in the five isolates with ISAba1 located in the promoter region, but was not detected in an isogenic imipenem-susceptible A. baumannii isolate that did not have ISAba1 located in the promoter region. It was concluded that there is a high prevalence of oxacillinases with activity against carbapenems among genetically unrelated A. baumannii clinical isolates from Spain, and that concomitant expression of two carbapenemases (OXA-51-like and either OXA-40-like or OXA-58-like) may take place. Insertion of an ISAba1-like element in the promoter of the bla(OXA-51)-like gene promotes the expression of this gene, although this did not seem to play a major role in carbapenem resistance.

[Standard error of measurement: an alternative to minimally important difference to access changes in patient-reported-health-outcomes]

OBJECTIVE

To assess the concordance level between the standard Error of Measurement (EEM) and the minimal important difference (MID) criteria when evaluating the magnitude of change in self-perceived health status due to a clinical intervention.

METHOD

Two scales of patient self-reported health are used [a measure of benign prostatic hyperplasia impact (BPH-PIM) and a life satisfaction scale (LISAT-8)] in two independent studies carried out in order to adapt each scale to Iberian Spanish population. These studies included 129 and 537 males with benign prostatic hyperplasia (BPH) and erectile dysfunction (ED), respectively. After computing EEM and MID values, patients where classified in three groups attending to each criterion: improvement, without change, and worsening. Cohen s kappa agreement index and Kendall s tau-b lineal correlation coefficient where used to assess the level of concordance between criteria.

RESULTS

The concordance level between EEM and MID criteria was found to be high for both scales: kappa agreement index attained values of 0.81 and 0.76, while tau-b correlation coefficient attained values of 0.87 and 0.79.

CONCLUSION

The agreement level found allows to state that the EEM criterion is an adequate alternative to the MID criterion when assessing the magnitude of change produced in patient reported health.

Can 1H-Nuclear magnetic resonance (NMR) be used for early detection of hepatocellular cancer (HCC)?

15107

Background: HCC is a common and rapidly fatal cancer. Current screening tools are inadequate for identification of potentially curable cases. Our aim was to determine whether H-NMR can identify HCC compared to controls in the woodchuck (WC) model of hepatitis related HCC. Methods: Eastern WCs were bred and inoculated at birth with dilute sera from WCs that are chronic carriers of Woodchuck Hepatitis B Virus (WHV). This resulted in chronic hepatitis in ∼60% animals and all carriers developed HCC by 24–36 months. Serum from 10 chronic WHV carriers with HCC (group 1), 5 WHV carriers with no HCC (group 2) and 15 matched non-infected controls (group 3) was obtained. 45uL serum was diluted with 5uL of D2O containing 27mM formic acid + 0.9% saline. Spectra were collected on a 600 MHz INOVA spectrometer using a CapNMR flow probe with 10uL flow cell at 298K without knowledge of group assignments. The resulting 1D spectra were processed using Nuts from AcornNMR. Results: Principle component analysis and supervised PLS-DA was performed using Simca P+ from Umetrics. Despite general separation of groups, the Q2 value of this model was relatively low (0.20). We trained a Support Vector Machine (SVM) algorithm, a supervised machine-learning algorithm, to learn to identify the groups. Evaluation of the performance of the algorithm using 10-fold validation on the data set achieved a Kappa value of 0.43. This algorithm learnt to identify HCC [0.765 ROC, 0.8 sensitivity, and 0.727 positive predictive value (PPV)] and controls (0.75 ROC, 0.69 sensitivity and 0.73 PPV) but not the WHV carrier group, likely due to the small numbers. In a second analysis of 10 HCC and 15 controls, PLS-DA showed clear separation using three components (Q2= 0.5). The corresponding SVM model showed a kappa value of 0.52 and ROC values of 0.767 for both classes. Conclusions: Our preliminary results indicate that H-NMR spectra alone can be used to distinguish HCC from healthy controls using the machine-learning algorithm for classification. Further validation in a larger cohort of woodchucks is ongoing and confirmation of these preliminary findings would support investigation of this technique as a screening tool in patients at risk for developing HCC.

No significant financial relationships to disclose.

Multicenter study of weekly trastuzumab, paclitaxel and carboplatin followed by a week of rest every 28 days in patients with HER2+ metastatic breast cancer (MBC)

1083

Background: The addition of Carboplatin to Trastuzumab and Paclitaxel improves the efficacy in HER2+ metastatic breast cancer (MBC). We have conducted a multicenter Phase II study to investigate the efficacy and safety of this combination given weekly × 3 followed by 1 week of rest. Primary endpoint was objective response rate and secondary endpoints were time to progression, overall survival and to study the toxicity profile of the combination. Methods: Between August 2003 and April 2006, 40 patients with HER2+ MBC (IHC 3+ or FISH+) have been included in the study. Pats received Trastuzumab (loading dose of 4 mg/kg/wk and 2 mg/kg/d following wks), Paclitaxel (80 mg/m2) and Carboplatin (AUC 2) all given weekly × 3 followed by 1 week of rest. Treatment was given until disease progression or unacceptable toxicity. Results: 40 pats had baseline data available. Median age was 54 yrs (range 29–75). 38 (95%) pats received prior adjuvant or neoadjuvant treatment. 11 (27,5%) pats have received one prior CT line for metastatic disease. 87,5% pats had PS 0 or 1 at study entry. Disease sites were liver 16 (40%), bone 12 (30%), lymph nodes 13 (32,5%) and lung 8 (20%). 19 (47,5%) had = 2 lesions. 97,5% had measurable disease. 36 pats have been evaluated for response: 11 CR (31%, 95% CI: 15–46%), 11 PR (31%, 15- 36%), 9 SD (25%, 9–36%), 5 PD (14%, 2–26%) and 4 NE resulting in an ORR of 61% (95% CI: 45–77%) and tumor growth control rate (RR+SD) of 86% of patients (95% CI: 75–97%). Median TTP was 12.1 mo (95% CI: 8.8–19.9 mo) and median duration of response and OS have not been reached yet. For a time of observation of 35 mo, the OS is 80,6%. 37 patients have received 194 cycles with a median of 5 cycles. Grade 3–4 toxicities/pats were: 3(7.5%) anaemia, 2 (5%) leucopenia, 8(20%) neutropenia, 1 (2,5%) febrile neutropenia, 1 (2,5%) trombopenia, 2(5%) asthenia, 2(5%) diarrhea, 3(7.5%) nausea, 2(5%) vomiting, 3(7.5%) mucositis Conclusions: This interim analysis shows an interesting activity with this regimen. One week of rest may be of better convenience for the patient and hospital but also may improve the tolerability profile and efficacy of the combination. Further results would be available for presentation.

No significant financial relationships to disclose.