A liberal preoperative fasting regimen improves patient comfort and satisfaction with anesthesia care in day-stay minor surgery

BACKGROUND

The aim of this study was to evaluate whether a single preoperative limited oral intake of a carbohydrate drink could improve perioperative patient comfort and satisfaction with anesthesia care in elective day-stay ophthalmologic surgery.

METHODS

A single-center, prospective, randomized clinical trial was conducted in a university hospital. The study included ASA I-III patients undergoing ophthalmologic surgery. Patients undergoing both general anesthesia and local anesthesia were included in the study. The control group fasted in accordance to nil per os after midnight, while patients in the experimental group received 200 mL of a carbohydrate drink 2 h before the operation. Both groups were allowed to drink and eat until midnight ad libitum. Patient characteristics, subjective perceptions, taste of the drink, and satisfaction with anesthesia care were ascertained using a questionnaire administered three times: after the anesthesiologist's visit, before surgery and before discharge from the ward to assess patient comfort. An analysis of variance and the Mann-Whitney U-test were used for statistical analysis.

RESULTS

A total of 123 patients were included and 109 patients were randomly assigned to one of two preoperative fasting regimens. Patients drinking 200 mL 2 h before surgery were not as hungry (P<0.05), not as thirsty preoperatively (P<0.001) and not as thirsty after surgery (P<0.05), resulting in increased postoperative satisfaction with anesthesia care (P<0.05).

CONCLUSION

Standardized limited oral preoperative fluid intake increases patient comfort and satisfaction with anesthesia care and should be a part of modern day-stay ophthalmologic surgery.

[In-hospital emergencies at a surgical university hospital]

BACKGROUND

Emergency treatment and resuscitation within hospitals are managed by so-called medical emergency teams (MET). The present study examined the circumstances, number, initial treatment and further hospital course of in-hospital emergency cases at a level 1 university hospital.

METHODS

A retrospective study of in-hospital emergencies on the surgical wards of a university hospital including all non-intensive care areas from January 2007 to June 2010 was carried out. A self-developed documentation protocol which was introduced in 2006 was used by the MET to document general patient characteristics and details of the emergency treatment. These data included the place where the emergency situation arose, the patient's assignment to a surgical discipline, a detailed description of the emergency situation, the effectiveness of basic life support measures as well as the further hospital course of the patient.

RESULTS

A total of 235 emergency cases were documented within the study period of 3.5 years. The frequency of in-hospital emergencies was 4/1,000 admitted patients per year. Cardiac arrest was encountered in 31,5%. Out of all patients 54,5% were admitted to an intensive care unit.

CONCLUSION

The tasks of a MET at a surgical university hospital go beyond mere cardiopulmonary resuscitation. Emergency cases within the full spectrum of perioperative complications are encountered. Further multicenter studies with standardized protocols are required to analyze the management of German in-hospital emergencies.

Immediate reduction of Salmonella enterica serotype typhimurium viability via membrane destabilization following exposure to multiple-hurdle treatments with heated, acidified organic acid salt solutions

The antimicrobial activity of organic acids in combination with nonchemical treatments was evaluated for inactivation of Salmonella enterica serotype Typhimurium within 1 min. It was observed that the effectiveness of the multiple-hurdle treatments was temperature (P ≤ 0.05) and pH (P ≤ 0.05) dependent and corresponded to the degree of organic acid lipophilicity (sodium acetate being least effective and sodium propionate being the most effective). This led to the hypothesis that the loss in viability was due at least in part to cell membrane disruption. Evaluation of osmotic response, potassium ion leakage, and transmission electron micrographs confirmed treatment effects on the cell membrane. Interestingly, all treatments, even those with no effect on viability, such as with sodium acetate, resulted in measurable cellular stress. Microarray experiments explored the specific response of S. Typhimurium to sodium acetate and sodium propionate, the most similar of the tested treatments in terms of pK(a) and ionic strength, and found little difference in the changes in gene expression following exposure to either, despite their very different effects on viability. Taken together, the results reported support our hypothesis that treatment with heated, acidified, organic acid salt solutions for 1 min causes loss of S. Typhimurium viability at least in part by membrane damage and that the degree of effectiveness can be correlated with lipophilicity of the organic acid. Overall, the data presented here indicate that a combined thermal, acidified sodium propionate treatment can provide an effective antimicrobial treatment against Salmonella.

Karyotype analyses of ten sections of Trigonella (Fabaceae)

Karyotypes of ten sections of genus Trigonella Linnaeus, 1753 (Fabaceae) from Turkey were investigated. Somatic chromosome numbers of examined species were determined as 2n=14 and 16. The karyotype analyses of the species were carried out and somatic chromosome numbers of Trigonella plicata Boiss., 1872, Trigonella brachycarpa (Fisch.) Moris, 1833, Trigonella rostrata Boiss., 1872, Trigonella lunata Boiss., 1843, Trigonella isthmocarpa Boiss. et Balansa 1856, Trigonella rhytidocarpa Boiss. et Balansa, 1859, Trigonella spicata Sibth. et Sm., 1813, Trigonella cephalotes Boiss. et Balansa 1856, Trigonella capitata Boiss., 1843 and Trigonella gladiata Steven, 1808 were reported for the first time. Two pairs of satellite metaphase chromosomes were observed in Trigonella cariensis Boiss., 1843 and one pair in Trigonella lunata.Moreover, 2 B-chromosomes were found only in Trigonella procumbens Rchb., 1830 among all studied species. The aims of this study are to provide karyological data for a significant pool of the taxa, to show differences among them in the number, size and morphology of somatic chromosomes, to verify previous reports or represent numbers which are different from those cited previously.

Biochemical and histochemical comparison of cholinesterases in normal and Alzheimer brain tissues

Cholinesterase activity associated with neuritic plaques (NPs) and neurofibrillary tangles (NFTs) in Alzheimer's disease (AD) brains exhibit altered histochemical properties, such as requiring lower pH (6.8) for optimal cholinesterase staining compared to the pH (8.0) for best visualization of cholinesterases in neurons. Furthermore, visualization of NPs and NFTs can be prevented by agents like the peptidase inhibitor/metalloantibiotic bacitracin. The anomalous behavior of cholinesterases associated with pathological lesions needs to be elucidated because of the putative links between these enzymes and the disease process in AD. In this study, cholinesterases were extracted from AD and normal brain tissue to determine whether the differences observed in histochemical analyses in the two sources were reflected in kinetic properties measured in solubilized enzymes. Isolated brain enzymes from both these sources exhibited comparable kinetic parameters with respect to pH dependence, substrate affinity and inhibitor sensitivity and were not significantly affected by other agents that blocked cholinesterase histochemical visualization, such as the structurally diverse metal-chelating antibiotics bacitracin, doxycycline, minocycline and rifampicin. Although the cholinesterases from AD brain tissue examined here represented a total pool of these enzymes from AD brain, rather than enzymes specifically from NPs and NFTs, their kinetic behavior being comparable to cholinesterases isolated from normal brain tissues implies that these enzymes do not undergo disease-related modification in their primary structures. This suggests that the atypical histochemical behavior of cholinesterases in NPs and NFTs may result from interaction of cholinesterases with other molecules within these lesions, mediated by transition metal ions known to be present in AD pathology lesions.

Exclusive chemoradiotherapy without TURBT for frail and elderly patients with an invasive bladder cancer: Which platin fits better?

279

Background: Frail and elderly patients (pts) with invasive bladder carcinoma (BC) are often unfit for surgery. Whether exclusive concomitant chemoradiotherapy (cCRT) without TURBT could be performed in a curative-intent remains uncertain.

Methods: From 1996 to 2007, 68 pts were treated with exclusive cCRT. Median age was 77.5 years (70-91). WHO performance status (PS) at baseline were: PS 0: 27 pts; PS 1: 36 pts; PS 2; 4 pts; PS 3: 1 pt. 31 pts (45.5%) had a Charlson's score ≥ 5. Tumors were staged T1 (5 pts), T2 (44 pts), T3 (13 pts) and T4 (6 pts). 87.5% of the pts were clinically staged N0. Transuretral resection bladder tumor (TURBT) was incomplete and thus done for a diagnostic purpose only. 58 pts had an urothelial tumor (85.29%). External radiotherapy (ERT) was delivered with 1.8-2.0 daily fractions: median total dose of 63Gy [18Gy-69.4Gy] to the bladder and 92% of the pts had a whole pelvic ERT: median dose: 37.2Gy [18Gy-46Gy]. Drug was either cisplatin (CDDP) for 40 pts or carboplatin (CBDCA) for 28 pts. Overall survival (OS) and progression-free survival (PFS) rates were evaluated.

Results: The rate of compliant pts with the full course of cCRT was 77.9% (53 pts). 5 pts stopped cCRT for acute urinary adverse events (AE) whereas 8 pts stopped chemotherapy only for hematological or renal biochemical AE. For late toxicity, 5 pts had a G3/4 toxicity (1 rectal bleeding, 1 urinary bleeding, 1 recto-urinary fistula, 1 urinary incontinence and 1 urinary retention). Median follow-up was 4.6 years [CI95%: 3.43-5.93]. Of the 68 pts, 14 are alive (13 recurrence-free) amongst the 61 evaluable pts and 47 have died (24 recurrence-free). OS rates at 2 and 5 years were 50% (CI95%: [37.45%-61.44%]) and 31% (CI95%: [13.67%-38.43%]). PFS rates at 2 and 5 years were 37.4% [CI95%: 25.89%-48.82%] and 22% [CI95%: 12.25%- 33.61%], respectively. OS and PFS rates were worse for pts treated with CBDCA in comparison with those treated with CDDP (p= 0.01 for OS and p= 0.03 for PFS). Combined 5-FU did not impact either OS or PFS.

Conclusions: cCRT for elderly pts with a BC was feasible. For selected pts with a good PS, the adequate drug that should be combined with a conventional full course of ERT remains CDDP.

No significant financial relationships to disclose.

Theory of the Physical Properties of Si Nanocrystals

This paper reviews calculations concerning several aspects of silicon crystallites and their relevance for porous silicon. This begins with the optical properties of perfect crystallites: gap versus size, radiative recombination time, relative importance of phonon assisted transitions. A second part is devoted to the determination of the excitonic exchange splitting and of the Stokes shift which are found to bring a similar contribution (∼10 to 20 meV). The effect of surface defects like dangling bonds is then investigated with their contribution to the recombination time. The Auger non radiative recombination time is also calculated and found to be short (∼1 nsec). This is confirmed by some experiments on porous silicon which show a saturation effect of the photoluminescence under intense optical excitation or under cathodic polarization in aqueous solution, Auger recombination preventing the existence of more than one electron-hole pair per crystallite. Donor and acceptor impurities are studied in detail (screening of Coulomb potential, notion of ionization energy) with the conclusion that they are ionized. A final discussion shows the present level of understanding and identifies problems remaining to be solved.

Mental number line training in children with developmental dyscalculia

Developmental dyscalculia (DD) is a specific learning disability that affects the acquisition of mathematical skills in children with normal intelligence and age-appropriate school education (prevalence 3-6%). One essential step in the development of mathematical understanding is the formation and automated access to a spatial representation of numbers. Many children with DD show a deficient development of such a mental number line. The present study aimed to develop a computer-based training program to improve the construction and access to the mental number line. Sixteen children with DD aged 8-10 years and 16 matched control children completed the 5-week computer training. All children played the game 15 min a day for 5 days a week. The efficiency of the training was evaluated by means of neuropsychological tests and functional magnetic resonance imaging (fMRI) during a number line task. In general, children with and without DD showed a benefit from the training indicated by (a) improved spatial representation of numbers and (b) the number of correctly solved arithmetical problems. Regarding group differences in brain activation, children with DD showed less activation in bilateral parietal regions, which reflects neuronal dysfunction in pivotal regions for number processing. Both groups showed reduced recruitment of relevant brain regions for number processing after the training which can be attributed to automatization of cognitive processes necessary for mathematical reasoning. Moreover, results point to a partial remediation of deficient brain activation in dyscalculics after consolidation of acquired and refined number representation. To conclude, the present study represents the first attempt to evaluate a custom-designed training program in a group of dyscalculic children and results indicate that the training leads to an improved spatial representation of the mental number line and a modulation of neural activation, which both facilitate processing of numerical tasks.

Modulation of the BP response to diet by genes in the renin-angiotensin system and the adrenergic nervous system

BACKGROUND

Essential hypertension results from the interaction of several genetic and environmental factors. Identification of genetic factors that modulate blood pressure (BP) response to interventions can lead to improved strategies for prevention and control. The purpose of this study was to identify genes that modulate BP response to dietary interventions.

METHODS

We used data and samples collected in two randomized feeding studies to determine the extent to which genetic architecture is associated with the effect on BP of sodium intake and the Dietary Approaches to Stop Hypertension (DASH) dietary pattern. Participants in both trials were adults with above-optimal BP or unmedicated stage 1 hypertension. Genomic DNA was typed for several candidate genes.

RESULTS

The effect of sodium intake on BP differed by genotype at the angiotensinogen, β2-adrenergic receptor, and kallikrein loci. The effect of DASH dietary pattern on BP differed by genotype at the β2-adrenergic receptor locus.

CONCLUSIONS

These findings have implications for understanding the mechanism(s) through which diet affects BP, the heterogeneity of these effects, and the extent to which dietary interventions can modulate genetic predisposition.

Leucobacter aerolatus sp. nov., from the air of a duck barn

A Gram-positive, non-spore-forming actinobacterium (Sj 10T) was isolated on tryptone soy agar from the air of a duck barn after filter sampling. Based on 16S rRNA gene sequence similarity studies, strain Sj 10T was shown to belong to the genus Leucobacter and was closely related to Leucobacter chromiireducens subsp. chromiireducens L-1T (97.8 %), Leucobacter tardus DSM 19811T (97.3 %) and Leucobacter luti RF6T (97.3 %). The peptidoglycan of strain Sj 10T contained 2,4-diaminobutyric acid in combination with a lower amount of lysine as diagnostic diamino acids. In addition, threonine, glycine, alanine and glutamic acid were found. Menaquinone MK-11 was the major respiratory quinone; MK-12 and MK-10 were detected in minor amounts. The polar lipid pattern consisted of phosphatidylglycerol, diphosphatidylglycerol and one unknown component each of a phospholipid, glycolipid and aminoglycolipid. Strain Sj 10T contained the major fatty acids anteiso-C15 : 0, iso-C16 : 0 and anteiso-C17 : 0, like other members of the genus Leucobacter. Results of DNA–DNA hybridization, physiological and biochemical tests enabled strain Sj 10T to be differentiated genotypically and phenotypically from the most closely related Leucobacter species. Strain Sj 10T represents a novel species of the genus Leucobacter, for which the name Leucobacter aerolatus sp. nov. is proposed, with Sj 10T (=DSM 22806T =CCM 7705T) as the type strain.

[Normal tissue tolerance to external beam radiation therapy: small bowel]

The small bowel is a hollow organ involved in the transit and absorption of food. In relation to its anatomical location, a significant amount of this organ is exposed in whole or in part to ionizing radiation in external radiotherapy during abdominal or pelvic irradiation either for primary cancers or metastasis. The acute functional changes during external beam radiation are mainly leading to diarrhea, abdominal pain and bloating. The main late side effects of irradiation of the small intestine are chronic diarrhea, malabsorption with steatorrhea, abdominal spasms, intestinal obstruction, bleeding and fistulas. The architecture of the small intestine may be considered as parallel with a significant correlation between the irradiated volume of small bowel and the likelihood of acute toxicity, whatever the dose. The literature analysis recommends to consider the volume of small bowel receiving 15 Gy (threshold of 100 to 200 cm(3)) but also 30 and 50 Gy (thresholds of 35 to 300 cm(3), depending on the level of dose considered). Modern techniques of conformal radiotherapy with modulated intensity will probably have beneficial impact on small bowel toxicity.

The Anesthesia Preoperative Evaluation Clinic (APEC): a prospective randomized controlled trial assessing impact on consultation time, direct costs, patient education and satisfaction with anesthesia care

AIM

Anesthetic preoperative evaluation clinics (APECs) are relatively new institutions. Although cost effective, APECs have not been universally adopted in Europe. The aim of this study was to compare preoperative anesthetic assessment in wards with an APEC, assessing time, information gain, patient satisfaction and secondary costs.

METHODS

Two hundred and seven inpatients were randomized to be assessed at the APEC or on the ward by the same two senior anesthetists. The outcomes measured were the length of time for each consultation, the amount of information passed on to patients and the level of patient satisfaction. The consultation time was used to calculate impact on direct costs. A multivariate analysis was conducted to detect confounding variables.

RESULTS

Ninety-four patients were seen in the APEC, and 78 were seen on the ward. The total time for the consultation was shorter for the APEC (mean 8.4 minutes [P<0.01]), and we calculated savings of 6.4 Euro per patient. More information was passed on to the patients seen in the APEC (P<0.01). The general satisfaction scores were comparable between groups. A multivariate analysis found that the consultation time was significantly influenced by the type of anesthesia, the magnitude of the operation and the location of the consultation. Gain in information was significantly influenced by age, education and the location of the visit.

CONCLUSION

The APEC reduced consultation times and costs and had a positive impact on patient education. The cost savings are related to personnel costs and, therefore, are independent of other potential savings of an APEC, whereas global patient satisfaction remains unaltered.

[Delirium in the intensive care unit]

In recent years delirium in the intensive care unit (ICU) has internationally become a matter of rising concern for intensive care physicians. Due to the design of highly sophisticated ventilators the practice of deep sedation is nowadays mostly obsolete. To assess a ventilated ICU patient for delirium easy to handle bedside tests have been developed which permit a psychiatric scoring. The significance of ICU delirium is equivalent to organ failure and has been proven to be an independent prognostic factor for mortality and length of ICU and hospital stay. The pathophysiology and risk factors of ICU delirium are still insufficiently understood in detail. A certain constellation of pre-existing patient-related conditions, the current diagnosis and surgical procedure and administered medication entail a higher risk for the occurrence of ICU delirium. A favored hypothesis is that an imbalance of the neurotransmitters acetylcholine and dopamine serotonin results in an unpredictable neurotransmission. Currently, the administration of neuroleptics, enforced physiotherapy, re-orientation measures and appropriate pain treatment are the basis of the therapeutic approach.

Wolbachia modulates Chikungunya replication in Aedes albopictus

The Aedes albopictus mosquito has been involved as the principal vector of recent major outbreaks due to the chikungunya virus (CHIKV). The species is naturally infected by two strains of Wolbachia (wAlbA and wAlbB). Wolbachia infections are thought to have spread by manipulating the reproduction of their hosts; cytoplasmic incompatibility is the mechanism used by Wolbachia to invade natural populations of many insects including Ae. albopictus. Here, we report a study on the effects of removing Wolbachia from Ae. albopictus on CHIKV replication and examine the consequences of CHIKV infection on some life-history traits (survival and reproduction) of Wolbachia-free Ae. albopictus. We found that Wolbachia-free mosquitoes maintained a highly heterogeneous CHIKV replication compared to Wolbachia-infected individuals. In Wolbachia-infected Ae. albopictus, the regular increase of CHIKV followed by a steady viral load from day 4 post-infection onwards was concomitant with a decline in Wolbachia density. This profile was also detected when examining the two key organs for viral transmission, the midgut and the salivary glands. Moreover, Wolbachia-free Ae. albopictus was not altered in life-history traits such as survival, oviposition and hatching characteristics whether infected or not with CHIKV. We found that Wolbachia is not essential for viral replication, its presence could lead to optimize replication from day 4 post-infection onwards, coinciding with a decrease in Wolbachia density. Wolbachia may regulate viral replication in Ae. albopictus, with consequences on survival and reproduction.

Jeotgalicoccus coquinae sp. nov. and Jeotgalicoccus aerolatus sp. nov., isolated from poultry houses

Two Gram-stain-positive, non-motile, non-spore-forming cocci (strains MK-7(T) and MPA-33(T)) were isolated from poultry houses. Strain MK-7(T) was isolated on marine broth agar from coquina, a food supplement for female ducks used in a duck-fattening farm. Strain MPA-33(T) was isolated from the air of a turkey house on TSA after filter sampling. On the basis of 16S rRNA gene sequence similarity studies, both strains were shown to belong to the genus Jeotgalicoccus; MK-7(T) was most closely related to Jeotgalicoccus psychrophilus YKJ-115(T) (99.3 % similarity) and MPA-33(T) was most closely related to Jeotgalicoccus halotolerans YKJ-101(T) (98.8 %). The quinone system of MK-7(T) was composed of equal amounts of menaquinones MK-7 and MK-6 and that of MPA-33(T) contained 76 % MK-7 and 24 % MK-6. The polar lipid profile of strain MK-7(T) consisted of the major compounds diphosphatidylglycerol and phosphatidylglycerol and six unidentified lipids present in minor to moderate amounts. In strain MPA-33(T), diphosphatidylglycerol was the single predominant lipid, whereas phosphatidylglycerol was detected in moderate amounts. In addition, one unidentified phospholipid and four unidentified lipids were detected. Fatty acid profiles with iso-15 : 0 and anteiso-15 : 0 as major fatty acids supported the affiliation of the strains to the genus Jeotgalicoccus. The results of physiological and biochemical tests as well as DNA-DNA hybridizations allowed clear phenotypic differentiation of strains MK-7(T) and MPA-33(T) from the most closely related species. Strains MK-7(T) and MPA-33(T) therefore represent novel species, for which the names Jeotgalicoccus coquinae sp. nov. (type strain MK-7(T) =DSM 22419(T) =CCM 7682(T) =CCUG 57956(T)) and Jeotgalicoccus aerolatus sp. nov. (type strain MPA-33(T) =DSM 22420(T) =CCM 7679(T) =CCUG 57953(T)) are proposed.

Vascular risk factors, HIV serostatus, and cognitive dysfunction in gay and bisexual men

BACKGROUND

The purpose of this study was to evaluate the relationship between cognitive performance, risk factors for cardiovascular and cerebrovascular disease (CVD), and HIV infection in the era of highly active antiretroviral therapy.

METHODS

We evaluated the cognitive functions of men enrolled in the cardiovascular disease substudy of the Multicenter AIDS Cohort Study who were aged > or =40 years, with no self-reported history of heart disease or cerebrovascular disease. Results from comprehensive neuropsychological evaluations were used to construct composite scores of psychomotor speed and memory performance. Subclinical CVD was assessed by measuring coronary artery calcium and carotid artery intima-media thickness (IMT), as well as laboratory measures, including total cholesterol, fasting glucose, glycosylated hemoglobin, glomerular filtration rate (estimated), and standardized blood pressure and heart rate measures.

RESULTS

After accounting for education, depression, and race, carotid IMT and glomerular filtration rate were significantly associated with psychomotor speed, whereas IMT was associated with memory test performance. HIV serostatus was not significantly associated with poorer cognitive test performance. However, among the HIV-infected individuals, the presence of detectable HIV RNA in plasma was linked to lower memory performance.

CONCLUSIONS

These findings suggest that HIV infection may not be the most important predictor of cognitive performance among older gay and bisexual men in the post-highly active antiretroviral therapy era, at least among those with access to medical care and to appropriate medications. Medical factors associated with normal aging are significantly associated with performance on neuropsychological tests, and good clinical management of these factors both in HIV-infected individuals and those at risk for infection may have beneficial effects in the short term and could reduce the risk of subsequent cognitive decline.

Giant perineal hernia: laparoscopic mesh repair complemented by a perineal cutaneous approach

Symptomatic perineal herniation after abdominoperineal resection is a rare complication and its management remains challenging. Perineal laparoscopic mesh repair is safe and effective and can be performed with minimal complications. We report a giant perineal hernia treated by a combined laparoscopic mesh repair approach and plastic resection of the cutaneous perineal wound. To the best of our knowledge, this is the first report with this technical approach that we could find in the English literature.

Impairments in memory and hippocampal function in HIV-positive vs HIV-negative women: a preliminary study

OBJECTIVE

Neurocognitive studies of HIV typically target executive functions dependent on frontostriatal circuitry. The integrity of medial temporal systems has received considerably less attention despite high hippocampal viral load. Studies also predominately involve HIV+ men, though HIV+ women may be at increased risk for cognitive dysfunction due to the high prevalence of psychosocial/mental health problems and lower educational attainment. Our aim was to conduct a preliminary investigation of episodic memory and its neural correlates in HIV-infected and at-risk uninfected women.

METHODS

Participants included 54 HIV+ and 12 HIV- women (mean age = 43 years; 86% African American) recruited from the Chicago site of the Women's Interagency HIV Study. Participants completed standardized tests of verbal and visual episodic memory, working memory, and executive function. A subset of 11 women also underwent functional MRI during a delayed verbal episodic memory task.

RESULTS

HIV serostatus predicted significantly lower immediate and delayed verbal episodic memory, working memory, and visual memory. Preliminary neuroimaging findings revealed group differences in bilateral hippocampal function, with HIV+ women showing decreased activation during encoding and increased activation during delayed recognition. These alterations correlated with worse episodic verbal memory.

CONCLUSIONS

Verbal episodic memory deficits are evident in HIV+ women and may be associated with hippocampal dysfunction at both encoding and retrieval.

[Toxicity of radiation therapy and antiangiogenics combination: a case report]

The combined administration of antiangiogenic agents (AA) and radiation is being evaluated. No AA has yet received Marketing Authorization in this indication. However, they are widely used in medical oncology and criteria for stopping their administration in case of irradiation have not been defined. We report the case of a 63-year-old man experiencing grade 2 skin toxicity while on radiation treatment and sorafenib (400mg twice daily) for a metastatic lesion developing between the vastus medialis muscle and the cortical of the mid-diaphysis of the right femur. Toxicity occurred at 21Gy, for a total dose of 36Gy (12 fractions of 3Gy). Cutaneous symptoms rapidly disappeared after treatment discontinuation. Radiotherapy alone was resumed after a few days and the total dose could be delivered, with good tolerance. At 2-month follow-up, the intramuscular lesion had regressed. Several other cases of patients with poor tolerance to the association of AA and radiotherapy have been reported. Further studies of the effectiveness and tolerance of the combination treatment are needed before indications for AA can be extended to other diseases.

Rice fields regulate organochlorine pesticides and PCBs in lagoons of the Nature Reserve of Camargue

In order to assess pollutant transfer in Camargue ponds from bordering agrosystems, a biomonitoring assay was conducted in irrigation and drainage channels of rice fields in the Rhone Delta (France). A filter-feeding bivalve, the Asian clam, Corbicula fluminea, was used as bioindicator and caged in upstream and downstream channels of an area of conventional rice fields. After 6 weeks incubation, many lipophilic biocides were identified in Corbicula tissues, including pesticides used in rice plantations (pretilachlor, oxadiazon), pesticides presumed in use in the Rhone basin [diuron and its metabolite 3,4 dichloroaniline (3,4-DCA)] and organochlorine pesticides (OCPs) banned for several decades. In addition, PCBs were highly bioaccumulated in Corbicula. Downstream bivalves had significantly lower concentrations of OCPs, PCB and 3,4-DCA. However, the exposure biomarkers (glutathione S-transferase, catalase and propionylcholinesterase) were not correlated with the decreased concentrations. The results of this experiment raise several questions concerning the potential role of immersed plants in a retention process.

Apparent diffusion coefficient values of middle ear cholesteatoma differ from abscess and cholesteatoma admixed infection

A retrospective study was conducted on a cohort of 15 patients who underwent surgery because cholesteatoma or abscess was suspected. All patients had MR imaging prior to surgery with diffusion-weighted images (DWI) from which the apparent diffusion coefficient (ADC) value was calculated. Using this technique, we were able to determine 3 distinct ADC value ranges corresponding to the 3 groups of lesions found at surgery (pure cholesteatoma, cholesteatoma with infection, and abscess or infection). This needs to be confirmed by further studies with a wider range of patients.

Safety of gadoversetamide in patients with acute and chronic myocardial infarction

PURPOSE

To assess the safety data from two large, multicenter, phase 2 trials on the use of gadoversetamide (OptiMARK, Tyco Healthcare/Mallinckrodt, St. Louis, MO) as a contrast agent in delayed hyperenhancement magnetic resonance imaging (DE-MRI) in patients with acute and chronic myocardial infarction (MI).

MATERIALS AND METHODS

The study population from both trials comprised 577 patients who were randomly assigned to one of four dose groups (0.05, 0.1, 0.2, or 0.3 mmol/kg) before undergoing DE-MRI. Safety evaluations included physical and electrocardiographic (ECG) examinations. Vital signs, laboratory values, adverse events (AE), and serious adverse events (SAE) were monitored before and after contrast administration.

RESULTS

Of the 577 patients who received gadoversetamide, 124 (21.5%) reported a total of 164 AEs; most were mild (139 AEs; 84.8%) or moderate (25 AEs; 15.2%). ECG-related changes were the most frequent AE. Site investigators judged only eight AEs as likely related to gadoversetamide and only two of the eight as clinically relevant. Further evaluation suggested neither AE was related to gadoversetamide. Two SAEs were reported, but none was judged related to gadoversetamide by the site investigators.

CONCLUSION

Gadoversetamide is safe for use in patients with acute or chronic MI up to a dose of 0.3 mmol/kg.

Influence of infection control report cards on patients' choice of hospital: pilot survey

The impact on patients' attitudes of quality report cards on infection control in hospitals has never previously been studied. In 2006, the French government implemented a mandatory report card on infection control activity (ICALIN) in all hospitals. This approach was aimed at encouraging professionals to change their routine practices in case they should lose patients due to a low ICALIN score. Our objective was to assess what impact ICALIN could have on patients' attitude as regards hospital choice. We performed a survey of patients and visitors in 14 randomly selected hospitals of various ICALIN scores. A convenience sample of 381 patients and visitors completed an anonymous questionnaire on ICALIN, their reasons for choosing a hospital and attitude in the event of a low ICALIN score. Factors associated with interest in ICALIN and impact of ICALIN on hospital choice were assessed by logistic regression. Our results showed that 77% of participants were interested in ICALIN. ICALIN was ranked sixth as a reason for choosing a hospital. In the case of a low ICALIN, 24.1% of participants would refuse admission and 54.9% would seek advice from their general practitioner. Sociodemographic factors had no influence on patients' attitude. In conclusion, our survey suggests that patients take note of poor performance on infection control report cards. As most patients rely on their general practitioner to interpret these report cards, there is a definite need for further communication with general practitioners on this issue.

145 FACTORS AFFECTING PREGNANCY RATE FOLLOWING TIMED EMBRYO TRANSFER PROGRAM IN CATTLE UNDER FIELD CONDITIONS

Hormonal estrus synchronization followed by heat detection of recipient animals is a widely used technique in embryo transfer (ET) programs around the world. However, the successful outcomes of ET rely heavily on appropriate heat detection of recipient animals. Additionally, limited availability of personnel and time to detect heat makes ET impractical at times. Therefore, pregnancy rates (PR) following a timed embryo transfer (TET) program were evaluated taking into account different variables of recipient cows, donor embryos, and season of transfer under field conditions in Argentina. Recipient cows were synchronized utilizing a progesterone (P4) intravaginal device (DIB, Syntex, Argentina) for 7 days. On Day 0 (day of DIB insertion) 2 mg of estradiol benzoate (EB) i.m. was administered and immediately after DIB removal on Day 7, 500 μg of D(+) Cloprostenol i.m. (PG, Ciclase, Syntex), 400 IU of eCG i.m. (Novormon, Syntex) plus 1 mg of cypionate estradiol i.m. (ECP; König, Agentina) were administered to all recipient cows. Fresh (n = 1746) and frozen (n = 2047) beef bovine embryos were nonsurgically transferred into recipient cows on Day 9 after PG. The effects of body condition score (1–9, BCS I: ≤5, n = 804 and BCS II: ≥6, n = 2989), corpus luteum (CL) score (CL1: prominent papilla, n = 932, CL2: small papilla, n = 2028, and CL3: asymmetric, n = 833), location of embryo placement in uterine horn (upper, n = 3566, and lower, n = 227), and type of recipient such as heifer (n = 487), lactating (n = 1010), or dry cows (n = 2296) on PR were evaluated. Additionally, stage of embryo development (4–7), quality (1–3), and season of transfer (spring, summer, fall, and winter) were included in the analysis. Pregnancy rate was confirmed by rectal palpation 60 days after ET. Data were first screened by chi square and then analyzed by Proc Logistic of SAS (SAS Institute Inc., Cary, NC). Overall PR was 54.7%. body condition score, CL, type of recipients, stage of embryo development, and year were not significantly (P > 0.05) associated with PR. As expected, cows that received direct fresh embryos had 1.49 times greater odds of conceiving (odds ratio, OR = 1.49, 95% CI: 1.22 to 1.82) than those receiving frozen embryos. Additionally, cows receiving embryos graded as quality 1 had greater probability to conceive (OR = 1.62, 95% CI: 1.34 to 1.95, or OR = 1.64, 95% CI: 1.25 to 2.21) compared to quality 2 or 3 respectively. Moreover, embryos placed into the upper portion of uterine horn were more likely (OR = 1.48) to conceive than those placed in the lower uterine portion. Regardless of embryos and recipient cow variables analyzed, there was a greater probability for cows to conceive during winter (OR = 1.41, 95% CI: 1.13 to 1.95) as compared with summer. In conclusion, synchronized recipient animals for a TET program resulted in acceptable PR for both fresh and frozen embryos. Results suggested that the quality and location of embryos (upper portion) in uterine horn were the most important variables associated with PR in recipient cows. Therefore, TET is a viable and practical option allowing a successful outcome for many beef operations where availability of personnel is limited.