Measurement of the depth of maximum of extensive air showers above 10{18} eV

We describe the measurement of the depth of maximum, X{max}, of the longitudinal development of air showers induced by cosmic rays. Almost 4000 events above 10;{18} eV observed by the fluorescence detector of the Pierre Auger Observatory in coincidence with at least one surface detector station are selected for the analysis. The average shower maximum was found to evolve with energy at a rate of (106{-21}{+35}) g/cm{2}/decade below 10{18.24+/-0.05} eV, and (24+/-3) g/cm{2}/decade above this energy. The measured shower-to-shower fluctuations decrease from about 55 to 26 g/cm{2}. The interpretation of these results in terms of the cosmic ray mass composition is briefly discussed.

Cutaneous manifestations in renal transplant recipients of Santiago, Chile

INTRODUCTION

Renal transplant recipients have a heightened risk of developing various cutaneous manifestations, such as skin infections, skin cancer, and secondary effects of immunosuppressive drugs. These manifestations differ depending on the evaluated population. The objective of this study was to describe the prevalence of cutaneous manifestations among renal transplant recipients in Chile between 1979 and 2008.

METHODS

Patients were recruited and then evaluated using a standardized questionnaire. Dermatologic physical examination was performed in every patient describing skin lesions, immunosuppressive drug effects, and malignant diseases. All suspicious lesions were biopsied for analysis. Every patient was queried for the development of skin cancer after his or her transplantation.

RESULTS

A total of 91 patients were enrolled; ages 10-67 years. Sixty percent of the patients presented with an infection at the initial evaluation. The most common infection was onychomycosis (58%) and verruca vulgaris (25%). In this study 58% of patients developed cutaneous side effects of immunosuppressive drugs. Among the evaluated patients, 16% showed premalignant or malignant manifestations on physical examination. The most frequent manifestations were actinic keratosis (17%), basal cell carcinoma (1%), and squamous cell carcinoma (1%). On a retrospective analysis, 12% of patients developed skin cancer after transplantation, 66% squamous cell carcinoma and 34% basal cell carcinoma, with a ratio of 1.9 to 1.

DISCUSSION

Cutaneous manifestations in renal transplant recipients are generally secondary to immunosuppression. These patients show a greater risk of having human papilloma virus (HPV) infections and nonmelanoma skin cancer. Periodic dermatologic evaluation of these patients should be performed to detect early lesions and modify risk factors.

Hemorrhagic cystitis secondary to adenovirus infection in a kidney transplant recipient: case report

Increasingly potent immunosuppressive agents have reduced the incidence of rejection of transplanted organs while increasing patient susceptibility to opportunistic infections and cancer. Adenoviruses are increasingly recognized as contributors to morbidity and mortality in stem cell and solid-organ transplant recipients. Clinical findings range from asymptomatic viremia to respiratory and gastrointestinal disease, hemorrhagic cystitis, and severe disseminated illness. We describe the first case in Chile of hemorrhagic adenovirus cystitis after renal transplantation in an adult.

Viability of Ascaris and other helminth genera non larval eggs in different conditions of temperature, lime (pH) and humidity

Helminth eggs are the pathogens most resistant to inactivation during sludge and wastewater treatment. For this reason, in several regulations and the WHO guidelines for wastewater and excreta reuse for agriculture and aquaculture they are considered as indicators of the performance of the treatment process. Conditions required to inactivate helminth eggs, notably Ascaris lumbricoides, are recommended in the literature, but in practice these have not always proven effective, not only for Ascaris but also other genera of helminth eggs. The objective of this research was to study the inactivation of a high total content of non larval Ascaris and other genera of helminth eggs of medical importance to developing countries under controlled conditions of (a) temperature (30 °C to 80 °C) and humidity (80, 90 and 95%) and (b) lime doses (15 and 20% of CaO w/w dry basis) and humidity (90 and 80%), using different contact times in both cases. The inactivation data obtained for different genera of non larval helminth eggs is presented. Results showed that there is a combination of conditions (temperature, pH and humidity) that is optimal for inactivation. To completely inactivate any genera of non larval helminth eggs: (a) a temperature above 70 °C and 80% humidity for a duration of 120 min; and, (b) a 20% CaO dose (pH 12.5) and a humidity level of 80% for a duration of 8 months are needed. With regard to the resistance of different genera of helminth eggs, Ascaris, Toxocara and Taenia, in that order, were the most resistant, while the most sensitive were Trichuris and Hymenolepis. For most of the conditions tested Ascaris showed the highest resistance, probably due to the chemical arrangement of its membrane.

Duration of delayed graft function is an important predictor of 1-year serum creatinine

OBJECTIVE

The purpose of this study was to evaluate the importance of various factors on 1-year serum creatinine (SCr) as a surrogate endpoint for allograft survival among a series of kidney transplantations performed at 2 centers.

PATIENTS AND METHODS

Two hundred sixty consecutive renal transplantations were included with overall mean age of 40 +/- 13 years, including 55% men and 19% living donor grafts. Factors considered for analysis were donor and recipient ages, and sexes, number of transplantations, panel-reactive antibodies, total number of HLA mismatches, cold ischemia time (CIT), acute rejection (AR) rate, and presence/duration of delayed graft function (DGF). Multiple regression analyses were performed for 1-year SCr, AR rate, and DGF duration.

RESULTS

One-year SCr was 1.46 +/- 0.5 mg/dL, 6-month AR rate was 22%, and DGF rate was 29% of mean duration 3 +/- 8 days. Multiple regression analysis for lower 1-year SCr value identified as significant female recipient sex, lower donor age, absence of AR within 6 months, and decreased DGF duration (P < .05). The only significant factor affecting AR rate was DGF duration. Finally, prolonged CIT was associated with a longer DGF duration.

CONCLUSIONS

We confirmed that 1-year SCr was primarily affected by well-known factors, such as AR incidence, donor age, and female recipient sex. However, we identified DGF duration as a significant factor affecting 1-year SCr. AR rate was also associated with DGF duration, which in turn depended upon longer CIT.

Observation of the suppression of the flux of cosmic rays above 4 x 10 (19) eV

The energy spectrum of cosmic rays above 2.5 x 10;{18} eV, derived from 20,000 events recorded at the Pierre Auger Observatory, is described. The spectral index gamma of the particle flux, J proportional, variantE;{-gamma}, at energies between 4 x 10;{18} eV and 4 x 10;{19} eV is 2.69+/-0.02(stat)+/-0.06(syst), steepening to 4.2+/-0.4(stat)+/-0.06(syst) at higher energies. The hypothesis of a single power law is rejected with a significance greater than 6 standard deviations. The data are consistent with the prediction by Greisen and by Zatsepin and Kuz'min.

The evolutionary history of the CD209 (DC-SIGN) family in humans and non-human primates

The CD209 gene family that encodes C-type lectins in primates includes CD209 (DC-SIGN), CD209L (L-SIGN) and CD209L2. Understanding the evolution of these genes can help understand the duplication events generating this family, the process leading to the repeated neck region and identify protein domains under selective pressure. We compiled sequences from 14 primates representing 40 million years of evolution and from three non-primate mammal species. Phylogenetic analyses used Bayesian inference, and nucleotide substitutional patterns were assessed by codon-based maximum likelihood. Analyses suggest that CD209 genes emerged from a first duplication event in the common ancestor of anthropoids, yielding CD209L2 and an ancestral CD209 gene, which, in turn, duplicated in the common Old World primate ancestor, giving rise to CD209L and CD209. K(A)/K(S) values averaged over the entire tree were 0.43 (CD209), 0.52 (CD209L) and 0.35 (CD209L2), consistent with overall signatures of purifying selection. We also assessed the Toll-like receptor (TLR) gene family, which shares with CD209 genes a common profile of evolutionary constraint. The general feature of purifying selection of CD209 genes, despite an apparent redundancy (gene absence and gene loss), may reflect the need to faithfully recognize a multiplicity of pathogen motifs, commensals and a number of self-antigens.

Upper limit on the diffuse flux of ultrahigh energy tau neutrinos from the Pierre Auger Observatory

The surface detector array of the Pierre Auger Observatory is sensitive to Earth-skimming tau neutrinos that interact in Earth's crust. Tau leptons from nu(tau) charged-current interactions can emerge and decay in the atmosphere to produce a nearly horizontal shower with a significant electromagnetic component. The data collected between 1 January 2004 and 31 August 2007 are used to place an upper limit on the diffuse flux of nu(tau) at EeV energies. Assuming an E(nu)(-2) differential energy spectrum the limit set at 90% C.L. is E(nu)(2)dN(nu)(tau)/dE(nu)<1.3 x 10(-7) GeV cm(-2) s(-1) sr(-1) in the energy range 2 x 10(17) eV< E(nu)< 2 x 10(19) eV.

Occurrence of faecal contamination in households along the US-Mexico border

AIMS

The study aim was to determine the presence of total and faecal coliforms on kitchen surfaces, in tap water and on the hands of caregivers in households on both sides of the US-Mexico border.

METHODS AND RESULTS

Samples were collected in 135 randomly selected households in Ciudad Juarez, Mexico, and El Paso, Texas. Different surfaces throughout the kitchen and head of households' hands were sampled using sterile cotton swabs moistened in D/E neutralizing solution. Sponge/dishcloth and drinking water samples were also obtained. Total and faecal coliforms were enumerated on m-Endo LES and mFC respectively. Total coliforms and Escherichia coli in drinking water samples were enumerated in accordance with the Quanti-Tray method. Sponge/dishcloth samples were the most commonly contaminated kitchen sites, followed by countertops and cutting boards. We recovered faecal coliforms from 14% of the hands of child caregivers, and this indicator was moderately associated with self-reported failure to wash hands after using the toilet (OR = 3.2; 95% CI: 0.9, 11.1).

CONCLUSIONS

Hand washing should continue to be emphasized, and additional interventions should be directed to specific kitchen areas, such as sponges/dishcloths, tables/countertops and cutting boards.

SIGNIFICANCE AND IMPACT OF THE STUDY

There is a need for additional interventions regarding kitchen sanitation.

Cholesterol reduction using psyllium husks - do gastrointestinal adverse effects limit compliance? Results of a specific observational study

PURPOSE

Despite known cholesterol lowering effects the use of psyllium husk (Plantaginis ovatae testa) in Germany for hypercholesterolemia is limited compared to their use as a laxative. To investigate whether use in hypercholesterolemia is limited due to adverse effects on the gastrointestinal system, a prospective observational study was conducted.

METHODS

Sixty-two outpatients with documented hypercholesterolemia and complaints of constipation were identified from an academic clinical center. Treatment with 3.5g psyllium husk preparation administered three times daily was initiated and patients were monitored at weekly intervals. Gastrointestinal symptoms were quantified using a validated Nepean Dyspepsia Index modified to identify both upper and lower abdominal symptoms. Diaries and study medication records were used to evaluate compliance.

RESULTS

Fifty-four of 62 patients enrolled in the study completed the study protocol with 4 subjects discontinuing due to adverse reactions associated with psyllium husks. Total cholesterol was significantly decreased from 252+/-39mg/dl before treatment to 239+/-37mg/dl after 3 weeks of treatment. Similarly, low density lipoprotein (LDL)-cholesterol decreased from 174+/-34 to 162+/-31mg/dl during the study. Triglycerides and high density lipoprotein (HDL) were unchanged. Gastrointestinal symptoms were rated lower at the end than at the beginning of the study. In week 1 most of the patients reported gastrointestinal symptoms and also gastrointestinal adverse reactions, which however, showed a decrease from week 1 to weeks 2 and 3 in the diaries. Patient response to study medication was positive for patients completing the study.

CONCLUSIONS

Psyllium husk preparations may be a therapeutic option for patients with mild to moderately elevated cholesterol levels. Adverse gastrointestinal symptoms associated with the preparation appear to be transient in some of the patients. Compliance may be optimized with adequate patient counseling.

Prevalence and determinants of high-risk human papillomavirus (HPV) infection and cervical cytological abnormalities in imprisoned women

The aim of the study was to estimate the prevalence and risk factors associated with infection by high-risk human papillomavirus (HR-HPV) in cervix and squamous intra-epithelial lesions (SIL) in imprisoned women. This was done by a cross-sectional study of imprisoned women attending the gynaecological clinic in Foncalent prison in Alicante, Spain. The study period was from May 2003 to December 2005. HR-HPV infection was determined through Digene HPV Test, Hybrid Capture II (HC-II). HPV typing was determined by multiplex nested PCR assay combining degenerate E6/E7 consensus primers. Multiple logistic regression modelling was used for the analysis of associations between variables where some were considered possible confounders after checking for interactions. A total of 219 women were studied. HR-HPV prevalence was 27.4% and prevalence of SIL was 13.3%. HIV prevalence was 18%, higher in Spaniards than in migrant women (24.6% vs. 14.3%, P<0.05). In multivariate analyses, risk factors for HPV infection were younger age (P for trend=0.001) and tobacco use (OR 2.62, 95% CI 1.01-6.73). HPV infection (OR 4.8, 95% CI 1.7-13.8) and HIV infection were associated with SIL (OR 4.8, 95% CI 1.6-14.1). The commonest HPV types were HPV16 (29.4%), HPV18 (17.6%), HPV39 (17.6%) and HPV68 (17.6%). The prevalence of both HR-HPV infection and SIL in imprisoned women found in this study is high. Determinants for each of the outcomes studied were different. HPV infection is the most important determinant for SIL. A strong effect of HIV co-infection on the prevalence of SIL has been detected. Our findings reinforce the need to support gynaecological clinics in the prison setting.

[Utility of monitoring with the PiCCO system during lung resection surgery]

OBJECTIVES

To evaluate the practical utility of the PiCCO system for monitoring cardiac output and its derived variables during lung resection surgery.

PATIENTS AND METHODS

Patients scheduled for lung resection surgery were enrolled. After anesthesia had been induced, a Pulsiocath catheter was placed in the femoral artery ipsilateral to the thoracotomy. The following parameters were evaluated: ease of placement of the arterial catheter, functioning of the system, and appearance of complications. When the catheter was connected to the PiCCO monitor, cardiac output and derived variables were recorded throughout the procedure.

RESULTS

Fifteen patients were enrolled in the study. Placement of the catheter in the femoral artery was easy in 9 cases (60%), difficult in 4 cases (27%), and impossible in 2 cases (13%). The catheter functioned correctly in 7 patients but problems developed in 6 patients (2 cases of a poor-quality pressure curve, 1 case of a discrepancy of more than 20% in comparison with blood pressure, and 3 cases of impossibility of extracting blood samples through the arterial catheter because the patients were in a lateral decubitus position). No complications relating to arterial puncture were observed. Hemodynamic monitoring showed increased cardiac output after surgery.

CONCLUSIONS

The results suggest that using the PiCCO system during lung resection surgery is of limited utility, given that problems developed in relation to 53% of the catheters. This makes the technique unreliable in the event of its being required.

Constitutive model for plasticity in an amorphous polycarbonate

A constitutive model for describing the mechanical response of an amorphous glassy polycarbonate is proposed. The model is based on an isotropic elastic phase surrounded by an SO(3) continuum of plastic phases onto which the elastic phase can collapse under strain. An approximate relaxed energy is developed for this model on the basis of physical considerations and extensive numerical testing, and it is shown that it corresponds to an ideal elastic-plastic behavior. Kinetic effects are introduced as rate-independent viscoplasticity, and a comparison with experimental data is presented, showing that the proposed model is able to capture the main features of the plastic behavior of amophous glassy polycarbonate.

Development of a clinical hepatic encephalopathy staging scale

AIM

To develop a scale to assess the severity of hepatic encephalopathy using simple dichotomic items.

METHODS

A list of 48 items was created by selecting items that are simple to recognize and categorize; it was applied to thirty-six cirrhotic in-patients with episodic encephalopathy, in addition to the adapted-West-Haven Criteria and the Glasgow Coma Score. The list underwent an item reduction process and principal component analysis; the metric characteristics were evaluated.

RESULTS

Multiple neurological abnormalities were observed and a Clinical Hepatic Encephalopathy Staging Scale of nine items was constructed. The principal component analysis of the Clinical Hepatic Encephalopathy Staging Scale obtained two factors that explained 77% of the variance. The Clinical Hepatic Encephalopathy Staging Scale exhibited adequate internal consistency and reproducibility. The scores of the Clinical Hepatic Encephalopathy Staging Scale correlated to those of adapted-West-Haven Criteria and the Glasgow Coma Score.

CONCLUSIONS

This study confirms that the evaluation of multiple neurological manifestations is not necessary to classify hepatic encephalopathy adequately, which can be simply undertaken by an assessment of the patient's orientation, alertness, ability to respond to commands and to talk. A list of nine items is proposed as a linear scale from normality (Clinical Hepatic Encephalopathy Staging Scale = 0) to deep coma (Clinical Hepatic Encephalopathy Staging Scale = 9).

A new human leukocyte antigen DRB1 allele, HLA-DRB1*1375

DRB1*1375 differs from DRB1*1304 allele in a point nucleotide mutation at codon 67 (ATC-->TTC), which produces an amino acid residue change from I to F.

Treatment of hirudin overdosage in a dialysis patient with heparin-induced thrombocytopenia with mixed hemodialysis and hemofiltration treatment

We report a patient who developed type II heparin-induced thrombocytopenia (HIT) and accidentally received a recombinant hirudin (r-hirudin) overdosage. Treatment with hemodialysis (HD) using high-flux polysulfone dialyzer and hemofiltration was performed. Length of treatment was adjusted, monitoring activated partial thromboplastin time (aPTT) to 1.5-2.5 times the mean of the normal range. She developed deep venous thrombosis and occlusion of vascular access. Only after cessation of heparin lock catheter, platelet count began to increase. After one year of treatment with acenocoumarol and additional low-dose r-hirudin, neither bleeding nor thrombotic episodes have been reported.