Mortality in Spain during the heat waves of summer 2003

The effect of the elevated temperatures on mortality experienced in Europe during the summer of 2003 was observed in several countries. This study, carried out in Spain, describes mortality between 1 June and 31 August and evaluates the effect of the heat wave on mortality. Observed deaths were obtained from official death registers from 50 provincial capitals. Observed deaths were compared with the expected number, estimated by applying a Poisson regression model to historical mortality series and adjusting for the upward trend and seasonality observed. Meteorological information was provided by the Instituto Nacional de Meteorologia (National Institute of Meteorology). Spain experienced three heat waves in 2003. The total associated excess deaths were 8% (43 212 observed deaths compared with 40 046 expected deaths). Excess deaths were only observed in those aged 75 years and over (15% more deaths than expected for the age group 75 to 84 and 29% for those aged 85 or over). This phenomenon (heat-associated excess mortality) is an emerging public health problem because of its increasing attributable risk, the aging of the Spanish population and its forecasted increasing frequency due to global warming. The implementation of alert and response systems based on monitoring of climate-related risks, emergency room activity and mortality, and strengthening the response capacity of the social and health services should be considered.

Perioperative stimulation of erythropoiesis with intravenous iron and erythropoietin reduces transfusion requirements in patients with hip fracture. A prospective observational study

BACKGROUND AND OBJECTIVES

Patients undergoing surgery for hip fracture (HF) often receive perioperative allogeneic blood transfusions (ABT) to avoid anaemia. However, concerns about the adverse effects of ABT have prompted the review of transfusion practice and the search for a safer treatment of perioperative anaemia.

MATERIALS AND METHODS

We prospectively investigated the effect of a blood-saving protocol of perioperative iron sucrose (3 x 200 mg/48 h, intravenously) plus erythropoietin (1 x 40,000 IU, subcutaneously) if admission haemoglobin level < 130 g/l, on transfusion requirements and postoperative morbid-mortality in patients with HF (group 2; n= 83). A parallel series of 41 HF patients admitted to another surgical unit within the same hospital served as the control group (group 1). Perioperative blood samples were taken for haematimetric, iron metabolism and inflammatory parameter determination.

RESULTS

This blood-saving protocol reduced the number of transfused patients (P < 0.001), the number of transfused units (P < 0.0001), increased the reticulocyte count and improved iron metabolism. In addition, the blood-saving protocol also reduced the rate of postoperative infections (P = 0.016), but not the 30-day mortality rate or the mean length of hospital stay.

CONCLUSIONS

The blood-saving protocol implemented seems to reduce ABT requirements in patients with HF, and is associated with a lower postoperative morbidity. The possible mechanisms involved in these effects are discussed.

Activity and resistance of iron-containing amorphous, zeolitic and mesostructured materials for wet peroxide oxidation of phenol

Iron-containing materials have been prepared following several strategies of synthesis and using different silica supports (amorphous, zeolitic and mesostructured materials). Activity and stability of these materials was evaluated on the wet peroxide oxidation of phenol under mild reaction conditions (100 degrees C, air pressure of 1MPa and stoichiometric amount of hydrogen peroxide for the complete mineralisation of phenol). Their catalytic performance was monitored in terms of phenol and total organic carbon (TOC) conversions, by-products distribution (aromatics compounds and carboxylic acids) and degree of metal leached into the aqueous solution. The nature and local environment of iron species is strongly dependent on the synthetic route, which dramatically influences their catalytic performance. Crystalline iron oxide species supported over mesostructured SBA-15 materials have demonstrated to be the most interesting catalysts for phenol degradation according to its high organic mineralisation, low sensitivity to leaching out and good oxidant efficiency.

Iron affects the structure of cell membrane molecular models

The effects of Fe(3+) and Fe(2+) on molecular models of biomembranes were investigated. These consisted of bilayers of dimyristoylphosphatidylcholine (DMPC) and of dimyristoylphosphatidylethanolamine (DMPE), classes of phospholipids located in the outer and inner moieties of cell membranes, respectively. X-ray studies showed that very low concentrations of Fe(3+) affected DMPC organization and 10(-3)M induced a total loss of its multilamellar periodic stacking. Experiments carried out with Fe(2+) on DMPC showed weaker effects than those induced by Fe(3+) ions. Similar experiments were performed on DMPE bilayers. Fe(3+) from 10(-7)M up to 10(-4)M had practically no effect on DMPE structure. However, 10(-3)M Fe(3+) induced a deep perturbation of the multilamellar structure of DMPE. However, 10(-3)M Fe(2+) had no effect on DMPE organization practically. Differential scanning calorimetry measurements also revealed different effects of Fe(3+) and Fe(2+) on the phase transition and other thermal properties of the examined lipids. In conclusion, the results obtained indicate that iron ions interact with phospholipid bilayers perturbing their structures. These findings are consistent with the observation that iron ions change cell membrane fluidity and, therefore, affect its functions.

192 PROBLEMS USING JC-1 TO ASSESS MITOCHONDRIAL STATUS IN BROWN BEAR (URSUS ARCTOS) SEMEN

Brown bear is a highly endangered species in Spain and could benefit from biological resource banking. Currently, we are studying several reproductive aspects in order to aquire the knowledge for establishment of a germplasm bank for this species. One of our objectives is to develop adequate protocols for the evaluation of bear sperm before and after cryopreservation. We have used the fluorescent probe JC-1 protocol, which differentially stains mitochondria, according to its activity (Garner DL et al. 1997 Biol. Reprod. 57, 1401–1406). Here we describe one problem that arose using this staining for evaluation of extended bear semen. We electroejaculated 13 adult brown bears (Ursus arctos) (206–311 kg) housed in a half-freedom regime in the Cabarceno Park (Cantabria, Spain). Anesthesia was performed with tiletamine + zolazepan (Zoletil 100®, 7 mg/kg; Virbac, Spain), and ketamine (Imalgene 1000®, 2 mg/kg; Mericl, Sain). We used an electroejaculator (PT Electronics®; Boring, OR, USA) with a 3-electrode transrectal probe (26 mm in diameter, 320 mm long). Ejaculation occurred at 10 V/250 mA. Samples were extended (prepared in our laboratory, Anel L et al. 2003 Theriogenology 60, 1293–1308; M3 modified) and cooled to 5°C for 70 min (pre-freezing protocol). We analyzed individual (MI) and progressive (MP) motility by means of an automated motility analyzer (Hamilton Thorne Biosciences, Inc., Beverly, MA, USA), using a phase contrast microscope (Nikon, ×10). Mitochondrial status was analyzed after diluting the sample 1:100 with buffered medium (20 mM HEPES, 153 mM NaCl, 2.5 mM KOH, 10 mM glucose; Sigma, Madrid, Spain) and adding JC-1 (6.8 μM final; Molecular Probes, The Netherlands). After 30 min at 37°C, 100 cells were counted with an epifluorescence microscope (Nikon, ×400), determining the percentage of sperm with orange-stained (active) mitochondria. We analyzed a total of 55 samples in three different models: fresh, pre-freezing, and thawed. We divided the samples into successful JC-1 staining (valids: V) or failed JC-1 staining (not valid: NV) (depending on the aspect of the stained cells). In not-valid samples we observed a greenish background, with almost no fluorescent spermatozoa. These observations were consistent in a given sample, giving the same V or NV result when we repeated the staining. In fresh and thawed groups there were no NV samples, but in the pre-freezing group there were 40 NV samples (73%). We calculated Pearson correlations (SAS; SAS Institute, Inc., Cary, NC, USA) between percent JC-1 orange population and MI and MP in fresh (r = 0.40 and 0.33; P < 0.001), thawed (r = 0.61 and 0.43; P < 0.001) and pre-freezing samples (r = −0.11 and −0.24; P > 0.05), all respectively. When pre-freezing samples were split between V and NV, the former had good correlations (r = 0.74 and 0.49; P < 0.05), and NV still did not (r = −0.17, −0.27; P > 0.05). We conclude that JC-1 staining is not reliable for the pre-freezing analysis of bear sperm, at least under the conditions described here. This could be due to the interaction of the extender or the refrigeration treatment with the sperm. However, this problem did not occur in the analysis of fresh and thawed samples. Nevertheless, it may be advisable to test other mitochondrial probes for analyzing this kind of samples.

Intronic L1 insertion and F268S, novel mutations in RPS6KA3 (RSK2) causing Coffin-Lowry syndrome

Two novel mutations of the ribosomal S6 kinase 2 gene (also known as RSK2) have been identified in two unrelated patients with Coffin-Lowry syndrome. The first mutation consists of a de novo insertion of a 5'-truncated LINE-1 element at position -8 of intron 3, which leads to a skipping of exon 4, leading to a shift of the reading frame and a premature stop codon. The L1 fragment (2800 bp) showed a rearrangement with a small deletion, a partial inversion of the ORF 2, flanked by short direct repeats which duplicate the acceptor splice site. However, cDNA analysis of the patient shows that both sites are apparently not functional. The second family showed the nucleotide change 803T>C in exon 10, resulting in the F268S mutation. This mutation was detected in two monozygotic twin patients and in their mother, who was mildly affected. The patients fulfill the clinical criteria of the syndrome, and therefore the mutation provides further support for the importance of phenylalanine at position 268, which is highly conserved in the protein kinase domain of many serine-threonine protein kinases.

Budd-Chiari syndrome caused by membranous obstruction of the inferior vena cava associated with coeliac disease

Ten cases of Budd-Chiari syndrome associated with coeliac disease have been reported in the literature, most of them in North African subjects. Supporting this association, we report a new case in a young Spanish Caucasian man in whom the cause of the syndrome was the membranous obstruction of the inferior vena cava, an infrequent cause of Budd-Chiari syndrome in Western countries. A percutaneous balloon angioplasty was performed, with satisfactory outcome.

The Stability of 2-Acetoxy-4-trifluoromethylbenzoic acid (Triflusal) in Micellar Pseudophase

The new platelet antiaggregant Triflusal or 2-acetoxy-4-trifluoromethylbenzoic acid presents a structural analogy to acetylsalicylic acid (ASA). Alkaline hydrolysis of triflusal was studied in the presence and absence of cationic micelles of N-cetyl-N-ethyl-N,N-dimethylammonium bromide (CDEABr) at different KOH concentrations and different temperatures (25, 30, and 37 degrees C) using a spectrophotometric method. The influence of potassium bromide concentration upon alkaline hydrolysis at 25 degrees C is also discussed. At constant [KOH] pseudofirst-rate constant (k(obs)) decreased with increasing [CDEABr] at concentrations greater than the CMC and also decreased with increasing [KBr] at constant [KOH] and [CDEABr]. To explain the effect of cationic micelles of CDEABr upon alkaline hydrolysis, the pseudophase ion exchange model was used. The values of the micellar properties such as the critical micelle concentration, the degree of micellar ionization and the neutralized fraction of the head group obtained by conductivity measurements were determined previously.

[MIBI and parathyroid gland function in secondary hyperparathyroidism]

The role of the double phase parathyroid scintigraphy with MIBI in the primary hyperparathyroidism has been well studied. The present work analyzes the benefit of this image technique in the diagnosis and therapeutic approach to uremia associated hyperparathyroidism. We studied 18 dialysis patients with clinical and analytical data of hyperparathyroidism. All of them were receiving treatment with i.v. vitamin D. We carried out two scintigraphic studies, the first under basal conditions (without changes in treatment) and the second one, a week later after the stimulation of the parathyroid gland through the cessation of the treatment with vitamin D and phosphorus binders, and the use of a low-calcium dialysate. In the basal study, fourteen patients had a positive uptake test in at least one of the four glands. These patients had significantly higher PTHi levels than those with a negative scintigraphic study. After the stimulation test, we found a statistically significative rise in PHTi (644 vs 979 p < 0.001) and phosphorus levels (5.8 vs 7.3; p < 0.01), a slight fall in calcium levels (p = NS) and a statistically significative increment in the score of scintigraphic captation (5.5 +/- 4.5 vs 6.8 +/- 5; p < 0.05). We found a statistically significative correlation between the PTHi level and the score of scintigraphic uptake, in the basal study (r = 0.6, p < 0.01) and after stimulation (r = 0.6, p < 0.01). The only variable associated with the scintigraphic uptake was PTHi, justifying 31.1% of the variance in the first study and 32.7% in the second. In conclusion, the MIBI scintigraphic is a useful exploration in the uremic patient with hyperparathyroidism, as it predicts the functional state of the parathyroid glands according to uptake intensity. The stimulation test could be useful in planning therapy, but some of its characteristics need to be established, such as the precise time to reach the maximum level of parathyroid stimulation.

Variaciones del sector anterior del polígono de Willis. Correlación anatomo-angiográfica y su implicancia en la cirugía de aneurismas intracraneanos (Arterias: ácigos cerebral anterior, mediana del cuerpo calloso y cerebral media accesoria)

It is worlwide accepted that in almost 60% of cases, anatomical variants in the Circle of Willis can be found. Some of them are associated with vascular malformations such as aneurysms. The knowledge of these anatomical variants is of vital importance when facing surgery, being the aims to preserve arteries in unusual localisations, which when injured can determine invalidating sequelae. The authors have reviewed 192 cerebral hemispheres, finding three variants in the anterior Circle of Willis: Azigos anterior cerebral artery; Median artery of the corpus callosum and accessory middle cerebral artery. The authors make an anatomical description of the findings, their angiographical correlation, and describe the influence of these changes during surgery of aneurysms in the involved regions.

Effect of two thermal regimes on the muscle growth dynamics of sea bass larvae, Dicentrarchus labrax L

Muscle growth was studied in larvae of sea bass, Dicentrarchus labrax L., reared at two temperatures: real ambient temperature ( congruent with 15 degrees C during vitelline phase and increased gradually) and 19 degrees C from fertilization until the end of larval development. Muscle cellularity, body length and body weight were measured. Early temperature influenced larval development and so, pre-larval phase finished earlier at 19 degrees C than at ambient temperature (4 and 6 days, respectively). Temperature also affected muscle growth such that at hatching and at mouth opening hypertrophy of muscle fibres was greater at 19 degrees C (P < 0.05), whereas hyperplasia was similar in both groups. After 25 days, the cross-sectional area of the white muscle was greater at 19 degrees C (P < 0.05), which was mainly associated with a higher proliferation of new white muscle fibres. At this stage the body length was also higher at 19 degrees C. Metamorphosis finished earlier in fish reared at 19 degrees C (52 days) than at natural temperature (82 days). At this developmental stage body length and cross-sectional area of the myotome were similar in both groups. However, muscle cellularity differed between groups. Thus, hypertrophy of muscle fibres was higher in fish reared at ambient temperature (P < 0.05), whereas proliferation of new muscle fibres was higher at 19 degrees C (P > 0.05).

X-linked hydrocephalus: another two families with an L1 mutation

X-linked hydrocephalus is a variable condition caused by mutations in the gene encoding for L1CAM. This gene is located at Xq28. Clinically the spectrum ranges from males with lethal congenital hydrocephalus to mild/moderate mental retardation and spastic paraplegia. Few carrier females show minimal signs of the syndrome. Although most cases are familial, de novo situations have been reported. We report two new families with the syndrome and a L1 mutation. Family 1 has two patients and family 2 a single patient. Clinical diagnosis in all three affected boys was beyond doubt. Prenatal testing through chorionic villus biopsy is possible only with a demonstrated L1 mutation. In lethal sporadic cases neuropathology is very important in order to evaluate for features of the syndrome. We stress the importance of further clinical reports including data on neuropathology and DNA analysis in order to further understand the mechanisms involved in this disorder.

Effects on run-off water quantity and quality of urban organic wastes applied in a degraded semi-arid ecosystem

Biosolids and composted municipal solid wastes were surface-applied (0 and 80 Mg ha(-1)) to a degraded soil in a semi-arid environment to determine their effects on the quantity and quality of run-off water. Three and 4 years after application, a simulated rainfall was performed (intensity=942.5 ml min(-1) and kinetic energy=3.92 J m(-2)) on 0.078 m(2) plots using a portable rainfall simulator. The run-off from the different treatment plots was collected and analysed. The type of treatment was highly related to infiltration, run-off and sediment production. The biosolid-treated plots showed the minimum value of total run-off, maximum time to the beginning of run-off and maximum run-off ratio (the relationship between total rainfall and run-off). The MSW-treated plots showed values intermediate between biosolid-treated plots and control plots. Soil losses were also closely related to treatment type. Control plots showed the maximum sediment yield, MSW-treated plots showed intermediate values, and biosolid plots the minimum values for washout. The concentrations of NH(4)-N and PO(4)-P in the run-off water were significantly higher in the treated plots than in control plots. The highest PO(4)-P value, 0.73 mg l(-1), was obtained in the soil treated with biosolids; NO(3)-N concentration also increased significantly with respect to the control and MSW treatments. NH(4)-N concentrations of 15.6 and 15.0 mg l(-1) were recorded in the soils treated with biosolids and MSW, respectively, values approximately five times higher than those obtained in run-off water from untreated soil. However, the concentrations of all these constituents were lower than threshold limits cited in water quality standards for agricultural use. With the exception of Cu, all trace metals analysed in the run-off water were below detection limits.

Biowaste effects on soil and native plants in a semiarid ecosystem

Many soils of the Mediterranean region with a semiarid climate are subjected to progressive degradation as a result of water erosion. Biosolids and municipal solid wastes (MSW) were surface-applied once at three rates (40, 80, and 120 Mg ha(-1)) to different plots in a degraded semiarid ecosystem. The study was conducted to determine the effects of such applications on soil chemical properties and native vegetation over a three-year period. Soil N, P, and K initially increased with increasing biowaste application rates, but then decreased over time. Levels of Zn and Cu were higher in MSW than biosolid-treated plots, and increased in both years after application. Concentrations of soil Cd, Pb, Ni, and Cr did not change as a result of biowaste amendment in the study period. The growth of native plants was enhanced by the addition of biowastes. Total plant canopy and plant biomass increased significantly and remained higher in all treatments than in the control plot over the three-year period. The species richness of native plants decreased with increasing biowaste rates. Differences in the development of native plant communities between treatments were observed, and were more remarkable three years after biowaste application. Tissue N, P, K, Zn, and Cu levels increased with the biowaste application rate, but concentrations of tissue Pb, Cd, Ni, and Cr did not increase significantly. Biowastes applied at the rate of 80 Mg ha(-1) gave rise to the most favorable soil and native vegetation results while avoiding environmental risks.

Minimal Residual Disease in Neuroblastoma: To GAGE or not to GAGE

We assessed the utility of GAGE gene expression as a marker of minimal residual disease (MRD) in neuroblastoma. The GAGE gene family shows a high degree of homology (>90%), clustering into two subgroups. GAGE-1, -2, and -8 form one subset, almost identical among themselves, while GAGE-3 to -7 constitute the other subset. The entire GAGE family (GAGE-1-8) was studied by RT-PCR followed by Southern blotting to increase both the sensitivity and specificity of the technique. Surprisingly, expression of GAGE was detected in 59% of peripheral blood samples from normal controls (20/35) as well as in a similar proportion from neuroblastoma patients with localized disease (stages 1 and 2). The study of GAGE-1, -2, and -8 with specific primers lowered this percentage to 28% (10/35), of which only two (6%) showed a high level of expression (directly visualized after RT-PCR). We conclude that GAGE genes can show a variable, usually low level of illegitimate expression in normal blood cells, and therefore their use as MRD markers should be taken with caution.

[Impact of the protocol of ABO group and irregular antibodies on the transfusional index]

OBJECTIVES

The ABO group/irregular red cell antibodies (G/A) protocol is a scheme for reducing the number of unnecessary crossmatch tests in selected patients scheduled for surgery. Reduction would lower expenses and risks related to the overuse of such tests. Studying transfusion rates allows us to predict which patients are candidates for application of the protocol. The present study evaluated the impact of the G/A protocol on transfusion rate.

PATIENTS AND METHODS

A retrospective analysis of pre-transfusion testing of patients in our hospital in 1996, before application of the G/A protocol, and in 2001, after four years of experience with the scheme.

RESULTS

The G/A protocol was followed with 194 patients in 2001. The surgical transfusion rate decreased by 27.8% over the rate for 1996 (1.84 vs. 2.55). The outdating of blood units in 2001 decreased by 42.4% (65 units outdated vs. 113). Only one patient subject to the protocol had to be transfused.

CONCLUSION

The transfusion rate can be significantly reduced by applying the G/A protocol with selected patients, with no loss of transfusion safety.

[Endoscopic treatment of pancreatitis and its complications]

OBJECTIVES

To study the long- and short-term safety and efficacy of endoscopic treatment of pancreatitis and its complications in our environment.

PATIENTS AND METHODS

We performed a retrospective analysis of 43 patients with chronic pancreatitis, acute pancreatitis complicated with pseudocyst, and pancreatic fistula diagnosed by endoscopic retrograde cholangiopancreatography who were suitable for endoscopic treatment.

RESULTS

Endoscopic treatment was attempted in 35 patients. The indication for treatment was pain in 17 patients (48.5%), jaundice in 7 (20%), pseudocyst in 10 (28.5%) and suspected external fistula in 1 (3%). The technique was successfully performed in 28 (80%). Of the patients with pain, pancreatic prosthesis was inserted in 13 and extracorporeal lithotripsy was applied in 6. Sixty-five percent of the patients improved. Of the 7 patients with jaundice, all had secondary stenosis of the biliary tract. Treatment was applied in 2, who showed partial improvement. Of the 15 patients with pseudocyst, endoscopic treatment was indicated in 10; the technique was successfully performed in 8 and complete resolution was achieved in 7 (87.5%). The patient with external fistula was treated with transpapillary prosthesis and complete resolution of disruption of Wirsung's duct was achieved. Overall improvement in successfully treated patients was: complete in 19 (68%), partial in 3 (18%), no improvement in 4 (14%) and 2 patients were lost to treatment. There were 4 short-term complications. There were 4 deaths and one was related to the technique.

CONCLUSIONS

Endoscopic treatment of chronic pain in chronic pancreatitis, pseudocysts and fistulas was effective in our environment with a low rate of complications.