Do hernia operations in african international cooperation programmes provide good quality?

BACKGROUND

Hernia is especially prevalent in developing countries where the population is obliged to undertake strenuous work in order to survive, and International Cooperation Programmes are helping to solve this problem. However, the quality of surgical interventions is unknown. The objective of the present study was to evaluate the quality of hernia repair processes carried out by the Surgical Solidarity Charity in Central African States.

MATERIALS AND METHODS

A total of 524 cases of inguinal hernia repair carried out in Cameroon and Mali during 2005 to 2009 were compared with 386 cases treated in a Multicentre Spanish Study (2003). General data (clinical, demographic, etc.), type of surgery, complications, and effectiveness and efficiency indicators were collected.

RESULTS

Preoperative studies in the Spanish group were greater in number than in the African group. The use of local anesthesia was similar. Antibiotic prophylaxis was higher in the African group (100% to 75.4%). The use of mesh was similar. The incidence of hematomas was higher in the Spanish group (11.61% to 4.61%), but the incidence of infection of the wound and of hernia recurrence was similar, although follow-up was only carried out in 20.97% in the African group (70% in the Spanish group). Hospital stay of more than 24 h was higher in the Spanish group.

CONCLUSIONS

The standard quality of surgery for the treatment of hernia in developing countries with few instrumental means, and in sub-optimal surgical conditions is similar to that provided in Spain.

Biomonitoring of metals under the water framework directive: detecting temporal trends and abrupt changes, in relation to the removal of pollution sources

Temporal trends in metal concentrations, i.e. Ag, Cd, Cu, Cr, Hg, Ni, Pb and Zn, measured in soft tissues of Mytilus galloprovincialis mussels and Crassostrea gigas oysters collected from estuarine waters within the Basque Country (Bay of Biscay), have been investigated to determine if actions undertaken have improved the environmental quality of rivers and estuaries. Data compiled between 1990 and 2010 have been analysed statistically, applying the Mann-Kendall and the Mann-Whitney-Wilcoxon tests. Moreover, in those cases with significant trends, the Kolmogorov-Zurbenko Adaptive (KZA) filter was applied to detect abrupt changes. Results showed significant decreasing trends for some metals, i.e. Ni, Cu, Pb and Zn, and differences between medians. Trend lines showed abrupt changes occurring between 1998 and 2002. Therefore, observed downward trends were related to increased wastewater treatment and diversions of discharges to ocean, implemented mainly during 2000-2002.

Comb-drive micro-electro-mechanical systems oscillators for low temperature experiments

We have designed and characterized micro-electro-mechanical systems (MEMS) for applications at low temperatures. The mechanical resonators were fabricated using a surface micromachining process. The devices consist of a pair of parallel plates with a well defined gap. The top plate can be actuated for shear motion relative to the bottom fixed plate through a set of comb-drive electrodes. Details on the operation and fabrication of the devices are discussed. The geometry was chosen to study the transport properties of the fluid entrained in the gap. An atomic force microscopy study was performed in order to characterize the surface. A full characterization of their resonance properties in air and at room temperature was conducted as a function of pressure, from 10 mTorr to 760 Torr, ranging from a highly rarefied gas to a hydrodynamic regime. We demonstrate the operation of our resonator at low temperatures immersed in superfluid (4)He and in the normal and superfluid states of (3)He down to 0.3 mK. These MEMS oscillators show potential for use in a wide range of low temperature experiments, in particular, to probe novel phenomena in quantum fluids.

[Description of the hemodynamic and respiratory effects of hemoperfusion treatment with polymyxin B in patients with abdominal septic shock]

The objective of this study is to describe the hemodynamic effects, inotropic and vasoactive drug dependence, and to analyze the PO2/FiO2 ratio in 13 patients with septic shock of abdominal origin after hemoperfusion treatment with polymyxin-B. Treatment with polymyxin hemoperfusion therapy is indicated for patients with severe sepsis/septic shock of abdominal origin who do not respond adequately to conventional therapy. Two complete cycles with polymyxin cartridge were performed on 11 of the 13 patients, and a single cycle on the other O2. After treatment, the mean airway pressure (MAP) was increased (P=.003), the need for norepinephrine decreased (P=.003), and the PO2/FiO2 ratio increased (P=.02). The use of polymyxin hemoperfusion in patients with septic shock of intra-abdominal origin can significantly improve hemodynamic and respiratory functions.

Expectation-maximization algorithm for determining natural selection of Y-linked genes through two-sex branching processes

A two-dimensional bisexual branching process has recently been presented for the analysis of the generation-to-generation evolution of the number of carriers of a Y-linked gene. In this model, preference of females for males with a specific genetic characteristic is assumed to be determined by an allele of the gene. It has been shown that the behavior of this kind of Y-linked gene is strongly related to the reproduction law of each genotype. In practice, the corresponding offspring distributions are usually unknown, and it is necessary to develop their estimation theory in order to determine the natural selection of the gene. Here we deal with the estimation problem for the offspring distribution of each genotype of a Y-linked gene when the only observable data are each generation's total numbers of males of each genotype and of females. We set out the problem in a non parametric framework and obtain the maximum likelihood estimators of the offspring distributions using an expectation-maximization algorithm. From these estimators, we also derive the estimators for the reproduction mean of each genotype and forecast the distribution of the future population sizes. Finally, we check the accuracy of the algorithm by means of a simulation study.

Extinction conditions for Y-linked mutant-alleles through two-sex branching processes with blind-mating structure

A new two-sex bidimensional branching process is introduced to model the evolution of the number of carriers of an allele and its mutations of a Y-linked gene. A population is assumed in which females and males coexist and mate without the gene influencing the mating process. It is deduced from the model that the key determining conditions for the extinction or survival of the allele are given by the probability that an offspring is female, the rate of mutation, and the mean number of offspring per mating unit. It is also proved that the destiny of the allele's mutations in the population also depends on the survival or extinction of the original allele.

Identification of a novel recurrent gain on 20q13 in chronic lymphocytic leukemia by array CGH and gene expression profiling

BACKGROUND

The presence of genetic changes is a hallmark of chronic lymphocytic leukemia (CLL). The most common cytogenetic abnormalities with independent prognostic significance in CLL are 13q14, ATM and TP53 deletions and trisomy 12. However, CLL displays a great genetic and biological heterogeneity. The aim of this study was to analyze the genomic imbalances in CLL cytogenetic subsets from both genomic and gene expression perspectives to identify new recurrent alterations.

PATIENTS AND METHODS

The genomic imbalances and expression levels of 67 patients were analyzed. The novel recurrent abnormalities detected with bacterial artificial chromosome array were confirmed by FISH and oligonucleotide microarrays. In all cases, gene expression profiling was assessed.

RESULTS

Copy number alterations were identified in 75% of cases. Overall, the results confirmed FISH studies for the regions frequently involved in CLL and also defined a new recurrent gain on chromosome 20q13.12, in 19% (13/67) of the CLL patients. Oligonucleotide expression correlated with the regions of loss or gain of genomic material, suggesting that the changes in gene expression are related to alterations in copy number.

CONCLUSION

Our study demonstrates the presence of a recurrent gain in 20q13.12 associated with overexpression of the genes located in this region, in CLL cytogenetic subgroups.

[Cardiovascular and respiratory changes during laparoscopy in neonates and infants]

The pneumoperitoneum induced during laparoscopy has cardiovascular and respiratory effects that have to be taken into account to perform laparoscopic procedures in neonates and small infants. The aim of this paper is to describe the hemodynamic and ventilatory changes that occur in a group of these patients undergoing standard laparoscopic procedure. We performed a retrospective review of patients undergoing laparoscopic pyloromyotomy in our institution. We collected demographic data, data from the intervention, outcome and complications and hemodynamic parameters (heart rate--HR--and blood pressure--BP--) and respiratory (O2 saturation--SO2--and exhaled CO2--ECO2--) at different times during surgery. We performed statistical analysis of these data. We reviewed a total of 55 charts. Mean age was 34 days and average weight 3,785 g. All patients were ventilated with pressure control mode and received maintenance fluid therapy. BP, HR and SO2 were stable throughout the surgery not showing significant differences. The ECO2 increased significantly after inflation, however it was controlled by increasig respiratory rate. In conclusion, the hemodynamic and ventilatory response in these patients is controllable with anesthetic and surgical measures but it is important to consider the possible consequences of pneumoperitoneum in this group of patients.

PP131. Regulation of heme oxygenase/carbon monoxide (ho/co) and l-arginine/nitric oxide (no) pathways by human chorionic gonadotropin (hcg) in human fetal endothelium

INTRODUCTION

HO/CO and l-arginine/NO pathways are critical regulators of vascular function in early human pregnancy. HO is the rate-limiting enzyme in heme catabolism leading to the formation of biliverdin, which is subsequently reduced to bilirubin by biliverdin reductase, carbon monoxide, and free iron. HO-1, the inducible isoform of the enzyme, is essential to promote placental function and fetal development (1). HO-1 is also required to maintain nitric oxide synthesis (2). Human chorionic gonadotropin (hCG) is the first blastocyst-derived hormonal signal playing a significant role in implantation and placentation (3). We hypothesized that hCG upregulates HO-1 and thus positively regulates early vascular events in human pregnancy.

OBJECTIVES

In this study we used human umbilical vein endothelial cells (HUVECs) to demonstrate that hCG up-regulates mRNA and protein abundance of HO-1. The effect of hCG on l-arginine transport and the expression of hCAT1, the main cationic amino acid transporter involved in endothelial nitric oxide synthesis were evaluated.

METHODS

HUVEC were isolated from normal pregnancies (approval from the Institutional Review Board) by collagenase digestion and grown (37°C, 5% CO2) in medium 199 supplemented with 20% newborn and fetal calf sera. Cells were treated with hCG (0.5-100IU/mL, 0-24hours and CoCl2 (150μM, 6hours) as positive control. Total proteins were separated by SDS-PAGE electrophoresis, transferred to nitrocellulose membranes and incubated with monoclonal anti human HO-1 or anti β-actin and respective secondary antibody conjugated with horseradish peroxidase. Protein bands were detected by enhanced chemiluminiscence. Total RNA was isolated and cDNA was obtained by reverse transcription. PCR assays were performed in a reaction mix containing 0.5μM primers, dNTPs, Taq DNA polymerase, 2 mM MgCl2. Relative abundance of HO-1, hCAT-1 and 28S were determined. l-[(3)H]Arginine transport (100μM, 2 μCi ml(-1), 37°C, 1min) were determined in HUVECs exposed (30min) to hCG (0.5-100IU/mL) and CORM-2 (CO donor).

RESULTS

The highest level of HO-1 protein were obtained at 5IU/mL of hCG and declined at higher concentrations. hCG increased HO-1 protein abundance and maximal response was observed at 6 hours (4-fold), decreasing at 24hours exposure. These effects of hCG on HO-1 protein abundance are well correlated with changes in HO-1 mRNA regarding time of exposure and concentration of hCG. L-arginine transport and hCAT-1 mRNA were also increased (2.8-fold and 4.5-fold, respectively) by hCG.

CONCLUSION

Upregulation of HO-1 as well as the increase in l-arginine transport and hCAT-1 mRNA in HUVECs are novel effects of hCG, which occur at physiological plasma concentrations of the hormone, as those found in the first weeks of pregnancy. These changes could be relevant for the maintenance of the NO synthesis in fetal and maternal vasculature, ensuring the predominance of the vasodilator tone. These effects could be also critical for vascular remodelling of uterine circulation and placental vascular development in early stages of pregnancy, the lack of which could result in abnormal placentation as described in preeclampsia and fetal growth restriction.

Effect of temperature and antimicrobial resistance on survival of Campylobacter jejuni in well water: application of the Weibull model

AIMS

The aims of this study were to measure the survival of two Campylobacter jejuni strains and their in vitro-challenged antimicrobial-resistant variants in well water, to evaluate the effects of antimicrobial resistance on survival and to develop a mathematical model for predicting the survival of Camp. jejuni in well water in the temperature range from 4 to 25°C.

METHODS AND RESULTS

The survival in log CFU ml⁻¹ of two Camp. jejuni strains and their antimicrobial-resistant variants was studied in well water stored at 4, 10, 15, 20 and 25°C. At 4°C, the estimated 4-log CFU ml⁻¹ decrease in ciprofloxacin-resistant variant ATCC33560CIP32 was 55·2 days, significantly longer (P < 0·05) than that of resistant variant 49/7RATCIP32 (the estimated 4-log CFU ml⁻¹ decrease was 29·9 days). The respective times for the wild-type strains were 49·8 and 60·4 days. The decrease in counts of Camp. jejuni was most dependent on temperature, because at 4°C, the estimated t (4D) varied from 29·9 to 60·4 days and at 25°C from 3·7 to 5·7 days.

CONCLUSIONS

Campylobacter jejuni survived in well water for long periods, especially at 4°C, and the effect of ciprofloxacin resistance on fitness and survival was strain and temperature dependent. Weibull model was found to fit the data in the temperatures from 4 to 25°C.

SIGNIFICANCE AND IMPACT OF THE STUDY

In water environment Camp. jejuni is exposed to a wide spectrum of temperatures, which affects its survival and potential to cause waterborne infections. Antimicrobial resistance in Camp. jejuni is increasing, and minor data exist on the effect of antimicrobial resistance on the survival of Camp. jejuni. Water is an important source of campylobacteriosis; thus, we need to have modelling data to predict the survival characteristics of these organisms in water.

Outcome of tracheotomized patients following reintubation

OBJECTIVE

To evaluate the outcome of tracheotomized patients after reintubation.

METHOD

Secondary analysis from a prospective, multicenter and observational study including 36 Intensive Care Units (ICUs) from 8 countries.

PATIENTS

A total of 180 patients under mechanical ventilation for more than 48 hours, extubated and reintubated within 48 hours.

INTERVENTIONS

None.

OUTCOMES

ICU mortality, length of ICU stay, organ failure.

RESULTS

Fifty-two patients (29%) underwent tracheotomy after reintubation. The median time from reintubation to tracheotomy was 2.5 days (interquartile range (IQR) 1-8 days). The length of ICU stay was significantly longer in the tracheotomy group compared with the group without tracheotomy (median time 25 days, IQR 17-43 versus 16.5 days (IQR 11-25); p<0.001). ICU mortality in the tracheotomy group was not significantly different (31% versus 27%; p 0.57).

CONCLUSIONS

In our cohort of reintubated patients, tracheotomy is a common procedure in the ICU. Patients with tracheotomy had an outcome similar to those without tracheotomy.

SNP-based mapping arrays reveal high genomic complexity in monoclonal gammopathies, from MGUS to myeloma status

Genetic events mediating transformation from premalignant monoclonal gammopathies (MG) to multiple myeloma (MM) are unknown. To obtain a comprehensive genomic profile of MG from the early to late stages, we performed high-resolution analysis of purified plasma cells from 20 MGUS, 20 smoldering MM (SMM) and 34 MM by high-density 6.0 SNP array. A progressive increase in the incidence of copy number abnormalities (CNA) from MGUS to SMM and to MM (median 5, 7.5 and 12 per case, respectively) was observed (P=0.006). Gains on 1q, 3p, 6p, 9p, 11q, 19p, 19q and 21q along with 1p, 16q and 22q deletions were significantly less frequent in MGUS than in MM. Although 11q and 21q gains together with 16q and 22q deletions were apparently exclusive of MM status, we observed that these abnormalities were also present in minor subclones in MGUS. Overall, a total of 65 copy number-neutral LOH (CNN-LOH) were detected. Their frequency was higher in active MM than in the asymptomatic entities (P=0.047). A strong association between genetic lesions and fragile sites was also detected. In summary, our study shows an increasing genomic complexity from MGUS to MM and identifies new chromosomal regions involved in CNA and CNN-LOH.

Prognostic value of serum progesterone and LH values on the day of hCG administration in IUI GnRH antagonist cycles

OBJECTIVE

to evaluate the effect of LH surge and progesterone rise in IUI cycles under gonadotropin stimulation with GnRH antagonist coadministration on pregnancy rates (PR).

STUDY DESIGN

The population under study consisted of 152 women prospectively studied and subjected to IUI.

RESULTS

The higher the progesterone cutoff value, the lower the PR were 26.5% and 10.9% when the cutoff was 1 ng/mL, 26.0% and 8.6% when the cutoff was 1.2 ng/mL, 25.6% and 7.1% when the cutoff was 1.4 ng/mL and 25.3% and 0% when the cutoff was 1.6 ng/mL.

CONCLUSION

In IUI cycles under GnRH antagonist coadministration, serum progesterone levels over 1.0 ng/mL are associated with lower PR, the higher the progesterone levels, the lower the PR.

Influence of microorganisms and leaching on simazine attenuation in an agricultural soil

Simazine is an s-triazine herbicide world widely used for the control of broadleaf weeds. The influence of leaching and microorganisms on simazine attenuation in an agricultural soil long-term treated with this herbicide was studied. To elucidate the leaching potential of simazine in this soil, undisturbed soil columns amended with simazine were placed in a specially designed system and an artificial precipitation was simulated. To evaluate the simazine removal by soil microorganisms, three soil microcosm sets were established: i) control soil; ii) soil subjected to gamma irradiation (γ-soil) and iii) γ-soil inoculated with the simazine-degrading bacterium Pseudomonas sp. strain MHP41. The simazine-degrading microorganisms in soil were estimated using an indicator for respiration combined with MPN enumeration. The simazine removal in soil was monitored by GC-ECD and HPLC. In this agricultural soil the leaching of the applied simazine was negligible. The gamma irradiation decreased in more than one order of magnitude the cultivable heterotrophic bacteria and reduced the simazine-degrading microorganisms. Simazine was almost completely depleted (97%) in control soil by natural attenuation after 23 d, whereas in γ-soil only 70% of simazine was removed. The addition of the simazine-degrading strain MHP41 to γ-soil restored and upheld high stable simazine catabolic microorganisms as well as increased the simazine removal (87%). The results indicated that simazine is subjected to microbial degradation with negligible leaching in this agricultural soil and pointed out the crucial role of native microbiota in the herbicide removal.

Effect of orally-administered Lactobacillus plantarum LPLM-O1 strain in an immunosuppressed mouse model of urinary tract infection

Urinary tract infections (UTIs) affect both healthy and immunocompromised people, and they are treated with antibiotics. However, the high recurrence of UTIs obliges the use of natural mechanisms to regulate the normal microbiota through the use of e.g. lactic acid bacteria. In order to induce a UTI, 20 µl of the Escherichia coli (Ec-01) strain, in doses of 2.7×107 cfu/ml, was inoculated by way of the urethra in female Balb/c mice, all of them immunosuppressed with dexamethasone (10 mg/kg). Lactobacillus plantarum LPLM-O1 was used as a treatment, in daily doses of 1×107 cfu/ml, which were orally administered for seven days before the infection (preventive) or alongside the infection for seven days (curative). The oral administration of LPLM-O1 did not cause any adverse effects when used in an immunosuppressed animal model. It was observed that, when used as a preventive measure, LPLM-O1 induces a decrease in the infection, in the concentration of urinary leukocytes, and in the bacterial load. This study proposes the use of this lactic bacterium as a probiotic.

Frequency of HLA-A, -B and -DRB1 specificities and haplotypic associations in the population of Castilla y León (northwest-central Spain)

The frequencies of human leukocyte antigen (HLA) class I and class II specificities and haplotypic associations were determined in 1940 unrelated donors from Castilla y León and compared with other Iberian, Mediterranean and European populations. Specificities were determined using polymerase chain reaction reverse sequence-specific oligonucleotide or polymerase chain reaction sequence-specific primer techniques. In the analysis, 19, 29 and 13 specificities were found for HLA-A, -B and -DRB1, respectively, with HLA-A*02 (26%), -A*01 (11%), -B*44 (16%), -B*35 (10%), -DRB1*07 (16%) and -DRB1*13 (14%) showing the highest frequencies. In addition, 10 common HLA-A-B-DRB1 haplotypic associations were observed, A*01-B*08-DRB1*03 (3%) and A*29-B*44-DRB1*07 (3%) being the most frequent ones. These findings indicate that the population of Castilla y León is genetically equidistant from the Portuguese and other Spanish populations and shares a common origin with other Iberian populations, in which European, Mediterranean and North African genetic components are present; this is in agreement with the historical and genetic background of the population. These data contribute to a better understanding of the genetic structure of the Iberian Peninsula and provide a healthy control population from our region that should be useful for the study of disease associations.

How to use sustainability indicators for tourism planning: the case of rural tourism in Andalusia (Spain)

This paper proposes an indicators system to analyse the sustainability of tourist activity at rural destinations in countries with a consolidated tourism sector. The proposed system aims at providing tourist managers and policy-makers with information to better understand the transition to sustainability at specific destinations and to encourage them to carry out corresponding policy and management responses. To illustrate how indicators can be quantified, we create a practical guideline on how to use the statistical information available. Likewise, we suggest a method for obtaining sustainability indexes by aggregation that reduces the subjectivity associated with the composite indicator. This procedure is based on the combination of principal component analysis and distance to a reference point. Together with the definition of sustainable tourism indicators, we explain how to use these systems and sustainability indexes to fulfil three practical uses in tourism sector planning: the comparison and characterisation of destinations, the definition of benchmarking practices, and the quantification of sustainable tourism objectives. Each practical use is illustrated using the case of rural zones in a consolidated destination such as Andalusia.

[Peritoneal strumosis: an extension study with (99m)Tc-pertecnectate]

We report the case of a 35-year-old nulliparous woman, with a previous history of ovarian cystectomy diagnosed 3 years earlier due a struma ovarii type of monodermal teratoma in the right ovary and a hemorrhagic cyst in the left ovary. Progressive growth of the left adnexal mass was observed in the periodic medical check-ups. Due to this, a second laparoscopy was performed and, based on the findings, a left ovarian cystectomy, right salpingectomy and resection of multiple peritoneal implants were carried out. The pathology diagnosis was left struma ovarii and peritoneal strumosis. A whole body and SPECT/CT scan with (99m)Tc-pertechnetate was performed to detect possible peritoneal implants. This study helped to make the therapeutic decision.

CB.Hep-1 hybridoma growth and antibody production using protein-free medium in a hollow fiber bioreactor

The protein-free medium TurboDoma HP.1 (THP.1) was used to produce the CB.Hep-1 monoclonal antibody (mAb) in a CP-1000 hollow fiber bioreactor (HFB). This mAb is used for the immunopurification of recombinant hepatitis B surface antigen (rHBsAg), which is included in a vaccine preparation against the Hepatitis B Virus. By using the experimental conditions tested in this work we were able to generate more than 433 mg of IgG in 43 days. The maximum antibody concentration obtained was about 2.4 mg ml(-1)and the IgG production per day was approximately 11 mg of monoclonal antibody, which constitutes a good concentration value in comparison to the results obtained in ascitic fluid, where concentration for this hybridoma was around 3 mg ml(-1). We used different analytical methods to control the quality of mAbs, obtained from the in vitro system. They included affinity constant determination, analysis of N-glycan structures, immunoaffinity chromatography and antigen binding properties. The results obtained suggest that no significant changes occurred in the mean characteristics of the mAb harvested from the bioreactor during the 43 days of cultivation.