Treatment of landfill leachate by combined use of ultrasound and photocatalytic process using fly ash as catalyst

Advanced oxidation processes, such as sonophotocatalysis and photocatalysis, have been proven to be interesting alternatives for the effective treatment of old landfill leachates. Since there is no specific information about which parameters help to improve the treatment efficiency when using fly ash (FA) in a sonophotoreactor, this research focuses on evaluating the use of an ultrasound process (US) combined with a photo-Fenton process, with FA as a catalyst for the first time. The removals of colour, chemical oxygen demand (COD), and aromatic compounds (UV 254) present in landfill leachates were studied using a factorial design, where the effect of different loads of FA (1, 1.5, and 2 g FA/L), pH (pH = 3, 6, and 8.9), and US frequency irradiation (576, 864, and 1138 kHz) on the efficiency of photo-Fenton was evaluated. The highest removals of COD (40.7%), colour (36.8%), and UV 254 (50.8%) were achieved adjusting the pH to 3, adding 2 g of FA/L, and applying 576 kHz of US frequency. It was found that pH is the parameter that has the highest effect on pollutant removal (95% confidence level). In addition, the removals of COD, colour, and UV 254 increased at lower pH values and US frequency. Also, the presence of Fe2O3, SiO2, and TiO2 in the FA under UV irradiation and ultrasound process, improved the removal of complex organic matter present in the landfill leachate, where HO• was the most important radical.

A facile synthesis of CuBi2O4 hierarchical dumbbell-shaped nanorod cluster: a promising photocatalyst for the degradation of caffeic acid

The present study reports on the synthesis of Cu-bismuth oxide (CuBi₂O₄)-based nanorods by using a simple co-precipitation method for the photocatalytic degradation of caffeic acid (CA). The incorporation of Cu metal ions during the synthesis of CuBi₂O₄ nanorods might be advantageous to avoid the aggregation and control the leach out of metal ions. The calculated bandgap values of ~ 1.04, 1.02, and 0.94 eV were observed for CuBi₂O₄ with different amounts of Cu 1.0, 0.50, and 0.25 g, respectively. Varying the quantity of Cu metal ions easily tuned the bandgap value within the CuBi₂O₄-based nanorods. However, a further decrease in the bandgap value increased the recombination rate, and the less photocatalyst performance was observed. The CA degradation could be explained based on the species distribution. The CA pKa was mainly located between pKa₁ and pKa₂ of 4.43 and 8.6, respectively. The Cu within the CuBi₂O₄-based nanorods changed the electronic properties and the antibacterial ability. Therefore, the synthesized CuBi₂O₄-based nanorod cluster might be a promising material for the photocatalytic degradation of CA.

Efficacy of the adjuvanted subunit protein COVID-19 vaccine, SCB-2019: a phase 2 and 3 multicentre, double-blind, randomised, placebo-controlled trial

BACKGROUND

A range of safe and effective vaccines against SARS CoV 2 are needed to address the COVID 19 pandemic. We aimed to assess the safety and efficacy of the COVID-19 vaccine SCB-2019.

METHODS

This ongoing phase 2 and 3 double-blind, placebo-controlled trial was done in adults aged 18 years and older who were in good health or with a stable chronic health condition, at 31 sites in five countries (Belgium, Brazil, Colombia, Philippines, and South Africa). The participants were randomly assigned 1:1 using a centralised internet randomisation system to receive two 0·5 mL intramuscular doses of SCB-2019 (30 μg, adjuvanted with 1·50 mg CpG-1018 and 0·75 mg alum) or placebo (0·9% sodium chloride for injection supplied in 10 mL ampoules) 21 days apart. All study staff and participants were masked, but vaccine administrators were not. Primary endpoints were vaccine efficacy, measured by RT-PCR-confirmed COVID-19 of any severity with onset from 14 days after the second dose in baseline SARS-CoV-2 seronegative participants (the per-protocol population), and the safety and solicited local and systemic adverse events in the phase 2 subset. This study is registered on EudraCT (2020-004272-17) and ClinicalTrials.gov (NCT04672395).

FINDINGS

30 174 participants were enrolled from March 24, 2021, until the cutoff date of Aug 10, 2021, of whom 30 128 received their first assigned vaccine (n=15 064) or a placebo injection (n=15 064). The per-protocol population consisted of 12 355 baseline SARS-CoV-2-naive participants (6251 vaccinees and 6104 placebo recipients). Most exclusions (13 389 [44·4%]) were because of seropositivity at baseline. There were 207 confirmed per-protocol cases of COVID-19 at 14 days after the second dose, 52 vaccinees versus 155 placebo recipients, and an overall vaccine efficacy against any severity COVID-19 of 67·2% (95·72% CI 54·3-76·8), 83·7% (97·86% CI 55·9-95·4) against moderate-to-severe COVID-19, and 100% (97·86% CI 25·3-100·0) against severe COVID-19. All COVID-19 cases were due to virus variants; vaccine efficacy against any severity COVID-19 due to the three predominant variants was 78·7% (95% CI 57·3-90·4) for delta, 91·8% (44·9-99·8) for gamma, and 58·6% (13·3-81·5) for mu. No safety issues emerged in the follow-up period for the efficacy analysis (median of 82 days [IQR 63-103]). The vaccine elicited higher rates of mainly mild-to-moderate injection site pain than the placebo after the first (35·7% [287 of 803] vs 10·3% [81 of 786]) and second (26·9% [189 of 702] vs 7·4% [52 of 699]) doses, but the rates of other solicited local and systemic adverse events were similar between the groups.

INTERPRETATION

Two doses of SCB-2019 vaccine plus CpG and alum provides notable protection against the entire severity spectrum of COVID-19 caused by circulating SAR-CoV-2 viruses, including the predominating delta variant.

FUNDING

Clover Biopharmaceuticals and the Coalition for Epidemic Preparedness Innovations.

Bimetal (Fe/Zn) doped BiOI photocatalyst: An effective photodegradation of tetracycline and bacteria

Tetracycline (TC) is one of the most commonly used broad-spectrum antibiotics to treat the bacterial infection. TC antibiotics enter into the environment because of partial metabolism in the humans and animals, thereby increasing the environmental toxicity. Therefore, it is highly needed to treat TC antibiotics from the water system. In this aspect, the present work focus on the synthesis of Fe and Zn (bimetal) incorporated with different concentrations into the bismuth-oxy-iodide (Fe/Zn-BiOI) based photocatalyst materials. The synthesized Fe/Zn-BiOI was tested against photocatalytic degradation of TC antibiotics and bacteria. The band gap value of the synthesized Fe/Zn-BiOI was calculated ~2.19 eV. The incorporation of the Fe and Zn metals within the BiOI aided advantages that increased the reactive sites, oxygen defects, photon adsorption, production of hydroxyl radicals, and decrease the recombination rate, thereby high photo-degradation ability. The maximum degradation of ~83% was observed using Fe/Zn-BiOI-1-1 at 10 mg/L of TC antibiotics concentration. Moreover, ~98% of degradation was observed at pH~10 of the TC antibiotics. The photo-activity against bacteria of the Fe/Zn-BiOI was also determined. The data suggested that the synthesized Fe/Zn-BiOI based photocatalyst materials effectively inhibited the bacterial strains. Therefore, Fe/Zn-BiOI based photocatalyst materials might be promising materials that effectively degrade TC antibiotics as well as bacteria.

Postoperative complications and waiting time for surgical intervention after radiologically guided drainage of intra-abdominal abscess in patients with Crohn's disease

BACKGROUND

In patients with active Crohn's disease (CD), treatment of intra-abdominal abscess usually comprises antibiotics and radiologically guided percutaneous drainage (PD) preceding surgery. The aim of this study was to investigate the risk of postoperative complications and identify the optimal time interval for surgical intervention after PD.

METHODS

A multicentre, international, retrospective cohort study was carried out. Details of patients with diagnosis of CD who underwent ultrasonography- or CT-guided PD were retrieved from hospital records using international classification of disease (ICD-10) diagnosis code for CD combined with procedure code for PD. Clinical variables were retrieved and the following outcomes were measured: 30-day postoperative overall complications, intra-abdominal septic complications, unplanned intraoperative adverse events, surgical-site infections, sepsis and pathological postoperative ileus, in addition to abscess recurrence. Patients were categorized into three groups according to the length of the interval from PD to surgery (1-14 days, 15-30 days and more than 30 days) for comparison of outcomes.

RESULTS

The cohort comprised 335 CD patients with PD followed by surgery. Median age was 33 (i.q.r. 24-44) years, 152 (45.4 per cent) were females, and median disease duration was 9 (i.q.r. 3.6-15) years. Overall, the 30-day postoperative complications rate was 32.2 per cent and the mortality rate was 1.5 per cent. After adjustment for co-variables, older age (odds ratio 1.03 (95 per cent c.i. 1.01 to 1.06), P < 0.012), residual abscess after PD (odds ratio 0.374 (95 per cent c.i. 0.19 to 0.74), P < 0.014), smoking (odds ratio 1.89 (95 per cent c.i. 1.01 to 3.53), P = 0.049) and low serum albumin concentration (odds ratio 0.921 (95 per cent c.i. 0.89 to 0.96), P < 0.001) were associated with higher rates of postoperative complications. A short waiting interval, less than 2 weeks after PD, was associated with a high incidence of abscess recurrence (odds ratio 0.59 (95 per cent c.i. 0.36 to 0.96), P = 0.042).

CONCLUSION

Smoking, low serum albumin concentration and older age were significantly associated with postoperative complications. An interval of at least 2 weeks after successful PD correlated with reduced risk of abscess recurrence.

A novel bimetallic (Fe/Bi)-povidone-iodine micro-flowers composite for photocatalytic and antibacterial applications

The present work describes the synthesis of polyvinylpyrrolidone (PVP) assisted Fe-BiOI based Fe/Bi-povidone‑iodine (Fe/Bi-P-I) micro-flowers based composite and its photocatalytic and antibacterial applications. The Fe/Bi-P-I micro-flowers-based composite material was synthesized using a simple co-precipitation method. The prepared Fe/Bi-P-I micro-flowers-based composite materials were characterized using various characterization techniques and tested against photocatalytic degradation of rhodamine B (RhB) dye and antibacterial analysis. The PVP or povidone‑iodine provides more exposure of reactive sites and oxygen vacancies, which leads to a high separation rate of photoinduced charge carriers, and migration, thereby 100% of photodegradation efficiency at 1 mg/L initial concentration of RhB dye towards the synthesized P-Fe-BiOI based micro-flowers composite. Interestingly, Povidone-Iodine in Fe/Bi-P-I micro-flowers-based composite might be advantageous for antimicrobial activity against both gram-negative (E. coli), and gram-positive (S. aureus) bacterial strains. Therefore, the prepared Fe/Bi-P-I micro-flowers-based composite improved both photocatalytic degradation of organic pollutants as well as high antimicrobial activity. The method of synthesizing the Bi/Fe-P-I micro flower composite in the present study is novel, facile, and economically viable.

Outcomes of single versus double hormone receptor-positive breast cancer. A GEICAM/9906 sub-study

BACKGROUND

Retrospective data suggest better outcomes for patients with double hormonal receptor (oestrogen [ER] and progesterone receptor [PgR])-positive (dHR+) early breast cancer, compared with single hormonal receptor-positive, sHR+, (ER+/PgR- or ER-/PgR+) disease. Here, we evaluate the classification according to intrinsic subtypes and clinical outcomes of sHR+ versus dHR+ in HER2-negative breast cancer patients enrolled in GEICAM/9906 study (NCT00129922).

METHODS

Archival tumours were retrieved retrospectively for the analysis of ER, PgR and HER2 status and classified into intrinsic subtypes using the PAM50 gene expression assay. Disease-free survival (DFS) and overall survival (OS) were explored using a Cox proportional hazard analysis.

RESULTS

Data on intrinsic subtypes were available in 571 (50%) patients with ER+ and/or PR+, and HER2-negative primary tumours. The incidence of luminal A and luminal B subtypes were 52%/36% in dHR+ tumours (ER+/PgR+), and 15%/58% in ER+/PgR-tumours. ER-/PgR+ tumours were mainly luminal A (52%). Compared with ER+/PgR+ patients, DFS was similar in ER-/PgR+ (hazard ratio [HR] 1.15, 95% confidence interval [CI] 0.57-2.34, p = 0.70) but worse in ER+/PgR- patients (HR 1.60, 95% CI 1.12-2.28, p < 0.01). Similar results were observed for OS (HR 1.50, p = 0.30 and HR 1.86, p < 0.01, respectively).

CONCLUSIONS

The ER+/PgR- group is characterised by higher proliferation and worse outcomes. In spite of the ER-/PgR+ subgroup resembles ER+/PgR+ disease in terms of molecular subtypes and outcomes, the small number of patients in this subgroup prevents from drawing any conclusions.

TRIAL REGISTRATION

EudraCT: 2005-003108-12 (retrospectively registered 28/06/2005). CLINICALTRIALS.

GOV IDENTIFIER

NCT00129922 (retrospectively registered 10/08/2005).

Abstract P4-21-16: Phase III trial to evaluate patient´s preference for subcutaneous versus intravenous trastuzumab administration in patients with HER2 positive advanced breast cancer (ABC) under IV trastuzumab (IV-t) treatment for at least 4 months. ChangHER-SC study (GEICAM/2012-07)

Background: Patients with HER2-positive ABC, receive anti-HER2 treatment for several months or even years. IV-t is administered weekly or 3-weekly, mandating patients to visit the hospital on a regular basis to receive infusions. This has inconveniences for patients and increase treatment costs. Subcutaneous administration could improve convenience of trastuzumab therapy. This study was designed to evaluate patient's preference for IV-t or SC trastuzumab (SC-t) in ABC patients.

Methods:This is a phase III, open label, multicenter study inpatients with HER2 positive ABC, receiving IV-t for at least 4 months and without evidence of disease progression. Patients received 600 mg of SC-t, either from a vial or from a single injection device (SID), every 3 weeks for 4 cycles. Before starting SC-t, patients received an additional IV-t cycle. Patients were randomized 1:1 to arm A, receiving 2 cycles of SC-t with vial followed by 2 cycles with SID or arm B, receiving the opposite sequence. After cycle 4, patients decided to continue with IV-t or SC-t till disease progression. Stratification criteria were the associated therapy (Chemotherapy, Hormone-therapy or none) and its administration route (IV, oral or none). Patients completed a questionnaire of experiences and preferences at three time points: before starting SC-t, after cycle 2 and after cycle 4. Health Care Professionals completed a satisfaction questionnaire every 5 patients. The primary objective was to evaluate patient´s preference for IV-t or SC-t (after cycle 2) and, secondary objectives were, to evaluate patient´s preference between the two SC-t administrations (vial or SID) after cycle 4, Health Care Professional satisfaction, associated costs of the administration options (Time and Motion pharmacoeconomic study) and safety.

Results: From September-13 to July-15, 166 patients were randomized (81 arm A, 85 arm B) in 26 Spanish sites from GEICAM. Median age was 60 years (35-93), 88% of patients were postmenopausal and 123 and 42 had an ECOG PS of 0 and 1, respectively. The median duration of prior IV-t for ABC was 1.8 years (range: 0.3-14). Patients received a median of 2 previous lines of Chemotherapy and/or Hormone-therapy (range: 1-9). Twenty patients were receiving pertuzumab at inclusion. According to patient questionnaires completed after cycle 2, 137 patients preferred the SC-t (66 arm A, 71 arm B), 11 the IV-t (6 arm A, 5 arm B), 11 didn't have a preference (4 arm A, 7 arm B), and 7 didn't answer (3 progressed, 2 withdrew participation before cycle 2 and 2 unknown reason). Three of the 11 patients choosing IV-t were receiving IV treatment as accompanying therapy; after cycle 4 five of these 11 patients finally continued with SC-t, 5 with IV-t and 1 progressed. From the 11 patients without any preference 7 received SC-t, 2 receive IV-t and 2 progressed; from the 137 patients preferring SC-t, 125 actually received it, 3 received IV-t and 9 progressed.

Conclusions: Our study shows that 82.5% of patients preferred the SC-t over the IV-t. Treatment choice was not influenced by the accompanying therapy.

Citation Format: Ciruelos EM, Montaño Á, Rodríguez CA, González-Flores E, Lluch A, Garrigós L, Quiroga V, Antón A, Malón D, Chacón JI, Velasco M, Gonzalez-Cortijo L, Jolis L, Pascual T, Amigo Y, Casas M, Cámara MC, Carrasco E, Casas A. Phase III trial to evaluate patient´s preference for subcutaneous versus intravenous trastuzumab administration in patients with HER2 positive advanced breast cancer (ABC) under IV trastuzumab (IV-t) treatment for at least 4 months. ChangHER-SC study (GEICAM/2012-07) [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-21-16.

Envelope-based technique for liquid level sensors using an in-line fiber Mach-Zehnder interferometer

This paper proposes a sensor interrogation technique based on the analysis of the overall spectrum envelope of an in-line Mach-Zehnder interferometer structure with three different fibers. The interference pattern created by a level sensor of 120 mm was evaluated with both the traditional and the proposed interrogation techniques. The result shows that the technique here proposed improves the sensitivity of the sensor by more than an order of magnitude. Moreover, our new interrogation technique allows the length of an in-line Mach-Zehnder interferometer to be extended up to 470 mm while maintaining high linearity and sensitivity.

[Impact of Lean methodology to improve care processes and levels of satisfaction in patient care in a clinical laboratory]

INTRODUCTION

The application of the Lean methodology in health institutions is an effective tool to improve the capacity and workflow, as well as to increase the level of satisfaction of patients and employees.

OBJECTIVE

To optimise the time of outpatient care in a clinical laboratory, by implementing a methodology based on the organisation of operational procedures to improve user satisfaction and reduce the number of complaints for delays in care.

MATERIAL AND METHODS

A quasi-experimental before and after study was conducted between October 2011 to September 2012. XBar and S charts were used to observe the mean service times and standard deviation. The user satisfaction was assessed using service questionnaires.

RESULTS

A reduction of 17 minutes was observed in the time of patient care from arrival to leaving the laboratory, and a decrease of 60% in complaints of delay in care. Despite the high staff turnover and 38% increase in the number of patients seen, a culture of empowerment and continuous improvement was acquired, as well as greater efficiency and productivity in the care process, which was reflected by maintaining standards 12 months after implementation.

CONCLUSION

Lean is a viable methodology for clinical laboratory procedures, improving their efficiency and effectiveness.

Gemcitabine and capecitabine in previously anthracycline-treated metastatic breast cancer: a multicenter phase II study (SOLTI 0301 trial)

BACKGROUND

On the basis of clinical activity of capecitabine and gemcitabine for metastatic breast cancer, we carried out a multicenter phase II clinical trial on the combination of these two agents in advanced anthracycline-pretreated breast cancer patients. Main objectives were to assess its efficacy and safety profile.

PATIENTS AND METHODS

Seventy-six anthracycline-pretreated breast cancer patients were evaluated and were stratified according to previous treatment of advanced disease (group-1: not previously treated and group-2: previously treated). Study treatment consisted of gemcitabine 1000 mg/m(2), i.v., as 30 min-infusion, days 1 and 8 every 21 days, plus oral capecitabine 830 mg/m(2) b.i.d., days 1-14 every 21 days.

RESULTS

Overall response rate was 61% for group-1, 48.5% for group-2 and 55.2% for the whole population. Clinical benefit rate was 73% for group-1, 80% for patients in group-2 and 76% for all patients. Median time to progression was 13.0 months for group-1, 8.2 months for group-2 and 11.1 months for the whole population. Most frequent grade 3-4 observed toxic effects per patient were neutropenia (60%), asymptomatic liver toxicity (13.5%), asthenia (14%) and hand-foot syndrome (16%). Only one patient presented febrile neutropenia. No treatment-related deaths occurred.

CONCLUSION

Combination of gemcitabine and capecitabine is an active and safe regimen in anthracycline-pretreated breast cancer patients.

A prospective observational study of the effectiveness, safety, and effect on fatigue of darbepoetin alfa for the treatment of chemotherapy-induced anaemia

OBJECTIVE

Anaemia is common in cancer patients treated with chemotherapy. Darbepoetin alfa (DA) is the only erythropoiesis-stimulating protein approved for administration at weekly and every-three-week intervals in cancer patients receiving chemotherapy. This article investigates the effectiveness, tolerability and effect on fatigue of DA.

METHODS

Prospective, observational study performed in 30 Spanish centres. Eligible patients were > or = 18 years of age, anaemic (haemoglobin [Hb] < or = 11 g/dL), with non-myeloid malignancies, receiving chemotherapy. DA (150 mug) was administered weekly for a maximum of 16 weeks (dosage doubled if Hb increased < 1 g/dL after 4 weeks).

MAIN OUTCOME MEASURES

Haematopoietic response (Hb increase > or = 2 g/dL or Hb > or = 12 g/dL in the absence of transfusions in the previous 28 days), transfusion required between Weeks 5 and 16 and fatigue measured by the Fatigue subscale of the Functional Assessment of Cancer Therapy.

RESULTS

293 adults were recruited (56.4% women), with lymphoproliferative malignancies (44.3%) or solid tumours (55.7%). Baseline Hb was 9-11 g/dL in 83.7% of patients. Sixty-four per cent (95% CI: 58.1-69.4%) had a haematopoietic response and 12% required transfusions. After adjusting for performance status, concomitant diseases and chemotherapy type, an increase in Hb level was significantly associated with an improvement in Fatigue subscale (+1.9 points per 1 g/dL). Only 2% of patients had treatment-related adverse events: thromboembolic pulmonary disease (0.3%); hypersensitivity reaction (0.3%); local pain following DA administration (0.3%); insomnia (0.3%); thrombocytosis (0.3%) and deep vein thrombosis (0.3%).

CONCLUSIONS

Fixed-dose DA administered once weekly seems to be an effective, well-tolerated treatment for chemotherapy-induced anaemia in patients with non-myeloid malignancies, and there is an indication of a possible benefit on fatigue in the clinical practice.

In situ study of the relevance of bacterial adherence to feed particles for the contamination and accuracy of rumen degradability estimates for feeds of vegetable origin

An in situ study was conducted on four rumen-cannulated wethers to determine (using (15)N infusion techniques) the microbial contamination (mg bacterial DM or crude protein (CP)/100 mg DM or CP) and the associated error on the effective degradability of fourteen feeds: barley and maize grains, soyabean and sunflower meals, full-fat soyabean, maize gluten feed, soyabean hulls, brewers dried grains, sugarbeet pulp, wheat bran, lucerne and vetch-oat hays, and barley and lentil straws. The DM or CP contamination in residues (M) fitted to single exponential or sigmoid curves. A general model (M=m (1-e(-ft) ) (j)) was proposed to match this fit. Asymptotic values (m) varied from 2.84% to 13.3% and from 2.85% to 80.9% for DM and CP, respectively. Uncorrected results underestimated the effective degradability of both DM (P<0.05) and CP (P<0.01). For CP, this underestimation varied from 0.59 % to 13.1%, with a higher but unascertainable error for barley straw. Excluding maize grain, the microbial contamination of both DM and CP, and the associated underestimation of the effective degradability of CP, were positively related to the cellulose content of the feed. The error in the effective degradability of CP was also negatively related to the CP content and its apparent effective degradability (R(2) 0.867). This equation allows easier and more accurate estimates of effective degradability, needed to improve protein-rationing systems.

[Interferon-alpha2b recombinant improved the cognitive dysfunction in patients with relapsing remitting multiple sclerosis]

INTRODUCTION

Some experimental, Phase II clinical trials and the preliminary reports of the Cuban Phase III clinical trial indicate that alpha-IFN (IFN) may be useful in relapsing remitting (RR) multiple sclerosis (MS). The reports in Cuba showed that 70% of the MS patients have cognitive dysfunction.

OBJECTIVE

To assess the efficacy of IFN-alpha2b recombinant in the cognitive dysfunction of RR MS.

PATIENTS AND METHODS

57 RR-MS clinical definite patients from the randomised, double blind, placebo controlled study of 225 patients with RR-MS and brain MRI confirmed. Patients were randomly assigned to receive intramuscular IFN-alpha2b (Heberon R) 10 million IU (high dose), 3 million IU (low dose) or placebo twice week for 2 years. Outcome results were blinding evaluated considering changes in the following tests: Luria, WAIS, Benton and PASAT-3. Adverse events and side effects were not evaluated to maintain physician blinding.

RESULTS

The initial comparison of the groups did not show any differences among the placebo (n=20), low dose (n=18) and high dose (n=19) considering age (p=0.234), gender, ethnic group (p=0.012), years ill (p=0.787), EDSS (p=0.203) and rate of relapses (p=0.432). The Luria's Test showed an improved in the low dose group from 2.50 +/- 1.34 to 1.39 +/- 1.85 (p=0.029) and in the high dose group from 3.22 +/- 1.89 to 2.17 +/- 1.50 (p=0.006) vs placebo 2.85 +/- 1.66 to 2.90 +/- 1.97 (p=0.723). The results of the Benton's test demonstrated that the low dose group had an improved from 5.50 +/- 1.10 to 6.22 +/- 1.31 (p=0.047), in the high dose group from 4.87 +/- 1.85 to 5.78 +/- 1.35 (p=0.005) where as in the placebo group worse from 5.15 +/- 1.76 to 5.05 +/- 2.11 (p=0.893). The WAIS test showed the same results, the low dose group increased from 5.17 +/- 1.34 to 6.06 +/- 1.21 (p=0.022), the high dose group from 4.56 +/- 1.38 to 5.39 +/- 1.29 (p=0.007) and the placebo group worse from 5.25 +/- 1.25 to 5.05 +/- 1.57 (p=0.354). Finally, the PASAT-3 test increased in the IFNs groups: from 45.72 +/- 10.61 to 49.94 +/- 11.68 (p=0.015) in the low dose group, from 42.67 +/- 11.04 to 48.72 +/- 8.84 (p=0.03) in the high dose group, but in the placebo group worse from 44.55 +/- 10.86 to 41.95 +/- 13.74 (p=0.655).

CONCLUSION

IFN-alpha improved the cognitive dysfunction in RR-MS patients. The higher dose is more beneficial.

Screening of antimutagenicity via antioxidant activity in Cuban medicinal plants

The reducing activity on the 1,1-diphenyl-2-picrylhydrazyl (DPPH) radical, z.rad;OH radical scavenging potential, in vitro inhibition of lipid peroxidation and modulation of mutagenicity induced by ter-butyl hydroperoxide (TBH) in Escherichia coli were sequentially screened in 45 species of plants used with medicinal purposes in Cuba, in a search for antioxidant agents which protect DNA against oxidative stress.Five species, e.g. Tamarindus indica L., Lippia alba L., Pimenta dioica (L.) Merr, Rheedia aristata Griseb. and Curcuma longa L. displayed IC(50)<30 micro g/ml in the DPPH radical reduction assay and IC(50)<32 micro g/ml in lipid peroxidation inhibition testing. Pimenta dioica and Curcuma longa L. showed also a 20% inhibition of the in vitro induced z.rad;OH attack to deoxyglucose. Further antimutagenesis assay in Escherichia coli IC 188 evidenced that only Pimenta dioica prevents DNA damage by TBH to the test bacteria. A role of antioxidant enzymes is presumed in this case, as judged by a different response in the isogenic Escherichia coli IC 203 deficient in catalase and alkyl hydroperoxide reductase and the discrete inhibition of oxidative mutagenesis also observed when pre-treatment of the extract was assayed. Eugenol, the main constituent of the essential oil of Pimenta dioica, also inhibited oxidative mutagenesis by TBH in Escherichia coli, at concentrations ranging from 150 to 400 micro g/plate.

Effects of feed intake on composition of sheep rumen contents and their microbial population size

The present study was conducted to determine the effect of feed intake on the composition of the rumen contents of sheep and on their bacterial densities. Whole rumen contents were sampled after a period of continuous inter-rumen infusion of 15NH3 from four rumen-cannulated wethers successively fed on a hay-concentrate diet (2:1, w/w on a DM basis) at two rates of feed intake: 40 and 80 g DM/kg body weight0.75. Total weight and chemical composition of rumen contents, as well as the distribution by size and chemical composition of particles, were determined. The populations of bacteria associated with the liquid (liquid-associated bacteria, LAB) and solid (solid-associated bacteria, SAB) fractions of rumen digesta and the distribution of SAB according to feed particle size were also examined. The greater feed intake caused an increase in the mass of the rumen contents, while its chemical composition did not change, except for a higher content of organic matter (P=0.023). The distribution of feed particles by size was similar at both levels of intake. The concentrations of neutral- and acid-detergent fibre in feed particles decreased and those of total, dietary, and microbial N increased, both with a quadratic response (P=0.001), as particle size decreased. The proportion of LAB in the microbial biomass of rumen digesta reached only 8.0 %. This proportion and the density of LAB were unaffected by the level of feed intake, whereas an apparent reduction (10.4 %) occurred with the SAB biomass in whole rumen contents. A systematic, but not significant, reduction (mean value 11.9 %) in the level of microbial colonisation in the different particle fractions with the increase of feed intake was also observed.

Effects of stage of harvest on the protein value of fresh lucerne for ruminants

The ruminal degradation of dry matter (DM) and crude protein (CP) and the intestinal availability of CP of four fresh lucerne (Medicago sativa L.) samples, corresponding to a 3rd growing cycle and harvested at 2-week intervals, were determined. Rumen degradability, measured by the nylon bag technique, and rumen outflow rates were determined on three rumen-cannulated wethers. Intestinal digestibility was determined by the mobile bag technique on three duodenal fistulated wethers. Both groups of animals were fed a 2:1 lucerne hay to concentrate diet at an intake level of 40 g DM x kg(-1) BW0.75. The effective degradability (ED) of DM decreased with maturity in linear and quadratic form, as a consequence of a decrease in the soluble fraction and a similar increase in the undegradable materials. The resultant values were 0.795, 0.661, 0.600, and 0.576 for harvests at 2, 4, 6, and 8 weeks. The ED of CP showed the same trend. However, the variations (values of 0.896, 0.832, 0.791, and 0.817, respectively), were moderate and mainly due to the reduction of the proportion of soluble CP. The intestinal digestibility of CP of all samples showed a downward trend with the increase in the ruminal incubation time, as modelled according to a logistic function. The undegraded CP digested in the gut (Di) and therefore the effective intestinal digestibility (EID) were derived from this function according to the rumen outflow of undegraded CP. The effects of maturity on the mean values of Di, expressed as a proportion of the original CP content, were the opposite of those recorded for the ED of CP. These values were 0.067, 0.102, 0.115, and 0.089 for samples harvested at 2, 4, 6, and 8 weeks, respectively. Nevertheless, when Di was expressed as g CP x kg(-1) DM, these values (18.0, 17.4, 17.1, and 14.3, respectively) decreased in linear form. The same trend was observed for EID values, which represent 0.641, 0.609, 0.549, and 0.488, respectively. The change of the digestion site produced by the reduction of ED of CP was also associated with an increase in the undigested CP (values of 0.037, 0.066, 0.094, and 0.094, at the four harvesting times).

Rumen effective degradability of amino acids from soybean meal corrected for microbial contamination

Rumen degradation kinetics and effective degradability of individual amino acids, total analysed amino acids (TAA) and crude protein (CP) of soybean meal were measured on four rumen-cannulated wethers using the nylon bag technique. Microbial contamination of the incubated residues was corrected using a continuous 15N intraruminal infusion and isolated solid associated bacteria as a reference sample. TAA showed a lower soluble fraction (14.9 vs. 20.8%; P < 0.01), a similar insoluble-degradable fraction (79.0 vs. 79.2%) and a higher degradation rate (11.5 vs. 8.4% x h(-1); P < 0.05) than CP. As a consequence, effective degradability was similar for TAA and CP (74.7 vs. 75.7%). Degradability values of individual amino acids varied moderately (range: +/-6% of TAA degradability). Valine, isoleucine, leucine, alanine, aspartic acid and tyrosine showed significantly lower degradability than TAA, while the opposite effect was observed for histidine, threonine and glutamic acid. Degradability of individual amino acids was related to their soluble fraction (r = 0.877; P<0.001).

Composition of bacteria harvested from the liquid and solid fractions of the rumen of sheep as influenced by feed intake

A study was conducted to determine the effect of the feed intake on the chemical composition of bacteria associated with the solid (solid-associated bacteria; SAB) and liquid (liquid-associated bacteria; LAB) fractions of rumen digesta, the digestive passage kinetics and their relationships. Whole rumen contents were sampled after a period of continuous infusion of 15NH3 from four ruminally-cannulated wethers provided successively with a hay-concentrate diet (2 : 1 w/w on a DM basis) at two rates of feed intake: 40 and 80 g DM/kg body weight 0.75. SAB had a higher content of organic matter and total lipids (P < 0.001) and a similar N content as compared with LAB. The concentration of purines and 15N was lower (P = 0.011 and P < 0.001 respectively) in SAB than LAB, whereas the opposite was observed for the concentration of amino acids (mg/g DM; P = 0.031). An increase in feed intake produced an increase in the N (P = 0.034) and purine (P = 0.066) concentrations in bacteria and a decrease (P = 0.033) in their amino acid concentrations. Significant increases of rumen outflow rates of liquid and particles were also observed with increased feed intake. Rates of rumen outflow showed positive and negative linear relationships (P < 0.001) with the purine : N ratio and the proportion of amino acid on total N of bacteria respectively. SAB contained significantly higher proportions of leucine, isoleucine, lysine and phenylalanine and lower proportions of alanine, methionine and valine than LAB. The increase in feed intake also induced significant changes in the amino acid profile of bacteria, increasing arginine and methionine and decreasing alanine and glycine proportions. Results show that the outflow rate of rumen contents is a major factor in determining the proportion of nucleic acids and protein in rumen bacteria and explains some of the differences observed between LAB and SAB.

[Work conditions of patients with controlled epileptic crises]

OBJECTIVES

To study the employment conditions in a group of patient epileptic adults with control of its seizures, assisted in the University Hospital of Cajuru.

PATIENTS AND METHODS

We studied 70 patients that we applied the specific protocol, obtaining data of its origin, profession and job situation.

RESULTS

We examined 46 men and 24 women, with mean age 34 years old, where 63 of urban origin and 7 rural. All the patients were in treatment with antiepileptic drugs and without seizures or less than three seizures in the last twelve months. The largest group of patients (35) they met unemployed: 14 retired, 11 of the motivated by the disease, 10 worked as autonomous, 3 only studied and 3 were public employees.

Venous irritation, pharmacokinetics, and tissue distribution of tirilazad in rats following intravenous administration of a novel supersaturated submicron lipid emulsion

PURPOSE

To compare the venous irritation, pharmacokinetics, and tissue distribution of tirilazad in rats after intravenous administration of a submicron lipid emulsion with that of an aqueous solution.

METHODS

Venous irritation was determined by microscopic evaluation of injury to the lateral tail veins of rats. Pharmacokinetic parameters were determined by following plasma concentrations of drug. Tissue distribution of [14C]-tirilazad was determined by quantitative whole body autoradiography.

RESULTS

Single dose injections of tirilazad as an emulsion at doses ranging from 1.52 mg to 13.5 mg were non-irritating whereas the solution was irritating at a dose of 1.3 mg. The pharmacokinetic parameters were not statistically different between the emulsion and the solution (p > 0.2) at doses of 6 mg/kg/day and 20 mg/kg/day. However, at 65 mg/kg/day dose, a higher AUC(0,6) (4-fold) and lower V(ss), (18-fold) and CL(5-fold) were observed for the lipid emulsion as compared to the solution (p < 0.05). Tissue distribution showed higher initial concentrations (two fold or more) in most tissues for the solution. These values, however, equilibrated by 4 h and AUC(0,4) differences were less than two fold in most tissues.

CONCLUSIONS

Formulating tirilazad in the lipid emulsion significantly reduces the venous irritation without changing the pharmacokinetics and tissue distribution at low doses.

[Sequential chemotherapy and radiotherapy in the treatment of locally advanced carcinoma of the head and neck]

In patients with non-resectable carcinoma of the head and neck, radiotherapy produces an average survival of 12 months. Neoadjuvant chemotherapy followed by radiotherapy has been shown to prolong survival and preserve organ structure and function, and to reduce systemic relapses in patients with advanced, resectable disease. An analysis was made of 35 patients treated with sequential chemotherapy and radiotherapy, 20 with non-resectable disease and 15 with resectable disease who refused surgery. Treatment consisted of 4 cycles of cisplatin + 5-fluoruracil in a 96-h continuous intravenous infusion in 16 patients, and the same treatment with leucovorin in 19 patients. After chemotherapy, the patients underwent cobalt irradiation of the primary tumor and neck. Chemotherapy produced a complete response rate of 46% and a partial response rate of 28%, yielding an overall rate of 74%. After radiotherapy, the CR increased to 63%. After 92 months of maximum follow-up, overall survival was 20% and median survival was 25 months. Locoregional relapses were the main cause of treatment failure. Our results suggest that sequential chemo-radiotherapy achieved encouraging CR rates with no significant increase in toxicity, prolonged survival in non-resectable patients, and enabled organ preservation in patients with resectable disease.

Neoadjuvant chemotherapy with continuous infusion of cisplatin and 5-fluorouracil, with or without leucovorin, for locally advanced nasopharyngeal carcinoma

Cisplatin-based induction chemotherapy has been extensively tested in nasopharyngeal carcinoma for the improvement of local and systemic control and survival of this disease. In this study, we report the results of the treatment with induction chemotherapy in 40 patients with locally advanced carcinoma of the nasopharynx (LANPC) with four courses of cisplatin (P) 25 mg/m2 per day and 5-fluorouracil (F) 1000 mg/m2 per day both in a 4-days continuous infusion, with or without leucovorin (L) 250 mg/m2 per day in 2-hour infusion at the beginning of daily administration of PF, followed by sequential radiotherapy. All except one were in stage IV. The overall response after induction chemotherapy was 93%, with 55% CR and 38% PR. Definitive overall response after radiotherapy was 98%, with 80% CR and 18% PR. At a maximum follow up of 11 years, the overall survival rate is 55%. Induction chemotherapy with continuous infusion of PF with or without leucovorin followed by radiotherapy is a highly active regimen for the treatment of locally advanced nasopharyngeal carcinoma with response and survival rates comparable to other combinations of sequential or simultaneous chemotherapy and radiotherapy.

[Hypertrophic myocardiopathy with isoelectric T waves]

INTRODUCTION AND OBJECTIVES

The lack of specificity of electrocardiographic (ECG) recording showing isoelectric T-waves often leads to diagnostic doubts. This study attempts to demonstrate that asymptomatic patients who demonstrate benign forms of hypertrophic cardiomyopathy may be identified from a typical ECG pattern showing isoelectric T-waves.

METHODS

In 45 out of 5,126 asymptomatic healthy aircrew members, an ECG pattern which showed isoelectric T-waves in all leads, but were normal in V2 and V3, was found. 12 of them had negative T-waves in III and aVF leads. Cardiac echo-Doppler, Bruce test and 24-hour Holter recordings were performed in 29 of the 45 cases; all were males aged 30-55 (43.1 +/- 7.1) without any associated disorder nor engaged in heavy exercise, and a control group of 15 healthy subjects. In each of the 29 cases, 2-21 ECG's (11.1 +/- 6.3) performed over a period of 2 to 20 years (13.0 +/- 5.9) were reviewed.

RESULTS

In 23 of the 29 cases (79.3%), echo-Doppler criteria of non obstructive mild hypertrophic cardiomyopathy were found. T-waves became normal during exercise testing, returning to isoelectric during recovery, in 19 of the 23 cases. In 17 of these cases, reversible T-wave changes were observed between successive ECG's; T-wave changes became clearly negative when the level of exercise was increased. Holter recordings did not show pathological findings.

CONCLUSIONS

We believe that echo-Doppler studies must be performed in asymptomatic patients showing the ECG pattern described above, because they are strongly suspicious of having mild hypertrophic cardiomyopathy.

Effect of angiotensin II-induced changes in perfusion flow rate on chlorothiazide transport in the isolated perfused rat kidney

Angiotensin II was used as a probe to study the effect of changes in perfusate flow rate on the renal clearance parameters of chlorothiazide in the isolated perfused rat kidney. Perfusion studies were performed in five rats with no angiotensin II present in the perfusate and in five rats with a 1-4 ng/min infusion of angiotensin II into the perfusate. Angiotensin II had a dramatic effect on the renal hemodynamics, resulting in a 43% decrease in perfusate flow, a 16% decrease in glomerular filtration rate (GFR), and a 45% increase in filtration fraction. Values for the fractional excretion of glucose were low and consistent, with or without angiotensin II. Although the unbound fraction (fu) of chlorothiazide was unchanged between treatments, the renal (CLr) and the secretion clearances were reduced by about 50% in the presence of angiotensin II; the excretion ratio [ER = CLr/(fu.GFR)] was reduced by 38% with angiotensin II present in the perfusate. Analysis of the data was complicated by the presence of a capacity-limited transport for renal tubular secretion. Transport parameters (+/- SD) were obtained and the corrected intrinsic secretory clearance [(Vmax/GFR)/Km] of chlorothiazide was 123 +/- 18 without angiotensin II vs. 72.8 +/- 30.0 with angiotensin II. These results demonstrate that alterations in organ perfusion can significantly reduce the clearance parameters of chlorothiazide in the rat IPK. These flow-induced changes in intrinsic secretory transport may reflect perturbations other than that of perfusion flow rate alone.

Influence of angiotensin II-induced alterations in renal flow on excretion of cefonicid in isolated perfused rat kidneys

The effects of variations in renal perfusate flow on the excretion of cefonicid was examined in isolated perfused rat kidneys. Cefonicid, an expanded-spectrum cephalosporin, is primarily eliminated by active tubular secretion and is neither metabolized nor reabsorbed in the isolated kidney. We used angiotensin II (AII), a strong vasoconstrictor hormone of the afferent and the efferent arterioles in the kidney, to determine whether the renal and secretion clearances, as well as the excretion ratio (ER = CLR/[fu x GFR], where CLR is renal clearance, fu is the unbound fraction, and GFR is glomerular filtration rate), of this low-extraction compound can be altered by a decreased perfusion flow. Control studies were performed in the absence (n = 5) and presence (n = 4) of AII; cefonicid studies were performed in the absence (n = 4) and presence (n = 5) of AII. AII (1 to 4 ng/min) and cefonicid (5 to 10 micrograms/min) were infused into the perfusate. Cefonicid was assayed by high-performance liquid chromatography, and its protein binding was determined by ultrafiltration. AII decreased the perfusate flow rate and increased the renal vascular resistance and filtration fraction of the isolated kidney in the presence and absence of cefonicid. The glomerular filtration rate remained unchanged among the groups. The fractional excretion of glucose was low and steady, indicating a well-preserved tubular function. Although the unbound fraction was unchanged between treatments, the renal and secretion clearances and the excretion ratio of cefonicid were reduced by about 40% in the presence of AII (excretion ratios, 10.3 without AII versus 6.03 with AII). These results suggest that the altered clearance parameters of cefonicid are the result of a flow-induced change in the intrinsic secretory transport of the drug.