Performance of standard systematic biopsy versus MRI/TRUS fusion biopsy using the Navigo® system in contemporary cohort

INTRODUCTION

The introduction of multi parameter magnetic resonance imaging (mpMRI) of the prostate in combination with MRI/TRUS fusion and systematic biopsy resulted in improved detection of prostate cancer. The aim of the current study was to document the performance of MRI/TRUS fusion biopsy of the prostate using the Navigo™ software in a contemporary cohort of patients from nonreferral centers.

MATERIAL AND METHODS

We performed a two centers prospective data collection (2014-2020) for men with clinically suspected Pca and patients on active surveillance for low-risk Pca that were referred for TRUS biopsy after performing mpMRI of the prostate with a visible lesion. The primary outcome was detection of clinically significant cancer (csPca) defined as ISUP grade group ≥2. Patients were stratified according to biopsy technique and PI-RADS category.

RESULTS

The study group included 236 patients of whom 129 (54.9%) were diagnosed with Pca and 82 (34.7%) with csPca (GG ≥ 2) on combined biopsy. The overall detection of csPca was 31% for targeted vs. 25.4% for systematic biopsy with an absolute difference of 5.6% in favor of the fusion technique. No significant difference between the two techniques was observed for detection of benign prostate or GG1 disease. The improved performance of the targeted approach was noted only in patients with PI-RADS 4 and 5 lesions. Of the patients with csPca 10 (12%) were diagnosed only by the systematic biopsy while 20 (24%) were detected only in the fusion biopsy. Systematic biopsy of prostate lobe without MRI lesion detected only 2 cases (∼1%) with high grade disease.

CONCLUSIONS

Detection of csPca by mpMRI/TRUS fusion biopsy using the 3D Navigo™ system is feasible. The targeted approach outperforms the systematic one, however the later technique also detects high risk disease and should be included in the biopsy procedure. The overall detection rate (34.9%) of clinically significant prostate cancer by both targeted and systematic sampling is relatively low.

The house is a machine for everything: the role of the built environment in group homes during the COVID-19 pandemic

OBJECTIVES

Individuals living in group homes during the COVID-19 pandemic faced unique challenges and health risks related to living in shared spaces. This study aimed to assess the experiences of living and working in a group home during the pandemic and to explore the role of the built environment.

STUDY DESIGN AND METHODS

We conducted longitudinal working groups with group home residents with intellectual and developmental disabilities and serious mental illness, group home staff, and families/caregivers of residents from December 2020 through December 2022. Common themes highlighting ways in which group home residents, staff, and caregivers perceived the built environment to impact living in a group home during the COVID-19 pandemic were identified.

RESULTS

Resonant themes centered around increased risk of COVID-19 infection, ad hoc spatial adaptations for infection control, space-related challenges due to isolation and quarantine requirements, and limited access to public spaces.

CONCLUSION

Group home residents and staff experienced multiple health and wellness challenges during the COVID-19 pandemic related to their surrounding built environment. Mechanisms to engage group home residents in modifications of their built environment may improve the effectiveness of infection control policies while acknowledging individual autonomy.

Wastewater-based monitoring of illicit drugs in Cyprus by UPLC-MS/MS: The impact of the COVID-19 pandemic

The outbreak and spread of COVID-19 impacted through various ways the lives of millions of humans globally. In this work, wastewater-based epidemiology (WBE) was applied to investigate the effect of the actions taken by the Republic of Cyprus to confine COVID-19 on the use of illicit stimulant drugs. Daily influent samples were collected from the six main wastewater treatment plants (WWTPs) of the country i) before lockdown (3-9 April 2019), ii) during lockdown (21-27 April 2020), iii) during the post-lockdown period (14-20 July 2020), and, iv) during each season of the following year (20-26 April 2021, 19-25 July 2021, 11-17 October 2021, 25 December 2021-2 January 2022), and analyzed for amphetamine, methamphetamine, MDMA and cocaine. In most areas, amphetamine and methamphetamine use was not affected during the confinement period, but as availability of the substances decreased with time, a drop in their use was observed when most restriction measures were eased (up to 9- and 22-fold decrease, respectively). The limitations on social interactions and events during the quarantine period seem to have led to the reduction of MDMA and cocaine and driven a sharp decrease of their use in most areas studied (up to 11 and 6 times lower, respectively). However, the re-opening of activities led to a pronounced consumption increase, reaching maximum daily values of 800 and 2691 mg/1000 inhabitants/day, respectively. In 2021, drug use was re-established to lower levels. The examination of weekly patterns during this year revealed higher weekend use of methamphetamine, MDMA and cocaine. Our results suggest that both the implementation and the easing of COVID-19 related measures affected the availability and the use of drugs. This study also provides the first insight on the consumption of illicit drugs in the Republic of Cyprus during pre-, post- and pandemic times and demonstrates the importance of WBE.

Psychological interventions for acute psychiatric inpatients with schizophrenia-spectrum disorders: A systematic review and meta-analysis

BACKGROUND

Acute inpatient psychiatric wards are important yet challenging environments in which to implement psychological interventions for people with schizophrenia-spectrum disorders. No meta-analysis to date has evaluated whether psychological interventions are effective in this context.

METHODS

We systematically searched Embase, Medline and PsycInfo databases for randomised controlled trials (RCTs) of psychological interventions implemented in acute inpatient psychiatric settings with individuals with schizophrenia-spectrum disorders. We conducted random effects meta-analyses of between-groups outcomes at post-intervention and relapse/re-hospitalisation rates by follow-up.

RESULTS

Twenty-nine trials were suitable for meta-analysis. Psychological interventions improved post-intervention positive symptoms, social functioning and treatment compliance and reduced the risk of relapse/ re-hospitalisation, relative to control conditions. Analyses of specific intervention effects found positive effects of psychoeducation on several key outcomes (power > 80%) and preliminary evidence for positive effects of acceptance and commitment therapy (ACT), cognitive behaviour therapy (CBT) and metacognitive training (MCT) on some outcomes (power < 80%).

CONCLUSION

Psychological interventions can be helpful for acute inpatients with schizophrenia-spectrum disorders. However, risk of bias was often high or unclear, and some analyses were underpowered. Further research should use more rigorous RCT designs and publish meta-analysable data on positive symptoms, general psychopathology, relapse/ re-hospitalisation, social functioning and treatment compliance.

On the capacity of ozonation to remove antimicrobial compounds, resistant bacteria and toxicity from urban wastewater effluents

The degradation of erythromycin (ERY) and ethylparaben (EtP) in urban wastewater effluents at low concentration level during ozonation was investigated under different experimental conditions. Both substrates were rapidly eliminated within 2min at low ozone dose of 0.3mgL^-1 and the experimental data were well fitted in the pseudo-first-order kinetic model. The ratio of HO- and O₃-exposure (R_ct) at the inherent pH was found to be 1.9×10^-8. The degradation of ERY and EtP was pronounced at pH 8 compared to acidic pH conditions, while the degradation rate of both substrates was found to be matrix-depended. It was also shown that both O₃- and HO-mediated pathways are involved in the degradation of EtP, whereas the saturated-rich structure of ERY renders it O₃-recalcitrant. Under the optimum O₃ dose, the BrO₃^- concentration was found to be lower than 10μgL^-1. Five and fifteen transformation products were elucidated during ERY and EtP oxidation, respectively. The root and shoot inhibition can be attributed to the oxidation products formed upon dissolved effluent organic matter transformation. Escherichia coli harbouring resistance to ERY survived ozonation better than EtP-resistant E. coli. However, neither ERY- nor EtP-resistant E. coli were detected after 15min of ozonation.

A photoelastic-modulator-based motional Stark effect polarimeter for ITER that is insensitive to polarized broadband background reflections

A motional Stark effect polarimeter insensitive to polarized broadband light is proposed. Partially polarized background light is anticipated to be a significant source of systematic error for the ITER polarimeter. The proposed polarimeter is based on the standard dual photoelastic modulator approach, but with the introduction of a birefringent delay plate, it generates a sinusoidal spectral filter instead of the usual narrowband filter. The period of the filter is chosen to match the spacing of the orthogonally polarized Stark effect components, thereby increasing the effective signal level, but resulting in the destructive interference of the broadband polarized light. The theoretical response of the system to an ITER like spectrum is calculated and the broadband polarization tolerance is verified experimentally.

Electron and Ion Heating Characteristics during Magnetic Reconnection in the MAST Spherical Tokamak

Electron and ion heating characteristics during merging reconnection start-up on the MAST spherical tokamak have been revealed in detail using a 130 channel yttrium aluminum garnet (YAG) and a 300 channel Ruby-Thomson scattering system and a new 32 chord ion Doppler tomography diagnostic. Detailed 2D profile measurements of electron and ion temperature together with electron density have been achieved for the first time and it is found that electron temperature forms a highly localized hot spot at the X point and ion temperature globally increases downstream. For the push merging experiment when the guide field is more than 3 times the reconnecting field, a thick layer of a closed flux surface form by the reconnected field sustains the temperature profile for longer than the electron and ion energy relaxation time ~4-10 ms, both characteristic profiles finally forming a triple peak structure at the X point and downstream. An increase in the toroidal guide field results in a more peaked electron temperature profile at the X point, and also produces higher ion temperatures at this point, but the ion temperature profile in the downstream region is unaffected.

Dissolved effluent organic matter: Characteristics and potential implications in wastewater treatment and reuse applications

Wastewater reuse is currently considered globally as the most critical element of sustainable water management. The dissolved effluent organic matter (dEfOM) present in biologically treated urban wastewater, consists of a heterogeneous mixture of refractory organic compounds with diverse structures and varying origin, including dissolved natural organic matter, soluble microbial products, endocrine disrupting compounds, pharmaceuticals and personal care products residues, disinfection by-products, metabolites/transformation products and others, which can reach the aquatic environment through discharge and reuse applications. dEfOM constitutes the major fraction of the effluent organic matter (EfOM) and due to its chemical complexity, it is necessary to utilize a battery of complementary techniques to adequately describe its structural and functional character. dEfOM has been shown to exhibit contrasting effects towards various aquatic organisms. It decreases metal uptake, thus potentially reducing their bioavailability to exposed organisms. On the other hand, dEfOM can be adsorbed on cell membranes inducing toxic effects. This review paper evaluates the performance of various advanced treatment processes (i.e., membrane filtration and separation processes, activated carbon adsorption, ion-exchange resin process, and advanced chemical oxidation processes) in removing dEfOM from wastewater effluents. In general, the literature findings reveal that dEfOM removal by advanced treatment processes depends on the type and the amount of organic compounds present in the aqueous matrix, as well as the operational parameters and the removal mechanisms taking place during the application of each treatment technology.

η and η' mixing from lattice QCD

We present a lattice QCD computation of η and η' masses and mixing angles, for the first time controlling continuum and quark mass extrapolations. The results for M(η) = 551(8)(stat) (6)(yst) MeV and M(η') = 1006(54)(stat)(38)(syst)(+61)(ex) MeV are in excellent agreement with experiment. Our data show that the mixing in the quark flavor basis can be described by a single mixing angle of Ø = 46(1)(stat)(3)(syst)° indicating that the η' is mainly a flavor singlet state.

Investigating the fate of iodinated X-ray contrast media iohexol and diatrizoate during microbial degradation in an MBBR system treating urban wastewater

The capability of a moving bed biofilm reactor (MBBR) to remove the iodinated contrast media (ICM) iohexol (IOX) and diatrizoate (DTZ) from municipal wastewater was studied. A selected number of clones of microorganisms present in the biofilm were identified. Biotransformation products were tentatively identified and the toxicity of the treated effluent was assessed. Microbial samples were DNA-sequenced and subjected to phylogenetic analysis in order to confirm the identity of the microorganisms present and determine the microbial diversity. The analysis demonstrated that the wastewater was populated by a bacterial consortium related to different members of Proteobacteria, Firmicutes, and Nitrisporae. The optimum removal values of the ICM achieved were 79 % for IOX and 73 % for DTZ, whereas 13 biotransformation products for IOX and 14 for DTZ were identified. Their determination was performed using ultra-performance liquid chromatography-tandem mass spectrometry. The toxicity of the treated effluent tested to Daphnia magna showed no statistical difference compared to that without the addition of the two ICM. The MBBR was proven to be a technology able to remove a significant percentage of the two ICM from urban wastewater without the formation of toxic biodegradation products. A large number of biotransformation products was found to be formed. Even though the amount of clones sequenced in this study does not reveal the entire bacterial diversity present, it provides an indication of the predominating phylotypes inhabiting the study site.

Superiority of solar Fenton oxidation over TiO2 photocatalysis for the degradation of trimethoprim in secondary treated effluents

The overall aim of this work was to examine the degradation of trimethoprim (TMP), which is an antibacterial agent, during the application of two advanced oxidation process (AOP) systems in secondary treated domestic effluents. The homogeneous solar Fenton process (hv/Fe(2+)/H2O2) and heterogeneous photocatalysis with titanium dioxide (TiO2) suspensions were tested. It was found that the degradation of TMP depends on several parameters such as the amount of iron salt and H2O2, concentration of TiO2, pH of solution, solar irradiation, temperature and initial substrate concentration. The optimum dosages of Fe(2+) and H2O2 for homogeneous ([Fe(2+)] = 5 mg L(-1), [H2O2] = 3.062 mmol L(-1)) and TiO2 ([TiO2] = 3 g L(-1)) for heterogeneous photocatalysis were established. The study indicated that the degradation of TMP during the solar Fenton process is described by a pseudo-first-order reaction and the substrate degradation during the heterogeneous photocatalysis by the Langmuir-Hinshelwood kinetics. The toxicity of the treated samples was evaluated using a Daphnia magna bioassay and was finally decreased by both processes. The results indicated that solar Fenton is more effective than the solar TiO2 process, yielding complete degradation of the examined substrate within 30 min of illumination and dissolved organic carbon (DOC) reduction of about 44% whereas the respective values for the TiO2 process were ∼70% degradation of TMP within 120 min of treatment and 13% DOC removal.

Solar photo-Fenton process on the abatement of antibiotics at a pilot scale: Degradation kinetics, ecotoxicity and phytotoxicity assessment and removal of antibiotic resistant enterococci

This work investigated the application of a solar driven advanced oxidation process (solar photo-Fenton), for the degradation of antibiotics at low concentration level (μg L(-1)) in secondary treated domestic effluents at a pilot-scale. The examined antibiotics were ofloxacin (OFX) and trimethoprim (TMP). A compound parabolic collector (CPC) pilot plant was used for the photocatalytic experiments. The process was mainly evaluated by a fast and reliable analytical method based on a UPLC-MS/MS system. Solar photo-Fenton process using low iron and hydrogen peroxide doses ([Fe(2+)](0) = 5 mg L(-1); [H(2)O(2)](0) = 75 mg L(-1)) was proved to be an efficient method for the elimination of these compounds with relatively high degradation rates. The photocatalytic degradation of OFX and TMP with the solar photo-Fenton process followed apparent first-order kinetics. A modification of the first-order kinetic expression was proposed and has been successfully used to explain the degradation kinetics of the compounds during the solar photo-Fenton treatment. The results demonstrated the capacity of the applied advanced process to reduce the initial wastewater toxicity against the examined plant species (Sorghum saccharatum, Lepidium sativum, Sinapis alba) and the water flea Daphnia magna. The phytotoxicity of the treated samples, expressed as root growth inhibition, was higher compared to that observed on the inhibition of seed germination. Enterococci, including those resistant to OFX and TMP, were completely eliminated at the end of the treatment. The total cost of the full scale unit for the treatment of 150 m(3) day(-1) of secondary wastewater effluent was found to be 0.85 € m(-3).

Human papillomavirus in the oral cavity of children and mode of delivery: a retrospective study

Our study aimed to examine the relationship between the presence of human papillomavirus (HPV) in the oral cavity of children and their mode of delivery. We investigated the presence of HPV infection in oral biopsies from 190 children (mean age: 7 years, range: 2–14 years) using the polymerase chain reaction (PCR) technique. Sixteen of 190 children (8.4%) were HPV-positive, with no significant difference between those delivered vaginally and by Caesarean section (C-section). The majority of the HPV-positive children were infected with type 16, whereas in the younger age group HPV type 11 was detected more frequently in children delivered by normal vaginal delivery (NVD) than by C-section. Our findings demonstrate the presence of HPV in the oral cavity of children delivered by both C-section as well as NVD. Further research on the possible modes of transmission of oral HPV infection will enable us to understand the natural history of HPV infection in childhood.

Development and validation of a UPLC-MS/MS method for studying the degradation kinetics of ofloxacin and trimethoprim during the application of solar Fenton process in secondary treated sewage

In this work, a sensitive and highly selective method was developed and validated to study the degradation of two antibiotic compounds (ofloxacin (OFX) and trimethoprim (TMP)), spiked in secondary treated domestic effluents, by the solar Fenton process. Three different chromatographic columns were tested on a ultra performance liquid chromatography-tandem mass spectrometric (UPLC-MS/MS) instrument working in the electrospray ionization (ESI) mode with twelve combinations of eluting solvents. Samples were enriched prior to the analysis by solid phase extraction using the hydrophilic-lipophilic balanced (HLB) reversed phase polymeric sorbent. The method was optimized and showed very good performance characteristics and was successfully applied to study the degradation kinetics of the selected antibiotics during the solar Fenton process applied. The degradation was found to follow a pseudo first-order kinetics for both compounds at initial concentration of 100 μg L(-1) with k = 0.0345 min(-1) for OFX and k = 0.0768 min(-1) for TMP, whereas the complete removal was achieved after 120 min of treatment for both compounds.

Solar Fenton and solar TiO2 catalytic treatment of ofloxacin in secondary treated effluents: evaluation of operational and kinetic parameters

Two different technical approaches based on advanced oxidation processes (AOPs), solar Fenton homogeneous photocatalysis (hv/Fe(2+)/H(2)O(2)) and heterogeneous photocatalysis with titanium dioxide (TiO(2)) suspensions were studied for the chemical degradation of the fluoroquinolone ofloxacin in secondary treated effluents. A bench-scale solar simulator in combination with an appropriate photochemical batch reactor was used to evaluate and select the optimal oxidation conditions of ofloxacin spiked in secondary treated domestic effluents. The concentration profile of the examined substrate during degradation was determined by UV/Vis spectrophotometry. Mineralization was monitored by measuring the dissolved organic carbon (DOC). The concentrations of Fe(2+) and H(2)O(2) were the key factors for the solar Fenton process, while the most important parameter of the heterogeneous photocatalysis was proved to be the catalyst loading. Kinetic analyses indicated that the photodegradation of ofloxacin can be described by a pseudo-first-order reaction. The rate constant (k) for the solar Fenton process was determined at different Fe(2+) and H(2)O(2) concentrations whereas the Langmuir-Hinshelwood (LH) kinetic expression was used to assess the kinetics of the heterogeneous photocatalytic process. The conversion of ofloxacin depends on several parameters based on the various experimental conditions, which were investigated. A Daphnia magna bioassay was used to evaluate the potential toxicity of the parent compound and its photo-oxidation by-products in different stages of oxidation. In the present study solar Fenton has been demonstrated to be more effective than the solar TiO(2) process, yielding complete degradation of the examined substrate and DOC reduction of about 50% in 30 min of the photocatalytic treatment.

Drugs degrading photocatalytically: Kinetics and mechanisms of ofloxacin and atenolol removal on titania suspensions

The conversion of the antibiotic ofloxacin and the beta-blocker atenolol by means of TiO(2) photocatalysis was investigated. Irradiation was provided by a UVA lamp at 3.37x10(-6)einstein/s photon flux, while emphasis was given on the effect of catalyst type and loading (50-1500mg/L), initial substrate concentration (5-20mg/L), initial pH (3-10) and the effect of H(2)O(2) (0.07-1.4mM) as an additional oxidant on substrate conversion and mineralization in various matrices (i.e. pure water, groundwater and treated municipal effluent). Conversion was assessed measuring sample absorbance at 288 and 224nm for ofloxacin and atenolol, respectively, while mineralization measuring the dissolved organic carbon. Degussa P25 TiO(2) was found to be more active than other TiO(2) samples for either substrate degradation, with ofloxacin being more reactive than atenolol. Conversion generally increased with increasing catalyst loading, decreasing initial substrate concentration and adding H(2)O(2), while the effect of solution pH was substrate-specific. Reaction rates, following a Langmuir-Hinshelwood kinetic expression, were maximized at a catalyst to substrate concentration ratio (w/w) of 50 and 15 for ofloxacin and atenolol, respectively, while higher ratios led to reduced efficiency. Likewise, high concentrations of H(2)O(2) had an adverse effect on reaction, presumably due to excessive oxidant scavenging radicals and other reactive species. The ecotoxicity of ofloxacin and atenolol to freshwater species Daphnia magna was found to increase with increasing substrate concentration (1-10mg/L) and exposure time (24-48h), with atenolol being more toxic than ofloxacin. Photocatalytic treatment eliminated nearly completely toxicity and this was more pronounced for atenolol.

Homogeneous oxidation of aqueous solutions of atrazine and fenitrothion through dark and photo-Fenton reactions

The homogeneous catalytic oxidation of atrazine and fenitrothion in single compound-containing solutions and in mixture, in pure water, was investigated in dark and light-driven oxidation systems using H(2)O(2) as the oxidant and Fe(II) as the catalyst. It was shown that the degradation during the dark Fenton reactions takes place during the first 2h and further prolongation of the reaction time does not lead to enhanced removals. The same holds true for the light-driven reactions. With the photo-Fenton reaction, fenitrothion was completely mineralized while the TOC contained in the atrazine solution was removed by 57%. Both compounds in their parent form were completely eliminated from the first 5 min of the oxidation both when being in the single-containing solutions and in their binary mixture. The oxidation of the TOC in the atrazine solution follows a two-stage second-order kinetic behavior which is attributed to the complex reaction pathways occurring during the oxidation while that of the TOC in the fenitrothion solutions follows a pseudo-first order degradation kinetic and that of binary mixture a two-stage degradation kinetics. The results obtained in this study, clearly indicate that the light-driven Fenton oxidation can be very efficient for the removal of atrazine and especially fenitrothion from polluted waters.

High-risk human papilloma viruses (HPVs) were not detected in the benign skin lesions of a small number of children

AIM

Human papilloma virus (HPV) can be transmitted via sexual as well as nonsexual routes. Recently, 'high-risk' HPVs were detected in the oral mucosa of children in whose cases there was no suspicion of sexual abuse. This implies that HPV 16 and 18 have additional nonsexual modes of transmission in childhood, such as vertical transmission and autoinoculation.

METHODS

Using polymerase chain reaction (PCR) assays, we examined the skin tissues of 12 children with benign skin lesions, aged between 6 and 13 years, for the presence of HPV.

RESULTS

Among 12 biopsy skin specimens, no 'high-risk' HPV DNA was detected. Specific PCRs for HPV DNA 16 and 18 were also negative.

CONCLUSION

This preliminary case-control study indicates the absence of mucosal 'high-risk' HPV types in the benign skin lesions of children.

Concurrent validity of augmented reality metrics applied to the fundamentals of laparoscopic surgery (FLS)

OBJECTIVE

Current skills assessment in the Fundamentals of Laparoscopic Surgery (FLS) program is labor intensive, requiring one proctor for every 1-2 subjects. The ProMIS Augmented Reality (AR) simulator (Haptica, Dublin IR) allows for objective assessment of physical tasks through instrument tracking technology. We hypothesized that the ProMIS metrics could differentiate between ability groups as well as standard FLS scoring with fewer personnel requirements

METHODS

We recruited 60 volunteer subjects. Subjects were stratified based on their laparoscopic surgical experience. Those who had performed more than 100 laparoscopic procedures were considered experienced (n = 8). Those with fewer than 10 laparoscopic procedures were considered novices (n = 44). The rest were intermediates (n = 8). All subjects performed up to five trials of the peg transfer task from FLS in the ProMIS simulator. The FLS score, instrument path length, and instrument smoothness assessment were generated for each trial.

RESULTS

For each of the five trials, experienced surgeons outperformed intermediates, who in turn outperformed novices. Statistically significant differences were seen between the groups across all trials for FLS score (p < 0.001), ProMIS path length (p < 0.001), and ProMIS smoothness (p < 0.001). When the FLS score was compared to the path length and smoothness metrics, a strong relationship between the scores was apparent for novices (r = 0.78, r = 0.94, p < 0.001) respectively), intermediates (r = 0.5, p = 0.2, r = 0.98, p < 0.001), and experienced surgeons (r = 0.86, p = 0.006, r = 0.99, p < 0.001).

CONCLUSIONS

The construct that the standard scoring of the FLS peg transfer task can discriminate between experienced, intermediate, and novice surgeons is validated. The same construct is valid when the task is assessed using the metrics of the ProMIS. The high correlation between these scores establishes the concurrent validity of the ProMIS metrics. The use of AR for objective assessment of FLS tasks could reduce the personnel requirements of assessing these skills while maintaining the objectivity.

Organochlorine and organophosphoric insecticides, herbicides and heavy metals residue in industrial wastewaters in Cyprus

Most industries in Cyprus possess permits either for disposal at central wastewater treatment plants (the treated effluent of which is reused or disposed into the sea), or discharge on soil, or reuse either for irrigation or groundwater recharge or discharge into the sea. A preliminary investigation undertaken by the University of Cyprus in regards to dangerous substances was the first step towards establishing a new licensing and monitoring system. Liquid-liquid extraction was used for the extraction of the selected pesticides from wastewaters. Gas chromatography with two different detection methods (ECD and FTD) was applied for the determination of 17 pesticides (12 organochlorine insecticides, 3 organophosphoric insecticides and 2 herbicides). In addition ICP and a mercury evaporation unit were used to determine the concentrations of heavy metals in the samples. The results revealed the presence of several priority substances in wastewaters, in most cases at concentrations well below the regulatory limits. Non-compliance was observed for a limited number of metals. Sixteen out of 17 organic substances that were monitored for 1-year period time were traced in different wastewater streams. What was found out is that there is a need to expand the analytical determinations and the monitoring to more wastewater streams and more priority substances, in order to safeguard the water resources in Cyprus.

Slow transition of energy transport in high-temperature plasmas

A new slow transition process for energy transport in magnetically confined plasmas is reported. The slow transition is characterized by the change between two metastable transport conditions characterized by a weak and a strong electron temperature (Te) dependence of normalized heat flux. These two branches are found to merge at the critical gradient. In metastable transport, the derivative of normalized heat flux to the Te gradient, [EQUATION: SEE TEXT], is positive, while it becomes negative during the transition phase. The time for the transition increases as the normalized Te gradient is increased and exceeds the transport time scale characterized by the global energy confinement time.

Study of plasma factors associated with neutrophil activation and lipid peroxidation in preeclampsia

Neutrophil activation occurs in women with preeclampsia and is resolved after delivery. The present study examined whether circulating factors in plasma of women with preeclampsia caused neutrophil activation and lipid peroxidation. Twenty-one women with proteinuric preeclampsia were matched for age and gestational age with 19 normal pregnant women. Plasma was collected from all subjects before delivery and at 6 weeks postpartum and incubated with autologous white-cell buffy coat collected at the postpartum visit. Neutrophil activation was assessed by level of CD11b and CD18 expression after incubation with autologous antepartum or postpartum plasma. Lipid peroxidation was assessed by measurement of F(2)-isoprostanes in plasma, plasma-white cell incubates, and urine. Neutrophil CD11b and CD18 expression was not differentially altered by incubation with plasma from either women with preeclampsia or normal pregnant women and was similar between groups when incubation was performed with plasma collected after delivery. In preeclampsia, plasma F(2)-isoprostanes were significantly increased before and after delivery compared with controls. Plasma F(2)-isoprostanes were increased 2-fold after incubation of plasma with buffy coat, but preeclamptic women had higher levels compared with those of controls when either pregnant or postpartum plasma was used. In pregnant preeclamptics, plasma F(2)-isoprostanes were positively correlated with lymphocyte count. Six weeks after delivery, plasma F(2)-isoprostanes in the preeclamptic women were significantly positively associated with lymphocyte count and cholesterol and negatively associated with albumin. In conclusion, the present study does not suggest that a stable circulating factor causes neutrophil activation in preeclampsia. However, lipid peroxidation is elevated before and after delivery in women with preeclampsia, which suggests that these women may have an underlying predisposition to increased oxidative stress that may be driven by or contribute to a persistent low-grade inflammatory response.

A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival

OBJECT

The extent of tumor resection that should be undertaken in patients with glioblastoma multiforme (GBM) remains controversial. The purpose of this study was to identify significant independent predictors of survival in these patients and to determine whether the extent of resection was associated with increased survival time.

METHODS

The authors retrospectively analyzed 416 consecutive patients with histologically proven GBM who underwent tumor resection at the authors' institution between June 1993 and June 1999. Volumetric data and other tumor characteristics identified on magnetic resonance (MR) imaging were collected prospectively.

CONCLUSIONS

Five independent predictors of survival were identified: age, Karnofsky Performance Scale (KPS) score, extent of resection, and the degree of necrosis and enhancement on preoperative MR imaging studies. A significant survival advantage was associated with resection of 98% or more of the tumor volume (median survival 13 months, 95% confidence interval [CI] 11.4-14.6 months), compared with 8.8 months (95% CI 7.4-10.2 months; p < 0.0001) for resections of less than 98%. Using an outcome scale ranging from 0 to 5 based on age, KPS score, and tumor necrosis on MR imaging, we observed significantly longer survival in patients with lower scores (1-3) who underwent aggressive resections, and a trend toward slightly longer survival was found in patients with higher scores (4-5). Gross-total tumor resection is associated with longer survival in patients with GBM, especially when other predictive variables are favorable.

Isotopic synovectomy with P-32 in paediatric patients with haemophilia

Isotopic synovectomy is being proposed as an option in the treatment of patients with haemophilic arthropathy. We present our experience with 11 paediatric patients who underwent 17, P-32 isotopic synovectomies for chronic haemophilic arthropathy. P-32 was injected into the joint per protocol, approved by the institutional review board. All our patients were male. Nine were factor VIII and two were factor IX deficient. The following joints were treated: ankle (n=10 procedures), elbow (n=5) and knee (n=2). The first procedure was performed on December 1993. None were human immunodeficiency virus positive. Mean age at the first procedure was 10.8 years (range, 5.2-15.2 years). Mean pretreatment joint clinical scores using the World Federation of Hemophilia guidelines for the ankle was 5.5 (SD +/- 2.3), the elbow 4.2 (+/-2.5), and knee 5.5 (+/-3.5); the corresponding post-treatment scores were 2.6 (+/-2.0), 1.4 (+/-0.5) and 2.5 (+/-3.5) respectively. Presynovectomy mean radiological scores using the Pettersson method were: ankle 1.8, elbow 1.8, and knee 1.5. A scoring system used in our centre for evaluating joints using magnetic resonance imaging (MRI) gave the following mean pretreatment scores: ankle 9.5, elbow 8.4, and knee 5.0. A marked decrease (an 80-100% decrease) in bleeding was seen in 13 of 17 procedures, and a moderate decrease (51-79% decrease) in two procedures, accounting for 85% reduction in bleeding into the target joints. The procedure was well tolerated and no untoward side-effects were noted as of May 1999, with a median follow-up of 40 months (range 19-65 months). None had any clinical evidence of cancer. Three patients had their joints retreated [elbow (one), ankle (two)]. These procedures were also well tolerated. In conclusion, in our study, isotopic synovectomy using P-32 appears to be feasible, safe and efficacious in the treatment of haemophilic arthropathy in paediatric patients who have been followed for a median of 40 months. As previously shown, MRI appears to give more detailed information about joint arthropathy than plain radiographs.

Does a predisposition to the metabolic syndrome sensitize women to develop pre-eclampsia?

OBJECTIVE

This study aimed to identify those factors in the non-pregnant state that distinguished women who developed pre-eclampsia from those who had normotensive pregnancies.

DESIGN AND SETTING

This was a retrospective analysis of anthropometry, blood pressure, biochemical and haematological variables in 62 women with pre-eclampsia and 84 normotensive pregnant women who took part in studies of the pathophysiology of pre-eclampsia. Pregnant volunteers were seen, after admission to hospital or in the outpatient clinic, and followed-up at 6 weeks and 6 months post-partum in the outpatient clinic or their home. Participants Proteinuric pre-eclampsia was defined as blood pressure > or = 140/90 mmHg with proteinuria of at least 300 mg/24 h after 20 weeks gestation, in women with no history of hypertension and whose blood pressure returned to normal levels by 6 months post-partum. Normotensive pregnancy was defined as blood pressure < 130/90 mmHg without proteinuria.

MAIN OUTCOME MEASURES

The primary outcome measures were blood pressure, body mass index (BMI), triglycerides, total cholesterol, low density lipoprotein (LDL) and high density lipoprotein cholesterol and markers of severity of pre-eclampsia.

RESULTS

Regardless of parity, women with pre-eclampsia had elevated BMI before, during and after pregnancy compared with women who had normotensive pregnancies. Triglycerides were significantly elevated in women who had pre-eclampsia both before and after delivery, while total and LDL cholesterol were elevated significantly at both visits after delivery. Systolic and diastolic blood pressure, which by definition were elevated antepartum in women with pre-eclampsia, remained higher at post-partum visits compared with women who had normotensive pregnancies. Women with pre-eclampsia reported a greatly increased frequency of both maternal hypertension and pre-eclampsia. Markers of severity of pre-eclampsia, which normalized by 6 months postpartum, included plasma creatinine, uric acid, albumin, endothelin 1 and urinary protein, 2,3, dinor-6-keto-PGF1alpha, blood platelet and neutrophil counts.

CONCLUSION

The relative elevation of blood pressure, BMI and lipids in the non-pregnant state are features of the metabolic syndrome and may be important sensitizing factors contributing to the pathogenesis of pre-eclampsia. A familial predisposition to pre-eclampsia may operate partly through these mechanisms.

p53 protein overexpression and gene mutation in mixed Müllerian tumors of the uterus

Alteration of the p53 tumor suppressor gene is associated with poor prognosis in many human cancer types. We examined the incidence and prognostic significance of p53 gene alterations in a series of uterine malignant mixed Müllerian tumors (MMT). Nuclear overexpression of p53 protein detected by immunohistochemistry (IHC) with the DO-7 antibody was observed in 12 of 24 (50%) tumors. Mutation of the p53 gene detected by single-strand conformation polymorphism (SSCP) of exons 5 to 8 was found in 11 of 24 (46%) tumors. The incidence of p53 alteration in uterine MMT was significantly higher than in several common epithelial tumor cell types previously investigated in our laboratory using identical techniques. However, unlike these tumors alteration of the p53 gene does not appear to be of prognostic importance in uterine MMT.

Obstetricians' knowledge and attitudes toward epidural analgesia in labour

A survey of all registered obstetrician/gynaecologists in Western Australia (n = 79) was conducted to obtain information regarding their level of knowledge about epidural analgesia (EA) in labour and its complications, their sources of information about EA, and their opinions regarding its role in labour and effect on progress of labour. Response rate was 68%. Most respondents had only received lectures about EA after specialist training and 20% did not achieve an adequate knowledge score. Those of less than five years' experience achieved significantly better scores. Over a third did not favour EA in labour until active labour was established, though 90% would recommend it by late first stage in those with a potentially complicated delivery. For women with cardiac or significant medical disease aggravated by labour, 18% would wait until the late first or second stage before suggesting EA. Seventy-seven per cent believed EA prolonged the second stage of labour, though opinion varied regarding EA effects on the duration and progress of first and third stages. Up to thirty minutes delay before epidural placement is acceptable to 87%. This survey suggests that there is both a demand and a need for greater education about EA in labour, particularly with respect to EA side-effects, complications and effects on labour, in the subgroup of obstetricians who have been in obstetric practice more than five years.

[Long-term monitoring of therapy-induced computerized tomographic cranial changes in children with acute lymphoblastic leukemia]

PURPOSE

Long-term follow-up of cranial CT scans of children with acute lymphoblastic leukemia and evaluation of the influence of chemo- and radiotherapy on the CCT changes.

PATIENTS AND METHODS

CCT scans of 68 children with non-B-ALL were analyzed retrospectively for signs of atrophy and changes in density. Patients were treated between 1981 and 1990 at the St. Anna Childrens Hospital Vienna according to the ALL-BFM protocols. Children were examined with CCT in defined periods from diagnosis until 3 years after cessation of treatment. As a control group served 69 patients with solid tumors who had not received corticoids or cranial irradiation.

RESULTS

At the initial examination 56% of the ALL-patients showed CCT changes, 85% of these patients had already received corticoids. In the control group only 20% of the CCTs were found abnormal (p = 0.005). In both groups an age-dependence was found: 64% of the ALL-patients under five years of age and 22% of the patients above 5 years had initial CCT changes (p = 0.001). In the control group 39% of the patients under five years of age and 7% of the older patients showed CCT changes at the beginning of treatment (p = 0.003). The highest incidence of abnormal CCT scans (68%) was seen during intensive chemo- and radiotherapy. Until the end of therapy the incidence of abnormal CCTs decreased to 32%. After cessation of antileukemic therapy 35% of the patients whose CNS-prophylaxis included cranial irradiation, and 12% of the non-irradiated patients had abnormal CCT scans.

CONCLUSION

Corticoids can cause reversible signs of cerebral atrophy. In the assessment of CCTs a physiological age-dependence of the volume of the CSF compartment has to be taken into consideration. The main reason for non-reversible CCT changes is the CNS- prophylaxis, above all the cranial irradiation, whereby younger children seem to be particular vulnerable.

The formation and persistence of carboplatin-DNA adducts in rats

The formation and persistence of platinum-DNA adducts were studied with immuno(cyto)chemical methods in male and female Sprague-Dawley rats treated with a single i.p. dose of carboplatin. Linear dose-effect curves were observed for kidney and liver with an immunocytochemical assay using NKI-A59 antiserum that recognizes intrastrand cross-links. With this method, no staining of the nuclei due to platinum-DNA damage could be observed in the spleen, testis, uterus, or ovary after administration of up to 80 mg/kg carboplatin. A homogeneous staining of the nuclei in the liver was observed. The nuclear staining in the kidney was somewhat more intense but less homogeneous, with small groups of intensely stained nuclei occasionally being seen in the outer cortex. An approximately 15 to 20-times lower dose of cisplatin than of carboplatin was needed to reach equal staining levels in the liver and kidney. Plateau staining levels in both tissues were reached at between approximately 8 and 48 h after administration of the carboplatin. This was followed by a significant reduction in the kidney samples, whereas the staining levels in the liver section seemed to be more persistent. No major difference was observed between male and female rats in the formation and removal of DNA damage in these tissues. The levels of the various DNA adducts were measured with a competitive ELISA in liver, kidney, spleen, testis, and combined ovary/uterus samples collected at 8 and 48 h after carboplatin administration. At both 8 and 48 h, the highest platination levels were observed in the kidney, followed--in decreasing order--by the liver, combined uterus and ovary samples, spleen, and testis. At 8 h after administration of carboplatin, the relative occurrence of the bifunctional adducts Pt-GG (34%), Pt-AG (27%), and G-Pt-G (32%), was similar in all tissues. The same held for the monoadducts that amounted to about 7% of the total DNA platination. These data indicate that in the first few hours after carboplatin treatment, no preference for the formation of Pt-GG adducts was observed, which confirms our earlier observations obtained with cultured cells. When the total DNA-platination levels (calculated from the sum of the adducts) seen at 8 and 48 h after treatment were compared, a substantial decrease in DNA platination was observed in the kidney (37%), liver (30%) and ovary/uterus (39%), whereas the repair levels in the testis (9%) and, probably, the spleen (18%) were substantially lower. In all tissues studied, only the relative occurrence of the Pt-GG adducts increased between 8 and 48 h, and as a result, at 48 h, after carboplatin administration the Pt-GG adduct was the major adduct persisting in the DNA samples.