CYTOTOXICITY AND BIOLOGICAL ACTIVITIES OF GEOPOPOLIS EXTRACT FROM THE STINGLESS BEE (Melipona scutellaris) IN CLINICAL ISOLATES OF Staphylococcus aureus

This work aims to evaluate the biological activities of the EEGP, in order to contribute with a natural therapeutic alternative, to face infections. The EEGP MIC tests showed antibacterial activity against two strains of S. aureus (LPM 63 and LPM 86), both at concentrations of 550 µg/mL. The MBC performed with the inhibition values showed that the EEGP has bacteriostatic activity in both strains. Biofilm inhibition rates exhibited an average value greater than 65% at the highest concentration. The EEGP antioxidant potential test showed good antioxidant activity (IC50) of 11.05 ± 1.55 µg/mL. In the cytotoxicity test against HaCat cells, after 24 hours, EEGP induced cell viability at the three tested concentrations (550 µg/mL: 81.68 ± 3.79%; 1100 µg/mL: 67.10 ± 3.76 % ;2200 µg/mL: 67.40 ± 1.86%). In view of the above, the safe use of EEGP from the brazilian northeast could be proven by the cytotoxicity test, and its use as an antioxidant and antibacterial agent has proven to be effective, as an alternative in combating oxidative stress and microorganisms such as S. aureus, which, through the spread and ongoing evolution of drug resistance, generates an active search for effective solutions.

The comparative efficacy and safety of biologics and small molecules for treating patients with ulcerative colitis in Portugal: a systematic literature review and network meta-analysis

OBJECTIVE

The use of biological drugs to treat ulcerative colitis (UC) represents a clear added value; nevertheless, many patients do not have a sustained response to these drugs. Small molecules were recently approved for the treatment of UC in Portugal. This network meta-analysis aimed to compare the efficacy and safety of the different therapies, including biological and small molecules, in patients prior exposed to biological treatment.

MATERIALS AND METHODS

A systematic review of the literature was performed on January 6, 2022, identifying all the relevant reports about the efficacy and safety of biologics (adalimumab, golimumab, infliximab, vedolizumab, ustekinumab) and small molecules (upadacitinib, filgotinib, tofacitinib) in the treatment of UC in Portugal. Network meta-analysis (NMA) was conducted using Bayesian Markov Chain Monte Carlo simulations. Results were presented in median Odds Ratio and Surface Under the Cumulative RAnking (SUCRA) score for each treatment.

RESULTS

Treatment of UC is divided into two phases: induction and maintenance. Upadacitinib 45 mg was the most efficacious therapy in achieving clinical remission and response and endoscopic improvement in the induction phase. Concerning the maintenance phase, upadacitinib 30 mg performed better than ustekinumab formulations in clinical remission and response, and endoscopic improvement. Regarding safety, there were no significant differences between all the drugs included in the analysis.

CONCLUSIONS

This network meta-analysis showed that upadacitinib reflects better efficacy compared to the available treatments for bio-exposed patients with moderate to severe UC. The safety profile is comparable to the other drugs.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

Protocol implementation for venous thromboembolism prophylaxis: a before-and-after study in medical and surgical patients

Objective

This study aimed to assess the adequacy of venous thromboembolism (VTE) prophylaxis prescription after a protocol implementation.

Methods

This was a before-and-after study conducted in a tertiary care hospital in Rio Grande do Sul, Southern Brazil. Medical and surgical inpatients aged 18 years or older were assessed for VTE risk and subsequently for thromboprophylaxis adequacy, according to their risk. The evaluations occurred before and after the protocol strategy implementation; it consisted of an online platform to access the protocol, a public posting of the protocol diagram, clinical alerts on the medical staff TV, e-mail alerts, and pop-up alerts on the computerized physician order entry system. The main outcome measure was the adequacy of VTE prophylaxis prescription according to the protocol.

Results

A total of 429 patients were evaluated for thromboprophylaxis adequacy (213 before and 216 after). The prevalence of adequacy increased from 54% to 63% (pre and post-intervention, respectively), and after adjustment for patient type and phase of the study, the prevalence ratio reached (PR)=1.20, 95% confidence interval (CI) 1.02-1.42.

Conclusion

The results showed that the overall appropriateness of thromboprophylaxis prescription was weakly improved. Despite these results, this study provides evidence to date a bunch of strategies for protocol implementations in private institutions in middle-income countries with an open medical staff, as there are few studies investigating these simple and pragmatic interventions.

Antimicrobial assessment of phage therapy using a porcine model of biofilm infection

Antibiotic resistant bacterial communities persist in many types of wounds, chronic wounds in particular, in the form of biofilms. Biofilm formation is a major cause of severe infections and the main reason for a negative treatment outcome and slow healing progression. Chronic wounds are a silent epidemic essentially affecting people with co-morbid conditions such as diabetes and obesity and elderly persons particularly those with movement limitations. The development of complementary and alternative effective strategies to antibiotics for the treatment of chronic wounds is highly desired. Phage therapy constitutes a very promising approach in the control of topical microbial populations. In this work newly isolated phages were tested for their efficacy to control bacterial species that predominate in chronic wounds. Phage effectiveness was studied on 24-h old biofilms formed in polystyrene microplates and in porcine skin explants using two treatment approaches: individual phage and a cocktail of phages against four main pathogens commonly isolated from chronic wounds. The two models produced variations in the surface colonization ability, assessed by viable bacterial counts and microscopy visualization after using peptide nucleic acid (PNA) or locked nucleic acid probes (LNA) and 2'-O-methyl (2'-OMe) in fluorescence in situ hybridization (FISH), and in the phage-host interactions. Phages alone and combined caused greater reductions in the number of viable cells when biofilms had been formed on porcine skins and with greater variations detected at 4 h and 24 h of sampling. These results suggest that porcine skin models should be preferentially used to assess the use of phages and phage cocktails intended for topical use in order to understand the fate, throughout treatment time, of the population when dealing with biofilm-related infections.

Cervical dilatation over time is a poor predictor of severe adverse birth outcomes: a diagnostic accuracy study

OBJECTIVE

To assess the accuracy of the World Health Organization (WHO) partograph alert line and other candidate predictors in the identification of women at risk of developing severe adverse birth outcomes.

DESIGN

A facility-based, multicentre, prospective cohort study.

SETTING

Thirteen maternity hospitals located in Nigeria and Uganda.

POPULATION

A total of 9995 women with spontaneous onset of labour presenting at cervical dilatation of ≤6 cm or undergoing induction of labour.

METHODS

Research assistants collected data on sociodemographic, anthropometric, obstetric, and medical characteristics of study participants at hospital admission, multiple assessments during labour, and interventions during labour and childbirth. The alert line and action line, intrapartum monitoring parameters, and customised labour curves were assessed using sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratio, and the J statistic.

OUTCOMES

Severe adverse birth outcomes.

RESULTS

The rate of severe adverse birth outcomes was 2.2% (223 women with severe adverse birth outcomes), the rate of augmentation of labour was 35.1% (3506 women), and the caesarean section rate was 13.2% (1323 women). Forty-nine percent of women in labour crossed the alert line (4163/8489). All reference labour curves had a diagnostic odds ratio ranging from 1.29 to 1.60. The J statistic was less than 10% for all reference curves.

CONCLUSIONS

Our findings suggest that labour is an extremely variable phenomenon, and the assessment of cervical dilatation over time is a poor predictor of severe adverse birth outcomes. The validity of a partograph alert line based on the 'one-centimetre per hour' rule should be re-evaluated.

FUNDING

Bill & Melinda Gates Foundation, United States Agency for International Development (USAID), UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), and WHO (A65879).

TWEETABLE ABSTRACT

The alert line in check: results from a WHO study.

Rapid Communication: Postmortem lesions and heart weights of in-transit-loss market pigs in Ontario

In-transit losses (ITL) of market-weight pigs are defined as pigs that die or pigs that become nonambulatory during loading and shipping from the farm to the abattoir. The low proportion of ITL in market pigs implies that individual pig factors may influence ITL, in addition to commonly considered environmental or transport factors. Postmortem examinations of in-transit-loss pigs ( = 85) from 1 Ontario, Canada, abattoir indicated the cause of death to be acute heart failure as a result of cardiac lesions that developed prior to transport. The presence of preexisting cardiac lesions may explain why no or only a few pigs die in a trailer even when the entire load is exposed to extreme temperatures and other common transport risk factors.

MHD marking using the MSE polarimeter optics in ILW JET plasmas

In this communication we propose a novel diagnostic technique, which uses the collection optics of the JET Motional Stark Effect (MSE) diagnostic, to perform polarimetry marking of observed MHD in high temperature plasma regimes. To introduce the technique, first we will present measurements of the coherence between MSE polarimeter, electron cyclotron emission, and Mirnov coil signals aiming to show the feasibility of the method. The next step consists of measuring the amplitude fluctuation of the raw MSE polarimeter signals, for each MSE channel, following carefully the MHD frequency on Mirnov coil data spectrograms. A variety of experimental examples in JET ITER-Like Wall (ILW) plasmas are presented, providing an adequate picture and interpretation for the MSE optics polarimeter technique.

A global reference for caesarean section rates (C-Model): a multicountry cross-sectional study

Objective

To generate a global reference for caesarean section (CS) rates at health facilities.

Design

Cross‐sectional study.

Setting

Health facilities from 43 countries.

Population/Sample

Thirty eight thousand three hundred and twenty‐four women giving birth from 22 countries for model building and 10 045 875 women giving birth from 43 countries for model testing.

Methods

We hypothesised that mathematical models could determine the relationship between clinical‐obstetric characteristics and CS. These models generated probabilities of CS that could be compared with the observed CS rates. We devised a three‐step approach to generate the global benchmark of CS rates at health facilities: creation of a multi‐country reference population, building mathematical models, and testing these models.

Main outcome measures

Area under the ROC curves, diagnostic odds ratio, expected CS rate, observed CS rate.

Results

According to the different versions of the model, areas under the ROC curves suggested a good discriminatory capacity of C‐Model, with summary estimates ranging from 0.832 to 0.844. The C‐Model was able to generate expected CS rates adjusted for the case‐mix of the obstetric population. We have also prepared an e‐calculator to facilitate use of C‐Model (www.who.int/reproductivehealth/publications/maternal_perinatal_health/c-model/en/).

Conclusions

This article describes the development of a global reference for CS rates. Based on maternal characteristics, this tool was able to generate an individualised expected CS rate for health facilities or groups of health facilities. With C‐Model, obstetric teams, health system managers, health facilities, health insurance companies, and governments can produce a customised reference CS rate for assessing use (and overuse) of CS.

Tweetable abstract

The C‐Model provides a customized benchmark for caesarean section rates in health facilities and systems.

The C‐Model provides a customized benchmark for caesarean section rates in health facilities and systems.

Walking Clinic in ambulatory surgery--A patient based concept: A Portuguese pioneer project

INTRODUCTION

Walking Clinic is an innovative, efficient and easily reproducible concept adapted to ambulatory surgery. It consists of a preoperative single day work-up, with a surgeon, an anesthetist and a nurse. The aim of this study was to evaluate patient satisfaction and its determinants.

METHODS

A survey was applied to 171 patients (101 of the Walking Clinic group and 70 not engaged in this new concept). Patient satisfaction was assessed evaluating five major questionnaire items: secretariat (quality of the information and support given), physical space (overall comfort and cleanliness), nurses and medical staff (willingness and expertise), and patients (waiting time until pre-operative consults and exams, waiting time until being scheduled for surgery, surgery day waiting time and postoperative pain control). Furthermore, overall assessment of the received treatment, and probability of patient recommending or returning to our ambulatory unit were also analyzed.

RESULTS

Walking Clinic group had overall better results in the five major questionnaire items assessed, with statistical significance, except for the physical space. It also showed better results regarding the sub-items postoperative pain control, waiting time until being scheduled for surgery and surgery day waiting time.

DISCUSSION

The results confirm better patient satisfaction with this new concept.

CONCLUSION

The Walking Clinic concept complements all the tenets of ambulatory surgery, in a more efficient manner.

Polyethylene glycol-400/H3PO2: an eco-friendly reductive system for the synthesis of selanylesters

An alternative green method was described for the synthesis of selanylesters by reactions of acyl chlorides with arylselenols, generated in situ by reaction of diaryl diselenides with hypophosphorous acid (H₃PO₂) using polyethylene glycol-400 (PEG-400) as the solvent.

[From fear of obesity to the obsesion with thinness; attitudes and diet]

OBJECTIVE

Investigate the relationship between body satisfaction, attitudes toward body and obesity, diet quality and emotional health in a group of university students. The initial hypothesis was that attitudes to thinness and fear of obesity induces weight control behaviours and lower diet quality.

METHODS

55 women of 19-25 years. The relationship between body mass index (BMI), diet quality (DQ), restrictive behaviours, eating attitudes (EDI-2, CIMEC) and attitudes toward obesity (AFA) was analyzed. Measures of health (SF-12) and emotional state (PNA) were also collected.

RESULTS

10.9% of the sample had a diet classified as "poor", 83.6% "needs improvement" and 5.5% followed a "good" diet. Most of participants were dissatisfied with their weight even when their BMI was located in the normal range. Weight-restrictive behaviors were associated with risk attitudes to eating disorders, but DQ did not discriminate among high and low BMI groups, nor was related to attitudes. The more was the anxiety (negative affect), the more were the body dissatisfaction and pressures on body image. Idealized social image of thinness was linked to the stigmatization of obesity, lower dietary diversity and more restrictive practices.

CONCLUSION

The results of this pilot study contributes to clarify the relationship between psychological and behavioral indices related to diet in university women students.

A real-time algorithm for the harmonic estimation and frequency tracking of dominant components in fusion plasma magnetic diagnostics

The real-time tracking of instantaneous quantities such as frequency, amplitude, and phase of components immerse in noisy signals has been a common problem in many scientific and engineering fields such as power systems and delivery, telecommunications, and acoustics for the past decades. In magnetically confined fusion research, extracting this sort of information from magnetic signals can be of valuable assistance in, for instance, feedback control of detrimental magnetohydrodynamic modes and disruption avoidance mechanisms by monitoring instability growth or anticipating mode-locking events. This work is focused on nonlinear Kalman filter based methods for tackling this problem. Similar methods have already proven their merits and have been successfully employed in this scientific domain in applications such as amplitude demodulation for the motional Stark effect diagnostic. In the course of this work, three approaches are described, compared, and discussed using magnetic signals from the Joint European Torus tokamak plasma discharges for benchmarking purposes.

The predictive power of r(0) in an epidemic probabilistic system

An important issue in theoretical epidemiology is the epidemic thresholdphenomenon, which specify the conditions for an epidemic to grow or die out.In standard (mean-field-like) compartmental models the concept of the basic reproductive number, R(0), has been systematically employed as apredictor for epidemic spread and as an analytical tool to study thethreshold conditions. Despite the importance of this quantity, there are nogeneral formulation of R(0) when one considers the spread of a disease ina generic finite population, involving, for instance, arbitrary topology ofinter-individual interactions and heterogeneous mixing of susceptible andimmune individuals. The goal of this work is to study this concept in ageneralized stochastic system described in terms of global and localvariables. In particular, the dependence of R(0) on the space ofparameters that define the model is investigated; it is found that near ofthe `classical' epidemic threshold transition the uncertainty about thestrength of the epidemic process still is significantly large. Theforecasting attributes of R(0) for a discrete finite system is discussedand generalized; in particular, it is shown that, for a discrete finitesystem, the pretentious predictive power of R(0) is significantlyreduced.

A protection system for the JET ITER-like wall based on imaging diagnostics

The new JET ITER-like wall (made of beryllium and tungsten) is more fragile than the former carbon fiber composite wall and requires active protection to prevent excessive heat loads on the plasma facing components (PFC). Analog CCD cameras operating in the near infrared wavelength are used to measure surface temperature of the PFCs. Region of interest (ROI) analysis is performed in real time and the maximum temperature measured in each ROI is sent to the vessel thermal map. The protection of the ITER-like wall system started in October 2011 and has already successfully led to a safe landing of the plasma when hot spots were observed on the Be main chamber PFCs. Divertor protection is more of a challenge due to dust deposits that often generate false hot spots. In this contribution we describe the camera, data capture and real time processing systems. We discuss the calibration strategy for the temperature measurements with cross validation with thermal IR cameras and bi-color pyrometers. Most importantly, we demonstrate that a protection system based on CCD cameras can work and show examples of hot spot detections that stop the plasma pulse. The limits of such a design and the associated constraints on the operations are also presented.

Using simplified models to communicate the importance of prevention, detection and preparedness before a disease outbreak

Frontline farm workers and veterinary-policy-makers are arguably in the best positions to influence prevention, detection, and preparedness-for-control of farm animal diseases. It is important that such individuals make biologically sound decisions concerning the daily management and regulation of the health of animals. Such decisions should be based on a good understanding of key principles of disease spread and control. This paper summarises these principles, as described in previous publications, into simple models. These models may be used to communicate concepts to readers who may not have time to study more complex models. These models illustrate the relationship between the development of new disease cases (from existing cases, i.e., the reproductive ratio R) and (i) the duration of the period during which existing cases are available as infectious, (ii) contact rates, (iii) transmission rates and (iv) susceptibility. Understanding these concepts through models has great utility, facilitating better decisions for disease prevention, detection and preparedness-for-control, before an outbreak becomes unmanageable. These basic concepts apply to all animal species, including humans.

Artificial intelligence techniques: predicting necessity for biopsy in renal transplant recipients suspected of acute cellular rejection or nephrotoxicity

The gold standard for nephrotoxicity and acute cellular rejection (ACR) is a biopsy, an invasive and expensive procedure. More efficient strategies to screen patients for biopsy are important from the clinical and financial points of view. The aim of this study was to evaluate various artificial intelligence techniques to screen for the need for a biopsy among patients suspected of nephrotoxicity or ACR during the first year after renal transplantation. We used classifiers like artificial neural networks (ANN), support vector machines (SVM), and Bayesian inference (BI) to indicate if the clinical course of the event suggestive of the need for a biopsy. Each classifier was evaluated by values of sensitivity and area under the ROC curve (AUC) for each of the classifiers. The technique that showed the best sensitivity value as an indicator for biopsy was SVM with an AUC of 0.79 and an accuracy rate of 79.86%. The results were better than those described in previous works. The accuracy for an indication of biopsy screening was efficient enough to become useful in clinical practice.

[Grade of knowledge about the advance directive document by the chronic patient who comes to the emergency department]

OBJECTIVE

To evaluate the patient's and their caregiver's knowledge of the advance directive document (ADD) in patients with chronic diseases who come to the emergency department due to decompensation and their caregivers. To discover the patient's willingness and associated factors to draw up an ADD.

MATERIAL AND METHODS

A descriptive cohort study including patients with an acutely decompensated chronic evolving disease attending the ED medicine section at an urban tertiary teaching hospital was performed. The patients' demographic and clinical variables were recorded. After control of their symptoms, an anonymous structured oral interview was also administered. Dependent variables included were previous knowledge of the ADD, and the patient willingness to draw it up. The relationship among independent and dependent variables was analyzed.

RESULTS

A total of 380 people (190 patients and 190 carers) were analyzed. Compared with patients, carers were more frequently women (76% vs 42%, p<0.001), younger (58+/-15 vs 73+/-12, p<0.001), and had a better knowledge of the disease (88% vs 74%, p<0.001) and of the ADD (28% vs 16%, p<0.001). Only 5% of the patients had received ADD information from their physician. The only factor associated with the patients' previous knowledge of the ADD was to have completed at least secondary school (p<0.05). Forty-six percent of patients were favorable to the drawing up of an ADD. The only variable associated with such a willingness was to be 70 or younger (p<0.05). Eighty-eight percent of the patients were in favor of the distribution of information leaflets in the ED.

CONCLUSIONS

There is poor patient and carer knowledge regarding the ADD among patients with chronic diseases. Nonetheless, almost half of patients would be willing to draw up an ADD. EDs can contribute to improve the information about it.

[Therapeutic implication of the azygos vein lobe in patients with pulmonary adenocarcinoma]

The azygos vein lobe is an anatomic variant reported in 0.1 to 8% of the population and results from an anomalous development of the right lung upper lobe. In the majority of the cases, clinical implications are lacking. Since the original description of a tumor of the azygos vein lobe, in 1969, only two more cases have been reported in the literature. Behind its rarity, a tumor with such location may pose some management implications. The authors report the clinical case of a 56 years old smoker man, in whom a chest x-rays revealed a poorly defined image in the upper lobe of the right lung. Complementary studies and evaluation allowed the diagnosis of pulmonary adenocarcinoma, adherent to the azygos vein, in a patient with azygos vein lobe. The authors emphasize the fact that despite the origin of the tumor being the lung, the presence of this anatomic variant of the azygos vein played a determinant role in the surgical approach.

Real-time data processing and magnetic field pitch angle estimation of the JET motional Stark effect diagnostic based on Kalman filtering

A novel technique for the real-time measurement of the magnetic field pitch angle in JET discharges using the motional Stark effect diagnostic is presented. Kalman filtering techniques are adopted to estimate the amplitude of the avalanche photodiode signals' harmonics that are relevant for the pitch angle calculation. The proposed technique {for extended technical details of the generic algorithm see [R. Coelho and D. Alves, IEEE Trans. Plasma Sci. 37, 164 (2009)]} is shown to be much more robust and provides less noisy estimates than an equivalent lock-in amplifier scheme, in particular when dealing with edge localized modes.

Real-time estimation of the poloidal wavenumber of ISTTOK tokamak magnetic fluctuations

The successful control of a fusion plasma discharge relies on the continuous improvement of existing diagnostics and on the development of new ones based on innovative concepts. It is equally important to provide efficient numerical tools capable of extracting, in real time, the most important physical quantities emerging from the collected data. This encompasses, for instance, the determination of the wavenumber and amplitude tracking of plasma instabilities, a necessary ingredient for establishing in real time the type of feedback control stabilization scheme to be used. In this paper, the characterization of the wavenumber spectra of unstable modes observed in ISTTOK plasma discharges is addressed using a set of two poloidal arrays of magnetic coils (Mirnov coils). In particular, the prospect for the estimation of the poloidal wavenumber in real time using recursive filtering techniques is investigated. It is shown that, in contrast with typical cross-spectrum analysis, where a large dataset is required to estimate the wavenumbers, with this innovative technique, the wavenumber spectra may be obtained in faster time scales.

Observation of plasma density fluctuations by a heavy ion beam probe diagnostic with multiple cell array detector on the tokamak ISTTOK

The heavy ion beam probe (HIBP) diagnostic permits the measurements of electron density and plasma potential as well as their fluctuations. The use of a multiple cell array detector (MCAD) spreads the HIBP capabilities to make simultaneous measurements across the plasma column. Two sets of current-to-voltage converters with respective bandwidths of 400 kHz and 4 MHz have been tested. This upgrade of the MCAD electronics has allowed the observation of quasicoherent fluctuations in bulk plasma at frequencies between 100 and 200 kHz. The localization and frequency of bulk plasma fluctuations correlate with the magnetohydranamic activity of the plasma.

Group selection models in prebiotic evolution

The evolution of enzyme production is studied analytically using ideas of the group selection theory for the evolution of altruistic behavior. In particular, we argue that the mathematical formulation of Wilson's structured deme model [The Evolution of Populations and Communities (Benjamin-Cumings, Menlo Park, 1980)] is a mean-field approach in which the actual environment that a particular individual experiences is replaced by an average environment. That formalism is further developed so as to avoid the mean-field approximation and then applied to the problem of enzyme production in the prebiotic context, where the enzyme producer molecules play the altruists role while the molecules that benefit from the catalyst without paying its production cost play the nonaltruists role. The effects of synergism (i.e., division of labor) as well as of mutations are also considered and the results of the equilibrium analysis are summarized in phase diagrams showing the regions of the space of parameters where the altruistic, nonaltruistic, and the coexistence regimes are stable. In general, those regions are delimitated by discontinuous transition lines which end at critical points.

[Early infantile ceroid lipofuscinosis -- role of nuclear magnetic resonance in the diagnosis]

The authors report a case of Infantile Neuronal Ceroid Lipofuscinosis and emphasize the role of MRI in the diagnosis and follow-up of the disease describing a severe progressive cerebral atrophy. Clinical findings and laboratory data were reviewed and the importance of palmitoyl-protein thiosterase activity is described.

[What do patients with head injuries remember about their time of hospitalization?]

Traumatic brain injured (TBI) patients with different trauma severity were analyzed about their recollection concerning the period of hospitalization. The study was carried out in the Head Injury Outpatient Clinic at the Central Institute of the FMUSP Hospital including 45 conscious patients able to sustain an interview. Most patients were male, young adults with the major cause of trauma such as traffic accidents and falls. Most patients (86%) reported unconsciousness state of different time duration in their hospitalization period and were unable to remember anything related to that period. The predominant recollection reported by the patients who never had consciousness decreased after the trauma and that ones who had it but awoke during the hospitalization were: seeing, feeling, hearing, and reacting either to sounds and procedures.

Application of a DNA hybridization-hydrophobic-grid membrane filter method for detection and isolation of verotoxigenic escherichia coli

Verotoxigenic Escherichia coli (VTEC) strains were isolated from food and animal fecal samples by using PCR to screen for the presence of VTEC after broth enrichment and then filtering VTEC-positive cultures through hydrophobic-grid membrane filters (HGMFs) which were incubated on MacConkey agar. The filters were probed with a digoxigenin-labeled PCR product generated by amplification of a conserved verotoxin gene sequence. Replication of the growth on filters allowed probe-positive colonies to be picked. When ground beef samples were inoculated with VTEC strains, 100% of the strains were recovered, and the detection limit was 0.1 CFU per g. Similar results were obtained with seven types of artificially contaminated vegetables. A survey of 32 packages of vegetables and 23 samples of apple cider obtained at the retail level did not reveal the presence of VTEC. However, the intestinal fecal contents of a moose, 1 of 35 wild mammals and birds examined, contained E. coli O157:H7. The DNA hybridization-HGMF method was also used in a prevalence survey of 327 raw and 744 ready-to-eat products; VTEC strains were recovered from 4.9% of the raw products and 0.7% of the ready-to-eat products. No serotype O157:H7 strains were detected. This method is particularly suited for surveys in which low numbers of VTEC-positive samples are expected and isolates are required.

Bupivacaine augments intrathecal fentanyl for labor analgesia

BACKGROUND

fentanyl has been shown to be an effective analgesic for labor; this study investigated the analgesic effect of low-dose bpivacaine added to intrathecal fentanyl for labor analgesia

METHODS

Ninety parturients in active labor who requested regional analgesia were randomized to receive an intrathecal injection of either fentanyl, 25 microg; bupivacaine, 1.25 mg, with fentanyl, 25 microg; or bupivacaine, 2.5 mg, with fentanyl, 25 microg, as part of a combined spinal-epidural technique. Visual analog pain scores were recorded before and at intervals after injection until the patient requested further analgesia. Maternal blood pressure and fetal heart rate were recorded before and at intervals after injection. Lower-extremity muscle strength was tested before and 30 min after injection; anesthetic level to cold sensation and the presence and severity of pruritus were recorded.

RESULTS

Duration of analgesia was longer in the group receiving bupivacaine, 2.5 mg, and fentanyl, 25 microg, than the group receiving plain fentanyl (108 vs. 92 min; P < 0.05). Onset of analgesia was faster in both groups receiving bupivacaine compared with plain fentanyl (P < 0.05). No differences in muscle strength after injection were found in any group, although anesthetic levels to cold were documented in all patients in the bupivacaine groups, and 21 of 30 in the plain fentanyl group. Baseline fetal heart rates did not change after injection in any group, and maternal blood pressure was unchanged.

CONCLUSIONS

The addition of 2.5 mg isobaric bupivacaine to 25 microg fentanyl for intrathecal labor analgesia modestly increases duration and speeds onset of analgesia compared with plain intrathecal fentanyl.

The incidence of fetal heart rate changes after intrathecal fentanyl labor analgesia

We performed a retrospective review to compare the incidence of new fetal heart rate abnormalities after institution of either intrathecal fentanyl or conventional epidural labor analgesia. In chronological order, the first 100 parturients in active labor who had received epidural analgesia and had recorded fetal heart rate (FHR) traces for 30 min before and after injection were identified, as were the first 100 parturients who had received intrathecal fentanyl analgesia. A perinatologist blinded to the anesthetic technique evaluated each recording and identified any changes in the FHR between the before and after tracings. The incidence of new "negative" (implying worsened fetal status) changes was 6% in the epidural group and 12% in the intrathecal group (P > 0.05, not significant). There were no differences in incidence or degree of blood pressure change, need for cesarean delivery, neonatal outcome, parity, or oxytocin use. No parturient required urgent or emergent cesarean delivery, and all changes resolved within the 30-min observation period. A much larger study would be required to determine whether this six percentage point difference represents a true difference between groups, and its clinical significance.

IMPLICATIONS

We compared the incidence of fetal heart rate changes after two techniques of labor analgesia. Both techniques were associated with a low (6%-12%) incidence of changes, but a much larger series would be required to determine whether this represents a true difference. No difference in neonatal outcome was found.

Dose-response relationship of intrathecal morphine for postcesarean analgesia

BACKGROUND

This series investigated the quality of analgesia and the incidence and severity of side effects of intrathecal morphine for post-cesarean analgesia administered over a dose range of 0.0-0.5 mg.

METHODS

ONE hundred eight term parturients undergoing cesarean delivery at term and given spinal anesthesia were randomized to receive a single dose of intrathecal morphine (0.0, 0.025, 0.05, 0.075, 0.1, 0.2, 0.3, 0.4, or 0.5 mg). A patient-controlled analgesia (PCA) device provided free access to additional analgesics. PCA morphine use, incidence and severity of side effects, and need for treatment interventions were recorded for 24 h. Data were analyzed with analysis of variance and linear regression analysis for trends among groups.

RESULTS

Patient-controlled analgesia use differed significantly between groups; PCA use was higher in the control group than in groups receiving 0.075, 0.1, 0.3, 0.4, or 0.5 mg. Twenty-four-hour PCA morphine use was 45.7 mg lower (95% CI, 4.8-86.6 mg lower) in the 0.075-mg group than the control group. There was no difference in PCA morphine use between the 0.075- and 0.5-mg groups (95% CI, 36.8 mg lower to 45.0 mg higher); despite a fivefold increase in intrathecal morphine dose, PCA morphine use remained constant. There was no difference between control and treatment groups or among treatment groups with respect to nausea and vomiting. Pruritus and the need for treatment interventions increased in direct proportion to the dose of intrathecal morphine (linear regression, P = 0.001 and P = 0.0002, respectively).

CONCLUSIONS

These data indicate there is little justification for use of more than 0.1 mg for post-cesarean analgesia. For optimal analgesia, augmentation [corrected] of intrathecal morphine with systemic opioids may be necessary.