Impact of surrogate outcomes in randomized controlled trials for shoulder rotator cuff tears

PURPOSE

Surrogate outcomes are clinical endpoints that are used as substitutes for direct measures of how a patient feels, functions, or survives. The present study aims to analyze the impact of surrogate outcomes on the results of randomized controlled trials on shoulder rotator cuff tears disorders.

METHODS

Randomized controlled trials (RCTs) related to rotator cuff tear conditions published up until 2021 were retrieved from the PubMed and ACCESSSS databases. The primary outcome of the article was considered a surrogate outcome when the authors used radiological, physiologic, or functional variables. The result of the article was considered positive when results supported the intervention based on the trial's primary outcome. We recorded the sample size, the mean follow-up, and the type of funding. Statistical significance was set at p < 0.05.

RESULTS

A total of 112 papers were included in the analysis. The mean sample size was 87.6 patients; mean follow-up period was 25.97 months. Thirty-six out of 112 RCTs used a surrogate outcome as a primary endpoint. More than half of papers using surrogate outcomes reported a positive finding (20 out of 36), while 10 out of 71 RCTs using patient-centered outcomes favored the intervention (14.08%, p < 0.001) [RR = 3.94 (95% CI 2.07-7.51)]. The mean sample size was smaller in trials using surrogate endpoints (75.11 vs 92.35 patients, respectively, p = 0.049), while the follow-up was shorter (14.12 m vs. 31.9 m, p < 0.001). Approximately 25% of the papers that reported surrogate endpoints (22.58%) were industry-funded projects.

CONCLUSIONS

The substitution of surrogate endpoints for patient-important outcomes in shoulder rotator cuff trials quadruplicates the chances of obtaining a favorable result that favors the analyzed intervention.

Surgical treatment of proximal humeral fractures with the transosseous suture fixation

BACKGROUND

The surgical treatment of displaced proximal humeral fractures is commonly affected by implant-related complications. We evaluated the functional and radiographic results of transosseous suture fixation in a series of displaced proximal humeral fractures (PHF).

METHODS

Sixty-four patients were retrospectively classified by age, sex, and the Neer fracture classification. Two-part greater tuberosity (2pGT) displaced fractures and 3-part (varus and valgus) and 4-part valgus impacted fractures were managed with fragment reduction and transosseous suture fixation. Patients with minimum follow-up of 24 months and assessed with the Constant-Murley score (CMS) were included. Radiological and medical complications, as well as reinterventions were also recorded.

RESULTS

Forty-six patients with a mean follow-up of 58 (24-132) and a mean age of 58 years old were analyzed. Patients with 2pGT (n = 10) fractures had a CMS of 76 points (59-89); patients with 3-part fractures (n = 22) had a score of 67 points (13-91); and those with 4-part fractures (n = 14) had a score of 64 (24-76) points. The overall complication rate was 6 out of 46, and 4 patients required reintervention for different reasons. Patients presenting with 3-part varus fractures had significantly lower functional outcomes scores (p = 0.007). Humeral head osteonecrosis was present in 9 patients and significantly affected the functional outcomes (p < 0.05). However, only three out of nine patients with osteonecrosis required subsequent surgery at the indicated follow-up.

CONCLUSIONS

The fracture reduction and transosseous fixation technique represents a safe technique with low complication and reintervention rates. The presence of humeral head necrosis did not lead to subsequent surgical intervention because no hardware had protruded.

LEVEL OF EVIDENCE

Level IV, retrospective study.

Knowledge at palm of hand: supported self-management and audiovisual content School of Patients DF

Background

The region of practice of the School of Patients DF is vulnerable at health literacy and income. Audiovisual information is strategic in primary care for its great power of reach and information retention.

Objectives

Since 2016 videos of health education have been produced, initially technical on the Planification for hypertension and diabetes. After the focus switched to popular health education, aiming at improving communication between health professionals and patients on chronic diseases and health promotion, including testimonials. The is potential for video exhibition in qualified waiting rooms and forwarding in social network.

Results

There are videos from diabetes, hypertension, obesity to dengue, pre-natal care and other APS themes, which follow printed orientation with pertinent links. There are graduate and post-graduate studies in course for optimizing audio-visual content for support and capacitation of the family caregivers, especially regarding the facilitated visual model of prescription (“Illustrated Prescription”). Data until 2020-January: YOUTUBE 3146 views, 118,6 hours of exhibition, 50 videos. FACEBOOK page with a reach of 369.248 views. INSTAGRAM 10.119 followers, 193 posts, 37.800 likes and 1003 commentaries.

Conclusions

Modifications in lifestyle and adherence to medication are fundamental for treatment, and videos are promising for health promotion and selfcare capacitation. There is potential for reducing the hierarchy barriers (testimonials). The shared construction of knowledge and its dissemination makes the patient active part in community diffusion of information.

Key messages

Health professionals have a vital role as educators, including for social online networks. Patients have a protagonist role in their treatment, as well as multipliers of knowledge at their community.

Each reading is a seed – prescribing books and links at the School of Patients DF

Issue

The fragile reading habit is a common feature in Brazil, having wide negative impacts in Health and Education areas. Itapoã-DF presents important social vulnerabilities with challenges about the reading habit. Stimulating individual reading from early childhood to elderly, associated with positive reinforcement during doctor appointments, is a way to provide health education.

Description of the problem

In October of 2016, the “Prescreva um Livro” (prescribe a book) project began from childcare doctor appointments, by encouraging children with books and the borrowing of material, in addition to positive reinforcement in consultations. In 2019, book references for adults were incorporated into the chapters of the School of Patients DF - especially for prenatal care and chronic conditions such as hypertension. It highlights the potencial of primary care as point of encouragement for reading and community support, reading coordinator.

Results

The Reading stimulus brought, since 2016, a change in the relationship of young people with the service, making it a space of curiosity and fun instead of “fear of needles”. The importance of primary care in constructive stimuli to reading is reinforced even more considering the difficulties of education in Brazil.

Lessons

Initially focused on children and adolescents, the practice was incorporated into the health education strategy of the School of Patients, grouping prevalent comorbidities and printed guidelines delivered at each consultation. The participating children reported the stories they had read at subsequent visits. This feedback reinforces the influence that the primary care environment can have in several areas of the user's life, including reading

Key messages

Waiting rooms and home visits are opportunities to exchange information also of a literary nature. The stimulus to reading is vital for the full exercise of citizenship, and health services can be a reference for reading.

Case simulations for permanent education in Primary Care – School of Patients DF

Background

In scenarios of vulnerability that include triple charge of diseases, permanent education in Primary Care and university is fundamental to allow greater access, efficiency and safety for users and health teams.

Objectives

The School of Patients DF was created as a tool for popular and technical health education, including case simulations for practice. It consists of standard technical content (Chapters), categorized by conditions and diseases, shared by Google Drive and used primarily in selected primary care units of Brazil's capital city.

Results

Technical simulations are performed in pairs, 1 participant acts as “patient” with script in hand (topics of the training) while the other acts as “health professional” as if in a regular visit. Simulations are timed for 10 minutes for consultation and 5 for feedback, boosting learning. Contents are based on guidelines and protocols from the Ministry of Health, Secretary of Health and Brazilian Community and Family Medicine Society. Since 2016 there have been realized over 1400 simulations, including weekly classes for last term medical students at the capital city federal university.

Conclusions

Simulations optimize the time necessary for permanent education (15 minutes blocks), avoiding limiting access for triage and consults, allowing smaller groups to train with greater focus and independent of computers or projectors.

Key messages

Standardizing training and practice bring benefit to patient care and safety. Simulations with structured physical examination are important both for professional as well as students.

AB1180 THE EVOLUTION OF AN FLS IN SEARCH OF EXCELLENCE: THE EXPERIENCE OF GRAN CANARIA

Background:

The implementation of an FLS in the Spanish public health system is not an easy task since there are no official plans for the incorporation of personnel dedicated to the unit

Objectives:

To expose the consolidation and improvement of an FLS after its implementation as well as the problems that have arisen over time.

Methods:

The health program for secondary fracture prevention was implemented in 2012. Initially worked with the same staff assigned to the Rheumatology service, since 2016 we have a part-time support nurse. Patients are identified from the emergency registry and, more recently, from patients admitted for hip fracture and treated in a monographic osteoporosis clinic. The baseline visit consists of consultation with the nurse, DXA and bone metabolism analytics. Falling patients are referred to a fall prevention school. Most patients are referred to their primary care physician to start a treatment.

Results:

Of the 2,416 patients attended the baseline visit, 30% were forearm fractures, 27% hip, 20% humerus, 10% spine and 11% other fractures. In comparison to 2012, in 2019 the monthly average of patients has doubled, increased the number of hip and spine fractures, and increased the percentage of captured patients (Table). In spite of consolidating the unit, getting a support nurse for the admitted patients and establishing a solid alliance with primary care, it is pending the involvement of Primary Care Nurses and start first prescription at the hospital.

Table.

Comparison of the first year with the last year of implementation of our FLS.

20122019Mean monthly number of fractures, N2242Type of fracture: forearm/hip/spine, %37/20/628/40/11Captured patients of elegible, %5777Delay in weeks until first visit to FLS, median1412Patient origin: emergency list/inpatient/outpatient, %100/0/059/31/9DXA performed, %10061Referral to fall prevention school, %026Criteria to start a treatment, %6790*Referral to the osteoporosis clinic, %377

*We apply the 2019 recommendations of the Spanish Society of Rheumatology

Conclusion:

We present the achievements made by our FLS along 8 years and the difficulties within the Spanish public health system.

Disclosure of Interests:

Antonio Naranjo Grant/research support from: amgen, Consultant of: UCB, Speakers bureau: AMGEN, Amparo Molina Speakers bureau: AMGEN, STADA, Cristina Sepúlveda: None declared, Candelaria Torres: None declared, Fabiola Santana: None declared, Francisco Rubiño: None declared, Rubén López: None declared, Soledad Ojeda Speakers bureau: AMGEN, LILLY, GEBRO

Reverse shoulder arthroplasty for acute proximal humeral fractures: Postoperative complications at 7 days, 90 days and 1 year

BACKGROUND

In the last decade, the biomechanics of reverse shoulder arthroplasty (RSA) for proximal humeral fractures in the elderly have led to more functional outcomes and greater pain relief. However, its use has also introduced a significant rate of complications. The purpose of this study is to assess the complication rate of RSA in these cases as well as the relationship to ASA score and basic disease history.

METHODS

We evaluate patients who underwent RSA due to acute proximal humeral fractures at three hospitals from 2010 to 2016. We analyze previous disease and anticoagulant treatment, American Society of Anesthesiologists (ASA) Physical Status Classification, and the transfusion rate to correlate these factors with major and minor postoperative complications at 7, 90, and 365 days.

RESULTS

We include 103 patients (104 shoulders) over 65 years of age. Mean age is 77.31 years (62-91), 20 of which are male. The overall rate of complications is 25%, with 17.4% minor and 7.6% major complications. We observe a statistically significant relationship between a higher ASA score (3,4) and major complication at 90 days (p = 0.024) and a trend (p = 0.072) towards a higher ASA score with minor complication during the first week. Rheumatoid disease significantly increases major complications at 90 days (p = 0.037). The transfusion rate is 11.5%.

CONCLUSIONS

The overall major complication rate of RSA for acute fractures is low in the elderly population. Although, the patient's history (e.g. previous rheumatoid pathology, neurological diseases, or anticoagulant treatment) as well as their ASA score should be considered before RSA surgery. The higher the ASA score and the presence of rheumatoid disease, leads to a higher rate of major complications during the first 90 days after surgery.

LEVEL OF EVIDENCE

Level IV; Case series; Treatment study.

Retaining or excising the supraspinatus tendon in complex proximal humeral fractures treated with reverse prosthesis: a biomechanical analysis in two different designs

PURPOSE

We aimed to biomechanically evaluate the effect of the supraspinatus tendon on tuberosity stability using two different reverse shoulder arthroplasty (RSA) models for complex proximal humeral fractures (PHFs).

METHODS

Four-part proximal humeral fractures were simulated in 20 cadaveric shoulders. Two different RSA designs were implemented: a glenosphere-medialized model and a glenosphere-lateralized model. Tuberosities were reconstructed, and displacement of bony fragments was measured (mm) by placing three sensors: in the humeral diaphysis (D), in the greater tuberosity (GT), and in the lesser tuberosity (LT). Axial forces were induced and measured in Newton (N). The test was performed twice in each specimen, with and without the supraspinatus tendon. The regression line (RL) was measured in mm/N.

RESULTS

In the medialized model, the GT-D displacement was greater in the supraspinatus preserving model than that in the tendon excision model (p < 0.001), as well as for the LT-D displacement (p < 0.001). In the lateralized model, GT-D displacement and GT-LT distance were greater in the preserving model than that in the excision model (p < 0.001, p = 0.04).

CONCLUSION

The supraspinatus tendon resection leads to a more biomechanically stable tuberosity construct when performing RSA for PHFs, while the rest of the rotator cuff tendons (infraspinatus and teres minor) are retained in the greater tuberosity.

LEVEL OF EVIDENCE

Basic science study. Cadaveric study.

Do we publish what we preach? Analysis of the European Society for Surgery of the Shoulder and Elbow Congress publication rates

Background

Scientific congresses have become the most expedient method to communicate novel findings on any research topic. However, an important question is whether this information will be published in peer-reviewed journals. Our aim was to determine the publication rate of the abstracts presented at the European Society for Surgery of the Shoulder and Elbow Congress and analyze factors that may influence this rate.

Methods

A total of 398 abstracts reported in the Abstract Book from the 2008 European Society for Surgery of the Shoulder and Elbow Congress were examined and categorized by oral and poster presentations, topic, and the number of authors listed. A search in PubMed and Google Scholar for subsequent peer-reviewed publications was performed in September 2015. The time to publication after the meeting had been held; the type of journal and its impact factor at the time to publication were recorded for those abstracts that reached peer-reviewed journal publication.

Results

The overall publication rate for the 2008 European Society for Surgery of the Shoulder and Elbow oral and poster presentations was 45.20% after 7 years. The mean time to publication was 18.53 months, and the mean impact factor value was 2.32. Oral presentations were significantly better represented in journals than posters (64.40 vs. 35.40%, p < 0.001). Abstracts with a greater number of authors listed had better publication rates (p < 0.001).

Conclusion

Less than half of the oral presentations and posters at the 21st European Society for Surgery of the Shoulder and Elbow Congress were published in peer-reviewed journals. Oral presentations with a higher number of authors had an increased likelihood of being published.

Forgetting of long-term memory requires activation of NMDA receptors, L-type voltage-dependent Ca2+ channels, and calcineurin

In the past decades, the cellular and molecular mechanisms underlying memory consolidation, reconsolidation, and extinction have been well characterized. However, the neurobiological underpinnings of forgetting processes remain to be elucidated. Here we used behavioral, pharmacological and electrophysiological approaches to explore mechanisms controlling forgetting. We found that post-acquisition chronic inhibition of the N-methyl-D-aspartate receptor (NMDAR), L-type voltage-dependent Ca²⁺ channel (LVDCC), and protein phosphatase calcineurin (CaN), maintains long-term object location memory that otherwise would have been forgotten. We further show that NMDAR activation is necessary to induce forgetting of object recognition memory. Studying the role of NMDAR activation in the decay of the early phase of long-term potentiation (E-LTP) in the hippocampus, we found that ifenprodil infused 30 min after LTP induction in vivo blocks the decay of CA1-evoked postsynaptic plasticity, suggesting that GluN2B-containing NMDARs activation are critical to promote LTP decay. Taken together, these findings indicate that a well-regulated forgetting process, initiated by Ca²⁺ influx through LVDCCs and GluN2B-NMDARs followed by CaN activation, controls the maintenance of hippocampal LTP and long-term memories over time.

Involvement of the infralimbic cortex and CA1 hippocampal area in reconsolidation of a contextual fear memory through CB1 receptors: Effects of CP55,940

The endocannabinoid system (ECS) has a pivotal role in different cognitive functions such as learning and memory. Recent evidence confirm the involvement of the hippocampal CB1 receptors in the modulation of both memory extinction and reconsolidation processes in different brain areas, but few studies focused on the infralimbic cortex, another important cognitive area. Here, we infused the cannabinoid agonist CP55,940 either into the infralimbic cortex (IL) or the CA1 area of the dorsal hippocampus (HPC) of adult male Wistar rats immediately after a short (3min) reactivation session, known to labilize a previously consolidated memory trace in order to allow its reconsolidation with some modification. In both structures, the treatment was able to disrupt reconsolidation in a relatively long lasting way, reducing the freezing response. To our notice, this is the first demonstration of ECS involvement in reconsolidation in the Infralimbic Cortex. Despite poorly discriminative between CB1 and CB2 receptors, CP55,940 is a potent agent, and these results suggest that a similar CB1-dependent circuitry is at work both in HPC and in the IL during memory reconsolidation.

Memory reconsolidation may be disrupted by a distractor stimulus presented during reactivation

Memories can be destabilized by the reexposure to the training context, and may reconsolidate into a modified engram. Reconsolidation relies on some particular molecular mechanisms involving LVGCCs and GluN2B-containing NMDARs. In this study we investigate the interference caused by the presence of a distractor - a brief, unanticipated stimulus that impair a fear memory expression - during the reactivation session, and tested the hypothesis that this disruptive effect relies on a reconsolidation process. Rats previously trained in the contextual fear conditioning (CFC) were reactivated in the presence or absence of a distractor stimulus. In the test, groups reactivated in the original context with distractor displayed a reduction of the freezing response lasting up to 20 days. To check for the involvement of destabilization / reconsolidation mechanisms, we studied the effect of systemic nimodipine (a L-VGCC blocker) or intra-CA1 ifenprodil (a selective GluN2B/NMDAR antagonist) infused right before the reactivation session. Both treatments were able to prevent the disruptive effect of distraction. Ifenprodil results also bolstered the case for hippocampus as the putative brain structure hosting this phenomenon. Our results provide some evidence in support of a behavioral, non-invasive procedure that was able to disrupt an aversive memory in a long-lasting way.

[Morbidity and mortality of surgically treated proximal humerus fractures]

BACKGROUND

The aim of the present study is to analyse the factors associated with mortality and the capacity to perform daily life activities (DLA) in patients with surgically treated proximal humeral fractures.

METHODS

A retrospective study was conducted on 94 patients with a surgically treated proximal humeral fracture, with a mean follow-up of 8 years (2 - 12 years). A correlation analysis was performed to determine the relationship between the type of fracture, surgical technique, comorbidities and mortality and DLA. The Student t test was used for statistical analysis.

RESULTS

A total of 72 patients were identified, 18.6% of them died during follow-up, all diagnosed with some comorbidity. There was no correlation between mortality, type of fracture or the technique used. Most of the patients (85.4%) had comorbidities, and 79.5% were completely independent for DLA. Although there was no relationship with the type of fracture, there was a significant reduction in the performing of DLA in patients treated with hemiarthroplasty, and in patients with neurological disorders.

CONCLUSIONS

There was a mortality of 18.6% among patients with surgically treated proximal humerus fractures. The majority of surgically treated patients were fully independent for DLA at long-term follow-up.

Biodegradation or simple adsorption to the support material? Development of a simple, fast and low-cost technique

Biofilms are present in several areas and are studied in microbiology, medical sciences, biology and, of course, sanitary engineering. Biofilms are used for the treatment of municipal wastewater, and their application was even before the invention of the activated sludge process. The main objective of this work was to develop a simple, fast and low-cost technique to evaluate the nature of the first decay in the concentration of an organic compound in the presence of a solid material. Though simple, the technique developed has allowed the clarification of whether the initial concentration decay is due to adsorption to the support material or a result of biodegradation. The results show that, with two different support materials, adsorption does not take place, and the biodegradation processes are responsible for the first decay in the organic concentration. The technique used offers a fast and low-cost way of studying the existence of adsorption. Two feed concentration solutions and two different support materials were used.

Biofilm thickness measurement using an ultrasound method in a liquid phase

In this report, the development of an online, noninvasive, measurement method of the biofilm thickness in a liquid phase is presented. The method is based in the analysis of the ultrasound wave pulse-echo behavior in a liquid phase reproducing the real reactor conditions. It does not imply the removal of the biomass from the support or any kind of intervention in the support (pipes) to detect and perform the measurements (non-invasiveness). The developed method allows for its sensor to be easily and quickly mounted and unmounted in any location along a pipe or reactor wall. Finally, this method is an important innovation because it allows the thickness measurement of a biofilm, in liquid phase conditions that can be used in monitoring programs, to help in scheduling cleaning actions to remove the unwanted biofilm, in several application areas, namely in potable water supply pipes.

Memory reconsolidation allows the consolidation of a concomitant weak learning through a synaptic tagging and capture mechanism

Motivated by the synaptic tagging and capture (STC) hypothesis, it was recently shown that a weak learning, only able to produce short-term memory (STM), can succeed in establishing long-term memory (LTM) with a concomitant, stronger experience. This is consistent with the capture, by the first-tagged event, of the so-called plasticity-related proteins (PRPs) provided by the second one. Here, we describe how a concomitant session of reactivation/reconsolidation of a stronger, contextual fear conditioning (CFC) memory, allowed LTM to result from a weak spatial object recognition (wSOR) training. Consistent with an STC process, the effect was observed only during a critical time window and was dependent on the CFC reconsolidation-related protein synthesis. Retrieval by itself (without reconsolidation) did not have the same promoting effect. We also found that the inactivation of the NMDA receptor by AP5 prevented wSOR training to receive this support of CFC reconsolidation (supposedly through the production of PRPs), which may be the equivalent of blocking the setting of a learning tag in the dorsal CA1 region for that task. Furthermore, either a Water Maze reconsolidation, or a CFC extinction session, allowed the formation of wSOR-LTM. These results suggest for the first time that a reconsolidation session can promote the consolidation of a concomitant weak learning through a probable STC mechanism. These findings allow new insights concerning the influence of reconsolidation in the acquisition of memories of otherwise unrelated events during daily life situations.

Translocation of bacterial DNA from Gram-positive microorganisms is associated with a species-specific inflammatory response in serum and ascitic fluid of patients with cirrhosis

Translocation of bacterial-DNA in patients with cirrhosis and ascites triggers an innate immune response. Identification of characteristics to which this response is sensitive is relevant from a clinical standpoint. The aim of this study has been to determine if the proinflammatory immune response established in vivo in cirrhotic patients with ascites as a consequence of bacterial-DNA translocation is related to the identified bacterial species and their frequency of cytosine-guanosine content in serum and ascitic fluid. Patients with advanced cirrhosis and ascites were included in the study and distributed into groups I and II according to the absence or presence of bacterial-DNA translocation, respectively. Serum and ascitic fluid levels of proinflammatory cytokines after normalization of bacterial-DNA concentration and the activated form of nuclear factor-kappa B in ascitic fluid pellets were measured by enzyme-linked immunosorbent assay techniques. Translocation of bacterial-DNA with higher cytosine-guanosine content induced the highest cytokine response, which was higher than that in patients without bacterial-DNA translocation. The activated form of nuclear factor-kappa B in ascitic fluid pellets of patients with bacterial-DNA translocation was greater in patients with higher bacterial-DNA cytosine-guanosine content, whereas the amount of total nuclear factor-kappa B remained unaltered. Bacterial-DNA translocation induces a marked immune reaction in vivo in patients with advanced cirrhosis and ascites which is related, among other factors, to the bacterial-DNA cytosine-guanosine content. Therefore, the host's immune response to bacterial-DNA translocation constitutes a species-specific phenomenon.

Monitoring biofilm thickness using a non-destructive, on-line, electrical capacitance technique

The present study was designed to evaluate indirect, non-invasive, on-line measurement of biofilm thickness using an electrical capacitance technique. Several assays were carried out and the results showed that, at a frequency of 1 kHz, electrical capacitance could be used to measure biofilm thickness indirectly (with a correlation coefficient of 0.9495). The reproducibility revealed by the assays was also highly satisfactory. However, in contrast to what was expected, there was an inverse relationship between electrical capacitance and biofilm thickness, i.e. electrical capacitance diminished with the increase in the biofilm thickness. The tests were also carried out at different frequencies (1 kHz, 10 kHz and 100 kHz).

A characterization of selected endocrine disruptor compounds in a Portuguese wastewater treatment plant

Anthropogenic compounds that are able to disrupt the endocrine system of wildlife species are a major cause for concern and have led to a demand for new screening methods. The identification and quantification of endocrine disruptor compounds at wastewater treatment plant is of major interest to assess the endocrine activity of wastewater treatment plant discharges into the environment. This study consists of a preliminary survey of concentrations of previously selected endocrine disruptor compounds, undertaken to establish environmental concentrations and to support a biological program assay exposing freshwater fish to them. Selected endocrine disrupting chemicals (APEs, bisphenol A and 17 beta-estradiol) were measured in samples from a wastewater treatment plant located in Lisbon (Portugal), using recent commercial enzyme-linked immunosorbent assay kits and also LC-MS/MS. The results show that the wastewater treatment plant treatment process is efficient on the removal of target endocrine disruptor compounds. However, environmentally significant concentrations are still present in the treated effluent. The results also show that enzyme-linked immunosorbent assay kit is suitable for routine analysis of the selected compounds. The results are also useful since the wastewater treatment plant is located in a Mediterranean region, which results in an effluent with its own characteristics.

Nitrite removal in a submerged biofilter

Nowadays submerged filters seem to be the preferred technology for denitrification purposes. Optimisation of biological nitrogen has recently been tried based the nitrate shunt in order to save two of the involved steps. Former studies have shown that a build-up of nitrite can be achieved by an appropriate control of the nitrification process either in suspended cultures or in fixed cultures. An experimental plan was conducted to study the effect of different types of carbon source (acetate, ethanol and urban wastewater) on the performance of a submerged down flow biofilter, as well as the influence of the hydraulic loading. Results have shown that maximum nitrogen removal rates were similar for acetate and ethanol attaining values significantly higher than for urban waste water. On the other hand, nitrogen massic loading appeared to be the limiting factor for efficiency rather than hydraulic loading.

Calcium channel subtypes and exocytosis in chromaffin cells: a different view from the intact rat adrenal

In the intact rat adrenal gland perfused with an oxygenated Krebs-bicarbonate solution at 37 degrees C, the electrical field stimulation of splanchnic nerves (100 V, 0.5 ms duration, 10 Hz during 10 s) produced transient catecholamine release peaks that were reproduced in subsequent stimuli, applied at 8-min intervals. Omega-Conotoxin GVIA (0.3 microM) caused only a modest inhibition of the secretory response, suggesting that the N-subtype of voltage-dependent Ca2+ channels are scarcely involved in such a response. Both omega-conotoxin MVIIC (1 microM) and furnidipine (1 microM) halved the secretion, suggesting that the L- and P/Q-types of Ca2+ channels were involved. N-type Ca2+ channels appear to be involved in the maintenance of secretion in response to sustained stimulus since omega-conotoxin GVIA (0.3 microM) reduced the catecholamine output to 28%. When secretion was elicited by acetylcholine (10 microM), furnidipine reduced the catecholamine release by 50% and omega-conotoxin MVIIC by 40%, whereas omega-conotoxin GVIA did not modify the response. The K+-induced secretory responses (23.6 mM K+, 15 s) were reduced 75% by furnidipine and 45% by omega-conotoxin MVIIC, indicating that this type of stimulation preferentially recruited L-type channels. These data show that electrical stimulation recruits Ca2+ channel subtypes different from those recruited by direct depolarization of chromaffin cells.

Interaction between G protein-operated receptors eliciting secretion in rat adrenals. A possible role of protein kinase C

Catecholamine release induced by angiotensin II, histamine, bradykinin and methacholine from the rat adrenal gland perfused in vitro was studied under conditions in which the activity of protein kinase C (PKC) was modified. Perfusion of glands with 10 nM bradykinin abolished, in a reversible way, the secretion induced by short pulses of angiotensin II, histamine and methacholine but did not modify the release evoked by 23.6 mM KCl (high K+). Perfusion with histamine or methacholine (30 microM) inhibited the secretion induced by the other agents by 30-50%, whereas incubation with angiotensin II (100 nM) caused little or no reduction in the release evoked by the other agents. The treatment of glands with 1 nM of the PKC activator phorbol 12,13-dibutyrate (PDBu) suppressed the responses induced by angiotensin II, histamine and methacholine, did not affect those evoked by bradykinin, and potentiated the secretion evoked by high K+. The adenylate cyclase stimulator forskolin (1 microM) did not affect the basal secretion but strongly potentiated the release evoked by all secretagogues used, suggesting a role for protein kinase A (PKA) downstream of the receptor. The PKC inhibitor Ro-31-8220 partially reversed the inhibitory effect of bradykinin. Our results suggest that angiotensin II, histamine and muscarinic receptors share some common transduction mechanism that is regulated by PKC. PKC activity was enhanced by these agents PDBu >> bradykinin = histamine > methacholine = angiotensin II. Bradykinin receptor transduction does not appear to be regulated by PKC.

Lifetime prevalence of specific psychiatric disorders among Mexican Americans and non-Hispanic whites in Los Angeles

The lifetime prevalence of specific DSM-III-defined psychiatric disorders among 1243 Mexican-American and 1309 non-Hispanic white residents of two Los Angeles communities is reported from the Los Angeles site of the Epidemiologic Catchment Area (ECA) research study. Results from household interviews in response to the National Institute of Mental Health Diagnostic Interview Schedule revealed overall rates of disorders for the total Los Angeles sample and ethnic subsamples that were similar to rates reported from the initial three ECA sites. Non-Hispanic whites reported far more drug abuse/dependence and more major depressive episodes than Mexican Americans. Young non-Hispanic white women reported high rates of major depressive episodes and drug abuse/dependence. Alcohol abuse/dependence is highly prevalent among Mexican-American and non-Hispanic white men of any age. Mexican-American women infrequently abuse or become dependent on drugs or alcohol at any age. Dysthymia, panic disorder, and phobia are somewhat more prevalent among Mexican-American women over 40 years of age compared with both non-Hispanic white women over and Mexican-American women under 40 years of age. Antisocial personality is predominantly a disorder of young men of both ethnic groups.

Expressed emotion and schizophrenic outcome among Mexican-American families

This study has demonstrated that among low-income, relatively unacculturated Mexican-American households, a high level of expressed emotion on the part of key relatives significantly increases the risk of relapse for remitted schizophrenics who return home to live with their families after hospital discharge. This cross-cultural replication of earlier research findings in London and southern California suggests that critical, hostile, or emotionally overinvolved attitudes and behaviors may be general major stressors that adversely influence the fragile adaptation of schizophrenic individuals in diverse cultural settings. The finding of a lower prevalence of high levels of expressed emotion among Mexican-American compared to Anglo-American and British households lends support to the hypothesis that intrafamilial behaviors may account for different schizophrenic outcomes in different cultures.