Cardioprotective effects of vaccination in hospitalized patients with COVID-19

COVID-19 vaccination has been shown to prevent and reduce the severity of COVID-19 disease. The aim of this study was to explore the cardioprotective effect of COVID-19 vaccination in hospitalized COVID-19 patients. In this retrospective, single-center cohort study, we included hospitalized COVID-19 patients with confirmed vaccination status from July 2021 to February 2022. We assessed outcomes such as acute cardiac events and cardiac biomarker levels through clinical and laboratory data. Our analysis covered 167 patients (69% male, mean age 58 years, 42% being fully vaccinated). After adjustment for confounders, vaccinated hospitalized COVID-19 patients displayed a reduced relative risk for acute cardiac events (RR: 0.33, 95% CI [0.07; 0.75]) and showed diminished troponin T levels (Cohen's d: - 0.52, 95% CI [- 1.01; - 0.14]), compared to their non-vaccinated peers. Type 2 diabetes (OR: 2.99, 95% CI [1.22; 7.35]) and existing cardiac diseases (OR: 4.31, 95% CI [1.83; 10.74]) were identified as significant risk factors for the emergence of acute cardiac events. Our findings suggest that COVID-19 vaccination may confer both direct and indirect cardioprotective effects in hospitalized COVID-19 patients.

Slowing gait during turning: how volition of modifying walking speed affects the gait pattern in healthy adults

Background

Turning during walking and volitionally modulating walking speed introduces complexity to gait and has been minimally explored.

Research question

How do the spatiotemporal parameters vary between young adults walking at a normal speed and a slower speed while making 90°, 180°, and 360° turns?

Methods

In a laboratory setting, the spatiotemporal parameters of 10 young adults were documented as they made turns at 90°, 180°, and 360°. A generalized linear model was utilized to determine the effect of both walking speed and turning amplitude.

Results

Young adults volitionally reducing their walking speed while turning at different turning amplitudes significantly decreased their cadence and spatial parameters while increasing their temporal parameters. In conditions of slower movement, the variability of certain spatial parameters decreased, while the variability of some temporal parameters increased.

Significance

This research broadens the understanding of turning biomechanics in relation to volitionally reducing walking speed. Cadence might be a pace gait constant synchronizing the rhythmic integration of several inputs to coordinate an ordered gait pattern output. Volition might up-regulate or down-regulate this pace gait constant (i.e., cadence) which creates the feeling of modulating walking speed.

Vaccination protects against acute respiratory distress syndrome (ARDS) in hospitalized patients with COVID-19

This study aimed to analyze the effect of COVID-19 vaccination on the occurrence of ARDS in hospitalized COVID-19 patients. The study population of this retrospective, single-center cohort study consisted of hospitalized COVID-19 patients with known vaccination status and chest computed tomography imaging between July 2021 and February 2022. The impact of vaccination on ARDS in COVID-19 patients was assessed through logistic regression adjusting for demographic differences and confounding factors with statistical differences determined using confidence intervals and effect sizes. A total of 167 patients (69% male, average age 58 years, 95% CI [55; 60], 42% fully vaccinated) were included in the data analysis. Vaccinated COVID-19 patients had a reduced relative risk (RR) of developing ARDS (RR: 0.40, 95% CI [0.21; 0.62]). Consequently, non-vaccinated hospitalized patients had a 2.5-fold higher probability of developing ARDS. This risk reduction persisted after adjusting for several confounding variables (RR: 0.64, 95% CI [0.29; 0.94]) in multivariate analysis. The protective effect of COVID-19 vaccination increased with ARDS severity (RR: 0.61, 95% CI [0.37; 0.92]). Particularly, patients under 60 years old were at risk for ARDS onset and seemed to benefit from COVID-19 vaccination (RR: 0.51, 95% CI [0.20; 0.90]). COVID-19 vaccination showed to reduce the risk of ARDS occurrence in hospitalized COVID-19 patients, with a particularly strong effect in patients under 60 years old and those with more severe ARDS.

Pulmonary computed tomographic manifestations of COVID-19 in vaccinated and non-vaccinated patients

This study aimed to analyze computed tomographic (CT) imaging features of vaccinated and non-vaccinated COVID-19 patients. The study population of this retrospective single-center cohort study consisted of hospitalized COVID-19 patients who received a chest CT at the study site between July 2021 and February 2022. Qualitative scoring systems (RSNA, CO-RADS, COV-RADS), imaging pattern analysis and semi-quantitative scoring of lung changes were assessed. 105 patients (70,47% male, 62.1 ± 16.79 years, 53.3% fully vaccinated) were included in the data analysis. A significant association between vaccination status and the presence of the crazy-paving pattern was observed in univariate analysis and persisted after step-wise adjustment for possible confounders in multivariate analysis (RR: 2.19, 95% CI: [1.23, 2.62], P = 0.024). Scoring systems for probability assessment of the presence of COVID-19 infection showed a significant correlation with the vaccination status in univariate analysis; however, the associations were attenuated after adjustment for virus variant and stage of infection. Semi-quantitative assessment of lung changes due to COVID-19 infection revealed no association with vaccination status. Non-vaccinated patients showed a two-fold higher probability of the crazy-paving pattern compared to vaccinated patients. COVID-19 variants could have a significant impact on the CT-graphic appearance of COVID-19.

Spatiotemporal parameters during turning gait maneuvers of different amplitudes in young and elderly healthy adults: A descriptive and comparative study

BACKGROUND

Turning during walking adds complexity to gait and has been little investigated until now. Research question What are the differences in spatiotemporal parameters between young and elderly healthy adults performing quarter-turns (90°), half-turns (180°) and full-turns (360°)?

METHODS

The spatiotemporal parameters of 10 young and 10 elderly adults were recorded in a laboratory while turning at 90°, 180° and 360°. Two-way mixed ANOVA were performed to determine the effect of age and turning amplitude.

RESULTS

Elderly were slower and needed more steps and time to perform turns of larger amplitude than young adults. Cadence did not differ across age or across turning amplitude. Generally, in the elderly, the spatial parameters were smaller and the temporal parameters enhancing stability (i.e., double-support phase and stance/cycle ratio) were larger, especially for turns of larger amplitudes. In elderly adults, the variability of some spatial parameters was decreased, whereas the variability of some temporal parameters was increased. Stride width of the external leg showed the most substantial difference between groups. Most parameters differed between turning at 90° and turning at larger amplitudes (180°, 360°). Significance This study extends the characterization of turning biomechanics with respect to ageing. It also suggested paying particular attention to the turning amplitude. Finally, the age-related differences may pave the way for new selective rehabilitation protocols in the elderly.

Non-invasive brain stimulation for Parkinson's disease: Clinical evidence, latest concepts and future goals: A systematic review

Parkinson's disease (PD) is becoming a major public-health issue in an aging population. Available approaches to treat advanced PD still have limitations; new therapies are needed. The non-invasive brain stimulation (NIBS) may offer a complementary approach to treat advanced PD by personalized stimulation. Although NIBS is not as effective as the gold-standard levodopa, recent randomized controlled trials show promising outcomes in the treatment of PD symptoms. Nevertheless, only a few NIBS-stimulation paradigms have shown to improve PD's symptoms. Current clinical recommendations based on the level of evidence are reported in Table 1 through Table 3. Furthermore, novel technological advances hold promise and may soon enable the non-invasive stimulation of deeper brain structures for longer periods.

Feeding Iberian × Duroc cross pigs with crude glycerine: Effects of diet and gender on carcass and meat quality

Ninety (45 castrated males and 45 gilts) Iberian × Duroc pigs were used in this study. During the finishing period (95-160 kg body weight, 74 days) animals received conventional feed (control G0) or the same feed plus 5% (G5) or 10% (G10) of crude glycerine to partially replace wheat. In general, neither the diet nor gender affected ultrasound, carcass or meat quality parameters. The G10 had lower values of cooking loss and a* than the G5 and G0 groups. The fatty acids, C10:0, C12:0 and C18:3, in intramuscular fat were lower in both glycerine groups. Polyunsaturated fatty acids and 18:2 decreased and C20:0 increased at the subcutaneous fat of G10 animals. Castrated males produced carcasses with higher backfat thickness and fat content. Castrated males had a higher SFA content in subcutaneous fat than females (P<0.001). In conclusion, up to 10% crude glycerine could be used in the Iberian × Duroc diet.

Effect of crude glycerin on feed manufacturing, growth performance, plasma metabolites, and nutrient digestibility of growing-finishing pigs

Three experiments were conducted to determine the effects of dietary addition of crude glycerin on pellet production efficiency and to evaluate its effect on growth performance and digestibility in growing-finishing pigs. Three dietary treatments were created by addition of 0, 2.5, or 5% crude glycerin to barley-soybean meal-based diet, and 4 batches of each dietary treatment (2 each for grower and finisher diets) were prepared. In the manufacturing process, crude glycerin supplementation linearly increased the feeder speed and production rate (P < 0.05), resulting in a 20 to 29% improvement in the feed production rate compared with the control. Production efficiency (kg/kWh) increased linearly (P < 0.05) as the level of crude glycerin in feed increased. A growth experiment was performed with 240 barrows (30 ± 1 kg initial BW) using a 2-phase feeding program over a 12-wk period with 4 pens per treatment and 20 pigs per pen. On the last day of the growth experiment, blood samples were collected to determine circulating glucose, fructosamine, and IGF-1 concentrations. Overall growth performance was not affected (P > 0.05) by dietary treatment, and there was no effect (P > 0.05) of dietary treatment on any plasma metabolite measured. A digestibility experiment involving 9 male pigs housed in metabolic cages was used to determine the coefficients of apparent fecal digestibility and N and mineral balances. Pigs were assigned to 1 of the 3 diets in each feeding period using a 3 × 3 Latin square arrangement of treatments (43 ± 3 and 74 ± 3 kg initial BW in the growing and finishing periods, respectively). In both feeding periods, fecal digestibility of OM and ether extract were affected by dietary treatment, increasing linearly (P < 0.05) with increasing crude glycerin levels. However, neither CP digestibility nor N retention was affected by the glycerin content in either the growing or finishing period. Digestibilities and balance of Ca and P showed opposite tendencies with the variations in crude glycerin content, which either decreased or increased depending on the feeding period. In conclusion, adding crude glycerin to the diet before pelleting improved feed mill production efficiency. The addition of crude glycerin up to 5% in the diet of growing-finishing pigs had no effect on growth performance, blood metabolites, nutrient digestibility, and N balance, but more studies are needed to determine how crude glycerin affects mineral metabolism and balance.

Effects of low protein diets on growth performance, carcass traits and ammonia emission of barrows and gilts

The aim of the present research was to determine the effect of low protein diets on growth performance, carcass traits and ammonia emission from barrows and gilts during the growing and finishing periods. For each period, three diets were formulated. A control diet (C) with 160 and 155 g crude protein (CP)/kg for the growing and finishing, respectively, a medium level diet (M) and a low level diet (L) with 10 and 20 g CP/kg less than the C, respectively. All the diets were supplemented with crystalline amino acids on an ideal protein basis. Barrows (90) and gilts (90) were sorted by bodyweight and sex and housed in three identical manually ventilated chambers. No significant effects of diet on pig performance were observed. In the finishing period, barrows were heavier (P < 0.001) and had higher average daily gain (P < 0.01) and average daily feed intake (P < 0.01) than gilts. Pigs fed the L diet had higher backfat thickness than those fed the other diets in the growing period (P < 0.05). Backfat thickness was higher (P < 0.01) in barrows than in gilts. Muscle depth decreased in pigs fed the L diet in the finishing period. Muscle depth was not affected (P > 0.05) by sex. Average ammonia emissions during the last 6 days were 117.7, 94.2 and 85.5 mg ammonia/kg pig.day for pigs fed the C, M and L diets, respectively. The results show that a reduction in dietary CP of 10 g/kg, accompanied by supplementation with crystalline amino acid reduced ammonia emission by 19.9% with no detrimental effects on growth performance and carcass characteristics, and a reduction of 20 g/kg reduced ammonia emission by 27.3% with no detrimental effects on growth performance but reduced muscle depth at slaughter.

Objective Bayesian vs. least squares estimation for by-products degradability with different rumen fluids

The degradation kinetic curves of different by-products have been obtained. The considered by-products were lemon and several types of treated and untreated barley straw, and they were degraded by in vitro incubation with rumen fluid extracted from two herds of Murciano-Granadina goats, one of them fed alfalfa hay and the other one fed barley straw. The feeds were incubated at 39ºC for 12, 24, 36, 48 and 72 hours with each rumen fluid. The resulting fitted exponential-type degradation curves obtained with a frequentist statistical analysis were compared with those resulting from an objective Bayesian statistical analysis. The use of the objective Bayesian analysis smoothed the estimates of the frequentist fit using least squares, which did not suitably process the involved restrictions and avoided biologically unacceptable results. On the other hand, the rumen fluid from goats fed alfalfa hay fomented the greatest effective degradability and the degradabilities of the different by-products were also compared, with the result that the lemon by-product was the best degraded one under both statistical analyses. Key words: In vitro fermentation, by-product, degradation curve

Effect of formic acid on performance, digestibility, intestinal histomorphology and plasma metabolite levels of broiler chickens

1. The effect of dietary formic acid on performance, digestibility, intestinal histomorphology and plasma metabolite levels of broiler chickens was studied. 2. An experiment with 120 Ross male broiler chickens was conducted from 1 to 42 d of age at the laboratory. There were 4 treatment groups: control (C), 10 mg/kg feed avilamycin (AV) and formic acid at two concentrations, 5 and 10 g/kg feed (FA5 and FA10, respectively). 3. No differences in weight gain, feed intake or feed conversion ratio were observed in male broiler chickens fed on the different diets. 4. An effect of the additives on ileal dry matter (DM) digestibility at 42 d of age was detected with the finisher diets; AV and 10 g/kg of feed formic acid slightly improved ileal DM digestibility compared to the other treatment groups. 5. Jejunum pH was not affected when 5 or 10 g/kg formic acid was added, and the results do not clearly show a positive effect of formic acid on the intestinal histomorphology. 6. No differences were noticed for blood metabolites in the different diets, and the levels of calcium and phosphorus in the plasma were not altered by formic acid addition. 7. In conclusion, when using broiler chickens under conditions of good hygiene, dietary formic acid did not have a clear positive effect on performance, intestinal histomorphology or plasma metabolite levels; however, there was a slight positive effect on the ileal digestibility of nutrients.

Response of Broilers to Feeding Low-Calcium and Phosphorus Diets Plus Phytase Under Different Environmental Conditions: Body Weight and Tibiotarsus Mineralization

Three experiments on Ross broiler chickens were conducted in 3 locations: cages (Experiment 1), floor pens (Experiment 2), and commercial farms (Experiment 3). The effect of low-total P (TP) wheat-soybean based diets plus microbial phytase (Natuphos) was evaluated. Four experimental starter and finisher diets were used in a 2-phase feeding program, as follows: control diet (SC until 21 d, FC from 22 to 42 d); 2 diets (SL400 and SL600 until 21 d, FL400 and FL600 from 22 to 42 d) with low TP (0.61% for starter and 0.54% for finisher), including 400 and 600 U/kg of phytase, respectively; and a very low-TP (0.52% for starter and 0.44% for finisher) diet (SVL600 until 21 d, FVL600 from 22 to 42 d) with 600 U/kg of phytase. In Experiment 1 (broilers in cages had movement limitation and no access to litter), no differences in BW, tibiotarsus mineralization, or mineral metabolism were observed among diets. In Experiment 2 (broilers in floor pens had movement limitation and access to litter), at 21 d of age, the lowest tibiotarsus ash percentage and BW were shown by birds fed the SVL600 diet. At 42 d of age, broilers fed the FC diet were the lightest. For the rest of the parameters of tibiotarsus mineralization and mineral metabolism measured in Experiment 2, no differences were shown. In Experiment 3 (broilers in commercial farms had access to litter without movement limitation), the BW of broilers fed the SC diet was the highest at 21 d of age. At 42 d of age, the broilers fed FL400 and FL600 diets were the heaviest. At the end of Experiment 3, broilers fed the FC diet had the highest dry litter Ca and P, whereas broilers fed the FVL600 diet had the lowest values. In conclusion, the very low-TP wheat-soybean based diet supplemented with 600 U/kg of phytase was sufficient to optimize all the parameters measured in Experiment 1 but not in Experiments 2 and 3. Therefore, when evaluating Ca and P in phytase-supplemented diets for broilers, it is necessary to bear in mind the environmental conditions of experimentation.

Effect of thyme essential oils (Thymus hyemalis and Thymus zygis) and monensin on in vitro ruminal degradation and volatile fatty acid production

The effect of the essential oils of thyme on the in vitro ruminal degradability of a barley seed/alfalfa hay substrate was studied. Two essential oils were used, one from Thymus hyemalis (TH), rich in carvacrol, and the other from Thymus zygis (TZ), rich in thymol. Four experimental treatments of in vitro degradability, using the Daisy II(200/220) incubator, were conducted including a negative control (CO), a positive control at 7.5 microg/mL of monensin (MO), and two treatments with essential oils (TH or TZ) at 1.35 microL/mL. The material was incubated at 39.5 degrees C for various lengths of time. At each time, the disappearance of dry matter, crude protein, and neutral detergent fiber was measured. Volatile fatty acids (VFAs) were determined after 48 h of incubation. CO and MO provided (p < 0.01) higher values of potential degradability (a + b) of DM than the TH and TZ treatments (72.6 and 70.8 vs 53.2 and 48.2%, respectively). Also, crude protein degradability was lowest in the essential oil treatments. The CO treatment showed the highest potential degradability of NDF. The values of VFA production obtained (p < 0.001) with CO and MO treatments were higher than those obtained with TH and TZ treatments (21.0 and 19.1 vs 11.2 and 10.1 mM). The essential oils decreased the molar proportion of propionate, increasing the acetate/propionate ratio. In conclusion, the effects of essential oils at assayed doses would not be nutritionally beneficial to the ruminal energetic metabolism.

Chemotherapy with FOLFOX IV in advanced gastric cancer

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Background: Gastric cancer is the first cause of mortality for cancer in Chile. 65% is observed in advanced form and the median survival without surgery is 5,4 months. We hypothesised that chemotherapy and specially FOLFOX IV is an active regimen and has low toxicity in patient with advanced gastric cancer. The main evaluated objectives were: response, toxicity and survival of patient with advanced gastric cancer. Methods: Patients with gastric adenocarcinoma, stage IV that accepted chemotherapy with FOLFOX IV in any time of evolution were included. The evaluation of response was obtained with CT scan every two month. The characteristics of patients, chemotherapy responses, toxicity and global survival were analysed. Results: Between November 2003 and October 2005, 20 patients were included, the median age was 51,5 years (range 28–67), 80% male. Hepatic, peritoneal and lung metastases were the principal places of dissemination. The response rate in first line was: PR 66%, SD 17%, with overall response of 83% (12 patients). In second line the response was: PR 37%, SD 63% (8 patients). The average of treatment was 5,5 months. The median of response was 5 months (2–12). The median overall survival was 12 months. 50% of patients showed toxicity; digestive grade 2 in 2 patients, neurological grade 2 in 4 patients and only 1 patient showed grade 3 toxicity. Conclusions: FOLFOX IV is an active chemotherapy regiment with low toxicity profile in advanced gastric cancer. With these results we propose a Phase III trial would be feasible to perform.

No significant financial relationships to disclose.

Influence of two plant extracts on broilers performance, digestibility, and digestive organ size

A 42-d trial was conducted to study the influence of 2 plant extracts on performance, digestibility, and digestive organ weights in broilers. The feeding program consisted of a starter diet until 21 d and a finisher diet until 42 d. There were 4 treatment groups: control; 10 ppm avilamycin (AB); 200 ppm essential oil extract (EOE) from oregano, cinnamon, and pepper; and 5,000 ppm Labiatae extract (LE) from sage, thyme, and rosemary. No differences in feed intake or feed conversion were observed. From 14 to 21 d of age, broilers fed the LE diet grew faster than the broilers fed the control or EOE feeds (68.8 vs. 63.9 and 61.6 g/d, respectively). Antibiotic and plant extract supplementation improved apparent whole-tract and ileal digestibility of the nutrients. For starter feed, LE supplementation improved apparent fecal digestibility of DM (P < 0.01), and all additives increased ether extract digestibility (P < 0.001). However, no effect was detected for CP digestibility (P > 0.1). At the ileal level, the AB, EOE, and LE supplementation of the starter feed increased DM and starch (P < 0.01) digestibility but not CP digestibility (P > 0.1). All additives improved apparent fecal digestibility of DM and CP of the finisher diet. No differences were observed for proventriculus, gizzard, liver, pancreas, or large or small intestine weight. In the present study, both plant extracts improved the digestibility of the feeds for broilers. The effect of different additives on digestibility improved the performance slightly, but this effect was not statistically significant.

Adjuvant radiochemotherapy in the treatment of completely resected, locally advanced gastric cancer

PURPOSE

To analyze the efficacy and toxicity of adjuvant whole abdomen irradiation (WAI) and concomitant chemotherapy in the treatment of completely resected, high-risk gastric cancer.

METHODS AND MATERIALS

Between October 1990 and September 1997, 52 patients with completely resected gastric cancer, with lymph node and/or serosal involvement, were treated. Ages were 16-78 (median, 53.5) years. Treatment was either total- or sub-total gastrectomy, followed by WAI, 2100 cGy/21 fractions plus a 2400 cGy/16 fractions boost to the tumor bed. Chemotherapy consisted of either 5-fluorouracil (5-FU) 450-500 mg/m(2) i.v. for 5 days first and 5th week or 200-300 mg/m(2) continuous infusion during irradiation. No further chemotherapy was given.

RESULTS

With a minimum follow-up of 30 months and a median follow-up of 43.5 months, 25 of the 52 patients have died. Overall 5-year survival rate is 54%. Three patients sustained Grade 3-5 complications. Two patients with Grade 5 complications (malabsorption syndrome) died 31 and 56 months after the beginning of the treatment, respectively, with no evidence of recurrent tumor. For patients with involvement of the lymph nodes alone (n = 19) the 5-year survival was 69%, which was significantly better than the 36% 5-year survival observed for those patients with both serosal and lymph node involvement (n = 26, p = 0.004).

CONCLUSION

Adjuvant radiochemotherapy, WAI, and concomitant 5-FU, is a feasible and a fairly well-tolerated treatment for patients with locally advanced (involvement of the lymph nodes or serosa) gastric carcinoma who undergo complete resection. The 54% overall 5-year survival compares favorably with the survival reported after surgery alone for those patients.

[Prostatic syndrome and pleural effusion: are they different diseases?]

OBJECTIVE

To report an uncommon association of prostate and lung cancer.

METHODS

The characteristics of both tumors, their association with tumors in other sites and the time of presentation are analyzed.

RESULTS

Both tumors were in the advanced stages. Metastatic carcinoma of the prostate was discarded due to the form of presentation.

CONCLUSIONS

Although the association of prostate and lung cancer is uncommon, the possibility of synchronous tumors should be considered in patients with urinary and pulmonary symptoms suggestive of neoplasm. It is important to determine if the lesion is a metastasis, since the prognosis depends on the second tumor.

[Review of complications of urinary diversions performed during a 6-year period in the era of orthotopic neobladders]

OBJECTIVE

To compare the morbidity of different types of permanent urinary diversion.

METHODS

We reviewed the postoperative and longterm complications observed in 85 patients who underwent permanent urinary diversion from December, 1986 to January, 1993: cutaneous ureterostomy (16 pts.), transintestinal incontinent cutaneous ureterostomy (41 pts.), orthotopic neobladder (27 pts.). All patients underwent radical cystectomy for bladder carcinoma. The surgical technique utilized for the construction of the orthotopic neobladders were as follows: Camey 1 (4 cases), Camey II (6 cases), Mainz (2 cases), Hautman (6 cases), detubularized sigmoid (6 cases). We also reviewed and used for comparison 18 augmentation cystoplasties that underwent simple subtotal cystectomy. Augmentation cystoplasty was performed with the sigmoid (n = 8), ileon (n = 5) and ileocecal segment (n = 4).

RESULTS

The incidence of postoperative complications was similar for all types of urinary diversion (64.3% for cutaneous ureterostomy, 61% for transintestinal intermittent cutaneous ureterostomy, 59.3% for orthotopic neobladder), although patients with orthotopic neobladders required surgery more frequently (7.1% for cutaneous ureterostomy, 22% for transintestinal cutaneous ureterostomy, 41% for orthotopic neobladder). The incidence of postoperative complications was much lower in patients who underwent augmentation cystoplasty (complications 17.7%; none required surgery). The percentage of longterm complications was 71.4% for cutaneous ureterostomy, 74.2% for cutaneous transintestinal ureterostomy, 86.9% for orthotopic neobladders and 100% for augmentation cystoplasties. The patients who required surgery were 14.3%, 19.3%, 26% and 47%, respectively. Twelve out of 24 patients in whom metalic staples were employed for the construction of the neobladders and cystoplasties developed bladder stones; 78.3% of the patients with orthotopic neobladders showed perfect daytime continence, 65.2% night-time incontinence and 21.7% stress incontinence. The figures for augmentation cystoplasties were 94.1%, 5.9% and 5.9%; 4.3% of patients with orthotopic neobladders and 29.4% of patients with augmentation cystoplasties required self intermittent catheterization. Patients with larger neobladders showed best continence rates. Fifty-three ureters were reimplanted in the orthotopic neobladders of augmentation cystoplasties with the Le Duc technique; 17% developed ureteral stenosis and 15.1% vesicoureteral reflux.

CONCLUSION

Patients who undergo permanent urinary diversion have a far from negligible number of postoperative and long-term complications. Orthotopic intestinal neobladders have a slightly higher rate of serious complications than incontinent cutaneous diversions.

[Prognostic value of lymphatic metastasis in bladder cancer]

OBJECTIVE

The presence of lymph node metastasis in bladder cancer is considered to be a sign of poor prognosis. The present study was performed to analyze the influence of the number of positive lymph nodes on survival and the therapeutic value of lymphadenectomy in pN+patients.

METHODS

From January, 1983 to January, 1993, 160 patients aged 39 to 77 years (mean 61.8) underwent radical cystectomy and pelvic lymphadenectomy for carcinoma of the bladder. The records of 122 patients were available for review. The UICC 1978 classification system was used.

RESULTS

Cancer-specific mortality was 22.8% (16/70) for pNo patients, 44.4% (4/9) for pN1 patients and 88.9% (16/18) for pN2-4 patients. We obtained the following cancer-specific mortality by stratifying according to T category: 5.4% (2/37) for pNoT1-T3a, 42.4% (14/33) for pNoT3b-T4, 0% (0/2) for pNIT1-T3a, 57.1% (4/7) for pNIT3b-T4 and 88.9% (16/18) for pN2-4T3b-T4.

CONCLUSION

The presence of only 1 positive regional lymph node (pN1) appears to worsen patient survival, particularly when the primary tumor is T3b or worse. In these cases cancer-specific mortality after patient discharge increased from 42% for the pNo patients to 57% for the pN1 patients (p > 0.05). Radical cystectomy was highly effective and curative in 95% of T1-T3apNo-1 patients (37/39). The presence of multiple positive lymph nodes carries a very poor prognosis, with 89% of the patients dying at a mean of 12 months.

Soluble insulin-like growth factor-II/mannose 6-P receptor inhibits deoxyribonucleic acid synthesis in cultured rat hepatocytes

Insulin-like growth factor-II/mannose 6-P (IGF- II/M6P) receptor is released from cultured cells and tissues in a soluble form that retains its affinity for IGF-II. To test the possibility that soluble receptor can therefore modulate the activity of IGF-II, we determined the effect of purified soluble receptor on DNA synthesis in cultured rat hepatocytes stimulated with epidermal growth factor (EGF) (5 ng/ml) and IGF-II (200 ng/ml). Thymidine incorporation in hepatocytes in the presence of EGF and IGF-II was inhibited by soluble receptor (50% inhibition at 212 +/- 45 ng/ml). However, thymidine incorporation in the presence of EGF alone was also inhibited with similar potency. This inhibitory effect was removed by immunodepletion of receptor from the purified preparation, demonstrating the absence of nonspecific cytotoxic effects of the preparation. Although soluble receptor blocked IGF-II binding to hepatocytes, inhibition of EGF-stimulated DNA synthesis was not due to inhibition of EGF binding or uptake by the cell. These results suggest that soluble IGF-II/M6P receptor not only plays a role in modulating the action of IGF-II but may also have IGF-independent actions on cells, possibly by modulating M6P protein action.

[Infections in the diabetic. Comparative study of infections in the foot and other locations]

Given the high morbi-mortality of foot infections among the diabetics and the poor knowledge of their predictive, clinical and evolutive factors, we have retrospectively studied a group of patients with these characteristics, comparing them with infections among diabetics affecting other locations. We studied 66 infections among diabetics: 34 patients with diabetic's foot and 32 with infections at other locations: 20 pyelonephritis and 12 pneumonias. Medical records were obtained in all cases and all patients underwent a complete physical exploration in order to assess their risk factors. We observed as a significant predictive factor of diabetic's foot, diabetes type I, with an evolution longer than 10 years, neuropathy, vasculopathy or retinopathy. From the clinical point of view and compared with the other infections, these patients showed longer hospitalization, greater initial clinical severity, glucemias higher than 200 mgr/l., anemia and high GSR. Ethiologically, the infection of diabetic's foot was polymicrobian in 42.3% of all cases, being S. aureus the microorganism more frequently isolated. On the contrary, in infections at other locations, monomicrobian flora was more frequent, being E. coli the most frequent in pyelonephritis and S. pneumoniae in pneumonias. The evolution was satisfactory in all cases, with a close medical and surgical combined treatment and the appropriate use of antibiotic combinations, mainly clindamicine + tobramicine in the diabetic's foot and cefuroxime in the other locations.

[Allogenic bone marrow transplantation: report of 3 cases in Chile]

Three patients, a 28 years old female (case 1), and two males aged 32 and 18 (cases 2 and 3) received allogeneic bone marrow transplants for acute non lymphatic leukemia (cases 1 and 2) and severe aplastic anemia (case 3) from HLA identical siblings. All patients were conditioned with Busulfan and Cyclophosphamide, and received GVHD prophylaxis with cyclosporin and steroids. Disease free survival is greater than 232, greater than 50 and greater than 201 days. Hematological reconstitution was detected 12, 13 and 10 days post transplant. All patients presented fever during the first month and received broad spectrum antibiotics including amphotericin in case 3. Acute GVHD presented in case 3 and chronic GVDH in case 1. Both patients responded to higher doses of cyclosporine and steroids. Allogeneic bone marrow transplant is a complex and expensive therapy, but can benefit a selected group of patients who fare poorly with conventional therapy. This report communicates the first three successful allogeneic bone marrow transplants performed in Chile.

Ifosfamide treatment of advanced ovarian cancer

To determine the efficacy of ifosfamide in the treatment of advanced ovarian malignancy, 20 patients with stages III and IV epithelial ovarian cancer were treated with this agent. Of these, 15 received the drug as primary chemotherapy. The response rate was 33%, with a median duration of remission of 13 months. Five patients were treated with ifosfamide after failure with previous chemotherapy; no responses were seen in this group. Hematuria was observed in 2% of the treatment cycles with the use of the antidote mercapto-ethan-sulfonate acid. This study shows that though ifosfamide is an active drug in the treatment of patients with advanced ovarian cancer, it is not superior to traditional single alkylating agents.

Presynaptic depolarization of unmyelinated primary afferent fibers in the spinal cord of the cat

Low intensity (1-20 micro A) intraspinal stimulation produces in the sural nerve of the anesthetized cat short latency responses (3-4 ms) due to antidromic activation of fibers conducting in the A range (43-65 m/s). With higher stimulus intensities (up to 400 micro A) late responses (120-250 ms latency) may also be recorded. Simultaneous recording from two sites in the sural nerve shows that the peripheral processes of the fibers generating the late responses have a conduction velocity between 0.8-1.3 m/s. Collision between antidromic and orthodromic responses further indicates that these fibers have a peripheral threshold 20-25 times that of the A fibers. The late responses were largest when the intraspinal stimulating electrode was located in the dorsal horn, in the region corresponding to Laminae II and III of Rexed. The above observations suggest that the late responses are due to population responses of C fibers which are antidromically activated in the dorsal horn. The excitability of the C fiber terminals is increased by conditioning stimuli applied to other cutaneous afferents with a time course resembling that of the excitability increase of the A fibers on the same nerve. It is suggested that the effectiveness of synaptic transmission from C fibers to second order cells may be modulated presynaptically. In the decerebrate cat the antidromic responses of C fibers are reduced, but not abolished, by reversible spinalization produced by cooling or by sectioning the thoracic spinal cord. This suggests in addition that in the decerebrate preparation the presynaptic effectiveness of the C fiber (presumably nociceptive) input may be tonically decreased by supraspinal influences.

[Response of growth hormone (GH) to glucagon-propranolol stimulation in diabetic subjects (author's transl)]

The functional study of growth hormone (GH) requires at least three different stimulation tests. To obtain a degree of hypoglycemia good enough to stimulate GH release is difficult in diabetic patients, and this fact has prompted us to utilize the stimulation induced by glucagon-propranolol. The test was performed in 15 diabetic patients and the results compared to those of 15 non-diabetic subjects. In the diabetic patients GH increased after stimulation from a mean basal level of 2.14 ng/ml to 15.32 ng/ml (p less than 0.01). Peak GH levels in plasma were reached between 120 and 180 minutes. Two failures were found and there were only minimal side effects. The results indicate that the test is valuable for the study of GH release in diabetic patients, and that it may substitute for the induction of hypoglycemia, which is more difficult to obtain in these patients. Finally, the results are compared to those obtained by other authors.

Phylogenetic distribution, regulation of secretion, and prolactin-like effects of placental lactogens

The occurrence of placental lactogens has been reported for members of 4 orders, 7 families, and 15 genera, while its absence has been documented in representatives from 4 orders, 5 families, and 5 genera. Placental lactogens from several genera have been isolated, purified, and characterized biochemically. The cellular sites of production and patterns of secretion of placental lactogens have been described. The regulation of placental lactogen secretion is not understood, although its synthesis and release can be modified experimentally by altering metabolic, ionic, and hormonal factors in the placental environment. Placental lactogens stimulate lactogenesis and steroidogenesis. The mechanism underlying placental lactogen's role in these processes has not been clarified.

The influence of the gamma system on cross-correlated activity of Ia muscle spindles and its relation to information transmission

In the decerebrate cat during static or slowly varying (less than 0.3 Hz) muscle stretches, the activity of muscle spindle (MS) pairs was poorly correlated and such correlation was not changed after ventral root sectioning. With slightly faster sinusoidal stretches (0.3-20 Hz) activity in pairs of MS was also poorly correlated. However, sectioning of the ventral roots produced preferential firing frequencies in the same muscle spindle pairs and increased their degree of correlation. The increase in correlation between MS activity detected after suppressing the gamma bias appeared to arise from extrinsic 60 Hz power line vibration in the range of micrometers. Nevertheless, activation of the gamma system could suppress such phase locking. When frequencies above 20 Hz were used, the gamma system could not decorrelate the MS pair activity since the two units became locked to their common input signal. It is suggested that decorrelation of MS activity by gamma influence may improve the fidelity of the information transmitted by the Ia MS ensemble by filtering distortion harmonics, as well as damping tremor oscillations in the stretch reflex loop.

A method for the dynamic continuous estimation of excitability changes of single fiber terminals in the central nervous system

A method is presented allowing direct and continuous estimation of the excitability changes of single fiber terminal arborizations within the central nervous system. In essence, the method measures the current required to maintain a preset antidromic firing probability of the unit under study. This implies operation in a closed loop system controlled by a computer. With this technique one can accurately determine input-output curves of single units requiring relatively small current variations (0.15-2.1 microA) to change from zero to maximal probability of response. The method also allows measurement of the excitability changes produced by conditioning volleys to sensory nerves.