The Roles of Protocols and Protocolization in Improving Outcome From Severe Traumatic Brain Injury

BACKGROUND AND OBJECTIVES

Our Phase-I parallel-cohort study suggested that managing severe traumatic brain injury (sTBI) in the absence of intracranial pressure (ICP) monitoring using an ad hoc Imaging and Clinical Examination (ICE) treatment protocol was associated with superior outcome vs nonprotocolized management but could not differentiate the influence of protocolization from that of the specific protocol. Phase II investigates whether adopting the Consensus REVised Imaging and Clinical Examination (CREVICE) protocol improved outcome directly or indirectly via protocolization.

METHODS

We performed a Phase-II sequential parallel-cohort study examining adoption of the CREVICE protocol from no protocol vs a previous protocol in patients with sTBI older than 13 years presenting ≤24 hours after injury. Primary outcome was prespecified 6-month recovery. The study was done mostly at public South American centers managing sTBI without ICP monitoring. Fourteen Phase-I nonprotocol centers and 5 Phase-I protocol centers adopted CREVICE. Data were analyzed using generalized estimating equation regression adjusting for demographic imbalances.

RESULTS

A total of 501 patients (86% male, mean age 35.4 years) enrolled; 81% had 6 months of follow-up. Adopting CREVICE from no protocol was associated with significantly superior results for overall 6-month extended Glasgow Outcome Score (GOSE) (protocol effect = 0.53 [0.11, 0.95], P = .013), mortality (36% vs 21%, HR = 0.59 [0.46, 0.76], P < .001), and orientation (Galveston Orientation and Amnesia Test discharge protocol effect = 10.9 [6.0, 15.8], P < .001, 6-month protocol effect = 11.4 [4.1, 18.6], P < .005). Adopting CREVICE from ICE was associated with significant benefits to GOSE (protocol effect = 0.51 [0.04, 0.98], P = .033), 6-month mortality (25% vs 18%, HR = 0.55 [0.39, 0.77], P < .001), and orientation (Galveston Orientation and Amnesia Test 6-month protocol effect = 9.2 [3.6, 14.7], P = .004). Comparing both groups using CREVICE, those who had used ICE previously had significantly better GOSE (protocol effect = 1.15 [0.09, 2.20], P = .033).

CONCLUSION

Centers managing adult sTBI without ICP monitoring should strongly consider protocolization through adopting/adapting the CREVICE protocol. Protocolization is indirectly supported at sTBI centers regardless of resource availability.

A Simple Validated Method for the Estimation of Pepsin Activity in Microtiter Array for the INFOGEST Protocol

The INFOGEST protocol has been widely used as a static in-vitro simulation of gastrointestinal food digestion for bioaccessibility assessments on bioactive compounds. The standardization of the activity of several enzymes, such as pepsin, via UV-spectrophotometry of digested hemoglobin at 280 nm is a key step in the protocol. Standardization is a crucial stage since it is necessary to determine the quantity of enzyme to be added to the sample for digestion. However, this method is yet to be analytically validated; it requires quartz cuvettes and large volumes of samples and is time-consuming. Thus, we reviewed and adapted a well-known colorimetric method in microplates array by using the Folin-Ciocalteu reagent, and this study is the first to report for miniaturization of this method, the advantages of which include its automation, ease of use, the low volume of samples required, the minimal use of reagents, and speed. This method was compared to the traditional UV method, and the comparison results show no statistical difference between the inter day means for each group (p > 0.05). The proposed method was validated, showing high reproducibility (8% as inter-day CV) and statistically comparable results with the traditional UV spectrophotometric method.

The Impact of 2-Ketones Released from Solid Lipid Nanoparticles on Growth Modulation and Antioxidant System of Lactuca sativa

2-Ketones are signal molecules reported as plant growth stimulators, but their applications in vegetables have yet to be achieved. Solid lipid nanoparticles (SLNs) emerge as a relevant nanocarrier to develop formulations for the controlled release of 2-ketones. In this sense, seedlings of Lactuca sativa exposed to 125, 375, and 500 µL L-1 of encapsulated 2-nonanone and 2-tridecanone into SLNs were evaluated under controlled conditions. SLNs evidenced a spherical shape with a size of 230 nm. A controlled release of encapsulated doses of 2-nonanone and 2-tridecanone was observed, where a greater release was observed as the encapsulated dose of the compound increased. Root development was strongly stimulated mainly by 2-tridecanone and leaf area (25-32%) by 2-nonanone. Chlorophyll content increased by 15.8% with exposure to 500 µL L-1 of 2-nonanone, and carotenoid concentration was maintained with 2-nonanone. Antioxidant capacity decreased (13-62.7%) in L. sativa treated with 2-ketones, but the total phenol concentration strongly increased in seedlings exposed to some doses of 2-ketones. 2-Tridecanone strongly modulates the enzymatic activities associated with the scavenging of H2O2 at intra- and extracellular levels. In conclusion, 2-ketones released from SLNs modulated the growth and the antioxidant system of L. sativa, depending on the dose released.

Stability of Phenolic Compounds, Antioxidant Activity and Color Parameters in Colored-Flesh Potato Chips

Potato (Solanum tuberosum) chips are the most consumed snacks worldwide today. Colored potato chips prepared from potato cultivars with red and purple flesh are a novel alternative to traditional potato chips because of their higher phenolic compound content, such as anthocyanins and hydroxycinnamic acid derivatives (HCADs), which might make these chips healthier compared with traditional chips. There is little information on the stability of these compounds. In this study, the nutritional value of these chips was evaluated by determining phenolic profiles, antioxidant activity and color parameters with liquid chromatography diode array and mass spectrometry detection (HPLC-DAD-ESI-MS/MS) and spectrophotometric methods during storage for four months. Five anthocyanins and three HCADs were detected, with the latter compounds being the most abundant, with concentrations on average between the first (97.82 mg kg-1) and the last (31.44 mg kg-1) week of storage. Similar trends were observed in antioxidant activity and stability, with the CUPRAC method showing the highest response among all the methods employed. The color indices were stable throughout the storage time. Based on these results, colored-flesh potato chips are an optimal alternative for consumption because of their high retention of phenolic compounds and antioxidant activity during storage, providing potential benefits to human health.

Testing the Impact of Protocolized Care of Patients With Severe Traumatic Brain Injury Without Intracranial Pressure Monitoring: The Imaging and Clinical Examination Protocol

BACKGROUND

Most patients with severe traumatic brain injury (sTBI) in low- or-middle-income countries and surprisingly many in high-income countries are managed without intracranial pressure (ICP) monitoring. The impact of the first published protocol (Imaging and Clinical Examination [ICE] protocol) is untested against nonprotocol management.

OBJECTIVE

To determine whether patients treated in intensive care units (ICUs) using the ICE protocol have lower mortality and better neurobehavioral functioning than those treated in ICUs using no protocol.

METHODS

This study involved nineteen mostly public South American hospitals. This is a prospective cohort study, enrolling patients older than 13 years with sTBI presenting within 24 h of injury (January 2014-July 2015) with 6-mo postinjury follow-up. Five hospitals treated all sTBI cases using the ICE protocol; 14 used no protocol. Primary outcome was prespecified composite of mortality, orientation, functional outcome, and neuropsychological measures.

RESULTS

A total of 414 patients (89% male, mean age 34.8 years) enrolled; 81% had 6 months of follow-up. All participants included in composite outcome analysis: average percentile (SD) = 46.8 (24.0) nonprotocol, 56.9 (24.5) protocol. Generalized estimating equation (GEE) used to account for center effects (confounder-adjusted difference [95% CI] = 12.2 [4.6, 19.8], P = .002). Kaplan-Meier 6-month mortality (95% CI) = 36% (30%, 43%) nonprotocol, 25% (19%, 31%) protocol (GEE and confounder-adjusted hazard ratio [95% CI] = .69 [.43, 1.10], P = .118). Six-month Extended Glasgow Outcome Scale for 332 participants: average Extended Glasgow Outcome Scale score (SD) = 3.6 (2.6) nonprotocol, 4.7 (2.8) protocol (GEE and confounder-adjusted and lost to follow-up-adjusted difference [95% CI] = 1.36 [.55, 2.17], P = .001).

CONCLUSION

ICUs managing patients with sTBI using the ICE protocol had better functional outcome than those not using a protocol. ICUs treating patients with sTBI without ICP monitoring should consider protocolization. The ICE protocol, tested here and previously, is 1 option.

Berberis microphylla G. Forst Intake Reduces the Cardiovascular Disease Plasmatic Markers Associated with a High-Fat Diet in a Mice Model

Polyphenols are bioactive substances that participate in the prevention of chronic illnesses. High content has been described in Berberis microphylla G. Forst (calafate), a wild berry extensively distributed in Chilean-Argentine Patagonia. We evaluated its beneficial effect through the study of mouse plasma metabolome changes after chronic consumption of this fruit. Characterized calafate extract was administered in water, for four months, to a group of mice fed with a high-fat diet and compared with a control diet. Metabolome changes were studied using UHPLC-DAD-QTOF-based untargeted metabolomics. The study was complemented by the analysis of protein biomarkers determined using Luminex technology, and quantification of OH radicals by electron paramagnetic resonance spectroscopy. Thirteen features were identified with a maximum annotation level-A, revealing an increase in succinic acid, activation of tricarboxylic acid and reduction of carnitine accumulation. Changes in plasma biomarkers were related to inflammation and cardiovascular disease, with changes in thrombomodulin (-24%), adiponectin (+68%), sE-selectin (-34%), sICAM-1 (-24%) and proMMP-9 (-31%) levels. The production of OH radicals in plasma was reduced after calafate intake (-17%), especially for the group fed with a high-fat diet. These changes could be associated with protection against atherosclerosis due to calafate consumption, which is discussed from a holistic and integrative point of view.

B-value variations in the Central Chile seismic gap assessed by a Bayesian transdimensional approach

The b-value can be used to characterize the seismic activity for a given earthquake catalog and provide information on the stress level accumulated at active faults. Here we develop an algorithm to objectively estimate variations of b-value along one arbitrary dimension. To this end, we employ a Bayesian transdimensional approach where the seismic domains will be self-defined according to information in the seismic catalog. This makes it unnecessary to prescribe the location and extent of domains, as it is commonly done. We first show the algorithm's robustness by performing regressions from synthetic catalogs, recovering the target models with great accuracy. We also apply the algorithm to a microseismicity catalog for the Central Chile region. This segment is considered a seismic gap where the last major earthquake with shallow slip was in 1730. Our results illuminate the downdip limit of the seismogenic zone and the transition to intraslab seismicity. In the along-strike direction, low b-value coincides with the extent of locked asperities, suggesting a high-stress loading at the Central Chile seismic gap. Our results indicate the reliability of the Bayesian transdimensional method for capturing robust b-value variations, allowing us to characterize the mechanical behavior on the plate interface of subduction zones.

Follow-up of gallbladder polyps in a high-risk population of gallbladder cancer: a cohort study and multivariate survival competing risk analysis

BACKGROUND

The risk of neoplasia in gallbladder polyps seems to be low, but the evidence from populations at high-risk of gallbladder cancer is limited. We aimed to estimate the risk and to identify the factors associated with neoplastic polyps in a high-risk Hispanic population.

METHODS

A retrospective cohort was recruited between January 2010 and December 2019 at a Chilean university center. Multivariate survival analyses were conducted. Fine-Gray models were fitted to account for competing risks. Covariate adjustment was conducted using propensity scores. The main outcome was the development of gallbladder adenomas or adenocarcinoma.

RESULTS

Overall, 748 patients were included, 59.6% underwent cholecystectomy. The median follow-up of patients not subjected to cholecystectomy was 54.7 months (12-128.6 months). Seventeen patients (2.27%) developed the outcome. After adjustment by age, sex, intralesional blood flow, lithiasis and gallbladder wall thickening, only polyp size (≥10 mm, adjusted-HR: 15.01, 95%CI: 5.4-48.2) and number of polyps (≥3 polyps, adjusted-HR: 0.11, 95%CI: 0.01-0.55) were associated with neoplasia.

CONCLUSION

In a Hispanic population at high-risk for gallbladder cancer, gallbladder polyps seem to have a low risk of neoplasia. Polyp size was the main risk factor, while having multiple polyps was associated with an underlying benign condition.

Berberis microphylla G. Forst (Calafate) Berry Extract Reduces Oxidative Stress and Lipid Peroxidation of Human LDL

Calafate (Berberis microphylla G. Forst) is a Patagonian barberry very rich in phenolic compounds. Our aim was to demonstrate, through in vitro models, that a comprehensive characterized calafate extract has a protective role against oxidative processes associated to cardiovascular disease development. Fifty-three phenolic compounds (17 of them not previously reported in calafate), were tentatively identified by Ultra-Liquid Chromatography with Diode Array Detector, coupled to Quadrupole-Time of Fly Mass Spectrometry (UHPLC-DAD-QTOF). Fatty acids profile and metals content were studied for the first time, by Gas Chromatography Mass Spectrometry (GC-MS) and Total X-ray Fluorescence (TXRF), respectively. Linolenic and linoleic acid, and Cu, Zn, and Mn were the main relevant compounds from these groups. The bioactivity of calafate extract associated to the cardiovascular protection was evaluated using Human Umbilical Vein Endothelial Cells (HUVECs) and human low density lipoproteins (LDL) to measure oxidative stress and lipid peroxidation. The results showed that calafate extract reduced intracellular Reactive Oxygen Species (ROS) production (51%) and completely inhibited LDL oxidation and malondialdehyde (MDA) formation. These findings demonstrated the potential of the relevant mix of compounds found in calafate extract on lipoperoxidation and suggest a promising protective effect for reducing the incidence of cardiovascular disease.

Isolation of Three Lycorine Type Alkaloids from Rhodolirium speciosum (Herb.) Ravenna Using pH-Zone-Refinement Centrifugal Partition Chromatography and Their Acetylcholinesterase Inhibitory Activities

Preparative separation of three lycorine type alkaloids from Rhodolirum speciosum (Amaryllidaceae) was successfully carried out using pH-zone-refinement centrifugal partition chromatography (CPC) using the solvent system methyl-tert-butyl ether/acetonitrile/water (4:1:5, v/v/v) in descending mode. Using this system, Alkaloid 1 (165.7 mg, 88.2%, purity), 2 (60.1 mg, 97.7% purity) and 3 (12.3 mg, 84.4% purity) were obtained in one step. For structure elucidation, the pure alkaloids were subjected to spectroscopy analysis using nuclear magnetic resonance experiments (¹H-NMR, ¹³C-NMR) and gas chromatography coupled with mass spectrometry (GC-MS). Alkaloids 1, 2, and 3 were identified as 1-O-acetyl-5,6-dehydrolycorine, 1-O-acetyl-lycorine, and 1,2-O-diacetyl-5,6-dehydrolycorine, respectively. The acetylcholinesterase inhibitory activity of these alkaloids was IC₅₀ 151.1 μg/mL, IC₅₀ 203.5 μg/mL, IC₅₀ 470.0 μg/mL, and IC₅₀ 17.1 μg/mL, respectively.

In vitro micropropagation and alkaloids analysis by GC-MS of Chilean Amaryllidaceae plants: Rhodophiala pratensis

INTRODUCTION

Plants from Amaryllidaceae family are of interest since they produce a particular type of alkaloid useful for the treatment of neurodegenerative diseases of the central nervous system, such as Galanthamine. Given the low content of these secondary metabolites in the plant, it is necessary to study mechanisms to increase the productivity of them.

OBJECTIVE

To obtain fast qualitative and quantitative analysis of the alkaloids and extend the understanding of biosynthesis and metabolism in these kinds of plants. Furthermore, establish a reliable, simple and fast analytical method for the in vitro callus culture of vegetative organs for Rhodophiala pratensis species.

METHODS

The alkaloids composition of the callus culture of R. pratensis were analysed by gas chromatography coupled with mass spectrometry (GC-MS).

RESULTS

A methodology for the qualitative and quantitative analysis of the alkaloids present in fresh callus culture of this wild plant species was established. The analysis showed alternation in the alkaloids type ratio and number of compounds between wild bulbs, in vitro bulbs and callus. It was possible to identify 24 alkaloids from a pool of 60 signals whose fragmentation pattern corresponds to the alkaloids of Amaryllidaceae plants. Together with the aforementioned, the amount and type of alkaloid present in the plant material obtained by in vitro culture of R. pratensis was determined in the same way. The results show the high biosynthetic potential of in vitro grown bulbs and callus tissue that are able to produce significant amounts of pharmacologically relevant alkaloids from R. pratensis in various proportions that depend on the culture conditions such as supplementation with growth substances. The in vitro grown bulbs produce an alkaloidal extract that contain a 52.6% w/w of alkaloids.

CONCLUSION

This study allowed the alkaloid content in callus culture of R. pratensis to be found by means of GC-MS. These results allowed a relationship between the type of growth regulator and the type of alkaloids found to be established. Finally, we can say that the results achieved to state that the production of alkaloids using different combinations of growth regulators could be directed during in vitro micropropagation from provided plant material.

Improved Treatment Related Mortality in Patients with Primary Systemic Amyloidosis (AL Amyloidosis) undergoing Autologous Hematopoietic Stem Cell Transplant (aHSCT)

To date, there is no standard of care for patients with newly diagnosed Primary (AL) amyloidosis. Autologous hematopoietic stem cell transplant (aHSCT) is a reasonable option, but has been limited in its use due to increase in treatment-related mortality (TRM). We retrospectively analyzed the outcomes of 42 newly diagnosed consecutive AL amyloidosis patients transplanted at our center. The median age at aHSCT was 57.5 (range 26-71). Twenty one (50%) had involvement of at least two organs and 40 (97%) patients had cardiac stage I or II. Patients received high dose Melphalan 140(n=4) or 200(n=38) mg/m². Median times to neutrophil and platelet engraftments were 12 and 18 days, respectively. Three months hematologic response were complete response in 21 patients (50%), very good partial response in 4 (10%), partial response in 5 (12%) and Minimal/Stable disease in 6(15%). The respective 1, 3, and 5 year progression-free survival were 79%, 67% and 57%, and overall survival from Transplant 81%, 73% and 66%. Day 100 and 1 year TRM were 4.8% and 7.1% respectively. Our results show that aHSCT is a safe and reasonable option for patients with AL amyloidosis. Day 100 and 1 year TRM compares favorably to multiple myeloma patients undergoing aHSCT.

A Crossover Comparison of Standard and Telerobotic Approaches to Prenatal Sonography

OBJECTIVES

To determine the feasibility of a telerobotic approach to remotely perform prenatal sonographic examinations.

METHODS

Thirty participants were prospectively recruited. Participants underwent a limited examination (assessing biometry, placental location, and amniotic fluid; n = 20) or a detailed examination (biometry, placental location, amniotic fluid, and fetal anatomic survey; n = 10) performed with a conventional ultrasound system. This examination was followed by an equivalent examination performed with a telerobotic ultrasound system, which enabled sonographers to remotely control all ultrasound settings and fine movements of the ultrasound transducer from a distance. Telerobotic images were read independently from conventional images.

RESULTS

The mean gestational age ± SD of the 30 participants was 22.9 ± 5.3 weeks. Paired-sample t tests showed no statistically significant difference between conventional and telerobotic measurements of fetal head circumference, biparietal diameter, or single deepest vertical pocket of amniotic fluid; however, a small but statistically significant difference was observed in measurements of abdominal circumference and femur length (P < .05). Intraclass correlations showed excellent agreement (>0.90) between telerobotic and conventional measurements of all 4 biometric parameters. Of 21 fetal structures included in the anatomic survey, 80% of the structures attempted across all patients were sufficiently visualized by the telerobotic system (range, 57%-100% per patient). Ninety-seven percent of patients strongly or somewhat agreed that they would be willing to have another telerobotic examination in the future.

CONCLUSIONS

A telerobotic approach is feasible for remotely performing prenatal sonographic examinations. Telerobotic sonography (robotic telesonography) may allow for the development of satellite ultrasound clinics in rural, remote, or low-volume communities, thereby increasing access to prenatal imaging in underserved communities.

Evaluation of microextraction by packed sorbent, liquid-liquid microextraction and derivatization pretreatment of diet-derived phenolic acids in plasma by gas chromatography with triple quadrupole mass spectrometry

Miniaturized sample pretreatments for the analysis of phenolic metabolites in plasma, involving protein precipitation, enzymatic deconjugation, extraction procedures, and different derivatization reactions were systematically evaluated. The analyses were conducted by gas chromatography with mass spectrometry for the evaluation of 40 diet-derived phenolic compounds. Enzyme purification was necessary for the phenolic deconjugation before extraction. Trimethylsilanization reagent and two different tetrabutylammonium salts for derivatization reactions were compared. The optimum reaction conditions were 50 μL of trimethylsilanization reagent at 90°C for 30 min, while tetrabutylammonium salts were associated with loss of sensitivity due to rapid activation of the inert gas chromatograph liner. Phenolic acids extractions from plasma were optimized. Optimal microextraction by packed sorbent performance was achieved using an octadecylsilyl packed bed and better recoveries for less polar compounds, such as methoxylated derivatives, were observed. Despite the low recovery for many analytes, repeatability using an automated extraction procedure in the gas chromatograph inlet was 2.5%. Instead, using liquid-liquid microextraction, better recoveries (80-110%) for all analytes were observed at the expense of repeatability (3.8-18.4%). The phenolic compounds in gerbil plasma samples, collected before and 4 h after the administration of a calafate extract, were analyzed with the optimized methodology.

Differences in Vvufgt and VvmybA1 Gene Expression Levels and Phenolic Composition in Table Grape (Vitis vinifera L.) 'Red Globe' and Its Somaclonal Variant 'Pink Globe'

A novel 'Red Globe' (RG)-derived grape variety, 'Pink Globe' (PG), was described and registered as a new genotype, with earlier ripening and sweeter taste than those of RG. Microsatellite analysis revealed that PG and RG are undifferentiable; however, the PG VvmybA1c contains six single-nucleotide polymorphisms within the coding and noncoding region, possibly related to the reduced VvmybA1 expression levels. Conversely, HPLC-DAD-ESI-MS/MS analysis showed significantly lower anthocyanin content in PG skin than in RG skin, and PG had no detectable trihydroxylated anthocyanins. Total flavonols did not differ between the variants, although some quercetin derivate concentrations were lower in PG. HPLC-FLD analysis revealed slightly higher concentrations of epicatechin and a procyanidin dimer in PG seeds, although the antioxidant capacity of crude extracts from either variety did not differ significantly. These differences, particularly in monomeric anthocyanin content, can be attributed to altered activity of a MYB-type transcription factor, reducing Vvufgt expression.

Case Report: Using a Remote Presence Robot to Improve Access to Physical Therapy for People with Chronic Back Disorders in an Underserved Community

Purpose: The purpose of this case study was to evaluate the delivery of an inter-professional (IP) spinal triage management approach to chronic back disorders using remote presence robotic technology as an innovative form of telerehabilitation in a northern Saskatchewan community. Methods: The IP team, consisting of a local nurse practitioner (NP) and a physical therapist in an urban centre, completed a comprehensive neuromusculoskeletal assessment of, and one follow-up visit with, a post-surgical spinal patient. Treatment included detailed education regarding self-management after spinal surgery, provision and progression of home exercises, and reassurance. The patient was then referred to regional, in-person physical therapy care to complete her treatment. Results: A semi-structured interview with the NP revealed a high level of satisfaction; qualitative themes included the value of IP practice and the benefit to the patient of telerehabilitation achieved through patient-centred care. In a post-treatment survey, the patient expressed a high level of satisfaction with and appreciation for the patient-centred approach and the IP team. Objective clinical improvements in spinal and straight-leg raise movements were noted at the final telerehabilitation session. Conclusion: This report demonstrates the feasibility of delivering IP spinal triage management using telerehabilitation, specifically remote presence robotics, in a remote setting. Further research should include larger scale studies that investigate health, system, and economic outcomes as well as comparative studies for other forms of telehealth technology.

Initial Experience Using a Telerobotic Ultrasound System for Adult Abdominal Sonography

PURPOSE

The study sought to assess the feasibility of performing adult abdominal examinations using a telerobotic ultrasound system in which radiologists or sonographers can control fine movements of a transducer and all ultrasound settings from a remote location.

METHODS

Eighteen patients prospectively underwent a conventional sonography examination (using EPIQ 5 [Philips] or LOGIQ E9 [GE Healthcare]) followed by a telerobotic sonography examination (using the MELODY System [AdEchoTech] and SonixTablet [BK Ultrasound]) according to a standardized abdominal imaging protocol. For telerobotic examinations, patients were scanned remotely by a sonographer 2.75 km away. Conventional examinations were read independently from telerobotic examinations. Image quality and acceptability to patients and sonographers was assessed.

RESULTS

Ninety-two percent of organs visualized on conventional examinations were sufficiently visualized on telerobotic examinations. Five pathological findings were identified on both telerobotic and conventional examinations, 3 findings were identified using only conventional sonography, and 2 findings were identified using only telerobotic sonography. A paired sample t test showed no significant difference between the 2 modalities in measurements of the liver, spleen, and diameter of the proximal aorta; however, telerobotic assessments overestimated distal aorta and common bile duct diameters and underestimated kidney lengths (P values < .05). All patients responded that they would be willing to have another telerobotic examination.

CONCLUSIONS

A telerobotic ultrasound system is feasible for performing abdominal ultrasound examinations at a distant location with minimal training and setup requirements and a moderate learning curve. Telerobotic sonography (robotic telesonography) may open up the possibility of remote ultrasound clinics for communities that lack skilled sonographers and radiologists, thereby improving access to care.

Variations in the anatomical relationship between the common carotid artery and the internal jugular vein: an ultrasonographic study

INTRODUCTION

The internal jugular vein locates anterior or anterolateral to the common carotid artery in two-thirds of the subjects studied by ultrasound when the head is in a rotated position.

AIM

To identify variables associated with the anterior location of the internal jugular vein.

METHODS

Ultrasound examinations were performed with the patients in the supine position, with the head rotated to the opposite side. The proximal third of the neck was visualized transversely with a 7.5-mHz transducer. The relationship between the vessels was described in accordance with the proportion of the artery overlapped by the vein. Univariate comparisons and a multivariate analysis of potential variables that may affect the anatomic relationships were performed.

RESULTS

Seventy-eight patients were included, 44 of whom were men. The patients' ages ranged from 17 to 90 years (median 64.0, interquartile range 41-73). The right and left sides were studied 75 and 73 times, respectively. The vein was located lateral to the artery in 24.3% (95%CI= 17.4-32.2) of the studies, anterolateral in 33.8% (95%CI= 26.2-41.4) and anterior in 41.9% (95%CI= 33.9-49.8). The multivariate analysis identified age group (OR= 3.7, 95% CI 2.1-6.4) and, less significantly, the left side (OR= 1.7, 95%CI= 0.8-3.5) and male gender (OR= 1.2, 95%CI= 0.6-2.7) as variables associated with the anterior position of the vein.

CONCLUSIÓN

The anterior position of the internal jugular vein relative to the common carotid artery increases gradually with age. Additionally, left-sided localization and male sex further increased the probability of an anterior position.

Flavonols, alkaloids, and antioxidant capacity of edible wild berberis species from patagonia

There are 20 species of the Berberidaceae family described in Chile, whose fruits are edible and show high anthocyanin and hydroxycinnamic acid levels. Berberis microphylla G. Forst, commonly known as calafate, is the most extensively distributed. Flavonols and alkaloids in seed, pulp, skin, and whole calafate berry extracts and other Berberis were studied using HPLC-DAD-ESI-MS/MS and HPLC with fluorescence detector. Berry samples from different locations in Chilean Patagonia, including different phenological stages, were systematically addressed. Results were compared with other organs of the plant and with other Berberis species. Total flavonol concentration in calafate (n = 65) was 1.33 ± 0.54 μmol/g. Glycosyl metabolites of quercetin and isorhamnetin were the most abundant. Similar profiles were observed in calafate from distinct locations, but important differences were observed for the other edible Berberis species. Calafate pulp and skin have higher flavonol concentrations than seeds, and the maturation process reduced its levels. TEACCUPRAC and TEACABTS of whole calafate extracts and fractions are also explored. Finally, only berberine was detected in the fruit (0.001%), mainly in seeds. Results contribute to the promotion of this berry as a superfruit from Patagonia.

Hydroxycinnamic acids and flavonols in native edible berries of South Patagonia

Diverse edible berries are native to the Patagonian region of Southern Chile. These berries are underused because their nutritional properties are relatively unknown. In this work, the profiles and concentrations of hydroxycinnamic acid derivatives and flavonols, and the antioxidant capacity of the berry extracts, were studied using HPLC-DAD-ESI-MS/MS and CUPRAC assays, respectively. In total, 46 compounds were identified, including 17 hydroxycinnamic acid derivatives and 26 flavonols. Caffeoylquinic acid isomers were the most abundant compounds, and quercetin and myricetin derivatives were the main flavonols found. The berries from Ribes genera showed a high diversity and concentration of these 2 families of compounds and contained 3-caffeoylquinic acid and quercetin-3-rutinoside at the highest concentrations. The Patagonian berries, especially the berries of Rubus and Ribes genera, had high cupric reducing antioxidant capacity, comparable with that described for berries from the Northern hemisphere. These results contribute to promote the nutritional study of these fruits.

New HLA polymorphism detection by molecular and serologic typing procedures. Complete coding region characterization of Cw*0525, Cw*0825, B*3950 and A*3219N alleles

Four new HLA class I alleles, Cw*0525, Cw*0825, B*3950 and A*3219N, have been characterized.

Characterization of the novel HLA-A*3217 allele in two Caucasian Spanish donors

A novel human leukocyte antigen-A allele, officially named A*3217, was found in two unrelated Spanish donors. A*3217 differs from A*320101 in a point mutation at codon 70 (CAC-->CAG), generating an amino acid substitution of His to Gln.

Sequencing of four new HLA-C alleles, Cw*070403, Cw*0757, Cw*1705, and Cw*0223

Sequencing-based typing for unrelated hematopoietic stem cell transplantation studies rendered four new HLA-C alleles. HLA-Cw*0757, Cw*070403, and Cw*1705 differ by single point mutations from their most similar alleles, Cw*070105, Cw*070401, and Cw*1701, respectively. In contrast, Cw*0223 discloses five amino acid replacements at the alpha2 domain regarding Cw*020202.

Sequencing of new HLA-A*3025 and HLA-Cw*0221 alleles found in Caucasian donors

Two new human leukocyte antigen (HLA) class I alleles, A*3025 and Cw*0221, were identified in Spanish Caucasian donors by polymerase chain reaction-sequence-specific oligonucleotide and subsequently characterized by full coding region sequencing. HLA-A*3025 shows a single amino acid replacement at residue 70 (H>Q) compared with A*300201. HLA-Cw*0221 differs from Cw*020202 by a change at position 14 (H>Q).

New HLA-A allele, A*0339, identified in a Spanish patient

A novel human leukocyte antigen-A allele, officially named A*0339, was found in a patient when sequence-based typing was carried out for unrelated stem cell donor search. A*0339 differs from A*03010101 in a point mutation at codon 102 (GAC-->TAC), generating an exchange of amino acid from Asp to Tyr.

Sequencing of a novel HLA-DRB1*07 allele with a new polymorphism at amino acid position 21 (DRB1*0715)

DRB1*0715 differs from DRB1*070101 in a point nucleotide mutation at codon 21 (ACG-->AAG), which produces an amino acid residue change from T to K.

HLA-A*020115 and HLA-Cw*030203 show new synonymous mutations in exon 4

Two novel human leukocyte antigen (HLA) class I alleles, A*020115 and Cw*030203, were completely characterized by sequencing-based typing. Both present synonymous new HLA polymorphisms at exon 4. A*020115 shows a single nucleotide change regarding A*02010101 at codon 245 GCG > GCC). In contrast, Cw*030203 differs from Cw*030202 in a point mutation at codon 271 (ACC > ACT).

The new HLA-C allele, Cw*0220, shows a new polymorphism at amino acid position 169

The new human leukocyte antigen (HLA)-C allele, Cw*0220, was identified in a Spanish Caucasian patient by sequence-based typing. HLA-Cw*0220 differs from Cw*020202 by a single amino acid replacement at constant position 169 (R > H).

HLA-A*68020103 shows an eight nucleotides deletion within intron 2 but has normal mRNA splicing and serological recognition

A novel A*68020103 allele was completely characterized by sequencing in a Spanish bone marrow donor. A*68020103 has an eight nucleotides deletion at the 5'-end of intron 2, when compared with other A*6802 alleles. This alteration does not affect either its mRNA splicing process or serological detection.

The effects of restraint stress on the neuropathogenesis of Theiler's virus infection II: NK cell function and cytokine levels in acute disease

Psychological stress is thought to play an important role in multiple sclerosis. We have been investigating the role of restraint stress in Theiler's virus infection in mice as a model for multiple sclerosis. We have previously determined that restraint stressed CBA mice had higher levels of mortality following infection with Theiler's virus. We proposed that this was due to high levels of stress-induced corticosterone, which resulted in decreased numbers of circulating lymphocytes, decreased inflammatory cell infiltrates into the brain and consequently decreased viral clearance from the central nervous system (CNS). The effect of restraint stress on the innate immune response to Theiler's virus is further investigated in the current study. Restraint stressed mice developed clinical signs of encephalitis, thymic atrophy, and adrenal hypertrophy. Decreased numbers of circulating lymphocytes and increased numbers of neutrophils were observed in the stressed mice. Stressed mice also had lower numbers of spleen cells which correlated with the decreased numbers of lymphocytes in circulation. Restraint stress caused elevations in serum tumor necrosis alpha (TNF-alpha). Virus-induced natural killer cell (NK) cytotoxic activity was significantly reduced in restrained mice at one day post infection which may account for the reduced viral clearance from the CNS. These data suggest that stress-induced immunosuppression of cytolytic NK cell activity may account in part for the reduced ability to clear virus from the CNS and increased mortality observed in this model.

Effects of the DT-diaphorase inhibitor dicumarol on striatal monoamine levels in L-DOPA and L-deprenyl pre-treated rats

It has been proposed that DT-diaphorase plays a strategic role as a neuroprotective enzyme for monoamine neurons, perhaps together with monoamine oxidase (MAO). Thus, we investigated the long-term effects produced by DT-diaphorase inhibition with dicumarol injected unilaterally into the medial forebrain bundle (MFB) on monoamine and metabolite levels, alone, or following dopamine loading with 3,4-dihydroxyphenyl-L-alanine (L-DOPA) or MAO inhibition with L-deprenyl. Monoamine levels were assayed in aliquots from tissue samples from right and left striatum, including both dorsal and ventral regions. Dicumarol alone produced increases in 5-hydroxytryptamine (5-HT) and 5-hydroxyindoleacetic acid (5-HIAA), but not in dopamine and metabolite levels when assayed two weeks later. However, following preloading with L-DOPA (3 x 25 mg/kg s.c. 7, 4 and 1 h before surgery), a long-lasting bilateral increase in dopamine and metabolite levels was observed after dicumarol. No effect was observed on dopamine, 5-HT and metabolite levels after L-deprenyl (3 x 10 mg/kg, s.c.) alone, but the levels were unilaterally increased when L-deprenyl was followed by dicumarol. The same result was produced when both L-deprenyl and dicumarol were injected simultaneously into the same brain region. In conclusion, the present study shows that intracerebral inhibition of DT-diaphorase produces long-term changes in 5-HT, but also in dopamine metabolism when DT-diaphorase inhibition is combined with MAO inhibition by systemic or intracerebral treatment with L-deprenyl. It is suggested that both MAO and DT-diaphorase have to be inhibited for inducing long-term changes in monoamine metabolism. Thus, DT-diaphorase is an enzyme to be taken into account when L-DOPA is used to treat Parkinson's disease, or when an MAO-inhibitor is used to treat depression.

Stroke as the first manifestation of calcific aortic stenosis

Heart valve calcifications are rarely recognized as a potential source for cerebral embolism. Previous studies have identified mitral, but not aortic, valve calcifications to be risk factors for stroke. Based on these studies, heart surgery is unlikely to be indicated in patients who present with a stroke and an 'incidental' aortic valve calcification. We report a case of a 46-year-old man presenting with acute onset of left-sided weakness and numbness. A previous smoking history was the only cardiovascular risk factor found. Head CT scan revealed a right middle cerebral artery territory infarct and an adjacent high-density lesion. CT angiography demonstrated the presence of calcific embolic material in the middle cerebral artery. A search for embolic sources revealed a calcific aortic stenosis (CAS). Initially placed on coumadin, the patient developed silent myocardial infarction 2 months later, presumed to be also embolic in origin from the CAS. After aortic valve replacement, the patient has been symptom-free during a 2-year follow-up. In conclusion, CT angiography may be the method of choice for detecting calcific cerebral emboli, and demonstration of a causal relationship between CAS and an embolic stroke by CT angiography may be an important adjunct in surgical decision-making.

La desesperacion: migrant and seasonal farm workers living with HIV/AIDS

Migrant seasonal farm workers (MSFWs) in south Texas are predominantly Mexican American and represent one of the most impoverished and medically underserved populations in the United States. La Frontera is a collaborative partnership between the University of Texas Health Science Center at San Antonio, migrant organizations, and HIV service delivery organizations to study and address special needs of MSFWs in Hidalgo and Maverick counties of south Texas. The purpose of this qualitative study is to explore the health-seeking experiences of HIV-positive MSFWs living in the La Frontera service area. Denzin's interpretive interactionism methodology guided the study. Thirteen participants were interviewed and audiotaped as they described their experiences. Findings from content analysis of the interviews revealed a description of the life of an HIV-positive MSFW as la desesperacion (a separate way of life). After their diagnosis of HIV/AIDS, the major themes in their lives were living in secrecy (a silent cry), finding and receiving health care, and accepting the disease (may it be the will of God).

Serum levels of 25-hydroxyvitamin D in a year of residence on the Antarctic continent

OBJECTIVE

Since exposure to sunlight is the main source of vitamin D in human beings and skin photosynthesis decreases markedly as the latitude increases, we studied the changes in serum 25-hydroxyvitamin D (25(OH)D) levels in young healthy men who lived in the Antarctic Continent during 1 year.

DESIGN

Blood was drawn in the fasting state every 2 months from March 1990 to January 1991 to determine the serum levels of calcium, alkaline phosphatase and 25(OH)D.

SUBJECTS

19 healthy volunteers, who left Buenos Aires (34 degrees S) during the 1990 summer, arriving at the Antarctic bases at the end of January (Belgrano) and in mid-March (San Martín) and stayed there up to summer 1991.

RESULTS

Serum calcium did not change significantly throughout the year. Serum alkaline phosphatase levels were not different comparing the beginning to the end of the year, but autumn and winter levels were lower (P < 0.05). At Belgrano Base the serum 25(OH)D levels (ng/ml) decreased from (mean +/- SD) 18.7 +/- 7.4 (March) to 10.0 +/- 4.3 (July) (P < 0.005) and did not recover for the rest of the year. At San Martín Base the serum 25(OH)D levels descended from 22.0 +/- 5.4 in March to 12.2 +/- 3.7 in August (P < 0.02) and did not increase even at the beginning of summer (January) except in two men with frequent outdoor activities.

CONCLUSIONS

The levels of 25(OH)D of healthy men living in the Antarctic continent decreased to approximately 46% of the initial values and did not increase even at the onset of summer. Further studies should determine the effect of these changes upon calcium-regulating hormones and bone metabolism.

Quantitative evaluation of anticonvulsant effects on penicillin-induced spike foci in cats

We evaluated the effects of phenytoin, carbamazepine, phenobarbital, sodium valproate, and ethosuximide on penicillin-induced spike foci. Phenytoin, carbamazepine, and phenobarbital at blood levels within or slightly above the human therapeutic range in humans increased spike frequency, decreased spike duration, and abolished after discharges. Ethosuximide and sodium valproate had no statistically significant effect even at blood levels considered toxic in humans. The experimental spike focus and the method of analysis appear useful for: (1) detection of new potentially anticonvulsant drugs, (2) classifying new potentially anticonvulsant drugs according to the type of clinical seizure for which benefit is most likely, and (3) comparing different anticonvulsant drugs.

Quantitative studies of spike foci induced by minimal concentrations of penicillin

The minimal concentrations of penicillin which induce stable recurrent spikes (20,000 U/ml) and which elicit stable recurrent after-discharges (100,000 U/ml) were determined. A quantitative study of the inter-relationships, variability and changes with time of a number of spike parameters (spike latency, spike amplitude, amplitude of prepositivity, spike duration and spike frequency) was performed. The study adds new information on the pathogenesis of the experimental spike focus and serves as baseline for quantitative evaluation of the effects of anticonvulsants on the characteristics of the primary spike focus and on after-discharges.

The effects of phenytoin on the penicillin-induced spike focus

A quantitative evaluation of the effects of phenytoin on penicillin-induced spike foci is reported. Phenytoin at blood levels considered within therapeutic range in humans increased spike frequency, decreased spike duration and abolished after-discharges. Spiking at weak foci was completely abolished when high concentrations of phenytoin were used. It is concluded that phenytoin affects mainly the long chain pathways whether the ultimate effects of these pathways are excitatory or inhibitory.