HIV matters when diagnosing TB in young children: an ancillary analysis in children enrolled in the INPUT stepped wedge cluster randomized study

BACKGROUND

Children under age five years, particularly those living with HIV (CLHIV), are at risk for rapid progression of tuberculosis (TB). We aimed to describe TB clinical presentations, diagnostic pathways and treatment outcomes in CLHIV compared to children without HIV in Cameroon and Kenya.

METHODS

This sub-analysis of a cluster-randomized trial evaluating the integration of pediatric TB services from May 2019 to March 2021 enrolled children age < 5 years with TB. We estimated the HIV infection rate with 95% confidence interval (CI). We compared TB clinical presentations, diagnostic pathways and treatment outcomes in CLHIV and children without HIV. Finally, we investigated whether HIV infection was associated with a shorter time to TB diagnosis (≤ 3 months from symptoms onset) after adjusting for covariates. Univariable and multivariable logistic regression analysis were performed with adjusted odds ratios (AORs) presented as measures of the association of covariates with HIV status and with shorter time to TB diagnosis.

RESULTS

We enrolled 157 children with TB (mean age was 1.5 years) and 22/157 (14.0% [9.0-20.4%]) were co-infected with HIV. CLHIV were more likely to initially present with acute malnutrition (AOR 3.16 [1.14-8.71], p = 0.027). Most TB diagnoses (140/157, 89%) were made clinically with pulmonary TB being the most common presentation; however, there was weak evidence of more frequent bacteriologic confirmation of TB in CLHIV, 18% vs. 9% (p = 0.067), due to the contribution of lateral-flow urine lipoarabinomannan to the diagnosis. HIV positivity (AOR: 6.10 [1.32-28.17], p = 0.021) was independently associated with a shorter time to TB diagnosis as well as fatigue (AOR: 6.58 [2.28-18.96], p = 0.0005), and existence of a household contact diagnosed with TB (AOR: 5.60 [1.58-19.83], p = 0.0075), whereas older age (AOR: 0.35 [0.15-0.85], p = 0.020 for age 2-5 years), night sweats (AOR: 0.24 [0.10-0.60], p = 0.0022) and acute malnutrition (AOR: 0.36 [0.14-0.92], p = 0.034) were associated with a delayed diagnosis. The case fatality rate was 9% (2/22) in CLHIV and 4% (6/135) in children without HIV, p = 0.31.

CONCLUSIONS

These results altogether advocate for better integration of TB services into all pediatric entry points with a special focus on nutrition services, and illustrate the importance of non-sputum-based TB diagnostics especially in CLHIV.

TRIAL REGISTRATION

NCT03862261, first registration 05/03/2019.

Mexican immigrant parents' hopes for their children and parenting strategies in different immigration climates

In the present article, we explore the hopes that immigrant parents of Mexican origin have for their children and the strategies they employ to foster such hopes in light of immigration status, immigration climate, and transnational lived experiences. We conducted six focus groups with 42 immigrant parents of Mexican origin living in Arizona and Texas to explore their hopes and strategies used to foster hopes. Parents, the majority of whom were mothers, defined hopes in terms of what they can provide to their children, including (a) a better life through education and economic opportunities, (b) a strong moral and civic upbringing, and (c) safety from neighborhood crime and hostile immigrant climates. Parents fostered these hopes through the strategies of using self as example, parental involvement and monitoring, self-sacrifice, and family unity. Mothers of unauthorized immigration status raising children in a harsh immigration climate also avoided undue public exposure to ensure their children's safety, a task that was difficult for fathers as breadwinners. Immigration status and climate influenced parents' ability to provide opportunities for their children to pursue educational and career opportunities. We discuss parents' hopes and parenting strategies in the context of different immigration climates, highlight emerging gender differences, and provide recommendations for research and practice.

The Impacts of Feeding Natursafe (an Immune Support Product) on Beef Quality

ObjectivesNaturSafe® (Diamond V, USA) is a Saccharomyces cerevisiae fermentation product developed as an animal feed supplement for the further manufacture of nutritionally balanced feeds for beef cattle. This immune support product (Association of American Feed Control Officials number 96.8, 73.046 and International Feed Name number 7–05–520, 8–08–034) has been specifically formulated to optimize beef cattle health and performance, antibiotic stewardship, and food safety. Research has shown that NaturSafe supports optimal rumen and liver health, overall health and immune function, consistency of feed intake, daily gain, feed conversion, and antibiotic effectiveness. As no research previously has assessed the impacts of this feed ingredient on the quality of meat, the objective of this research was to characterize the effects of feeding NaturSafe on meat quality characteristics in beef.Materials and MethodsCrossbred steers (N = 60, n = 12 per treatment; mean hot carcass weight = 421 kg), through an antibiotic free production system, were individually fed diets containing 12, 15, or 18 g/d of NaturSafe or a control diet without (–AB) antibiotics or a control with antibiotics (+AB; 330 mg monensin + 110 mg tylosin·steer–1·d–1) for 112 d. Strip loins were collected and aged for 13 or 29 d postmortem prior to fabrication. Steaks (m. Longissimus) were then evaluated for Warner-Bratzler shear force, pH, sarcoplasmic calcium concentration, troponin-T degradation, fatty acid profile, proximate composition, sarcomere length, total collagen and insoluble collagen. After each aging period, steaks were evaluated for lipid oxidation, and color characteristics (L*, a*, b*, discoloration percentage, and percentage surface oxymyoglobin, metmyoglobin and deoxymyoglobin), during and/or after a 7 d simulated retail display period. A subset of samples at various aging and retail display periods were analyzed for lactic acid bacteria (LAB), psychotrophic plate counts (PPC), and aerobic plate counts (APC). Animal was considered the experimental unit and hot carcass weight and marbling score were used as covariates in the analysis.ResultsTreatment had no effect on pH, sarcomere length, troponin-T degradation, fatty acid profile, proximate composition, total collagen, insoluble collagen, LAB, PPC, APC, lipid oxidation, oxymyoglobin percentage, or metmyoglobin percentage. Meat from cattle fed 18 g/d of NaturSafe was (1) equal to–AB controls and had higher shear force values compared to all other treatments (P < 0.01), (2) had higher (P < 0.05) sarcoplasmic calcium levels than +AB controls and cattle fed 12 g of NaturSafe/d, (3) was redder (higher a* values, P < 0.05) than all other treatments, and (4) was yellower (higher b* values, P < 0.01) than the 12 or 15 g dose and the–AB control. There were no differences among treatments fed NaturSafe for lightness (L*) at either aging time. There were no differences for meat from animals fed 12 or 15 g NatureSafe/d, except deoxymyoglobin percent and discoloration, which were both minimal. Discoloration values were low for all treatments (< 10%).ConclusionThese data indicate that feeding NaturSafe had few discernible effects on meat quality characteristics.

Dry Aging of High Ultimate pH Beef

ObjectivesDry aging is a process in which water is removed from the meat by evaporation. As meat loses water, the flavor compounds are concentrated, resulting in stronger flavor. Meat pH may be important when dry aging as it relates to the ability of muscle to bind water. Therefore, this study aimed to evaluate pH effects on water loss when dry aging and the effects on meat quality characteristics. Dry aging of dark cutting (DC) beef may improve flavor and increase yield.Materials and MethodsSix USDA low Choice and six dark cutting (DC) carcasses with the same degree of marbling were selected and boneless strip loins from both sides were obtained. Longissimus muscle pH was measured, and carcasses were classified as DC (pH = 6.69), or control (pH = 5.47). Then, strip loins from each animal were assigned to 2 aging methods (wet or dry). The 4 treatments included 2 dry aging (DRY and DRY-DC) and 2 wet-aging treatments (WET and WET-DC). Dry aging occurred in individual dry-aging chambers at 50% relative humidity and 2200 RPM fan speed. The chambers (86 cm Length × 48 cm Width × 35 cm Height) have built-in weighing scales that can continuously monitor weight loss (± 5 g). Wet and dry-aged loins were aged in the same cooler for 45 d at 1°C.After aging, loins were fabricated into steaks and evaluated for trim loss, yield, tenderness (WBSF), color, discoloration, lipid oxidation, and sensory analysis (flavor) via triangle test (n = 32). Steaks assigned for color and lipid oxidation were placed under retail display (RD) at 2°C for 7 d. Rate of moisture loss and color data were analyzed as a split plot design with repeated measures. The TBARS data were analyzed as a split-plot design. All the other data were analyzed as a completely randomized design. Chamber (loin) was considered the experimental unit. Data were analyzed using the PROC GLIMMIX procedure of SAS with α = 0.05.ResultsWet-aged treatments had lower moisture loss, trim loss and higher yield than dry-aged treatments (P < 0.05). However, no differences in rate of moisture loss (P = 0.51), total moisture loss (P = 0.96), trim loss (P = 0.69), or yield (P = 0.75) between DRY-DC and DRY were found. There were no differences among treatments for WBSF (P = 0.67). In general, DRY-DC and WET-DC steaks had the lowest lightness (L*) values, redness (a*) values (Fig. 3a), and yellowness (b*) values over the first 5 d of RD (P < 0.05). Discoloration scores for DC steaks remained low throughout the RD period (Fig. 3b). DRY steaks had greater TBARS values than any other treatment at 0 d RD. At 4 and 7 d of RD, DRY-DC and WET-DC steaks had the lowest TBARS values, DRY steaks had the highest, while WET was intermediate (P < 0.001). Results from the triangle test indicated a detectable difference between DRY-DC versus DRY (P = 0.01), DRY-DC versus WET-DC (P = 0.01), DRY-DC versus WET (P = 0.01), and WET-DC versus WET (P < 0.01). Panelists frequently made unsolicited comments which suggested inferior eating satisfaction associated with DC flavor (wet or dry), although they were not asked questions regarding preference.ConclusionUltimate pH did not affect the rate and total moisture loss in dry aged beef. Results suggest that neither yield nor flavor were positively affected by dry aging of DC beef.Figure 3.a) Effect of ultimate pH (Dark cutters [DC] vs. Normal) and aging method (Wet vs. Dry) on objective redness (a*) values of strip loins steaks aged for 45 d through 7 d of retail display. b) Effect of ultimate pH (Dark cutters [DC] vs. Normal) and aging method (Wet vs. Dry) on discoloration (%) of strip loins steaks aged for 45 d through 7 d of retail display. a-c Means within a day with different superscripts are different (P < 0.005).

Color and Lipid Stability of Dry Aged Beef During Retail Display

ObjectivesThere has been an increased interest in merchandising dry-aged steaks at the retail level. Further understanding of the influence of the dry aging process on meat color and lipid stability is needed to ensure dry-aged beef products can be merchandised without adverse impacts on retail display life. Therefore, this study aimed to determine color and lipid stability of steaks from dry-aged beef loins over 7 d (d) of retail display.Materials and MethodsSixteen USDA low Choice boneless strip loins were assigned to one of four aging treatments: vacuum (Wet), dry-aging at 50% relative humidity (RH) (RH50), dry-aging at 70% RH (RH70), or dry-aging at 85% RH (RH85). Dry-aged loins were placed in each assigned dry aging chamber, while wet aged counterparts were aged in vacuum bags in the same cooler. Loins were aged for 42 d at 1°C. After aging, loins were trimmed of dehydrated lean/fat and fabricated into steaks. Steaks were trimmed of subcutaneous fat, and placed on foam trays, overwrapped with oxygen permeable film and placed under retail display (RD) conditions for 7 d at 2°C. Objective color measurements were taken once daily from d 0 to 7 of RD. Trained visual color panelists (n = 6) evaluated surface discoloration from d 0 to 7 of RD once daily. Lipid oxidation was measured via thiobarbituric acid reactive substance assay (TBARS) at 0, 4, and 7 d of RD. Color data were analyzed as a split-plot repeated measures design with treatment as the whole-plot and RD time as the repeated measures. TBARS data were analyzed as a split-plot design with aging treatment as the whole-plot, and RD time as the split-plot. In this study, chamber (loin) was considered the experimental unit. Data were analyzed using the PROC GLIMMIX procedure of SAS with α = 0.05.ResultsFor all three-color scales, a RD effect was found (P < 0.001). In general, L*, a* and b* values decreased as RD time increased, regardless of the aging treatment. Wet-aged steaks had higher L* (P < 0.05), a* (P < 0.05), and b* values (P < 0.001) than any other dry-aged treatment. No differences in L*, a*, and b* values among dry aging treatments were found (P < 0.05). A 2-way interaction between treatment and RD for discoloration was observed (P < 0.05). No differences were found among treatments over the first 2 d of RD (P > 0.05). Samples began to diverge on Day 3 of RD. Dry-aged steaks had greater discoloration scores (P < 0.05) than wet-aged steaks at 4, 5, 6, and 7 d of RD. However, no differences in discoloration scores among RH treatments were found. There was a RD effect on TBARS values (P < 0.001). Greater TBARS values were found as RD progressed from d 0 to d 4 and d 7, regardless of the aging treatment. A treatment effect was observed for lipid oxidation (P < 0.05). Dry-aged steaks had higher TBARS values than wet-aged steaks. No differences in TBARS values among dry aging treatments were found.ConclusionDry aging of beef resulted in decreased lightness and redness values and increased lipid oxidation compared to wet aging. Results suggest that with prolonged RD dry aging of beef has the potential to reduce color and lipid stability compared to wet-aging and thus reduce display life. Dry-aged steaks met the 20% discoloration threshold and overcame the acceptability threshold of 2.28 mg of malonaldehyde/kg at d 4 of RD, indicating that dry-aged steaks can be merchandised in the retail level for 3 d without detrimental effects on color and lipid oxidation.

Impact of Myoglobin Oxygenation State at Freezing on Color Stability of Frozen Beef

ObjectivesMeat color is the number one factor influencing consumer purchase decisions. The emerging market of frozen meat emphasizes the need to understand beef surface discoloration and the ideal parameters of freezing beef to retain a superior color. Therefore, the objectives of this study were to determine the impacts of oxygenation level and frozen storage duration on frozen beef color.Materials and MethodsUSDA Choice strip loins (n = 36) were aged for 4 d or 20 d. Steaks were randomly assigned to a myoglobin state [deoxymyoglobin (DeOxy; immediately packaged), low oxygenation (LoOxy; oxygenated in air for 30 min), and high oxygenation (HiOxy; packaged for 24 h in 80% O2)]. Steaks were then vacuum packaged in oxygen permeable or impermeable film and immediately frozen (–20°C). Following either 0, 2, 4, or 6 mo of frozen storage, steaks were removed from the packaging and immediately analyzed for instrumental color (L*, a*, b*), delta E (magnitude of difference in the L*, a*, b* color space), subjective discoloration, lipid oxidation (via thiobarbituric acid reactive substances- TBARS), oxygen penetration, percent oxymyoglobin, metmyoglobin, and deoxymyoglobin (via spectrometer), and redness (calculated as 630nm/530nm). Data were analyzed using PROC Glimmix procedure in SAS as a split-split-plot with an incomplete block and a 2 × 3 factorial.ResultsHiOxy steaks had greater oxygen penetration and the highest a* values compared to DeOxy and LoOxy steaks regardless of packaging (P < 0.0005). Conversely, DeOxy steaks exhibited the lowest oxygen penetration and a* values regardless of film (P < 0.0005). HiOxy steaks at 4 d had higher a* values than DeOxy and LoOxy at all storage times (P = 0.0118). HiOxy steaks had the highest delta E values compared to DeOxy and LoOxy in permeable packaging and with increasing storage time an increase in delta E for the HiOxy steaks was observed (P = 0.0010).Redness and percent oxymyoglobin were highest for HiOxy steaks within each storage period (P < 0.0002). HiOxy and LoOxy steaks were similar in percent oxymyoglobin when in permeable packaging film. HiOxy steaks had the highest percent oxymyoglobin and DeOxy had the lowest percent oxymyoglobin within each aging and storage period (P < 0.01). Conversely, DeOxy steaks had the highest percent metmyoglobin and HiOxy had the lowest percent metmyoglobin when packaged in impermeable film (P < 0.0001). Lowest percent metmyoglobin values were from the 4 d HiOxy steaks at 2, 4, and 6 mo of storage (P = 0.0188).The HiOxy 20 d steaks had the highest discoloration compared to 4 d aging and more discoloration than all other myoglobin treatments at 6 mo of storage (P < 0.0001). Lipid oxidation increased with storage time (P = 0.0169). HiOxy 20 d aged steaks exhibited the highest TBARS values at 2, 4, and 6 mo (P = 0.0224). HiOxy and LoOxy were similar in discoloration and lipid oxidation except with the HiOxy 20 d (which were less desirable).ConclusionHiOxy steaks exhibit a brighter and deeper cherry red color compared to the DeOxy steaks. HiOxy steaks were superior or similar when compared to LoOxy steaks but displayed more detrimental effects when frozen storage was extended. Based on the results, HiOxy steaks aged for 4 d give a superior red color for extended storage with few unfavorable effects. However, it is not advised to freeze deoxygenated steaks and expect a cherry red color through frozen storage.

Relationship Between Relative Humidity and Moisture Loss in Dry Aged Beef

ObjectivesThe objective of this research was to assess the impact of low relative humidity (RH) during dry aging on moisture and trim loss, tenderness, and flavor. The working hypothesis was that rapid drying would create a hard crust on the meat surface that could reduce moisture release over time, thereby reducing weight loss, enhancing tenderness (by retaining more water), and altering flavor when compared to dry aging at higher RH.Materials and MethodsSixteen USDA low Choice boneless strip loins were assigned to one of the four aging treatments: vacuum (Wet), dry-aging at 50% RH (RH50), dry-aging at 70% RH (RH70), or dry-aging at 85% RH (RH85). Loins were placed in individual dry aging chambers and aged for 42 d at 1°C and 2200 RPM fan speed. A computerized dry aging system was designed and built that is capable of measuring and precisely controlling RH (± 1%), temperature (± 0.5°C), and air velocity (± 0.1m/s). The chambers have built-in weighing scales that can continuously monitor weight loss (± 5 g). All measured data can be saved on the connected computer in intervals of 1 s. After aging, loins were trimmed of dehydrated fat/lean and evaluated for trim loss. Loins were fabricated anterior to posterior, cut into steaks and evaluated for water activity (aw), Warner-Bratzler shear force (WBSF), and by sensory analysis to detect flavor differences via triangle test (n = 32). Rate of moisture loss was analyzed as a split plot design with treatment as the main plot and days of aging as the repeated measures. All the other data were analyzed as a completely randomized design. Chamber (loin) was considered the experimental unit. Data were analyzed using the PROC GLIMMIX procedure of SAS with α = 0.05.ResultsThere was a treatment by day interaction for rate of moisture loss (P < 0.001). A faster rate of moisture loss was found for RH50 when compared to RH85 on the first day of aging (P < 0.001), while RH70 was intermediate. Loins dry-aged at RH50 and RH70 had higher rates of moisture loss than RH85 on Days 2 and 3 of aging (P < 0.05). By Day 4, no differences in rate of moisture loss among RH treatments were found (P > 0.05). Wet-aged samples had lower moisture loss (P < 0.001), trim loss (P < 0.001) and higher yield (P < 0.001) than all dry-aged treatments. However, there were no differences among RH treatments for total moisture loss (P > 0.05), trim loss (P > 0.05) and yield (P > 0.05). Steaks from dry-aging treatments had lower aw values (P < 0.001) than steaks from the Wet group. No differences in aw values among RH treatments were found (P > 0.05). There was a location effect for aw values. Samples from the ventral region of the steak had lower aw values than samples from the central and dorsal region (P < 0.001). There were no differences among treatments for WBSF (P > 0.05). Results from the triangle test indicated that there was a detectable difference between Wet and RH70 (P < 0.05). However, there was no detectable difference between RH50 and RH85 (P > 0.05).ConclusionResults suggest that no such case hardening effect occurs when dry aging beef, even when the RH was kept very low (50%) and the total weight loss was 23%. Instead, the lower RH results in more rapid moisture loss at the beginning of the aging process without significantly affecting the total amount of moisture loss. Trim loss, yield, tenderness and flavor were not affected by relative humidity during dry aging.

Systemic immunoregulatory and proteogenomic effects of tacrolimus to sirolimus conversion in liver transplant recipients

Immunosuppression (IS) withdrawal from calcineurin inhibitors is only possible in ≈ 20% of liver transplant recipients. However, mammalian target of rapamycin inhibitors (e.g., sirolimus; SRL) appear to be more immunoregulatory and might promote a tolerant state for withdrawal. Our aim was to determine whether systemic (i.e., blood, marrow, and allograft) signatures of immunoregulation are promoted by conversion from tacrolimus (TAC) to SRL. We therefore performed the following serial assays before and after SRL conversion in liver transplant recipients to test for enhanced markers of immunoregulation: (1) flow-cytometry immunophenotyping of peripheral blood mononuclear cells (PBMCs) and bone marrow aspirates for regulatory T cells (Tregs) (e.g., CD4(+) CD25(+++) FOXP3(+) ) and regulatory dendritic cells (DCregs) (immunoglobulin-like transcript 3(+) /4(+) ); (2) liver biopsy immunohistochemical staining (e.g., FOXP3:CD3 and CD4:CD8 ratios) and immunophenotyping of biopsy-derived Tregs after growth in culture; (3) effects of pre- versus postconversion sera on Treg generation in mixed lymphocyte reactions; (4) peripheral blood nonspecific CD4 responses; and (5) peripheral blood gene transcripts and proteomic profiles. We successfully converted 20 nonimmune, nonviremic recipients (age, 57.2 ± 8.0; 3.5 ± 2.1 years post-liver transplantation) from TAC to SRL for renal dysfunction. Our results demonstrated significant increases in Tregs in PBMCs and marrow and DCregs in PBMCs (P < 0.01) after conversion. In biopsy staining, FOXP3:CD3 and CD4:CD8 ratios were significantly higher after conversion and a number of biopsy cultures developed new or higher FOXP3(+) cell growth. Nonspecific CD4 responses did not change. Both pre- and postconversion sera inhibited mixed lymphocyte reactions, although only TAC sera suppressed Treg generation. Finally, 289 novel genes and 22 proteins, several important in immunoregulatory pathways, were expressed after conversion.

CONCLUSIONS

TAC to SRL conversion increases systemic Tregs, DCregs, and immunoregulatory proteogenomic signatures in liver transplant recipients and may therefore facilitate IS minimization or withdrawal.

Common gamma chain cytokines promote rapid in vitro expansion of allo-specific human CD8+ suppressor T cells

Human CD8⁺ regulatory T cells, particularly the CD8⁺CD28⁻ T suppressor cells, have emerged as an important modulator of alloimmunity. Understanding the conditions under which these cells are induced and/or expanded would greatly facilitate their application in future clinical trials. In the current study, we develop a novel strategy that combines common gamma chain (γc) cytokines IL-2, IL-7 and IL-15 and donor antigen presenting cells (APCs) to stimulate full HLA-mismatched allogeneic human CD8⁺ T cells which results in significant expansions of donor-specific CD8⁺CD28⁻ T suppressor cells in vitro. The expanded CD8⁺CD28⁻ T cells exhibit increased expressions of CTLA-4, FoxP3, and CD25, while down-regulate expressions of CD56, CD57, CD127, and perforin. Furthermore, these cells suppress proliferation of CD4⁺ T cells in a contact-dependent and cytokine-independent manner. Interestingly, the specificity of suppression is restricted by the donor HLA class I antigens but promiscuous to HLA class II antigens, providing a potential mechanism for linked suppression. Taken together, our results demonstrate a novel role for common γc cytokines in combination with donor APCs in the expansion of donor-specific CD8⁺CD28⁻ T suppressor cells, and represent a robust strategy for in vitro generation of such cells for adoptive cellular immunotherapy in transplantation.

Studies with neuronal cells: From basic studies of mechanisms of neurotoxicity to the prediction of chemical toxicity

Neurotoxicology considers that chemicals perturb neurological functions by interfering with the structure or function of neural pathways, circuits and systems. Using in vitro methods for neurotoxicity studies should include evaluation of specific targets for the functionalism of the nervous system and general cellular targets. In this review we present the neuronal characteristics of primary cultures of cortical neurons and of cerebellar granule cells and their use in neurotoxicity studies. Primary cultures of cortical neurons are constituted by around 40% of GABAergic neurons, whereas primary cultures of cerebellar granule cells are mainly constituted by glutamatergic neurons. Both cultures express functional GABAA and ionotropic glutamate receptors. We present neurotoxicity studies performed in these cell cultures, where specific neural targets related to GABA and glutamate neurotransmission are evaluated. The effects of convulsant polychlorocycloalkane pesticides on the GABAA, glycine and NMDA receptors points to the GABAA receptor as the neural target that accounts for their in vivo acute toxicity, whereas NMDA disturbance might be relevant for long-term toxicity. Several compounds from a list of reference compounds, whose severe human poisoning result in convulsions, inhibited the GABAA receptor. We also present cell proteomic studies showing that the neurotoxic contaminant methylmercury affect mitochondrial proteins. We conclude that the in vitro assays that have been developed can be useful for their inclusion in an in vitro test battery to predict human toxicity.

Endoscopic treatment of postoperative fistulas resistant to conservative management using biological fibrin glue

BACKGROUND AND STUDY AIMS

Postoperative fistulae occur frequently in standard surgical practice, but there is no general agreement on how to treat them. We summarize here our experience with endoscopic treatment.

PATIENTS AND METHODS

Postoperative digestive fistulae resistant to conservative treatment, in 15 patients, are retrospectively reviewed. Our series included two internal fistulas: (one rectovesical, and one high-output pleuroesophagic), and 13 external fistulas (one low-output gastrocutaneous, two low-output esophagocutaneous, seven low-output enterocutaneous, and three high-output enterocutaneous). After failure of conservative treatment, the fistulas were endoscopically located and 2 - 4 ml of reconstituted fibrin glue, Tissucol 2.0 at 37 degrees C, was injected through a catheter.

RESULTS

The mean age of the patients was 61.2 years (38 - 86), and 60 % were men. Of the fistulas, 26.6 % were of the high-output type. The mean healing time was 16 days (5 - 40), and a mean of 2.5 sessions per patient were required (1 - 5). Complete sealing of fistulas was achieved in 86.6 % of cases; (87.5 % of the low-output and internal fistulas, and 55 % of the high-output fistulas). After follow-up ranging between 2 months and more than 3 years, only one of the sealed fistulas reopened. No complications were encountered. Overall mortality was 13.3 % (two out of 15), but in only one patient was this related to clinical deterioration because of the persistence of the fistula.

CONCLUSIONS

We think that conservative treatment should not be prolonged beyond 14 days and that endoscopic treatment should be performed at that stage. Endoscopic sealing treatment achieves a very high success rate, without complications and at a lower cost. It could probably reduce the hospital stay, and avoid some unnecessary surgical interventions. Appropriate multicenter randomized trials are needed to confirm these results.

Chromatographic removal combined with heat, acid and chaotropic inactivation of four model viruses

The virus removal of protein A affinity chromatography, inactivation capacity, acid pH and a combination of high temperature with a chaotropic agent was determined in this work. The model viruses studied were sendaivirus, human immunodeficency virus (HIV-IIIb), human poliovirus type-II, human herpesvirus I and canine parvovirus. The protein A affinity chromatography showed a maximum reduction factor of 8 logs in the case of viruses larger than 120 nm size, while for small viruses (18-30 nm) the maximum reduction factor was about 5 logs. Non viral inactivation was observed during the monoclonal antibody elution step. Low pH treatment showed a maximum inactivation factor of 7.1 logs for enveloped viruses. However, a weak inactivation factor (3.4 logs) was obtained for DNA nonenveloped viruses. The combination of high temperature with 3 M KSCN showed a high inactivation factor for all of the viruses studied. The total clearance factor was 23.1, 15.1, 13.6, 20.0 and 16.0 logs for sendaivirus, HIV-IIIb, human poliovirus type-II, human herpesvirus I and canine parvovirus, respectively.

[Polyps of the biliary tract: is their preoperative diagnosis possible?]

Bile duct polyps are a very uncommon cause of obstructive jaundice. We present our experience of three patients diagnosed in the last 10 years. Initial presentation usually takes the form of obstructive jaundice associated with abdominal pain, which simulates biliary lithiasis. The diagnosis is usually surgical. Although in some cases radiological studies and endoscopic retrograde cholangiopancreatography (ERCP) may sometimes detect bile duct polyps, exact diagnosis before surgery is very unusual. The radiological signs that suggest the existence of a bile duct polyp in the ERCP seem to be the presence of repletion defects, fixed unilaterally to the biliary conduit, without meniscus and without circumferential stenosis of the affected conduit. The most frequently found polyps are fibroinflammatory, and less frequently adenomatous.

[Esophageal perforation and postoperative fistulae of the upper digestive tract treated endoscopically with the application of Tissucol]

We present three patients with serious gastro-esophageal complications which were treated with Tissucol. The first patient developed a rare postoperative oesophago-pleural fistula. The second suffered a traumatic esophageal perforation (possibly iatrogenic) that was discovered at the end of the removal procedure of an alimentary bolus impacted in the distal esophagus. Attempts to close the high output oesophago-pleural fistula with standard treatment were unsuccessful. It was closed with Tissucol at the third attempt, in conjunction with oesophago-jejunal stenosis by means of endoscopic dilatation. In the second patient, early Tissucol application after detection of pneumomediastinum was an effective complementary treatment to the conservative approach and rapidly closed the perforation. The third patient developed a low debit postoperative gastro-cutaneous fistula that did not resolve with conservative treatment. It was closed with only one session of Tissucol sealing. We consider that the endoscopic application of fibrin glue should become the first step in the conservative treatment of small esophageal perforations or postoperative esophageal pleural fistulae, especially in cases of high output fistulae. The success of this technique depends on the localization and selective catheterization of the fistula and on brushing the fistular opening. Total resolution of any distal stenosis is necessary to prevent reopening of the fistula.

Formation of copper oxychloride and reactive oxygen species as causes of uterine injury during copper oxidation of Cu-IUD

The lining of the uterus and cervix might be injured by a variety of oxidation products of Cu in a Cu-IUD, including cuprous ions, dissolved and precipitated cupric ions, and reactive oxygen species such as superoxide radicals, hydrogen peroxide, and hydroxyl radicals. In this study, the human amnious WISH cell line was employed as a model of uterine cells in the presence of copper. The cell viability was decreased by elemental copper, which was alleviated up to 70% by the addition of catalase. The addition of copper oxychloride caused cell death in a dose-dependent manner. Hydroxyl radicals in the presence of copper were determined by the formation of malondialdehyde. Soluble cuprous chloride complexes are formed in the uterus by slowly entering oxygen. The complexes are partly oxidized to insoluble copper oxychloride. which damages the endometrium. Unoxidized cuprous ions migrate to the oxygen-rich cervix and are oxidized to copper oxychloride, causing cervix damage.

[High frequency ventilation strategies with neonatal conventional ventilator. Assessment of gas exchange, hemodynamic status and lung injury]

Experiments were performed to consider the use of conventional neonatal ventilators with assisted expiratory mechanism using ventilatory high frequency strategies. Gas exchange, hemodynamic state, and lung injury were also assessed. Twenty Albino Wistar rats, undergoing and acute lung lesion through physiological solution wash of the lungs were studied. Afterward, they were distributed into four groups according to the different ventilator strategies, based on the different pressure changes and the tidal volume, the baseline lung volume and the respiratory frequency. Group I, High Frequency Ventilation, with high baseline lung volumes (HFVh); group II, Conventional Mechanical Ventilation, with high baseline lung volume (CMVh), group III, High Frequency Ventilation, with low baseline lung volume (HFV1) and group IV Conventional Mechanical Ventilation, with low baseline lung volume (CMV1). Significant differences were found between group I (HFVh) and groups II (CMVh), III (HFV1) and IV (CMV1) as regards pO2, Artery/Alveolar relation to O2 (a/A), pCO2, arterial blood pressure and histopathologic lung lesion. The hypothesis concerning the decisive role of the baseline lung volume maintainence to minimize progressive damage caused by mechanical ventilation on a previously injured lung while attending ventilatory strategies that generate little pressure and volume cyclical changes was confirmed. We conclude that, high frequency mechanical ventilation is possible through conventional neonatal respirators with assisted expiratory mechanism.

[Phenotypic and molecular features of Vibrio cholerae isolated in Chile, Peru and Bolivia. Comparison with environmental reservoirs]

BACKGROUND

Since 1991, a massive cholera epidemic started in Peru and involved most Central and South American Countries. In Chile, 147 cases were registered, the last one in 1995.

AIM

To study the phenotypic and molecular features of Vibrio cholerae strains isolated from patients in Perú, Bolivia and Chile and from environmental reservoirs in Santiago, Chile.

MATERIALS AND METHODS

The phenotype, biotype and susceptibility to nine antimicrobials was determined for each isolated strain. Also, the genes of cholera and termolabile toxins were determined using DNA probes and a chromosomal restriction profile was done using HindIII, EcoRI and NotI enzymes.

RESULTS

Features studied were similar in the 53 strains isolated from patients. Those isolated from environmental reservoirs had different antimicrobial susceptibility, showing ampicillin resistance, and the GT gene was detected in one of 20 strains, compared to clinical samples were it was present in all. Strains isolated from patients and environment had similar chromosomal restriction profiles.

CONCLUSIONS

The chromosomal restriction profile gives an image of bacterial genome and it is a useful and reliable tool for the epidemiological surveillance of cholera.

Nicotine gum, 2 and 4 mg, for nicotine dependence. A double-blind placebo-controlled trial within a behavior modification support program

The effectiveness of nicotine gum in combination with a behavior modification program was studied. The nicotine dependence of participating smokers (N = 322) was assessed. One hundred sixty-eight smokers were labeled as high nicotine dependent and 154 as moderate to low dependent. In a randomized double-blind procedure, the high-dependent smokers were given gum containing 4 mg of nicotine (87) or 2 mg of nicotine (81) and the smokers with medium or low dependence were given gum containing 2 mg (76) or a placebo gum (78). The smokers were also randomized to familiarizing themselves with the medication a week before quit day (112) or to regular use, that is starting gum use on the quit day (122). In the high-dependent group, sustained and chemically verified nonsmoking rates at 6 weeks, 1 year, and 2 years were, respectively, 60%, 39%, and 34% in the subjects given the 4-mg dose compared with 41%, 16%, and 16% for those using the 2-mg dose. In the group with medium or low dependence, the success rates at the same time periods were 70%, 49%, and 39% for the subjects given the 2-mg dose and 38%, 22%, and 17% for those given placebo gum. The differences in success rates were significant at least at the p < 0.02% level for all comparisons. Familiarizing with the gum as compared with regular use gave fewer reports of side effects, 15% vs 34%, p < 0.001. A trend toward better success rates at 6 weeks, although not statistically significant, was observed for the familiarization group, 61% vs 52%. The study shows that high nicotine-dependent smokers need higher doses of nicotine replacement, in this case the 4-mg dose rather than the 2-mg dose, whereas 2 mg is superior to placebo among less dependent smokers. These results compare favorably with those reported from the more recent nicotine patch therapy.

[Comparative in vitro activity of new oral macrolides against Streptococcus pyogenes strains]

Some recently introduced macrolides have several clinical advantages over erythromycin. Azithrommcin, a prototype of these new macrolides could be a good alternative for the treatment of streptococcal pharyngitis, even over penicillin, whose failure rate can be as high as 30%. The aim of this study was to evaluate the in vitro susceptibility of 120 strains of S pyogenes isolated between 1990 and 1992 (40 per year), from diverse infections (specially tonsillitis). We determined Minimal Inhibitory Concentrations (MIC) of azithromycin, clarithromycin, roxithromycin, erythromycin and penicillin using the agar dilution method and the Minimal Bactericidal Concentration (MBC) by tube dilution for azythromycin and erythromycin. The MIC 90 for the new macrolides ranged from 0.03 to 0.12 microgram/ml, and was 0.03 microgram/ml for erythromycin and penicillin (not different). All strains were susceptible to all antibiotics and the date of isolation did not influence susceptibility. The MBC for azithromycin was 0.12 microgram/ml (identical to its MIC), which demonstrates the bactericidal effect of this antibiotic. It is concluded that this in vitro data supports the potential role of these new macrolides in the treatment of streptococcal infections.

[Pathogenic potential of vibrio cholerae 01 isolated from the Mapocho river and Aguada ditch]

The pathogenic potential of 20 strains of Vibrio Cholerae 01 isolated from the Mapocho river and Aguada ditch in Santiago, Chile was studied using a rabbit intestinal loop biological model. The presence of cholera toxin (CT) was previously found by the detection of CT gene, ELISA and passive reserve agglutination in only one of these strains. After 24 h of intestinal loop inoculation, the 20 strains showed enterotoxic activity. In four of these strains the secretory reaction was particularly intense. In these same four strains, the presence of cholera toxin was detected after the passage through the animal model. Thus, the number of cholera toxin producing strains increased after the inoculation in intestinal loops. These results suggest that the enterotoxic activity of strains that do not produce CT is given by the new cholera toxin (NCT). It is concluded that most of the strains of Vibrio Cholerae isolated from Mapocho river and its affluents are producers of NCT toxin, that some strains recover the capacity to produce CT after colonization of intestinal loops of living organisms and that the additive effects of CT and NCT may explain the intense enterotoxic activity of the strains that produce CT.

The World Health Organization and International Atomic Energy Agency second interlaboratory comparison study in 16 countries on quality performance of nuclear medicine imaging devices

Sixteen European countries participated in this WHO-IAEA intercomparison for which transmission CAP (College of American Pathologists) thyroid and IAEA-WHO liver phantoms were used. A total of 257 laboratories submitted 428 image evaluation reports. Overall results showed differences in performance between the various countries but similarities in performance for two gamma camera subgroups defined by year of manufacture, before and after 1980. A unique review of current European liver imaging practice is presented in terms of technical parameters, imaging conditions and evaluation procedures, and quality control procedures. The WHO-IAEA intercomparison demonstrated the need to establish new, or to improve the existing, quality control programmes in certain countries. However, the large number of participating laboratories, 257 compared with 70 in the previous WHO study, (Volodin et al. 1985), shows that these international studies are serving a useful purpose in promoting quality control in nuclear medicine imaging laboratories.

Effect of pentobarbital on the contraction and calcium movements in cat cerebral and peripheral arteries

Pentobarbital (PB) induced concentration-dependent vasodilation in cylindrical segments of cat cerebral and femoral arteries precontracted with 75 mM K+ or 10(-5) M serotonin (5-HT). PB (10(-4) or 10(-3) M, 10 min preincubations) caused concentration-dependent inhibition of the contraction produced by both agents. The exposure of the vessels to a Ca2+-free medium annulled the response elicited by K+ in both kinds of arteries. In this medium, the contraction induced by 5-HT in cerebral arteries was abolished, whereas in femoral ones it was significantly reduced. This residual response was abolished by PB. The intracellular 45Ca2+ uptake (La3+ method) elicited by K+ in both kinds of arteries and by 5-HT in cerebral ones was reduced in a concentration-dependent manner by PB (10(-4)-10(-3) M). The spontaneous 45Ca2+ efflux from these arteries and that induced by La3+ (10 mM) were unaffected by PB (10(-3) M). These results indicate that the vasodepressor effects induced by PB are essentially due to an interference of the barbiturate with the Ca2+ entry into the vascular smooth muscle cell in both kinds of arteries and with the intracellular Ca2+ movements in femoral ones. It does not seem to exist a clear selectivity of PB for brain or peripheral arteries for antagonizing the responses caused by K+ or 5-HT.