Assessing nitrate groundwater hotspots in Europe reveals an inadequate designation of Nitrate Vulnerable Zones

Monitoring networks show that the European Union Nitrates Directive (ND) has had mixed success in reducing nitrate concentrations in groundwater. By combining machine learning and monitored nitrate concentrations (1992-2019), we estimate the total area of nitrate hotspots in Europe to be 401,000 km2, with 47% occurring outside of Nitrate Vulnerable Zones (NVZs). We also found contrasting increasing or decreasing trends, varying per country and time periods. We estimate that only 5% of the 122,000 km2 of hotspots in 2019 will meet nitrate quality standards by 2040 and that these may be offset by the appearance of new hotspots. Our results reveal that the effectiveness of the ND is limited by both time-lags between the implementation of good practices and pollution reduction and an inadequate designation of NVZs. Substantial improvements in the designation and regulation of NVZs are necessary, as well as in the quality of monitoring stations in terms of spatial density and information available concerning sampling depth, if the objectives of EU legislation to protect groundwater are to be achieved.

A Qualitative Study on Dentists' Communication Approaches in Managing Fluoride-Hesitant Caregivers

OBJECTIVES

Guidelines on effective provider-led communication are available but may be underused in dentistry, even if such guidelines could help dentists manage complex clinical scenarios like topical fluoride hesitancy. The purpose of this study was to investigate current chairside communication approaches used by dentists with fluoride-hesitant caregivers.

METHODS

A 27-item semistructured interview script was developed and pretested with 3 dentists, revised, and finalized. One-on-one interviews were conducted with a purposive sample of pediatric dentists and general dentists from April to June 2020. Interviews were digitally recorded, transcribed, and analyzed to identify dentists' communication approaches used during clinical interactions with fluoride-hesitant caregivers. Thematic analyses identified themes and subthemes, and exemplary quotes were provided to illustrate each theme.

RESULTS

Twenty-seven dentists participated (21 pediatric dentists and 6 general dentists). The mean age of participants was 43.0 ± 8.2 y (range, 30-73). Most participants were women (88.9%), white (51.9%), and non-Hispanic (85.2%). Participants had been practicing dentistry for a mean of 13.2 ± 10.5 y (range, 2-40). There were 4 themes: leaving topical fluoride decisions completely up to the caregiver, educating the caregiver about fluoride, insisting that the caregiver accept fluoride, and engaging the caregiver and child.

CONCLUSION

Most communications approaches used by interviewed dentists to manage fluoride hesitancy in clinical settings are not evidence based. Future dental education efforts should ensure that trainees are exposed to and can demonstrate competency in appropriate, evidence-based patient-provider communication strategies.

KNOWLEDGE TRANSFER STATEMENT

The study highlights the need for dentists to apply evidence-based communication strategies when managing difficult clinical scenarios like fluoride hesitancy, which is important in optimizing dentist-patient trust.

Paliperidone palmitate-induced enuresis: a case report

Introduction

Schizophrenia is a severe mental illness that requires long-term treatment with antipsychotics and the intramuscular (IM) long-acting injectable (LAI) formulations may enhance treatment adherence. Some antipsychotics have been associated with enuresis, including atypical antipsychotics such as risperidone(6.2%), quetiapine(6.7%), olanzapine (9.6% ) and clozapine (20.7%) [1]. Although oral paliperidone has been related to urinary incontinence, there is only 1 report of urinary incontinence linked to monthly paliperidone palmitate [2]. [1] Harrison-Woolrych, M., Skegg, K., Ashton, J., Herbison, P., Skegg, D.C., 2011. Nocturnal enuresis in patients taking clozapine, risperidone, olanzapine and quetiapine: comparative cohort study. British Journal of Psychiatry 199, 140–144. doi:10.1192/bjp.bp.110.087478 [2] Karslıoǧlu, E.H., Özalp, E., Çayköylü, A., 2016. Paliperidone Palmitate-induced Urinary Incontinence: A Case Report. Clinical Psychopharmacology and Neuroscience 14, 96–100. doi:10.9758/cpn.2016.14.1.96

Objectives

To establish an association between paliperidone palmitate and enuresis.

Methods

Case report and a narrative review of the literature.

Results

The patient was a 25-year-old healthy man when he was diagnosed with schizophrenia. Doctors prescribed paliperidone palmitate (LAI) 200mg monthly and he started to complain of enuresis. He was clearly suffering with this unpleasant and embarrassing adverse effect so the LAI was reduced to 150mg. Enuresis remained, so it was prescribed oxybutynin 20 mg/day and the patient improved.

Conclusions

We reported a case in which enuresis is likely to be associated with high-dose paliperidone LAI (with no clinical evidence of an organic cause). To treat it, the most effective strategy was oxybutynin 20 mg/day. This case is also important to show the impact of this symptom, which is not actively investigated.

Disclosure

No significant relationships.

Overlap between substance and behavioural addictions: substance abuse in patients with pathological gambling

Introduction

Pathological gambling consists of a persistent and maladaptive pattern of gambling behavior, that often leads to significant adverse psychosocial and financial outcomes. It is currently classified as an “Impulse Disorder” on ICD-10 but the DSM-5 moved this diagnosis from “Impulse-Control Disorders” to “Substance-Related and Addictive Disorders” section^[1]. Behavioral addictions, especially pathological gambling, share many features with substance dependences, namely clinical findings and behavioural patterns, comorbidity with psychiatric disorders, genetic factors and family history, neurobiology, natural history and response to treatment^[2].

Objectives

To study the impact of substance abuse in patients with pathological gambling.

Methods

Literary review, using PubMed database search, regarding substance abuse and pathological gambling.

Results

57,5% of individuals with pathological gambling also present with some form of substance use^[3].There was also a large percentage of patients presenting with nicotine dependence (60,1%) and a fourfold increase in the risk of developing an alcohol use disorder^[3]. Individuals with substance use disorders also show a threefold risk of developing pathological gambling and substance use appears to negatively influence gambling behaviours in this population. Gambling habits in adolescents have been linked to an increased risk of current and lifetime drug use of multiple substances^[4]. Other psychiatric comorbidities were also frequent in this population: 37.9% of patients presented with mood disorders and 37.4% with anxiety disorders^[3].

Conclusions

There is a significant clinical and neurobiological overlap between substance use disorders and pathological gambling. Individuals with pathological gambling have a high prevalence of substance use disorders and an increased lifetime risk of substance use, which negatively influences gambling behavior.

Disclosure

No significant relationships.

The Effect of Dioxin Contamination and Remediation on Property Values

Loss of property value is a major concern in communities faced with the toxic byproducts of industrial practices. Even after site remediation, stigma may persist and negatively affect market values of residential properties. To study the effects of contamination and of remediation on property values in Midland, Michigan, where dioxins have been released into the environment through the incineration of contaminated waste and the discharge of contaminated water for many years, records of assessed value were obtained for 229 homes within the same neighborhood for the previous 18 years. A multilevel, longitudinal analysis was conducted to determine if there was a relationship between level of dioxin and assessed value after controlling for housing characteristics. Remediated and un-remediated properties saw increases in value at a similar rate over time. However, a property's level of dioxin was found to have a small, significant, and negative relationship with assessed value, and this negative effect was present regardless if a home had been remediated or not. These results suggest that while environmental remediation may be effective at removing the contamination, its economic effects may persist for a longer period of time.

Learning and the Unknown: Surveying Steps toward Open World Recognition

As science attempts to close the gap between man and machine by building systems capable of learning, we must embrace the importance of the unknown. The ability to differentiate between known and unknown can be considered a critical element of any intelligent self-learning system. The ability to reject uncertain inputs has a very long history in machine learning, as does including a background or garbage class to account for inputs that are not of interest. This paper explains why neither of these is genuinely sufficient for handling unknown inputs – uncertain is not unknown, and unknowns need not appear to be uncertain to a learning system. The past decade has seen the formalization and development of many open set algorithms, which provably bound the risk from unknown classes. We summarize the state of the art, core ideas, and results and explain why, despite the efforts to date, the current techniques are genuinely insufficient for handling unknown inputs, especially for deep networks.

Fungal Planet description sheets: 785-867

Novel species of fungi described in this study include those from various countries as follows: Angola, Gnomoniopsis angolensis and Pseudopithomyces angolensis on unknown host plants. Australia, Dothiora corymbiae on Corymbia citriodora, Neoeucasphaeria eucalypti (incl. Neoeucasphaeria gen. nov.) on Eucalyptus sp., Fumagopsis stellae on Eucalyptus sp., Fusculina eucalyptorum (incl. Fusculinaceae fam. nov.) on Eucalyptus socialis, Harknessia corymbiicola on Corymbia maculata, Neocelosporium eucalypti (incl. Neocelosporium gen. nov., Neocelosporiaceae fam. nov. and Neocelosporiales ord. nov.) on Eucalyptus cyanophylla, Neophaeomoniella corymbiae on Corymbia citriodora, Neophaeomoniella eucalyptigena on Eucalyptus pilularis, Pseudoplagiostoma corymbiicola on Corymbia citriodora, Teratosphaeria gracilis on Eucalyptus gracilis, Zasmidium corymbiae on Corymbia citriodora. Brazil, Calonectria hemileiae on pustules of Hemileia vastatrix formed on leaves of Coffea arabica, Calvatia caatinguensis on soil, Cercospora solani-betacei on Solanum betaceum, Clathrus natalensis on soil, Diaporthe poincianellae on Poincianella pyramidalis, Geastrum piquiriunense on soil, Geosmithia carolliae on wing of Carollia perspicillata, Henningsia resupinata on wood, Penicillium guaibinense from soil, Periconia caespitosa from leaf litter, Pseudocercospora styracina on Styrax sp., Simplicillium filiforme as endophyte from Citrullus lanatus, Thozetella pindobacuensis on leaf litter, Xenosonderhenia coussapoae on Coussapoa floccosa. Canary Islands (Spain), Orbilia amarilla on Euphorbia canariensis. Cape Verde Islands, Xylodon jacobaeus on Eucalyptus camaldulensis. Chile, Colletotrichum arboricola on Fuchsia magellanica. Costa Rica, Lasiosphaeria miniovina on tree branch. Ecuador, Ganoderma chocoense on tree trunk. France, Neofitzroyomyces nerii (incl. Neofitzroyomyces gen. nov.) on Nerium oleander. Ghana, Castanediella tereticornis on Eucalyptus tereticornis, Falcocladium africanum on Eucalyptus brassiana, Rachicladosporium corymbiae on Corymbia citriodora. Hungary, Entoloma silvae-frondosae in Carpinus betulus-Pinus sylvestris mixed forest. Iran, Pseudopyricularia persiana on Cyperus sp. Italy, Inocybe roseascens on soil in mixed forest. Laos, Ophiocordyceps houaynhangensis on Coleoptera larva. Malaysia, Monilochaetes melastomae on Melastoma sp. Mexico, Absidia terrestris from soil. Netherlands, Acaulium pannemaniae, Conioscypha boutwelliae, Fusicolla septimanifiniscientiae, Gibellulopsis simonii, Lasionectria hilhorstii, Lectera nordwiniana, Leptodiscella rintelii, Parasarocladium debruynii and Sarocladium dejongiae (incl. Sarocladiaceae fam. nov.) from soil. New Zealand, Gnomoniopsis rosae on Rosa sp. and Neodevriesia metrosideri on Metrosideros sp. Puerto Rico, Neodevriesia coccolobae on Coccoloba uvifera, Neodevriesia tabebuiae and Alfaria tabebuiae on Tabebuia chrysantha. Russia, Amanita paludosa on bogged soil in mixed deciduous forest, Entoloma tiliae in forest of Tilia × europaea, Kwoniella endophytica on Pyrus communis. South Africa, Coniella diospyri on Diospyros mespiliformis, Neomelanconiella combreti (incl. Neomelanconiellaceae fam. nov. and Neomelanconiella gen. nov.) on Combretum sp., Polyphialoseptoria natalensis on unidentified plant host, Pseudorobillarda bolusanthi on Bolusanthus speciosus, Thelonectria pelargonii on Pelargonium sp. Spain, Vermiculariopsiella lauracearum and Anungitopsis lauri on Laurus novocanariensis, Geosmithia xerotolerans from a darkened wall of a house, Pseudopenidiella gallaica on leaf litter. Thailand, Corynespora thailandica on wood, Lareunionomyces loeiensis on leaf litter, Neocochlearomyces chromolaenae (incl. Neocochlearomyces gen. nov.) on Chromolaena odorata, Neomyrmecridium septatum (incl. Neomyrmecridium gen. nov.), Pararamichloridium caricicola on Carex sp., Xenodactylaria thailandica (incl. Xenodactylariaceae fam. nov. and Xenodactylaria gen. nov.), Neomyrmecridium asiaticum and Cymostachys thailandica from unidentified vine. USA, Carolinigaster bonitoi (incl. Carolinigaster gen. nov.) from soil, Penicillium fortuitum from house dust, Phaeotheca shathenatiana (incl. Phaeothecaceae fam. nov.) from twig and cone litter, Pythium wohlseniorum from stream water, Superstratomyces tardicrescens from human eye, Talaromyces iowaense from office air. Vietnam, Fistulinella olivaceoalba on soil. Morphological and culture characteristics along with DNA barcodes are provided.

Trust in Whom? Dioxin, Organizations, Risk Perception, and Fish Consumption in Michigan's Saginaw Bay Watershed

Trust is generally recognized as important for risk-relevant behavior but research suggests that trust in different organizations may have varying effects. This research advances the literature by testing two hypotheses which postulate that this variability can be explained by risk perception. We collected data from 351 anglers regarding their trust in nine organizations whose efforts are relevant to dioxin contamination in Michigan's Saginaw Bay Watershed, risk perceptions, and self-reports of risky behavior (i.e., consumption of local fish identified as especially likely to contain contaminants). As hypothesized (H1), the negative effect of trust in two agencies-the Michigan Department of Natural Resources (MDNR) and a Michigan Department of Health and Human Services-sponsored River Walker Program (RWP)-on risky behavior was significantly mediated by risk perception but these effects differed from each other such that trust in the MDNR was associated with increased perceptions of risk while trust in the RWP was associated with decreased perceptions of benefit. Also as hypothesized (H2), the positive effect of trust in Dow Chemical Company on risky behavior was significantly mediated by risk perception such that increased trust in Dow was associated with reduced risk perception. The current results lend credence to arguments regarding the importance of specificity in the target of trust and advance this literature by suggesting that differential effects on risk perception help explain this variability. Thus, organizations whose efforts focus on risk communication appear ideally situated to reduce risky behavior through a negative impact on risk perception. Other organizations, however, may run the risk of increasing risky behavior if their efforts result in reduced perceptions of risk.

Fluorescence spectroscopy and parallel factor analysis as a dissolved organic monitoring tool to assess treatment performance in drinking water trains

Fluorescence excitation emission matrix (FEEM) spectroscopy was used to evaluate its applicability as a tool to track dissolved organic matter (DOM) in a drinking water treatment plant (DWTP) that incorporates a conventional line (consisting in ozonation and GAC filtration) and a membrane-based line (consisting in ultrafiltration, reverse osmosis and mineralization) working in parallel. Seven sampling points within the different process stages were characterized monthly during 2014. A global Parallel Factor Analysis (PARAFAC) was used to pull out underlying organic fractions from the fluorescence spectra. Accordingly a five components model was selected to describe the system and the pros and cons of the model were discussed by analysis of the residuals. Among the five fluorescent components, those associated to humic-like matter (C1, C3 and C4) showed a similar season variability in the river water feeding the DWTP (which resembled that of UV₂₅₄ and TOC), whereas the two components associated to protein-like matter (C2 and C5) exhibited a different behavior. The maximum fluorescence intensity values (Fmax) were used to quantify DOM removals across the plant. Compared to the conventional line, water from the UF/RO membrane-based line showed between 6 and 14 times lower fluorescence intensity signal for the humic-like components and between 1 and 3 for the protein-like components as compared to the conventional line. The differences in DOM composition due to seasonal variations and along the treatment trains point out the suitability of using fluorescence measurements over other parameters such as UV₂₅₄ as a monitoring tool to help optimize operation conditions of each treatment stage and improve produced water quality in a DWTP.

Environmental Stigma: Resident Responses to Living in a Contaminated Area

This article examined the extent to which residents living in the Midland-Saginaw-Bay City area in Eastern Michigan felt stigmatized due to industrial contamination. Seventy in-depth interviews were conducted with local residents, focusing on the extent to which they experienced three aspects of stigma-affective, cognitive, and behavioral. Results indicated that although some participants were not concerned with living in a contaminated community, local residents largely perceived dioxin as a risk to individual health and the local environment. Concern, shock, and irritation were typical affective responses at the time participants learned of the contamination. Several participants indicated a feeling of embarrassment and fear of being rejected by others because of the stigma associated with industrial contamination. Instead of actively seeking information about dioxin contamination and remediation, participants often relied on information provided to them by government officials. Behaviorally, participants avoided eating locally caught fish and prepared fish more carefully in order to avoid exposure to contaminants. As a whole, this study provided insight to understand affective, cognitive, and behavioral responses to environmental stigma.

Oestrous cycle-dependent expression of Fas and Bcl2 family gene products in normal canine endometrium

During the oestrous cycle canine endometrium undergoes cyclical cellular proliferation, apoptosis and differentiation. To study the regulation of endometrial apoptosis and proliferation events the expression of apoptosis-related genes was analysed by real-time polymerase chain reaction and cellular expression of their proteins was identified through immunohistochemistry. Cellular apoptosis and proliferation events were detected by TdT-mediated dUTP-biotin nick end labeling (TUNEL) and proliferation marker Ki67 immunostaining, respectively. The highest proliferative index was observed in the follicular phase (all endometrial cellular components) and at early dioestrus (basal glands). This was associated with a low apoptotic index and a strong expression of anti- (Bcl2) and pro-apoptotic proteins (Fas, FasL, Bax). Subsequently (Days 11-45 of dioestrus), basal glandular epithelium experienced the highest apoptotic index, coincidental with a decrease of Bcl2 expression and a low ratio of Bcl2/Bax transcription. An increase in the apoptotic index of crypts, stromal and endothelial cells was observed at late dioestrus and the beginning of anoestrus. These results indicate that pro- and anti-apoptotic proteins regulate the balance between cell proliferation and death in the canine endometrium during the oestrous cycle. High Bcl2 expression in both the follicular and early dioestrous phases stimulate glandular proliferation and prevent apoptosis but, in the non-pregnant uterus, a decrease in Bcl2 expression together with an increase in pro-apoptotic proteins induces apoptosis of basal glandular epithelium cells.

Cross-Sectional Validation of a Quality of Life Questionnaire in Spanish for Patients Allergic to Hymenoptera Venom

INTRODUCTION AND OBJECTIVES

The first quality of life questionnaire for Vespula-allergic patients (Vespid Allergy Quality of Life Questionnaire [VQLQ) was developed in 2002. Our objective was to perform the cross-sectional validation of the Spanish version of this questionnaire.

PATIENTS AND METHODS

Using the original English-language version of the VQLQ as a starting point, the Spanish translation and cultural adaptation were performed and the first Spanish version was backtranslated into English and discussed with the authors of the original version. The result was the Spanish Health-related Quality of Life Questionnaire for Hymenoptera Venom-Allergic Patients (HRQLHA). Cross-sectional validation was carried out in a multicenter study using a test-retest design. Patients over the age of 14 diagnosed with systemic allergic reaction to venom from Apis, Vespula, or Polistes species were included. The test-retest reliability, external validity, and internal consistency of the questionnaire were measured.

RESULTS

The sample comprised 116 patients. The mean HRQLHA score was 3.48. Test-retest reliability showed an intraclass correlation coefficient of 0.85. HRQLHA showed a positive correlation (0.5) with an external questionnaire, thus demonstrating its external validity. Analysis of the internal consistency of the HRQLHA yielded a Cronbach α of 0.95, which can be considered to be excellent.

CONCLUSIONS

Statistical analysis revealed the high test-retest reliability, internal consistency, and external validity of the HRQLHA. The HRQLHA is the first validated questionnaire to include patients allergic to Polistes species, which is common in our area. Our findings show that the questionnaire is also valid for these patients.

Social networks and the communication of norms about prenatal care in rural Mexico

Many normative beliefs are shared and learned through interpersonal communication, yet research on norms typically focuses on their effects rather than the communication that shapes them. This study focused on interpersonal communication during pregnancy to uncover (a) the nature of pregnancy-related communication and (b) normative information transmitted through such communication. Results from interviews with pregnant women living in rural Mexico revealed limited social networks; often, only a woman's mother or the baby's father were consulted about prenatal care decisions. However, women also indicated that communication with others during pregnancy provided important normative information regarding prenatal care. First, most referents believed that women should receive prenatal care (injunctive norm), which was conceptualized by participants as biomedical, nonmedical, or a blend of both. Second, family members often received prenatal care, whereas friends did not (descriptive norms). These findings highlight the key role of personal and social networks in shaping personal pregnancy-related beliefs and behaviors.

Protocol of orofacial myofunctional evaluation: validity and reliability

Short Communication selected from the Oral Presentations of the 56th Congress of the Groupèment International pour la Recherche Scientifique en Stomatologie et Odontologie, Peñafiel (Portugal) May 2012.

Exploration of substrate vibrations as communication signals in a webspinner from Ecuador (Embioptera: Clothodidae)

Embiopterans are among the least known of all insect orders, and yet their behavior is worthy of investigation for many reasons. They spin silk produced in glands in their front tarsi and live in groups, usually mothers with their young and sometimes in large colonies with many reproductive females sharing the silk. We discovered a large embiid (Clothodidae) in an Ecuadorian rain forest living under camouflaged silk sheets spun onto the bark of trees. Observations in previous studies of a related Trinidadian clothodid revealed that individuals shake and lunge their bodies in response to intruders of their silk domicile. We took the opportunity afforded by the discovery of the large clothodids to rear them in the laboratory and to investigate their communication behavior. We used piezoelectric film to detect substrate vibrations generated by adult females as elicited by a variety of intruders (an artificial stimulus, conspecific female or male, or a female of different species of webspinners). The residents produced three signals distinguishable by behavioral action, frequency (hertz), pulses per bout, and amplitude at peak frequency. We designated these as lift silk, shake, and snapback. Shakes varied the most in amplitude and frequency in response to the different intruders, and therefore, we propose that shakes may transmit the most information as individuals contact each other. This is the first report to characterize spectral qualities and contexts of substrate vibrations in an embiopteran.

Component-resolved diagnosis of vespid venom-allergic individuals: phospholipases and antigen 5s are necessary to identify Vespula or Polistes sensitization

BACKGROUND

Cross-reactivity between hymenoptera species varies according to the different allergenic components of the venom. The true source of sensitization must therefore be established to ensure the efficacy of venom immunotherapy.

OBJECTIVE

In the Mediterranean region, Polistes dominulus and Vespula spp. are clinically relevant cohabitating wasps. A panel of major vespid venom allergens was used to investigate whether serum-specific IgE (sIgE) could be used to distinguish sensitization to either vespid.

METHODS

Fifty-nine individuals with allergic reactions to vespid stings and positive ImmunoCAP and/or intradermal tests to vespid venoms were studied. sIgE against recombinant and natural venom components from each wasp species was determined using the ADVIA Centaur(®) system.

RESULTS

sIgE against recombinant antigen 5s sensitization to be detected in 52% of the patients tested (13/25). The sensitivity increased to 80% (20/25), when using natural antigen 5s, and to 100% with the complete panel of purified natural components, because the sIgE was positive to either the antigen 5s (Pol d 5/Ves v 5) or to the phospholipases (Pol d 1/Ves v 1) of the two vespids, or to both components at the same time. In 69% of cases, it was possible to define the most probable sensitizing insect, and in the rest, possible double sensitization could not be excluded. Vespula hyaluronidase was shown to have no additional value as regards the specificity of the assay.

CONCLUSIONS

The major allergens of P. dominulus' and Vespula vulgaris' venom, namely phoshpholipases and antigen 5s, are required to discriminate the probable sensitizing species in vespid-allergic patients.

Fixed number of segments in unidirectional decompositions of fluence matrices for step-and-shoot IMRT

The decomposition of a fluence matrix in step-and-shoot mode for intensity-modulated radiation therapy (IMRT) usually yields a large number of segments (NS) and, consequently, treatment time is substantially increased. In this paper, we propose a method for reducing the original NS in multileaf collimator segmentations to a user-specified quantity. The proposed method clusters original segments into the same number of groups as desired NS, and computes for each group an equivalent segment and an associated weight. In order to avoid important changes in dose-volume histograms (DVHs), equivalent segments and weights are computed taking into account the original fluence matrix and preserving the highest fluence zones, thus staying as close as possible to the original planned radiation. The method is applicable to unidirectional segmentations, where there is no backtracking of leaves, since this property facilitates the grouping of segments. The experiments showed that treatment times can be considerably reduced, while maintaining similar DVHs and dosimetric indexes. Furthermore, the algorithm achieved an excellent reduction/dose-quality ratio since the final NS was close to that reported for direct step-and-shoot solutions.

Chronic morphine administration induces tolerance to suppressive morphine effects in two canonical LPS-induced innate immunity responses in mice. (162.20)

The immunosuppressive effects of acute morphine administration are well described. However, little is known about chronic morphine treatment actions using different administration schedules. The aim of this work was to study the effects of various morphine administration schemes on peritoneal Tumor Necrosis Factor-α (TNF-α) release and serum corticosterone levels after i.p. injection of bacterial lipopolysaccharide (LPS) in mice. Our results show that morphine per se (0.1-10 mg/kg) had no effects on TNF-α levels. Morphine inhibited LPS-induced TNF-α release but this effect occurred only at high doses (3.1 y 10 mg/kg) and was not dose dependent. Serum corticosterone levels increased after a single LPS challenge and morphine dose-dependently prevented this effect. After repeated administration, tolerance developed to the inhibitory effects of morphine on peritoneal TNF-α release and serum corticosterone levels in response to LPS. These data suggest that morphine inhibitory effects on innate immunity depend on the opioid administration schedule and duration treatment.

Reducing the number of segments in unidirectional MLC segmentations

In intensity-modulated radiation therapy (IMRT), fluence matrices obtained from a treatment planning system are usually delivered by a linear accelerator equipped with a multileaf collimator (MLC). A segmentation method is needed for decomposing these fluence matrices into segments suitable for the MLC, and the number of segments used is an important factor for treatment time. In this work, an algorithm for reduction of the number of segments (NS) is presented for unidirectional segmentations, where there is no backtracking of the MLC leaves. It uses a geometrical representation of the segmentation output for searching the key values in a fluence matrix that complicate its decomposition. The NS reduction is achieved by performing minor modifications in these values, under the conditions of avoiding substantial modifications of the dose-volume histogram, and does not increase in average the total number of monitor units delivered. The proposed method was tested using two clinical cases planned with the PCRT 3D treatment planning system.

[Tooth loss in diabetic patients with and without chronic kidney disease and dialysis]

AIM

To compare tooth loss (TL) in ESRD (ESRD DM) and non-ESRD (DM) type 2 diabetic patients.

METHODS

Teeth loss was quantified, and dentition classified as: Non-Compromised (NCD) with > or = 25 teeth, partially compromised (PCD) with 9 to 24, and compromised (CD) with 0 to 8 teeth.

RESULTS

ESRD DM and DM: n> or = 103 and 130, mean age 57.9 and 58.5 yr (p> or =0.716), and at diabetes diagnosis 38.5 and 47.8 yr (p<0.001). Edentulous 23.5% and 13.8% (p> or =0.057), NCD 24.5% and 35.4% (p> or =0.074). TL was strongly associated mainly to periodontal disease (p<0.001). For ESRD DM, a low serum albumin (<3.5 g/dl) was more prevalent in peritoneal dialysis cases (p> or =0.0014), women (p> or =0.0100), people reporting unpleasant taste (UT) (p> or =0.0174), and those with a CD (p> or =0.0242).

CONCLUSIONS

There was a clear trend for more severe TL in ESRD DM cases, but no statistical difference was found. The association between low serum albumin, UT and CD imply a need for treatment of these conditions as a part of nutritional intervention in ESRD DM cases.

Mediastinitis in pediatric cardiac surgery: treatment and cost-effectiveness in a low-income country

Mediastinitis is a serious postoperative complication following pediatric cardiac surgery. The objective of this study is to evaluate the cost-effectiveness of surgical treatment for mediastinitis in Guatemala. All children who underwent a median sternotomy and developed postoperative mediastinitis between January 2004 and December 2005 were evaluated. Type of surgical treatment for mediastinitis, hospital outcome, and costs were analyzed. Eighteen (3.3%) of the 535 children who underwent a median sternotomy developed mediastinitis. Two patients underwent debridement of the infected tissues and delayed sternal closure, whereas 16 patients had debridement, primary chest closure, and continuous antibiotic irrigation of the mediastinum. All 11 patients who had the diagnosis of mediastinitis within 2 weeks after the operation survived. Three of the 7 patients (43%) who had delayed diagnosis died (p = 0.0003); all 3 had osteomyelitis (p = 0.0007). Primary closure with antibiotic irrigation was associated to a lower mortality rate and proved less expensive in comparison to delayed sternal closure (p = 0.003) mainly due to the shorter intensive care requirement. Debridement followed by primary closure of the chest and continuous antibiotic irrigation of the mediastinum seems to be a feasible and less expensive method to treat selected cases of postoperative mediastinitis in children.

[Heparin immune thrombocytopenia in a hemodialysis patient. A case report. Literature review]

Heparin-induced thrombocytopenia (HIT) is an important side effect of heparin therapy associated with significant morbidity and mortality if unrecognized. The platelet count typically falls below 150,000/ll 5-14 days after heparin is started. Thrombosis is the major clinical complication. We present the case gives a patient that develops a deep vein thrombosis ilio-femoral left, with trombocytopenia, one week after beginning treatment with haemodialysis in which Ac anti heparin is detected by test PaGIA (Particle Gel Inmuno Assay.

Effect of pentoxifylline on levels of pro-inflammatory cytokines during chronic hepatitis C

The cellular and humoral natural immune response induced by hepatitis C virus (HCV) is commonly unable to eradicate the virus. HCV is a highly mutable, hepatotropic RNA virus that causes acute and chronic hepatitis, an infection that involves the production of various cytokines. The aim of the study is to analyse the expression of pro-inflammatory cytokines IL-1beta, TNF-alpha, IFN-gamma and the chemokine CXCL8 (IL-8) in liver tissue and their expression and secretion in PBMC of patients with chronic hepatitis C (CHC), in response to pentoxyfilline (PTX). We studied six CHC patients, naive to treatment. Patients received PTX 400 mg twice a day/8 weeks. Pentoxyfilline resulted in decreased expression of mRNA of liver IL-1beta, TNF-alpha and IFN-gamma: 144.2 versus 83.5 molecules of IL-1beta (P < 0.05), TNF-alpha 194.3 versus 17.6 molecules (P = 0.03) and IFN-gamma 26.1 versus 0.5 molecules (P = 0.04). Following PTX, PBMC exhibited a decrease in IFN-gamma mRNA 12.2 versus 1.5 molecules (P = 0.028) and CXCL8 4.2 versus 2.5 molecules (P = 0.027). In PBMC, only the secretion of TNF-alpha was decreased 1109 versus 933.5 pg/ml, P = 0.046. Production of cytokines both locally (within the liver) and systemically (PBMC) may serve as biomarkers of the infection with hepatitis C. PTX inhibits the expression of several pro-inflammatory cytokines in the liver. These results indicate that it is worth exploring PTX in hepatitis in future clinical trials in nonresponders to antiviral treatment.

Laryngotracheal reconstruction in subglottic stenosis: an ancient problem still present

BACKGROUND

Subglottic stenosis is an ancient but persistent problem as a cause of airway obstruction. The etiology and the results of surgical treatment with thyrotracheal anastomosis were reviewed.

METHODS

Fifty-six patients with subglottic stenosis were studied. All were subjected to laryngotracheal reconstruction by thyrotracheal anastomosis with partial resection of the cricoid.

RESULTS

Of all 56 cases of subglottic stenosis, 48 (86%) had history of previous tracheal intubation, and only 8 (14%) had different non-neoplastic obstructive processes such as scleroma, direct injury, hamartoma, and amyloidosis. Immediate results were good in all cases. After 1 year follow-up, results of thyrotracheal anastomosis were successful in 44 (91%). In 4 other cases a restenosis was observed. Eight patients were lost to follow-up.

CONCLUSIONS

Subglottic stenosis is still frequent after tracheal intubation, but other causes must be considered. Laryngotracheal reconstruction with thyrotracheal anastomosis with partial cricoid resection was feasible with good results in 91% of the cases with follow-up, but this procedure must be performed by a skilled surgical team.

Mapping of monoclonal antibodies specific to P64k: A common antigen of several isolates of Neisseria meningitidis

P64k is a minor outer membrane protein from Neisseria meningitidis. This protein has been produced at high levels in Escherichia coli. We generated a group of monoclonal antibodies (mAbs) against recombinant P64k, which recognise four non-overlapping epitopes, as shown using competition assays with biotinylated mAbs. The P64k sequences involved in mAbs binding were mapped with synthetic overlapping peptides derived from the P64k protein, and located in the previously determined three-dimensional structure of the protein. These antibodies were also characterised by whole-cell ELISA and bactericidal tests against N. meningitidis. Only two of the recognised epitopes were exposed on the bacterial surface, and none of the mAbs showed bactericidal activity. The relationship between these results and the structural data on the epitopes bound by the mAbs is discussed.Key words: Neisseria meningitidis, P64k, monoclonal antibodies, epitope mapping.

Mapping of monoclonal antibodies specific to P64k: a common antigen of several isolates of Neisseria meningitidis

P64k is a minor outer membrane protein from Neisseria meningitidis. This protein has been produced at high levels in Escherichia coli. We generated a group of monoclonal antibodies (mAbs) against recombinant P64k, which recognise four non-overlapping epitopes, as shown using competition assays with biotinylated mAbs. The P64k sequences involved in mAbs binding were mapped with synthetic overlapping peptides derived from the P64k protein, and located in the previously determined three-dimensional structure of the protein. These antibodies were also characterised by whole-cell ELISA and bactericidal tests against N. meningitidis. Only two of the recognised epitopes were exposed on the bacterial surface, and none of the mAbs showed bactericidal activity. The relationship between these results and the structural data on the epitopes bound by the mAbs is discussed.

A bacterial single-chain Fv antibody fragment that inhibits binding of its parental anti-E-selectin monoclonal antibody to activated human endothelial cells

Using the polymerase chain reaction, we cloned, modified, and linked antibody variable (V) region coding genes from a mouse hybridoma, and produced a bacterial single-chain Fv (scFv) antibody fragment specific for E-Selectin. A vector of pBR322 origin, bearing the tryptophan promoter and the ompA bacterial signal peptide, was used to direct scFv expression to periplasm. The vector included a six-histidine coding sequence 5' to the scFv for the purification of the expressed protein using immobilized metal affinity chromatography (IMAC). We found that the VH-Linker-VL 32-33 kDa scFv remained insoluble after cellular fractionation, and transmission electron microscopy showed the new protein to be present in the periplasm as inclusion bodies. The scFv was solubilized using urea, purified using IMAC, and renatured to its active form. In a competitive enzyme-linked immunosorbent assay with activated human vein endothelial cells in the solid phase, the scFv competed for binding with the original monoclonal antibody.

Dehydroepiandrosterone protects low density lipoproteins against peroxidation by free radicals produced by gamma-radiolysis of ethanol-water mixtures

Oxidized low density lipoproteins (LDL) are believed to play a central role in the events that initiate atherosclerosis. Antioxidants have been shown to decrease the oxidation of LDL, leading to the diminution of atherosclerosis. Since it is well-known that decreased levels of dehydroepiandrosterone (DHEA) are linked to the development of atherosclerosis, we studied the modulation of the oxidation of LDL by DHEA. LDL were obtained from 10 healthy subjects and oxidized by free radicals produced by gamma-radiolysis of ethanol-water mixtures. The formation of conjugated dienes and thiobarbituric acid-reactive substances (TBARS), the vitamin E content, as well as the incorporation of 4-[14C]DHEA in LDL and the chemotactic effect of oxidized LDL in the presence of DHEA towards monocytes, were investigated. It was found that DHEA was able to inhibit the oxidation of LDL by reducing over 90% of the conjugated dienes and TBARS formation, as well as by reducing the vitamin E disappearance and significantly decreasing the chemotactic activity towards monocytes. Our results suggest that DHEA exerts its antioxidative effect by protecting the endogenous vitamin E of LDL.

Clinical and electrophysiological phenotype of a homozygously duplicated Charcot-Marie-Tooth (type 1A) disease

Type 1A of Charcot-Marie-Tooth disease (CMT1A) is associated with a microduplication of chromosome 17 (region 17p11.2) which contains PMP22, an important gene for peripheral nerve myelination. Patients carrying two duplications are expected to have a more severe phenotype, close to the Dejerine-Sottas syndrome. In this article, we report a family of 5 CMT1A patients in whom the unrelated father and mother carry a 17p11.2 duplication. The 2 daughters carry only one duplication (one given by the father, the other given by the mother), but the son carries two 17p11.2 duplications. Interestingly, the clinical phenotype of the son is more severe (scoliosis) compared to those of his sisters, but his motor nerve conduction velocities are in the range of a heterozygote CMT1A patient. The mechanisms leading to a more severe phenotype for CMT1A are discussed and may not be strictly related to lower nerve conduction velocities.

Smooth muscle relaxing compounds from Dodonaea viscosa

Bioassay-directed fractionation of the chloroform-methanol (1:1) extract of Dodonaea viscosa (L.) Jacq. (Sapindaceae) resulted in the isolation of four active spasmolytic principles: sakuranetin (1), 6-hydroxykaempferyl 3,7-dimethyl ether (2) hautrivaic acid (3), and ent-15, 16-epoxy-9 alpha H-labda-13(16)14-diene-3 beta, 8 alpha-diol (4). All the isolated compounds elicited a concentration-dependent inhibition of the spontaneous and electrically-induced contractions of guinea-pig ileum. Sakuranetin and the ent-labdane inhibited ileum contractions evoked by acetylcholine (Ach), histamine, and barium chloride. In addition, both substances were capable of relaxing contractions of rat uterus induced by Ca2+ in K(+)-depolarizing solution, displacing to the right the concentration-response curves to Ca2+. These results suggest that sakuranetin and ent-15,16-epoxy-9 alpha H-labda-13(16)14-diene-3 beta, 8 alpha-diol produce an interference with calcium metabolism in smooth muscle cells. The spasmolytic activity exhibited by the active principles from D. viscosa, provides the pharmacological basis for the traditional use of the plant as an antispasmodic agent.

Spasmolytic potential of some plants used in Mexican traditional medicine for the treatment of gastrointestinal disorders

The present investigation describes the effect on the isolated rat ileum of methanolic extracts derived from Conyza filaginoides (D. C.) Hieron (Asteraceae), Croton fragilis HBK. (Euphorbiaceae), Dodonaea viscosa Jacq. (Sapindaceae), Gymnosperma glutinosum (Spreng) Less. (Asteraceae), Parthenium tomentosum DC. var. stramonium (Greene) Rollins (Asteraceae), Potentilla thurberi A. Gray (Rosaceae), Pterogonum atrorubens (Englem.) H. Gross (Polygonaceae), Zornia venosa Mohlenbr. (Fabaceae) and Datura lanosa Barclay ex Bye (Solanaceae). In all the cases the extracts inhibited, in a concentration-dependent manner, the spontaneous contraction of the intestinal smooth muscle. The most active extract was that of D. viscosa. These findings tend to support the ethnomedical use of the selected species as spasmolytic agents in Mexican traditional medicine. Additionally, the potential antimicrobial activity of the extracts against pathogenic enterobacteria was investigated. Seven of the nine plants evaluated displayed antibacterial effects.

Psychometric analysis in children with mental retardation due to perinatal hypoxia treated with fibroblast growth factor (FGF) and showing improvement in mental development

Basic fibroblast growth factor (bFGF) has shown a neurotrophic effect in the neurons of several CNS areas. In vivo, it contributes to restore neurochemical and morphological deficits in different rodent models of brain damage, including rats with brain damage induced by hypoxia/ischemia when FGF was intramuscularly (i.m.) administered. Toxicological and immunological studies performed in rats, mice and volunteers showed no evidence of side-effects. Bovine FGF was i.m. administered in children with mental retardation caused by perinatal hypoxia, aged 1-15 years, at dosages of 0.4 or 0.28 microgram kg-1, once or twice a month, over 7-12 months. Group A [n = 12; 6 treated (T), 6 controls (Ct)], group B (n = 16; 8 T, 8 Ct) and group C (n = 67; 45 T, 22 Ct) were evaluated with the P. A. R. scale, the WISC-RM and the Gesell scale, respectively. Development increased significantly in treated children from groups A (P < 0.02) and C (P < 0.001), and IQ rose by more than 10 points (P < 0.001) in group B patients.